Conceptual development of an instrument to measure the internalized stigma of AIDS based on the Roy adaptation model

In this column the author describes the development of an instrument to measure internalized stigma of HIV/AIDS based on the self-concept adaptive mode of the Roy adaptation model. The Internalized Stigma of AIDS Tool is a 10-item instrument that is derived from the physical self (body sensation and image) and personal self (self-consistency, self-ideal and moral-ethical-spiritual self) as set forth by Roy. An overview of the Roy adaptation model and the theory of the person as an adaptive system illustrates how this instrument was derived.     

男男HIV/AIDS患者自我歧视的影响因素研究

目的了解男男HIV/AIDS患者自我歧视现状及影响因素。方法选取北京市2所医院277例男男HIV/AIDS患者,采用艾滋病自我歧视量表、刻板印象量表和医疗社会支持量表对其进行问卷调查,利用多元线性回归分析结果确立自我歧视的影响因素。结果男男HIV/AIDS患者自我歧视处于中等偏高水平,年龄、刻板印象及信息与情绪支持为自我歧视主要影响因素。结论可通过认知行为治疗改善其对自身的负性刻板印象,同时增加社会支持力度,从而更好地应对男男HIV/AIDS患者的自我歧视。     

Development of an instrument to measure hope

The purpose of this study was to develop an instrument to measure hope in adults and to evaluate its psychometric properties. A 40-item Miller Hope Scale (MHS) was developed based on critical elements of hope revealed in a comprehensive review of the literature and on an exploratory study of hope in persons who survived a critical illness. The instrument was critiqued by measurement and content experts, and content validity was established. The MHS was pretested on 75 subjects. The refined instrument was next evaluated using 522 healthy adults. The intent was to establish norms on the instrument before using it on ill subjects. The range of scores on the MHS is 40 to 200, with high scores indicating high hope. Mean hope score for this healthy sample was 164.46 (SD = 16.31). A leptokurtic curve, skewed to the left, was noted in these responses. As expected, the instrument detected high hope in individuals who were screened to have no physical or mental health problems. The internal consistency alpha coefficient was .93 with a 2-week test-retest reliability of .82. Criterion-related construct validity was established by correlating the MHS to the Psychological Well-Being Scale, r = .71, the Existential Well-Being Scale, r = .82, and a 1-item hope self-assessment, r = .69. Divergent validity with the Hopelessness Scale was established, r = -.54. Maximum likelihood factor analysis with oblimin rotation resulted in a three-factor solution: I, Satisfaction with Self, Others, and Life; II, Avoidance of Hope Threats; and III, Anticipation of a Future.     

HIV/AIDS awareness in those diagnosed with mental illness

The spread of human immunodeficiency virus (HIV) continues to increase among the general population. Previous studies in this field focused mainly on the 'at-risk' groups such as homosexuals, prostitutes, intravenous drug users, bisexual men and women. Mentally ill men and women remain one of the subgroups understudied and yet continue to show disproportionately high levels of seroprevalence. The purpose of this study was to elucidate awareness of the risk factors associated with HIV transmission and development of AIDS in those diagnosed with mental illness. Using questionnaires, information regarding HIV method of transmission, knowledge on HIV/AIDS and at-risk behaviour awareness was obtained from 30 subjects in an acute psychiatric mental health unit (13 women and 17 men). Significant association between different variables was determined at 95.5% confidence level (P=0.05). Assessment of HIV/AIDS awareness and at-risk behaviour awareness revealed significant knowledge deficit among this subject group. The outcome of this study underscores the need to introduce intervention programmes tailored to individual needs of the mentally ill. Measures such as 'at-risk sexual' behaviours should be incorporated into the current assessment process or profile so that accurate information and informed judgement can be reached regarding client or patient sexual behaviour.     

HIV感染者和AIDS患者病耻感的研究进展

从HIV感染者和艾滋病患者病耻感的测评工具、影响因素以及干预措施3个方面进行综述,旨在通过理论依据的总结,以期促进病耻感临床相关干预措施的实施。     

Development of an Instrument to Measure Internalized Stigma in Those with HIV/AIDS

Stigma has grave consequences for persons living with HIV/AIDS. Stigma hampers prevention of HIV transmission to sexual partners and to unborn babies, diagnosis, and early treatment, and negatively affects mental and physical health, quality of life, and life satisfaction. Internalized stigma of HIV/AIDS may have even more severe consequences than perceived or enacted stigma. The purpose of this study was to develop an instrument to measure internalized stigma in those with HIV/AIDS.

Data were drawn from the Rural Women's Health Project. Research assistants administered structured interviews at baseline, 3 months, and 6 months. Instruments used in these analyses included a demographic data form, the Centers for Epidemiological Studies Depression Scale (CES-D), the Perceived Stigma Scale (PSS), and the Internalized Stigma of AIDS Tool (ISAT). Exploratory factor analysis confirmed that the ten items of the ISAT measure a single factor that explains 88% of the variance in the construct. Internal consistency was demonstrated by a Cronbach's alpha of .91 (Time 1), .92 (Time 2), and .92 (Time 3). Convergent validity was supported with significant positive correlations with the CES-D (rho = 0.33, p < 0.0001) and the PSS (rho = 0.56, < 0.0001). The Internalized Stigma of AIDS Tool appears to be a reliable and valid instrument to measure internalization of the stigma of HIV/AIDS. It may be of value in research and clinical assessment.     

Development of an instrument to measure technological caring in nursing

Twenty-seven statements make up the Technological Caring Instrument (TCI) which was developed to measure technological caring in nursing. In order to establish a database and its reliability and validity, responses were generated from 193 professional nurses who participated in the study. The results indicate that the TCI has a high internal consistency, construct validity, and sufficient split-half reliability. Cronbach's alpha was 0.8129 with split-half alpha of 0.666 for 14 items in Part 1 and 0.828 for 13 items in Part 2. Significant differences were found between factors (F = 97.0199, P = 0.0000). Factor analysis identified eight items with the first factor revealing nine cluster statements with values of 0.51–0.84. The second factor had two cluster statements with 0.75 and 0.74 values. The independent sample t -test results demonstrated the influence of education, area of expertise, and years of experience on the technological caring of registered professional nurses. The utilization and continued investigation of TCI are suggested.     

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.     

HIV/AIDS stigma among older PLWHA in south rural China

Stigma is a common problem among people living with HIV/AIDS (PLWHA). However, little is known about HIV/AIDS‐related stigma in older PLWHA over the age of 50. This study described the stigma of HIV/AIDS and its factors based on 120 PLWHA aged 50 or older in an area of high HIV prevalence in south rural China. Each participant completed a face‐to‐face questionnaire that collected information on demographic characteristics, AIDS‐related events and experience of HIV/AIDS‐related stigma. Finally, only 18.1% reported experiencing external stigma compared with 64.3% feeling internal stigma. Regression analysis indicated that social support and health status were the two variables that were significantly predictive of both external and internal stigma. Whatever, the more support were received from family members by PLWHA, the less external stigma was perceived. Negative marital situation was also related to external stigma. Reducing HIV/AIDS stigma requires a supportive environment, positive attitude and correct knowledge of AIDS. Health workers and policy makers should take practical approaches to reduce prejudice.     

Development of an instrument to measure stress in the older adult

The purpose of this study was to develop and carry out initial psychometric evaluation of a tool to measure stress in adults 65 years of age and older. The universe of stressors for this age group was elicited from 25 older adults, a literature review, and consultations with gerontological nursing experts. The stressors were ranked and weighted, using a Q-sort, by a sample of 43 adults 65 and over, resulting in the Stokes/Gordon Stress Scale (SGSS). The instrument was evaluated using reliability and validity measures. Test-retest reliability estimates yielded a Pearson's r ranging from .98 to .90. Coefficient alpha was .86. Pearson's r in a 1-year test of predictive validity was .36, p = .014; in tests of concurrent validity correlations ranged from .65 to .81. The SGSS can be used for clinical and research purposes to aid in assessing and planning care for the older individual.     

Development of an instrument to measure job satisfaction among dentists

Because of the rapid changes that have occurred in the dental profession, the Dentist Satisfaction Survey (DSS) was developed to assess both facet and overall job satisfaction among dentists. The DSS was administered to a sample of 558 California general dentists. The results suggest that the DSS is a practical, reliable, and valid measure of dentists' job satisfaction. Internal consistency reliability coefficients for all facet subscales and the overall job satisfaction scale ranged from 0.60-0.92. The DSS discriminated between groups of dentists known to have different levels of job satisfaction; dentists identified by dental society presidents as being very dissatisfied scored significantly differently in the hypothesized direction on the DSS. A high correlation (r = 0.68) was found between judges' independent ratings of dentists' satisfaction based on their open-ended comments and DSS scores. While the majority of respondents were satisfied with most facets of their jobs, substantial variation was found among dentists in their levels of satisfaction.     

Development and validation of an instrument to measure nurse-patient bonding

Background

Most instruments on nurse-patient relationship determine the caring behavior of the nurse, but have minimal consideration of the patient's role in the interaction. Moreover, it is the patients that complete many of those instruments, thus leaving out the perspective of the nurse. There is then a need to account for the contributions that both the nurse and the patient bring into their encounter where bonding is formed.

Objective

This study aimed to develop and validate an instrument that determines the degree of bonding between nurse and patient based on their openness to each other and their engagement in patient care.

Settings

Data were collected from nurses and patients in the wards of four public and private tertiary hospitals in Manila, Philippines, where most Filipino nurses render care to patients before getting employed in other countries.

Participants

A total of 420 nurses and patients (i.e., 210 dyads) participated in this research conducted in 2008. Most of the nurses were young females with beginning clinical experience, while the patients had a wider age range with the majority having no college education and no employment.

Methods

The Nurse-Patient Bonding Instrument (NPBI), which dimensions were generated from qualitative observations and interviews, and corroborated by literature, was validated at the bedside setting. To determine interrater reliability, two trained raters unobtrusively observed actual nurse-patient interactions and ticked on the NPBI behavioral indicators of openness and engagement. Construct validity was established using known-groups technique. Moreover, bonding score was correlated with patient satisfaction for predictive validity.

Results

Reliability ranged from r = .80 to .95 (p < .01). Factor analysis demonstrated that the subscale scores of patient openness, nurse openness, patient engagement, and nurse engagement all loaded on one factor, the bonding factor, demonstrating a unified structure of the NPBI. Nurses and patients had higher bonding scores in interactions of longer duration than shorter duration, controlling for number of previous encounters. This provided evidence for construct validity using known-groups technique. The NPBI was likewise shown to distinguish groups based on age, education, and civil status. Patient satisfaction correlated positively with bonding score, providing evidence suggestive of the predictive validity of the NPBI.

Conclusion

The NPBI was shown to be a reliable and valid tool for assessing nurse-patient bonding, and can possibly predict patient satisfaction. The openness and engagement of nurse and patient were demonstrated to result in a structure, a nurse-patient dyad. This finding invites further investigations on the characteristics and development of this dyad.     

艾滋病相关羞辱与歧视的研究

自1981年美国首次发现并确诊第1例艾滋病起,艾滋病(AIDS)相关的羞辱与歧视就相应产生了。Mann[1]曾于1987年将艾滋病的流行分为3个阶段:HIV感染的流行、AIDS的流行以及艾滋病相关羞辱与歧视的流行,并强调其中第3个阶段是全球艾滋病面临疾病自身挑战的关键时期。艾滋病相关羞辱与歧视的存在,很大程度上阻碍了社区、国家、乃至全球艾滋病防治工作的开展[2],消除羞辱与歧视已成为控制HIV感染和AIDS流行的核心问题[3]。我们从羞辱与歧视的定义出发,综述了艾滋病相关羞辱与歧视的现状、产生的原因、对感染者和社会的影响,以及相应的干预…     

Development and validation of an instrument to measure patient satisfaction with pharmacy services

A research program was undertaken to develop and validate a multidimensional measure of patient satisfaction with pharmacy services. A self-administered questionnaire consisting of 44 Likert-type attitudinal items was adapted from the Patient Satisfaction Questionnaire developed by Ware et al. In an iterative scale development process, the adapted questionnaire and its revisions were evaluated in three successive studies conducted on convenience samples (n = 30, 313, 489) of individuals in attendance at family practice clinics in a southwestern city. Methods used to construct multi-item scales measuring separate dimensions of service included principal components factor analysis and item analyses. Acquiescent response set (ARS), the tendency to agree with statements of opinion regardless of content, was measured by the method of matched pairs of items. A partial correlation matrix which controlled for ARS was used as the data in a principal components factor analysis in an effort to reduce the biasing effect of ARS on factor analytic outcomes. Dimensions of satisfaction identified were Explanation, Consideration, Technical Competence, Financial Aspects, Accessibility, Drug Efficacy, OTC (over-the-counter) Product Availability, and Quality of the Drug Product. Questionnaire revision is suggested to confirm the validity of the latter two dimensions Future research should examine the relationship between separate dimensions of satisfaction and other patient attitudes and behaviors, and the convergence between this instrument and other measures of patient satisfaction with pharmacy services.     

Development of an instrument to measure exercise of self-care agency.

The purpose of this study was to develop an instrument to measure a person's exercise of self-care agency. Reliability and validity were established. Content validity was established through a rating of each item of the questionnaire by five nursing experts practicing under the self-care concept. The Adjective Check List and Rotter's Internal-External Locus of Control of Reinforcement Scale were used in establishing construct validity. Subjects consisted of 84 associate degree nursing students and 153 psychology students. Results showed (a) a positive correlation of self-confidence, achievement, and intraception with exercise of self-care agency and (b) a negative correlation between abasement and exercise of self-care agency. The test-retest reliability was .77 for the nursing students; split-half reliabilities were .80 and .81, respectively, for the first and second testings of the nursing students, and .77 for the psychology students.     

Development of an observational instrument to measure mother-infant separation post birth

The importance of the timing, quality, and quantity of early maternal-infant contact has gained prominence over the years. However, no researcher has adequately documented the nature of maternal-infant contact and separation. This study assessed the psychometric properties of the Index of Mother-Infant Separation (IMIS), pronounced "I miss," which is a 37-item observational measure of the process of mother-infant contact or separation post birth. Assessment of reliability and validity of the IMIS was conducted using data collected in a randomized clinical trial with 224 healthy newborn infants assigned at 1 hour post birth to self-regulatory or routine nursery care (control) groups. Time-sampled observations occurred every 15 minutes. Content validity indices of the IMIS, determined by nine nationally known perinatal experts, were 77% to 100% for instrument items. Construct validity was supported through known-groups hypothesis testing (p < .0001). Interrater reliability was from 86% to 90%. The IMIS is a valid observational measure of maternal contact when raters are trained to score it reliably.     

A conceptual model of HIV/AIDS stigma from five African countries

AIM: This paper is a report on the development of a conceptual model delineating contexts and processes of HIV/AIDS stigma as reported by persons living with HIV/AIDS and nurses from African countries. It is part of a larger study to increase understanding of HIV/AIDS stigma. BACKGROUND: Researchers have defined stigma, explored determinants and outcomes of stigma and attempted to measure its multiple dimensions. This literature is difficult to synthesize, and often does not distinguish adequately between experiences of stigma and its causes and outcomes. METHOD: Forty-three focus groups were held with persons living with HIV/AIDS and nurses in five African countries in 2004. Focus group recordings were transcribed and coded. The data were organized into a conceptual model of HIV/AIDS stigma. FINDINGS: Two components were identified in the data: contextual factors--environment, healthcare system, agents--that influence and affect stigma and the stigma process itself. The stigma process included four dimensions: triggers of stigma, stigmatizing behaviours, types of stigma and the outcomes of stigma. CONCLUSION: A conceptual model is presented that delineates the dynamic nature of stigma as reported by study participants. The model may be used to identify areas appropriate for the design and testing of stigma reduction interventions that have a goal of reducing the burden of HIV/AIDS stigma.