QualiComp: Development and Initial Validation of a Competency Questionnaire for Quality Improvement in Health Services
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Background Successful quality improvement (QI) projects hinge on professionals' competencies to diagnose, implement, and sustain change. Objective To develop and provide initial validation evidence for QualiComp, a competency questionnaire for QI in health services. Methods We built a competency model combining widely used approaches in Brazil (diagnostic-oriented cycles) and international QI methods, explicitly integrating attitudes/beliefs, technical-analytical, and behavioral (soft) skills. Content validity was assessed by a two-round Delphi with experts, using item- and scale-level Content Validity Indexes (CVI). Cognitive interviews (n = 10) evaluated comprehensibility and response burden. The 31-item prototype was administered to a convenience sample of healthcare students and professionals (n = 155). Using polychoric correlations and WLSMV estimator with oblique rotation, we conducted exploratory factor analysis (EFA) to assess structural validity; factor retention combined fit indices, explained variance, and interpretability. Results Scale-level CVI was high across criteria (relevance 0.96; adequacy 0.97; usefulness 0.97; clarity 0.95). Cognitive interviews indicated good comprehensibility and ~ 7-minute completion time. EFA supported a parsimonious three-factor solution - beliefs/attitudes (4 items), technical-analytical competencies (19 items), and behavioural skills (7 items) - with adequate fit (e.g., RMSEA 0.077; CFI 0.954; TLI 0.943; SRMR 0.075) and improved structure after removing one misfitting item. Although four- and five-factor models yielded slightly better global fit, they produced conceptually weak/sparse factors and higher cross-loadings; therefore, we retained a parsimonious three-factor structure. Conclusion QualiComp shows promising evidence of content validity, acceptability, and structural validity, offering an integrated view of QI competencies. proving to be a promising and reliable instrument for assessing attitudes, technical, and It can support formative diagnosis, training design, and competency monitoring in QI cycles. Further studies should confirm the structure (CFA), test invariance, reliability, and responsiveness.
