Initial Validity Evidence for the Student Health Equity Survey: Assessing Knowledge, Attitudes, and Capacity across Health Professions Programs.

Abstract

Construct: Health equity can be understood as an opportunity to achieve one's fullest health potential and health professionals play a central role in advancing this aim. Thus, equipping health professional students with key competencies is paramount to achieving health equity.

Background: There is no universally accepted definition of health equity. As such, standardized training of health professions students to address the unfair burden of poor outcomes among socially disadvantaged populations does not exist. These ongoing threats to health equity can be mitigated with competency-based training. We assess the health professions training programs at an academic medical center that has documented health equity values and no standardized or measurable health equity curriculum.

Approach: We collected validity evidence for an instrument, the Student Health Equity Survey, to assess what students across nine health professions programs know and perceive about health equity concepts. Our 36-item instrument reflects the tenets of the Health Equity Framework. Content validity was assessed using an expert panel of faculty, staff and potential employers while content validity was further assessed alongside response process validity through cognitive testing-based focus groups. We used a Rasch analysis to assess for preliminary internal structural validity and construct validity. We strengthened our assessment of construct validity with an assessment of relationships between subscales through a series of cross plots and corresponding correlation coefficients for student measures on each subscale.

Findings: Content and response process validity were established. Construct validity for the capacity, perspective taking, and reflection subscales included Cronbach's alphas of 0.97, 0.71, and 0.82, respectively. The Cronbach alpha for the knowledge scale was low. Threats to construct validity are thought to be due in large part to sample selection bias.

Conclusion: We developed a competency-based instrument to measure health equity knowledge, attitudes, and capacity of entering health professions students. Further research is necessary to test this instrument among health professions graduates entering the workforce.