The purpose of this study was to identify the significant dimensions of the concept of community acceptance of nurse practitioners/physician’s assistants and to construct areliable and valid instrument which would reflect these dimensions. The methodological approach included: conceptualization of categories, development of items for each category, development of the tool, administration of the tool, and psychometric analysis of results. Community input through focus-group interviews and post-administration questions provided qualitative data. The survey tool, consisting of items in four conceptualized categories (knowledge, access, competence, and trust), was administered in five rural communities. The responses of 967 residents were analyzed through factor analysis. The criterion, eigenvalue > 1.0, resulted in seven factors. Oblique rotation was applied to the seven factors and marker variables (loadings > .70) facilitated the identification of the underlying dimensions of each factor. Overall, 98% of the items assigned to the original categories were maintained after factor analysis. The identification of these dimensions helped to simplify the description and understanding of community acceptance of nurse practitioners and physicians’ assistants. Community acceptance of these advanced health care providers is a necessary precursor to use of services.

This article reports the use of higher-order factor analysis to examine the underlying dimensions of an instrument designed to measure community acceptance of nurse practitioners/physician's assistants. The instrument consisted of both dichotomous and Likert scale items. Use of factor analysis with dichotomous data is controversial. Higher-order factor analysis provides a potential solution to this dilemma. Following initial factor analysis using maximum likelihood extraction with oblique rotation, the factor correlation matrix was factored to obtain second order factors. The second order factors were interpreted using the factor pattern matrix and examining correlations of individual survey items with the second order factors. This procedure provides additional factorial validity of the underlying uni- and multidimensional concepts related to acceptance of NPs and PAs in rural settings: knowledge, competence, access, and trust.