Development of the Rural Practice Awareness and Skills Scale

Background and Purpose: Rural communities continue to experience growing health disparities and suffer from a shortage of healthcare professionals (Bolin et al., 2015; Weinhold & Gurtner, 2014). To address this social work and public health crisis, a variety of educational and training efforts focus on the recruitment and retention of practitioners to rural areas (MacQueen et al., 2018; Wilson, Couper, De Vries, Reid, Fish & Marais, 2009). Many of these initiatives focus on improving practitioners’ awareness of challenges in rural areas and strengthening practitioners’ skills for rural practice (Asghari et al., 2017; Brooks, Walsh, Russell, Lewis, & Clawson, 2002; National Rural Health Association, 2015; Soles, Wilson, & Oandsan, 2017). Unfortunately, there are few psychometrically sound scales in the public domain to assess these targets of rural educational, training, and recruitment/retention efforts (Adams et al., 2005). This study sought to develop the Rural Practice Awareness and Skills Scale (RPASS) and provide evidence of the validity and reliability of the measure.

Methods: A pool of 63 items (1=Strongly Disagree to 5=Strongly Agree) was developed by two research team members during Fall 2017 based on a literature review and rural health practice experience. The scale was administered to 41 students to assess item wording, the length of time to complete the survey, and any other potential issues. An expert panel (n=9) also reviewed the scale to assess the face validity of the items. Through this process, 24 items were deleted and seven were refined for clarity. The revised 39-item scale was then administered via pencil-and-paper survey to social work students in two different social work classes and also disseminated online to social work practitioners and other helping professionals involved in rural health. Three hundred forty-one individuals completed the survey, and of those, 333 had less than five missing responses on the scale and were included in the final sample (73.27% female; 67.5% White). Missing data were imputed using predictive mean matching and an exploratory factor analysis with varimax rotation was conducted. The scree plot, eigenvalues, variance explained by each factor, and factor loadings were examined. Reliability was calculated. To further establish validity, a correlation was conducted between years of experience in rural health and RPASS score.

Results: After looking at the scree plot, two factors explained approximately 37.1% of the variance. The first factor, skills for rural practice, contained 21 items with factor loadings greater than 0.5 and had a Cronbach’s alpha of .92. The second factor, awareness of rural challenges, contained 10 items with factor loadings of 0.5 or greater and had a Cronbach’s alpha of 0.79. The reliability for the entire scale was 0.89. The correlation between years of rural practice and RPASS score was 0.27.

Conclusions and Implications: Overall, despite study limitations (e.g., sample composition), this study provided initial validity and reliability evidence for RPASS. This scale can be used by social workers to assess their efforts to improve rural health. Additional implications for the use of RPASS for social work research, practice, and policy will be discussed.