Developing an instrument to assess non-hospital health centers’ preparedness to provide initial emergency care

Abstract

Abstract: Introduction: Basic emergency management in urban and rural areas is a critical challenge. Aim: The main aim of the study was to develop, validate, and pilot an instrument to non-hospital health centers’ preparedness to provide initial emergency care. Materials and Methods: This study was designed based on a sequential exploratory mixed- method in two phases, in each of which there are three steps. In the phase I, the literature systematic review and qualitative methods (Focus Group Discussions (FGDs) and Semi-Structured Interviews (SSIs)) were applied to identify the domains and items. In the phase II, content validity, feasibility, and reliability of the instruments were performed. Content validity was assessed using modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the instruments was randomly assessed through its implementation in 4 centers in Tabriz. Reliability was randomly assessed in a pilot on 25 centers and 30 physicians. Reliability was assessed through measuring internal consistency, test-retest reliability, and inter-rater agreement. The main statistical methods for assessing reliability include Cronbach’s alpha, Intra-class Correlation Coefficient, and Kendal’s Tau-b. All the statistical analyses were performed using Stata 14. Result: In the phase I, primary version of the instruments containing 134 items related to assessing preparedness of non-hospital health centers and 54 items related to assessing KAP physicians were generated. In the phase II, item reduction was applied and the final version of the instruments were developed containing 126 items and 48 items, respectively. These items were classified in 9 domains which include: “Environmental Infrastructures of Centers”, “Protocols, Guidelines and Policies”, "Medical Supplies and Equipment”, “Emergency Medicines”, “Human Resources”, “Clinical Interventions”, “Maintenance of equipment”, “Medicine Storage Capability”, and “Management Process”. The instruments had acceptable validity and reliability. Conclusion: This study provided standard and valid instruments which can be used to assess preparedness of non-hospital health centers to deliver initial emergency care and measure KAP physicians.