SAGE open medicine · 2026
Development and validation of a psychometric tool for assessing the readiness and feasibility of CRE screening in LMICs: A cross-sectional instrument validation study.
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The Ngo Anh, Huyen Nguyen Thi Thu, Thanh Nguyen Duc, Thanh Tran Chi, Lien Tran Thi
Аннотация
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.
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.