Validation of a risk perception questionnaire on handling hazardous drugs
Psychometric validation of an instrument that measures perceived risk of exposure to hazardous drugs among healthcare professionals, with a comparison of perception across professional groups
Testing whether a risk perception questionnaire measured reliably, and whether perception differed across professional groups
The research group needed a reliable instrument to measure how healthcare professionals perceive the risk of exposure to hazardous drugs. Without sound psychometric validation, any conclusion about that perception would be open to question.
The study captured risk perception with a 21-item questionnaire scored on a Likert scale, aimed at professionals experienced in handling hazardous drugs in hospital-at-home services and hospital units. Before drawing any conclusion about the level of perceived risk, it had to be shown that the instrument measured consistently and reliably.
The challenge had a nuance that went beyond a standard reliability calculation: the questionnaire was answered by three different professional groups —nursing, occupational medicine and pharmacy—, with different training and exposure. Overall reliability was not enough: the analysis also had to establish whether scores differed between the three groups.
144 questionnaires
with a 70.2% response rate among professionals experienced in handling hazardous drugs
α = 0.93
Cronbach's alpha, with an intraclass correlation coefficient of 0.94
3 groups
nursing, occupational medicine and pharmacy, compared with one another
Assessing the instrument's reliability and analysing differences between professional groups
Reliability and internal consistency of the questionnaire
Internal consistency of the instrument assessed with Cronbach's alpha, and overall reliability of the scores with the intraclass correlation coefficient. Item-level behaviour examined to verify that every item contributed to the measure and none degraded it, confirming that the questionnaire could support the study's conclusions.
Analysis of risk perception and of differences between professional groups
Risk perception quantified on the questionnaire's scale and compared across the three professional groups. Identification of statistically significant differences in scores —nursing versus occupational medicine and versus pharmacy— and of the stage of the process where those differences were concentrated.
Reading the results by stage of the process
Risk perception broken down by stage of drug handling to identify where perception was higher or lower. The analysis placed the main source of difference between professional groups in the administration stage, a finding with direct implications for the design of protective measures.
A validated instrument for measuring the perception of a real occupational risk, with results published in an international journal
High internal consistency and reliability in the sample analysed
The questionnaire showed high internal consistency (Cronbach's alpha of 0.93) and an ICC of 0.94 in the study sample, supporting the use of its scores in this analysis and providing a basis for future applications and evaluations of the instrument.
An actionable finding on professional safety
The analysis showed that perceived risk was moderate and higher among nursing staff, with the differences concentrated in the administration stage. On that basis, the study recommended integrating the handling of hazardous drugs into a standardised management system, applicable to any healthcare centre, to improve the safety of professionals.
Published evidence and institutional backing
The results were published in PLOS ONE (2021), an international peer-reviewed journal, and the validation is part of a PhD thesis by publication defended at the Universidad Miguel Hernández, within a project funded by the Carlos III Health Institute (ISCIII). That track record independently supports the rigour of the work and gives it reach beyond the study itself.
What this case shows about the way we work
Validate before concluding
We did not take the questionnaire as valid just because it seemed reasonable. We first checked that it measured reliably, and only then analysed what it measured. That sequence —validating the instrument before interpreting its results— is what separates a sound conclusion from a well-presented impression.
A question that goes beyond Cronbach's alpha
Validating a questionnaire answered by three different professional groups is not just a matter of calculating its overall reliability. We analysed whether scores differed statistically between nursing, occupational medicine and pharmacy, and at which stages of the process those differences were concentrated, turning the validation into a finding that matters for professional safety.
Method and healthcare domain, together
Interpreting what it means for one professional group to perceive more risk at a specific stage of handling a drug requires an understanding of healthcare, not only of statistics. The combination of methodological rigour and knowledge of the clinical context is what made it possible to translate the figures into an applicable recommendation.
Julia y Rubén son profesionales que no sólo dominan las técnicas estadísticas, sino que conocen bien el ámbito de la salud y saben escuchar las necesidades del cliente. Han comprendido perfectamente lo que necesitábamos y nos han aportado mucho valor con sus ideas.
Dr Carmina Wanden-Berghe
Principal Investigator, Grupo de Investigación en Nutrición Clínica y Hospitalización a Domicilio, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)
Resulting scientific output
Perception of risk of exposure in the management of hazardous drugs in home hospitalization and hospital units
Control de calidad y trazabilidad de medicamentos peligrosos en las unidades de hospital a domicilio
Capabilities deployed in this project
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