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2015 HSR&D/QUERI National Conference Abstract

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3071 — Developing and Evaluating the Psychometric Properties of the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI)

LaVela SL, Center of Innovation for Complex Chronic Healthcare (CINCCH); Northwestern University; Locatelli SM, Center of Innovation for Complex Chronic Healthcare (CINCCH); Kostovich C, Center of Innovation for Complex Chronic Healthcare (CINCCH); Loyola University Chicago; Gosch M, Office of Public Health, National Center for Occupational Health and Infection Control;

Objectives:
To develop and evaluate the psychometric properties of an instrument designed to measure the comfort and tolerability of filtering face-piece respirators (FFRs).

Methods:
Items were developed through literature reviews, focus groups with healthcare workers (HCWs), and several iterations of ranking and refining by experts. Psychometric evaluation of the instrument was conducted using Rasch partial credit model analysis.

Results:
The initial 28-item instrument was completed by 12 HCWs, who evaluated item clarity and relevance; an additional 12 HCWs ranked items in order of comfort and tolerability to finalize the instrument for the next step. The final instrument was completed by 165 HCWs from 3 VA facilities, and data were analyzed using Rasch. Items were removed if they 1) violated the assumption of independence, 2) were mis-fitting, or 3) were deemed not relevant. Pivot anchoring was used to specify the threshold defining item difficulty; in our analyses, this was the point that participants moved from possessing none of the trait to some of the trait. Category function analysis demonstrated that all categories progressed monotonically. Principal components analysis demonstrated the existence of three subscales (Discomfort, General Wearing Experience, and Function). Final reliability analyses showed that the scale had moderate to high person reliability and high item reliability. The final instrument contained 21 items.

Implications:
We developed and provided reliability and validity evidence for a 21-item instrument named: Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI). This measure is ideal for assessing comfort and tolerability of current FFRs, as well as for developing the next wave of FFRs.

Impacts:
FFRs are a method of protecting HCWs and patients from airborne particles; however, research has demonstrated that adherence to use of FFRs is poor due to discomfort. Until now, no instrument with evidence supporting its reliability and validity was available to assess discomfort among HCWs using FFRs. Our instrument, the R-COMFI, is a psychometrically sound measure of comfort and tolerability of FFRs, which can be used in and outside of VA as a valid instrument to evaluate respirator prototypes. R-COMFI may help efforts to improve wearing adherence and therefore improve patient and provider safety.