Item distribution, internal consistency and structural validity of the German language Person-centred climate questionnaire - Staff version (PCQ-G-S): a cross-sectional study

Item distribution, internal consistency and structural validity of the German language Person-centred climate questionnaire - Staff version (PCQ-G-S): a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Item distribution, internal consistency and structural validity of the German language Person-centred climate questionnaire - Staff version (PCQ-G-S): a cross-sectional study Denise WILFLING, Ralph MÖHLER, Almuth BERG, Jonas Dörner, Natascha BARTMANN, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2705323/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Jan, 2024 Read the published version in BMC Geriatrics → Version 1 posted 9 You are reading this latest preprint version Abstract Background Person-centredness is considered as best practice for people with dementia. A frequently used instrument to assess person-centredness of a care environment is the Person-centred Climate Questionnaire (PCQ). The questionnaire comprises of 14 items with the three subscales a climate of safety, a climate of everydayness and a climate of community. Aim The aim of the study is to describe the translation process of the English language Person-centred Climate Questionnaire (Staff version, Patient version, Family version) into German language (PCQ-G) and to evaluate the first psychometric properties of the German language Person-centred Climate Questionnaire– Staff version (PCQ-G-S). Methods We conducted a cross-sectional study. The three versions of the 14-item English PCQ were translated into German language (PCQ-G) based on the recommendations for cross-cultural adaption of measures. Item distribution, internal consistency and structural validity of the questionnaire were assessed among nursing home staff (PCQ-G-S). Item distribution was calculated using descriptive statistics. Structural validity was tested using principal component analysis (PCA), and internal consistency was assessed for the resulting subscales using Cronbach’s alpha. Data collection took place from May to September 2021. Results A total sample of 120 nurses was included in the data analysis. Nine out of 14 items of the PCQ-G-S demonstrated acceptable item difficulty, while five times showed a ceiling effect. The PCA analysis demonstrated a strong structural validity for a three-factor solution explaining 68.6% of the total variance. The three subscales demonstrated a strong internal consistency with Cronbach’s alpha scores of 0.8 for each of the subscales. Conclusion The analysis of the 14-item German version (PCQ-G-S) showed first evidence for a strong internal consistency and structural validity for evaluating staff perceptions of the person-centredness in German nursing homes. Based on this, further investigations for scale validity of the PCQ-G versions should be carried out. person-centeredness dementia validity instrument psychometric properties nursing homes Figures Figure 1 Background In Germany, 1.8 million people live with dementia [ 1 ] and one third of them live in a long-term care facility [ 2 ]. Worldwide, around 57.4 million people are affected, and this number will increase 152.8 million in 2050 [ 3 ]. Dementia is a clinical syndrome, characterised by cognitive, neuropsychiatric, and functional symptoms. Psychological and psychiatric changes finally lead to restrictions in daily life [ 4 ]. The care of people with dementia is challenging for all people involved, i.e. the person living dementia, family members and health professionals. Such challenges arise through disease-related behaviour that challenges, like aggressive behaviour, agitation, sleep disturbances, wandering and restlessness [ 5 ]. In order to meet the complex care needs of people with dementia, it is necessary to provide care based on patients’ individual needs [ 6 ]. Person-centredness is considered as best practice for people with dementia and essential for high-quality long-term care for older people [ 7 ]. Person-centred care (PCC) was developed by Tom Kitwood, based on Roger’s social-psychological theory of personhood [ 8 ]. It is based on an established therapeutically relationship between the respective person and the health professional and means respect for the person, the individual's right to self-determination, mutual respect and understanding [ 9 ]. To provide PCC, a supportive care environment is needed. This includes, for example, creating a PCC culture, implementing PCC educational programs for staff or designing health care facilities promoting PCC [ 10 ]. For this reason, some organisational conditions are necessary, e.g., PCC skills training for health professionals and creating a person-centred culture and environment. It is essential, that the organisation (e.g., the nursing home) creates conditions to enable person-centredness [ 11 ]. It becomes clear, that the implementation of PCC is very complex and this change process is time consuming [ 10 ]. In recent years, PCC has become a key indicator of quality in health care. In the course of this, numerous measurement instruments have been developed that capture person-centredness or related constructs [ 12 ]. An early developed, theoretically based and in research frequently used instrument is the Person-centred Climate Questionnaire (PCQ) [ 13 – 15 ]. The PCQ was developed based on a theoretical concept regarding supportive care settings [ 16 ], literature and a content validity analysis [ 13 ]. The original Swedish 14-item version for patients (PCQ-P) was developed and later on supplemented by another version for health care staff (PCQ-S) and family members (PCQ-F). The items of these versions are identical, they are answered using a six-point scale (1 = No, I disagree completely to 6 = Yes, I agree completely). Different versions only differ in their perspective. The instrument items operationalise the following subscales: a climate of safety, a climate of everydayness and a climate of community. All items are sum scored and scores can range from 14 (a climate not very person-centred) to 84 (a climate very person-centred) [ 17 ]. After the PCQ-S was translated into English [ 18 ], numerous further translations and psychometric evaluation studies were carried out for the Norwegian PCQ-S [ 19 ], the Chinese PCQ-S [ 20 ], and the Slovenian PCQ-S [ 21 ]. A German version of the instrument is not available so far. Therefore, we translated all three versions of the questionnaire into German language within the project “MoNoPol-Sleep - Multi-modal, non-pharmacological intervention to avoid sleep disturbances in nursing home residents with dementia” [ 22 ] and piloted. We report the translation of the English language PCQ and the evaluation of the item distribution, internal consistency and structural validity of the translated German version based on staff ratings (PCQ-G-S) in a nursing home context. Methods Study design A cross-sectional study was conducted to determine the item distribution, internal consistency and structural validity of the PCQ-G-S. The investigation of the structural validity was based on an exploratory factor analysis (principal component analysis). This methodical approach was based on the COSMIN standards for test theory studies [ 23 ]. The Ethical Committee of the German Society of Nursing Science approved the study protocol for all study centres (no. 20–016). Setting and population Participants were nurses and nursing assistants of the nursing homes enrolled in the MoNoPol-Sleep study (trial registration: ISRCTN36015309) during baseline assessment. Nursing homes were recruited by three regions in Germany (Lübeck: Northern Germany; Halle (Saale): Eastern Germany; Witten: Western Germany). Each region recruited eight nursing homes, first using already existing contacts. Additionally, nursing homes were recruited by means of nursing home registers, information folders, announcements in relevant nursing journals in Germany and the study website ( www.monopol-sleep.de ). Nursing homes were contacted via phone or email and verbally informed about the aim and content of the study. Nursing homes with at least 50 residents were eligible for inclusion. Nurses and nursing assistants were included if they were working at least three night shifts in the last three months and were contracted for at least part-time (half-a-day). Inclusion criteria and recruitment have been described in detail elsewhere [ 22 ]. Questionnaire translation All three versions of the PCQ have been translated into German language (PCQ-G) based on recommendations for cross-cultural adaption of measures [ 24 ] in the prparatory phase of the MoNoPol-sleep study [ 22 ]. The translation process comprised five stages each of which was documented in a comprehensible manner. The first stage was the forward translation, performing two independent translations from English to German by two different persons. Both translators were native German speakers with excellent English language skills. Next to the translation, it was possible to enter comments on difficulties in wording or other uncertainties. The second stage contained the synthesis of the translations. Translation results were discussed, inconsistencies were reviewed, and a final translation was agreed. Stage three comprised the back translation. The final version from stage two was back translated by two persons independently. The back-translators had English as mother tongue and excellent skills in German language. Both have been involved with translation issues in research before. Also, in this stage it was possible to enter comments on difficulties in wording or other uncertainties. In stage four an expert committee meeting was carried out. All four translators and the coordinator of the translation process (first author of this paper) were involved in this meeting. During the meeting, all versions of the questionnaire were reviewed, and discrepancies discussed until a consensus was reached. This stage was for validity checking to make sure that the translated version of the questionnaire was reflecting the same item content as the original version. After the fourth stage, the whole documentation of the translation process was sent to the author of the original PCQ, and we received permission for the accuracy of the translation. The final version of the PCQ-G is displayed in Table S1 . In a final step, based on the available knowledge from the literature and the translation process, a user manual for the German language PCQ was created that is freely available to potential users[ 25 ]. Data collection procedures The PCQ-G staff version (PCQ-G-S) was part of a 7-page questionnaire measuring nurses’ attitudes regarding the implementation of change processes, person-centredness in care and inter-professional cooperation, as part of the process evaluation in the MoNoPol-Sleep study [ 22 ]. Beside the PCQ-G-S, the questionnaire consisted demographic variables. The questionnaire was handed out by the supervising nurse. Participating nurses and nursing assistants received information about the aim and content of the study at the first page of the questionnaire. Furthermore, they received information that informed consent was provided by filling in the questionnaire. Questionnaires were returned by postal mail or personally collected by one researcher in the nursing home. In general, the application of the PCQ-G-S was based on the recommendations by the authors of the original instrument as documented in the German user manual [ 25 ]. Data analysis Descriptive statistics were calculated for demographic characteristics and item distribution of the PCQ-G-S items. For the item distribution, the cut-off values were set at 3.2, based on the recommendations of Bortz & Döring (2006)[ 26 ]. In a second step, a factor analysis was performed based on a principal component analysis (PCA). First of all, the prerequisites for conducting a PCA were tested [ 27 ]. Measure of sample adequacy was performed with the Kaiser-Meyer-Olkin (KMO) criterion. The KMO should be ≥ 0.5. Additionally, the Bartlett’s test for sphericity was conducted. The common significance level of < 0.05 was used for verification of a non-existent item correlation assumed before conducted the component analysis [ 27 ]. After, the factor analysis was performed, based on a PCA using an orthogonal rotational procedure (varimax). The factor extraction followed the criteria: (1) eigenvalues > 1 for a factor (Kaiser-Guttman criterion), and (2) scree plot. Missing values were pairwise excluded. The internal consistency of the scale was evaluated by calculating Cronbach’s α coefficients [ 28 ]. Data were entered into SPSS v. 22 [ 29 ]. Plausibility checks were carried out during data entry. To ensure data quality, all data were checked by a second person. Results Characteristics of the sample A total sample of 120 nurses was included in data analysis. The mean age of participants was 40.7 (SD 11.7), with an average working experience in elderly care of 14.6 years (SD 10.1). Participants’ demographic characteristics are displayed in Table 1 . Table 1 Characteristics of nurses and nursing assistants (Total N = 120) Nurses and nursing assistants Age, years, mean (SD) 40.7 (± 11.7) Contract hours, number (%) Full time 46 (50.5) Part time 45 (49.5) Years working in elderly care, mean (SD) 14.6 (± 10.1) Healthcare training, number (%) Elderly care 57 (50) Health care nursing 20 (17.5) Paediatric nursing 2 (1.8) Other* 35 (30.7) Missing values were pairwise excluded. * e.g. nursing assistant. Item distribution The descriptive investigation of the PCQ-G-S showed a balanced distribution (Table 2 ). The response option “yes, I agree” was used most often whereas the response option “no, I disagree completely” was used least frequently. Distributions of the other response options also varied. Based on the mean values, five items (item 4, item 11, item 12, item 13, item 14) showed a ceiling effect (> 0.8). Missing value analyses demonstrated very low percentages of missing values in general. Only item 3, 5 and 9 of the PCQ-G-S showed a percentage of missing values of 1.7% and items 2, 4, 7 and 11 a percentage of missing values of 0.8%. The reason for this was nurses’ and nursing assistants’ denial to rate. Table 2 Item distribution per item and total score – German version of the PCQ-G-S (N = 120) Subscales and Items Response options A climate of safety No, I disagree completely No, I disagree No, I partly disagree Yes, I partly agree Yes, I agree Yes, I agree completely Missing values Item difficulty Mean 1. A place where I feel welcome 0 2 6 25 58 29 0 (0) 0.77 4.9 (0.9) 2. A place where I feel acknowledged as a person 0 1 9 22 52 35 1 (0.8) 0.78 4.9 (0.9) 3. A place where I feel I can be myself 1 7 8 28 44 30 2 (1.7) 0.72 4.7 (1.2) 4. A place where the patients are in safe hands a 0 5 2 23 44 45 1 (0.8) 0.88 5.0 (1.0) 5. A place where the staff use a language that the patients can understand 0 1 9 26 43 39 2 (1.7) 0.77 4.9 (1.0) A climate of everydayness 6. A place which feels homely even though it is in an institution 1 8 11 37 41 22 0 (0) 0.69 4.5 (1.1) 7. A place where there is something nice to look at 2 4 18 42 42 11 1 (0.8) 0.64 4.3 (1.0) 8. A place where it is quiet and peaceful 0 6 19 29 53 13 0 (0) 0.68 4.4 (1.0) 9. A place where it is possible to get unpleasant thoughts out of your head 3 11 23 36 33 12 2 (1.7) 0.60 4.0 (1.2) 10. A place which is neat and clean 2 4 17 27 45 25 0 (0) 0.71 4.5 (1.2) A climate of community 11. A place where it is easy for the patients to keep in contact with their loved ones a 0 2 4 25 40 48 1 (0.8) 0.81 5.1 (0.9) 12. A place where it is easy for the patients to receive visitors a 0 3 1 17 47 52 0 (0) 0.81 5.2 (0.9) 13. A place where it is easy for the patients to talk to the staff a 0 0 6 15 37 62 0 (0) 0.84 5.3 (0.9) 14. A place where the patients have someone to talk to if they so wish a 0 3 6 18 42 51 0 (0) 0.82 5.1 (1.0) Total Score 66.6 (10.4) a Item difficulty: Items with floor effects ( 0.8) in boldt. Data are the mean (SD) or number (%). Missing values were pairwise excluded. Structural validity PCA was used to evaluate scale dimensionality and structural validity since Bartlett’s test of sphericity yielded X 2 = 1048,911, was significant (P 1 criterion was used to decide on the number of components to extract and a component loading cut-off of 0.5 was used to conclude if an item loaded on a specific component. Based on a first exploratory PCA, three factors with a Kaiser’s eigenvalue > 1 were determined. The scree plot illustrates the result (see Fig. 1 ). Thus, the analysis resulted in a 3-component solution, where all 14 items could be assigned with 68.6% of the total variance. The results of the analysis including factor loads of each item are presented in Table 3 . Table 3 Structural validity results of the PCQ-G-S based on the total sample (N = 120) No. PCQ-G Staff version Factor 1 A climate of safety Factor 2 A climate of everydayness Factor 3 A climate of community 1. A place where I feel welcome 0.804 2. A place where I feel acknowledged as a person 0.793 3. A place where I feel I can be myself 0.810 4. A place where the patients are in safe hands 0.502 (0.473) 5. A place where the staff use a language that the patients can understand 0.521 6. A place which feels homely even though it is in an institution (0.470) 0.498 7. A place where there is something nice to look at 0.715 8. A place where it is quiet and peaceful 0.707 9. A place where it is possible to get unpleasant thoughts out of your head (0.426) 0.725 10. A place which is neat and clean 0.805 11. A place where it is easy for the patients to keep in contact with their loved ones (0.472) 0.673 12. A place where it is easy for the patients to receive visitors (0.409) 0.779 13. A place where it is easy for the patients to talk to the staff 0.748 14. A place where the patients have someone to talk to if they so wish 0.442 0.788 Cumulative explained variance (%) 51,60 61,07 68,88% Cronbach’s alpha 0,845 0,877 0,867 Kaiser-Meyer-Olkin (KMO) criterion 0,863 Bartlett’s test of sphericity P 0.40 are presented; factor loadings in parentheses imply that a specific item loads to more than one factor and that the factor loading to the other factor is higher. Missing values were pairwise excluded. Internal consistency The reliability analysis using Cronbach’s alpha coefficient of the 14-item PCQ-G-S showed a strong internal consistency based on Cronbach’s alpha scores for each of the three subscales: “a climate of safety”: alpha = 0.845, “a climate of everydayness”: alpha = 0.877 and “a climate of community”: alpha = 0.867 (Table 3 ). Discussion The investigation of the item distribution of the PCQ-G-S demonstrated a balanced distribution of the six response options. Nine out of 14 items showed an acceptable item difficulty, but five items (item 4, 11, 12, 13, 14) showed a ceiling effect (> 0.8). However, it should not be generally indicated to cancel these items of the PCQ-G-S. Instead, it must be considered that this is an exploratory study and further evaluation of the scale validity are needed including a lager sample. Since the item distribution has not yet been examined in other studies, no comparison of the results is possible. Further research is justified needed here, because the identified ceiling effects affect all items of the subscale climate of community and 36% of all PCQ-G-S items. The results for structural validity show that the original factor structure of the PCQ-G is robust. Similar to the original Swedish version [ 13 ], the 14 items of the PCQ-G-S could be assigned to the three subscales a climate of safety, a climate of everydayness, and a climate of community. The same instrument structure was found for the Swedish (Edvardsson et al., 2009), Norwegian [ 19 ], Slovenian [ 21 ], and Chinese [ 20 ] versions. Thus, Cai et al. (2017) found a stable three-factor solution explaining 73.3% of the total variance for the Chinese version, Bergland et al. (2012) reported the three-factor solution that explained nearly 68% of the variance in the data for the Norwegian version and Vrbnjak et al. (2017) found a three-factor solution that explained 71.22% of the variance in the data of the Slovenian version. The analysis of the original Swedish version resulted in a three-factor solution explaining 60.0% of the total variance [ 17 ]. Therefore, scale dimensionality could be seen as confirmed. Psychometric evaluation of the English PCQ-S resulted in a four-component rotated solution (a climate of safety, a climate of everydayness, a climate of community and a climate of comprehensibility) explaining 71,8% of the total variance [ 18 ]. The fourth subscale “a climate of comprehensibility” included four items, relating to the extent staff provided understandable information to patients, patients felt safe, staff were easy to talk to and where patients also had others to talk about their experiences [ 18 ]. In the original version, these four items belonged to the subscales a climate of safety and climate of community [ 17 ]. Edvardsson et al. (2010) explained the deviation from the original version with three subscales by the fact that the study evaluating the original Swedish version included a sample working on an elective surgery ward with a short length of stay. Because of limited possibility for interactions between staff and patients, the sample in this study may felt prioritising that patients understand implemented medical procedures instead of focusing on proving PCC [ 18 ]. Based on a Rasch analysis of the English PCQ-S, residual correlations greater than 0.29 than the mean correlation in the matrix were found. This indicated some evidence of local dependence between two items (item 13 “a place where it is easy for patients to talk to staff”; item 14 “a place where patients have someone to talk”) of subscale three. Since removing or combining item 13 and 14 caused other difficulties, according to Wilberforce et al. (2019) the two items were kept. The 14-item PCQ-G-S consists of three subscales. It showed strong internal consistency for each of the three subscales a climate of safety (alpha = 0.845), a climate of everydayness (alpha = 0.877), and a climate of community (alpha = 0.867). These results are in line with the results of previous psychometric evaluations. Also, the Swedish [ 17 ], English [ 18 ], Norwegian [ 19 ], Slovenian [ 21 ] and Chinese [ 20 ] version of the PCQ-S showed internal consistency scores of at least 0.77 for each subscale. Sample sizes in previous studies were comparable to our study. Only in the study of Cai et al. (2017) included more participants (n = 1237). Strengths And Limitations A major strength of this study is that a German version of the PCQ is available and additionally, a user manual for the questionnaire (PCQ-G). Thus, an internationally proven questionnaire for the assessment of person-centredness is available for research and practice in the German-speaking countries. Moreover, this is the first study evaluating the psychometric properties of the staff version of the PCQ-G. This study has some limitations. First, only the staff version of the PCQ-G was evaluated. This means that an evaluation of the patient and family versions is pending and recommended. Second, given the relatively small number of nurses and nursing assistants included in the study, results must be interpreted with caution and have to be proven in a larger study with a confirmatory approach for the PCQ-G-S. Third, the PCQ-G-S was only applied in nursing homes participating in the MoNoPol-Sleep study [ 22 ]. Further psychometric validation in different settings is needed to ensure generalisability and to help for further comparisons in different contexts. Moreover, the development of cut-off scores for interpretation purposes is a future goal for the PCQ-G versions. Conclusions The aim of this study was the translation and examination of first psychometric properties of the PCQ-G-S in a nursing home context. The results of this study indicate first evidence for the internal consistency and structural validity for the use of the PCQ-G-S to assess the degree of person-centeredness. Based on these results the questionnaire should be used in further studies to measure person-centredness in nursing homes. Therefore, the item distribution, reliability and especially the construct validity of the PCQ-G-S should be further investigated. Declarations Ethics approval and consent to participate: Ethical approval was received from the ethics committee of the German Society of Nursing Science (no. 20–016). This study was performed in accordance with the relevant regulations and guidelines. All participants provided informed consent. Consent of publication: Not applicable Availability of data and materials: Data is available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study was funded by the German Federal Ministry of Education and Research (BMBF grants 01GL1802A-C). Author’s contribution Study Concept and Design: DW, RM, AB, JD, NB, TK, GM, MH, SK, MND Data Analysis and Interpretation: DW, RM, AB, JD, NB, TK, GM, MH, SK, MND Drafting the Manuscript: DW, RM, AB, JD, NB, TK, GM, MH, SK, MND Acknowledgements: We would like to thank all staff nurses, nursing assistants and nursing home managers who participated in the study. References DAlzG. Informationsblatt 1. Die Häufigkeit von Demenzerkrankungen. 2020 14.12.2021]; Available from: https://www.deutsche-alzheimer.de/fileadmin/Alz/pdf/factsheets/infoblatt1_haeufigkeit_demenzerkrankungen_dalzg.pdf . DAlzG. 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Supplementary Files supplementmaterial.docx Cite Share Download PDF Status: Published Journal Publication published 12 Jan, 2024 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Major revision 30 Aug, 2023 Reviews received at journal 20 Aug, 2023 Reviewers agreed at journal 16 Aug, 2023 Reviewers agreed at journal 12 Aug, 2023 Reviewers invited by journal 11 Aug, 2023 Editor assigned by journal 09 Aug, 2023 Editor invited by journal 24 Mar, 2023 Submission checks completed at journal 24 Mar, 2023 First submitted to journal 17 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2705323","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":186176159,"identity":"6d194d8b-7fff-4b6b-9fce-b3a2f0272e6a","order_by":0,"name":"Denise WILFLING","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIie3PMUvEMBTA8VcCvSXWNbd4XyFSOJfDz5Ig2MWuh8N5Fg7iou5+i46OKYV2eddb3bRLJwfd7ha10Z64xOommD8PkiE/kgC4XH8x/T4A/sCrtQDYAwo+mOknhHBDwh+RjwxpF5n0kaC8yrL1KchrQkDXt2dRimXzANOJlQyxEjlFkMoQiWWcLi8POFTHVsLvTnjuKYgV2dVaqiJOV9Rnnsrt5P6RZ5sXQ8wtqoj4atC05PWbWyjXO8knmQm+TMYt0VYyxPZhtGDnHdH7N4hjJqojKwlKDJ/Xs0k4ulh49UbNRwFGDXuaHlpJF9tuul+LPvCl+S/Oulwu13/pDYCVW2IrHw6/AAAAAElFTkSuQmCC","orcid":"","institution":"University of Lübeck","correspondingAuthor":true,"prefix":"","firstName":"Denise","middleName":"","lastName":"WILFLING","suffix":""},{"id":186176162,"identity":"bf0922b3-ba26-4cde-b6ae-0e0ef1382c88","order_by":1,"name":"Ralph MÖHLER","email":"","orcid":"","institution":"University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Ralph","middleName":"","lastName":"MÖHLER","suffix":""},{"id":186176165,"identity":"83864ff8-7c2c-47cd-852e-0446607fb76f","order_by":2,"name":"Almuth BERG","email":"","orcid":"","institution":"Martin Luther University Halle- Wittenberg","correspondingAuthor":false,"prefix":"","firstName":"Almuth","middleName":"","lastName":"BERG","suffix":""},{"id":186176167,"identity":"b73a2229-ab86-4f47-baa9-bee485bfacc0","order_by":3,"name":"Jonas Dörner","email":"","orcid":"","institution":"Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)","correspondingAuthor":false,"prefix":"","firstName":"Jonas","middleName":"","lastName":"Dörner","suffix":""},{"id":186176170,"identity":"892e5818-c817-4e37-8997-e7ede699b3ac","order_by":4,"name":"Natascha BARTMANN","email":"","orcid":"","institution":"University of Lübeck","correspondingAuthor":false,"prefix":"","firstName":"Natascha","middleName":"","lastName":"BARTMANN","suffix":""},{"id":186176173,"identity":"e2726a29-3a14-4e99-9e3a-b72b7edccecf","order_by":5,"name":"Thomas KLATT","email":"","orcid":"","institution":"Martin Luther University Halle- Wittenberg","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"KLATT","suffix":""},{"id":186176175,"identity":"71175afd-1542-4fb2-8282-969fd637f4e4","order_by":6,"name":"Gabriele MEYER","email":"","orcid":"","institution":"Martin Luther University Halle- Wittenberg","correspondingAuthor":false,"prefix":"","firstName":"Gabriele","middleName":"","lastName":"MEYER","suffix":""},{"id":186176177,"identity":"9ea20392-6e5a-4659-820d-585b1c49ae8b","order_by":7,"name":"Margareta HALEK","email":"","orcid":"","institution":"Witten/Herdecke University","correspondingAuthor":false,"prefix":"","firstName":"Margareta","middleName":"","lastName":"HALEK","suffix":""},{"id":186176179,"identity":"2da1a4b4-4505-4b5b-802c-597a39e89155","order_by":8,"name":"Sascha KÖPKE","email":"","orcid":"","institution":"University of Cologne, University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Sascha","middleName":"","lastName":"KÖPKE","suffix":""},{"id":186176181,"identity":"8cf52a9b-3ec1-47de-ab19-1c4680f3e1d5","order_by":9,"name":"Martin N. DICHTER","email":"","orcid":"","institution":"University of Cologne, University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"N.","lastName":"DICHTER","suffix":""}],"badges":[],"createdAt":"2023-03-17 14:44:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2705323/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2705323/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-023-04528-3","type":"published","date":"2024-01-12T15:02:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":34866566,"identity":"e79311cc-44aa-4e81-b588-ad7634f26384","added_by":"auto","created_at":"2023-03-27 14:30:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":15838,"visible":true,"origin":"","legend":"\u003cp\u003ePrincipal component analysis – scree plot (Total N = 120)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2705323/v1/21bb1c1afb5a2f08dae0955c.png"},{"id":49628675,"identity":"1c43c407-e44c-48af-af27-01fdb5f963f8","added_by":"auto","created_at":"2024-01-15 15:08:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":510569,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2705323/v1/486376e1-7cbb-42b7-9685-2f0f63e9af4f.pdf"},{"id":34866567,"identity":"0c0f0a40-0291-4c9d-9363-68780aee9801","added_by":"auto","created_at":"2023-03-27 14:30:51","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13853,"visible":true,"origin":"","legend":"","description":"","filename":"supplementmaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-2705323/v1/c485379763d43531b8e956b6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Item distribution, internal consistency and structural validity of the German language Person-centred climate questionnaire - Staff version (PCQ-G-S): a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eIn Germany, 1.8\u0026nbsp;million people live with dementia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and one third of them live in a long-term care facility [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Worldwide, around 57.4\u0026nbsp;million people are affected, and this number will increase 152.8\u0026nbsp;million in 2050 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Dementia is a clinical syndrome, characterised by cognitive, neuropsychiatric, and functional symptoms. Psychological and psychiatric changes finally lead to restrictions in daily life [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The care of people with dementia is challenging for all people involved, i.e. the person living dementia, family members and health professionals. Such challenges arise through disease-related behaviour that challenges, like aggressive behaviour, agitation, sleep disturbances, wandering and restlessness [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn order to meet the complex care needs of people with dementia, it is necessary to provide care based on patients\u0026rsquo; individual needs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Person-centredness is considered as best practice for people with dementia and essential for high-quality long-term care for older people [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Person-centred care (PCC) was developed by Tom Kitwood, based on Roger\u0026rsquo;s social-psychological theory of personhood [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It is based on an established therapeutically relationship between the respective person and the health professional and means respect for the person, the individual's right to self-determination, mutual respect and understanding [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. To provide PCC, a supportive care environment is needed. This includes, for example, creating a PCC culture, implementing PCC educational programs for staff or designing health care facilities promoting PCC [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. For this reason, some organisational conditions are necessary, e.g., PCC skills training for health professionals and creating a person-centred culture and environment. It is essential, that the organisation (e.g., the nursing home) creates conditions to enable person-centredness [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It becomes clear, that the implementation of PCC is very complex and this change process is time consuming [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In recent years, PCC has become a key indicator of quality in health care. In the course of this, numerous measurement instruments have been developed that capture person-centredness or related constructs [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn early developed, theoretically based and in research frequently used instrument is the Person-centred Climate Questionnaire (PCQ) [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The PCQ was developed based on a theoretical concept regarding supportive care settings [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], literature and a content validity analysis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The original Swedish 14-item version for patients (PCQ-P) was developed and later on supplemented by another version for health care staff (PCQ-S) and family members (PCQ-F). The items of these versions are identical, they are answered using a six-point scale (1\u0026thinsp;=\u0026thinsp;No, I disagree completely to 6\u0026thinsp;=\u0026thinsp;Yes, I agree completely). Different versions only differ in their perspective. The instrument items operationalise the following subscales: a climate of safety, a climate of everydayness and a climate of community. All items are sum scored and scores can range from 14 (a climate not very person-centred) to 84 (a climate very person-centred) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. After the PCQ-S was translated into English [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], numerous further translations and psychometric evaluation studies were carried out for the Norwegian PCQ-S [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], the Chinese PCQ-S [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and the Slovenian PCQ-S [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A German version of the instrument is not available so far. Therefore, we translated all three versions of the questionnaire into German language within the project \u0026ldquo;MoNoPol-Sleep - Multi-modal, non-pharmacological intervention to avoid sleep disturbances in nursing home residents with dementia\u0026rdquo; [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and piloted. We report the translation of the English language PCQ and the evaluation of the item distribution, internal consistency and structural validity of the translated German version based on staff ratings (PCQ-G-S) in a nursing home context.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted to determine the item distribution, internal consistency and structural validity of the PCQ-G-S. The investigation of the structural validity was based on an exploratory factor analysis (principal component analysis). This methodical approach was based on the COSMIN standards for test theory studies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The Ethical Committee of the German Society of Nursing Science approved the study protocol for all study centres (no. 20\u0026ndash;016).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSetting and population\u003c/h2\u003e \u003cp\u003eParticipants were nurses and nursing assistants of the nursing homes enrolled in the MoNoPol-Sleep study (trial registration: ISRCTN36015309) during baseline assessment. Nursing homes were recruited by three regions in Germany (L\u0026uuml;beck: Northern Germany; Halle (Saale): Eastern Germany; Witten: Western Germany). Each region recruited eight nursing homes, first using already existing contacts. Additionally, nursing homes were recruited by means of nursing home registers, information folders, announcements in relevant nursing journals in Germany and the study website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.monopol-sleep.de\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.monopol-sleep.de\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Nursing homes were contacted via phone or email and verbally informed about the aim and content of the study. Nursing homes with at least 50 residents were eligible for inclusion. Nurses and nursing assistants were included if they were working at least three night shifts in the last three months and were contracted for at least part-time (half-a-day). Inclusion criteria and recruitment have been described in detail elsewhere [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire translation\u003c/h2\u003e \u003cp\u003eAll three versions of the PCQ have been translated into German language (PCQ-G) based on recommendations for cross-cultural adaption of measures [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] in the prparatory phase of the MoNoPol-sleep study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The translation process comprised five stages each of which was documented in a comprehensible manner. The first stage was the forward translation, performing two independent translations from English to German by two different persons. Both translators were native German speakers with excellent English language skills. Next to the translation, it was possible to enter comments on difficulties in wording or other uncertainties. The second stage contained the synthesis of the translations. Translation results were discussed, inconsistencies were reviewed, and a final translation was agreed. Stage three comprised the back translation. The final version from stage two was back translated by two persons independently. The back-translators had English as mother tongue and excellent skills in German language. Both have been involved with translation issues in research before. Also, in this stage it was possible to enter comments on difficulties in wording or other uncertainties. In stage four an expert committee meeting was carried out. All four translators and the coordinator of the translation process (first author of this paper) were involved in this meeting. During the meeting, all versions of the questionnaire were reviewed, and discrepancies discussed until a consensus was reached. This stage was for validity checking to make sure that the translated version of the questionnaire was reflecting the same item content as the original version. After the fourth stage, the whole documentation of the translation process was sent to the author of the original PCQ, and we received permission for the accuracy of the translation. The final version of the PCQ-G is displayed in Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e. In a final step, based on the available knowledge from the literature and the translation process, a user manual for the German language PCQ was created that is freely available to potential users[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedures\u003c/h2\u003e \u003cp\u003eThe PCQ-G staff version (PCQ-G-S) was part of a 7-page questionnaire measuring nurses\u0026rsquo; attitudes regarding the implementation of change processes, person-centredness in care and inter-professional cooperation, as part of the process evaluation in the MoNoPol-Sleep study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Beside the PCQ-G-S, the questionnaire consisted demographic variables. The questionnaire was handed out by the supervising nurse. Participating nurses and nursing assistants received information about the aim and content of the study at the first page of the questionnaire. Furthermore, they received information that informed consent was provided by filling in the questionnaire. Questionnaires were returned by postal mail or personally collected by one researcher in the nursing home. In general, the application of the PCQ-G-S was based on the recommendations by the authors of the original instrument as documented in the German user manual [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were calculated for demographic characteristics and item distribution of the PCQ-G-S items. For the item distribution, the cut-off values were set at \u0026lt;\u0026thinsp;0.8 and \u0026gt;\u0026thinsp;3.2, based on the recommendations of Bortz \u0026amp; D\u0026ouml;ring (2006)[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a second step, a factor analysis was performed based on a principal component analysis (PCA). First of all, the prerequisites for conducting a PCA were tested [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Measure of sample adequacy was performed with the Kaiser-Meyer-Olkin (KMO) criterion. The KMO should be \u0026ge;\u0026thinsp;0.5. Additionally, the Bartlett\u0026rsquo;s test for sphericity was conducted. The common significance level of \u0026lt;\u0026thinsp;0.05 was used for verification of a non-existent item correlation assumed before conducted the component analysis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. After, the factor analysis was performed, based on a PCA using an orthogonal rotational procedure (varimax). The factor extraction followed the criteria: (1) eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1 for a factor (Kaiser-Guttman criterion), and (2) scree plot. Missing values were pairwise excluded. The internal consistency of the scale was evaluated by calculating Cronbach\u0026rsquo;s α coefficients [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Data were entered into SPSS v. 22 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Plausibility checks were carried out during data entry. To ensure data quality, all data were checked by a second person.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the sample\u003c/h2\u003e \u003cp\u003eA total sample of 120 nurses was included in data analysis. The mean age of participants was 40.7 (SD 11.7), with an average working experience in elderly care of 14.6 years (SD 10.1). Participants\u0026rsquo; demographic characteristics are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of nurses and nursing assistants (Total N\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNurses and nursing assistants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge, years, mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.7 (\u0026plusmn;\u0026thinsp;11.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eContract hours, number (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFull time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (50.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePart time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (49.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eYears working in elderly care, mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.6 (\u0026plusmn;\u0026thinsp;10.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eHealthcare training, number (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eElderly care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHealth care nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (17.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePaediatric nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOther*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (30.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eMissing values were pairwise excluded.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* e.g. nursing assistant.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eItem distribution\u003c/h2\u003e \u003cp\u003eThe descriptive investigation of the PCQ-G-S showed a balanced distribution (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The response option \u0026ldquo;yes, I agree\u0026rdquo; was used most often whereas the response option \u0026ldquo;no, I disagree completely\u0026rdquo; was used least frequently. Distributions of the other response options also varied. Based on the mean values, five items (item 4, item 11, item 12, item 13, item 14) showed a ceiling effect (\u0026gt;\u0026thinsp;0.8). Missing value analyses demonstrated very low percentages of missing values in general. Only item 3, 5 and 9 of the PCQ-G-S showed a percentage of missing values of 1.7% and items 2, 4, 7 and 11 a percentage of missing values of 0.8%. The reason for this was nurses\u0026rsquo; and nursing assistants\u0026rsquo; denial to rate.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eItem distribution per item and total score \u0026ndash; German version of the PCQ-G-S (N\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSubscales and Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e \u003cp\u003eResponse options\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eA climate of safety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo, I disagree completely\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo, I disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo, I partly disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes, I partly agree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes, I agree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes, I agree completely\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMissing values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eItem difficulty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where I feel welcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.9 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where I feel acknowledged as a person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.9 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where I feel I can be myself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.7 (1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where the patients are in safe hands\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.88\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.0 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where the staff use a language that the patients can understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.9 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA climate of everydayness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place which feels homely even though it is in an institution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.5 (1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where there is something nice to look at\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.3 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where it is quiet and peaceful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.4 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where it is possible to get unpleasant thoughts out of your head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.0 (1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place which is neat and clean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.5 (1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA climate of community\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where it is easy for the patients to keep in contact with their loved ones\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where it is easy for the patients to receive visitors\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where it is easy for the patients to talk to the staff\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.84\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.3 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA place where the patients have someone to talk to if they so wish\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.82\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e66.6 (10.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003e\u003csup\u003ea\u003c/sup\u003e Item difficulty: Items with floor effects (\u0026lt;\u0026thinsp;0.2) or ceiling effects (\u0026gt;\u0026thinsp;0.8) in boldt. Data are the mean (SD) or number (%). Missing values were pairwise excluded.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStructural validity\u003c/h2\u003e \u003cp\u003ePCA was used to evaluate scale dimensionality and structural validity since Bartlett\u0026rsquo;s test of sphericity yielded X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1048,911, was significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and Kaiser-Meyer-Olkin was satisfactory (0.863). This indicates the appropriateness of the factor analysis of the data. Kaiser\u0026rsquo;s eigenvalue\u0026thinsp;\u0026gt;\u0026thinsp;1 criterion was used to decide on the number of components to extract and a component loading cut-off of 0.5 was used to conclude if an item loaded on a specific component. Based on a first exploratory PCA, three factors with a Kaiser\u0026rsquo;s eigenvalue\u0026thinsp;\u0026gt;\u0026thinsp;1 were determined. The scree plot illustrates the result (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Thus, the analysis resulted in a 3-component solution, where all 14 items could be assigned with 68.6% of the total variance. The results of the analysis including factor loads of each item are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStructural validity results of the PCQ-G-S based on the total sample (N\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCQ-G Staff version\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003cp\u003eA climate of safety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003cp\u003eA climate of everydayness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFactor 3\u003c/p\u003e \u003cp\u003eA climate of community\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where I feel welcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where I feel acknowledged as a person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where I feel I can be myself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where the patients are in safe hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.473)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where the staff use a language that the patients can understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place which feels homely even though it is in an institution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.470)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where there is something nice to look at\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where it is quiet and peaceful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where it is possible to get unpleasant thoughts out of your head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.426)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place which is neat and clean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where it is easy for the patients to keep in contact with their loved ones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.472)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where it is easy for the patients to receive visitors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.409)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where it is easy for the patients to talk to the staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA place where the patients have someone to talk to if they so wish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCumulative explained variance (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51,60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61,07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68,88%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCronbach\u0026rsquo;s alpha\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,867\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eKaiser-Meyer-Olkin (KMO) criterion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBartlett\u0026rsquo;s test\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eof sphericity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0,005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eOnly factor loadings\u0026thinsp;\u0026gt;\u0026thinsp;0.40 are presented; factor loadings in parentheses imply that a specific item loads to more than one factor and that the factor loading to the other factor is higher.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eMissing values were pairwise excluded.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eInternal consistency\u003c/h2\u003e \u003cp\u003eThe reliability analysis using Cronbach\u0026rsquo;s alpha coefficient of the 14-item PCQ-G-S showed a strong internal consistency based on Cronbach\u0026rsquo;s alpha scores for each of the three subscales: \u0026ldquo;a climate of safety\u0026rdquo;: alpha\u0026thinsp;=\u0026thinsp;0.845, \u0026ldquo;a climate of everydayness\u0026rdquo;: alpha\u0026thinsp;=\u0026thinsp;0.877 and \u0026ldquo;a climate of community\u0026rdquo;: alpha\u0026thinsp;=\u0026thinsp;0.867 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe investigation of the item distribution of the PCQ-G-S demonstrated a balanced distribution of the six response options. Nine out of 14 items showed an acceptable item difficulty, but five items (item 4, 11, 12, 13, 14) showed a ceiling effect (\u0026gt;\u0026thinsp;0.8). However, it should not be generally indicated to cancel these items of the PCQ-G-S. Instead, it must be considered that this is an exploratory study and further evaluation of the scale validity are needed including a lager sample. Since the item distribution has not yet been examined in other studies, no comparison of the results is possible. Further research is justified needed here, because the identified ceiling effects affect all items of the subscale climate of community and 36% of all PCQ-G-S items.\u003c/p\u003e \u003cp\u003eThe results for structural validity show that the original factor structure of the PCQ-G is robust. Similar to the original Swedish version [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], the 14 items of the PCQ-G-S could be assigned to the three subscales a climate of safety, a climate of everydayness, and a climate of community. The same instrument structure was found for the Swedish (Edvardsson et al., 2009), Norwegian [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Slovenian [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and Chinese [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] versions. Thus, Cai et al. (2017) found a stable three-factor solution explaining 73.3% of the total variance for the Chinese version, Bergland et al. (2012) reported the three-factor solution that explained nearly 68% of the variance in the data for the Norwegian version and Vrbnjak et al. (2017) found a three-factor solution that explained 71.22% of the variance in the data of the Slovenian version. The analysis of the original Swedish version resulted in a three-factor solution explaining 60.0% of the total variance [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, scale dimensionality could be seen as confirmed.\u003c/p\u003e \u003cp\u003ePsychometric evaluation of the English PCQ-S resulted in a four-component rotated solution (a climate of safety, a climate of everydayness, a climate of community and a climate of comprehensibility) explaining 71,8% of the total variance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The fourth subscale \u0026ldquo;a climate of comprehensibility\u0026rdquo; included four items, relating to the extent staff provided understandable information to patients, patients felt safe, staff were easy to talk to and where patients also had others to talk about their experiences [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In the original version, these four items belonged to the subscales a climate of safety and climate of community [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Edvardsson et al. (2010) explained the deviation from the original version with three subscales by the fact that the study evaluating the original Swedish version included a sample working on an elective surgery ward with a short length of stay. Because of limited possibility for interactions between staff and patients, the sample in this study may felt prioritising that patients understand implemented medical procedures instead of focusing on proving PCC [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on a Rasch analysis of the English PCQ-S, residual correlations greater than 0.29 than the mean correlation in the matrix were found. This indicated some evidence of local dependence between two items (item 13 \u0026ldquo;a place where it is easy for patients to talk to staff\u0026rdquo;; item 14 \u0026ldquo;a place where patients have someone to talk\u0026rdquo;) of subscale three. Since removing or combining item 13 and 14 caused other difficulties, according to Wilberforce et al. (2019) the two items were kept.\u003c/p\u003e \u003cp\u003eThe 14-item PCQ-G-S consists of three subscales. It showed strong internal consistency for each of the three subscales a climate of safety (alpha\u0026thinsp;=\u0026thinsp;0.845), a climate of everydayness (alpha\u0026thinsp;=\u0026thinsp;0.877), and a climate of community (alpha\u0026thinsp;=\u0026thinsp;0.867). These results are in line with the results of previous psychometric evaluations. Also, the Swedish [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], English [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], Norwegian [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Slovenian [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Chinese [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] version of the PCQ-S showed internal consistency scores of at least 0.77 for each subscale. Sample sizes in previous studies were comparable to our study. Only in the study of Cai et al. (2017) included more participants (n\u0026thinsp;=\u0026thinsp;1237).\u003c/p\u003e\n\u003ch3\u003eStrengths And Limitations\u003c/h3\u003e\n\u003cp\u003eA major strength of this study is that a German version of the PCQ is available and additionally, a user manual for the questionnaire (PCQ-G). Thus, an internationally proven questionnaire for the assessment of person-centredness is available for research and practice in the German-speaking countries. Moreover, this is the first study evaluating the psychometric properties of the staff version of the PCQ-G.\u003c/p\u003e \u003cp\u003eThis study has some limitations. First, only the staff version of the PCQ-G was evaluated. This means that an evaluation of the patient and family versions is pending and recommended. Second, given the relatively small number of nurses and nursing assistants included in the study, results must be interpreted with caution and have to be proven in a larger study with a confirmatory approach for the PCQ-G-S. Third, the PCQ-G-S was only applied in nursing homes participating in the MoNoPol-Sleep study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Further psychometric validation in different settings is needed to ensure generalisability and to help for further comparisons in different contexts. Moreover, the development of cut-off scores for interpretation purposes is a future goal for the PCQ-G versions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe aim of this study was the translation and examination of first psychometric properties of the PCQ-G-S in a nursing home context. The results of this study indicate first evidence for the internal consistency and structural validity for the use of the PCQ-G-S to assess the degree of person-centeredness. Based on these results the questionnaire should be used in further studies to measure person-centredness in nursing homes. Therefore, the item distribution, reliability and especially the construct validity of the PCQ-G-S should be further investigated.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical approval was received from the ethics committee of the German Society of Nursing Science (no. 20\u0026ndash;016).\u0026nbsp;This study was performed in accordance with the relevant regulations and guidelines. All participants provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was funded by the German Federal Ministry of Education and Research (BMBF grants 01GL1802A-C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy Concept and Design:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;DW, RM, AB, JD, NB, TK, GM, MH, SK, MND\u003c/p\u003e\n\u003cp\u003eData Analysis and Interpretation:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;DW, RM, AB, JD, NB, TK, GM, MH, SK, MND\u003c/p\u003e\n\u003cp\u003eDrafting the Manuscript:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;DW, RM, AB, JD, NB, TK, GM, MH, SK, MND\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe would like to thank all staff nurses, nursing assistants and nursing home managers who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDAlzG. \u003cem\u003eInformationsblatt 1. Die H\u0026auml;ufigkeit von Demenzerkrankungen.\u003c/em\u003e 2020 14.12.2021]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.deutsche-alzheimer.de/fileadmin/Alz/pdf/factsheets/infoblatt1_haeufigkeit_demenzerkrankungen_dalzg.pdf\u003c/span\u003e\u003cspan address=\"https://www.deutsche-alzheimer.de/fileadmin/Alz/pdf/factsheets/infoblatt1_haeufigkeit_demenzerkrankungen_dalzg.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDAlzG. \u003cem\u003eZahlen zu H\u0026auml;ufigkeit, Pflegebedarf und Versorgung Demenzkranker in Deutschland.\u003c/em\u003e 2016 14.12.2021]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pflegeversicherung-direkt.de/_Resources/Persistent/5cd8c700bdeb89e0795b2480b1a9d99c8c1523c1/Daten-Zahlen_2016-10-von-DALZG.pdf.\u003c/span\u003e\u003cspan address=\"https://www.pflegeversicherung-direkt.de/_Resources/Persistent/5cd8c700bdeb89e0795b2480b1a9d99c8c1523c1/Daten-Zahlen_2016-10-von-DALZG.pdf.\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD. 2019 Dementia Forecasting Collaborators, \u003cem\u003eEstimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019.\u003c/em\u003e Lancet Public Health, 2022. 7(2): p. e105-e125.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGale SA, Acar D, Daffner KR. Dement Am J Med. 2018;131(10):1161\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. 2015;350:h369.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFazio S, et al. The Fundamentals of Person-Centered Care for Individuals With Dementia. Gerontologist. 2018;58(suppl1):S10\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdvardsson D, Winblad B, Sandman O. Person-centred care of people with severe Alzheimer's disease: current status and ways forward. Lancet Neurol. 2008;7(4):362\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitwood T. Dementia reconsidered: the person comes first. Berkshire, UK.: Open University Press; 1997.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCormack B, McCance TV. Person-centred Practice in Nursing and Healthcare: Theory and Practice. London: Wiley-Blackwell; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantana MJ et al. \u003cem\u003eHow to practice person-centred care: A conceptual framework.\u003c/em\u003e 2018(1369\u0026ndash;7625 (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDichter MN et al. \u003cem\u003eOrganizational interventions for promoting person-centred care for people with dementia (Protocol).\u003c/em\u003e Cochrane Database of Systematic Reviews, 2019(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeSilva D. Helping Measure Person-centred Care: A Review of Evidence about Commonly used approaches and tools used to help measure person-centred Care. London.: The Health Foundation; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdvardsson D, Sandman PO, Rasmussen B. Swedish language Person-centred Climate Questionnaire - patient version: construction and psychometric evaluation. J Adv Nurs. 2008;63(3):302\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu L et al. \u003cem\u003ePerson-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study\u003c/em\u003e.Int J Environ Res Public Health, 2022. 20(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Y, et al. Resident and staff perspectives of person-centered climate in nursing homes: a cross-sectional study. BMC Geriatr. 2019;19(1):292.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdvardsson J, Sandman P, Rasmussen B. Sensing an atmosphere of ease: a tentative theory of supportive care settings. Scand J Caring Sci. 2005;19(4):344\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdvardsson D, Sandman PO, Rasmussen B. Construction and psychometric evaluation of the Swedish language Person-centred Climate Questionnaire - staff version. J Nurs Manag. 2009;17(7):790\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdvardsson D, Koch S, Nay R. Psychometric evaluation of the English language Person-centred Climate Questionnaire\u0026ndash;staff version. J Nurs Manag. 2010;18(1):54\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBergland \u0026Atilde;, Kirkevold M, Edvardsson D. Psychometric properties of the Norwegian Person-centred Climate Questionnaire from a nursing home context. Scand J Caring Sci. 2012;26(4):820\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCai L, et al. Psychometric evaluation of the Chinese version of the Person-centred Climate Questionnaire - Staff version (PCQ-S). BMJ Open. 2017;7(8):e017250.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVrbnjak D, et al. Psychometric testing of the Slovenian Person-centred Climate Questionnaire - staff version. J Nurs Manag. 2017;25(6):421\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDichter MN, et al. Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-sleep): study protocol for a cluster-randomized exploratory trial. BMC Geriatr. 2021;21(1):40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMokkink LB, et al. COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study. BMC Med Res Methodol. 2020;20(1):293.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeaton DE, et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilfling D et al. \u003cem\u003ePerson-Centered Climate Questionnaire \u0026ndash; German version (PCQ-G). Benutzerhandbuch f\u0026uuml;r die deutschsprachige Version.\u003c/em\u003e 2022, K\u0026ouml;ln.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBortz J, D\u0026ouml;ring N. \u003cem\u003eForschungsmethoden und Evaluation: f\u0026uuml;r Human- und Sozialwissenschaftler.\u003c/em\u003e Vol.\u0026nbsp;4. \u0026uuml;berarb. Auflage. 2006, Heidelberg.: Springer.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eField A, Miles J, Field Z. \u003cem\u003eDiscovering Statistics Using R.\u003c/em\u003e 2012, London: SAGE Publication Ltd.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolit DF. Statistics and Data Analysis for Nursing Research. Upper Saddle River, NJ: Prentice Hall; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIBM. IBM SPSS Statistics for windows. Armonk: IBM Corp; 2013.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"person-centeredness, dementia, validity, instrument, psychometric properties, nursing homes","lastPublishedDoi":"10.21203/rs.3.rs-2705323/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2705323/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePerson-centredness is considered as best practice for people with dementia. A frequently used instrument to assess person-centredness of a care environment is the Person-centred Climate Questionnaire (PCQ). The questionnaire comprises of 14 items with the three subscales a climate of safety, a climate of everydayness and a climate of community.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe aim of the study is to describe the translation process of the English language Person-centred Climate Questionnaire (Staff version, Patient version, Family version) into German language (PCQ-G) and to evaluate the first psychometric properties of the German language Person-centred Climate Questionnaire\u0026ndash; Staff version (PCQ-G-S).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study. The three versions of the 14-item English PCQ were translated into German language (PCQ-G) based on the recommendations for cross-cultural adaption of measures. Item distribution, internal consistency and structural validity of the questionnaire were assessed among nursing home staff (PCQ-G-S). Item distribution was calculated using descriptive statistics. Structural validity was tested using principal component analysis (PCA), and internal consistency was assessed for the resulting subscales using Cronbach\u0026rsquo;s alpha. Data collection took place from May to September 2021.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total sample of 120 nurses was included in the data analysis. Nine out of 14 items of the PCQ-G-S demonstrated acceptable item difficulty, while five times showed a ceiling effect. The PCA analysis demonstrated a strong structural validity for a three-factor solution explaining 68.6% of the total variance. The three subscales demonstrated a strong internal consistency with Cronbach\u0026rsquo;s alpha scores of 0.8 for each of the subscales.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe analysis of the 14-item German version (PCQ-G-S) showed first evidence for a strong internal consistency and structural validity for evaluating staff perceptions of the person-centredness in German nursing homes. Based on this, further investigations for scale validity of the PCQ-G versions should be carried out.\u003c/p\u003e","manuscriptTitle":"Item distribution, internal consistency and structural validity of the German language Person-centred climate questionnaire - Staff version (PCQ-G-S): a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-27 14:30:46","doi":"10.21203/rs.3.rs-2705323/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-08-30T10:41:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-08-20T19:34:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"669bbc27-756a-410d-ba6a-11593b865195","date":"2023-08-16T09:52:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75c7b672-4352-40d9-bd54-502ba9559446","date":"2023-08-12T08:06:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-08-11T06:31:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-08-09T17:38:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-03-24T10:27:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-03-24T10:26:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2023-03-17T14:41:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"817505bd-7406-4ba5-9910-349c3353ceac","owner":[],"postedDate":"March 27th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-01-15T15:05:29+00:00","versionOfRecord":{"articleIdentity":"rs-2705323","link":"https://doi.org/10.1186/s12877-023-04528-3","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2024-01-12 15:02:00","publishedOnDateReadable":"January 12th, 2024"},"versionCreatedAt":"2023-03-27 14:30:46","video":"","vorDoi":"10.1186/s12877-023-04528-3","vorDoiUrl":"https://doi.org/10.1186/s12877-023-04528-3","workflowStages":[]},"version":"v1","identity":"rs-2705323","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2705323","identity":"rs-2705323","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}