Professional ethics in pharmacy practice: developing a psychometric measure of moral reasoning

Objective To develop and validate a psychometric measure of cognitive moral development in professional ethics in pharmacy. Setting Pharmacy practice in Australia. Method A psychometric instrument, the Professional Ethics in Pharmacy (PEP) test, was developed and validated following a systematic procedure. The theoretical foundation of the instrument was based on a hypothesised theory of cognitive moral development in professional ethics, which was integrated into a selection of scenarios experienced in practice by pharmacists in NSW, Australia. The PEP, along with the well established DIT test, was mailed in the form of a questionnaire to a randomly selected sample of 1,500 practising pharmacists. Data collected from returned questionnaires were statistically analysed to establish validity and reliability of the instrument. Main outcome measures The P-score calculated for each participant from DIT and PEP data and defined as a measure of principled moral reasoning, represented the main outcome measure for statistical testing. Pearson's correlation coefficient was used to determine the strength of the relationship of the PEP with the DIT (regarded as the "gold standard") in order to establish criterion and concurrent validity. Factor analysis was used to investigate construct validity. Cronbach's Alpha, a measure of reliability of the instrument, was used for indicating internal consistency. Linear regression models further investigated construct validity in relation to predictors of moral reasoning. Results Face and content validity were established by pilot and peer review. Pearson's coefficient of 0.53 indicated an acceptable level of concurrent validity. Factor analysis yielded factors closely related to the theoretical stages of cognitive moral development hypothesised, which indicated construct validity. Cronbach's alpha of 0.75 demonstrated the reliability of the instrument, and linear regression models provided further evidence of construct validity. The PEP was established as a robust instrument on several dimensions of validity and reliability. Conclusion The validated PEP test has the potential to provide the pharmacy profession with valuable information for use education and research. The validation process also provided evidence supporting the hypothesis that moral reasoning in professional ethics in pharmacy is a developmental process, which has profound implications for furthering the understanding of professional behaviour.