Design and psychometrics of communities of practice questionnaire in Tabriz University of Medical Sciences

Introduction In recent years, with the advancement of research in the field of knowledge management and the emphasis on the integration of knowledge creation and sharing processes, the working patterns and structures of organizations are of renewed interest, especially educational organizations and universities and, in particular, universities of medical sciences (UMS) that deal with human health. An example of one such structure is communities of practice (CoPs), which are different from work groups and work teams. CoPs are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.1 CoPs are intersubjective social structures that constitute a normative and epistemic ground for action.2 These communities offer a new vision and approach to develop a learning organization3 and a structural solution to promote knowledge development, learning and performance.4 CoPs have been identified as an effective method to extract and disseminate tacit knowledge.5 As a vehicle for learning, a CoP is a place where people generate new knowledge that both increases knowledge and facilitates the flow of knowledge capital in an organization.6 CoPs are thus regarded as very important since they create a link between individual and organizational learning.7 They help people learn and thus increase performance in the workplace.8 The critical point of a CoPs perspective is that a social context for learningwhere relationships between people become a basis for solving problems, doing practices and enhancing specialized knowledge – is essential in order to formulate these communities.9 Learning in CoPs occurs in a trusted work environment and targeted social


Introduction
In recent years, with the advancement of research in the field of knowledge management and the emphasis on the integration of knowledge creation and sharing processes, the working patterns and structures of organizations are of renewed interest, especially educational organizations and universities and, in particular, universities of medical sciences (UMS) that deal with human health.An example of one such structure is communities of practice (CoPs), which are different from work groups and work teams.CoPs are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. 1CoPs are intersubjective social structures that constitute a normative and epistemic ground for action. 2These communities offer a new vision and approach to develop a learning organization 3 and a structural solution to promote knowledge development, learning and performance. 4CoPs have been identified as an effective method to extract and disseminate tacit knowledge. 5As a vehicle for learning, a CoP is a place where people generate new knowledge that both increases knowledge and facilitates the flow of knowledge capital in an organization. 6oPs are thus regarded as very important since they create a link between individual and organizational learning. 7They help people learn and thus increase performance in the workplace. 8The critical point of a CoPs perspective is that a social context for learning-where relationships between people become a basis for solving problems, doing practices and enhancing specialized knowledge -is essential in order to formulate these communities. 9Learning in CoPs occurs in a trusted work environment and targeted social participation through social engagement and collective activity. 10A community of practice is an environment in which organizational learning mostly forms based on cultural vision. 11This semi-formal and autonomous group focuses on collaborative teamwork and the mutual sharing of knowledge and experience among members in order to supplement current organizational structures. 12oPs promote interaction between different components of the organization, which encourages creativity and innovation. 13The selection of members is voluntary, based on their interests, commitment and skills for the main activities of the community. 14Community members participate due to "value added, " the excitement of building new ideas, and the satisfaction of relationships. 15oPs can be a strategy for enhancing organizational development.This is because they reinforce both formal and informal learning in the workplace 16 and, in providing opportunities to apply knowledge, tools, and social relationships, discriminate among individuals' activities. 17oPs have positive influences on individual, group and organizational performance.Individuals mutually engage with others participating in the same practice, learn to conduct work-related tasks, and thus improve their ability to perform their work-related tasks, with an outcome being improved performance for individuals, the CoP and the organization. 18t is known that due to the positive impact of CoPs on creating and sharing knowledge within and outside the organization, an increasing number of organizations use these as strategic tools. 19The main mission of UMS is to foster scientific development and promote physical and social health.The knowledge acquired by UMS in this role is reflected in their clinical decision-making and practices, creating added value in medical sciences.Therefore, CoPs in these universities have an important function in achieving these goals, since they promote sharing and transferring of knowledge and experiences among members, learning and improving methods of doing work, professional development and performance of faculty members through communication and interactions.The Tabriz University of Medical Sciences (TUMS) sees a need to set up, cultivate and develop CoPs to attain and implement goals for various programs in the fields of education, research, etc.This study has been carried out for the first time in UMS in Iran and until the implementation of this study, there were no reliable tools for assessing the components of CoPs in these universities.Most of the previous studies were conducted in commercial, industrial and service organizations or abroad without including all components of CoPs [20][21][22] ; therefore, the development of a comprehensive model of CoPs based on the perspective of faculty members seems necessary.The purpose of this study was to design a psychometrics Communities of Practice Questionnaire at the TUMS.

Design and participants
The present study was a cross-sectional, psychometric survey.First, through conducting a literature review about CoPs, components of CoPs were extracted and a questionnaire was constructed with 37 items.The psychometrics of tool, face, content and construct validity, internal consistency and repeatability were examined.To determine the face and content validity of the instrument, 14 faculty members of the TUMS 10 associate professors and 4 assistant professors from different departments, participated.To examine reliability and construct validity, 2 groups of faculty members of TUMS participated in this study; 30 faculty members were included in a pilot study in order to examine the reliability of the instrument.The sample size for performing factor analysis recommended by different authors is 5-10 samples for each item. 23onstruct validity was examined using data from 210 faculty members (each sample for each item).

Face validity
In determining face validity via a qualitative method, experts were asked to review the Communities of Practice Questionnaire (COPQ) in order to simplify and comprehend the questionnaire's measures; incoherent and ambiguous words and phrases were corrected and replaced based on their feedback.The face validity of the COPQ was quantitatively measured using the impact method. 24In order to assess the impact scores, participants were asked to rate the significance of each of the items on a 5-point scale.To confirm the face validity of each item, its score should not be less than 1.5.

Content validity
To answer questions such as "Does the designed tool consist all important aspects of the measured concept?Does the construction of the tool examine what is to be studied?" the content validity of the tool was examined quantitatively and qualitatively. 25In order to evaluate content validity qualitatively, evaluators were asked to provide feedback based on criteria such as "grammar structure, using proper words, placing items in their proper place, " and any necessary changes based on feedback were made.The content validity of the test was assessed quantitatively by 2 indicators, (a) content validity ratio (CVR) to ensure that the most relevant and correct content was selected (the necessity of the item), and (b) content validity index (CVI) to ensure that the tool items were valid to measure. 26,27To determine CVR, the panel of experts was asked to comment on each of the items based on a 3-point scale.Based on the number of experts who evaluated the questions, acceptable minimum amount of CVR was obtained based on the Lawshe table, and the 2 items for which the CVR value was less than the sufficient amount according to the number of experts were deleted.To evaluate the CVI, the Waltz and Bausell method was used. 28xperts express their views on 3 criteria of 'simplicity' , 'relevance' , and 'clarity or accuracy' of each item based on a 4-point scale.The CVI score is calculated by aggregating the concession points for each item that was ranked third or fourth (highest score) by the total number of specialists.

Reliability and repeatability
In order to ensure of the similarity, accuracy, predictability and reliability of the results in the same conditions, the reliability of the COPQ research tool was estimated using Cronbach's alpha coefficient, and to test the stability of the questionnaire, the intraclass correlation coefficient (ICC) method was used. 29In order to conduct a re-test over the period of 2 weeks, 30 persons from the target group completed questionnaires on a 5-point Likert scale (1 = absolutely proper to 5 = absolutely improper).

Construct validity
The questionnaires were distributed among 210 faculty members of the TUMS from different departments, consisting of both genders, with academic ranks of professor, associate professor and assistant professor.After collecting the data, in order to verify the construct validity, exploratory factor analysis (EFA) using the principal component method was done.To ensure the appropriateness of data for factor analysis, Kaiser-Meyer-Olkin (KMO) and Bartlett test of sphericity was used, and to determine the number of factors, the Kaiser criterion or eigenvalue was used. 23,30

Statistical analysis
The data were analyzed using SPSS 21 and Excel to check the face and content validity; reliability; KMO and Bartlett test of sphericity.EFA was performed with EQS 6.1.

Participants
71.4% of experts who examined face and content validity were associate professors and the rest were assistant professors.In order to check reliability, the majority of faculty members who participated in the pilot study were faculty of the pharmacy and research centers (33.3% and 26.7% respectively).For conducting construct validity, 58.1% of participants were male and 41.9% were female.In terms of rank, 13.3% of them were professors, 23.8% associate professors, and 62.9% were assistant professors.The majority (37.1%) were from the faculty of medicine and the rest of them were from other departments and research centers.

Face validity
In this research in the face validity study by qualitative method, items that required correction were amended.In quantitatively measures of face validity, impact scores of items that were higher than 1.5 were considered appropriate and were maintained.

Content validity
After calculating CVI for each item, items with a score of above 0.79 were accepted, and items with a CVI between 0.70 and 0.79 were again reviewed and corrected by the experts.Then, based on the number of experts who evaluated the questions, the minimum amount of CVR acceptable was obtained based on the Lawshe table. 28Based on these results, the average size of CoPs with a CVR of 0.42 and asynchrony virtual communication with the CVR of 0.28 were deleted, because their CVRs were less than the corresponding value for the Lawshe table (<0.51), and approved items with an acceptable level of significance (P < 0.05) were considered essential for this tool.Content related to CVI and CVR of the COPQ are given in Table 1.The CVR and CVI of the COPQ after eliminating 2 items was 0.78 and 0.92, respectively.

Reliability and repeatability
Using the Cronbach's alpha coefficient, inner consistency of the tool was calculated to be 0.89 and the ICC was 0.92.Based on the recommended rate by researchers, 31,32 these results are acceptable.

Construct validity
According to results, the value of the KMO index was 0.881 and Bartlett's test of sphericity was performed, with a result of 3906.519 with a P < 0.001, which indicates the justification of the implementation of the factor analysis.Based on the PCA and scree plot, 6 factors were identified with eigenvalues higher than 1 that could explain 58.493% of the variance.Results are shown in Figure 1.Table 2 shows results of the factor loadings in the related rotated matrix.

Discussion
Learning occurs through the process of participation in social learning systems (SLSs) and CoPs are one of the constructive elements of SLSs.Because previous studies have shown that CoPs have individual, social, and organizational benefits, it is necessary to establish these communities in educational organizations, including UMS, which are centers of knowledge creation and sharing, learning, and scientific development.Studies of CoPs have been carried out in commercial, industrial and service organizations [20][21][22] yet there was not a standard tool that encompassed all components of CoPs while considering the specific context environment of a university.What was significant in assessing validity is that from the perspective of experts, the objectives of CoPs; helping members to solve problems, consulting community leaders with members in making decisions and using their suggestions, the presence of community members in a freely and voluntary manner in a CoP, lack of restrictions on the presence of members in a CoP, presence of members in the community in continuous manner, leader and member engagement and commitment in community activities, and trust between members of CoPs, were distinguished more necessary and it can be concluded that more informal and liberal aspects of CoPs have been of great importance and value to experts in their opinion.Their selection of the above indicators, in most cases, confirms the previous studies.As the exploratory study by American Productivity and Quality Center has shown, "CoPs have different strategic goals, and most communities have mechanisms for community members for mutual assistance to solve work problems and common ideas and can act as a practical and effective tool for problem solving". 33There is also a need for appropriate leadership and management support, 34,35 and a participatory leadership style is one of the common leadership styles in CoPs, which, according to Yukl, is the ability to influence leader decisions through employee participation in decision making and empowerment. 36ccording to Schiavone 14 and Mládková, 15 participation in CoPs is voluntary.Dubé et al, in their study, stated that the process of selecting members for the CoPs can be open and members can be present in these communities without any restrictions.The process of selecting members is also related to the sustainability of membership.Open CoPs tend to have floating and temporary members, as volunteers join communities when they are asked, while closed communities tend to have fixed members. 37According to Carlson (cited by Koch and Fusco 38 ), building trust in members is the key to the success of community.Vestal (cited by Borzillo 39 ) also states that community success largely depends on the level of commitment and engagement of members.However, due to the comparison of the results of Dubé et al regarding the relationship between the choice of members and the sustainability of members, 37 it was found that experts of the TUMS determined the process of selection of members and the stable presence of members in CoPs were considered necessary, which could be due to the fact that, in the opinion of the experts of the university, members who are constantly present in the community are more aware of the issues in these communities and thus can take better steps to resolve problems and issues.The extracted components from the EFA were consistent with the theoretical foundations of CoPs such as the purpose of forming these communities, 1,33 the various leadership styles that are appropriate to the structure of communities, and the role of leaders in community development. 34,35,40

Limitations
In this study participants were faculty members, which limits the external validity and generalizability of the results to other members of the TUMS.Another limitation of this study was the lack of confirmatory factor analysis to confirm the results of the EFA.Therefore, it is necessary to conduct studies comprising other members of this university and to confirm the results of this study using other psychometric methods.

Conclusion
The results of this study indicate that the designed tool is a standard and valid tool for measuring the CoPs at the TUMS, because it was designed with all the components of the CoPs and the local environment of this university.

Table 1 .
CVR and CVI of questionnaire

Table 2 .
Exploratory factor loadings of Components