The development and psychometric analyses of ADEPT: An instrument for assessing the interactions between doctors and their elderly patients

Abstract

Background: The lack of instruments and methodologies designed specifically for assessing doctor-elderly patient interactions has constricted research on effective communication in the medical care of older adults. Purpose: This article reports on the development, qualitative analyses, and psychometric testing of the Assessment of Doctor-Elderly Patient Transactions (ADEPT), an instrument for assessing interactions between doctors and their elderly patients. Methods: The ADEPT was based on the recommendations of an expert panel and designed around the three-function model of the medical interview. The ADEPT is meant to operationalize the research findings of interactional analysis studies of doctor-patient interaction. Following preliminary testing with standardized patients, the ADEPT was applied to videotaped visits of 433 patients 65 years of age and older to the doctor (n = 40) identified as their primary source of care. Results: Four final scales derived from exploratory and confirmatory factor analyses were scored: Supporting, comprised of the 12 items from the first factor; Eliciting Needs, containing the 5 items from the second factor; and Informing, based on the final 6-item factor. Individual Cronbach's alphas across raters for this sample ranged from .71 to.79 for the first scale, from .83 to .88 for the second scale, and from .64 to .81 for the third scale. The reliability estimates for the total scale (23 items) ranged from .80 to .86 across raters. A fifth summed index composed of 46 binary checklist items also was computed. Conclusions: The findings indicate that credible scales can be developed for assessing communication behaviors. © 2005 by The Society of Behavioral Medicine.