The development and psychometric evaluation of a medical practitioner compassion competency questionnaire

Visser, Michelle ; Jackel, Michelle (2020-03)

Thesis (PhD)--Stellenbosch University, 2020.

Thesis

ENGLISH SUMMARY : Medical practitioner compassion has been identified as a key construct in healthcare, not only by prominent healthcare stakeholders such as the World Health Organisation, the Health Professions Council of South Africa and the South African National Department of Health, but also by patients and practitioners themselves. Patients want to be treated in a compassionate way during the medical encounter. The concern, however, exists that too many medical practitioners still utilise a biomedical approach, as opposed to a bio-psychosocial approach, when interacting with patients. If the level of compassion competence displayed by medical practitioners is to be purposefully managed it needs to be monitored through measurement. Defining and measuring a behavioural construct like medical practitioner compassion, however, remains a challenge and therefore provides a strong rationale for research in this area. Despite some research done on compassion where the construct is typically described as either a state or trait, inconclusive and varied research results are offered for the construct “compassion”, specifically in the healthcare sector. In addition, a psychometrically sound instrument measuring this construct, conceptualised as a multidimensional behavioural competency, seems to be absent, not only in the South African context, but also internationally. This emphasised the need to not only conceptualise medical practitioner compassion from a theoretical perspective, but to also operationalise the compassion construct via a Medical Practitioner Compassion Competency Questionnaire (MPCCQ) and to follow a rigorous empirical investigation into the construct validity of the construct-referenced inferences derived from the dimensions’ scores obtained on the MPCCQ. By addressing this challenge in an attempt to contribute to the improvement of medical practitioner compassion in the South African public healthcare sector, the current study firstly conceptualised and constitutively defined compassion as a behavioural construct. The connotative meaning that the constitutive definition of this construct needed to capture lies in the internal structure of the construct and the manner in which the construct is embedded in a larger nomological network of other related constructs. By dissecting the competency of compassion, insight was gained into the internal structure of the construct, resulting in the identification of six structurally inter-related latent compassion dimensions. The connotative meaning of the competency was finally brought to fruition in the outcome structural model that was proposed. The research methodology utilised in operationalising the six latent compassion dimensions in terms of their behavioural denotations, consisted of qualitative critical incident technique interviews, where medical practitioners were utilised as co-researchers in understanding their mental models of compassion from a competency perspective. The research findings from the qualitative interviews enabled the researchers to write behavioural anchors that were subsequently re-written as test items for the MPCCQ. Qualitative validation sessions were held with some of the medical practitioners to obtain subject matter feedback on the wording of the items so as to iterate the wording of the items to the final version of the standardised 37-item competency questionnaire, which was then completed by medical practitioners (n = 234) at the 21st National Family Practitioners Congress held in Cape Town during 2019, at Karl Bremer hospital, Khayelitsha hospital, Tygerberg hospital and at Worcester hospital, all situated in the Western Cape province, South Africa. Subsequently the quantitative data gathered from the questionnaire were analysed with the statistical packages, SPSS 25 and LISREL 8.8. The quantitative findings based on the evaluation of the MPCCQ provided excellent model fit, not only for the measurement model but also for the structural model reflecting the internal structure that was attributed to the multidimensional compassion construct. Even though above expectation good measurement and structural model fit was obtained, it is still recommended that additional test items should be developed for the subscales where lower Cronbach alpha values were obtained and where factor fission was obtained. Most importantly, the MPCCQ showed construct validity, thus clearing the first hurdle necessary to allow the eventual utilisation of this instrument in practice. The study concludes with practical managerial implications and suggestions for further research necessary to allow the confident utilisation of the MPCCQ in practice.

AFRIKAANSE OPSOMMING : Mediese praktisynmedelye is geїdentifiseer as ʼn sleutel-konstruk in gesondheidsorg, nie net deur prominente gesondheidsorgbelanghebbendes soos die Wêreld Gesondheidsorganisasie, die Suid Afrikaanse Beroepsraad en die Suid Afrikaanse Nasionale Departement van Gesondheid nie, maar ook deur pasiënte en praktisyns. Pasiënte wil met medelye behandel word gedurende die mediese ontmoeting. Die kommer bestaan egter dat té veel mediese praktisyns steeds ’n bio-mediese benadering gebruik, instede van ’n bio-psigo-sosiale benadering tydens hul interaksie met pasiënte. Indien die vlak van medelye-bevoegdheid wat mediese praktisyns toon, doelgerig bestuur wil word, moet dit deur meting gemonitor word. Die definiëring en meting van ’n gedragskonstruk soos mediese praktisynmedelye bly egter ’n uitdaging en dien dus as sterk rasionaal vir navorsing in hierdie area. Ten spyte van vorige navorsing oor medelye waar die konstruk tipies as eienskap of gemoedtoestand (‘state’) beskryf word, is die resultate steeds onbeslis en gevarieerd, spesifiek vir die gesondheidsorgsektor. Dit blyk ook dat daar geen psigometriese grondige meetinstrument bestaan wat die konstruk, gekonseptualiseer as ’n multidimensionele gedragsbevoegdheid, in Suid Afrika meet nie, maar ook nie internasionaal nie. ’n Behoefte word dus beklemtoon vir ’n streng empiriese ondersoek asook meting van die bevoegdheid as deel van ’n werksprestasie-ooreenkoms. Mediese praktisynmedelye kan nie net vanaf ’n teoretiese perspektief verstaan word nie. Dit het die behoefte beklemtoon om nie net mediese praktisynmedelye vanuit ’n teoretiese perspektief te konseptualiseer nie, maar ook om die medelye-konstruk te operasionaliseer via ’n Mediese Praktisyn Medelye Bevoegdheidsvraelys (MPMBV) en om ’n nougesette empiriese ondersoek te onderneem na die konstrukgeldigheid van die konstrukgerigte inferensies wat uit die dimensietellings afgelei word, wat van die MPMBV verkry word. Deur hierdie uitdaging aan te spreek in ’n poging om ’n bydrae te lewer tot die bevordering van mediese praktisynmedelye in die Suid Afrikaanse gesondheidsorgsektor het die studie eerstens medelye as ’n gedragskonstruk gekonseptualiseer en konstitutief gedefinieer. Die konnotatiewe betekenis wat die konstitutiewe definisie van die konstruk moet vasvang is geleë in die interne struktuur van die konstruk en die wyse waarop die konstruk ingebed is in ’n groter nomologiese netwerk van verbandhoudende konstrukte. Deur die medelye-bevoegdheid te dissekteer is insig verkry in die interne struktuur wat daartoe gelei het dat ses struktureel geskakelde latent medelye-bevoegdheidsdimensies geїdentifiseer is. Die konnotatiewe betekenis van die bevoegdheid is ten slotte aan die lig gebring deur die strukturele uitkoms-model wat voorgestel word. Die navorsingsmetodologie wat gebruik is om die ses latente medelye dimensies te operasionaliseer in terme van hul gedragsdenotasies het bestaan uit kwalitatiewe kritieke insident tegniek onderhoude. Mediese praktisyns is as mede-navorsers benut met die doel om die modelle wat hulle vir hulleself bou ten op sigte van medelye uit ’n bevoegdheidsperspektief te verstaan. Die navorsingsbevindinge uit die kwalitatiewe onderhoude het die navorsers in staat gestel om gedragsankers te ontwikkel wat vervolgens dan weer omskryf is as toets-items vir die MPMBV. Kwalitatiewe valideringsessies is gehou met sommige praktisyns ten einde terugvoer op die bewoording van die items te verkry om sodoende die bewoording van die items na finale weergawe van die gestandaardiseerde 37-item bevoegdheidsvraelys te itereer, wat daarna deur mediese praktisyns (n = 234)voltooi is by die 21ste Nasionale Familie Praktisyn Kongres in Kaapstad gedurende 2019, by dieKarl Bremer hospitaal, die Khayelistha hospitaal, die Tygerberg hospitaal en die Worcester hospitaal, almal geleë in die Wes-Kaap provinsie, Suid Afrika. Daarna is die kwantitatiewe data met die vraelys ingevorder en is geanaliseer met behulp van die statistiese pakkette SPSS 25 asook LISREL 8.8. Die kwantitatiewe bevindinge, gebasseer op die evaluering van die MPMV het uitstekende model-passing gelewer vir beide die metingsmodel asook die strukturele model, wat die interne struktuur wat aan die multidimensionele medelye konstruk toegeskryf is, reflekteer. Ten spyte van bo-verwagting goeie metingsmodelle en strukturele modelpassing, is daar steeds aanbeveel om addisionele toets-items te ontwikkel vir die dimensies waar ’n laer Cronbach alpha verkry is en waar faktorsplitsing waargeneem is. Meer belangrik, is dat die MPMBV konstrukgeldigheid getoon het, en dus die eerste hekkie na die gebruik van die instrument in praktyk suksesvol oorgesteek het. Die studie eindig met praktiese bestuursimplikasies asook voorstelle vir verdere noodsaaklike navorsing ten einde die uiteindelike vrymoedige gebruik van die MPMBV moontlik te maak.

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