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1 The Reliability and Validity of the WHOSATHPH ( Chinese Version)
1.1 Chinese version WHOSATHPH has high reliability
The reliability of a investigation instrument refers to the stability and equivalence which measures of the same concept over time or across methods of gathering the data. The stability is the consistency for the same respondent given to a same question at different time if the fact didn`t change. The equivalence is the consistency of different data gathering methods by different respondents to the same questionnaire (American Psychological Association, 1999; De Vellis, 2003). Nunnally and Bernstein thought if the internal consistency reliability for group level is over 0.7, that the instrument could be considered as reliability (Nunnally Bernstein,1994).
Though WHOSATHPH has been translated into seven languages ( Oliver Groene, 2008), none of them adapts a culture-cross instrument development research method nor tests the reliability and validity of the translation version. Taiwan has been translated WHOSATHPH into Chinese, however, this Chinese version WHPSATHPH don`t published, moreover, there was not reliable and validity test reported for this translation version. There is not any Chinese hospital adapts it.
Furthermore, the comparison research related HPH is few, the current research of WHOSATHPH reliability and validity test existed weakness. For example, the comparison research for HPH and Non-HPH by using WHOSATHPH which was performed by Kaja Pôlliste et al, defined the Non- HPH were the hospitals which didn`t join the HPH Net-work (Kaja Pôlliste et al, 2008). Kaja Pôlliste et al thought HPH performance result concerned with quality management effect,however, the hospitals which have well quality management system may do not join the HPH Net-work, so their research conclusion may have bias.
This Chinese Vision WHOSATHPH development was performed completely an entire cross culture research procedure as an international instrument development. The translation was experienced forward translation, backward translation and comments translation three stages.
The authors of source instrument help to comment the translation quality. Besides ensuring the quality of the translation, this research performed a pilot test which was performed in Montréal. 8 Chinese health professionals who had been worked in Chinese hospitals or health institution accept the interview for pilot test. The Chinese version was revised and updated after each investigation till form the formal Chinese translation version. There were total 15 words (including phrases) were changed or revised through the pilot test.In the pilot test, only one 48-years-old TCM female doctor thought this questionnaire was difficult to understand, the other 7 health professionals thought this Chinese version WHOSATHPH was easy to understand and no difficult word, especially 2 public health professionals thought this instrument was very easy for them.
Furthermore, to evaluate the content equivalence between the Chinese version WHOSATHPH with source English versions WHOSATHPH and to comment the translation quality of Chinese version, this reserch supervisor, the author of WHOSATHPH and a native American checked the quality of backward translation. The equivalence comment document includes all the parts of WHPSATHPH). There were 37 of 40 items were marked as completely the same or almost the same meaning by three valuators, only 1 of 40 items was regarded as different meaning by the author of original instrument. This item which marked difference meaning by three evaluators was cause by the word ` match` the back translator used `satisfy` replace `match` is more in line with the MHRPC `s quality requirement to China hospitals.
The spot field investigation for reliability and validility test which included 3 core capital cities, 22 hospitals and 40 hospital leaders. In addition, 2 health ministry officer and1 hospital management professor accept deep interview. 24 cases thought this instrument was easy to understand, but 16 respondents thought it was difficult. Result of total items of this instrument Cronbach’s Alpha is 0.938, between the domains Cronbach’s alpha values is 0.896. The Cronbach`s alpha for standard1 ( hospital management policy) is 0.793, for standard 2( the patients’ assessment for health promotion needs), is 0.819, for standard 3( the patient information and intervention) is 0.807, for standard 4(promoting a healthy workplace) is 0.785 and for standard 5(continuity of care provision) is 0.755, the Split-half models analysis by the correlation is 0.86, Guttman split-half reliability is 0.91. These result shows that Chinese version WHOSAT HPH has reliability. Moreover. However, the Cronbach’s alpha may also be influenced by the number of items of the instrument.
Paired T-Test for 40 items, the signification p was from 0.1-1, indicated this WHOSAT HPH (Chinese Version) is stable and is in consistency with different times to test the same concepts.
To test the equivalence of the information obtained by different hospital leaders in the same hospital, the inter-Rater Reliability was also test. Eight hospitals were evaluated by two or three hospital leaders to test the different raters evaluation equivalence. Shanghai hospital leaders showed better equivalent results, but Hefei and Kunming hospital leaders showed separated equivalence and non equivalence. In each of those hospitals, there was a hospital leader gave very different scores than his peers to the hospital health promotion situation. However, at the domains level, to some standards, all the hospital leaders gave the same comment, though different rators gave different comments to a same hospital may throw off the ratings somewhat, nevertheless, these results may also indicate that it needs further research to study its rator reliability through big size random sampling investigation.
1.2. Factor analysis shows that Chinese version has general content validity
The original instrument tested the reliability through 32 hospitals and 8 countries, the researcher did not externally assess the reliability or validity of the data (Groene Oliver, 2008). Moreover, although Oliver Groene et al researched the reliability and validity of WHOSATHPH, they defined the HPH as those hospitals who were members of WHOHPH Network (Oliver Groene, 2008).
However, the question is whether or not the hospital that joined the WHOHPH net matches the conception and principle HPH?
Factor analysis usually used to analysize the construct validity of an instrument. WHO defined the conception of Health Promotion Hospital into five standards, this Chinese version WHOSATHPH total has five standards and forty items. The management policy standard has 3 domains and 6 items; The standard of patient assessment has 3 domains and 5 items, the patient information and intervention standard has 2 domains and 5 items, the standard of promoting a healthy workplace standard has 3 domain and 6 items, and the standard of continuity and cooperation has 2 domain and 9 items. In this study, KMO measure of sampling adequacy at standard level is 0.789 and at sub-standard level (domains) is 0.754, displays that factor analysis can be used for analysis the structure of this instrument at the standard and substandard (domain) level. Principle analysis model was used to extract principal factors, the conceptual structure of the Chinese Vision WHOSATHPH assumed that 13 domains belong to five standards, and these five standards contribute to only one overall conception of health promotion. These standards would therefore be expected to load onto only one factor (a hypothetical theory structure should match the original instrument structure). The result shows that 5 factors were extracted with one principle component which loading about 70% information of total conception. It indicates that Chinese version WHOSATHPH has general theory construct validity but not high. At the domain level, 13 domains were extracted five principle components which contribute 83.8% conception information of the total. However, the 13 domains don`t have clear conception boundary which belong to one component. This result indicated that even this Chinese version WHOSATHPH is high reliable and has general content structure validity, but its construct validity is not sensitive and 13 sub-domains doesn`t show clear conception boundary.
In addition, 35 hospital leaders who answered the acceptance question, only 17 of them(48.57%) will accept this instrument in their work, 15 of them refused it, 3 of them were not sure. Although one Shanghai ministry governor thought this instrument was valuable and will accept this instrument, and another Shanghai government officier and two hospital management researchers thought it was valuable to do this research, nevertheless, they thought this instrument is too abstract to use for evaluating hospitals` health promotion degree effective even HPH topic deserve research. Because this research is small sample size, so the further big sample size research to test the instrument validity is necessary, and it is necessary to test the validity of other language version WHOSATHPH.