Translation and Validation of a Parent Satisfaction Instrument for Neonatal Intensive Care: The EMPATHIC-N (Hong Kong) study

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Authors (including presenting author) :
Wong MSM(1), Leung YPD(2), Chan H(2), Chan SY(1), Yeung YM(1), Law CW(1), But B(1), Latour JM(3)
Affiliation :
(1) Neonatal Intensive Care Unit, Department of Paediatrics, Queen Elizabeth Hospital, (2) The Nethersole School of Nursing, The Chinese University of Hong Kong, (3) Erasmus University Medical Centre, Department of Pediatrics, Rotterdam, Netherlands.
Introduction :
To evaluate the healthcare services provided, Patient Satisfaction is one of the measures. The Hospital Authority (HA) has made its pledge in her Strategic Plan (2017-2022) to provide patient-centered services. According to the Institute of Medicine (2001) and the American Academy of Pediatrics (2003), quality care is equivalent to family-centered care (FCC). Since 2010, with the assistance from CUHK-SPHPC, HA has conducted Patient Satisfaction Survey every 3 years to evaluate the quality of service. However, the current patient experience and satisfaction survey (PESS) does not cover Paediatric Service. Therefore, the way parents experiencing family-centered care in NICU is not structurally assessed in Hong Kong.
Objectives :
1. To translate and culturally adapt the 57-item EMPATHIC-N questionnaire from English into Chinese language. (EMPATHIC-N stands for EMpowerment of PArents in THe Intensive Care – Neonatology) 2. To validate the Chinese questionnaire in a local NICU setting. 3. To measure the quality of NICU care through parental satisfaction.
Methodology :
The study employed a methodological research design which consisted of two phases: Phase I was translation and adaptation of the EMPATHIC-N into Chinese language following the systematic ten steps recommended by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force for Translation and Cultural Adaptation. Phase II was a cross-sectional survey to examine the psychometric properties of the Chinese version of EMPATHIC-N in a local NICU setting.
Result & Outcome :
Phase I was completed as scheduled. The ISPOR Task Force’s ten steps were followed, including 1) Preparation (Permission obtained), 2) Forward translation by 2 neonatal nurses (qualified with PRCC-NICN plus 20 years' specialty experiences), 3)Reconciliation (Expert panel; CVI), 4) Back translation by 1 person with PhD(Applied Psychology), 5) Cognitive debriefing (pilot testing with 10 parents). The content validity indices at item level (I-CVI=0.857-1) and scale level (S-CVI=0.895) had both attained good content validity, denoting its ability to measure the family centered component in NICU care delivery. In Phase II, 140 parents completed questionnaires in 7 months of data collection from February to August 2018. The response rate of parents was 91.5%. (47.4% father of mean age 36.2; 52.6% mother of mean age 33.8). 76.9% had paid occupation, 23.1% were housewives. 68.7% parents received tertiary education. Infant demographics: 57.1% male, 42.9% female. Median birth weight 2080g (650g-3870g). Median gestational age was 34.3weeks (24-41wk). Mean period of mechanical ventilation (7.5days ± 20.2days). Mean period of surgical care (0.81days ± 4.0days). Mean length of stay in NICU (16.7days ± 27.0days). Reliability by Cronbach’s alpha was shown high in all five domains, demonstrating strong internal consistency of the item statements. Information domain (α=0.953), Care & Treatment domain (α=0.965), Parental Participation domain (α=0.945), Organization domain (α=0.881), Professional Attitude domain (α=0.951). Construct validity by Spearman’s r showed strong correlation (r=0.550-0.811) between each domain of family-centered care and the four overall-satisfaction-with-care control scales. All correlations were significant at 0.01 level (2-tailed). The mean scores of parent satisfaction towards the family-centered care provided in the NICU in QEH for babies admitted during the period Jul2017-Aug2018 were as follows: Information domain: 5.40/6.00; Care & Treatment domain: 5.41/6.00; Parental Participation domain: 5.52/6.00; Organization domain: 5.44/6.00; Professional Attitude domain: 5.33/6.00 Overall satisfaction with physicians: 9.08/10.00 Overall satisfaction with nurses: 9.18/10.00 In conclusion, the EMPATHIC-N (Chinese version) was demonstrated to be valid and reliable to measure the quality of care in NICU. The local NICU setting had provided a consistently high level of family-centered care.

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