Interprofessional collaboration within teams comprised of health and other professionals: a systematic review of measurement tools and their psychometric properties

Background and Purpose: Measuring collaboration within interprofessional teams allows professionals to evaluate their practice, set benchmarks and improve outcomes. In the context of healthcare, most research has focused on teams comprised solely of health professionals, with limited attention given to collaboration between health and other professionals. Given the escalating complexities of healthcare, and the growing need for interprofessional collaborative practice involving team members external to health care, this represents a considerable gap in the literature. Therefore, the purpose of this review was to identify tools that measure collaboration within interprofessional teams comprised of members from health and other disciplines, and evaluate their psychometric properties. This review focused on the area of children’s services, to assist professionals working in this area with their collaborative practice. Methods: A systematic search including nineteen electronic databases was conducted. Eleven articles (describing ten tools) were identified for inclusion and were critically appraised. Results: Overall, it was found that few psychometrically sound tools exist for more diverse professional groups working together. The PINCOM-Q was found to be the most appropriate tool for the context of children’s services, and with the highest critical appraisal score, as reported. Conclusions: Recommendations are made for further development of existing tools before practical implementation. Further research could develop new and innovative tools to accommodate the evolving composition of future interprofessional teams. Introduction Interprofessional collaboration in health care is defined as “the process in which different professional groups work together to positively impact health care”, and also adding to this definition, “...each (profession) making unique contributions to common goals.”1,2 There is a prevalent view that interprofessional collaboration leads to enhancements in health care such as gains in quality of care and patient safety and has positive associations with the satisfaction of patients and staff, as well as improvements in clinical outcomes and greater patient outcomes.2-5 Whilst these definitions and benefits derive from health care, health professionals often need to collaborate with other professionals outside health to deliver services to client groups. A cohesive and holistic approach is often required in the area of children’s services, focussing on the family and community, resulting in the need to tap into a variety of interdisciplinary expertise, from professional areas such as education, health and welfare.6 Since children’s services has been noted by a large number of authors as complex and challenging, our focus has been on the area of children’s services in order to assist professionals working in this area.7-9 An example of such a setting is the South Australian Children’s Centres. Children’s Centres is a state government initiative that provides a variety of services (including education and health), to children and families in a single familiar setting within the community. Thus, Children’s Centres contain a unique team environment where professionals from different backgrounds/disciplines work together, requiring interprofessional Interprofessional Collaboration within Teams Comprised Of Health and Other Professionals: A Systematic Review of Measurement Tools and Their Psychometric Properties 2 © The Internet Journal of Allied Health Sciences and Practice, 2017 collaboration. Team members at these sites may include occupational therapists, speech language pathologists, educators, and welfare staff as well as child care staff members. In health literature, the benefits, need for, and importance of effective collaboration has been documented. Environments with poor collaboration have shown to have decreased levels of patient care and provision of health services.1,10 Based on this evidence, it is important for teams to continually strive towards optimal collaboration. In order to do this, professionals within teams need to be able to reflect on and understand their level of collaboration, and its impact on practice.11 Literature should be used to guide practitioners in developing their collaborative practice. However, most literature is related to health settings, with less known about interprofessional collaboration between diverse professional groups, including health professionals collaborating with those external to health. A self-evaluation tool to measure or describe a team’s interprofessional collaboration would be beneficial for their reflection on and development of their collaborative practice, a strategy supported by authors in this field.6 Prior reviews on collaboration tools have either focussed only on healthcare settings, interprofessional education, or a combination of the two.12-16 Known tools originate mostly from a health care perspective and/or include only health care professionals as team members; examples include the Communication and Teamwork Skills Assessment (CATS), the Observational Teamwork Assessment of Surgery (OTAS) – a speciality specific tool, and the Collaborative Practice Assessment Tool (CPAT) developed by the Office of Interprofessional Education at the Queens University.17-19 In order to assist professionals working in interprofessional teams consisting of a variety of diverse professional backgrounds to critically reflect on their collaboration and consequently work on their team development, it was necessary to conduct a review to find a relevant interprofessional collaboration measurement tool. Given the increased need for interprofessional collaboration due to escalating complexities of current day healthcare – such as staff shortages and the growing demand for services, as well as in addressing the multi-faceted complexities of health problems, this review is intended to address a significant gap in the literature.20,21 METHOD: Data Sources and Search Strategy The protocol for this review was developed, conducted, and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.21The search terms were identified by referring to collaboration literature and were based on personal experience in the field. A scoping search was conducted after which all authors agreed upon the final terms, and an expert librarian vetted the terms to ensure the terms were correct and exhaustive. Because of the inconsistencies of terms within the literature, the search was kept broad and then narrowed down with selection criteria (Appendix 1). Database platforms searched included Ovid, EBSCO, Web of knowledge, Cochrane Library, Informit, and Scopus. Under the guidance of our consultant academic librarian, any database deemed likely to index potentially relevant articles was included to help facilitate adequate capture of the published literature. Nineteen electronic databases were searched (Appendix 2) using key words, and where available, Medical Subject Headings (MeSH). The search strategy, first developed for Medline, was adapted for all other database platforms in order to accommodate their unique search criteria. Searches were conducted between February 23 and March 20, 2014. Selection Criteria and Process Articles were included if they were primary studies which reported on the development processes and psychometric testing of measurement tools for interprofessional collaboration in teams comprising health and other professionals. Health professionals included any profession within the medical or allied health field (for example, nurse, occupational therapist, and speech pathologist) and other professions included anyone from outside this field (for example teacher, child care worker). Tools were included if they measured collaboration via self-evaluation of the team’s collaboration with each other, therefore excluding studies which focus on professionals’ attitudes towards, and views on, theoretical collaboration. Additional inclusion criteria included peer-reviewed articles, publication in English, and publication within the last ten years (2004 to 2014 inclusive) to ensure our review was based on current literature. Reference lists were reviewed to identify any further relevant studies. PRISMA guidelines were followed within the review process (refer to the flow chart in Figure 1). A total of 16,366 articles were identified (Figure 1). Duplicates were removed electronically and double checked manually, and non-peer reviewed articles were excluded. Following this, articles were examined against eligibility criteria on title level by two of the authors independently, then also on abstract level with 1,131 articles. Any discrepancies were resolved by sourcing the article for full text review and discussion. If titles or abstracts provided insufficient detail to determine suitability, they were retained. A total of 80 articles were included for review of the full-text. Four authors were independently involved in the full text review process, ensuring each article Interprofessional Collaboration within Teams Comprised Of Health and Other Professionals: A Systematic Review of Measurement Tools and Their Psychometric Properties 3 © The Internet Journal of Allied Health Sciences and Practice, 2017 was screened by two authors. Articles were excluded if they did not meet the selection criteria as agreed by reviewers. Any debate about inclusion was resolved through discussion and consensus. Figure 1 – Adapted PRISMA Flow Diagram Data Extraction: Data were extracted from the selected articles by the first author and then reviewed by one of the other authors. Information extracted was determined by common themes or areas which the articles reported on as well as the information needed for critical appraisal such as psychometric properties. Critical Appraisal There are limited tools available for critical appraisal of questionnaire development research. Current tools do not include items that considered all aspects of psychometric testing deemed relevant by the authors, such as relevance to the setting, piloting samples, and layout of the questionnaire. Therefore, a purpose-designed critical appraisal tool was developed for use in the current study using firstly the McMaster Critical Review Form (quantitative) – a form used extensively in reviews and which has undergone testing by the McMaster University, and secondly, guiding literature regarding questionnaire design, as well as the use of an example of a questionnaire development study (refer Appendix 3 for the critical appraisal tool).23-25 The critical appraisal tool contained six sub categories including purpose, validity, reliability, external validity, layout, and piloting. Under each category there was a series of criteria accompanied by weighted scoring options. Larger critical appraisal scores were considered to represent greater methodological rigor (i.e. reliability and validity) and relevance for applied settings. In order to capture items relevant to teamwork comprising health and other disciplines in children’s services, the external validity section of the critical appraisal tool was developed with reference to key publications referring to health and non-health professionals in these services.11,23-25 These items were that the setting was not purely health, that the sample had adequate representation of health and other professionals, that the sample worked in a child-based setting, and that team members were employed by different agencies. Four of the authors were involved in developing the critical appraisal tool and thus had a detailed understanding of the scoring process. Two authors independently appraised all included articles. Each article was assigned a score out of 70 points by each author, with averages calculated to enhance methodological rigor. A variance of 15% or more Interprofessional Collaboration within Teams Comprised Of Health and Other Professionals: A Systematic Review of Measurement Tools and Their Psychometric Properties 4 © The Internet Journal of Allied Health Sciences and Practice, 2017 was deemed to warrant further discussion and re-evaluation by the reviewers, disagreements were resolved by discussion and consensus to ensure reviews scores were within less than 15% variance. RESULTS: Characteristics of the Studies Ten measurement tools were described within 11 peer reviewed articles. Two articles discussed the same measurement tool, the PINCOM-Q, using different methods and samples.26-27 The majority of included articles (n=6, 54%) were published within the last five years (i.e. 2009 – 2014) (Table 1).19,27-31 The main areas of practice in which tools were tested varied and included health promotion, geriatric care, child and youth mental health, assistive communication, mental health, and hospital based teams.19,26-34,36 Three of the eleven articles did not detail the composition of interdisciplinary teams. Where reported, health professionals within teams commonly included nurses, social workers, doctor/physicians, psychologists, occupational therapists, speech therapists, physical therapists, dieticians, physiotherapists, pharmacists, and allied health aides (Table 1).28-29,36 Along the spectrum of other professional team members described were those working in the following roles: spiritual provider/chaplain, education/teachers, administration staff, volunteers, driver/porter, managers, child welfare staff, computer technicians, art therapists, social services staff, cleaners, and activity coordinator. The sub-scales of tools included a range of different constructs, with the most common being leadership (n=4), communication (n=3), goals (n=3), role independence (n=3), decision making (n=3), team structures (n=3), conflict (n=3), motivation (n=2), coordination (n=2), client involvement (n=2), organisational aspects (n=2) and reflection (n=2) (Table 2). There were a range of psychometric assessment approaches used across the tools (Table 2) and included face, content, and construct validity, as well as internal consistency. The majority of studies conducted factor analysis on the tools, using either principal component analysis (PCA, n= 5) or exploratory factor analysis (EFA, n= 3), few in addition employed confirmatory factor analysis (CFA, n= 2).19,26,28-31,34-35 Interprofessional Collaboration within Teams Comprised Of Health and Other Professionals: A Systematic Review of Measurement Tools and Their Psychometric Properties 5 © The Internet Journal of Allied Health Sciences and Practice, 2017 Table 1 Characteristics of the Included Studies Tool Author Location Setting Participants Sample Size Theoretical model Internal structure Perception of Interprofessional Collaboration Model Questionnaire (PINCOM-Q)27 Ødegård, A Western Norway Professionals engaged in interprofessional collaboration in relation to children with mental health problems Primary care, specialist services or schools. Including; teachers, special educators, psychologists, social workers, primary nurses, child welfare workers, medical doctors. 134 PINCOM theoretical model26 (Ødegård, 2005) 48 questions 7 point Likert scale Teamwork in Assertive Community Treatment (TACT) Scale32 Wholey, D Zhu, X Knoke, D Shah, P ZellmerBruhn, M Witheridge, T Minnesota USA Mental health rehabilitation Assertive Community Treatment teams. Multidisciplinary but no details of professions. May include professionals from; mental health, substance abuse, supported employment, social services and nursing. Wave 1 287