Development of knowledge-attitude-practice questionnaire for mechanical prophylaxis of deep venous thrombosis and its reliability and validity testing

doi:10.3969/j.issn.1674-8115.2022.01.005

Abstract

Abstract: Objective

·To develop a knowledge-attitude-practice questionnaire for mechanical prophylaxis of deep venous thrombosis for orthopedic nurses in China, and analyze its reliability and validity.

Methods

·On the basis of literature review, combined with the characteristics of orthopedic diseases and orthopedic nurses, a preliminary questionnaire for mechanical prophylaxis of deep venous thrombosis was prepared. In January 2020, two rounds of expert letter consultation were conducted to demonstrate and modify the items in the first draft and form the test version of the questionnaire for mechanical prophylaxis of deep vein thrombosis.In March 2020, tests were conducted among 620 orthopedic nurses from 36 medical units in 13 cities in Jiangsu Province. Item analysis was carried out with critical ratio method and homogeneity test. Reliability analysis was carried out from internal consistency reliability, split-half reliability and retest reliability. Validity was analyzed from content validity and structure validity.

Results

·The first draft of the questionnaire contained 37 items; after the first round of expert consultation, 4 items were revised and 7 items were added; after the second round of expert consultation, a test version of the questionnaire containing 44 items was formed. A total of 620 questionnaires were distributed. The effective recovery rate of the questionnaire was 96.77%. The critical ratio method showed that the item decision values t, which reflected the t-test results of independent samples of high and low groups, ranged from 5.89 to 20.31, and the difference was statistically significant (all P<0.05). The homogeneity test showed that Pearson correlation coefficient r, which reflected the correlation between the score of each item and the total score of the scale, ranged from 0.49 to 0.79, and the difference was statistically significant (all P<0.05). Therefore, 44 items were retained after item analysis. The Cronbach's α coefficient reflecting the internal consistency of the total questionnaire was 0.893, the Spearman-Brown coefficient reflecting the half-fold reliability was 0.794, and the intraclass correlation coefficient reflecting the retest reliability was 0.909. The scale-level content validity index reflecting content validity was 0.926 and the item-level content validity index was 0.833?1. Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's sphericity test chi-square value which reflected the structure validity were 0.883 and 12 560.176 (df=666, P<0.05) respectively. These values indicated that the questionnaire was suitable for exploratory factor analysis. In addition, 7 items were deleted according to the absolute value of factor load. Finally, 37 items remained. Seven common factors with eigenvalue greater than 1 were extracted. The 7 common factors were named the act of mechanical prophylaxis, risk perception of mechanical prophylaxis, indications of mechanical prophylaxis, contraindications of mechanical prophylaxis, conceptual cognition of mechanical prophylaxis, mechanical preventive response and health education cognition of mechanical prophylaxis, respectively. The cumulative variance contribution rate was 61.992%.

Conclusion

·The questionnaire in this study shows good reliability and validity. It can be used as an investigation tool to study the current attitude, knowledge and behavior of mechanical prophylaxis of orthopedic nurses.

Key words: orthopedic nurse, deep vein thrombosis, mechanical prophylaxis, questionnaire, reliability, validity

CLC Number:

R473.6

Chunhong HAN, Jie WANG, Yang HONG, Yahui TONG. Development of knowledge-attitude-practice questionnaire for mechanical prophylaxis of deep venous thrombosis and its reliability and validity testing[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 28-35.

Figures/Tables 2

TrendMD

References 13

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No.	Item	I-CVI
1	Do you think mechanical prophylaxis of deep vein thrombosis is important？您认为深静脉血栓形成机械预防重要吗？	1
2	Do you consider graduated compression stockings as mechanical prophylaxis？您认为逐级加压袜属于机械预防吗？	1
3	Do you consider intermittent pneumatic compression as mechanical prophylaxis？您认为间歇充气加压装置属于机械预防吗？	1
4	Do you consider venous foot pumps as mechanical prophylaxis？您认为足底加压泵属于机械预防吗？	1
5	Do you think a risk assessment of the patient is necessary before doing mechanical prophylaxis？您认为采用机械预防措施前需要对患者进行风险评估吗？	1
6	Do you think patients should be screened for deep vein thrombosis before doing mechanical prophylaxis？您认为采用机械预防措施前需要筛查患者是否已患有深静脉血栓吗？	1
7	Do you think mechanical prophylaxis is appropriate for patients at low risk of deep vein thrombosis？您认为深静脉血栓低风险患者适宜采用机械预防吗？	1
8	Do you think mechanical prophylaxis is appropriate for patients at high risk of deep vein thrombosis with anticoagulant contraindications？您认为深静脉血栓中高危风险且伴有抗凝禁忌的患者适宜采用机械预防吗？	1
9	Do you think patients need to be assessed for contraindications before doing mechanical prophylaxis？您认为采用机械预防措施前需要评估患者有无禁忌证吗？	1
10	Do you think that lower limb disorders such as dermatitis， infection， gangrene or recent skin graft surgery are contraindications of GCS and IPC？您认为下肢腿部疾患，如皮炎、感染、坏疽或近期接受过皮肤移植手术属于GCS和IPC的禁忌证吗？	1
11	Do you think congestive heart failure is a contraindication of mechanical prophylaxis？您认为充血性心衰属于机械预防禁忌证吗？	1
12	Do you think pulmonary edema is a contraindication of mechanical prophylaxis？您认为肺水肿属于机械预防禁忌证吗？	0.833
13	Do you think severe deformity of lower limbs， severe vascular sclerosis of lower limbs or severe edema of lower limbs are contraindications of mechanical prophylaxis？您认为下肢严重畸形、下肢血管严重硬化或严重下肢水肿属于机械预防的禁忌证吗？	1
14	Do you think improper size is contraindicated for mechanical prophylaxis？您认为尺寸不合适属于机械预防禁忌证吗？	1
15	Do you think mechanical prophylaxis is appropriate for hip and knee replacement patients？您认为髋膝关节置换患者适宜采用机械预防吗？	1
16	Do you think mechanical prophylaxis is appropriate for patients with unilateral lower limb fracture？您认为下肢骨折患者的健侧肢体适宜采用机械预防吗？	1
17	Do you agree that mechanical prophylaxis is not appropriate for cancer patients？肿瘤患者不适宜采用机械预防，您认同吗？	1
18	Do you think mechanical prophylaxis is appropriate for patients with multiple injuries？您认为多发伤患者适宜采用机械预防吗？	1
19	Do you think mechanical prophylaxis is appropriate for spinal surgery patients？您认为脊柱手术患者适宜采用机械预防吗？	1
20	Do you think mechanical prophylaxis should continue until the patient is able to move normally or leave the hospital？您认为机械预防应该做到患者可以正常活动或出院吗？	1
21	Do you think that the use site of patients should be dynamically evaluated during the use of mechanical prophylaxis to guard against adverse reactions such as lower limb circulation disorders， skin allergies and pressure injuries？您认为机械预防使用过程中应该对患者的使用部位进行动态评估，谨防下肢循环障碍、皮肤过敏及压力性损伤等不良反应出现吗？	1
22	Do you think health education should be given to patients and their families when using mechanical prophylaxis？您认为采用机械预防措施时需要对患者及家属进行健康教育吗？	1
23	Do you think it is necessary to let patients and their families know the principle and purpose of the equipment when using mechanical prophylaxis？您认为采用机械预防措施时需要让患者及家属了解设备的使用原理与目的吗？	1
24	Do you think it is necessary to let patients and their families know the use time， maintenance methods， activities and other matters of attention when using mechanical prophylaxis？您认为采用机械预防措施时需要让患者及家属了解使用时间、保养方法及活动等注意事项吗？	1
25	How do you obtain the knowledge of mechanical prophylaxis？（multiple choice）您通过哪些途径获得机械预防的相关知识？（多选题）	1
26	Does your department have policies and procedures for prevention and treatment of deep vein thrombosis？您所在科室是否有深静脉血栓防治制度和流程？	1
27	Does your department have the operation procedure of mechanical prophylaxis？您所在科室是否有机械预防相关操作流程？	1
28	Have you used any mechanical prophylaxis during your employment？您在岗期间是否采用过机械预防相关措施？	1
29	What mechanical prophylaxis have you used during your employment？（multiple choice）您在岗期间采用过哪些机械预防措施？（多选题）	0.833
30	Do you use graduated compression stockings only after surgery？您是否只在术后使用逐级加压袜？	1
31	Do you instruct patients to wear graduated compression stockings for 24 hours？逐级加压袜是否24小时穿戴？	1
32	Do you use intermittent pneumatic compression devices only after surgery？您是否只在术后使用间歇充气加压装置？	1
33	Is the intermittent pneumatic compression device used until the patient is discharged？间歇充气加压装置是否一直使用至患者出院？	1
34	Do you use venous foot pumps only after surgery？您是否只在术后使用足底加压泵？	1
35	Is the venous foot pump used until the patient is discharged？足底加压泵是否一直使用至患者出院？	1
36	Do you conduct a risk assessment of the patient before using mechanical prophylaxis？采用机械预防措施前您是否会对患者进行风险评估？	1
37	Is there a unified risk assessment form for deep vein thrombosis in your department？您科室内目前是否具备统一的深静脉血栓风险评估表？	1
38	Which patients are currently receiving mechanical prophylaxis in your department？（multiple choice）您科室目前采用机械预防措施的人群有哪些？（多选题）	1
39	Do you give health education to patients before taking mechanical prophylaxis？您在采取机械预防措施前是否会对患者进行健康教育？	1
40	What aspects of health education do you usually conduct on mechanical prophylaxis？（multiple choice）您通常会进行哪些机械预防的健康教育？（多选题）	1
41	Do you know the main basis for taking mechanical prophylaxis？您是否了解采取机械预防的主要依据？	1
42	Have you ever worked without mechanical prophylaxis for patients at high risk of deep vein thrombosis？您工作中是否发生过未对深静脉血栓中高风险患者采取机械预防的情况？	1
43	Has your department conducted a cause analysis for failure to take mechanical prophylaxis？您科室是否进行过未采取机械预防的原因分析？	1
44	Does your department have a plan to purchase equipments of mechanical prophylaxis in the near future？您科室近期是否有购置机械预防相关设备的计划？	0.833

No.	Item	I-CVI
1	Do you think mechanical prophylaxis of deep vein thrombosis is important？您认为深静脉血栓形成机械预防重要吗？	1
2	Do you consider graduated compression stockings as mechanical prophylaxis？您认为逐级加压袜属于机械预防吗？	1
3	Do you consider intermittent pneumatic compression as mechanical prophylaxis？您认为间歇充气加压装置属于机械预防吗？	1
4	Do you consider venous foot pumps as mechanical prophylaxis？您认为足底加压泵属于机械预防吗？	1
5	Do you think a risk assessment of the patient is necessary before doing mechanical prophylaxis？您认为采用机械预防措施前需要对患者进行风险评估吗？	1
6	Do you think patients should be screened for deep vein thrombosis before doing mechanical prophylaxis？您认为采用机械预防措施前需要筛查患者是否已患有深静脉血栓吗？	1
7	Do you think mechanical prophylaxis is appropriate for patients at low risk of deep vein thrombosis？您认为深静脉血栓低风险患者适宜采用机械预防吗？	1
8	Do you think mechanical prophylaxis is appropriate for patients at high risk of deep vein thrombosis with anticoagulant contraindications？您认为深静脉血栓中高危风险且伴有抗凝禁忌的患者适宜采用机械预防吗？	1
9	Do you think patients need to be assessed for contraindications before doing mechanical prophylaxis？您认为采用机械预防措施前需要评估患者有无禁忌证吗？	1
10	Do you think that lower limb disorders such as dermatitis， infection， gangrene or recent skin graft surgery are contraindications of GCS and IPC？您认为下肢腿部疾患，如皮炎、感染、坏疽或近期接受过皮肤移植手术属于GCS和IPC的禁忌证吗？	1
11	Do you think congestive heart failure is a contraindication of mechanical prophylaxis？您认为充血性心衰属于机械预防禁忌证吗？	1
12	Do you think pulmonary edema is a contraindication of mechanical prophylaxis？您认为肺水肿属于机械预防禁忌证吗？	0.833
13	Do you think severe deformity of lower limbs， severe vascular sclerosis of lower limbs or severe edema of lower limbs are contraindications of mechanical prophylaxis？您认为下肢严重畸形、下肢血管严重硬化或严重下肢水肿属于机械预防的禁忌证吗？	1
14	Do you think improper size is contraindicated for mechanical prophylaxis？您认为尺寸不合适属于机械预防禁忌证吗？	1
15	Do you think mechanical prophylaxis is appropriate for hip and knee replacement patients？您认为髋膝关节置换患者适宜采用机械预防吗？	1
16	Do you think mechanical prophylaxis is appropriate for patients with unilateral lower limb fracture？您认为下肢骨折患者的健侧肢体适宜采用机械预防吗？	1
17	Do you agree that mechanical prophylaxis is not appropriate for cancer patients？肿瘤患者不适宜采用机械预防，您认同吗？	1
18	Do you think mechanical prophylaxis is appropriate for patients with multiple injuries？您认为多发伤患者适宜采用机械预防吗？	1
19	Do you think mechanical prophylaxis is appropriate for spinal surgery patients？您认为脊柱手术患者适宜采用机械预防吗？	1
20	Do you think mechanical prophylaxis should continue until the patient is able to move normally or leave the hospital？您认为机械预防应该做到患者可以正常活动或出院吗？	1
21	Do you think that the use site of patients should be dynamically evaluated during the use of mechanical prophylaxis to guard against adverse reactions such as lower limb circulation disorders， skin allergies and pressure injuries？您认为机械预防使用过程中应该对患者的使用部位进行动态评估，谨防下肢循环障碍、皮肤过敏及压力性损伤等不良反应出现吗？	1
22	Do you think health education should be given to patients and their families when using mechanical prophylaxis？您认为采用机械预防措施时需要对患者及家属进行健康教育吗？	1
23	Do you think it is necessary to let patients and their families know the principle and purpose of the equipment when using mechanical prophylaxis？您认为采用机械预防措施时需要让患者及家属了解设备的使用原理与目的吗？	1
24	Do you think it is necessary to let patients and their families know the use time， maintenance methods， activities and other matters of attention when using mechanical prophylaxis？您认为采用机械预防措施时需要让患者及家属了解使用时间、保养方法及活动等注意事项吗？	1
25	How do you obtain the knowledge of mechanical prophylaxis？（multiple choice）您通过哪些途径获得机械预防的相关知识？（多选题）	1
26	Does your department have policies and procedures for prevention and treatment of deep vein thrombosis？您所在科室是否有深静脉血栓防治制度和流程？	1
27	Does your department have the operation procedure of mechanical prophylaxis？您所在科室是否有机械预防相关操作流程？	1
28	Have you used any mechanical prophylaxis during your employment？您在岗期间是否采用过机械预防相关措施？	1
29	What mechanical prophylaxis have you used during your employment？（multiple choice）您在岗期间采用过哪些机械预防措施？（多选题）	0.833
30	Do you use graduated compression stockings only after surgery？您是否只在术后使用逐级加压袜？	1
31	Do you instruct patients to wear graduated compression stockings for 24 hours？逐级加压袜是否24小时穿戴？	1
32	Do you use intermittent pneumatic compression devices only after surgery？您是否只在术后使用间歇充气加压装置？	1
33	Is the intermittent pneumatic compression device used until the patient is discharged？间歇充气加压装置是否一直使用至患者出院？	1
34	Do you use venous foot pumps only after surgery？您是否只在术后使用足底加压泵？	1
35	Is the venous foot pump used until the patient is discharged？足底加压泵是否一直使用至患者出院？	1
36	Do you conduct a risk assessment of the patient before using mechanical prophylaxis？采用机械预防措施前您是否会对患者进行风险评估？	1
37	Is there a unified risk assessment form for deep vein thrombosis in your department？您科室内目前是否具备统一的深静脉血栓风险评估表？	1
38	Which patients are currently receiving mechanical prophylaxis in your department？（multiple choice）您科室目前采用机械预防措施的人群有哪些？（多选题）	1
39	Do you give health education to patients before taking mechanical prophylaxis？您在采取机械预防措施前是否会对患者进行健康教育？	1
40	What aspects of health education do you usually conduct on mechanical prophylaxis？（multiple choice）您通常会进行哪些机械预防的健康教育？（多选题）	1
41	Do you know the main basis for taking mechanical prophylaxis？您是否了解采取机械预防的主要依据？	1
42	Have you ever worked without mechanical prophylaxis for patients at high risk of deep vein thrombosis？您工作中是否发生过未对深静脉血栓中高风险患者采取机械预防的情况？	1
43	Has your department conducted a cause analysis for failure to take mechanical prophylaxis？您科室是否进行过未采取机械预防的原因分析？	1
44	Does your department have a plan to purchase equipments of mechanical prophylaxis in the near future？您科室近期是否有购置机械预防相关设备的计划？	0.833

No.	Factor 1 loading	Factor 2 loading	Factor 3 loading	Factor 4 loading	Factor 5 loading	Factor 6 loading	Factor 7 loading
36	0.908	0.094	0.062	0.067	0.088	0.148	-0.005
37	0.878	0.104	0.058	0.080	0.042	0.155	0.021
27	0.855	0.063	0.023	0.042	0.070	0.071	-0.014
32	0.829	0.051	0.081	0.030	0.087	0.156	-0.006
30	0.786	0.070	-0.007	0.072	0.090	0.161	-0.013
29	0.759	0.134	0.052	0.069	0.019	0.025	-0.009
33	0.746	0.083	0.072	0.082	0.088	0.094	-0.054
31	0.741	0.162	0.002	0.111	0.095	0.052	0.040
40	0.721	0.120	0.097	0.055	0.032	-0.080	0.025
35	0.695	-0.032	0.031	0.119	0.099	0.116	-0.023
38	0.501	0.178	0.057	-0.069	0.033	0.452	-0.078
34	0.484	0.132	0.069	0.007	0.010	0.439	-0.157
21	0.141	0.751	0.259	0.158	0.102	0.068	0.013
8	0.179	0.709	0.222	0.169	0.151	0.155	0.065
6	0.139	0.700	0.018	0.112	0.130	0.084	0.057
7	0.059	0.581	0.022	0.139	0.099	0.033	-0.003
9	0.174	0.574	0.359	0.113	0.034	0.031	-0.209
5	0.101	0.435	0.064	0.167	0.427	0.080	0.076
16	0.052	0.159	0.857	0.098	0.069	0.044	0.022
19	0.071	0.061	0.833	0.093	0.090	0.031	0.088
15	0.086	0.148	0.777	0.188	0.086	0.054	0.016
18	0.089	0.386	0.523	0.146	0.006	0.067	0.067
10	0.108	0.140	0.044	0.847	0.056	0.016	0.008
11	0.178	0.171	0.201	0.835	0.022	0.018	0.041
12	0.137	0.185	0.283	0.704	0.065	0.073	-0.052
14	0.081	0.281	0.070	0.618	0.174	0.076	0.119
3	0.151	0.147	0.079	0.118	0.814	-0.049	-0.092
4	0.090	0.182	-0.015	0.136	0.800	0.013	-0.007
2	0.056	0.002	0.009	-0.011	0.713	0.052	-0.255
1	0.124	0.113	0.148	-0.009	0.581	0.045	-0.033
41	0.112	0.061	0.036	-0.016	0.057	0.799	0.023
42	0.264	0.129	0.072	0.050	0.074	0.679	-0.006
43	0.010	-0.047	-0.006	0.109	-0.113	0.645	0.283
44	0.356	0.189	0.068	0.101	0.110	0.472	-0.077
22	0.066	0.147	0.117	0.069	-0.099	0.089	0.905
23	0.023	0.151	-0.014	-0.043	-0.165	0.090	0.878
24	-0.130	-0.197	0.045	0.056	-0.051	-0.043	0.539
Eigenvalue	9.723	4.037	2.772	1.849	1.724	1.499	1.332
Variance explained/%	26.278	10.912	7.491	4.997	4.661	4.052	3.601
Cumulative variance explained/%	26.278	37.190	44.681	49.679	54.339	58.391	61.992

No.	Factor 1 loading	Factor 2 loading	Factor 3 loading	Factor 4 loading	Factor 5 loading	Factor 6 loading	Factor 7 loading
36	0.908	0.094	0.062	0.067	0.088	0.148	-0.005
37	0.878	0.104	0.058	0.080	0.042	0.155	0.021
27	0.855	0.063	0.023	0.042	0.070	0.071	-0.014
32	0.829	0.051	0.081	0.030	0.087	0.156	-0.006
30	0.786	0.070	-0.007	0.072	0.090	0.161	-0.013
29	0.759	0.134	0.052	0.069	0.019	0.025	-0.009
33	0.746	0.083	0.072	0.082	0.088	0.094	-0.054
31	0.741	0.162	0.002	0.111	0.095	0.052	0.040
40	0.721	0.120	0.097	0.055	0.032	-0.080	0.025
35	0.695	-0.032	0.031	0.119	0.099	0.116	-0.023
38	0.501	0.178	0.057	-0.069	0.033	0.452	-0.078
34	0.484	0.132	0.069	0.007	0.010	0.439	-0.157
21	0.141	0.751	0.259	0.158	0.102	0.068	0.013
8	0.179	0.709	0.222	0.169	0.151	0.155	0.065
6	0.139	0.700	0.018	0.112	0.130	0.084	0.057
7	0.059	0.581	0.022	0.139	0.099	0.033	-0.003
9	0.174	0.574	0.359	0.113	0.034	0.031	-0.209
5	0.101	0.435	0.064	0.167	0.427	0.080	0.076
16	0.052	0.159	0.857	0.098	0.069	0.044	0.022
19	0.071	0.061	0.833	0.093	0.090	0.031	0.088
15	0.086	0.148	0.777	0.188	0.086	0.054	0.016
18	0.089	0.386	0.523	0.146	0.006	0.067	0.067
10	0.108	0.140	0.044	0.847	0.056	0.016	0.008
11	0.178	0.171	0.201	0.835	0.022	0.018	0.041
12	0.137	0.185	0.283	0.704	0.065	0.073	-0.052
14	0.081	0.281	0.070	0.618	0.174	0.076	0.119
3	0.151	0.147	0.079	0.118	0.814	-0.049	-0.092
4	0.090	0.182	-0.015	0.136	0.800	0.013	-0.007
2	0.056	0.002	0.009	-0.011	0.713	0.052	-0.255
1	0.124	0.113	0.148	-0.009	0.581	0.045	-0.033
41	0.112	0.061	0.036	-0.016	0.057	0.799	0.023
42	0.264	0.129	0.072	0.050	0.074	0.679	-0.006
43	0.010	-0.047	-0.006	0.109	-0.113	0.645	0.283
44	0.356	0.189	0.068	0.101	0.110	0.472	-0.077
22	0.066	0.147	0.117	0.069	-0.099	0.089	0.905
23	0.023	0.151	-0.014	-0.043	-0.165	0.090	0.878
24	-0.130	-0.197	0.045	0.056	-0.051	-0.043	0.539
Eigenvalue	9.723	4.037	2.772	1.849	1.724	1.499	1.332
Variance explained/%	26.278	10.912	7.491	4.997	4.661	4.052	3.601
Cumulative variance explained/%	26.278	37.190	44.681	49.679	54.339	58.391	61.992

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