RT Journal Article
SR Electronic
T1 Results From a Multimethod Exploratory Scale Development Process to Measure Authoritarian Provider Attitudes in Democratic Republic of Congo and Togo
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2200421
DO 10.9745/GHSP-D-22-00421
VO 11
IS Supplement 1
A1 Silva, Martha
A1 Spielman, Kathryn
A1 Dougherty, Leanne
A1 Kassegne, Sethson
A1 Kalamar, Amanda
YR 2023
UL http://www.ghspjournal.org/content/11/Supplement_1/e2200421.abstract
AB Key FindingsThere is growing interest in understanding what drives providers' behaviors and attitudes toward clients and how these behaviors and attitudes are important to client health outcomes.Iteration and testing with target populations were key elements of the scale development process, starting with testing 23 items and retaining 14 items in the scale that measures authoritarian provider attitudes.Measuring provider attitudes using validated scales such as the scale presented in this article can identify areas for programmatic improvement by helping stakeholders understand drivers of provider behavior.Key ImplicationsPublic health practitioners working to measure and improve provider behavior may consider expanding their scope to broader attitudes that may influence behavioral drivers relevant to multiple health areas.Designers of provider behavior change programs should consider how authoritarian provider attitudes interact and affect the quality of health services.Background:Health care providers' actions can significantly influence clients' experiences of care, adherence to recommendations, and likelihood of re-engaging with health services. There are currently no validated scales that measure provider attitudes that could affect service delivery in multiple health areas.Methods:We developed provider attitude measures in 3 phases. In phase 1 (2019), survey items were developed based on literature reviews, and quantitative items were tested through a health facility survey conducted in the Democratic Republic of the Congo (DRC). Health care providers (N=1,143) completed a 23-question survey focused on 3 subdomains: provider perceptions of clients, provider roles, and gender roles. In phase 2 (2021), cognitive interviews were administered to 17 health care providers in DRC to assess and improve respondents' understanding and interpretation of questionnaire items and response options. In phase 3 (2021), 52 family planning providers were sampled from urban health facilities in Togo to retest and validate the improved measures.Results:Phase 1 showed the provider attitude items had low scale reliability, and 8 survey items had low variability. In phase 2, results from the cognitive interviews of the 21 items retained from phase 1 found 16 questions were not well understood or had low response variability and thus modified, and 4 survey items were added to test different iterations of specific survey items. In phase 3, exploratory factor analysis resulted in 1 provider attitude scale of 14 items reflecting authoritarian attitudes related to the 3 initial subdomains.Conclusion:This research highlights the importance of iteration and testing during scale development, implementable even across geographic locations. Provider behavior change programming should consider how authoritarian provider attitudes pertaining to professional roles, their clients, and gender norms may interact and influence the quality of health services provided.