Psychometric Properties of the Mandarin Version of the Quality Improvement Self-Efficacy Inventory Among the Nurses: A Methodological Study.

Background: Quality improvement is crucial for improving healthcare systems and providing high-quality, safe care for patients. Accurate assessment of nurses' quality improvement knowledge and skills is necessary to integrate quality improvement into nursing practice. The Quality Improvement Self-Efficacy Inventory measures nurses' knowledge and skills in quality improvement. Objectives: To translate the Quality Improvement Self-Efficacy Inventory into Mandarin and evaluate its psychometric properties among nurses. Design: A Methodological Study. Setting: At a tertiary hospital in Tianjin, China, between January and April 2023. Participants: A total of 436 nurses participated in the psychometric evaluation, and 9 nurses participated in the cognitive interviews. Methods: The Quality Improvement Self-Efficacy Inventory was translated into Mandarin using Brislin's translation model. Item analysis was conducted using extreme group, correlation coefficient, corrected item-total correlation and Cronbach's alpha coefficient methods. Both exploratory and confirmatory factor analyses were employed to determine the factor structure and evaluate the proposed model. A likelihood ratio test and power analysis were combined to test hypotheses regarding the model fit. Structural, convergent and discriminant validity were assessed. Reliability was evaluated using internal consistency and test-retest reliability. Results: The Mandarin-Quality Improvement Self-Efficacy Inventory consists of 10 items, all exhibiting sufficient homogeneous and good discrimination abilities (coefficient of variance = 0.233-0.306; critical ratio = 17.943-25.348; corrected item-total correlation = 0.769-0.877). Exploratory factor analysis revealed a new two-factor structure, with a total variation of 74%. Confirmatory factor analysis indicated good model fit indices for the new two-factor and original four-factor models. The new two-factor structure and original four-factor structure were considered valid based on the results from the likelihood ratio test and power analysis. The composite reliability and average variance extracted indicate good convergent and discriminant validity. Internal consistency (Cronbach's alpha coefficient = 0.947) and test-retest reliability (intraclass correlation coefficient = 0.807) of the Mandarin-Quality Improvement Self-Efficacy Inventory were excellent. Conclusions: The Mandarin-Quality Improvement Self-Efficacy Inventory, encompassing both the new two-factor structure version (Mandarin-Quality Improvement Self-Efficacy Inventory-2) and the original four-factor structure version (Mandarin-Quality Improvement Self-Efficacy Inventory-4), proved to be a reliable, effective, stable and relatively concise measurement instrument. The Mandarin-Quality Improvement Self-Efficacy Inventory-2 can serve as a practical instrument to assess Chinese nurses' quality improvement knowledge and skills. The Mandarin-Quality Improvement Self-Efficacy Inventory-4 can be used to investigate cross-cultural measurement invariance in future studies. Two recommendations were proposed as a methodological reference for factor structure research in the development, translation and psychometric evaluation of measurement instruments.