# Early psychometric characteristics of the NUrsing Behavioral Engagement (NuBE) Scale in cancer settings: A three-phases validation study

## TL;DR

This study created and tested a new tool to measure nursing behaviors that help cancer patients feel more engaged in their care.

## Contribution

The NuBE Scale is a new validated instrument measuring nursing behaviors that promote patient engagement in oncology from the patient’s perspective.

## Key findings

- The NuBE Scale has a four-factor structure explaining 70% of the variance in nursing behaviors promoting patient engagement.
- The scale demonstrated excellent internal consistency and convergent validity with patient satisfaction and healthcare climate measures.
- The final version of the scale includes 29 items grouped into four factors related to patient-centered nursing behaviors.

## Abstract

Patient engagement in cancer care is increasingly recognized as essential for improving clinical outcomes. Nurses play a crucial role in fostering patient engagement, yet there is a lack of validated instruments to assess which nursing behaviors are most effective in promoting engagement from the patient’s perspective.

This study aimed to develop and test the psychometric characteristics of the Nurses’ Behavioral Engagement Scale, a tool designed to measure nursing behaviors that support patient engagement in oncology settings, from patients’ point of view.

The study followed a three-phase exploratory sequential mixed-methods design. In the first phase, 53 items were generated based on findings from a previous qualitative study and a systematic review of the literature. In the second phase, the items underwent content validation through a modified e-Delphi procedure with 19 experts in oncology nursing, patient engagement, tool development, and linguistics. Forty-eight items were deemed relevant and tested in the third phase with a sample of 250 cancer patients to evaluate construct validity, internal consistency, and convergent validity.

Exploratory Factor Analysis revealed a four-factor structure, collectively explaining 70.0% of the total variance: Factor 1 – Acknowledgment of Patient’s Uniqueness, Factor 2 – Meeting Patient’s Knowledge Expectations, Factor 3 – Fostering Patient’s Motivation, and Factor 4 – Valuing Patient’s Informal Caregivers. The final Nurses’ Behavioral Engagement Scale comprises 29 items. Internal consistency was excellent, with Cronbach’s alpha coefficients of 0.953, 0.890, 0.942, and 0.920 for the four factors, respectively. The Nurses’ Behavioral Engagement Scale demonstrated significant and meaningful correlations with the Health Care Climate Questionnaire and items assessing satisfaction with nursing care, supporting its convergent validity.

The Nurses’ Behavioral Engagement Scale provides a psychometrically sound measure of nursing behaviors that promote patient engagement in oncology care. This tool has the potential to inform targeted interventions and quality improvement initiatives, ultimately enhancing patient-centered care and improving health outcomes in cancer patients.