Psychometric Properties of the Management of Aggression and Violence Attitude Scale in Hong Kong’s Emergency Care Setting.
Introduction: A safe and therapeutic environment in health care settings is imperative for staff to deliver high quality and effective care. Emergency unit is one of the most high-risk areas for patient violence. The Management of Aggression and Violence Attitude Scale’s (MAVAS) is the only instrument designed to measure the perceived causes and attitudes towards management strategies of patient violence in mental health care settings. Therefore, this study was to test the MAVAS’s validity and reliability in Emergency unit.
Methods: The Scale- and Item-Content Validity Index (CVI) of the MAVAS were rated by 5-experts’ panel members in terms of the relevance of each item of the MAVAS on a 4-point Likert scale. Scale-level content validity was calculated by averaging the item-level CVIs (averaging method) and proportion the items for which there was universal agreement of relevance among experts (universal agreement method). A convenience sample of 123 nurses working in 4 public Emergency Units in Hong Kong was recruited. The construct validity was tested using exploratory factor analysis and the reliability was assessed by Cronbach’s alpha and test-retest reliability.
Results: The Scale- Content Validity Index was 97.0% and the Item- Content Validity Indexes ranged from 80.0% to 100.0%. Exploratory factor analysis indicated 4-factors solution and explaining 43.4% of the total variance. These four factors rename as “Importance of communication with patients”, “Perceived effectiveness of interventions”, “Pitfalls of interventions” and “Perceived need for intervention”. Its’ internal consistency was satisfactory (Cronbach’s alphas = 0.40 – 0.77) across the 4 subscales and test-retest reliability over 4-week interval was satisfactory (Pearson’s coefficient = 0.85).
Conclusion and clinical implication: The findings of this study indicated MAVAS with good content validity and test-retest reliability in assessing both nurses and patients’ views on violence behaviour and managing strategies in Emergency units, and provide information in developing effective strategies and training programs in management of violence. However, a lack of theoretical support to the four-factor structure and an overall low total variance of the factor solutions to explain the construct. Further refinement and validation of the scale are recommended before it is widely used in Emergency units.
Dr Wai Kit Wong
Clinical Associate, The Hong Kong Polytechnic University.