ArticleSAGE open medicine2026
Development and validation of a psychometric tool for assessing the readiness and feasibility of CRE screening in LMICs: A cross-sectional instrument validation study.
Article in SAGE open medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background & Objectives: Carbapenem-resistant Enterobacterales (CRE) pose a critical threat in Intensive Care Units (ICUs) within low- and middle-income countries (LMICs), with prevalence exceeding 20% and mortality reaching 50%. Despite high clinical demand, routine screening remains unstandardized in Vietnam due to resource constraints and a lack of validated tools. This study aimed to develop and validate a psychometric instrument to evaluate healthcare workers' (HCWs) perspectives across three domains: barriers, feasibility and readiness. Methods: A cross-sectional validation study was conducted using total population census sampling (n=97, total front-line staff) across three hospitals in Vietnam (Viet Tiep, Kien Thuy, and Thuy Nguyen). Following expert panel review (S-CVI/Avg = 0.89) and a 10.3% pilot test (n=10), construct validity and reliability were evaluated via Exploratory and Confirmatory Factor Analysis (EFA/CFA). Group differences were analyzed using Fisher's Exact and Chi-square tests. Results: The barriers subscale was excluded due to low internal consistency (alpha < 0.60), yielding a refined 16-item, two-factor instrument (6.1:1 observation-to-item ratio). The final tool demonstrated excellent reliability (alpha: 0.84-0.89). CFA confirmed a robust model fit for the Feasibility and Readiness structure [GFI/CFI = 0.95; RMSEA = 0.062]. HCWs reported high Readiness but moderate Feasibility. Significant occupational divergences emerged: 88.9% of nurses viewed sampling as simple (Item R4) compared to only 45.8% of laboratory technicians (p = 0.003). Furthermore, an experience-perception paradox was identified (p < 0.05); mid-career staff (5-10 years) reported the lowest feasibility scores (50.0% high score) compared to junior and senior cohorts. Conclusion: The psychometric validation resulted in a methodologically sound 16-item tool tailored for LMICs. The divergence between clinical readiness and laboratory feasibility highlights critical implementation bottlenecks. Sustainable transition to routine CRE surveillance requires resource-optimized targeted workflows to reduce frontline workloads, alongside peer-led governance that leverages senior expertise to mitigate mid-career burnout.
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