Intercultural adaptation and psychometric properties of the Spanish instrument Quality in Psychiatric Care Forensic Inpatient Staff (QPC-FIPS)
The sample consisted of professionals from different disciplines who work in forensic mental health units (nursing, psychiatry, psychology, social education, nurse aide, social work and occupational therapy), who participate voluntarily. Having less than six months of experience in the field of mental health was established as an exclusion criterion. Non-probability convenience sampling was used.
A total of 153 professionals participated, including 61.4% women and 38.6% men. The average age was 39.92 ± 9.83 years, while the average number of years worked in forensic units was 7.10 ± 4.94 years. The sample was made up of various professional categories, with 34.6% nursing auxiliaries, 22.9% occupational therapists, 21.6% nurses, 9.2% psychologists, 7.8% psychiatrists and 3.9% social workers. Some 85% of professionals said they would define their work environment as good or very good and 15% as bad or very bad. In total, 41.2% say they often or always have the opportunity to work on improving the quality of medical care, 51.0% sometimes and 7.8% rarely or never.
The professional perception of the quality of care was obtained using the QPC-FIPS-Spanish. This version is an adaptation of the original QPC-FIPS questionnaire24.
The Quality of Forensic Hospital Staff in Psychiatry (QPC-FIPS)24, described in the introduction, is a self-administered questionnaire composed of 34 items and measures 7 dimensions of the quality of care: meeting (8 items), participation (8 items), exit (3 items), support (4 items), Environment isolated (2 items), secure environment (3 items) and specific forensic (6 items). Each item is linked to the statement “I consider that…” and the answers are based on 4-point Likert scales, where 1 corresponds to “strongly disagree” and 4 to “strongly agree”. All items also have the “does not match” option.
To analyze convergent validity, the NTP 394: Overall Job Satisfaction scale created by Warr et al.ten has been used. This scale, which assesses working conditions (intrinsic and extrinsic), is made up of 15 items evaluated on a scale of 1 to 7 (1 “very dissatisfied” and 7 “very satisfied”).11.
The translation and back-translation process was carried out in accordance with standards for educational and psychological testing26.
First, the original version was translated into Spanish by two independent native-speaker translators who had no knowledge of the instrument or the objectives of the study. A group of experts made up of a specialist in psychometrics, three quality experts, five nurses specialized in mental health, a psychologist and a psychiatrist specialized in forensic medicine first assessed the semantic equivalence (grammatical difficulties of translation, equivalent meaning of words), and idiomatic (contextualization of the text, colloquialisms) and conceptual equivalence. The translation and back-translation process did not present any major difficulties. After the back-translation process, the committee of experts suggested modifying certain terms of points 30 and 33 to adapt them to the Spanish context, respecting the semantic meaning of the original version. Point 30 after retranslation of the Swedish version stated: “the staff helps the patients, if they wish, to present their wishes and their file before the administrative court”24, it was considered appropriate to change it in the Spanish version to “users can access the judge through their lawyer or through the legal advice service”, changing the term “patients” to “users” because in Spain this term is widely used. Item 33 of the Swedish version stated: “Patients receive help from the staff to work out their offence” because “during the stay in prison, the professionals help the user to talk about the offense he has committed “24, thus the term “patients” has been replaced by “users” and “staff” by “professionals”. In addition, “talk about the offence” was chosen instead of “specify the offence”.24. Finally, inclusive and non-discriminatory language was used to refer to gender.
A pilot cognitive test was administered to 30 professionals to assess comprehension and completion time. The test included an open-ended question asking participants to indicate whether an item might present difficulties in understanding. The average response time to the questionnaire varied between 15 and 20 min and no item presented comprehension difficulties. After debriefing, it was not deemed necessary to make any changes to either content format. The adapted Spanish version of the QPC-FIPS scale was configured with the same number of items and dimensions as the original, with the final Spanish version named QPC_FIPS-Spain.
The adaptation and psychometric assessment process was carried out in four forensic mental health units of Parc Sanitari Sant Joan de Déu, Barcelona, Spain. Data collection was carried out between February 2019 and December 2021.
To analyze temporal stability, it was estimated that a minimum of 60 professionals would be needed to detect an intraclass correlation coefficient (ICC) around 0.70 between two administrations of the instrument, assuming a confidence level of 95 % and 80% power in a two-sided comparison22.
Version 26 of the SPSS Statistics program was used for the analyses, as well as version 6.2 of the EQS program for the confirmatory factor analysis (CFA).27.
Construct validity was analyzed by confirmatory factor analysis (CFA) with parameters estimated using the least squares (LS) method which is similar to maximum likelihood (ML) but estimates patterns of relationships between variables by minimizing the sum of the squares of the difference between the hypothetical and observed model. LS performs better than ML with small samples and provides a better estimate when the normal distribution assumptions are violated28. The criteria for a good fit were the Bentler Bonnet Normalized Fit Index (BBNFI), the Bentler Bonnet Non-Normed Fit Index (BBNNFI), the Goodness of Fit Index (GFI), the Adjusted Goodness of Fit Index (AGFI), the Comparative Fit Index (CFI) > 0.9029,30,31; the ratio of chi-square to degrees of freedom (χ2/df) 32. The value of root mean square error of approximation (RMSEA) and standardized root mean square (SRMR) and root mean square residual (RMR) was ≤ 0.0833.34.
The NTP 394 General Satisfaction Scale: Global Job Satisfaction was used for convergent validity11; Spearman’s correlation coefficient analysis was performed. Additionally, as an additional method, a Spearman correlation analysis was also performed between the QPC-FIPS instrument factors for the purpose of verifying the Fayers & Machin35 hypothesis that indicates that the correlation was higher between each factor and the general scale than the correlations between the subscales.
To assess the internal consistency of the instrument at a general level and for each of the factors, Cronbach’s alpha was used and ordinal alpha, with a value greater than or equal to 0.7036 considered to be sufficiently reliable. Temporal stability or test-retest reliability was assessed after 7 to 14 days by the ICC in a sample of 77 professionals. A value greater than or equal to 0.70 was considered an indicator of good agreement36. In addition, the composite reliability was calculated. Item analyzes included calculation of item means, standard deviations, and item-adjusted total correlation.
Ethical aspects of research
This study was approved by the research ethics committee of the Sant Joan de Déu Foundation, under the CEIC code PIC-73-18. All research was conducted in accordance with applicable guidelines and regulations. All participants were informed of the purpose of the study and gave their written consent to participate voluntarily and anonymously.