Validation and Psychometric Analysis of the German Translation of the Appraisal of Self-Care Agency Scale-Revised

Self-care and self-management are essential for well-being, especially in advancing age or chronic illness. To assess these complex behaviors, validated questionnaires are needed. The Appraisal of Self-Care Agency Scale-Revised (ASAS-R) is a self-report questionnaire to evaluate the actions people take to manage their health. This manuscript reports the psychometric properties of the German ASAS-R translation. After standardized translation, convergent validity was assessed with the Patient Activation Measure (PAM) controlling for sociodemographic and health factors. Internal consistency, descriptive statistics, and principal component analysis (PCA) are reported. We analyzed data of 215 community-dwelling German adults aged 51.6 ± 14.7 years with at least one chronic illness. Similar to the original ASAS-R, PCA revealed three factors, although item allocation differed. The ASAS-R showed good internal consistency overall and for each factor, although ceiling effects were present for some items. Convergent validity was good, and the ASAS-R was as a predictor for the PAM irrespective of other variables. As self-care is highly complex, we conclude that factor structure should be assessed for each dataset. Overall, the German ASAS-R is a valid instrument to measure self-care and self-management of chronic diseases that may enhance research on this fundamental health behavior in German-speaking countries.

Self-care appraisal in nursing assistant students: Adaptation, validation and psychometric properties of the Spanish ASAS

The core implication of nursing professionals’ labor is promoting self-care and foster well-being among healthcare service users. The beginning of the healing process starts with the provider, and self-care habits are needed to positively impact on patients’ care outcomes at different spheres. Overall, current literature supports the idea that nurses’ personal self-care should be a necessary skill to be expected in their professional role. In this regard, the Appraisal of Self-care Agency Scale (ASAS) is a worldwide known instrument aimed at assessing the ability to engage in self-care. However, it has never been tested in the Spanish context before, and much less in nursing practitioners or apprentices. The aim of this study was to translate, adapt and validate the ASAS for Spanish nursing apprentices, assessing its dimensionality, psychometric properties and convergent validity by means of the Sense of Coherence (SOC-13) questionnaire. Methods: Data were collected from a random sample of 921 Certificated Nursing Assistant (CNA) Spanish students and was analyzed trough confirmatory factor analyses via structural equation models. The core ASAS construct and its subscales were correlated with the SOC-13 scores. Results: Fair psychometric properties for the questionnaire were set. Also, SEM models endorse the validity and reliability of the four-factor dimensionality of the Spanish adaptation of the ASAS, whose associations to SOC scores were coherent and significant. Conclusion: This study allowed to establish that the Spanish version of the ASAS might be a useful tool for addressing self-care-related issues among nursing apprentices, a key population for promoting both their own and patients’ health and welfare through healthy and care-related behaviors.

Validación de escala de Valoración de Agencia de Autocuidado (ASA) en adolescentes chilenos

Resumen Objetivo Realizar validación y análisis de confiabilidad de la Escala de Valoración de Agencia de Autocuidado en adolescentes chilenos. Método Fue realizado en una muestra 199 adolescentes. La validación de contenido se hizo por revisión de expertos. Se exploró la confiabilidad y la validez de constructo por medio de análisis factorial exploratorio (AFE) y confirmatorio (AFC). Resultados Algunos términos de la escala se adaptaron culturalmente. La confiabilidad alfa de Cronbach de la escala de 24 ítems fue de 0,88. Los ítems 6, 11, 20 presentaron baja confiabilidad y correlación con la escala (<0,4). El AFE, sugirió solución factorial de cinco factores y un factor por gráfico de sedimentación. Las ecuaciones estructurales de los posibles modelos resultaron con valores de índices de ajuste, cercano a lo satisfactorio. Conclusiones e Implicaciones para la práctica Considerando la combinación de criterios: objetivos; basados en la teoría y en los análisis factoriales, la solución óptima es la de un factor con 21 ítems. La escala presenta ítems adaptados culturalmente. Se propone incorporar ítems más específicos de autocuidado en adolescentes. Investigaciones que evalúen intervenciones tendientes a mejorar la capacidad de autocuidado en adolescentes podrían utilizar la nueva versión de la escala ASA con mejores propiedades psicométricas.

Alcohol and Drug Use in European University Health Science Students: Relationship with Self-Care Ability

Background: Drug abuse in university students is an emerging social and health issue. The present study assesses alcohol and abuse of other illicit drugs and the adverse consequences related to such use and its relationship with self-care agency among European university students. Methods: A multicenter cross-sectional study was performed among 592 European students from different health science degrees. The screening of alcohol abuse was evaluated with the Alcohol Use Disorder Test (AUDIT), and the screening for substance-related risks and problems was conducted with the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening test. We analyzed the relationship of substance abuse with self-care agency, assessed by the Appraisal of Self-Care Agency Scale (ASA). Results: 51.4% of the surveyed students reported alcohol intake, 16.6% of the students consumed both alcohol and cannabis, 1.6 % reported alcohol and other illicit drugs, and 3.7% consumed alcohol, marijuana, and other illicit drugs (73.3% of students reported alcohol intake alone or together with cannabis/hashish and/or other illicit drugs). The self-care agency scores were significantly different among groups in relation to certain sociodemographic factors such as gender (p = 0.008) and country of residence (p = 0.031). The self-care agency scores significantly correlated (p = 0.001) with the personal motivations and consequences related to the consumption of drugs of abuse evaluated by the CRAFFT screening tool. Within the ASA domains, the most significant effects were observed regarding the subdomains of resources, awareness, and health behaviors. Conclusions: Self-care agency should be promoted to counteract the health and social consequences of the consumption of drugs of abuse among university students who will be future health care professionals.

The Appraisal of Self-Care Agency Scale - Revised (ASA-R): Adaptation and Validation in a Sample of Spanish Older Adults

Self-care agency is an important determinant of healthy aging. The Appraisal of Self-care Agency Scale (ASA-R) (Sousa et al., 2010) is one of the main instrument to assess self-care capacity. The objectives of the study were: 1) to adapt and validate ASA-R scale for use in Spanish population; 2) to examine the dimensionality, validity and reliability; 3) and to establish the convergent validity of ASA-R using a self-reported health measure. The ASA-R Scale and the 12-item Short Form Health Survey (SF-12) were administered to 488 Spanish seniors aged 65 and over. Confirmatory Factor Analysis (CFA) was used to analyze the dimensionality, validity and reliability. Convergent validity was tested by correlating the ASA-R factors with the SF-12 subscales; correlations were significant (p 0.05 (0.436), RMSEA closer to 0 (0.006), SRMR 0.95 (0.996 and 0.995). The results also demonstrated that ASA-R is a reliable and valid instrument. The ASA-R has demonstrated to be a reliable (CR indices > 0.7) and valid (AVE > 0.5) instrument in measuring self-care agency among Spanish older population.

Confirmatory factor analysis of the Appraisal of Self-Care Agency Scale - Revised

Objective

to analyze the factor structure of the Appraisal of Self-Care Agency Scale-Revised (ASAS-R), adapted for Brazil.

Method

methodological study conducted with 150 individuals with diabetes mellitus cared for by the Family Health Strategy, most of whom are elderly with low educational levels. The test of the hypothesis concerning the confirmatory factor composition of the ASAS-R was performed using latent variables structural equations.

Results

the model's goodness-of-fit indexes were satisfactory (χ2 = 259.19; χ2/g.l = 2.97, p < 0.001; GFI = 0.85; RMR = 0.07; RMSEA = 0.09); the factor loads were greater than 0.40; and most item-to-factor-correlations presented moderate to strong magnitude (0.34 to 0.58); total alpha value was 0.74, while the alpha of the three factors were 0.69, 0.38 and 0.69, respectively.

Conclusion

the scale's factor structure presented satisfactory validity and reliability results, with the exception of one factor. Application of this scale to samples of the general population is desirable in order to strengthen analyses of internal consistency and the dimensionality of the factor structure. This study is expected to contribute to further studies addressing the self-care agency construct and the development of the ASAS-R.

Self-care agency and quality of life in the preoperative period of coronary artery bypass graft surgery

Resumo OBJETIVO Analisar os fatores condicionantes básicos do autocuidado e a qualidade de vida relacionada à saúde, associando-os à capacidade de autocuidado em indivíduos no pré-operatório de revascularização miocárdica. MÉTODO Estudo descritivo com abordagem quantitativa, ancorado teórico-metodologicamente na Teoria de Enfermagem do Déficit de Autocuidado. Coleta de dados realizada entre março e agosto de 2013, utilizando-se da Escala para Avaliação do Autocuidado e do Medical Outcomes 36 Item Short Form Health Survey. RESULTADOS Há correlação entre capacidade de autocuidado e a qualidade de vida no pré-operatório de revascularização miocárdica. CONCLUSÃO Entre os participantes do estudo pode ocorrer uma redução na qualidade de vida, tendo em vista a convivência com doenças e agravos não transmissíveis e, mesmo assim, os indivíduos buscam as melhores maneiras de cuidar de si.

The relationships among depression, self-care agency, self-efficacy and diabetes self-care management

At the time the study was conducted, Besher Gharaibeh, Byron Gajewski, and Diane Boyle were affiliated with School of Nursing University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Ahmed Al-smadi was affiliated with University of Ulster, Belfast, Newtownabbey Co. Antrim BT37 0QB, Jordandtown road, UK. The coexistence of diabetes and depression is associated with negative outcomes such as poor diabetes self-care management (DSCM). Complex relationships exist among diabetes knowledge, self-efficacy, self-care agency, depression and DSCM. No study has examined the relationships among all these factors at the same time. We aimed to examine relationships among depression, diabetes knowledge, self-care agency, self-efficacy and DSCM in insulin- treated people based on a modification of the DSCM model. A cross-sectional, correlational model testing design was used. Participants with type 1 ( n = 35) and type 2 ( n = 43) diabetes were recruited from both outpatient and community sites. Participants mean age was 46.6 years (standard deviation 13.7) and the majority were men (56.4%). Multiple regression analyses tested the hypothesised relationships. Depression was found to have a direct negative relationship with self-care agency and self-efficacy. The relationship between depression and DSCM was not direct. Self-care agency and self-efficacy completely mediated the effect of depression on DSCM. Self-efficacy completely mediated the effect of self-care agency on DSCM. We conclude that effective treatment programmes for persons managed with insulin should probably include not only screening and treatment of depression, but also skills training to enhance patient self-care agency and self-efficacy alongside DSCM.

The Appraisal of Self-Care Agency Scale - Revised (ASAS-R): adaptation and construct validity in the Brazilian context

This study presents the psychometric properties of the Brazilian version of the Appraisal of Self-Care Agency Scale - Revised (ASAS-R). The sample was made up of 627 subjects (69.8% women) aged between 18 and 88 years (mean = 38.3; SD = 13.26) from 17 Brazilian states. Exploratory factor analysis of part of the sample (n1 = 200) yielded a three-factor solution which showed adequate levels of reliability. Two confirmatory factor analyses of the other part of the sample (n2 = 427) tested both the exploratory and the original model. The analysis of convergent validity using the Subjective Happiness Scale, the Satisfaction with Life Scale, and the 36-item Short Form Health Survey Version 2 (SF-36v2) demonstrated adequate levels of validity. A significant correlation was found between levels of self-care agency and age, level of education and income. The analysis of sample members with chronic disease (n = 134) showed that higher levels of self-care agency indicated lower levels of negative impact of the chronic illness in the individual's everyday life.

Tradução, adaptação e validação de uma escala para o autocuidado de portadores de diabetes mellitus tipo 2 em uso de insulina

Objetivo Traduzir, adaptar e validar a escala Appraisal of Self Care Agency Scale-Revised (ASAS-R) para o Brasil.Métodos Utilizou-se o método descritivo de adaptação de instrumentos de medidas, em 150 portadores de diabetes mellitus. As etapas foram: tradução, síntese das traduções independentes, avaliação pelo Comitê de Juízes, retrotradução, submissão das versões retrotraduzidas aos autores da versão original, validação semântica, submissão da versão adaptada aos autores da versão original e pré-teste.Resultados ASAS-R manteve as equivalências semântica, cultural e conceitual. O alfa de Cronbach foi de 0,74, e o coeficiente de correlação intraclasse, no teste e reteste, foi de 0,81, e na análise interobservadores, de 0,84.Conclusão A versão manteve as equivalências conceitual, semântica e cultural. Confirmou-se a correlação entre os construtos capacidade de autocuidado, depressão e percepção do estado de saúde, exceto apoio social. Na validade discriminante, observaram-se diferenças significantes entre grupos, quanto à idade, escolaridade e autoaplicação de insulina.

Factors influencing self-management in patients with type 2 diabetes: a quantitative systematic review protocol

AIM

To describe a protocol for a quantitative systematic review, to identify critique and summarize factors that influence self-management education.

BACKGROUND

Self-management education enables patients to manage their condition successfully and it is associated with better self-care, good control over lifestyle and leading the best possible quality of life, notwithstanding the presence of a chronic disease. Type II Diabetes is a chronic disease that requires lifestyle adjustments and disease management to keep glycaemia and long-term complications under control. Education has to be customized and based on an assessment that includes factors influencing self-management, such as personal characteristics that can optimize the educational intervention.

DESIGN

The protocol for the systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination, York (UK).

METHOD

The review question was defined in terms of population, interventions, comparators, outcomes and study designs. The protocol included decisions about the review question, inclusion criteria, search strategy, study selection, data extraction, quality assessment, data synthesis and plans for dissemination. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome.

DISCUSSION

An initial summary will be made by tabulating the data; the review will be reported in a narrative style and be developed according to the PRISMA guidelines. The protocol for the systematic review will allow us to identify, among the factors influencing self-management in people with Type II diabetes, the personal characteristics most relevant to the factors of motivation and empowerment. In addition, the systematic review will also identify an appropriate self-management model.

Diabetes Disease Management in a Home Care Setting

The purpose of this Orem’s Self-Care Deficit Theory of Nursing guided project was to extend a program evaluation project to examine the effects of three different approaches to home health care diabetes care on patient self-care behaviors. Group 1 (n = 64) received an experimental Diabetes Disease Management Program, group 2 (n = 167) received a Diabetes Learning Collaborative program, and group 3 (n = 132) received standard diabetes home care. No statistically significant group differences were found for self-care behaviors. Statistically significant associations in group 2 between emergent care and patients who met American Diabetes Association criteria for glucose control regarding discharge management of injectable medication management were found. A significant clinical finding was that 46% of patients (n = 117) did not meet the glucose criteria.

The relationship between self-care agency, disability levels and factors regarding these situations among patients with rheumatoid arthritis

AIMS AND OBJECTIVES

To assess the relationship between self-care agency scores, disability levels and factors regarding these situations among Turkish patients with rheumatoid arthritis.

BACKGROUND

Rheumatoid arthritis is characterised by severe to slight synovial joint inflammation that can lead to pain, stiffness and joint destruction with subsequent physical deformities, disabilities and reduced self-care. Self-care is an important component of comprehensive chronic disease management such as rheumatoid arthritis. If patients have high levels of self-care and adhere to rheumatoid arthritis treatment, it can be expected that they will have fewer symptoms and better functional capabilities.

DESIGN

A cross-sectional, design was used.

METHOD

This study was conducted with 467 rheumatoid arthritis patients who applied at the Rheumatology Outpatient Department of Gaziantep University between September 2008-February 2009. The data collection instruments used in this study were the Demographic Data Form, Health Assessment Questionnaire (including disability index and pain scale) and Self-as-Carer Inventory. The frequency, mean, Student's t-test, one-way anova, Kruskal-Wallis, chi-square, correlation and regression analysis were used; p < 0·05 was accepted as statistically significant.

RESULTS

For patients the self-care agency classification of 13·7% and 86·3% were 'moderate' and 'poor', respectively; while the disability levels of 12·2 51·2 and 36·6% were 'mild', 'moderate' and 'severe', respectively; and their pain average was 'moderate'. It was also determined that, as the patients' self-agency scores declined, their disability levels deteriorated even further and their pain levels increased even more.

CONCLUSIONS

In conclusion we found that in Turkish patients with Rheumatoid Arthritis, the higher disability and pain rate were, the lower self-care agency score was.

RELEVANCE TO CLINICAL PRACTICE

Nurses should strive to provide individuals with RA the knowledge, skills and resources necessary for active participation in self-care, as this might promote the capacity for self-care.

Confirmatory factor analysis of the depressive cognition scale

The purpose of this study was to validate the single-factor structure of the Depressive Cognition Scale (DCS) among individuals from the U.S. general population. The sample was composed of 629 adults from 42 states of the United States. All measures of model fit of the DCS exceeded the recommended criteria for the good model fit (χ(2)/df = 2.57, goodness-of-fitness index = .98, adjusted goodness-of-fitness index = .96, comparative fit index = .99, Tucker Lewis index = .98, root mean square error of approximation = .05, root mean residual = .01, and the P value for test of close fit = .464). Thus, the DCS was found to be a reliable and valid instrument to measure depressive cognitions among individuals from the general population.

Reliability, validity and factor structure of the Appraisal of Self-Care Agency Scale-Revised (ASAS-R)

RATIONALE, AIMS AND OBJECTIVES

Self-care agency is a fundamental concept in nursing and health care research. Having self-care agency enhances an individual's health-promoting behaviours and/or specific capabilities for chronic disease self-management. The purpose of this study was to continue the development and psychometric testing of the Appraisal of Self-Care Agency - Revised (ASAS-R).

METHODS

A cross-sectional methodological design was used to examine the reliability, validity and factor structure of the ASAS-R among individuals from the general population. The sample consisted of 629 adults who were randomly selected to conduct an exploratory factor analysis (EFA; n=240) and a confirmatory factor analysis (CFA; n=389) of the scale. A demographic questionnaire, the ASAS-R and the Health-Promoting Lifestyle Profile (HPLP-II) were the measures used to collect the data.

RESULTS

The final 15-item three-factor ASAS-R had an overall Cronbach's alpha (α) of 0.89. The three factors extracted, rotated and scored in this study were labelled: having power for self-care, developing power for self-care and lacking power for self-care. All inter-items and item-to-total correlations met recommended criteria of r=0.30 to r=0.70, except for one of the items that had an item-to-total correlation of 0.71, slightly exceeding the maximum recommended item-to-total correlation. The three factors had Cronbach's alphas of 0.86, 0.83 and 0.79, respectively. The three factors together explained 61.7% of the scale items variance. Each item of the scale had a strong factor loading ranging from 0.52 to 0.81. All measures of model fit exceeded the recommended criteria, indicating that the 15-item ASAS-R had a very good fit (χ(2) /d.f.=1.97, GFI=0.94, AGFI=0.92, CFI=0.96, TLI=0.95, RMSEA=0.05, RMR=0.05 and the PCLOSE=0.48).

CONCLUSIONS

The 15-item three-factor ASAS-R is a short, reliable and valid instrument to measure self-care agency among individuals from the general population, but further psychometric evaluation is needed among individuals with chronic diseases, especially those with diabetes mellitus.

Chronic sorrow in parents of children with type 1 diabetes

AIM

This paper reports on a study exploring parents' longer-term experiences of having a child with type 1 diabetes.

BACKGROUND

Parents of children with type 1 diabetes may experience a grief reaction at diagnosis similar to that normally associated with bereavement, but little is known about their long-term emotional adaptation. Chronic sorrow, a sustained but intermittent grief reaction, is identified in adults with diabetes but has not previously been explored in relation to parents.

METHODOLOGY

In-depth interviews were conducted in 2007 with a convenience sample of 17 parents of children with type 1 diabetes 7-10 years after diagnosis. Data were explored within a theoretical framework of grief, loss, adaptation, and change.

FINDINGS

Parents had adapted to the needs of diabetes management but most had not 'come to terms' with the diagnosis. They experienced a resurgence of grief at critical times during their child's development and some, particularly mothers, became upset during their interviews, even though these took place 7-10 years after their child's diagnosis. Mothers elaborated more on their emotions than fathers, but continuing feelings associated with grief, such as anger and guilt, were expressed by both fathers and mothers.

CONCLUSION

Greater understanding of parents' long-term emotional responses and recognition that grief may never resolve in these parents may enable healthcare professionals to provide appropriate and timely support at critical times.