Development and psychometric validation of the hospitalized older adults' dignity scale for measuring dignity during acute hospitalization

Abstract

AimTo develop and validate a culturally appropriate patient‐reported outcome measure for measuring dignity for older adults during acute hospitalization.DesignA three‐phased exploratory sequential mixed‐method design was used.MethodsDomains were identified and items were generated from findings of a recent qualitative study, two systematic reviews and grey literature. Content validity evaluation and pre‐testing were undertaken using standard instrument development techniques. Two‐hundred and seventy hospitalized older adults were surveyed to test construct and convergent validity, internal consistency reliability and test–retest reliability of the measure. Analysis was performed using Statistical Package for the Social Sciences, version 25. The STROBE checklist was used to document reporting of the study.ResultsWe established the 15‐item Hospitalized Older Adults' Dignity Scale (HOADS) that has a 5‐factor structure: shared decision‐making (3 items); healthcare professional‐patient communication (3 items); patient autonomy (4 items); patient privacy (2 items); respectful care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability and good test–retest reliability were demonstrated.ConclusionWe established the HOADS is a valid and reliable scale to measure dignity for older adults during acute hospitalization. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may inform the development of strategies to improve dignity‐related care in the future.ImpactThe development and validation of the HOADS will provide nurses and other healthcare professionals with a feasible and reliable scale for measuring older adults' dignity during acute hospitalization. The HOADS advances the conceptual understanding of dignity in hospitalized older adults by including additional constructs that have not been captured in previous dignity‐related measures for older adults (i.e. shared decision‐making and respectful care). The factor structure of the HOADS, therefore, includes five domains of dignity and offers a new opportunity for nurses and other healthcare professionals to better understand the nuances of dignity for older adults during acute hospitalization. For example, the HOADS enables nurses to identify differences in levels of dignity based on contextual factors and to use this information to guide the implementation of strategies that promote dignified care.Patient or Public ContributionPatients were involved in the generation of items for the scale. Their perspectives and the perspectives of experts were sought in determining the relevance of each item of the scale to patients' dignity.

Self‐reported dignity and factors that influence dignity in hospitalised older adults: A cross‐sectional survey

“…To address this issue, there is a need for objective and standard criteria for measuring patientreported dignity (Macklin, 2003). The Hospitalized Older Adults' Dignity Scale (HOADS) is a newly developed scale that measures dignity in hospitalised older adults and has been validated for use in the Ghanaian context (Fuseini, Mohebbi, et al, 2023).…”

“…A researcher administered a structured questionnaire to gather data. This included a demographic information section and the 15-item HOADS (Table 1) (Fuseini, Mohebbi, et al, 2023). The participants' demographic data gathered included their age, sex, marital status, religious affiliation, type of ward, medical diagnosis, occupation, level of education, length of hospitalisation and number of hospitalisations.…”

“…Psychometric analysis has demonstrated the HOADS to be a reliable and valid tool in the Ghanaian context (Fuseini, Mohebbi, et al, 2023).…”