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Volume 10, Issue 1 (6-2020)                   cmja 2020, 10(1): 12-33 | Back to browse issues page


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Kaviani N, Tagharrobi Z, Sharifi K, Sooki Z. Development of Nurses’ Beliefs and Attitudes Towards Complementary and Alternative Medicine Questionnaire and its Psychometric Evaluation. cmja 2020; 10 (1) :12-33
URL: http://cmja.arakmu.ac.ir/article-1-703-en.html
1- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran.
2- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran. , tagharrobi_z@yahoo.com
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Extended Abstract
1. Introduction

Among the possible influencing factors, the role of nurses’ beliefs and attitudes towards Complementary and Alternative Medicine (CAM) has been emphasized [15, 16]. In order to measure the belief and attitude of the treatment staff in Iranian society and culture, it is necessary to have a suitable tool. Based on the data recorded in the available national and international databases, a questionnaire that can covers different dimensions of belief and attitude and be specific to measuring the attitude and attitude of nursing staff towards CAM, has not yet been designed, localized, and psychometrically evaluated. Therefore, this study aimed to design a questionnaire for measuring belief and attitude towards the CAM for nurses in Iran working in the clinical fields, based on the constructs proposed in the theory of planned behavior, and evaluate its psychometric properties.
2. Materials and Methods
In this methodological study, first the initial version of the Nurses’ Beliefs and Attitudes towards CAM Questionnaire (NBACQ) was developed based on the 4-step approach of Waltz et al. [31] by reviewing the studies and based on the theory of planned behavior. The second phase was related to psychometric evaluation in three steps: 1. measuring face and content validity; 2. measuring construct validity (exploratory factor analysis and comparison of known groups) and ceiling and floor effect; and 3. assessing the reliability (internal consistency and stability) [33].
In order to perform the second step of the phase 2 and determine the internal consistency of the NBACQ, 250 eligible nurses were selected using stratified sampling method in June 2018 from different wards in hospitals affiliated to Kashan University of Medical Sciences, and then were asked to complete the initial version of the NBACQ. To measure the stability of the tool, the test-retest method was performed on 20 samples ,33] 34].
Collected data were analyzed in SPSS V. 16. Content Validity Index (CVI), Content Validity Ratio (CVR), and modified kappa statistic were used for measuring the content validity, item impact test for measuring the face validity, exploratory factor analysis for measuring construct validity, One-way ANOVA to compare known groups, Cronbach’s alpha coefficient to check the internal consistency, and Intraclass Correlation Coefficient (ICC) for assessing the correlation of scores reported by two raters in the test-retest method. Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were also calculated [34].
3. Results
The initial draft of NBACQ had 60 items. CVRStrict was three items lower than that reported by Ayre & Scally (2014); hence, these three items were removed. The calculated CVI for each item was in the range of 0.8-1. The kappa statistic of all items was above 0.74 and the S-CVIAverage of the tool was obtained 0.97. 
The item impact of all items was calculated to be above 1.5, except for one item which was removed. Exploratory factor analysis yielded 6 factors in the tool by removing 14 items. These factors were named as “patient-centered outcomes”, “normative beliefs”, “executive needs”, “treatment team performance”, “infrastructural beliefs” and “professional outcomes” which could explain 52.28% of total variance (Table 1, and Appendix 1).
Based on the scores of designed 42-item NBACQ, the overall score of nurses’ beliefs and attitudes (on a scale from 42 to 294) was 178.81±20.948, and their score based on the response to the 1-item attitude assessment was 5.488±1.109 (on a scale of 1-7). There was a statistically significant difference between the scores of nurses’ beliefs and attitudes in terms of their degree of agreement or disagreement with CAM (F=6.85, P<0.0001) (Table 2). Cronbach’s alpha coefficient for the overall reliability of the NBACQ was calculated to be 0.878, and the ICC between test-retest scores for the whole instrument was reported 0.973 (CI: 0.932-0.989, P<0.0001). Furthermore, SEM and SDC were obtained ±14.685 and 10.62, respectively at 95% confidence interval.
4. Discussion
Due to the use of theoretical infrastructure in designing the tool [31, 32] in this study, and the values of CVI, CVR, S-CVIAverage and kappa statistic, it can be said that the NBACQ had met the necessary criteria for content validity [33]. Based on the impact score of all remained items, it was found that there was no problem in perceiving the NBACQ items by the target group and, hence, its face validity is confirmed [34]. Having 6 factors indicates the tools’ optimal construct [34] and shows that there is compatibility between these factors and the belief and attitude concepts in the theory of planned behavior. The construct of this tool was more desirable than that of similar tools [20, 21]; Of course, examining its construct using confirmatory factor analysis provides more accurate information. The result of comparing known groups was also in favor of the construct validity of the instrument [39]. 
The absence of ceiling and floor effects indicated the adequacy and appropriateness of the used items and supported the content validity and stability of the NBACQ [36]. The Cronbach’s alpha coefficient and the ICC of the whole instrument indicated the desired its internal consistency [31] and stability [33], respectively, and showed that this NBACQ has a higher internal consistency compared to Integrative Medicine Attitude Questionnaire (IMAQ) and CAM Health Belief Questionnaire (CHBQ) [21, 22]. 
5. Conclusion 
The study showed that if the test be repeated for an individual, the score may change as 14.68 units. Given that the small size of the SEM is important and indicates the stability of the tool [34], its stability, repeatability and in overall, reliability, can be considered desirable. Therefore, it can be concluded that the 42-item NBACQ designed in this study is a valid and reliable tool and can be used to measure nurses’ beliefs and attitudes toward CAM. It is suggested that its short form be designed in future studies.
Ethical Considerations
Compliance with ethical guidelines
This study obtained ethical approval from the Research Ethics Committee of Kashan University of Medical Sciences (Code: IR.KAUMS.NUHEPM.REC.1396.35).
Funding
This study was extracted from the master thesis of the first author approved by Kashan University of Medical Sciences and received financial support from the Deputy for Research and Technology of this university (Grant no. 96225).
Authors' contributions
Conceptualization: All authors; data collection and initial draft preparation: Nafiseh Kabiani; data analysis, editing & review, supervision: Zahra Tagharrobi, Khadihej Sharifi, and Zahra Sooki.
Conflicts of interest
The authors declare no conflict of interest
Acknowledgements
The authors would like to thank the participants and the Deputy for Research and Technology of Kashan University of Medical Sciences for their cooperation and support.






 
Type of Study: Research | Subject: Nursing and Midwifery

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