title: Development and psychometric evaluation of the Primary Health Care Engagement (PHCE) Scale: a pilot survey of rural and remote nurses.
abstract: OBJECTIVE
  To report the development and psychometric evaluation of a scale to measure rural and remote (rural/remote) nurses' perceptions of the engagement of their workplaces in key dimensions of primary health care (PHC).
  
  
  BACKGROUND
  Amidst ongoing PHC reforms, a comprehensive instrument is needed to evaluate the degree to which rural/remote health care settings are involved in the key dimensions that characterize PHC delivery, particularly from the perspective of professionals delivering care.
  
  
  METHODS
  This study followed a three-phase process of instrument development and psychometric evaluation. A literature review and expert consultation informed instrument development in the first phase, followed by an iterative process of content evaluation in the second phase. In the final phase, a pilot survey was undertaken and item discrimination analysis employed to evaluate the internal consistency reliability of each subscale in the preliminary 60-item Primary Health Care Engagement (PHCE) Scale. The 60-item scale was subsequently refined to a 40-item instrument.
  
  
  RESULTS
  The pilot survey sample included 89 nurses in current practice who had experience in rural/remote practice settings. Participants completed either a web-based or paper survey from September to December, 2013. Following item discrimination analysis, the 60-item instrument was refined to a 40-item PHCE Scale consisting of 10 subscales, each including three to five items. Alpha estimates of the 10 refined subscales ranged from 0.61 to 0.83, with seven of the subscales demonstrating acceptable reliability (α ⩾ 0.70). The refined 40-item instrument exhibited good internal consistency reliability (α=0.91). The 40-item PHCE Scale may be considered for use in future studies regardless of locale, to measure the extent to which health care professionals perceive their workplaces to be engaged in key dimensions of PHC.
authors: 1Professional Research Associate,Canadian Centre for Health and Safety in Agriculture,University of Saskatchewan,Saskatoon,Saskatchewan,Canada.
authors: Julie G
authors: JG
authors: Kosteniuk
authors: 2Assistant Professor,School of Nursing,University of Northern British Columbia,Prince George,British Columbia,Canada.
authors: Erin C
authors: EC
authors: Wilson
authors: 3Assistant Professor,College of Nursing,University of Saskatchewan,Regina,Saskatchewan,Canada.
authors: Kelly L
authors: KL
authors: Penz
authors: 4Professor and Chair,School of Nursing,University of Northern British Columbia,Prince George,British Columbia,Canada.
authors: Martha L P
authors: ML
authors: MacLeod
authors: 5Professor,College of Nursing,University of Saskatchewan,Saskatoon,Saskatchewan,Canada.
authors: Norma J
authors: NJ
authors: Stewart
authors: 6Professor and University Scholar, Faculty of Health Sciences,University of Lethbridge,Lethbridge,Alberta,Canada.
authors: Judith C
authors: JC
authors: Kulig
authors: 7Professional Research Associate,Canadian Centre for Health and Safety in Agriculture,University of Saskatchewan,Saskatoon,Saskatchewan,Canada.
authors: Chandima P
authors: CP
authors: Karunanayake
authors: 8Assistant Professor, Faculty of Nursing,Maisonneuve-Rosemont Hospital Research Center,Université de Montréal,Montréal,Québec,Canada.
authors: Kelley
authors: K
authors: Kilpatrick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D011594:Psychometrics; D015203:Reproducibility of Results; D019035:Rural Health Services / Q000706:statistics & numerical data*; D017132:Workplace / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: instrument development; nurses; primary health care; psychometric evaluation; rural nursing; survey