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Patient Satisfaction with Navigator Interpersonal Relationship (PSN-I): item-level psychometrics using IRT analysis

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Abstract

Background

Patient navigation (PN) is a promising intervention to eliminate cancer health inequities. Patient navigators play a critical role in the navigation process. Patients’ satisfaction with navigators is important in determining the effectiveness of PN programs. We applied item response theory (IRT) analysis to establish item-level psychometric properties for the Patient Satisfaction with Interpersonal Relationship with Navigators (PSN-I).

Methods

We conducted a confirmatory factor analysis (CFA) to establish unidimensionality of the 9-item PSN-I in 751 cancer patients (68% female) between 18 and 86 years old. We fitted unidimensional IRT models—unconstrained graded response model (GRM) and Rasch model—to PSN-I data, and compared model fit using likelihood ratio (LR) test and information criteria. We obtained item parameter estimates (IPEs), item category/operating characteristic curves, and item/test information curves for the better fitting model.

Results

CFA with diagonally weighted least squares confirmed that the one-factor model fit the data (RMSEA = 0.047, 95% CI = 0.033–0.060, and CFI ≈ 1). Responses to PSN-I items clustered into the 4th and 5th categories. We aggregated the first three response categories to provide stable parameter estimates for both IRT models. The GRM fit the data significantly better than the Rasch model (LR = 80.659, df = 8, p < 0.001). Akaike’s information coefficient (6384.978 vs. 6320.319) and Bayesian information coefficient (6471.851 vs. 6443.771) were lower for the GRM. IPEs showed substantial variation in items’ discriminating power (1.80–3.35) for GRM.

Conclusions

This IRT analysis confirms the latent structure of the PSN-I and supports its use as a valid and reliable measure of latent satisfaction with PN.

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Funding sources

Research reported in this publication was supported by grants from the National Cancer Institute of the National Institutes of Health under award numbers: 3U01CA116924-03S1, U01 CA116924-01, 1R25CA 10261801A1, U01CA116892, U01CA 117281, U01CA116903, U01CA116937, U01CA116885, U01CA116875, and U01 CA116925 and the American Cancer Society: SIRSG-05-253-01. Dr. Wells’ efforts on this manuscript was supported by NIH grants U54CA132384, U54CA132379, and R21CA161077.

Author information

Authors and Affiliations

  1. Florida State University College of Medicine, 1115 W. Call Street, 4104, Tallahassee, FL, 32306-4300, USA

    Pascal Jean-Pierre

  2. Cancer Neurocognitive Translational Research Laboratory, 1115 W. Call Street, 4104, Tallahassee, FL, 32306-4300, USA

    Pascal Jean-Pierre

  3. Curriculum Associates, San Francisco, CA, USA

    Can Shao

  4. University of Notre Dame, Notre Dame, IN, USA

    Ying Cheng

  5. San Diego State University, San Diego, CA, USA

    Kristen J. Wells

  6. Ohio State University, Columbus, OH, USA

    Electra Paskett

  7. University of Rochester Medical Center, Rochester, NY, USA

    Kevin Fiscella

Authors
  1. Pascal Jean-Pierre
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  2. Can Shao
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  3. Ying Cheng
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  4. Kristen J. Wells
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  5. Electra Paskett
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  6. Kevin Fiscella
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Corresponding author

Correspondence to Pascal Jean-Pierre.

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Institutional Review Boards of participating institutions approved this study. All participants provided signed informed consent for this study.

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Jean-Pierre, P., Shao, C., Cheng, Y. et al. Patient Satisfaction with Navigator Interpersonal Relationship (PSN-I): item-level psychometrics using IRT analysis. Support Care Cancer 28, 541–550 (2020). https://doi.org/10.1007/s00520-019-04833-x

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