Staff perception of new pain care practices in dementia care psychometric properties of the Duke Diffusion of Innovation in long-term care battery

Approximately 80% of long-term care (LTC) residents suffer from chronic pain, and residents with dementia are at highest risk for inadequate pain control. Delayed implementation of evidence-based care practices is a key contributor to these poor outcomes. The Diffusion of Innovations (DOI) framework could guide efforts to accelerate adoption of new care practices if suitable measures were available for LTC staff members to evaluate their own perspectives and organizational practices related to adoption. This study examined the psychometric properties of a measure designed to assess staff perceptions of new pain care practices-the Duke-DOI-LTC battery-administered as part of the evaluation of the Foundations of Dementia Care educational program. Supervisory staff (n = 147) and certified nursing assistants or personal care assistants (n = 327) from 16 LTC facilities in 4 states (North Carolina, South Carolina, Virginia, and Kentucky) participated. Exploratory factor analysis of certified nursing assistants or personal care assistants' perceptions of New Pain Practices scale yielded a 4-factor solution, explaining 52% of the variance in responses. Factors that emerged corresponded to the following constructs from the DOI model: relative advantage, complexity/compatibility, visibility/image, and organizational support for innovation, suggesting that the measure is a reliable and valid measure of DOI constructs for use with LTC staff. The Duke-DOI-LTC battery is a promising approach to understanding staff perceptions when implementing evidence-based care.