Concept analysis of empowerment in old people with chronic diseases using a hybrid model

Concept analysis of self-neglect in the elderly: a hybrid model

PURPOSE

Clarifying the concept of elder self-neglect.

METHODS

Researchers investigated the concept of elder self-neglect using a hybrid approach, including theoretical, fieldwork, and final analysis phases. After an extensive review of related literature to define the concept of self-neglect and describe its characteristics, the fieldwork phase was carried out to illustrate its empirical features. Accordingly, it led to the extraction of the elder self-neglect attributes from the first two phases.

FINDINGS

Elder self-neglect includes "subjective and objective high-risk behaviors pertinent to physical and spiritual health as well as restricted social interactions, disregarding the living environment, and a lack of compliance to personal hygiene routines that the elderly demonstrate deliberately or unintentionally. Various factors can contribute to such behaviors, including individual features, poor physical performance, elderly-oriented psychological disorders, financial challenges, detrimental stressors, unsuccessful social interactions, inaccessible supportive resources, inadequate educational resources, and inappropriate cultural norms. Consequently, such behaviors result in impaired physical and psychological health status, higher risk of misbehavior, poor quality of life, extra caregiving-treatment burden, and affected mental security in society."

CONCLUSION

Given that elder self-neglect is considered a relatively unknown concept in Iran, the study findings can pave the way for future extensive research in the Iranian context by clarifying the concept. It can play a significant role in developing related tools to design more efficient interventions and improve the quality of nursing care services.

IMPLICATIONS FOR NURSING PRACTICE

The elder self-neglect concept can lead to numerous health-related disorders among the elderly in society. Nurses cannot deal with an unknown phenomenon without exploring and identifying its exact meaning. It is, therefore, imperative to illustrate the different dimensions of this concept to help create a deep understanding among the nurses and perform timely diagnosis and interventional procedures.

Empowerment of individuals in Iranian health systems: a qualitative study using the Z-cognitive map approach

The empowerment of people is considered as one of the most effective approaches in national healthcare systems. Identifying the effective criteria for this empowerment approach can be useful for planning enhancements. Therefore, studying and researching different aspects of people empowerment, and identifying the various relationships among related factors are of great importance. In this study - after identifying and extracting the effective factors in empowering individuals/insured persons, and interviewing health insurance and healthcare experts through content analysis - a causal model examining variables and their impact intensity through cognitive mapping is designed and drawn up. In modeling the concept of empowerment, to cover the ambiguity of expert comments, a combination of the Z-number approach with cognitive mapping has been used. Results demonstrate how various factors relate to insured empowerment. According to the results of empowerment strategies, the insurance participation strategy with the highest central index was determined as the most effective strategy, and the appropriate component for individuals gained the highest score in the centrality index. The results of this article help a lot to policy making in medical insurance.

Association between health-related empowerment and health-protective behaviors among community-dwelling older adults

BACKGROUND

Empowerment is a broad concept seen as a critical approach for helping older adults who lack power to gain control over various aspects of their lives, including their health-protective behaviors.

AIM

The study investigated the association between health-related empowerment and health-protective behaviors in older adults.

DESIGN

A cross-sectional correlational research design was used by recruiting a convenient sample of 200 older adults.

TOOLS

The Elder Health Empowerment Scale and Health Protective Behavior Scale were used to collect the participant data.

RESULTS

It showed a significant positive correlation between health-related empowerment and health-protective behaviors in older adults (r = 0.891, p = 0.001), indicating that as health-related empowerment increases, engagement in health-protective behaviors also increases. Furthermore, health-related empowerment accounted for a large proportion of the variation in health-protective behaviors (85.7 %).

CONCLUSION

Overall, these findings suggest that there is a need for interventions to improve the health-related empowerment of older adults, particularly in terms of their ability to turn their health goals into actionable plans, overcome barriers to health, and make informed healthcare choices. However, the studied older adults generally engage in health protective behaviors; there is variability in the extent to which they engage in specific behaviors, which may provide valuable insights for developing targeted health promotion programs and interventions.

Empowerment of the older adults in the context of Chinese culture: an evolutionary concept analysis

Background

With the increasing focus on addressing the challenges of aging, researchers have begun to recognize the potential impact of empowering older individuals in addressing retirement issues. However, within different cultural contexts, there still needs to be a more precise analysis regarding the definition of empowering older individuals.

Objective

To define and analyze the concept of empowering older individuals within the cultural context of China.

Method

Using Rodgers' concept analysis approach, a search was conducted in five databases (PubMed, Web of Science, China National Knowledge Infrastructure, Wan fang Data, and VIP Chinese Journal Platform) for studies on empowering older individuals from the time the databases were established until February 2023. The main disciplines involved in the search included nursing, medicine, and public health.

Results

Out of the 7,028 studies, 50 articles met the inclusion criteria. The identified attributes are as follows: support system, belief change, and behavioral autonomy. The antecedents were grouped into four categories: physical obstacles, psychological concerns, personal needs and external challenges. The consequences were determined to be improved quality of life, reduced burden of old-age care, gain respect, and self-actualization.

Conclusion

Empowering older individuals is a dynamic and evolving concept that involves aligning personal aspirations with appropriate external resources and expressing a certain degree of belief and behavioral change. This study deepens our understanding of empowering older individuals through comprehensive concept analysis, and the identified attributes, antecedents, and consequences of empowering older individuals can be utilized in practice, education, and research.

Association of eHealth Literacy with Health Promotion Behaviors of Community-Dwelling Older People: The Chain Mediating Role of Self-Efficacy and Self-Care Ability

In the digital age, electronic health literacy (eHealth literacy) of community-dwelling older people plays a potentially important role in their health behaviors which are critical for health outcomes. Researchers have documented that self-efficacy and self-care ability are related to this relationship. This study aimed to assess the relationship between eHealth literacy and health promotion behaviors among older people living in communities and explore the chain mediating role of self-efficacy and self-care ability. For this cross-sectional study, we used data from 425 older adults at 3 communities in Qingdao, Shandong Province in Northeastern China, from June to September 2021. Path analysis using the structural equation model was performed. We found that eHealth literacy was significantly associated with health promotion behaviors in older people. Additionally, eHealth literacy indirectly affected health promotion behaviors through self-efficacy and self-care ability, respectively. In addition, the chain mediation effect was identified in the relationship of eHealth literacy and health promotion behaviors: eHealth literacy→ self-efficacy→ self-care ability→ health promotion behaviors. These findings offer promising directions for developing interventions to modify older adults' health behaviors through enhancing their eHealth literacy. These interventions should integrate components that target improving the self-efficacy and self-care ability of older people.

The Impact of the Otago Exercise Program on Frailty and Empowerment in Older Nursing Home Residents: A Randomized Controlled Trial

Background

This study assessed the impact of Otago exercises on frailty and empowerment in older nursing home residents.

Methods

This randomized controlled trial included 72 individuals aged over 65 years residing in a single nursing home in Izmir, Turkey. The participants were randomly assigned to the Otago exercise group (OEG) or control group (CG). The OEG performed Otago exercises for 45 minutes, 3 days per week for 12 weeks plus a walking program the 3 other days of the week. In addition to Otago exercise training, the OEG received training based on empowerment consisting of 10 sessions lasting 30 minutes each. The CG received no intervention except routine care in the nursing home. The data collected were sociodemographic characteristics, Edmonton Frail Scale (EFS) scores, and Elderly Empowerment Scale (EES) scores before and 3 months after the intervention.

Results

We observed significant differences between the mean EFS (p=0.0001) and mean EES (p=0.0001) before and 3 months after the intervention in the OEG compared to the CG. We also observed a significant difference between the OEG and CG in mean EFS (p=0.018) and EES (p=0.0001) 3 months after the intervention.

Conclusion

The results of the present study demonstrated the positive impact of the Otago exercise program on preventing/delaying frailty and enhancing empowerment in older people.

Concept Analysis of the Empowerment of Patients With Coronary Artery Disease Using a Hybrid Model

This study aimed to conceptualize the empowerment of patients with coronary artery disease (CAD) using a hybrid model. In the final phase, "perceived competence and knowledge on lifestyle management," "sense of control of one's own health care," "self-acceptance to change," and "motivation for voluntary behavior" were identified as intrapersonal aspects; "information search," "active communication between patients and health care professionals," and "supportive relationships" were identified as interactional aspects; "self-management in one's life" and "coping behavior with disease" were identified as behavioral aspects. A concept accurately reflecting CAD characteristics may facilitate the implementation of risk factor management.

Causal Model of Psychological Empowerment Among People With Spinal Cord Injury in Thailand

The purpose of this study was to develop and evaluate a causal model illustrating the relationships of age, education, physical impairment duration, social support, functional ability, and self-esteem with psychological empowerment in persons with spinal cord injury. Participants were 260 individuals admitted to a hospital in Thailand. Data were analyzed using path analysis (with the maximum likelihood estimation technique) in Linear Structural Relationship (LISREL). The study results revealed that age and education did not significantly influence psychological empowerment. However, self-esteem had a direct effect on psychological empowerment, whereas physical impairment duration, functional ability, and social support had indirect effects through self-esteem. These four predictors explained 64% of the total variance in this model of psychological empowerment for people with spinal cord injury. These findings can be used as a guideline for developing appropriate interventions to promote psychological empowerment among Thais with spinal cord injury.

Exploring integrated supply chain performance in healthcare: a service provider perspective

Purpose

The paper identifies the antecedents and consequences of integrated supply chain performance (ISCP) in healthcare systems.

Design/methodology/approach

Based on a review of the literature constructs of supply chain flexibility (SCF), employee relationships (ERs), organizational orientation (OO) and knowledge exchange (KE) were identified as antecedents of ISCP, and patient centricity (PC) emerged as its consequence. This structural relationship was tested using partial least square structural equation modeling (PLS-SEM).

Findings

ERs, SCF, OO and KE positively impacted the performance of an integrated healthcare supply chain. Furthermore, enhanced ISCP in operational processes of the hospital positively influenced patient centeredness and care quality.

Research limitations/implications

Paper contributes by identifying antecedents and consequences of ISCP. Future researchers may explore the inter-relationships among the antecedents of ISCP.

Practical implications

Insights from this study will help practitioners in enhancing hospital operations by integrating processes along the healthcare service supply chain and developing a patient-centric approach.

Social implications

This paper highlights how PC may be achieved by focusing on a facilitative internal environment. This understanding may help in designing processes that deliver health as a social good in an effective manner.

Originality/value

The empirical evidence from this study can help hospitals integrate their functions, thus, enabling them to deliver quality care.

Development and psychometric evaluation of the healthy lifestyle questionnaire for elderly (heal)

BACKGROUND

The present study was conducted to design and evaluate the psychometric properties of a questionnaire for assessing the healthy lifestyle among older adults in Iran.

METHODS

First, items were generated based on a qualitative study, the literature review, and with help received from experts in gerontology and questionnaire design. Then, content validity was carried out. Accordingly, a cross sectional study was conducted to perform factor analysis and known groups comparison in order to examine the construct validity. Internal consistency was measured by the Cronbach's alpha coefficient and the stability of the questionnaire was evaluated by estimating interclass correlation coefficient (ICC).

RESULTS

In total 68 items was generated. Following development process 22 items were removed and a provisional version of the questionnaire with 46 items was subjected to psychometric evaluation. At this stage a sample of 390 elderly people attending the community centers in Tehran, Iran were entered into the study and completed the questionnaire. Most elderly were female (52.8%) and the mean age of participants was 67.97 (SD ± 7.77) years. After performing factor analysis, overall 10 items were removed due to low loading and the questionnaire was reduced to 35 items tapping into eight factors, which explained a total of 57.1% of the variance. In addition, the results obtained from known groups comparison indicated that the questionnaire well differentiated among participants who were differed in self-reported health condition. The Cronbach's alpha coefficient showed excellent internal consistency (alpha = 0.89). The intraclass correlation coefficient also indicated a good stability for the questionnaire (ICC = 0.94).

CONCLUSION

The healthy lifestyle questionnaire for elderly (Heal) can be used as a simple and an easy-to-use valid and reliable measure in determining healthy life style and the frequency of health-oriented activities among older adults.

Empowerment in healthcare: A thematic synthesis and critical discussion of concept analyses of empowerment

OBJECTIVE

The objective of this study is to shed light on common characteristics revealed in concept analyses of empowerment to contribute to further understanding. A further objective is to discuss how the perspective of healthcare service users appeared in the concept analyses.

METHODS

The review was performed by systematically searching Medline, CINAHL, EMBASE, PsycINFO and ERIC. The search yielded 255 abstracts, which were reduced by relevance and critical appraisal to the 12 concept analyses included. The analysis process involved thematic synthesis as described by Thomas and Harden.

RESULTS

The synthesis led to 13 descriptive themes structured according to antecedents, attributes and consequences of empowerment. The synthesis revealed how sparsely the question of equality and power in the relation between health professionals and healthcare service users is addressed.

DISCUSSION

To a great extent empowerment is viewed as a helping process of making patients act differently, rather than redistribution of power. For groups that are particularly vulnerable to oppression, questions of power are of severe importance.

PRACTICE IMPLICATIONS

As user participation is a growing discourse in health policy, health professionals need education to develop and address dimensions of power and reciprocity in empowering relations between users and themselves.

An empowerment model of Iranian women for the management of menopause: a grounded theory study

Background and Objectives: There is still no clear portrayal of women's empowerment in managing menopause. The present study was conducted to design a model for the empowerment of Iranian women in managing menopause. Materials and Methods: This qualitative study was conducted using the grounded theory on  40-60-year-old women who were first selected through purposive sampling and then by theoretical sampling from November 2013 to July 2016. Data were collected using 33 in-depth, semi-structured, individual interviews with 30 participants. Data were analyzed using the Strauss and Corbin(2008) approach and organized in MAXQDA-10. Results: The analysis of the data led to the emergence of "active coping with menopause" as the core variable with four themes. The two themes "threat to feminine identity" and "latent opportunity" explained the context of the study, and "redefining the feminine identity" and "self-retrieval" explained its process. Conclusion: In our social context, the phenomenon of menopause is a coin with two sides and its experience leans more on the threat to feminine identity and less on latent opportunity. The model of postmenopausal women's empowerment for managing menopause might offer health policy-makers a realistic and divergent understanding of the challenges of empowering women by explaining key concepts.

Improvement in Quality of Life and Activities of Daily Living in Patients with Liver Cirrhosis with the Use of Health Education and Patient Health Empowerment

BACKGROUND The management of quality of life (QoL) in patients with cirrhosis is important due to the chronic nature of compensated cirrhosis. The aim of the study was to evaluate the effect of health education using health empowerment theory in patients with liver cirrhosis. MATERIAL AND METHODS Between January 2014 and November 2014, 30 patients who were hospitalized with liver cirrhosis patients were recruited to the study, as the study group. Health education was conducted using the principles of health empowerment theory. Between January 2013 and November 2013, 30 hospitalized cirrhosis patients were recruited as the control group, who were given conventional health education. The QoL scores and Health-Promoting Lifestyle Profile II (HPLP II) scores were evaluated at hospital discharge and at two-month follow-up. The health knowledge awareness rate, activity of daily living (ADL), and health-promoting lifestyles were evaluated. RESULTS On discharge from the hospital, understanding of the major clinical symptoms, etiology, diet and nutrition, use of medication, treatment, and disease awareness rates were significantly higher in the study group compared with the control group (all P<0.05). There were significant differences in ADL scores between the two groups at two-month follow-up (81.5±15.5 vs. 68.5±15.4; P=0.006). All HPLP II scores were higher in the study group compared with the control group at hospital discharge and at two-month follow-up (all P<0.05). CONCLUSIONS Patient health empowerment can improve the cognitive level and health behaviors of patients with liver cirrhosis, improve their ability to perform ADL, and improve their QoL.

Empowering Patients to Co-Create a Sustainable Healthcare Value

Extensive literature suggests that a solution to the current problems of healthcare sustainability is the active involvement of patients in health management through the empowerment of their abilities. Latest marketing frameworks suggest that patients are important resources for co-creating health value together with operators. This research aims to analyze the effects of patient empowerment on patients’ value co-creation behaviors. An empirical survey was conducted on 250 patients with chronic diseases in Italy. The results, analyzed using the structural equation modeling, showed that their empowerment enhanced value co-creation behaviors. Patients apply their health competencies and resources in their co-creation of health service with operators. It is, therefore, important to empower patients in their transformation from passive to active stakeholders, working with providers for the most optimal health outcomes. This research provides practitioners with suggestions for patient involvement which utilizes their knowledge, capabilities and responsibility to improving healthcare services.

The effects of an empowering self-management model on self-efficacy and sense of coherence among retired elderly with chronic diseases: a randomized controlled trial

Background

Being elderly and retired are related phenomena that overlap in a time symmetry. The present study aimed to assess the effect of an empowering self-management model on the self-efficacy and sense of coherence (SOC) in retired elderly with chronic diseases.

Methods

A randomized controlled trial that included 60 elderly people was carried out in Bushehr (Iran) in 2016. The participants were randomly assigned to either a control group or an intervention group. Based on an empowering self-management model, the intervention group participated in a five-stage plan: 1) self-awareness of changes and understanding their personal level of performance and expectations; 2) optimal goal setting; 3) planning; 4) adjusting physical, psychological, and social structures; and 5) evaluation. Self-efficacy and SOC were measured using the questionnaires developed by Sherer and Antonovsky, respectively, before and after the intervention. The results of the observed differences between the groups were subsequently compared. Data were presented as mean±SD.

Results

The mean change of the self-efficacy score in the intervention and control groups was 9.48±5.32 and 1.68± 6.04, respectively, (t[56]=5.20, P<0.001). The mean change of the SOC score in the intervention and control groups was 24.17±12.05 and 0.10±13.42, respectively, (t[56]=7.18, P<0.001).

Conclusion

The applied empowering self-management model led to an improved self-efficacy and SOC among the retired elderly with chronic diseases. This model can be used to empower the elderly to achieve comprehensibility, manageability, and meaningfulness in their lives.

The excellence of patient-centered healthcare

Purpose

Nowadays, international healthcare agendas are focused on patient centeredness. Policies are aimed at improving patient’s satisfaction by enhancing patient empowerment and value co-creation. However, a comprehensive model addressing the relationships between these constructs has not so far been developed. The purpose of this paper is to develop and test a model which explains the effects of patient empowerment and value co-creation on patients’ satisfaction with the quality of the services they experience.

Design/methodology/approach

The links between patient satisfaction, empowerment and value co-creation are theoretically outlined via an in-depth literature review. The resulting model is tested through a survey administered to 186 chronically ill patients. The results are analyzed through covariance-based structural equation modeling.

Findings

The results show that patient empowerment positively influences value co-creation which, in turn, is positively related to patient satisfaction. In addition, the analysis reveals that patient empowerment has no direct effects on satisfaction.

Research limitations/implications

Although the cross-sectional design made it possible to clearly estimate the relationships among variables, it overlooked the longitudinal dimensions of co-creation processes.

Practical implications

The study provides practitioners with suggestions to design patient-centered healthcare services by leveraging on patient knowledge, participation, responsibility in care and involvement in the value-creation process.

Originality/value

Over the last decade, healthcare management literature has shifted its focus from healthcare organizations to patients. The number of contributions about patient satisfaction, empowerment and value co-creation exponentially increased. However, these dimensions are often studied separately. This work advances available knowledge by clarifying and testing the relationships between these three constructs.

Empowerment in Dermatology

The term empowerment refers to any process that facilitates behavioral changes and encourages responsibility and making informed choices. The concept has been applied mainly to help patients with chronic conditions achieve therapeutic goals. The aim of the approach in health care is to enhance self-caring and self-efficacy. The term derives from the English verb to empower meaning "to give (someone) the authority or power to do something" or "to make an individual or a group stronger or more powerful". One of the responsibilities of health professionals is to improve patients' knowledge and their ability to choose between the different alternatives available to them so that they can act accordingly. In this article, we review the various definitions of the term empowerment, the tools used to measure patient empowerment, the implications of the concept for the management of chronic disease, and its use in dermatological conditions.

Interdisciplinary care praxis in groups of people living with fibromyalgia

Objectives:

to analyze the integrated community therapy model for the empowerment of people living with fibromyalgia and discuss the impact of this interdisciplinary intervention in the health-disease process and self-care.

Method:

a participatory-approach qualitative study, developed in 2015 with 11 participants at the Laboratory of Physiology Applied to Physical Education of the Rio de Janeiro State University, RJ. Data production comprised World Café, participant observation and semi-structured interview. The analysis was performed according to Bardin, through data triangulation in dialogue with the relevant literature.

Results:

the integrated community therapy group is a driving force in building and expanding knowledge about fibromyalgia and in self-care empowerment.

Conclusion:

this group strategy proved to be an interdisciplinary praxis tool that enables the development of solidary care networks. Thus, shared knowledge was generated, transformed into a listening and reflection environment to manage personal and family obstacles.

The empowerment of elderly patients with chronic obstructive pulmonary disease: Managing life with the disease

Chronic obstructive pulmonary disease (COPD) is a serious health problem that has significant effects on the life status of elderly persons. Use of the empowerment approach is necessary for health promotion in older people with COPD, but little attention has so far been paid to all the dimensions of empowerment in the management of COPD, which would provide useful knowledge regarding elders with COPD. This article reports on a study exploring people's experiences of the empowerment of older people with COPD. This study adopted an exploratory qualitative design and was carried out using grounded theory methodology. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems that they encounter. We collected data by conducting in-depth semi-structured interviews and taking field notes. Twenty-four participants were selected through purposive sampling. The results showed that in encountering the complexity of disease and in response to difficulties induced by COPD, three strategies were applied. Elderly persons with COPD, their family caregivers, and professional team members engaged in "managing life with COPD," "striving to keep abreast of life," "preparing for battle with disease," and "helping to stabilize the elder's life." The outcome of these strategies was "co-existence with disease." The potential of "managing life with COPD" was influenced by the following factors: "co-existence with ageing," "personal potential," "a challenged health system," and "weak social support." "Managing life with COPD" enables the elder to feel in control and live optimally. This is a fragile balance, however, and the unpredictability of COPD can tip the elder into "self-efficacy." Understanding the experiences of the empowerment process of older people with COPD can help health professionals provide more focused elderly care.

Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review

OBJECTIVES

The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact meaning in hospital care remains somewhat unclear. This absence of theoretical and conceptual clarity has led to (1) poor understanding and communication among researchers, health practitioners and policy makers and (2) problems in measurement and comparison between studies across different hospitals.

METHODS

This paper examines all three concepts through a concept analysis based on the method of Avant and Walker (2005) [1] and the simultaneous concept analysis of Haase et al. (1992) [2].

RESULTS

Through these methods, the antecedents, attributes, consequences and empirical referents of each concept are determined. In addition, similarities and differences between the three concepts are identified and a definition offered for each concept. Furthermore, the interrelatedness between the key concepts is mapped, and definitions are proposed.

CONCLUSIONS

It can be concluded that patient empowerment is a much broader concept than just patient participation and patient-centeredness.

PRACTICE IMPLICATIONS

The present study may provide a useful framework that researchers, policy makers and health care providers can use to facilitate patient empowerment.

Concepts and measures of patient empowerment: a comprehensive review

Abstract OBJECTIVE Analyze the definitions and dimensions of empowerment. Identify the strengths and weaknesses of empowerment measures based on the conceptual model. METHOD This was a comprehensive literature review of publications on the MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Twenty-nine articles were selected. Seventeen definitions and seven dimensions of empowerment, and 10 empowerment measures were selected. Empowerment can be seen as an enabling process involving a shift in the balance of power, or as an outcome of this process. The dimensions reflect outcome indicators, such as participation in decision-making and control, and process indicators, such as knowledge acquisition and coping skills. Six of the tools analyzed by this study could be said to provide a robust measure of patient empowerment. CONCLUSION we propose a definition of empowerment that helps to deepen understanding of the term and, therefore, its operationalization.

[Development and Effects of a Cognitive-behavioral Therapy Based Program in Reducing Internalized Stigma in Patients with Schizophrenia]

PURPOSE

This study was done to develop a internalized stigma reducing program based on cognitive-behavioral therapy and appropriate for patients with schizophrenia and to evaluate its effectiveness.

METHODS

The study design was a mixed method research. Qualitative study, 13 patients with schizophrenia who had experience in overcoming stigma were purposively chosen for interviews and data were analyzed using Giorgi method. Quantitative study, 64 patients with schizophrenia (experimental group=32, control group=32) were recruited. The cognitive-behavioral therapy-based program for reducing internalized stigma in patients with schizophrenia was provided for 8 weeks (12 sessions). Data were collected from June. 20, 2013 to Feb. 14, 2014. Quantitative data were analyzed using χ²-test, t-test, repeated measures ANOVA with the SPSS program.

RESULTS

Qualitative results, from the experience of coping with stigma in patients with schizophrenia seventeen themes and five themes-clusters were drawn up. Quantitative results showed that internalized stigma, self-esteem, mental health recovery and quality of life were significantly better in the experimental group compared to the control group.

CONCLUSION

Study findings indicate that this program for reducing internalized stigma in patients with schizophrenia is effective and can be recommended as a rehabilitation program intervention to help patients with schizophrenia to cope with internalized stigma.

[Development and Validation of the Empowerment Scale for Woman with Breast Cancer]

PURPOSE

The purpose of this study was to develop a scale to evaluate empowerment in woman with breast cancer and to examine the validity and reliability of the scale.

METHODS

The development process for the initial items included a literature review, interviews, and construction of a conceptual framework. The identified items were evaluated for content validity by experts, resulting in 3 factors and 48 preliminary items. Participants were 319 women with breast cancer recruited to test reliability and validity of the preliminary scale. Data were analyzed using item analysis, confirmatory factor analysis, criterion related validity, internal consistency and test-retest reliability.

RESULTS

The final scale consisted of 30 items and 3 factors. Factors, including 'intrapersonal factor' (14 items), 'interactional factor' (8 items), and 'behavioral factor' (8 items), were drawn up after confirmatory factor analysis. Goodness of fit of the final research model was very appropriate as shown by χ²/df=1.86, TLI=.90, CFI=.92, SRMR=.06, and RMSEA=.05. Criterion validity was evaluated by total correlation with the Cancer Empowerment Questionnaire .78. Cronbach's alpha for total items was .93 and test-retest reliability was .69.

CONCLUSION

Findings from this study indicate that the scale can be used in the development of nursing interventions to promote the empowerment of women having breast cancer.