Attitudes Toward Health Care Teams Scale (ATHCT)

National Center for Interprofessional Practice and Education's picture
Submitted by National Center... on Sep 29, 2016 - 5:16pm CDT

Heinemann, G.D.
Schmitt, M.H.
Farrell, M.P.
Brallier, S.A.

The ATHCT was designed to gauge the attitudes of trainees and providers towards working in interprofessional healthcare teams. Specifically, the tool measures individuals' beliefs about the quality of care provided by interprofessional teams (i.e., Quality of Care/Process) and their attitudes regarding the physician's central authority role in healthcare teams (i.e., Physician Centrality). These two factors are measured in a 19-item self-report tool. The development of this version came about through a series of systematic validation studies, beginning with analysis of data from 132 healthcare professionals and trainees and their responses to a longer version of the tool.  Preliminary analyses found support for expected relationships with separate measures of nurse-physician collaboration and attitudes toward health care teams.  These analyses also found support for three separate factors, two of which were ultimately combined.  Subsequent analysis of data from 973 geriatric health care team members demonstrated adequate factor structure and good internal reliability for two factors, but total variance accounted for by the factors was low.  Since the ATHCT was developed in 1999, other researchers have used a 14-item version of the ATHCT (see Curran, et al., 2007) which measures Quality of Care/Process and excludes Physician Centrality.

Link to Resources
Descriptive Elements
Who is Being Assessed or Evaluated?: 
Instrument Type: 
Self-report (e.g., survey, questionnaire, self-rating)
Source of Data: 
Health care trainees
Health care providers, staff
Notes for Data Sources: 

The tool has been administered to physicians, social workers, advanced practice nurses, registered nurses, extended health care team members, graduate school nurses, and geriatric health care teams.

Instrument Content: 
Attitudes, values, beliefs regarding IPE, IPCP, professions
Notes for Content: 

The final tool version in the series of studies contains two subscales. "Quality of Care/Process" combines two previous scales measuring individuals' beliefs about the "quality of care" that interprofessional teams can deliever, and the "costs of team care," into one scale.  "Physician Centrality" measures individual attitudes toward the authority of physicians in interprofessional teams. 

Instrument Length: 

The authors recommend the14-item Quality of Care/Process measure finalized in the final Phase III analysis along with the 6-item Physician Centrality measure identified in the Phase II factor analysis.  No time length was specified.

Item Format: 
6-point Likert-type scale ranging from strongly disagree (0) to strongly agree (5).
Paper and pencil questionnaires were administered. No specific administration instructions are provided.
The items from the Quality of Care/Process and Physician Centrality measures are likely averaged separately to form two scores. No specific scoring instruction are provided.
None described.
Open access (available on this website)
Notes on Access: 

The 14-item Quality of Care/Process measure is available on this website; the 6 items measuring Physician Centrality from Phase II can be viewed in the article referenced above (see p. 131).  Contact the author, Dr. Curran, for permission to use.

Psychometric Elements: Evidence of Validity
Thirty-one (n = 31) items were developed from existing, un-validated scales and through health professional focus group discussions. This version of the tool was administered to a convenience sample of 287 professionals at a health care team conference. In Phase I of the study, initial statistics were computed (factor analysis and Cronbach's alpha), three distinct scales emerged, and comparisons across professionals were made. These findings led to revisions and additions to the tool. Four experts (i.e., current healthcare professionals and scale development researchers) then reviewed an expanded set of 38 items. The expert panel judged the items highly relevant and none of the experts identified missing content.
Response Process: 
In the Phase II and Phase III factor analysis studies in the series, the response rates were 66% (n = 132 sample) and 96% (n = 973 sample).
Internal Structure: 
In the final factor analysis based on 21 items, all but two items loaded on to one of two factors. The combined Quality of Care/Process and Physician Centrality proved to be distinct factors, not correlated with each other. The Quality of Care/Process factor had an eigenvalue of 4.64, and these 14 items explained 22.1% of the total variance. The Cronbach's alpha for this scale was 0.83. The Physician Centrality factor had an eigenvalue of 2.27, and these 5 items explained 10.8% of the total variance. Cronbach’s alpha for this scale was 0.68.
Relation to Other Variables: 
To assess concurrent validity, analyses based on the 28 items studied in Phase II revealed expected correlations between the Quality of Care scale of the ATHCT and nurse-physician collaboration, as measured by the "nurse section" of the Collaborative Practice Scale (Weiss and David, 1985) (r = 0.21, p <0.05). Stronger correlation was found between positive responses to the ATCHT and the Clutter and Sach's (1990) semantic differential measure of attitudes towards health care teams (r = 0.60, p < 0.001). To assess construct validity, analyses during all three phases found consistent differences between nurses, social workers, and physicians on the ATCHC. As predicted, physicians were less positive about the benefits of team care, and more positive about physician centrality. Analyses based on the 21-item version in Phase III found correlations in expected directions between the Quality of Care/Process scale with separate measures of anomie (r = -0.35, p < 0.001), cohesion (r = 0.25, p < 0.001), quality of communication (r = 0.35, p < 0.001), quality of external relations (r = 0.21, p < 0.001), and team effectiveness (r = 0.39, p < 0.001).
None described.