Development and psychometric testing of a scale for the assessment of the quality of developmental care in neonatal intensive care units in Iran.

INTRODUCTION Developmental care provided to infants hospitalized at neonatal intensive care units (NICU) help weaken environmental stressors and reduce infant morbidity rates. Assessments are the first step to improving the quality of any type of care. Therefore, this study was conducted to design and assess the psychometric features of a scale designed for measuring quality of developmental care in the NICU in Iran. METHODS This study was conducted from December 2014 through September 2015 in Tehran, Iran. The present mixed-methods sequential exploratory (quantitative-qualitative) study used the Delphi method to design an initial questionnaire through a review of the literature and by using the input of experts. The validity of the questionnaire was ensured by assessing then validity of its content (qualitative-quantitative), face (qualitative-quantitative), and construct (exploratory factor analysis with 500 NICU personnel from 34 hospitals in Tehran), and its reliability was ensured by assessing its internal consistency (using Cronbach's alpha) and by assessing its stability through the test-retest method. RESULTS The qualitative stage of the study resulted in a 93-item questionnaire with eight domains. After performing the content and face analyses, a factor analysis was performed on 90 items of the questionnaire, yielding a 76-item questionnaire with five domains, including "sleep, pain and stress management," "routine care," "the family," "management," and "sensory care," which explained 62.5% of the variance. The reliability of the questionnaire was confirmed with a Cronbach's alpha of 0.9 and its stability was confirmed by an Intraclass Correlation Coefficient (ICC) of 0.93. CONCLUSION The questionnaire developed for the assessment of developmental care in the NICU covered all of the dimensions of this type of care, and it is a valid and reliable tool for assessing and improving developmental care in the NICU.