Development and Psychometric Testing of a Weight Sensitivity Instrument to Assess Weight Bias

Background and Purpose: Efforts to reduce weight bias in health care are increasing, yet few tools assess whether improvements in behavior are then translated into patient care. The Weight Sensitivity Instrument (WSI) is being developed to assess the presence or absence of provider weight bias-related clinical behaviors during educational patient encounters. Methods: WSI items were developed and refined using the implicit bias theory, a comprehensive literature review, and an e-Delphi review by content experts. The WSI was then pilot tested with two cohorts of advanced practice nursing students (n = 20 and n = 23) during simulation-based learning experiences involving standardized patients with obesity. The interrater reliability of the tool was assessed. Results: Three e-Delphi rounds with five content experts improved item clarity, with the final round resulting in a scale-level content validity index of .91. In the first pilot, 14 out of 20 items demonstrated good-to-very-good interrater reliability (Gwet's AC1 > 0.60); low-reliability items were revised or removed. Seventeen revised items demonstrated high interrater agreement and reliability scores (Gwet's AC1 > 0.90), except one. Conclusions: Future work will continue to assess WSI validity, reliability, and additional psychometric properties across educational settings.