Original article
Two new scales for integrative medical education and research: confidence in providing calm, compassionate care scale (CCCS) and self-efficacy in providing non-drug therapies (SEND) to relieve common symptoms

https://doi.org/10.1016/j.eujim.2014.10.010Get rights and content

Abstract

Introduction

Training in integrative medicine aims to promote compassionate, patient-centered care, including non-pharmaceutical therapies to reduce common symptoms. Although specific competencies have been identified, few tools are available to assess clinician confidence in providing integrative care. We evaluated two instruments to address this gap.

Methods

We assessed face validity with focus groups. We assessed internal reliability (Cronbach's alpha) and convergent validity in a survey of 213 health professionals, correlating the new instruments to each other and to standard measures of mindfulness, compassion, empathy, training, and practice.

Results

The two measures each had 10 items with scores ranging from 0 to 100, and had good face validity. Cronbach's alpha was 0.87 for the calm, compassionate care scale (CCCS) and 0.95 for self-efficacy in providing non-drug therapies to relieve common symptoms (SEND). Scores for CCCS were significantly correlated with measures of mindfulness, compassion, empathic concern, and perspective-taking as well as training and practice (p < 0.05 for each). Scores for SEND were similarly correlated with CCCS, compassion, empathic concern, and perspective-taking as well as training and practice (p < 0.05 for each).

Conclusion

These two new tools, CCCS and SEND, have good psychometric properties and may be useful to educators and researchers evaluating clinicians’ confidence in providing calm, compassionate care and self-efficacy in using non-drug therapies to relieve common symptoms.

Introduction

Based on the growing use of complementary and alternative medical (CAM) therapies by the American public, a growing number of academic health centers have developed training programs in integrative medicine [1], [2], [3]. Specific competencies for physicians practicing integrative medicine have been identified [4], [5], [6], [7].

Ultimately, the goal of training is to improve the quality of care and patients’ lives, but the vast majority of medical education focuses on intermediate steps thought to contribute to these outcomes (acquisition of knowledge and confidence). The most commonly measured outcomes are changes in knowledge as these are readily and reliably assessed with easily scored multiple choice questions. A few programs have also measured changes in attitudes [8], but these often reflect attitudes about complementary therapies themselves and the value of the clinician–patient relationship, e.g., the CAM Health Belief Questionnaire and the Integrative Medicine Attitudes Questionnaire [9], [10], [11], [12].

Self-efficacy is the strength of one's belief in one's own ability to complete tasks and achieve goals; it is highly predictive of trainees’ motivation and learning as well as the ability to initiate, persist in, and succeed with a task [13]. Bandura's social cognitive theory posits that self-efficacy develops from external experiences and observations, and suggests that those with high self-efficacy are more likely to view a difficult task as something to be mastered rather than something to be avoided [14]. Theoretically, four major factors affect self-efficacy: a) experience of mastery (success); b) seeing someone else succeed (modeling); c) encouragement (social persuasion); and d) interpreting physiologic responses to stress (such as higher heart rate, sweating, and fatigue) as normal and unrelated to ability [15]. Self-efficacy is strongly linked to behavior change [16], [17]; it is also linked to mood and social support among family caregivers [18]. Self-efficacy includes an affirmation of a capacity and the strength of that belief, whereas self-confidence is a more general concept that might include, for example, confidence that one will fail at a task. Self-efficacy is a critical factor in taking the step from new knowledge about integrative medicine to offering integrative care in practice. However, few training programs have measured self-efficacy among diverse health professionals using integrative, complementary, or non-drug therapies to relieve common symptoms [19], [20].

Although self-report scales may over- or under-estimate actual performance, they are often used because in general, self-reported self-efficacy and self-reported behavior have significant correlations with actual behaviors [21], [22], [23], [24], and they are less expensive to administer and score than observational methods or focus groups. In the field of mind-body health, self-report instruments are widely used to measure stress [25], mindfulness [26], [27], [28], empathy [29], [30], and self-compassion [31].

Integrative care requires at least two related aspects of self-efficacy: a) clinicians’ ability to provide calm, compassionate, relationship-based care and b) their confidence in using non-drug therapies to relieve common symptoms and achieve patients’ unique health goals. To assess the first of these, when teaching a medical student elective on Therapeutic and Healing Touch, one of us (KK) developed a questionnaire to measure changes in students’ sense of self-confidence in providing calm, compassionate, comforting care [32]. Although this scale showed expected improvements from before to after the course, it has not been formally evaluated for its psychometric characteristics.

Interprofessional training programs to educate health professionals to use an integrative approach to address patients’ symptoms may benefit from another instrument to assess clinicians’ sense of self-efficacy. Accordingly, we developed a self-efficacy scale focusing on confidence in using non-drug therapies to help relieve common symptoms: pain, anxiety, nausea, insomnia, coping, stress (PANICS), and fatigue. Though similar to the first instrument, the second focused more explicitly on self-efficacy in relieving symptoms and less on the clinician's internal state of calm and compassion.

Before using these new tools to evaluate training programs, we wished to assess their psychometric properties. Specifically, our three goals were: 1. describe their face validity and internal reliability by discussing them in focus groups and measuring Cronbach's alpha; 2. describe their convergent validity by examining correlations between scores on these measures with established measures; and 3. describe the relationship between scores on these measures and training and experience in mind-body therapies.

Section snippets

Face validity

Two of us (KK and GG) provided workshops in April and May, 2014, on outcome measures in integrative medicine for interprofessional groups of researchers, students, clinicians, and teachers both at our institution in the Midwestern USA and at the International Research Congress on Integrative Medicine and Health in Miami, FL. Both workshop discussions included these measures and over a dozen other outcome measures for multiple domains of health. Discussion topics included conceptual foundations,

Results

The focus groups were attended by a range of participants including students, faculty, and staff in medicine, nursing, public health, dietetics, and social work. Participants found the scales easy to read, score, and interpret, and suggested no additions or deletions to the two instruments.

Discussion

This is the first study to describe two new scales to measure clinicians’ confidence and self-efficacy in providing integrative care: 1) confidence in providing calm, compassionate care and 2) self-efficacy in providing non-drug therapies to relieve common symptoms. In this sample, both scales showed good face validity, internal reliability, and meaningful correlations with other measures, as well as training and practice experience. Not surprisingly, since both scales measured the closely

Conclusions

Two new scales, a) self-confidence in providing calm, compassionate care (calm, compassionate care scale, CCCS) and b) self-efficacy in providing non-drug therapies to relieve common symptoms (SEND scale) have good face validity, are easily scored, and have good convergent validity with standard measures of related constructs as well as with training and experience. Additional research is needed to confirm their correlation with actual performance in diverse practitioners and settings, but they

Conflicts of interest statement

The authors declare no actual or potential conflicts of interest. This work has not been published previously, is not under consideration for publication elsewhere, and, if accepted, will not be published elsewhere in the same form without the written consent of the copyright holder.

Authors’ roles

All research was done by the authors.

KK conceived of the study, designed the questionnaires, collected the data, conducted the final analysis of the data, and wrote and edited the drafts of the manuscript.

GG co-led the focus groups, conducted the initial analysis and interpreted the data, and assisted in editing and revising the manuscript

JM recruited participants, interpreted the data, and assisted in drafting and revising the manuscript.

All approve the final version of the submitted

Funding source

There was no extramural funding for this project. The participant gifts were supported by a grant from the OSU College of Medicine Alumni Fund.

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    This article belongs to the Special Issue on Diagnostic Techniques and Outcome Measures for Integrated Health.

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