Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research.

BACKGROUND: The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. METHODS: This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. RESULTS: The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate). CONCLUSIONS: The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.

A Comparison of Practice Patterns Among Certified and Noncertified Asthma Educators.

BACKGROUND: Asthma educators are essential for providing patients with the knowledge and skills needed to control asthma. The purpose of this descriptive, cross-sectional survey was to examine the differences in practice patterns between certified and noncertified asthma educators. METHODS: Subjects (N = 98) included certified asthma educators (n = 66) and noncertified asthma educators (n = 32) who provided asthma education directly to patients and their families. Subjects were asked to complete an asthma task assessment tool, composed of a 31-item Likert scale survey based on the AE-C certification exam content and the National Asthma Education Prevention Program's Expert Panel Report 3 guidelines, which include 6 domains of asthma education (ie, the asthma condition, assessing the patient and family, behavioral and environmental factors, asthma management education, asthma medications, and organizational issues). Subjects identified frequency in performing specific asthma education tasks on a scale from "Always" to "Never." RESULTS: Noncertified asthma educators were significantly more likely than certified asthma educators to report performing tasks more frequently than certified asthma educators for item 17: Explain the definition of asthma control and loss of control, and controlled versus not well controlled. The largest difference in reported means between certified and noncertified asthma educators was for item 8: Diagnose asthma, with certified asthma educators reporting higher frequencies. Certified asthma educators reported higher frequency scores on 11 of the 31 tasks. CONCLUSIONS: For a majority of the education tasks, certified versus noncertified responses did not differ in their reported frequency of performing education tasks. Future researcher should examine the potential differences in patient outcomes based on provider certification status.

Randomized trial of oral versus intravenous acetaminophen for postoperative pain control.

PURPOSE: Results of a study comparing pain control outcomes with preoperative oral versus intraoperative i.v. acetaminophen use in adults undergoing total hip or knee arthroplasty are reported. METHODS: A single-center, randomized, placebo-controlled, equivalence trial was conducted. Patients were assigned (1:1) to receive 2 500-mg capsules of acetaminophen before surgery, with an i.v. placebo infusion during surgery (the oral group), or 2 oral placebo capsules followed by an i.v. infusion of acetaminophen 1,000 mg/100 mL (the i.v. group). Patients were followed after postanesthesia care unit (PACU) admission up to 24 hours postoperatively. RESULTS: Among 486 patients included in a modified intention-to-treat analysis (mean ± S.D. age, 66.3 ± 9.4 years), there were no significant differences in preoperative and intraoperative use of pain medication between the oral and i.v. groups. Postoperative opioid use in morphine milligram equivalents (MMEs) was equivalent in the oral and i.v. groups (i.e., the mean difference in median MME values was within the prespecified equivalence margin), with no significant between-group differences in mean pain scores over 24 hours. CONCLUSION: In patients undergoing hip or knee arthroplasty, oral acetaminophen given preoperatively was equivalent to i.v. acetaminophen administered in the operating suite in controlling pain in the immediate postoperative period. I.V. acetaminophen was not superior to oral acetaminophen in reducing postoperative nausea and vomiting, time to ambulation, time to first dose of as-needed pain medication, length of PACU stay, or total length of hospital stay.

Maintaining functional independence in elderly adults: the roles of health status and financial resources in predicting home modifications and use of mobility equipment.

PURPOSE: We investigated whether health status (i.e., need characteristics) and financial resources (i.e., enabling characteristics) were important predictors of two types of functional adaptations among elderly adults: home modifications such as putting nonslip tape on rugs or installing more telephones and use of equipment for mobility or activities of daily living (ADLs) such as canes or walkers. DESIGN AND METHODS: Participants were identified from the National Survey of Self-Care and Aging (n = 3,485), a nationally representative sample of noninstitutionalized U.S. adults aged 65 and older. Need and enabling characteristics were used to predict home modifications and equipment use in multinomial logistic analysis, controlling for predisposing characteristics. RESULTS: Although several health-status (need) variables had significant, direct effects on functional adaptations, the effects of ADL limitations were diminished at higher levels of impairment. Among the financial (enabling) variables, subjective income measures and supplemental insurance had significant, direct effects on functional adaptations. IMPLICATIONS: Promotion of functional adaptations among elderly people may benefit from both a proactive approach that targets elders with few limitations and a consideration of financial factors in addition to health status.

Barriers to enrollment and successful outreach strategies in CHIP: reflections on the Arizona experience.

This paper presents a case study of the efforts by one state (Arizona) to increase Children's Health Insurance Program enrollment through outreach projects funded by private foundations. Barriers to enrollment include the organization of the Children's health Insurance Program and perceptions of parents. The most successful outreach either involves intensive personal contact or is connected with a health care provider agency. The paper concludes by discussing how the barriers and successful outreach strategies in Arizona can be generalized to other states and can inform Children's Health Insurance Program outreach broadly.

Perceived influence of community oral health curriculum on graduates' dental practice choice and volunteerism.

The purpose of this study was to determine if A.T. Still University Arizona School of Dentistry and Oral Health (ASDOH) curricular content regarding community oral health has influenced graduates' dental practice choice and volunteering activities in their communities. At ASDOH, the community oral health curriculum consists of three components: 1) coursework in public health resulting in a certificate or master's degree in public health; 2) service-learning activities in the Dentistry in the Community series of course modules, wherein students plan and implement community projects; and 3) community-based clinical rotations of approximately ninety-five days during the fourth year. To accomplish the purposes of the study, a survey was sent to ASDOH alumni who graduated between 2007 and 2010. Of the 208 graduates contacted, ninety-four responded (45.2 percent). Of those who responded, 85 percent reported that the community oral health curriculum influenced their practice choice, and 76 percent reported that they volunteer. Additionally, 58 percent of the respondents reported that the amount of dental school debt they had incurred affected their career plans and professional decision making.

Critical incidents, successes, and challenges of community-based dental education.

In 2006, the Arizona School of Dentistry & Oral Health at A.T. Still University (ATSU ASDOH) implemented an intensive community-based education program for its inaugural fourth-year students called the Integrated Community Service Partnerships (ICSP) program. As part of the ICSP program, students spend half of their clinical experience (approximately ninety-five days) in rotations at four or five community-based clinics. More than sixty clinics in Arizona and throughout the country serve as rotation sites. ATSU ASDOH conducts focus groups with all fourth-year students prior to graduation for program improvement and research. The purpose of this study was to characterize critical incidents students identified as instrumental to learning, as well as successes and challenges of the program. Qualitative data from the 2009 and 2010 focus groups were analyzed, including a total of 104 students. The types of critical incidents students chose to describe in the focus groups involved patient factors, contextual factors, and interpersonal factors. While students believed their ICSP program external rotation experiences were fundamental in their clinical and professional development, they also noted challenges associated with this intense community-based education program.

A comparison of transcutaneous and total serum bilirubin in newborn Hispanic infants at 35 or more weeks of gestation.

INTRODUCTION: Transcutaneous bilirubin (TcB) measurement in newborns has been studied extensively in the non-Hispanic population, but its usefulness in the Hispanic population remains unclear. We evaluate the accuracy of TcB measurements in assessing jaundice in Hispanic neonates by using total serum bilirubin (TSB) measurements as the reference standard and determine the TcB level that can be used to identify neonates at risk for clinically significant jaundice (above the 95th percentile). METHODS: A total of 192 Hispanic neonates were enrolled. TcB measurements were performed within 30 minutes of obtaining the TSB measurement. The linear relationship between TcB and TSB was measured by using the Pearson correlation coefficient (r). We calculated sensitivity, specificity, and positive and negative predictive values by using a TcB level above the 75th percentile to identify neonates with a TSB level above the 95th percentile. RESULTS: TSB ranged from 1.7 to 13.9 mg/dL, with 62% falling below the 75th percentile. TcB correlated well with TSB in Hispanic neonates (r = 0.87). A TcB level above the 75th percentile detected all infants with a TSB level above the 95th percentile, sensitivity 100%, and specificity 66%. CONCLUSIONS: In Hispanic newborns, the TcB level correlated well with the TSB level. TcB monitoring is a useful clinical screening tool to evaluate for the risk of clinically significant jaundice.