This study was approved by the Ethics Committee of Soochow University (No. SUDA 20200515H03). All participants were given both verbal and written information about the study; those who agreed to participate in this study signed an informed consent.
Instrument and Sinicization
The SSS has 15 items and includes two parts. The first part is labeled “Respect Uniqueness” and the second part “Being Reliable” . Answer options are “never”, “seldom”, “occasionally”, “often”, “always”, which successively represent the score of “1, 2, 3, 4, 5”.
The SSS was translated from English into Chinese using Brislin’s translation model . The steps for sinicization of SSS are shown in Fig. 1. Firstly, two bilingual researchers separately translated the original SSS into Chinese. The discrepancies between these two translations were reviewed and discussed comprehensively, and formed a single version, which was then translated back into English by another bilingual researcher. The retroversion was repeatedly compared with the original SSS scale and the Chinese expressions were adjusted accordingly. During this procedure, the translation validity index (TVI) was used to assess the translation equivalence of versions. It used a 4-point Likert scale (1=uncorrected, 2=needs major modification on equivalent item, 3=equivalent but needs minor modification, and 4=equivalent). In this study, three language experts were recruited to compare the SSS in English and Chinese. The items were revised until a TVI score of 4 was achieved. The revised version of SSS was pilot tested with a convenience sample of 30 HCAs in a LTCF in Suzhou to evaluate whether the Chinese version of SSS was easy to understand. Language expression was adjusted if HCAs felt it was difficult to understand. After the pilot test, the Chinese version of SSS (SSS-C) was finalized for the test of its psychometric properties.
Fig.1 Sinicization steps of SSS
Sample and Setting
The study was conducted in 4 LTCFs in Suzhou, China. Health care aides meeting the following criteria were enrolled in the study: (i) working in the LTCFs for more than 3 months; (ii) able to give written consent. A total of 300 participants completed the scale. 41.4% of the HCAs were less than 50 years old and 54% were 51-60 years old; 85.3% were female; 100% of the respondents were employed full-time. The mean number of years that the respondents have worked in the LTCF was less than 5 years (n=241, 80.3%).
After giving written consent, HCAs were asked to fill out the survey questionnaire independently in the nursing station or staff lounge. The researchers remained in the room and were available to answer questions when necessary. Neither compensation nor remuneration was offered to the participants.
Analyses were performed by IBM SPSS Statistics 21. Participant characteristics and major variables were summarized by descriptive statistics (Table 1). Reliability was tested by internal consistency (Cronbach’s alpha), split-half reliability (Spearman-Brown coefficient) and test-retest reliability (Pearson correlation coefficient) (reliability coefficient ≥0.7 was acceptable) . Construct validity was examined by exploratory factor analysis (EFA) (principal component analysis with varimax rotation). Scree plot, Kaiser criterion (eigenvalue≥1.0), and clinical interpretability were considered in determination of factor solution (When the factor loading ≥ 0.40, the item can be considered in the factor) . Discriminative validity was assessed by examining if supervisory support varied between the different facilities by one-way analysis of variance. Multiple comparisons, using Bonferroni’s procedure, were completed to compare every pair of facilities. The significant level was 0.05.