We developed ISTCQ - a questionnaire measuring the instrumental support in transitional care. A polit test was followed among older adults with chronic diseases to test the reliability and validity of ISTCQ. The study was conducted in three phases, ISTCQ development, ISTCQ validation, and Cross-sectional validation survey. Each phase follows the recommendations for questionnaire development [42].
Results from ISTCQ development were a basis for the concept of ISTCQ and item development. Interviews with experts underscored the importance of instrumental support in transitional care. According to the interviews, we concluded the four dimensions of instrumental support in transitional care: service support, staff support, financial support, and equipment and supplies support. Hence, the preliminary formation of ISTCQ included 4 dimensions (anticipated support, received support, subjective support, and support utilization) and 16 items.
In ISTCQ validation, two dimensions subjective support, and support utilization were replaced with support satisfaction after the first round of Delphi expert anonymous consultation. Three items were deleted after the second round, and appropriate adjustments and modifications were made to certain items in the last round. The experts who participated in three rounds were specialized in clinical nursing, nursing management, geriatric nursing, nursing education, community nursing and sociology. Their authority coefficients ranged from 0.74 to 0.99, showing a high degree of credibility. More importantly, the Kendall W value was higher in the third round than in the first and second rounds, and the CV was lower in the third round than in the first and second rounds; thus, there was a convergence of expert opinions. After modification and screening of questionnaire items through Delphi method, the final version of ISTCQ contains 3 dimensions (anticipated support, received support, support satisfaction) and 12 items.
Cross-sectional validation survey was conducted in the last stage as a pilot study. During the test, we found grammatical problems in some items and adjusted them immediately. The EFA findings indicated that the ISTCQ can be interpreted by three factors: namely, anticipated support (items 1, 2, 3, 4), received support (items 5, 6, 7, 8) and support satisfaction (items 9, 10, 11, 12). Cronbach’s alpha for the ISTCQ (0.827) showed that all items had high consistency, demonstrating satisfactory reliability of internal consistency. The results are similar to previous studies on measuring the informational support of older adults with chronic diseases in transitional care [43]. In practice, few studies measured instrumental support alone. Instrumental support is usually included social support as a certain dimension of social support [44, 45]. However, instrument support alone is complex and the measurement of instrumental support divers among different contexts in different studies. Therefore, our study hopes to develop an effective measure of instrumental support in transitional care.
According to the content of ISTCQ, we can assess the anticipated and received instrumental support in transitional care for older adults with chronic diseases. Differences in these two dimensions is an indicator of the gaps between demands among elderly chronically ill patients and the current situation of support. Through comparison, we can ascertain other instrumental support that is not anticipated and received in transitional care. Based on that, the transitional care team can provide targeted services, staff and funds to reduce unnecessary waste of resources. In term of the support satisfaction dimension we can see the level of satisfaction with the service support, staff support, and financial support in transitional care. The sum of scores from received support and support satisfaction could be calculated to show the quality of instrumental support. The practical application of our questionnaire in clinical work needs further study, and we will continue to report the follow-up results.