Climate, Health, and Nursing Tool (CHANT)

NURSING SCIENCE

Climate, Health, and Nursing Tool (CHANT): A confirmatory factor analysis

Article Review by Pinky Shani, PhD, MSN, RN, NE-BC, Nurse Scientist, Houston Methodist West

Title:

Climate, Health, and Nursing Tool (CHANT): A confirmatory factor analysis

Published: March 2023 in Public Health Nursing

Level of Evidence: Level III

What was the purpose?

Limited research addresses nurses’ perceptions, awareness, and actions related to climate change. The Climate, Health, and Nursing Tool (CHANT) was initially developed and tested in 2017 to address the gap in nurses’ knowledge, motivation, and behavior on environmental health. This study aimed to continue the scale development process of the 22-item, Likert-type CHANT survey assessing Awareness, Concern, Motivation, and Behavior by confirmatory factor analysis.

What was the population studied?

The sample consisted of 489 nurses from 35 states in the US and 12 nations with a mean age of 35.33 (15.34). The sample consisted of 95% US nurses, 90% women, and 85% White. Nurses included Licensed Practical Nurses, Bachelor of Nursing students, Registered Nurses, and Advanced Practice Registered Nurses with a mean (SD) years of nursing experience of 12.12 (14.61).

Was the setting comparable to Houston Methodist? Were the nurses like our nurses?

The setting and population of nurses were not comparable to those at Houston Methodist, as it included several hospitals.

Did they use appropriate methods?

The authors incorporated several methods to complete the confirmatory factor analysis of the CHANT tool. Descriptive statistics, including means, standard deviations, skewness, and kurtosis scores, were calculated for all CHANT items and presented in Table 1 of the article. Confirmatory factor analysis was conducted to test the five-factor measurement model using the Full Information Maximum Likelihood Robust estimation. Overall model fit was evaluated using several fit indices, including the chi-square statistic, robust comparative fit index, robust root mean square error of approximation, and the robust standardized root mean square residual. Finally, Cronbach’s α was used to test the scale's reliability, with ≥ 0.70 indicating a reliable instrument.

What were their findings?

Descriptive statistics and item-level factor loadings of the 5-factor CHANT model were included in Table 1 of the article. Factors analyzed included Awareness, Concern, Motivation, Behavior at Home, and Behavior at Work. The five CHANT subscales are a reliable tool with Cronbach’s α ranging from 0.67 to 0.91. In addition, the five-factor model of CHANT demonstrated good fit, x2(199) = 582.747, p < .001, CFI = 0.94, RMSEA = 0.06, and SRMR = 0.04. The authors included the results of the factor correlations within Table 2. All correlations were statistically significant at p < 0.001 and ranged from 0.25 to 0.72 (Table 2).

Do their findings make sense?

Yes, the findings aligned with the purpose of the study.

How did things change?

The CHANT scale addresses the gap in the literature about nurses’ responses to climate change. Originally, CHANT began as a tool focused on nurses, but it has since expanded to include all health professionals. Furthermore, the authors indicated that CHANT has been used in over 30 nations and translated into five languages in addition to English.

How is this important for nursing?

Nursing has an imperative role in addressing the challenges related to environmental changes. Nurses should advocate for and prepare patients and communities to address the impacts of climate change, as it is associated with chronic disease, housing, food insecurity, community resilience, and empowerment. CHANT is a reliable and robust instrument measuring awareness, concern, motivation, home, and work behaviors regarding climate change and health among nurses and health care professionals. This can then further inform nursing research, education, practice and advocacy.

References:

Winquist A, Schenk EC, Cook C, Demorest S, Burduli E. Climate, Health, and Nursing Tool (CHANT): A confirmatory factor analysis. Public Health Nurs. 2023 Mar;40(2):306-312. doi: 10.1111/phn.13161. Epub 2022 Dec 15. PMID: 36519942.

Schenk EC, Cook C, Demorest S, Burduli E. Climate, Health, and Nursing Tool (CHANT): Initial survey results. Public Health Nurs. 2021 Mar;38(2):152-159. doi: 10.1111/phn.12864. Epub 2021 Jan 11. PMID: 33427325.

Schenk EC, Cook C, Demorest S, Burduli E. CHANT: Climate, Health, and Nursing Tool: Item Development and Exploratory Factor Analysis. Annu Rev Nurs Res. 2019 Dec 23;38(1):97-112. doi: 10.1891/0739-6686.38.97. PMID: 32102957.