Development and Preliminary Psychometric Evaluation of a Questionnaire on Comprehensive Protection, Quality, and...

We aimed to develop a questionnaire for pediatric healthcare professionals assessing the rights of hospitalized children, service quality, clinical relationships, and care practices and to obtain preliminary evidence of its content validity, internal consistency, and exploratory psychometric properties.

A four-phase methodological study was conducted: (0) instrument construction based on a review of the literature and relevant regulations; (1) expert content validation (n = 8) using the Content Validity Coefficient (CVC) and Kendall's coefficient of concordance (W); (2) preliminary pilot testing (n = 10) for item refinement; and (3) post-pilot testing with pediatric healthcare professionals (n = 35) to examine internal consistency and exploratory psychometric properties. Descriptive statistics, the Kaiser-Meyer-Olkin (KMO) measure, Bartlett's test of sphericity, principal component analysis (PCA) with Varimax rotation, average variance extracted (AVE), the heterotrait-monotrait ratio (HTMT), and correlations with a global satisfaction item (P50) were used.

The initial questionnaire comprised 77 items. Expert validation showed high CVC values for relevance (0.976), appropriateness (0.982), and clarity (0.973), with strong concordance among experts (Kendall's W = 0.85, p < 0.001). During preliminary pilot testing, two single-choice questions were converted into two dichotomous items, yielding a 79-item post-pilot version. Refinement removed 18 items, resulting in a 61-item questionnaire. All four a priori theoretical dimensions showed Cronbach's alpha values ≥ 0.70, providing preliminary evidence of internal consistency. Exploratory principal component analyses conducted separately within the four a priori theoretical dimensions yielded 4 to 6 components, accounting for 65.9-76.5% of the total variance. KMO values were modest (0.515-0.545), although Bartlett's tests of sphericity were statistically significant. The retained items showed communalities and component loadings above 0.50. AVE and HTMT were calculated as exploratory indicators related to convergent and discriminant validity, respectively. The global satisfaction item (P50) loaded on the second component of Dimension 4 (communality = 0.60) and showed positive correlations with the remaining dimensions.

The questionnaire showed high content-validity coefficients and acceptable preliminary internal consistency. The PCA, AVE, HTMT, and P50 findings provide exploratory information on item behavior and relationships among the theoretically defined dimensions but do not establish convergent, discriminant, criterion-related, or empirical dimensional validity. Given the small, single-center sample and modest KMO values, larger independent samples are required to confirm the dimensional structure and provide further validity evidence.