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Nurse practitioner primary care organizational climate questionnaire: Item response theory and differential item functioning


Aims and objectives

To validate Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP‐PCOCQ) items using item response theory (IRT) models and conduct differential item functioning (DIF) analysis to test the item functioning among nurse practitioners (NPs) practicing in different U.S. states with variable regulations governing NP practice.


Nurse Practitioner Primary Care Organizational Climate Questionnaire is the only NP‐specific tool measuring NP work environment and is being used in different U.S. states with variable NP scope of practice regulations and internationally to produce evidence about NP work environments within their organisations.


Cross‐sectional survey design was used to collect data from 278 primary care NPs in New York (NY) and 314 NPs in Massachusetts (MA).


NPs completed the 29‐item NP‐PCOCQ. Data collection involved an online survey in NY and a mail survey in MA in 2012. We used Samejima's graded response model for IRT and ordinal logistic regression for DIF analysis. A STROBE checklist was completed.


IRT models yielded discrimination parameters ranging from 0.98–4.65 in NY and 1.25–6.94 in MA. Item difficulty parameters were within −3 to +3 range, suggesting a fair range of item difficulties exist in the scale. Only five of the 29 items on NP‐PCOCQ exhibited DIF, suggesting some other state‐related factor besides the measured construct influenced item responses; thus, the items were removed.


Our findings indicate that a shortened, 24‐item NP‐PCOCQ is capable of measuring organisational climate of NPs practicing in different U.S. states. NP‐PCOCQ can be used in future research to measure NP work environment.

Relevance to clinical practice

The tool can also be used by practice administrators to assess NP work environment and identify deficiencies to address them. This evidence about NP work environment can be used by practice administrators to promote favourable work environments for NPs to deliver high‐quality care.

Shared decision‐making in the BREATHE asthma intervention trial: A research protocol


To evaluate the preliminary effectiveness of the BRief Evaluation of Asthma TH erapy intervention, a 7‐min primary care provider‐delivered shared decision‐making protocol that uses motivational interviewing to address erroneous asthma disease and medication beliefs.


A multi‐centre masked two‐arm group‐randomized clinical trial.


This 2‐year pilot study is funded (September 2016) by the National Institute of Nursing Research. Eight providers will be randomized to one of two arms: the active intervention (N = 4) or a dose‐matched attention control (N = 4). Providers will deliver the intervention to which they were randomized to 10 Black adult patients with uncontrolled asthma (N = 80). Patients will be followed three months postintervention to test the preliminary intervention effects on asthma control (primary outcome) and on medication adherence, lung function, and asthma‐related quality of life (secondary outcomes).


This study will evaluate the preliminary impact of a novel shared decision‐making intervention delivered in a real world setting to address erroneous disease and medication beliefs as a means of improving asthma control in Black adults. Results will inform a future, large‐scale randomized trial with sufficient power to test the intervention's effectiveness.


Shared decision‐making is an evidence‐based intervention with proven effectiveness when implemented in the context of labour‐ and time‐intensive research protocols. Medication adherence is linked with the marked disparities evident in poor and minority adults with asthma. Addressing this requires a novel multifactorial approach as we have proposed. To ensure sustainability, shared decision‐making interventions must be adapted to and integrated into real‐world settings.

Trial registration: Registered at as NCT03036267 and NCT03300752.