Construction of a Scale Assessing Patients' Perceptions Regarding Sanitation and Hygiene in a Clinical Setting

This study attempted to develop a scale, hereby called HYGIENICCARE, that assesses patients' perceptions regarding sanitation and hygiene in a healthcare environment. It also evaluated the relationship between the new measure and a previously validated scale measuring healthcare quality.

This study was a psychometric test in which we constructed a new survey and administered the survey to patients in wards and the outpatient departments of 5 hospitals in Accra North. A robust procedure, including a review of selected questions by an expert panel, was followed to determine the original bank of items of the instrument. Principal component analysis with varimax rotation was used to select items for the scale, whereas confirmatory factor analysis was used to assess construct validity. Multiple linear regression was used to examine the association between the new scale and an existing measure of healthcare quality.

A bank of 10 items was determined through a systematic review of the literature and the engagement of 7 expert reviewers. Through principal component analysis, the items were reduced to 9. Principal component analysis yielded 2 factors: "environment and equipment" and "personnel and process," which both explained 82% of the total variance and produced Cronbach α coefficients of 0.912 and 0.86, respectively. Confirmatory factor analysis confirmed the 2-factor solution and produced satisfactory discriminant validity and convergent validity indicators. The 2 domains of the new scale were highly correlated with all dimensions of a scale measuring healthcare quality called HEALTHQUAL (r ≥ 0.76, P < 0.001). In multiple linear regression, each of the 2 domains of HYGIENICCARE explained a total variance of 41% or greater in all domains of HEALTHQUAL (P < 0.001).

We developed a brief scale measuring hospital hygiene and sanitation that correlated well with an existing measure of healthcare quality. This effort shows that the new tool is a valid measure of patient-perceived hospital hygiene and sanitation.