Development and psychometric properties of the Individualized Care Scale

RATIONALE, AIMS AND OBJECTIVES: In this study we describe the development of the Individualized Care Scale (ICS) and evaluate its validity, psychometric properties and feasibility. The ICS was designed to measure patients' views on how individuality is supported through specific nursing interventions (ICA) and how they perceive individuality in their own care (ICB) during hospitalization. METHOD: Three different data sets were collected among patients being discharged from hospital (n1 = 203, n2 = 279, n3 = 454). This bipartite 38-item ICS promises to be a brief, timely, easy to administer and useful self-completion measure for evaluating clinical nursing practice from the patient's point of view. RESULTS: The findings supported the internal consistency reliability of the ICS (alpha 0.94 for ICA and ICB 0.93) and the three subscales (alphas 0.85-0.90). Item analysis supported the item construction of each scale. Content validity was furthered by a critical literature review and four expert analyses. Principal component analysis (Promax with Kaiser normalization) among earlier factor analyses supported construct validity by generating a three-factor solution which accounted for 65% of the variance in the ICA and 61% in the ICB. Pearson's correlation coefficients were at least 0.88 between the subscales and the total domain ICA or ICB. CONCLUSIONS: The ICS has demonstrated promise as a tool for measuring patients' evaluations of their hospital experience and individuality in care.     

Assessing psychosocial distress in diabetes: development of the diabetes distress scale

OBJECTIVE: The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. RESEARCH DESIGN AND METHODS: In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158). RESULTS: Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001). CONCLUSIONS: The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.     

Black and Latina womens' AIDS related knowledge, attitudes, and practices

As part of a larger study designed to provide an AIDS education and prevention program for low-income black and Latina women in Los Angeles County, a pilot study of black (n = 51) and Latina (n = 56) womens' AIDS related knowledge, attitudes and practices was conducted to gather baseline data and to test an instrument that would measure these variables. The factors underlying the instrument were identified and reliability coefficients were determined. The need for changes in the format and administration of the instrument was identified due to nonresponse to some items. There were sociodemographic differences between the two groups of women as well as differences in knowledge and attitudes. In general, black women had more knowledge of AIDS than Latina women and more positive attitudes. Practices did not differ. Both groups denied drug use and multiple sexual partners.     

The Health Self-Determinism Index for Children

A convenience sample of 501 children 7 to 13 years old completed the newly developed Health Self-Determinism Index for Children (HSDI-C), a measure of intrinsic motivation in health behavior. Construct validity was supported through the factorial isolation of four theory-consistent subscales, and the correlation of the total HSDI-C (r = .36, p less than or equal to .009) with a general measure of intrinsic motivation. Alpha coefficients in three separate trials ranged between .79 and .88 for the total scale, and .78 to .88, .87 to .92, .78 to .86, and .63 to .77 on the respective subscales. Test-retest reliability for the total scale was .83 at 2 weeks and .48 at 1 year. A nominated population of 21 third- through seventh-grade children known to practice positive health promotion behaviors had an HSDI-C mean score of 106.5 versus 76.5 in the general sample of children.     

Development of a diabetes diet-related quality-of-life scale

OBJECTIVE: The purpose of this study was to assess the reliability and validity of the Diabetes Diet-Related Quality-of-Life (DDRQOL) scale, which is a measure of the influence of diet therapy on patients' quality of life (QOL). RESEARCH DESIGN AND METHODS: Patients with type 2 diabetes (n = 236) who were being treated on an outpatient basis were asked to complete the self-administered DDRQOL instrument. The factor validity, convergent and discriminant validity, internal consistency, and reproducibility of the DDRQOL scale were then assessed. Spearman's rank correlation coefficients among the DDRQOL scale and each of the SF-36 subscale scores were calculated to evaluate its convergent and discriminant validity. RESULTS: Based on the results of the factor analysis, the following seven subscales were adopted for the DDRQOL: "satisfaction with diet," "burden of diet therapy," "perceived merits of diet therapy," "general perception of diet," "restriction of social functions," "vitality," and "mental health." As hypothesized, the DDRQOL scale was associated with each of the SF-36 subscales, with convergent and discriminant validity being generally exhibited. Cronbach's alpha-coefficient was between 0.71 and 0.84, suggesting strong internal consistency. The intraclass correlation coefficient of the subscales, with the results of a test-retest conducted 2 weeks later, was between 0.46 and 0.75, suggesting some degree of reproducibility. CONCLUSIONS: These findings indicate that the DDRQOL scale has a reasonable degree of reliability and validity, and its application for the assessment of the needs of a patient's diet and the evaluation of diet education with regard to QOL is awaited.     

A quality of life instrument for adolescents with chronic headache

We developed a generic Quality of Life (QL) measurement scale for adolescents between 12 and 18 years of age, primarily for use on youngsters with chronic headaches or migraine. The Quality of Life Headache in Youth (QLH-Y) is a 71 item (69 multiple choice items and two visual analogue scales) QL measurement scale. It assesses an individual's QL in six QL subdomains. Study 1 ( n = 223) was aimed at item selection and scale construction. Thirteen subscales were developed to cover the four QL subdomains Psychological Functioning, Functional Status, Physical Status and Social Functioning. The QL subdomains satisfaction with life in General and Satisfaction with Health were covered by two visual analogue scales. Internal consistency of nearly all the subscales was satisfactory. Study 2 ( n = 159) was conducted to evaluate the validity and stability of the QLH-Y. Indications for parent-youth agreement, construct validity and sensitivity for headache and migraine were obtained. Stability coefficients were between 0.47 and 0.72 for the 1-week interval and between 0.31 and 0.60 for the 6-month interval. Nearly all of the QLH-Y subscales appeared to be more sensitive to differences between subjects with headaches and headache-free subjects, while the QL subdomain Functional Status was most sensitive for subjects who had suffered from a recent headache.     

Scale to measure patient satisfaction with physical therapy

BACKGROUND AND PURPOSE: Patient satisfaction can be one indicator of quality of care. In this study, a patient satisfaction questionnaire for physical therapy was developed. SUBJECTS: The subjects were a consecutive sample of 1,024 patients who received physical therapy between January and March 1999 at a teaching hospital in Geneva, Switzerland. METHODS: A cross-sectional mail survey was conducted in which a structured questionnaire measuring patient satisfaction with various aspects of physical therapy followed by open-ended questions was sent to the subjects. RESULTS: Overall, 528 of 1,024 patients (52%) responded (patient demographics for 501 respondents who provided demographic data: mean years of age=58.6, SD=18.9, range=15-95; 258 men, 243 women). Factor analysis was used to identify main domains of satisfaction, and a scale was constructed to measure satisfaction with each dimension: treatment subscale (5 items), admission subscale (3 items), logistics subscale (4 items), and a global assessment subscale (2 items). All subscales had good acceptability and small floor and ceiling effects. Internal consistency coefficients varied between.77 and.90, indicating good reliability for all subscales. Scale validity was supported by a logical grouping of items into subscales, according to their content, and by correlations of satisfaction scores with the patient's intention to recommend the facility and with the number of positive and negative comments to open-ended questions. Younger patients were less satisfied than older patients for 2 of the subscales (admission and logistics). DISCUSSION AND CONCLUSION: The 14-item instrument is a promising tool for the evaluation of patient satisfaction with physical therapy in both inpatients and outpatients.     

Measuring the violence prevention climate: Development and evaluation of the VPC-14

BackgroundViolence and aggression are common in inpatient mental health hospital settings and cause problems for staff, patients and organisations. An important factor in treatment efficacy is ward atmosphere, and one element of this is the violence prevention climate.ObjectivesTo develop and test the psychometric properties of a new scale to measure perceptions of the violence prevention climate among staff and patients in mental health inpatient settings.DesignScale development and cross-sectional validation study. Setting and participants: Three hospital sites within an independent sector provider of secure mental health care. Participants were patients and staff residing in/working on wards in the adult male and female mental health care pathways.MethodsThe study was conducted in three stages: scale development, pilot testing and psychometric evaluation. The scale items were developed from systematic literature review, informant interviews (staff) and focus groups (patients) and expert review. The resulting scale was subject to pilot testing with staff and patients (n = 58 and n = 25). The reliability and validity of the scale was examined by administering it to 326 staff and 95 patients. Exploratory factor analysis was used to establish construct validity, and this was further assessed with Rasch modelling. Internal consistency was assessed by calculation of Cronbach's alpha coefficients. Convergent and discriminant validity were measured by comparing results with existing validated instruments. Temporal stability of the items was assessed using test-retest reliability coefficients.ResultsThe VPC-14 is a 14-item scale demonstrating good psychometric properties. Exploratory factor analysis revealed two subscales, staff actions and patient actions, each demonstrating good internal consistency (Cronbach's alpha .89 and .76). All items demonstrated good temporal stability. Rasch modelling confirmed the unidimensionality of the two subscales, and items demonstrated high construct validity. Moderate correlations were found between subscales of the VPC-14 and the EssenCES, whilst no correlations were found with items in the ACMQ, thus demonstrating good convergent and discriminant validity.ConclusionThe VPC-14 is currently the most robust available measure of the inpatient violence prevention climate. It is quick and easy to administer, considers views of both staff and patients and thus can be introduced as standard practice in a ward setting. Potential uses include tracking the violence prevention climate longitudinally and in evaluation of new policy and procedural interventions.     

Translation and validation of champion's health belief model scale with Korean women

The Champion's Health Belief Model Scale (CHBMS) is a reliable and valid instrument developed for American women to measure beliefs about breast cancer and breast self-examination. The purpose of this study is to translate the CHBMS into Korean and to validate the scale among Korean women. The CHBMS was translated using a back-translation technique. A convenience sample of 264 women was recruited from a continuing education center, a community health center, and a university in 3 South Korean cities. The participants were asked to complete the translated Korean version of the CHBMS questionnaire. The data obtained were analyzed using a principal component analysis with varimax rotation for construct validity. Loading criterion was set at.45. Cronbach's alpha was computed for the reliability of the scale. From the analysis, two items from the Benefits domain and four items from the Motivation domain were deleted from the original scale. Thus, the final Korean version of the CHBMS (CHBMS-K) consisted of 36 items that were clustered to 6 subscales: susceptibility (5 items), seriousness (7 items), benefits (4 items), barriers (6 items), confidence (11 items), and motivation (3 items). Cronbach's alpha reliability coefficients for the 6 subscales ranged from.92 to.72. The CHBMS-K was found to be reliable and valid in scale for use with Korean women. It can be used in planning and testing interventions to improve breast self-examination beliefs and practice.     

Psychometric Characteristics of the Headache-Specific Locus of Control Scale

Martin and colleagues have described their development of a Headache-Specific Locus of Control scale (HSLC) which contains 11 items for each of its three subscales: internal, health care professional, and chance orientations. In this replication study, we gathered data from patients who came to a Headache Clinic in a medical center (n = 151) and from a comparison sample (n = 192). Factor analysis and alpha coefficients were similar to those reported by Martin. Only small correlations were found between the subscale scores although some of them were statistically significant. This suggests that the HSLC is a psychometrically competent instrument. Additionally, mean scores of its three subscales differentiated the patient population from those whose headaches were less severe and thus did not seek help.     

Effects of a CD-ROM educational program on sexual knowledge and attitude

This study evaluated a CD-ROM educational program in sexual violence prevention for middle school students. A randomized control-group pretest-posttest design was used. Seventy-nine students were randomly assigned to either an experimental (n = 39) or control (n = 40) group. The experimental group watched the CD-ROM, whereas the control group did not. Both groups were pretested for the levels of knowledge and attitude about sexual violence prevention prior to intervention. A CD-ROM titled Educational Program for the Prevention of Sexual Violence was used for the intervention. The instrument contains 32 true-false items that measure knowledge level and 20 items comprising a four-point Likert-type scale that measure the attitude to sexual violence. There was a significant increase in knowledge in the experimental group, while no differences on attitude were found between the experimental and control groups. A CD-ROM-based program can be effective for delivering instructions on sexual violence prevention in the classroom.     

The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy

OBJECTIVE: The purpose of this study was to assess the validity, reliability, and utility of the Diabetes Empowerment Scale (DES), which is a measure of diabetes-related psychosocial self-efficacy. RESEARCH DESIGN AND METHODS: In this study (n = 375), the psychometric properties of the DES were calculated. To establish validity, DES subscales were compared with 2 previously validated subscales of the Diabetes Care Profile (DCP). Factor and item analyses were conducted to develop subscales that were coherent, meaningful, and had an acceptable coefficient alpha. RESULTS: The psychometric analyses resulted in a 28-item DES (alpha = 0.96) with 3 subscales: Managing the Psychosocial Aspects of Diabetes (alpha = 0.93), Assessing Dissatisfaction and Readiness To Change (alpha = 0.81), and Setting and Achieving Diabetes Goals (alpha = 0.91). Consistent correlations in the expected direction between DES subscales and DCP subscales provided evidence of concurrent validity. CONCLUSIONS: This study provides preliminary evidence that the DES is a valid and reliable measure of diabetes-related psychosocial self-efficacy. The DES should be a useful outcome measure for various educational and psychosocial interventions related to diabetes.     

Psychometric qualities of the coping response inventory-youth form

This study examined the psychometric qualities of the Coping Response Inventory-Youth (CRI-Y) form. Participants were 376 females and 248 males (age 15.9 + 1.0 year) recruited from four rural high schools in Western Pennsylvania who completed the CRI-Y as part of the instrument battery of a longitudinal study. Exploratory factor analysis was conducted to examine the factorial validity of the CRI-Y scale, and reliability coefficients were examined to address the reliability of the scale. The eight subscales of CRI-Y exhibited low to moderate reliability coefficients (from .47 to .70). The approach, avoidance, cognitive, and behavioral coping domains and total CRI-Y showed good reliability coefficients (.81, .87, .85, .84, and .91, respectively). Factor analysis of CRI-Y subscales exhibited a unidimensionality of the subscales with a one-factor solution explaining 28%-40% of the total variance.     

Validation of a Swedish version of the Cancer Dyspnea Scale

The Cancer Dyspnea Scale (CDS) is a multidimensional measure of dyspnea experience, with three subscales related to sense of effort, sense of anxiety and sense of discomfort, and a total score. In this study, we evaluated the validity and reliability of a Swedish version, the CDS-S, in 99 patients with advanced lung cancer who were not receiving curative or life-prolonging treatments. Criterion-related validity was demonstrated by significant group differences in CDS-S scores when patients were stratified by dyspnea intensity, as measured by a visual analogue scale (VAS-D). Correlations between the total CDS-S score and other dyspnea scales varied between 0.63 and 0.68. Convergent validity was shown by comparing the CDS-S subscales with conceptually related measures of physical and emotional function and discomfort, and correlations ranged from 0.34 to 0.57. The CDS-S captured the psychological dimension of dyspnea better than did the VAS-D. Internal consistency of the CDS-S scales was confirmed by Cronbach's alpha coefficients ranging from 0.81 to 0.90. The CDS-S was well received by the patients and completed in 2 minutes. This study supports the CDS as a valid and reliable instrument to measure dyspnea experience in a palliative setting, well suited for use in research as well as in clinical practice.     

Evaluation of stroke patients with the extended activities of daily living scale in Taiwan

PURPOSE: This study examined the construct validity of the Nottingham Extended Activities of Daily Living scale (EADL) in stroke patients in Taiwan. METHODS: The EADL and the Barthel Index were administered via telephone interview. Minor revisions were made for the EADL to reflect cultural differences and the recommendations of two previous studies on the use of EADL. One hundred and fifty three stroke patients from the community participated in the study. RESULTS: Two items, 'make hot snack' and 'write letters', were deleted from the EADL because they appeared to be of little discriminative value. The results suggest that a changed hierarchical order was present among the domestic and leisure subscales. All of the subscales, then, fulfilled the Guttman scaling criteria (coefficient of reproducibility > 0.9, coefficient of scalability > 0.6). The scores of the revised EADL were significantly related to age and the Barthel Index scores (Spearman correlation coefficients = -0.41 and 0.69, respectively, p < 0.001). There was no significant difference between the overall scores of men and women (median = 10, 10, respectively, Mann-Whitney U test, p = 0.67). CONCLUSION: These data support the validity of the EADL with minor modifications in the evaluation of the functional performance in stroke patients in Taiwan and confirm it to be a useful outcome measure in stroke research.     

The Life Closure Scale: a measure of psychological adaptation in death and dying

The Life Closure Scale (LCS) is a measure of the multidimensions of psychological adaptation during the dying process and was developed in two phases. The first phase of instrument construction was based on a retroductive method utilizing: theoretical and empirical sources, a small qualitative study and analysis of concept definitions. Three subscales identifying dimensions of psychological processes and patterns of adaptation were defined: the self-reconciled, self-restructuring, and self-closing. A corrected content validity of .83 was established by a panel of experts. The LCS scale of 45 items was devised into a 5 point Likert scale with responses from 1 (not at all) to 5 (most of the time). Phase two began a study, with 45 hospice subjects, to determine internal consistency reliability and construct validity. On preliminary testing with 20 subjects, the self-closing subscale was found to interrelate with the other two subscales. An intercorrelation of r = -.10 defined the presence of two independent subscales: the self-reconciled and the self-restructuring. Internal consistency reliability coefficients of a = .85 for the self-reconciled subscale and a = .86 for the self-restructuring subscale. Construct validity is reported for the LCS. A Pearson correlation coefficient of r = .75 was found between the LCS and the convergent measure of quality of life and an r = -.60 substantiated discriminant validity with a depression tool. Plans for tool development include further testing.     

Development and refinement of an instrument to measure hope

This article describes the development and psychometric evaluation of a measure designed to evaluate hope in adults, the Herth Hope Scale, which was completed by 180 cancer patients, 185 well adults, 40 well elderly and 75 elderly widow(er)s. The alpha reliability coefficients for the total scale ranged from .75 to .94 with a three-week test-retest reliability of .89 to .91. A negative correlation (r = -.69) was found between the Herth Hope Scale and the Beck Hopelessness Scale. The multidimensionality of the construct was supported through the factorial isolation of three subscales: temporality and future, positive readiness and expectancy, and interconnectedness. These three factors accounted for 58% of the total variance in the measure. With refinement, this measure should enable exploration of the antecedents and correlates of hope in diverse adult populations. Further, hope enhancing strategies could be identified and examined for their ability to alter hope states.     

A Spanish language version of the Health-Promoting Lifestyle Profile

The development and initial psychometric evaluation of a Spanish language version of the Health-Promoting Lifestyle Profile (HPLP) is described. The 48-item instrument was translated into Spanish and found to be culturally relevant and reliable in a pilot study. The Spanish version was then administered to a diverse but predominantly Mexican-American group of 485 Hispanics residing in metropolitan and surrounding rural areas. In a principal components factor analysis, all but one item loaded significantly on six factors similar to those isolated previously during psychometric assessment of the English language version. Those six dimensions comprise the HPLP subscales of self-actualization, health responsibility, exercise, nutrition, interpersonal support, and stress management. The six factors explained 45.9% of the variance in the measure. Second-order factor analysis yielded a single factor, interpreted as health-promoting lifestyle. The alpha reliability coefficient for the total scale was .93 and 2-week test-retest reliability was .86; alpha coefficients for the subscales ranged from .70 to .87.     

Reliability and validity of the work assessment scale for persons with multiple sclerosis

Reliability and validity of the Work Assessment Scale (WAS) was done on a sample of 551 subjects with multiple sclerosis. Work was defined as those activities performed in employment, homemaking and/or personal care. The WAS has two parts consisting of: Work-Impeding (WAS-I) and Work Enhancing (WAS-E) situations and conditions. Varimax rotated factor analysis of the WAS-I resulted in a seven-factor solution containing 33 of the 53 scale items. Theta reliability coefficients for the factors ranged between .73 and .90 and test-retest correlation coefficients (n = 51) ranged between .76 and .91. Varimax rotated factor analysis of the WAS-E resulted in a five-factor solution containing 19 of the 27 scale items. Theta reliability coefficients for the factors ranged between .66 and .81 and test-retest correlation coefficients ranged between .68 and .82. Concurrent validity was shown between WAS and both ADL and Symptom subscales.     

Reliability and validity of the Japanese version of the short questionnaire to assess health-enhancing physical activity (SQUASH) scale in older adults

[Purpose] We tested the reliability and validity of the Japanese version of the Short Questionnaire to Assess Health-enhancing Physical Activity scale in asymptomatic older adults and sought to confirm discriminator validity in women with osteoarthritis. [Subjects] The participants included an asymptomatic comparison group (men and women) and women with knee or hip osteoarthritis. [Methods] The test-retest method was used to assess reliability. The International Physical Activity Questionnaire was chosen to assess criterion-related validity. Discriminator validity was assessed by comparing the asymptomatic and osteoarthritis groups. [Results] Mean age for the asymptomatic groups was 63 ± 6 years for men (n = 23) and 61 ± 7 years for women (n = 51), and it was 63 ± 9 years for the osteoarthritis group (n = 32). The total score and scores for all items, except for heavy housework items, were significantly correlated with the retest. Criterion-related validity showed significantly weak to moderate correlations between the respective scale categories. For discriminator validity, the total scores and scores for bicycle commuting, light housework, and three leisure items differed significantly between the asymptomatic and osteoarthritis groups. [Conclusion] The Short Questionnaire to Assess Health-enhancing Physical Activity scale is a reliable and valid measure in asymptomatic older adults, and can discriminate between osteoarthritic and asymptomatic women.Key words: Physical activity scale, Older adults, Osteoarthritis