Psychometric properties of the Participation Reasons Scale (PRS ) questionnaire

Introduction

The Bologna Declaration of 1999 initiated the need for reforms in nursing education in Poland, establishing a foundation for enhancing the professional training of nurses and midwives. The field of modern nursing, like other medical professions, continues to evolve in response to ongoing political and economic changes [1].
It is the mission of health care facilities to provide health services of the highest quality. Therefore, they expect, like all of society, the highest quality medical care provided by qualified medical staff who have appropriate medical knowledge, are aware of their role in the therapeutic, diagnostic, and care process, and are motivated to improve the level of quality of care in relation to the patient [2].
This role requires continuous improvement of competencies. Research has shown that healthcare workers need to consistently engage in learning and growth throughout their professional lives [3]. For learning to be successful, the learner’s motivation is essential [4]. A 2015 study conducted by the World Health Organisation demonstrated that nursing education holds global significance. The study revealed that enhanced education through postgraduate continuing professional development equips nurses with greater opportunities to deliver patient care, ensures high-quality services, and fosters further professional growth [5].
Adults are motivated to engage in learning for a variety of reasons. They are more inclined to learn when it enables them to tackle current challenges or when they can recognise the benefits of acquiring new knowledge. Fulfilling internal needs serves as a more powerful motivator for adults than external rewards, although the external rewards still play a role. Factors such as achievement, determination, significance, and enjoyment influence adult motivation [6].
In Poland, numerous psychological tools are available for studying adult motivation; however, there is a notable shortage of questionnaires specifically designed to understand the factors that drive medical staff to pursue ongoing education in their careers. Commonly used scales for assessing motivation include the Work and Family Orientation Scale, the Motivation to Avoid Failure Scale, the Inventory of Preferred Work Styles, the Behavioural Inventory for Measuring Achievement Motivation, the Achievement Motivation Inventory, and the Career Achievement Motivation Scale [7]. In recent years, a questionnaire assessing motivational factors among medical staff has been adapted to Polish conditions. However, this adaptation primarily focuses on motivation to work in the medical profession and commitment to quality improvement [8]. Poland still lacks appropriate tools for examining the factors that motivate individuals to pursue postgraduate education and professional development, particularly among medical professionals, especially nurses.
The aim of this study was to adapt the Participation Reasons Scale (PRS) questionnaire linguistically and culturally to Polish conditions [9]. Additionally, the study aimed to assess the reliability and validity of the PRS questionnaire within a professional group of nurses.

Material and methods

The Polish language version of the questionnaire, which examines the factors motivating nurses’ participation in continuing education, was developed and validated. The Participation Reasons Scale questionnaire, created in 1985 at the University of Illinois at Urbana-Champaign under the guidance of Professor Arden DR Grotelueschen, was utilised for this research [9]. The Polish language version was developed at the Institute of Health Sciences of the Collegium Medicum of Jan Kochanowski University in Kielce. All formalities were completed to secure permission for the use of the original PRS questionnaire.
The English language version of the questionnaire was translated into Polish by 2 independent translators, following international guidelines. The 2 Polish translations were compared to find any discrepancies, and a unified version was produced. A bilingual medical expert reviewed the initial versions of the translations and evaluated them. A version was created that met the condition of semantic consistency for each answer. In the next stage, 2 back translations were created by 2 subsequent independent translators. This process resulted in the development of a Polish version of the questionnaire.
The PRS consists of 30 items reflecting internal and external motivational factors. Their classification was carried out using a 7-point Likert scale, where 1 means “not important” and 7 means “extremely important”. Motivators in PRS are divided into 5 groups:
• factors motivating professional development and improvement,
• factors motivating individuals to achieve professionalism in services,
• factors motivating learning and interacting with colleagues,
• factors related to personal benefits and job security,
• factors motivating professionalism, commitment, and reflection.
The reliability of the original PRS scale was assessed using Cronbach’s a, with values ranging from 0.78 to 0.92 [9].
The random selection of medical facilities for the study was conducted using the R programming tool (The R Project for Statistical Computing). This selection process identified 11 hospitals and 17 primary care facilities. Paper questionnaires were distributed to all departments within the selected hospitals and primary care facilities. The inclusion criterion required participants to have been employed as nurses for a minimum of one year. Participation in the study was voluntary for all nurses.

Participations

The study involved 564 nurses from 28 medical facilities in the Świętokrzyskie voivodeship, including 522 individuals employed in hospitals and 24 individuals working in primary health care units.
The youngest nurse surveyed was 21 years old, and the oldest was 65 years old (M = 42.2, SD = 11.5). They mostly lived in rural areas (n = 295; 52.3%) and towns (n = 210; 37.2%), with fewer residents of cities (n = 59; 10.5%). Most of the surveyed nurses had higher education in nursing: master’s degree (n = 234; 41.5%) or bachelor’s degree (n = 229; 40.6%). This was followed by secondary education (n = 56; 9.9%) and master’s degree in a field other than nursing (n = 43; 7.6%), while 2 people (0.4%) held a doctoral degree.

Data analysis

Firstly, the factor structure of the PRS was examined with confirmatory factor analysis (CFA) using JAMOVI software. Secondly, the reliability of the PRS was analysed, and McDonald’s Ω and Cronbach’s a were calculated. The comparative fit index (CFI) and Tucker-Lewis index (TLI) were used to assess model fit relative to a baseline model in which all variables are uncorrelated and values above 0.95 indicate good fit, while values above 0.90 are considered to indicate acceptable fit. The root-mean-square error of approximation (RMSEA) is also presented. Values less than 0.08 are considered to be acceptable [10].

Results of the psychometric analyses

Factor structure

The fit between the structure of the Polish version and the original PRS was tested with CFA on a group of n = 564 participants. In CFA, we tested 4 different models: 1) a 5-factor model that is consistent with the factor structure proposed by Kinsella, Fray, and Zecchin (2018), and 3 complex models: 2) a hierarchical second-order model with 5 lower-order factors and 2 higher-order factors, 3) a hierarchical third-order-model model with 5 first-order factors, 2 second-order factors, and one third-order factor. Finally, we assessed 4) the bi-factor model with correlated subscale-specific factors. Table 1 summarises the goodness-of-fit indexes for the tested models. The fit indices for the 5-factor structure show that the model is acceptable (RMSEA = 0.079, CFI = 0.932, TLI = 0.908). Also, the result of CFA confirmed that the hierarchical solution, i.e. 2 plus 5 factors, was a good fit to the data (RMSEA = 0.079, CFI = 0.931, TLI = 0.908). The other 2 solutions (bi-factor and hierarchical 1-2-5) also achieved an acceptable fit.
Figures 1-3 present the different models of the PRS.

Internal consistencies

To assess the reliability of the PRS sub-scales in both 3- and 5-factor versions, we computed Cronbach’s a internal consistency coefficient and McDonald’s Ω coefficient. As can be seen in Table 2, both coefficients demonstrated good reliability of the PRS.

External validity

In the next step, we tested the theoretical validity of the Polish version of the PRS. The results of relevance were obtained by correlating the factors of PRS and the Career Achievement Motivation Scale [7] (see Table 3).
The correlation analysis showed that all sub-scales of PRS were positively related to all sub-scales of the Career Achievement Motivation Scale. In the case of Keeping up with the competition, Maintaining self-esteem, and Perfectionism, the strength of correlation with the PRS scales were average. In the case of Embarrassment and fear of judgement, the strength of correlation with the PRS scales was weak.

Discussion

The aim of the research presented in the article was to examine the psychometric properties of the Polish adaptation of the PRS. The analyses conducted included CFA, external validity, and reliability analysis to validate the Polish version of the scale for nurses. The scale proposed by Kinsella et al. consisted of 5 sub-scales [4].
In CFA, we tested 4 alternative factor structures. The CFA analyses showed the best fit of the 5-factor structure and hierarchical second-order model with 5 lower-order factors and 2 higher-order factors. Kinsella et al. suggested 2 main components (internal motivation and external motivation) as higher-order factors. Internal motivation includes 2 scales: Professional improvement and Development and professional service, whereas External motivation includes 3 scales: Collegial learning and interaction, Personal benefits and job security, and Professional commitment and reflection.
In both cases, all the indicators such as CFI, TLI, and RMSEA had values with an acceptable fit. Also, 5 sub-scales revealed satisfactory internal consistency (Cronbach’s a and MacDonalds Ω). We confirmed the criterion-related validity of the PRS. The nurses with higher internal motivation (general and 2 subscales) reported higher achievement motivation. In case of external motivation, also we observed positive correlation with achievement motivation.
Our results are consistent with previous research. Xiang et al. demonstrated that achievement motivation in nurses is positively related to innovative behaviour and is inversely related to the motive to avoid failure [11].
In another study, Lina et al. observed a negative correlation between achievement motivation and procrastination behaviours among nursing students. Nurses with high levels of achievement motivation are more likely to engage in work tasks that they perceive as valuable (e.g. pursuing additional education), which can provide them with a sense of accomplishment and satisfaction. Furthermore, nursing students with high levels of achievement motivation are more likely to experience positive emotions and maintain high expectations for task completion, prompting them to participate in further educational opportunities [12].
The results are comparable to a study carried out in 2016 in Athens and the Peloponnese region using PRS. The study aimed to investigate why nurses participate in professional development programs. Additionally, research conducted in 2020-2021, during the pandemic, aimed not only to identify the motivations that drive nurses to engage in continuous professional development projects but also to explore their perspectives and eagerness to enhance their professional knowledge. The results demonstrated the importance of continuity and informed participation in professional development throughout their careers. Individuals are enabled to feel constantly prepared and respond effectively in the event of a new crisis in healthcare [13, 14].
Continuing education is an ongoing concern for healthcare professionals, who must invest significant effort to enhance their knowledge and skills. Nurses are required to participate in continuous professional development. Consequently, there is a need for tools to assess and evaluate both educational progress and the factors that may influence this process. Understanding the motivational factors and personal attitudes of professional nurses is essential; this is the purpose of the Participation Motives Scale. The results obtained from the analysis of the Participation Motives Scale offer valuable insights that can guide the development of educational programs tailored to the specific needs of healthcare employees. This, in turn, is expected to enhance nursing care, reduce costs, minimise the risk of errors and professional stress, and improve the productivity and quality of healthcare.
The scale of participation motives was utilised to examine the motivations of nurses:
• Greece, Athens, and the Peloponnese region – 475 people examined, year 2016 [13],
• Greece, Athens – 114 people tested in 2021-2022 [14],
• Mexico in 2005 – 305 people were tested [15],
• In the USA in 1995 – 866 people were tested [16],
• In the USA – 443 people were examined from 1998 to 2003 [17],
• USA 1994 [18].

Limitations

As part of the PRS validation process, a study was conducted with Polish nurses working in the Świętokrzyskie voivodeship. The setting in which healthcare services are provided may influence the factors that motivate postgraduate education among this group of professionals.

Conclusions

The Polish adaptation of the Participation Motives Scale adheres to essential guidelines regarding statement coherence and quality. It meets the psychometric requirements for both reliability and validity. This adaptation has been acknowledged for its significance among nurses and can be utilised to assess the motivational factors influencing healthcare workers. Further studies employing PRS adaptation could be conducted in various regions of the country or with different groups of healthcare professionals.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References