This study aimed to translate and validate the POPAC into Dutch and test the Dutch version of the questionnaires for psychometric properties among Dutch nurses working in acute hospital settings (28). Data were collected with the online questionnaire program QualtricsXM (version 2018, Prove, UT USA).
The POPAC consists of 15 items, as shown in table one. The items describe care procedures and processes in patients with dementia in hospitals (19). With the self-report of nurses in hospitals, the POPAC measures the extent to which nursing interventions are based on best practices in association with Person-centred care. The items are divided into three subscales: Using cognitive assessments and care interventions (items 1–5), Using evidence and cognitive expertise (items 6–8) and Individualizing care (items 9–15) (19). The scales are to be summed as well on a subscale level, as they are on a total level whereby higher scores imply higher levels of person-centeredness (10,19,25).
Translation of the Person-centred care of Older People with cognitive impairment in Acute Care scale
The instrument's principal author was involved in the translation, validation, and writing of the evaluation. Therefore, the instrument was translated according to the guideline described by Sousa (29). Two independent translators from a certified translation agency translated the questionnaire into Dutch. Two researchers (AK and EF) independently assessed these two translations to determine the optimal translation of the question formulations and the answer options.
During the translation process, there was some discussion about using the term ‘cognitive functioning’ or ‘cognitive status’ whereby all translators agreed upon the choice was made for ‘cognitive functioning’ because this term is commonly used in nursing care in the Netherlands. There were no disagreements on a lingual or cultural base. The final selection of all of the items could be made by unanimous consensus.
This Dutch version was also translated back into English by two other independent translators from the same certified translation agency. These translations were again independently assessed by the same researchers to decide on the best translation. This time, there was consensus on all of the items. The author reviewed this final English version, and the conclusion was that the outcomes closely resemble the original version. There were no specific reasons to expect systematic errors during the translation due to linguistic or cultural differences (30). The final version is attached as Additional file 1.
According to scientific literature, the sample size depends on the number of factors and the factor load, where a minimum sample size of 100 is recommended, and a sample size of 150 is suggested for three-phase models (30, 31). The COSMIN checklist advocates seven times the number of items (33). Based on this knowledge, the targeted sample size was at least 150 (34, 35). It may be noted that, in the aftermath, the sample size was sufficient for almost all estimated parameters to be (highly) significant.
Setting, recruitment, and participants
Six hospitals in the northern part of the Netherlands participated in this study and were supplemented by Dutch nurses who were approached via LinkedIn and Facebook. The data were collected in one university hospital, two non-university teaching hospitals (Top-Clinical), and three rural hospitals. The capacity of the hospitals varied from 241 to 1300 beds, with additional outpatients.
Nurses with at least three months' experience in the clinical setting, working in the direct care of people with dementia, and willing to participate were included in the study. All hospital departments were included, except for pediatrics and obstetrics. The measurements were made from July 2018 to March 2019.
The recruitment of participants in the hospitals was performed by contact persons working in the hospital, based on a convenience sample (27). The authors also used LinkedIn and Facebook for recruiting hospital nurses. A general request was made for nurses to participate via LinkedIn in which nursing managers are active and then repeated the call once. For Facebook, which is often used by Dutch nurses, a different approach was used for which the authors requested two groups on Facebook. One was in a private group for questionnaires of a professional nursing magazine, and the other was in an open group for nurses in general. On Facebook, a daily update of the response was provided. This Facebook group has many members; however, it is not known how many members are active.
Only complete cases are used in the data analysis by analyzed using IBM SPSS statistics (version25), and JASP (Version 0.11.1) with Lavaan was employed for the Confirmatory Factor Analysis (CFA)(34). Before starting the analysis, Item 5 was coded reversed due to the negative formulation of this item. The decision for using complete cases was made based on the response rate of 159 complete cases instead of 164 with the inclusion of incomplete cases. Because the sample was sufficiently large, it was decided only to include complete completed questionnaires. This makes the data as accurate as possible.
Descriptive analyses are used to describe the sample. Item performance was executed by item means and standard deviations, the Inter-Item Correlation Matrix, and the Corrected Item-Total Correlation.
The CFA was performed by robust maximum likelihood estimation, after which four types of fit indices were used to evaluate the fit of the model to the data. These were: The Chi-square model fit, the Comparative Fit Index (CFI), the Root Mean Square Error of Approximation (RMSEA), and the Standardized Root Mean-square Residual (SRMR). The Hoelter index was utilized to check the smallest sample size at which the chi-square interpretation would not be significant. As criterium for significance, a p-value <0.05 was used. An acceptable model fit was defined with the following criteria: p-value for the χ2 model fit compared to the baseline model smaller than 0.05, CFI and GFI values between 0.90 and 0.95 or above RMSEA and RMR values of 0.08 or below (35).
Cronbach's alpha on the total scale and its subscales were assessed to determine the internal consistency.
Ethics approval and consent to participate
The study was performed following the Helsinki declaration, and all of the participants provided written informed consent before filling out the questionnaire. Nurses had an option to choose whether the results would also be available for further research. The Medical Ethical Committee of the University Medical Center Groningen considered approval unnecessary (decision M17.221048) because the questionnaire was intended for staff. The questionnaire was completely anonymous; no one could be identified based on the results. The managers received an email with a general explanation and a link to the questionnaire to forward it to the nurses of their team. Managers were not informed about the number of participating nurses from their ward, nor about their responses. Based on the contact persons' information and the response per ward, there is no reason to believe that nurses felt obliged to participate in this survey. The voluntary nature of the participation has been emphasized in the explanations.