Development and psychometric testing of a knowledge tool for incontinence-associated dermatitis for clinicians: The Barakat-Johnson Incontinence-Associated Dermatitis Knowledge Tool (Know-IAD).

Introduction: The purpose of this study is to describe the development and evaluation of the psychometric properties of a tool used to assess clinician knowledge of incontinence-associated dermatitis (IAD). Materials & methods: The instrument was developed in three phases: Phase 1 involved item development, Phase 2 evaluated content validity of the instrument by surveying clinicians and lay stakeholders within a single state of Australia and Phase 3 used a pilot multi-site cross-sectional survey design to determine composite reliability and evaluate scores of the knowledge tool. In Phase 1, the instrument was developed by five persons with clinical and research subject expertise. In Phase 2, content validity was evaluated by a group of 13 clinicians (nurses, physicians, occupational therapists, dietitians, and physiotherapists) working in an acute care health service and two consumer representatives. In Phase 3, clinicians, working across five health services and on wards with patients who were diagnosed with IAD, participated in pilot-testing the instrument. During Phase 1, a group of local and international experts developed a preliminary tool based on an international consensus document, our prior research evaluating IAD knowledge, and consensus among an expert panel of clinicians and researchers. Phase 2 used a survey design to determine content validity of the knowledge tool. Specifically, we calculated item- and scale-level content validity ratios and content validity indices for all questions within the draft instrument. Phase 3 comprised pilot-testing of the knowledge tool using a cross-sectional survey. Analysis involved confirmatory factor analysis to confirm the hypothesised model structure of the knowledge tool, as measured by model goodness-of-fit. Composite reliability testing was undertaken to determine the extent of internal consistency between constituent items of each construct. Results: Phase 1 developed the Barakat-Johnson Incontinence-Associated Dermatitis Knowledge tool (Know-IAD)1, comprising 19 items and divided into three domains of IAD-related knowledge: 1) Aetiology and Risk, 2) Classification and Diagnosis, and 3) Prevention and Management. In Phase 2, 18 of the 19 items demonstrated high scale content validity ratios scores on relevance (0.75) and clarity (0.82); and high scale-content validity indices scores on relevance (0.87) and clarity (0.91). In Phase 3, 204 respondents completed the survey and the Know-IAD tool. The final 18-item Know-IAD tool demonstrated construct validity by model goodness-of-fit, as measured by the root mean square error of approximation (RMSEA), which was excellent for the Aetiology and Risk domain (RMSEA=0.02) and Prevention and Management domains (RMSEA=0.02); and good in the Classification and Diagnosis domain (RMSEA=0.04). Composite reliability (CR) was good in the Aetiology and Risk domain (CR=0.76) and Prevention and Management domains (CR=0.75) and adequate in the Classification and Diagnosis domain (CR=0.64). Respondents had good understanding of aetiology and risk (72% correct responses); fairly good understanding of prevention and management of IAD (64% correct responses) and moderate understanding of classification and diagnosis (40% correct responses). Conclusion: The Know-IAD demonstrated good psychometric properties and provides preliminary evidence that it can be applied to evaluate clinician knowledge of IAD. [ABSTRACT FROM AUTHOR]