Resident Preferences and CNA Empowerment: Testing Validity and Reliability of a Culture Change Survey Tool

J Appl Gerontol. 2020 Dec;39(12):1284-1291. doi: 10.1177/0733464819884862. Epub 2019 Oct 29.


Culture change (CC) is an innovation to improve nursing home resident quality of life. Inconsistencies in how CC is measured make the interpretation of findings inconclusive. The purpose of this study is to determine the underlying factors of CC among Ohio nursing homes to extract the core essence of CC. Data from the 2015 Ohio Biennial Survey of Long-Term Care Facilities with n = 721 nursing homes answering a CC module comprising of 21 questions are included in an exploratory factor analysis (EFA). EFA results identified two underlying factors of CC that are extracted using principal factor method. These factors include items related to resident preferences for care (RPC) and certified nursing assistant (CNA) empowerment. This study presents two valid and reliable scales to advance the measurement of CC. These scales can be used to explore both RPC and CNA empowerment components as predictors or outcomes.

Keywords: measurement; nursing homes; person-centered care; policy; psychometrics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Allied Health Personnel*
  • Empowerment*
  • Humans
  • Nursing Homes*
  • Organizational Culture*
  • Quality of Life
  • Reproducibility of Results
  • Surveys and Questionnaires