Development and Psychometric Evaluation of a Catheter Associated Urinary Tract Infection Prevention Knowledge Measurement Scale

Background: Catheter-associated urinary tract infections (CAUTI) present a considerable challenge in healthcare, substantially contributing to avoidable healthcare costs, morbidity, mortality, and antimicrobial drug resistance. Effective CAUTI prevention is influenced by multiple factors, notably healthcare professionals’ infection prevention knowledge level. Therefore, a valid and reliable instrument for assessing this knowledge is essential to identify knowledge gaps and inform training needs. This research aimed to explore the psychometric quality of existing instruments and develop valid and reliable CAUTI prevention measurement items. Methods: The research employed both deductive and inductive approaches to instrument development, guided by the catheter lifecycle model and the COSMIN checklist. Systematic literature and clinical guideline reviews were conducted, followed by two rounds of Delphi surveys and a brainstorming workshop to develop knowledge items. The collaboratively developed item pool was then evaluated through an online survey of healthcare professionals with direct and indirect urinary catheterisation roles. Data were analysed using item analysis, confirmatory and exploratory factor analyses, and latent class analysis. Initial validity was assessed via known-group hypothesis tests. Results: The systematic review confirmed inadequacies in the psychometric quality of existing instruments, making them unsuitable for CAUTI prevention knowledge measurement. The review also affirmed and expanded the catheter lifecycle model. The Delphi rounds, involving n=76 participants from 10 countries and a brainstorming workshop with IPC experts produced a comprehensive item pool. Psychometric analysis of n=270 responses to n=115 items indicated most items had appropriate difficulty index and discrimination index. Factor analyses of 50 promising items indicated a unitary model for CAUTI prevention knowledge measurement. Latent class analysis identified patterns of responses across items describing incorrect practices, revealing variations in CAUTI prevention knowledge across countries, professional groups, years of clinical experience, and clinical specialities. A review of training guidelines evidenced differences in undergraduate training curricula related to CAUTI. Conclusion: This study establishes valid and reliable CAUTI prevention knowledge measurement items. The validation process revealed the importance of standardised measurement instruments in IPC research and practice and highlighted the need for harmonised IPC education, training curricula and clinical guidelines. Additionally, the research established 50 unidimensionally scored items, recommended for future use and further validation.