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Development and Psychometric Evaluation of the Telenursing Interaction and Satisfaction Scale (TISS)


 Background: In telenursing, interaction between caller and telenurse is crucial for outcomes such as adherence, safety and satisfaction. There is a recurring demand for improved interaction in telenursing and a lack of measurement scales focusing on caller satisfaction with interaction. The purpose of this study was to develop and evaluate psychometric properties of the Telenursing Interaction and Satisfaction Scale (TISS).Methods: This instrumental development stud was based on cross-sectional data. Callers to the National Medical Advisory Service in Sweden (n=616) completed a 60-item questionnaire, the Telenursing Interaction and Satisfaction Questionnaire (TISQ). Twenty-five of these items were selected to form the TISS. Selected items represent four dimensions of interaction according to the Interaction Model of Client Health Behavior; health information, professional-technical competence, affective support and decisional control. Data quality was evaluated in terms of missing data patterns and score distributions. Factor structure of the scale was evaluated with confirmatory factor analysis, convergent validity with Spearman correlations, internal consistency with ordinal alpha, scale reliability with composite reliability coefficients, and test-retest reliability with intraclass correlations. Results: The amount of missing data was acceptable and equally distributed. The completeness of data was the highest for the subscale of professional-technical competencies (94%) and the lowest for the TISS total scale (80%). Data deviated significantly from a normal distribution, but all response options were endorsed. The CFA confirmed the hypothesized four-factor structure. Factor loadings ranged from 0.56 to 0.97, and factor correlations were high (0.88-0.96). Internal consistency (ordinal alpha = 0.82-0.97), scale reliability (0.88-0.99) and test-retest reliability (ICC = 0.77-0.86) were satisfactory for all scales.Conclusion: The TISS holds satisfactory psychometric properties in the study sample. Findings support the use of four sub-scales for measuring caller satisfaction with interaction in telenursing. A total-score can be calculated and used in situations where multi-collinearity is a problem.