| Description |
The purpose of this instrumentation study was to develop a scale to test nurses' attitudes about health beliefs. Experience and knowledge has indicated the imperative need for the integration of transcultural beliefs, values and practices into nursing care and health care systems. Assessing nurses' attitudes about culturally diverse beliefs and practices is the beginning step in a line of research to develop way of increasing the quality of care for the culturally diverse client. The problem statements investigated were: 1) Will the development of a measurement scale give a reliable and valid assessment of nurses' attitudes about health beliefs? 2) Will the development of a behavior component of the attitudes scale give reliable and valid assessment of nurses' compliance with the health practice? 3) Do most nurses' feel that culturally specific practices or requests as expressed by patients are reasonable or unreasonable? 4) Will the nurse generally comply with or aid the patient in carrying out specific cultural beliefs and practices? 5) Do nurses' attitudes about cultural beliefs affect their responses in carrying out specifically appropriate care? And 6) Does age, racial background, education, experience with working with other cultures, or geographic regions influence nurses' attitudes about health beliefs? The problem in assessing nurses' attitudes was measurement. A method was needed that: would be convenient to administer to any number of nurses anywhere in the U.S., would not address a particular cultural group, would require a minimum of time to complete, and would tabulate easily. Standards of scale construction based on psychometric theory were used for the development of this scale. The final standardized measure consisted of self-report, seven step, Likert type summative model scale with agreement/disagreement (reasonable/unreasonable) anchors. The steps in the development of this scale were described as well as the statistical procedures used to test reliability, validity, and analyze hypotheses derived from the problem statements. The pretest that was developed consisted of 67 questions of health beliefs and practices that were stated as requests. The results of the reliability testing of the pretest were alpha = .097 for the attitude scale and alpha = .95 fro the behavior scale. The test was revised and named with Utah test on Attitudes about Health Beliefs (UTAHB). A population of 300 nurses and nursing students completed the test. The majority of these nurses was Caucasian, female, single, and had worked with people of different cultural backgrounds. The reliability coefficient alpha was correlated for the UTAHB. The alpha was .96 for the attitudes scale and alpha = .89 for the behavior scale. Descriptive statistics for item scales is as follows: total scales mean score for attitude = 131.539 and standard deviation = 35.812. Total mean score for behavior = 140.670 and standard deviation = 24.066. The factor analysis procedures of principal components with iteration: PA2 were used to test construct validity of the scales. The first factor of the attitudes scale accounted for 83.4% if the variance, but the first two factors of the behavior scale accounted for 61.5% and 10.2% respectively. Therefore, the construct of attitude was strong, but behavior not as well defined. Other constructs or dimensions of behavior were involved. A value of response was applied to the item mean scores of the scales. The results revealed that the population of nurses tested felt that diverse cultural beliefs were only slightly reasonable, i.e., a slightly positive response (attitude scale item mean score = 4.384). The 10 items with the highest factor loading from the varimax rotated factor matrix were tested for reliability. The behavior factor loading of the same 10 items also tested. The reliability coefficient alpha for the attitude scale was .93 (scale means = 36.000 and S.D. = 14.471). However, the behavior scale alpha was .57. Therefore, this behavior scale cannot be used as a reliable test of nurses' compliance with a specific health practice. However, the 10-item attitude scale, remained Z-TAUB, is a reliable and valid test of nurses' attitudes about health beliefs. Variable of age, education, race, experience of working with people of other cultures, and geographic region were analyzed using appropriate statistical procedures. A statistically significant finding was the relationships of age and attitude (Pearson Correlation Coefficient, r = .1547, p , .005). A t-test that was done between groups of younger nurses (under thirty) and older nurses (thirty or over) revealed significant probability that the older nurses have more positive attitudes about health beliefs (t = 2.67, p < .004). Spearman Correlation Coefficient procedure results revealed significant finding in the relationship between degree of education and attitude (rho = .2623, p < .001). A t-test of the mean scores between that group of nurses without a B.S. degree and those nurses with B.S. degree or higher was also significant (t = 3.38, p < .001). Therefore, the probability is that the attitude response will be more positive with a greater degree of education. Determining nurses' attitudes about health beliefs is a necessary beginning step toward the integration of culturally diverse beliefs and practices into health care settings. This is the only tool available that is not culturally specific and is tested to be both reliable and valid. Administrators, educators, and health care planners may find the test useful in developing programs for increasing the quality of care for clients, increasing nurses' satisfaction in caring for people of diverse cultures, and in setting guidelines for increasing the knowledge base of nurses about various health beliefs and practices. Also, the research contributes to the growing body of nursing knowledge and transcultural nursing care. Increasing this knowledge base is imperative for improving the quality of care for people of diverse cultures. |
