Exploring the psychometric properties of the Working Alliance Inventory in general practice: a cross-sectional study

Abstract

Background: Therapeutic alliance is a framework from psychology that describes three components: bond, task and goals. The Working Alliance Inventory adapted for general practice (WAI-GP), measures the strength of the therapeutic alliance between patient and clinician and could be useful in both research and clinical settings. Aim: To determine if the patient score on WAI-GP can delineate the three components and to test concurrent validity with the Consultation and Relational Empathy (CARE) and the Patient Perception of Patient-Centred (PPPC) measure. Design and Setting: A cross-sectional study in twelve general practice waiting rooms in Australia. Method: The research instruments included the 12-item WAI-GP(patient), the CARE and PPPC measures plus a survey of demographics and reason for consultation. To perform a principal components factor analysis of the WAI-GP, we combined this dataset with an existing dataset. We used Spearmen correlations determined concurrent validity between the WAI-GP and the CARE and PPPC. Results: Participants (97-99%) reported a strong positive alliance after the consultation (average WAI-GP mean 4.30 ± 0.62, out of 5,n=142). Factor analysis could not separate the three components (one factor, Eigen value >1; Cronbach’s α=0.957;n=281). Concurrent validity was supported by moderate correlations with the other measures (PPPC rho=-0.51, P <0.005, CARE rho=0.56, P <0.005). Conclusions: We couldn't identify three components, but the WAI-GP has a high internal consistency and concurrent validity with moderate correlations with the CARE and PPPC. A more diverse sample may better distinguish the three components leading to more specific feedback to clinicians on their consultation practice.