International Journal for Quality in Health Care Advance Access originally published online on February 16, 2006
International Journal for Quality in Health Care 2006 18(3):195-202; doi:10.1093/intqhc/mzi104
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Lack of validity of a French adaptation of a scale measuring attitudes towards clinical practice guidelines
1 Université Paris-Descartes, Service de 6 Neurologie, Hôpital Sainte-Anne Paris, 2 Université Paris-Descartes, AP-HP, Hôpital Cochin Paris, 3 Comité de Coordination de l’Evaluation Clinique et de la Qualité en Aquitaine (CCECQA), Hôpital Xavier Arnozan, Pessac, 4 Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou Paris, 5 General Practitioners are from Paris, and 6 Medexact Company, Boulogne-Billancourt, France
Background. Valid instruments to measure practitioners’ attitudes towards clinical practice guidelines need to be developed. However, few of the available instruments have been thoroughly validated.
Objective. To adapt into French and to test the reliability and validity of a scale for measurement of attitudes towards guidelines developed by Elovainio et al.
Methods. A 27-item scale (divided into six dimensions) measuring attitudes towards guidelines was translated into French by two English native translators, reviewed and finalized by expert committee and administered to 314 practitioners who agreed to participate. Main practitioners’ characteristics were collected. Item and dimension reproducibility were assessed for 62 practitioners by calculation of intraclass correlation coefficients. Internal construct validity was assessed by principal components analyses. Convergent and discriminant validity were analysed.
Results. Item response rates ranged from 82 to 100%. In the test–retest procedure, intraclass correlation coefficients for separate items ranged from 0.1 to 0.7 and those for dimensions were 0.7 [95% confidence interval (CI): 0.5–0.8] for usefulness, 0.5 (0.3–0.6) for reliability, 0.4 (0.2–0.5) for individual competence, 0.5 (0.3–0.6) for organizational competence, 0.7 (0.5–0.8) for impracticality and 0.4 (0.3–0.6) for availability. The factorial structure after Varimax rotation showed that none of the different solutions obtained had a strictly comparable structure to that of the original scale. External construct validity was satisfactory.
Conclusion. This scale does not have satisfactory psychometric properties and therefore cannot confidently be used in future research assessing whether attitudes towards guidelines are a determining factor in physicians’ compliance with guidelines. More research is needed to develop valid scales in a more rigorous procedure, involving qualitative and quantitative steps.
Keywords: data validation, physicians’ opinions, practice guidelines, questionnaire, translation
Address reprint requests to Emmanuel Touzé, Université Paris-Descartes, Service de Neurologie, Hôpital Sainte-Anne, 1 rue Cabanis, 75674 Paris Cedex 14, France. E-mail: e.touze{at}ch-sainte-anne.fr
Accepted for publication January 17, 2006.
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