Development and psychometric testing of role-efficacy evaluation tool for nurses in the primary care setting

Year Submitted: 2025
Published Date: 29 January 2026

Tags: Education Research, Education Analytics, Training ＆ Education

About this Content

Aims

The aim is to develop and conduct psychometric testing of a role-efficacy tool for evaluating nurses' confidence and performance in the primary care setting

Background

Healthcare is transitioning to community-based preventive models centred on enhanced primary care. This positions nurses as patients' primary contact for acute and chronic care, health education, and disease prevention. Primary care effectiveness depends on nurses' confidence and competence, termed 'Role-Efficacy, which bridges training and real-world performance. Unlike specialised settings, primary care demands broad
knowledge spanning paediatrics, geriatrics, chronic care, women's health, and mental health. Welsh's (2014) Nursing Care Self-Efficacy Scale was modified to address primary care nursing's unique challenges and strengths.

Methods

This study was conducted in two phases. Firstly, content validity was established through rigorous qualitative expert panel review, prioritize iterative feedback and consensus on item clarity and relevance to primary care. Then, a quantitative phase assessed scales factor structure and reliability. Sample size determination followed the established 10:1 participant-to-item ratio for factor analysis, yielding a minimum sample of 120
participants for the 12-item instrument. Results were analyzed using SPSS Version 21, to determine the tools dimensionality, sampling adequacy, internal consistency and construct coherence.

Results

The processs effectiveness is confirmed by the 12-item tools strong unidimensional factor structure and exceptional reliability. Cronbach alpha (0.90) indicated excellent internal consistency (refer to Table 1). Kaiser-Meyer-Olkin (KMO) value of 0.922, reflects good sampling adequacy. Barletts Test of Sphericity was significant (2=1584.6, df=66, p0.001), confirming data suitability for factor analysis and indicating correlation between items were sufficiently large (refer to Table 2). The principal component analysis (PCA) showed a single-factor solution that explained 79.4% of total variance. All 12-items demonstrated strong factor loading (0.78-0.94) and communalities (0.60-0.89), indicating excellent construct alignment (refer Table 3). Internal consistency was excellent (inter-item correlation=0.334), which is a significant strength of this tool.
This combination of superb psychometric properties have provided overwhelming evidence that the 12-item tool is highly reliable and valid measure of a single, cohesive construct.

Conclusion

This study demonstrates the tools strong psychometric properties. It is shown to be reliable in evaluating nurses confidence and role-efficacy in the primary care setting. The tool has potential to enhance nursing education and nurses professional development by augmenting existing clinical education programs, subsequently resulting in quality care delivery. The next crucial step is to confirm this factor structure in a new sample using confirmatory factor analysis.

Lessons Learnt

The factor analysis confirms a unidimensional structure, with all 12 items converging on health-centred orientation as intended. However, the exceptionally high internal consistency (0.90) may indicate item redundancy, suggesting some items represent semantic variations rather than capturing construct breadth (Tavakol & Dennick, 2011). Sample size of 94 participants, whilst meeting the minimum 10:1 ratio, is relatively modest for robust factor identification. The homogeneous expert panel may have introduced systematic bias, potentially limiting diverse perspectives in content validation. Additionally, uniformly strong factor loadings (0.78-0.94) and high communalities, though statistically sound, suggest susceptibility to response biases including social desirability and acquiescence bias (Furr & Bacharach, 2014). The consistently high item performance indicates potential ceiling effects in operational use, where respondents may cluster at elevated endpoints, compromising
discriminative capacity between varying efficacy levels. These findings necessitate replication with larger, heterogeneous samples to establish cross-validation and psychometric stability. Future research should consider item refinement to enhance discriminative validity whilst maintaining theoretical coherence, and implement strategies to mitigate response bias.

Additional Information

Silver award for SHBC Best Poster Award (Health Professions Education)

Keywords

workplace learning, nursing education, primary healthcare, competency assessment, clinical induction

Innovators' Details

Connect with this contributor!

Cindy lee ching siang - cindy.cs.lee@nhghealth.com.sg

lu yen ling - yen.ling.lu@nhghealth.com.sg

Project Attachment

BP-HPE-02 poster for submmission.pdf