Measurement characteristics of the levels of institutionalization scales: examining reliability and validity.

The Level of Institutionalization (LoIn) scales were developed to assess the extent to which a health promotion program has become integrated into a health care organization. The instrument was designed specifically to measure the amount of routinization and niche saturation of four subsystems (production, maintenance, supportive, and managerial) believed to make up an organization. In this study, the LoIn scales were completed for diabetes programs in 102 general hospitals and 30 home health agencies in Maryland and Pennsylvania. Reliability estimates across the four subsystems for routines (alpha = .61) and for niche saturation (alpha = .44) were substandard. Average correlation among the four subsystems for routines was .67, and among the four subsystems for niche saturation was .38, indicating moderate to large amounts of shared variance among subsystems and challenging claims of discriminant validity. Given these large correlations and a poor fit when testing the eight-factor model, higher-order confirmatory factor analyses were carried out. Results supported the existence of two second-order factors. When collapsed into two factors, the reliabilities were adequate (routines alpha = .90; niche saturation alpha = .80). Criterion-related validity also was found between length of program existence and the routine factor.