Development and validation of a self-efficacy scale for postoperative rehabilitation management of lung cancer patients

Validation of the Maslach Burnout Inventory-General Survey 9-item short version: psychometric properties and measurement invariance across age, gender, and continent

Background

The Maslach Burnout Inventory-General Survey (MBI-GS) stands as the preeminent tool for assessing burnout across various professions. Although the MBI-GS9 emerged as a derivative of the MBI-GS and has seen extensive use over several years, a comprehensive examination of its psychometric properties has yet to be undertaken.

Methods

This study followed the Standards for Educational and Psychological Testing guidelines to validate the MBI-GS9. Employing a combined approach of classical test theory and item response theory, particularly Rasch analysis, within an integrated framework, the study analyzed data from 16,132 participants gathered between 2005 and 2015 by the Centre for Organizational Research at Acadia University.

Results

The findings revealed that the MBI-GS9 exhibited satisfactory reliability and validity akin to its predecessor, the MBI-GS. Across its three dimensions, Cronbach's α and omega coefficients ranged from 0.84 to 0.91. Notably, the MBI-GS9 displayed no floor/ceiling effects and demonstrated good item fit, ordered threshold, acceptable person and item separation and reliability, clear item difficulty hierarchy, and a well-distributed item threshold. However, the results suggested a recommended minimum sample size of 350 to mitigate potential information loss when employing the MBI-GS9. Beyond this threshold, the observed mean difference between the MBI-GS and MBI-GS9 held minimal practical significance. Furthermore, measurement equivalence tests indicated that the MBI-GS9 maintained an equivalent three-factor structure and factor loadings across various gender, age, and continent groups, albeit with inequivalent latent values across continents.

Conclusion

In sum, the MBI-GS9 emerges as a reliable and valid alternative to the MBI-GS, particularly when utilized within large, diverse samples across different age and gender demographics. However, to address potential information loss, a substantial sample size is recommended when employing the MBI-GS9. In addition, for cross-cultural comparisons, it is imperative to initially assess equivalence across different language versions at both the item and scale levels.

Validation of the Chinese version of academic goals orientation questionnaire in nursing student: a study based on SEM and IRT multidimensional models

OBJECTIVE

To translate the Academic Goals Orientation Questionnaire (AGOQ) into Chinese and to determine the validity and reliability of the (AGOQ) in Chinese nursing students based on SEM and IRT multidimensional models.

METHODS

The participants were 654 nursing students with an age range of 17-26 years (mean age 21.61 ± 1.73 years). The psychometric properties of AGOQ were investigated based on a dual analytical perspective of structural equation modeling (SEM) and item response theory (IRT).

RESULTS

The Cronbach's α value of the questionnaire is 0.895. A four-factor model was obtained by exploratory factor analysis, which explained the variance of 71.892%. With confirmatory factor analysis, a new four-factors model was built and showed an acceptable goodness-of-fit, chi-square/degree of freedom (CMIN/DF) = 4.008, goodness of fit index (GFI) = 0.932, adjusted goodness of fit index (AGFI) = 0.905, comparative fit index (CFI) = 0.952, incremental fit index (IFI) = 0.952, Tucker Lewis index (TLI) = 0.941. In the analysis part of IRT, according to the comparison between Akek's information criterion (AIC) and Bayesian information criterion (BIC), we choose the Graded Response Model (GRM) for analysis. The results show that the difficulty value is monotonically increasing, and the discrimination of all items is greater than 0.19, which shows that 16 items can be retained.

CONCLUSIONS

This study tested the psychometric characteristics of AGOQ of nursing students in China. The results confirmed that the Chinese version of AGOQ has good psychometric characteristics and can be used to measure the academic goal orientation of nursing students in China.

Modification and validation of the COVID-19 stigma instrument in nurses: A cross-sectional survey

Background

Nurses taking care of patients with infectious diseases have suffered from noticeable societal stigma, however currently, there is no validated scale to measure such stigma. This study aimed to revise and validate the COVID-19 Stigma Instrument-Nurse-Version 3 (CSI-N-3) by using item response theory (IRT) as well as classical test theory analysis.

Methods

In phase I, the Chinese CSI-N-3 was modified from the English version of HIV/AIDS Stigma Instrument-Nurse based on standard cross-cultural procedures, including modifications, translation/back translations, pilot testing, and psychometric testing with classical test theory and Rasch analysis. In phase II, a cross-sectional study using cluster sampling was conducted among 249 eligible nurses who worked in a COVID-19-designed hospital in Shanghai, China. The influencing factors of COVID-19-associated stigma were analyzed through regression analysis.

Results

In phase I, the two-factor structure was verified by confirmatory factor analysis, which indicated a good model fit. The 15-item CSI-N-3 achieved Cronbach's α of 0.71-0.84, and composite reliability of 0.83-0.91. The concurrent validity was established by significant association with self-reported physical, psychological, and social support levels (r = -0.18, -0.20, and -0.21, p < 0.01). In IRT analysis, the CSI-N-3 has ordered response thresholds, with the Item Reliability and Separation Index of 0.95 and 4.15, respectively, and the Person Reliability and Separation Index of 0.20 and 0.50, respectively. The infit and outfit mean squares for each item ranged from 0.39 to 1.57. In phase II, the mean score for the CSI-N-3 in Chinese nurses was 2.80 ± 3.73. Regression analysis showed that social support was the only factor affecting nurses' COVID-19-associated stigma (standardized coefficients β = -0.21, 95% confidence interval: -0.73 ~ -0.19).

Conclusion

The instrument CSI-N-3 is equipped with rigorous psychometric properties that can be used to measure COVID-19-associated stigma during and after the COVID-19 pandemic among nurses. The use of this instrument may facilitate the evaluation of tailored stigma-reduction interventions.

Validation of the Chinese version of the Walsh Family Resilience Questionnaire

The Walsh Family Resilience Questionnaire (WFRQ) is one of the most widely used and strong theory-based measurement tools of family resilience. This study aimed to develop and psychometrically test the Chinese version of the WFRQ (WFRQ-C). The WFRQ was translated following Brislin's translation model. Psychometric testing, combining classical theory test and item response theory, was conducted with a sample of 800 community adult residents. The Connor-Davidson resilience scale-10 (CD-RISC-10), Self-reported Family Happiness Scale (SFHS-1), and Family APGAR (Adaption, Partnership, Growth, Affection, Resolve) Scale (Family APGAR-5) were applied for convergent validity. Six items were deleted at the item analysis level. The minimum average partial test and a parallel analysis supported a three-factor structure, which was validated by confirmatory factor analysis. The three factors were named "Family belief system," "Organization, communication and problem solving," and "Utilization of external resources." The WFRQ-C was significantly correlated with CD-RISC-10, SFHS-1, and Family APGAR-5, with r values ranged from 0.51 to 0.56. The Cronbach's α was 0.97 for the scale and 0.93, 0.95, and 0.72 for the three factors, respectively. The ICCs of 0.96 for the whole scale, and 0.95, 0.75, and 0.95 for the three factors, respectively. The mean score for the WFRQ-C was 97.00 ± 17.94, of which per capita monthly income and education level were predictors. The 26-item WFRQ-C is a stable, concise, and validated tool to measure family resilience. It is applicable for Chinese community adults in nonspecific stressful settings and has potential utility in the health care domain.

Psychometric Evaluation of a Myanmar Version of the Perceived Stress Scale for People Living with HIV/AIDS

Background and Purpose: Reliable instruments for the measurement of perceived stress in people living with HIV (PLHIV) are crucial. However, there is no Myanmar version of such an instrument. Methods: We adapted the 35-item Perceived Stress Scale for People Living with HIV/AIDS (PSSHIV) into a Myanmar version (PSSHIV-M), and 150 PLHIV completed the survey. Results: The 31-item PSSHIV-M with a five-factor structure has a Cronbach's alpha of .85 to .95. Construct validity was demonstrated for the instrument, and the findings of Rasch analysis also suggest evidence of reliability and validity. Conclusions: The psychometric properties of the 31-item PSSHIV-M with a five-factor structure support its efficacy in ascertaining how HIV perceived stress affects Myanmar PLHIV. It could also facilitate the development of stress management interventions for that population.

Adaptation and validation of the Chinese version of the lung cancer screening health belief scales

Background

Health belief is an important factor affecting lung cancer screening in high-risk population, but the research based on Chinese cultural background is still insufficient. Therefore, we adapted the English version of the Lung Cancer Screening Health Belief Scales (LCSHB) into the Chinese version (LCSHB-C) and examined its psychometric characteristics.

Methods

After obtaining authorization from the original author, the LCSHB-C was adapted based upon Brislin's translation model. Using a variety of community-based recruitment methods, a total of 353 participants were recruited in Fuzhou, Fujian province, China to complete the questionnaires. We combined the classical test theory and item response theory to examine the psychometric properties of the LCSHB-C.

Results

The Cronbach’s alpha for the four subscales ranged from 0.83 ~ 0.93. The content validity index for the four subscales was ranged from 0.87 ~ 1.0. Confirmatory factor analysis supported each subscale structure model fit well. Rasch analysis results further validated the reliability and validity of the four subscales. The person reliability and separation index of each subscale ranged from 0.77 to 0.87 and 1.83 to 2.63, respectively.

Conclusions

The LCSHB-C is a reliable and valid instrument used to measure health beliefs related to lung cancer screening among those high-risk for lung cancer in China, which facilitates the development of lung cancer screening programs and promotes the "three early prevention strategies" of lung cancer (i.e.,early detection, early diagnosis and early treatment).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13041-y.

Validation and Psychometric Testing of the Chinese Version of the Mental Health Literacy Scale Among Nurses

The Mental Health Literacy Scale (MHLS) is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale (MHLS-C) and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin's translation model and tested with a sample of 872 clinical registered nurses. The Jefferson Scale of Empathy-Health Professionals (JSE-HP), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder-2 (GAD-2) were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named "knowledge of mental disorder," "ability to seek information and help," "recognition of mental disorder," and "acceptance of patients with mental illness," with factor 1-3 were summarized into MHLS-Core (Core literacy subscale) and factor 4 as MHLS-SA (Social acceptance subscale). The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 (-0.111, -0.081) and highly positively correlated with JSE-HP (0.492). The Cronbach's α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients (ICCs) of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50 th percentile for the MHLS-C was 99, with 50 th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended.

The Perspectives and Lived Experience of Postoperative Patients with Lung Cancer Participating in a Home-Based Exercise Intervention

OBJECTIVES

Postoperative patients with lung cancer experience a cluster of symptoms and reduced quality of life. This study aimed to collect the pre- and postexercise intervention opinions of postoperative patients with lung cancer and to identify their perceptions of barriers, facilitators, and benefits of a home-based exercise intervention and its impact on their future exercise.

DATA SOURCES

Fourteen participants (aged 53 to 78) were purposively recruited from a tertiary hospital to participate in a 4-week home-based walking exercise intervention after discharge. Semi-structured, one-on-one interviews were conducted to collect data. The interviews were transcribed verbatim, and the data were analyzed using a thematic analysis approach. Details regarding the exercise duration and intensity for each participant were collected using a sports watch app, and participants exercise diaries.

CONCLUSION

Three main themes emerged: (1) participants' differing opinions preintervention, (2) barriers and facilitators encountered during the exercise period, and (3) the positive impact on participants' future exercise. Other results showed that 12 of the 14 participants reached the goal of exercise duration and intensity. Postoperative patients with lung cancer need an exercise intervention to motivate and guide them to perform exercise after discharge. This study showed that a home-based walking exercise intervention was feasible and acceptable; patients perceived benefits and became more active and confident about their future exercise plans.

IMPLICATIONS FOR NURSING PRACTICE

Against the backdrop of inadequate staffing, insufficient funding, and lack of supervised exercise programs for this rapidly increasing population, this study of a nurse-led home-based exercise program provides a feasible and realistic approach and qualitative evidence to address these issues.

Adaptation and Validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) in People Living with HIV in Myanmar

Objectives

Valid and reliable instruments for the measurement of mindfulness are crucial for people living with HIV. However, there was no Myanmar version of such an instrument.

Methods

We adapted the English version of the 12-item Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) based on standard cross-cultural procedures. By randomly sampling methods, a sample of 248 eligible people living with HIV was contacted from a closed Myanmar Facebook group; 159 PLHIV completed the initial 12-item version of the adapted survey.

Results

Three items were removed due to low item-to-total correlations of the corrected item-total correlation as well as having infit and outfit mean squares outside the range of 0.6 to 1.4. After deleting the 3 items, the three-factor structure was confirmed by confirmatory factor analysis, which indicated good model fit. The resultant 9-item CAMS-R in Myanmar (CAMS-R-M-2) achieved good internal reliability (Cronbach's α of 0.75 to 0.87, and the corrected item-total correlation ranged from 0.44 to 0.81). Construct validity of the scale was demonstrated by significant association with self-reported HIV stigma and social support levels (r = 0.63, and - 0.53). In Rasch analysis, the infit and outfit mean squares for each item ranged from 0.49 to 1.24, and the person reliability was 2.17 and the separation index was 0.83.

Conclusions

The 9-item CAMS-R-M-2 with a three-factor structure has good reliability and validity. Higher total scores and subscale score reflected greater mindfulness qualities in people living with HIV in Myanmar.

Adaptation and validation of a culturally adapted HIV stigma scale in Myanmar

BACKGROUND

HIV stigma is a common barrier to HIV prevention, testing, and treatment adherence, especially for low- and middle-income countries such as Myanmar. However, there was no validated Myanmar version of a stigma scale. Therefore, we adapted the English version of the 40-item Berger's HIV stigma scale and the 7-item Indian HIV stigma scale into a 47-item Myanmar HIV stigma scale and then evaluated the scale's psychometric properties.

METHOD

From January 2020 to May 2020, using random sampling methods, 216 eligible Myanmar people living with HIV/AIDS (PLWHA) were contacted from a closed Facebook group that included more than 10,000 PLWHA. A sample of 156 Myanmar PLWHA completed the online self-reported survey.

RESULTS

A six-factor structure for the scale was determined through exploratory factor analysis, explaining 68.23% of the total variance. After deleting 12 items, the 35-item HIV stigma scale achieved Cronbach 's α of 0.72 to 0.95. Construct validity of the scale was demonstrated by significant association with self-reported depression and social support levels (r = 0.60, and - 0.77, p < 0.01). In Rasch analysis, the scale achieved person reliability of 3.40 and 1.53 and a separation index of 0.92 and 0.70. The infit and outfit mean squares for each item ranged from 0.68 to 1.40. No differential item functioning across gender or educational level was found.

CONCLUSIONS

The psychometric properties of the 35-item Myanmar version of the HIV stigma scale support it as a measure of stigma among PLWHA in Myanmar. This instrument could help healthcare providers to better understand how stigma operates in PLWHA and to develop tailored stigma-reduction interventions in Myanmar.

Translation, Adaption, and Psychometric Testing of the Myanmar Version of the Medical Outcomes Study Social Support Survey for People Living With HIV/AIDS

Introduction: Valid and reliable instruments are crucial for measuring perceived social support among people living with HIV (PLHIV). We aimed to investigate the psychometric properties of the English version of the 19-item Medical Outcomes Study Social Support Survey (MOS-SSS) adapted for PLHIV in Myanmar. Methods: Based on a standard cross-cultural procedure, we adapted the MOS-SSS and formed a Myanmar version of the scale (MOS-SSS-M), and then tested its validity and reliability. A sample of 250 eligible PLHIV was collected from a closed Facebook group that included more than 10,000 Myanmars, most of whom were PLHIV. Results: The MOS-SSS-M achieved a Cronbach's α of 0.82-0.95. Confirmatory factor analysis revealed an acceptable fit index for the four-factor structure. Construct validity was demonstrated by significant association with self-reported HIV stigma and stress levels, and further confirmed by the findings of Rasch analysis. Conclusion: The MOS-SSS-M with a four-factor structure can be used to measure the level and categories of perceived social support among PLHIV in Myanmar.

Psychometric Testing of the Chinese Simple Version of the Simulation Learning Effectiveness Inventory: Classical Theory Test and Item Response Theory

BACKGROUND

High-fidelity simulation (HFS) has become a widely used and established pedagogy for teaching clinical nursing skills. Nevertheless, there are few evidence-based instruments that validate the effectiveness of simulation learning in mainland China.

METHODS

The Simulation Learning Effectiveness Inventory (SLEI) was adapted and validated for use in this study. Psychometric evaluation, incorporating classical test theory and item response theory (IRT) methods, was performed with 533 third-year undergraduate nursing students who were recruited from May 2017 to July 2018.

RESULTS

The findings of exploratory and confirmatory factor analyses revealed that the simplified Chinese version of the SLEI (SLEI-SC) was composed of six factors, namely, course arrangement, equipment resource, debriefing, clinical ability, problem solving, and confidence, which explained 60.84% of the total variance. The Cronbach's α, MIIC, marginal reliability, and test-retest reliability values obtained for the total scale were 0.88, 0.38, 0.96, and 0.88, respectively. Furthermore, the difference between the total scores for learning effectiveness pre- and post-course was statistically significant (t = 2.59, p < 0.05, Cohen's d = 0.60). IRT analysis showed that the SLEI-SC discriminates well between students with high and low levels of learning effectiveness and offers information about a broad range of learning effectiveness measures. The relationship between final course grade and total score on the SLEI-SC was statistically significant (r = 0.63, p < 0.05).

CONCLUSION

We demonstrated initial psychometric evidence and support for the 31-item SLEI-SC as a developmentally appropriate instrument for assessing the learning effectiveness of all phases of HFS use with nursing students.

An Assessment of the Reliability and Factorial Validity of the Chinese Version of the Health Professional Education in Patient Safety Survey (H-PEPSS)

Background

A nursing student's reflection on their knowledge and competence in patient safety (PS) may prepare them to provide safer care in certain circumstances. The Health Professional Education in PS Survey (H-PEPSS) is a validated tool for assessing the perceptions of nursing students with regards to competence in PS. The H-PEPSS is widely used internationally but is not available in Chinese.

Objectives

This study aimed to translate the H-PEPSS into Chinese and test its psychometric properties among Chinese undergraduate nursing students.

Design

This was a cross-sectional online survey that was conducted in 2018.

Settings

Seven nursing schools in North, East, Northeast, Central, Southwest, South, and Northwest China.

Participants

A total of 732 final-year undergraduate nursing students were recruited by convenience sampling.

Methods

Translation was conducted rigorously in accordance with an adapted version of Brislin's translation model. Psychometric evaluation was conducted by incorporating classical test theory and item response theory (IRT) analysis.

Results

The Chinese version of the H-PEPSS (both the classroom and clinical practice versions) achieved a Cronbach's α, marginal reliability and 2-week test-retest reliability of >0.85. A six-factor solution explaining 81.49% and 82.32% of the total variance was obtained for the classroom and clinical practice versions, respectively. This was further validated by confirmatory factor analysis. IRT analysis showed that the scale offers a broad range of information on PS competence and discriminates efficiently between patients with high and low levels of competence in PS.

Conclusion

The Chinese version of the H-PEPSS is a reliable and valid instrument that is capable of evaluating competence in PS perceived by undergraduate nursing students. In addition, the survey may also be used to evaluate gaps in classroom knowledge and clinical competence, and to offer valid data for designing or tailoring new education strategies.

Adaptation and validation of the Chinese version of the modified Leiden index of depression sensitivity

BACKGROUND

The revised Leiden index of depression sensitivity (LEIDS-RR) is commonly used worldwide to measure a marker of depression vulnerability termed cognitive reactivity (CR). However, the optimal cut-off scores for this scale and for the Chinese version of LEIDS-RR (LEIDS-RR-CV) are unknown.

OBJECTIVES

The main aims were to examine the psychometric properties of the LEIDS-RR and establish appropriate cut-off scores for the Chinese population.

METHODS

Psychometric evaluation was performed for 330 healthy individuals and 330 depression patients in remission, by incorporating classical test theory and item response theory (IRT) methods. Receiver operating characteristic curve analysis was used to determine the optimal LEIDS-RR-CV cut-off.

RESULTS

Cronbach's α, two-week test-retest reliability, and marginal reliability for the LEIDS-RR-CV were 0.92, 0.40, and 0.96, respectively. Confirmatory factor analysis validated the five-factor model, and the cut-off values to screen a population at risk of depression were 60 and 55 for the healthy individuals and patients, respectively. Patients had higher CR than healthy individuals (t = 6.10, p = 0.00), and this was positively correlated with the total CES-D Scale score (r = 0.52, p = 0.00), also confirmed by IRT analysis, indicating the discriminative and concurrent validity of the scale.

LIMITATIONS

The generalizability of these findings may be limited given the sampling method and the fact that all patients were recruited from a tertiary hospital.

CONCLUSIONS

The 26-item LEIDS-RR-CV is a reliable and valid instrument to assess CR in Chinese populations. It can be used for screening at-risk populations and in epidemiological studies to guide the development of tailored intervention strategies.

Psychometric properties and performance of existing self-efficacy instruments in cancer populations: a systematic review

Background

This study aims to provide a systematic compilation of existing measures of self-efficacy developed specifically for use in cancer patients and provide descriptions and comparative evaluations of the characteristics, psychometric properties and performance parameters.

Method

A systematic electronic database search was conducted in PubMed, Ovid (PsyINFO), EBSCO, Elsevier, Scopus to identify self-efficacy assessment tools for cancer patients, between January 1977 to February 2018. The characteristics of target population, instrument, development process and psychometric properties were summarized. All included instruments were subsequently appraised using a psychometric quality assessment tool based on previous publications. Validity of the quality assessment was reviewed and confirmed by five experts.

Results

Fifteen cancer-related self-efficacy instruments were identified. Among them, (40.0%) 6/15 were task-specific, focusing on cancer-related health issues such as fatigue, communication, rehabilitation, exercise, and narcotic pain killer usage. Six instruments were disease-specific for breast cancer, lung cancer, or advanced cancer. Weaknesses of the development processes included the singularity of instrument construction methods, and non-transparent selection of the final items. The main limitation seen in the validation processes was that some important properties of instruments (e.g. test-retest reliability, criterion validity, responsiveness, interpretability, feasibility, and acceptability) were not evaluated.

Conclusions

This review summarizes the limitations and strengths of current self-efficacy instruments for cancer patient. The information reported here can assist clinicians and researchers in the selection of the appropriate instrument. Finally, it points out the need for reporting validation statistics to facilitate the use of these instruments.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-1066-9) contains supplementary material, which is available to authorized users.

The structural equation model on self-efficacy during post-op rehabilitation among non-small cell lung cancer patients

BACKGROUNDS

Self-efficacy plays an important role in pulmonary rehabilitation, but it is still unknown which factors exert their effects on postsurgical rehabilitation self-efficacy among non-small cell lung cancer (NSCLC) patients. This study aims to assess relationships among physical function, social factors, psychological factors, quality of life (QOL) and self-efficacy, and the effects of these variables on self-efficacy among NSCLC patients.

METHODS

A cross-sectional survey was administered to 238 postsurgical NSCLC patients (response rate 95.2%) at five tertiary hospitals in Fuzhou, China. the participants completed a pack of questionnaires. Structural equation modeling (SEM) was conducted to test the hypothetical model.

RESULTS

The SEM results supported the hypothesized structural model (χ2/df = 1.511, p>0.05). The final model showed that confrontation coping, subjective well-being (SWB), social support, psychological growth (PTG) and anxiety and depression can be directly related to self-efficacy (coefficient = 0.335, coefficient = 0.288, coefficient = 0.150, coefficient = 0.024, and coefficient = -0.004, respectively, p<0.01). Confrontation coping also had indirect effect via SWB (coefficient = 0.085, p<0.01), which had indirect connection via PTG (coefficient = 0.005, p<0.01). Social support and anxiety and depression had indirect pathways as well. As expected, self-efficacy directly affected the quality of life.

CONCLUSIONS

This study suggests that higher confrontation coping style, SWB, social support, and PTG and lower anxiety and depression levels could effectively enhance their self-efficacy and consequently, improve QOL. These findings may help develop an intervention aimed at enhancing self-efficacy for this patient population.