• Enhancing nursing trainees’ health communication through self-assessment: questionnaire development and validation
  • Shahrzad Ghiyasvandian ,1 Mahbobeh Abdolrahimi ,2,* Masoumeh Zakerimoghadam,3 Abbas Ebadi,4
    1. Tehran University of Medical Sciences
    2. shahid beheshti University of Medical Sciences
    3. Tehran University of Medical Sciences
    4. Behavioral Sciences Research Center, Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences


  • Introduction: in recent years, particular attention has been paid to nursing students` health communication (HC) with patients, due to a strong emphasis on patient-centered education care in Iranian healthcare reform. In Iran, HC which is used for patient education as well as health promotion, is taught through theoretical lectures by nursing instructors and is evaluated through written exams. However, various studies have highlighted the poor communication of future nurses. self-assessment is a student-centered approach, which involves students in the learning process, as it helps them have a better understanding of learning objectives and adjust their learning speed relative to their educational goals. Using student-centered and innovative strategies before clinical placements such as simulation is recommended to promote novice nursing students` self-esteem and professional socialization and prepare them to interact with patients therapeutically. There is a lack of a native, valid and reliable tool to measure HC for educational and research purposes. Therefore, this study aimed to design and validate a questionnaire for assessing Iranian nursing students` HC.
  • Methods: This study was an exploratory mixed-method research conducted in two phases of developing tool content and validation of the scale during 2016 to 2018. In the first phase, a hybrid model of concept analysis was used to classify the features of HC among nursing students and patients in three dependent steps: integrative review, semi-structured interviews, and final analysis. After analyzing thirty relevant papers and interpreting eighteen interviews using memos and conventional content analysis, "interpersonal interaction", "purposive information exchange process", "patient-centered conversations", "conscientiousness", "understandable interaction", and "flexible and emotional companionship" were yielded as attributes of HC. Nursing students` HC with patients is defined as one of the most important aspects of nursing professional commitment in which trainees accept patients unconditionally and develop an empathic, flexible, and patient-centered interpersonal interaction for purposeful and comprehensible information transmission and rapid satisfaction of patients` needs and demands. Based on obtained results, 57-item preliminary scale was created and its content and face validity were checked via qualitative and quantitative opinions of nursing scholars and trainees. Then, to evaluate construct validity using exploratory factor analysis , 440 undergraduate nursing students of Tehran University of Medical Sciences who were in different semesters with at least one clinical rotation were collected via multistage sampling to complete the instruments. Before testing scale reliability, confirmatory factor analysis was employed on another sample of 220 nursing trainees.
  • Results: In content validity, two items were merged into one and nine items with a low content validity ratio were eliminated. In terms of face validity, two items were revised according to the participants` suggestions. Further, seven items were omitted after conducting the pilot study. For exploratory factor analysis, out off 440 students , 427 (97.04%) completed the questionnaire. Five items with poor factor loadings were removed after examining the Kaiser-Meyer-Olkin and Bartlett`s test. Finally, five factors were specified, including "promoting patient participation", "maintaining dignity", "preparedness", "empathic understanding", and "responsiveness", explaining 42.89% of the total variance. Further, the known-groups validity implied that HC score was significantly higher in senior nursing students, compared to other trainees, thereby indicating the construct validity of the instrument. Regarding convergent validity, the positive correlation between the total scores of the developed instrument and another questionnaire (communication skills scale) was very significant, showing that the two scales measured a similar construct of HC among nursing students. In terms of CFA, the values of fit indicators were compared with the standard criteria. The results indicated that all yield indices were acceptable, and the items were congruent with the scale model. The cronbach`s alpha and intraclass correlation coefficient of the scale were 0.83 and 0.82, respectively.
  • Conclusion: Nursing students` health communication questionnaire, which is the first instrument developed based on deductive and inductive findings, was a valid and reliable scale for self-assessment of HC in nursing trainees. Furthermore, nursing scholars can apply this tool to compare nursing students` HC before and after educational interventions.
  • Keywords: Health communication, nursing, patients, self-assessment