Development and Testing of an Instrument to Measure Contextual Factors Influencing Self-Care Decisions Among Adults with Chronic Illness

Abstract Background: Adults with chronic illness frequently experience bothersome symptoms (e.g., pain). Decisions about how to manage these symptoms are complex and influenced by factors related to the patient, their illness, and their environment. The naturalistic decision-making framework describes decision-making when conditions are dynamically evolving, and the decision maker is uncertain because the situation is ambiguous and missing information. The contextual factors influencing decisions include time stress, the perception of high stakes, and input from other individuals, which may facilitate or complicate the decision about the self-care of symptoms. There is no valid instrument to measure these contextual factors. The purpose of this study was to develop and test a self-report instrument measuring the contextual factors that influence self-care decisions about symptoms. Methods: Items were drafted from the literature and refined with patient input. Content validity of the instrument was evaluated using a Delphi survey of expert clinicians and researchers, and cognitive interviews with adults with chronic illness. Psychometric testing included exploratory factor analysis to test dimensionality, item response theory-based approaches for item recalibration, confirmatory factor analysis to generate factor determinacy scores, and evaluation of construct validity. Results: The content validity of the Self-Care Decisions Scale is excellent with all items achieving a content validity index of greater than 0.78 in the Delphi survey of experts (n=12). Adults with chronic illness (n=5) endorsed the relevance, comprehensiveness, and comprehensibility of the instrument during cognitive interviews. Initial psychometric testing (n=431) revealed a 6-factor multidimensional structure that was further refined for precision, and high multidimensional reliability. In construct validity testing, there were modest associations with some scales of the Melbourne Decision Making Questionnaire and the Self-Care of Chronic Illness Inventory. Conclusion: The Self-Care Decisions Scale is a 27-item self-report instrument that measures the extent to which contextual factors influence decisions about symptoms of chronic illness with six scales reflecting naturalistic decision making (external, urgency, uncertainty, cognitive/affective, waiting/cue competition, and concealment). The scale can support research that aims to better understand how adults with chronic illness make decisions in response to symptoms. Additional testing of the instrument is needed to evaluate clinical utility.

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Cross-cultural adaptation and validation of the caregiver contribution to self-care of chronic illness inventory in China: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2021-048875 ◽

2021 ◽

Vol 11 (9) ◽

pp. e048875

Author(s):

Dan Dan Chen ◽

Hui Zhang ◽

Nianqi Cui ◽

Leiwen Tang ◽

Jing Shao ◽

...

Keyword(s):

Factor Analysis ◽

Chronic Disease ◽

Chronic Illness ◽

Content Validity ◽

Self Care ◽

Cross Cultural ◽

The Self ◽

Fit Indices ◽

Validity Index ◽

Cross Sectional

ObjectiveCaregiver contribution (CC) is important for the self-care behaviors of chronic disease individuals, as it could enhance patient outcomes. Therefore, it is necessary to assess this CC by using a good validity and reliability instrument. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) was designed to assess CC to self-care behaviors of patients with chronic illness in Italy. However, it was unclear whether this tool had sound psychometrics properties in the context of Chinese culture. Therefore, we performed the cross-cultural adaption of the CC-SC-CII and we tested its psychometric properties among Chinese caregivers of patients with chronic disease.DesignA cross-sectional observational design.SettingsParticipants were recruited from communities and institutions in Pingdingshan, Henan Province, China.Participants301 caregivers of care recipients with chronic disease completed the Chinese version of the CC-SC-CII (C-CC-SC-CII).Primary and secondary outcome measuresThe content validity index of items (I-CVI), the scale content validity index-average (S-CVI/Ave), exploratory factor analysis, confirmatory factor analysis (CFA), internal consistency and item analysis were tested.ResultsThe range of I-CVI was between 0.833 and 1.00, and the score of S-CVI was 0.991. In CFA, the C-CC to self-care monitoring scale had satisfactory fit indices. However, the C-CC to self-care maintenance and management scales had unsupported fit indices. The reliability coefficients of C-CC-SC-CII were 0.792, 0.880 and 0.870 for its three scales. Item-total correlations were all over 0.590. Test–retest reliability showed that the range of intraclass correlation coefficients was from 0.728 to 0.783.ConclusionThe C-CC-SC-CII has sound psychometrics characteristics and is a culturally appropriate and reliable instrument for assessing CC to the self-care behaviours of patients with chronic disease in China.

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Development and Psychometric Testing of the Self-Care in COVID-19 (SCOVID) Scale, an Instrument for Measuring Self-Care in the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17217834 ◽

2020 ◽

Vol 17 (21) ◽

pp. 7834

Author(s):

Maddalena De Maria ◽

Federico Ferro ◽

Davide Ausili ◽

Rosaria Alvaro ◽

Maria Grazia De Marinis ◽

...

Keyword(s):

General Population ◽

Construct Validity ◽

Content Validity ◽

Self Care ◽

Psychometric Testing ◽

The Self ◽

Validity And Reliability ◽

New Instrument ◽

Instrument Measuring ◽

Test Retest Reliability

Aim: To develop the Self-Care in COVID-19 (SCOVID) scale and to test its psychometric characteristics in the general population. Methods: We tested SCOVID scale content validity with 19 experts. For factorial and construct validity, reliability, and measurement error, we administered the 20-item SCOVID scale to a sample of 461 Italians in May/June 2020 (mean age: 48.8, SD ± 15.8). Results: SCOVID scale item content validity ranged between 0.85–1.00, and the total scale content validity was 0.94. Confirmatory factor analysis supported SCOVID scale factorial validity (comparative fit index = 0.91; root mean square error of approximation = 0.05). Construct validity was supported by significant correlations with other instrument scores measuring self-efficacy, positivity, quality of life, anxiety, and depression. Reliability estimates were good with factor score determinacy, composite reliability, global reliability index, Cronbach’s alpha, and test-retest reliability ranging between 0.71–0.91. The standard error of measurement was adequate. Conclusions: The SCOVID scale is a new instrument measuring self-care in the COVID-19 pandemic with adequate validity and reliability. The SCOVID scale can be used in practice and research for assessing self-care in the COVID-19 pandemic to preventing COVID-19 infection and maintaining wellbeing in the general population.

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Development of a brief, generic, modular resource-use measure (ModRUM): cognitive interviews with patients

BMC Health Services Research ◽

10.1186/s12913-021-06364-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kirsty Garfield ◽

Samantha Husbands ◽

Joanna C. Thorn ◽

Sian Noble ◽

Will Hollingworth

Keyword(s):

Resource Use ◽

Content Validity ◽

Psychometric Testing ◽

Sampling Strategy ◽

Self Report ◽

Cognitive Interviews ◽

Healthcare Use ◽

Missing Responses ◽

The Core ◽

Core Module

Abstract Background Self-report resource-use measures (RUMs) are often used to collect healthcare use data from participants in healthcare studies. However, RUMs are typically adapted from existing measures on a study-by-study basis, resulting in a lack of standardisation which limits comparability across studies. Psychometric testing of RUMs is rarely conducted. This paper reports on cognitive interviews with patients to test the content validity and acceptability of a new RUM (ModRUM). ModRUM is a brief, generic RUM with a core module on healthcare use and questions/modules to increase depth and breadth. Methods A purposeful sampling strategy with maximum variation was used to recruit patients from primary care to participate in “think-aloud” interviews with retrospective probing. Participants verbalised their thought processes as they completed ModRUM, which allowed errors (issues with completion) to be identified. The interviewer asked follow-up and probing questions to investigate errors, clarity and acceptability. Interviews were audio-recorded and transcribed verbatim. Research team members independently scored transcripts to identify errors in comprehension, recall, judgement and response. Members met to agree on final scores. Interview transcripts were analysed qualitatively using techniques of constant comparison, to identify common themes and ideas for improvement. Data collection and analysis were performed concurrently and in rounds. Results Twenty participants were interviewed between December 2019 and March 2020. Interviews were conducted in three rounds, with revisions made iteratively and in response to interview findings. Seven participants completed the core module and 13 completed the core module plus depth questions. Of 71 issues, 28 were in comprehension, 14 in retrieval, 10 in judgement, 18 in response and 1 uncategorised. Most issues (21 issues by 2 participants) were due to participants including family healthcare use. Other issues included using incorrect recall periods (5 issues) and overlooking questions leading to missing responses (9 issues). Common participant suggestions included highlighting important details and providing additional definition or examples for some terms. The length, content and layout were acceptable to most participants. Conclusions A generic RUM is needed to increase study comparability. RUM development requires thorough testing to demonstrate and enhance validity. Cognitive interviewing has demonstrated the acceptability and content validity of ModRUM.

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Scale of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis: A Psychometric Study in Brazil

Clinical Nursing Research ◽

10.1177/1054773821989800 ◽

2021 ◽

pp. 105477382198980

Author(s):

Marta Nunes Lira ◽

Clemente Neves Sousa ◽

Maria Carolina Medeiros Wanderley ◽

Natália Ramos Costa Pessoa ◽

Kelly Cristiane Rocha Lemos ◽

...

Keyword(s):

Factor Analysis ◽

Psychometric Properties ◽

Arteriovenous Fistula ◽

Content Validity ◽

Self Care ◽

The Self ◽

Expert Committee ◽

Cronbach’S Alpha ◽

Cronbach's Alpha ◽

Confirmatory Factor

The purpose of this study was to evaluate the psychometric properties of the Brazilian Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis. Cross-sectional validation study, followed the recommendation provided by Sousa and Rojjanasrirat. Content validity, explanatory and confirmatory factor analyses used to check validity and Cronbach’s alpha was the reliability measure. Three hundred hemodialysis patients with arteriovenous fistula were included in the study. The expert committee assessed the content validity. Exploratory factor analysis confirmed the same two-factor structure found for the original scale, explaining 60.10% of the variance. Such solution was checked by confirmatory factor analysis with Cronbach’s alpha equal to 0.920, 0.810, and 0.884 for the overall scale, the self-care in management of signs and symptoms and the self-care in prevention of complications subscales respectively. The scale has good psychometric properties to assess self-care behaviors and can be used with Brazilian patients on hemodialysis with arteriovenous fistula.

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Effect of Self - Care Program on the Self- Esteem of Multiple Sclerosis Patients

European Psychiatry ◽

10.1016/s0924-9338(09)71173-3 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

H. Madani ◽

H. Navipoor ◽

P. Roozbayani

Keyword(s):

Multiple Sclerosis ◽

Self Care ◽

Care Program ◽

Self Esteem ◽

The Self ◽

Self Report ◽

The Mean ◽

Muscular Spasm ◽

Multiple Sclerosis Patients ◽

Paired T Test

Aims:According to decreased self- esteem in multiple sclerosis (MS) patients, it is necessary to utilize appropriate methods in order to improve self- esteem in MS patients. So this study was conducted on patients with MS supported by the Iranian MS society for determining the effect of self - care program on their self- esteem.Method:In this semi - experimental study 34 patients with MS who were not in the acute phase of disease were selected. The data were collected via personal questionnaires, problem list, Cooper and smith standard questionnaire for self- esteem and self report check lists. Self - care program(self - care for muscular spasm, fatigue, constipation and amnesia and …) was educated, then it was performed for one month period and the data were analyzed using paired t- test, wilcoxon, croscal - wallis and manwithney tests.Results:Application of self - care program improve the self- esteem and reduced some symptoms such as muscular spasm, fatigue, constipation and amnesia in MS patients. The mean valve of self- esteem increased from 54 before performing the program to 68 after the program ( p < 0.05).Conclusion:Using self-care program can be an effective method for improving self- esteem of MS patients.

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Self-Care of African Immigrant Adults with Chronic Illness

Clinical Nursing Research ◽

10.1177/10547738211056168 ◽

2021 ◽

pp. 105477382110561

Author(s):

Onome Henry Osokpo ◽

Lisa M. Lewis ◽

Uchechukwu Ikeaba ◽

Jesse Chittams ◽

Frances K. Barg ◽

...

Keyword(s):

Chronic Illness ◽

Self Efficacy ◽

Self Care ◽

African Immigrants ◽

Cross Sectional Study ◽

The Self ◽

Cross Sectional ◽

Income Adequacy ◽

The Us ◽

Scale Scores

This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance ( p < .0001), monitoring ( p < .0001), and management ( p < .0001). The perception of inadequate income was a significant determinant of poor self-care management ( p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.

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Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

BMC Endocrine Disorders ◽

10.1186/s12902-017-0218-y ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 23

Author(s):

Davide Ausili ◽

Claudio Barbaranelli ◽

Emanuela Rossi ◽

Paola Rebora ◽

Diletta Fabrizi ◽

...

Keyword(s):

Self Care ◽

Psychometric Testing ◽

The Self ◽

Diabetes Patients

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Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI)

Research in Nursing & Health ◽

10.1002/nur.21755 ◽

2016 ◽

Vol 40 (1) ◽

pp. 15-22 ◽

Cited By ~ 5

Author(s):

Victoria Vaughan Dickson ◽

Christopher S. Lee ◽

Karen S. Yehle ◽

Ana Mola ◽

Kenneth M. Faulkner ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Self Care ◽

Psychometric Testing ◽

The Self

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From Qualitative Meta-Summary to Qualitative Meta-Synthesis: Introducing a New Situation-Specific Theory of Barriers and Facilitators for Self-Care in Patients With Heart Failure

Qualitative Health Research ◽

10.1177/1049732318800290 ◽

2018 ◽

Vol 29 (1) ◽

pp. 96-106 ◽

Cited By ~ 4

Author(s):

Oliver Rudolf Herber ◽

Sabrina Kastaun ◽

Stefan Wilm ◽

Julie Barroso

Keyword(s):

Heart Failure ◽

Decision Making ◽

Behavioral Interventions ◽

Self Care ◽

Barriers And Facilitators ◽

Decision Making Process ◽

Naturalistic Decision Making ◽

Patients With Heart Failure ◽

Key Concepts ◽

New Situation

Situation-specific theories provide nurses with a vehicle to interpret situations, guide their decisions or make assumptions about factors influencing a health problem. In this article, we used meta-synthesis techniques to integrate statements of findings pertaining to barriers and facilitators to heart failure self-care that were derived previously through meta-summary techniques leading to a new situation-specific theory. According to our proposed theory, self-care behavior is the result of a patient’s naturalistic decision-making process. This process is influenced by two key concepts: “self-efficacy” and the “patient’s disease concept of heart failure.” Numerous facilitative and inhibitive factors have been identified influencing these two key concepts as well as the decision-making process, thereby either enabling or hampering the execution of effective heart failure self-care. Further research is needed to validate the model through empirical testing. Once fully matured, the model may be useful in developing behavioral interventions aiming at enhancing adherence to self-care recommendations.

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