Instrument translation and evaluation of equivalence and psychometric properties: the Chinese Sense of Coherence Scale

Dyadic effects of social support on psychological distress in patients with advanced lung cancer and spousal caregivers: The mediating role of sense of coherence

OBJECTIVE

The primary objective of this study was to examine the dyadic relationships between perceived social support, sense of coherence (SOC), and psychological distress in advanced lung cancer patients and their spousal caregivers with the dyadic analysis method.

METHODS

302 dyads of patients and their spouses were recruited between April 2023 to October 2023 from a Chinese tertiary hospital. Participants' perceived social support, SOC, and psychological distress were evaluated by corresponding questionnaires. In order to explore the potential dyadic associations between the covariates, the data were analyzed by adopting the actor-partner interdependence mediation model (APIMeM).

RESULTS

The findings demonstrated that the impact of perceived social support on psychological distress had both actor and partner effects. Specifically, the perceived social support of patients and their spouses was directly and positively associated with their own psychological distress. Furthermore, in patient-spouse dyads, SOC mediated the actor effects of perceived social support on psychological distress. Another important finding was that perceived social support by spouse had a direct or indirect negative partner effect on the psychological distress of patients.

CONCLUSION

The investigation uncovered a dyadic interdependence between perceived social support, psychological distress, and SOC. It is necessary for medical professionals to identify patients and spouses who report poor levels of SOC and perceived social support and implement targeted interventions to address these concerns.

Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial

INTRODUCTION

Smoking cessation is an essential, but often overlooked aspect of diabetes management. Despite the need for tailored smoking cessation support for individuals with diabetes, evidence of effective interventions for this cohort is limited. Additionally, individuals with diabetes do not easily adopt such interventions, resulting in low uptake and abstinence rates. This protocol describes a study that aims to assess the feasibility and acceptability of a unique smoking cessation intervention, based on the best evidence, theory and the needs of individuals with diabetes, among patients and service providers, the diabetes nurse educators.

METHODS AND ANALYSIS

This is an open-label pragmatic randomised controlled trial. Between 80 and 100 individuals with type 1 or type 2 diabetes who smoke will be recruited from the diabetes outpatients at the main acute public hospital in Malta, starting in August 2023. Participants will be randomly assigned (1:1 ratio) to the intervention or control arm for 12 weeks. The experimental intervention will consist of three to four smoking cessation behavioural support sessions based on the 5As (Ask, Advise, Assess, Assist and Arrange) algorithm, and a 6-week supply of nicotine replacement therapy. The control intervention will consist of an active referral to the Maltese National Health Service's one-to-one smoking cessation support service, which is based on motivational interviewing. The primary feasibility and acceptability outcomes include the recruitment and participation rates, resources used, problems identified by the nurses, the nurses' perceived challenges and facilitators to implementation and the nurses' and patients' acceptability of the study intervention. Data analyses will be descriptive, with quantitative feasibility and acceptability outcomes reported with 95% confidence intervals.

ETHICS AND DISSEMINATION

Ethical clearance was obtained from the Faculty of Health Sciences Research Ethics Committee, University of Malta. The study results will be disseminated through conference presentations and a publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05920096.

Acceptability measures for evaluating smoking cessation interventions among individuals with diabetes

Background

The literature indicates that individuals with diabetes do not easily adopt smoking cessation interventions. Given that the success of such interventions depends on patient involvement and attitudes, assessing intervention acceptability, including patient satisfaction and perceived usefulness, is crucial before implementing a smoking cessation intervention. This paper reports the preliminary validation of the satisfaction and perceived usefulness questionnaires for evaluating smoking cessation interventions among individuals with diabetes.

Study design

Validity study.

Methods

The satisfaction questionnaire contained eight statements while the perceived usefulness questionnaire had fourteen; both rated on a 5-point Likert scale. Content validation involved five tobacco cessation facilitators rating item relevance using a 4-point ordinal rating scale, suggesting improvements. The questionnaires were also translated into Maltese for local use and assessed for translation validity using a similar scale. Unanimous agreement among experts was required for item relevance and equivalence. Thirty-four individuals with type 1 or type 2 diabetes, attending a diabetes-specific smoking cessation intervention, received either the Maltese or English versions of the questionnaires. Internal consistency was measured using Cronbach's alpha.

Results

After two rounds of content validation, the experts unanimously agreed on item relevance and conceptual equivalence. Fifteen and sixteen participants completed the Maltese and English versions of the questionnaires, respectively. Both questionnaires' versions were found to have a high internal consistency (>0.8).

Conclusions

These findings provide the initial validation of these instruments for assessing the acceptability of smoking cessation interventions among individuals with diabetes. Further validation in different settings using a larger sample is suggested.

The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China

Childhood trauma is strongly linked to emotional distress. However, few studies have explored the impact of sense of coherence (SOC) on the relationship between childhood trauma and emotional distress in college students. This study aimed to explore its impact on the relationship between childhood trauma and emotional distress. Analyzing data from 2307 Chinese college students, we found that SOC moderated the association between childhood trauma and anxiety/depression levels. Females showed higher SOC and lower anxiety/depression despite experiencing more childhood trauma. Multiple linear regression revealed that anxiety was negatively associated with SOC(P < 0.001) and grade(P = 0.027), and positively with childhood trauma(P < 0.001) and male gender(P = 0.004). Similarly, the depression exhibited similar associations. SOC moderated negatively the relationship between CTQ and anxiety, as well as between CTQ and depression. Childhood trauma is associated with increased emotional distress risk among college students, but a strong SOC can reduce this risk.

Factors of preparedness for loss from cancer among Taiwanese family caregivers

This cohort study investigated factors associated with 336 Taiwanese family caregivers' emotional and cognitive preparedness for death of a loved one with terminal cancer. Caregivers' death-preparedness states (no-death-preparedness [as reference], cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) were previously identified. Associations of factors with these states were determined by a hierarchical generalized linear model. Financial hardship decreased caregivers' likelihood for the emotional-death-preparedness-only and sufficient-death-preparedness states. Physician prognostic disclosure increased membership in the cognitive-death-preparedness-only and sufficient-death-preparedness states. The better the quality of the patient-caregiver relationship, the higher the odds for the emotional-death-preparedness-only and sufficient-death-preparedness states, whereas the greater the tendency for caregivers to communicate end-of-life issues with their loved one, the lower the odds for emotional-death-preparedness-only state membership. Stronger coping capacity increased membership in the emotional-death-preparedness-only state, but perceived social support was not associated with state membership. Providing effective interventions tailored to at-risk family caregivers' specific needs may facilitate their death preparedness.

Sense of Coherence as a Mediator Between Functional Status and Health-Related Quality of Life in Patients With Heart Failure

BACKGROUND

Poor functional status relating to heart failure (HF) negatively affects health-related quality of life (HRQOL). Patients with HF, especially those with New York Heart Association (NYHA) Class III or IV HF, often exhibit poor HRQOL because of physical limitations and HF-related symptoms. Although sense of coherence (SOC) has been reported to be a determinant of HRQOL, its role as a mediator between functional status and HRQOL remains unclear, and few studies have explored the prevalence of HF in patients in NYHA Classes I and II.

PURPOSE

This study was designed to investigate SOC as a mediator between different functional status classes and HRQOL in patients with HF.

METHODS

A cross-sectional study was conducted on patients with HF recruited from a hospital in northern Taiwan from April 2020 to September 2020. The Minnesota Living with Heart Failure Questionnaire and a questionnaire on sociodemographic characteristics; functional classification in terms of NYHA Classes I, II, and III; and SOC were administered. The PROCESS v3.5 (by Andrew F. Hayes) macro was applied to analyze the effects, and Model 4 was used to examine the mediating role of SOC on the relationship between NYHA functional class and HRQOL.

RESULTS

Of the 295 participants, SOC was found to mediate the effects of functional status on HRQOL more significantly in patients in Class II than those in Class III but not more significantly in patients in Class I than those in Class III. A weaker mediating effect of SOC was noted on the relationship between functional status and HRQOL in patients with HF in NYHA Class II than those in Class III.

CONCLUSIONS

In patients with HF, poor functional status often reduces HRQOL significantly. SOC mediates the relationship between functional status and HRQOL more significantly in those in NYHA Class II than those in Class III. Nursing staff should work to increase patients' SOC by strengthening their coping capacity and improving their functional status to improve their HRQOL.

Association of Maternal Sense of Coherence With Oral Health Behavior of Children With Special Health Care Needs: A Cross-Sectional Study

BACKGROUND

Sense of coherence (SOC) has been adopted to analyze stress coping skills as well as to find its association with health and oral health behavior. The Arabic version of SOC has not been developed and adopted in the Saudi Arabian population; furthermore, few studies have attempted to analyze the association of a mother's sense of coherence with the oral health behavior of Special Care Health Needs (SCHN) children. Hence, this study aimed to observe the association of mothers' SOC scores with their children's oral health behavior, along with the validation of the scale.

MATERIALS AND METHODS

A cross-sectional study was conducted among 170 mothers of children with SCHN. Participants were recruited from two schools in Riyadh City and one school in Makkah, respectively. Descriptive statistics, validation, reliability, factor analysis, and multinomial logistic regression were carried out using the Statistical Package for the Social Sciences (SPSS, Version 20, 2011; IBM Corp., Armonk, USA).

RESULTS

The mean SOC-13 score was 61.6 (±10.1), with a median value of 61. The SOC scale elicited a Cronbach's alpha value of 0.77. The Spearman-Brown-Brownuttman split-half reliability coefficients were found to be 0.70, respectively. The analysis confirmed a three-factor solution, which explains about 51.9% of the total variance. Mothers with higher SOC tend to utilize dental services for children [OR 5.69, P = 0.029, CI 1.19-27.02] and restrict sugary drinks to once a day [OR 9.31, P = 0.00, CI 1.95-44.44].

CONCLUSION

The reliability of the Arabic scale that was adopted after translation in the present study was found to be high; the scale confirms the three-factor solution. Mothers who scored low on the SOC scale tended to utilize less dental service for their children as well as overlook the sugary drink/day intake of the children.

Translating and Adapting the DISCERN Instrument Into a Simplified Chinese Version and Validating Its Reliability: Development and Usability Study

BACKGROUND

There is a wide variation in the quality of information available to patients on the treatment of the diseases afflicting them. To help patients find clear and accessible information, many scales have been designed to evaluate the quality of health information, including the Patient Education Materials Assessment Tool; the Suitability Assessment of Materials for evaluation of health-related information for adults; and DISCERN, an instrument for judging the quality of written consumer health information on treatment choices. These instruments are primarily in English. Few of them have been translated and adapted into simplified Chinese tools for health information assessment in China.

OBJECTIVE

This study aimed to translate and adapt DISCERN into the first simplified Chinese version and validate the psychometric properties of this newly developed scale for judging the quality of patient-oriented health information on treatment choices.

METHODS

First, we translated DISCERN into simplified Chinese using rigorous guidelines for translation and validation studies. We tested the translation equivalence and measured the content validity index. We then presented the simplified Chinese instrument to 3 health educators and asked them to use it to assess the quality of 15 lung cancer-related materials. We calculated the Cohen κ coefficient and Cronbach α for all items and for the entire scale to determine the reliability of the new tool.

RESULTS

We decided on the simplified Chinese version of the DISCERN instrument (C-DISCERN) after resolving all problems in translation, adaptation, and content validation. The C-DISCERN was valid and reliable: the content validity index was 0.98 (47/48, 98% of the items) for clarity and 0.94 (45/48, 94% of the items) for relevance, the Cronbach α for internal consistency was .93 (95% CI 0.699-1.428) for the whole translated scale, and the Cohen κ coefficient for internal consistency was 0.53 (95% CI 0.417-0.698).

CONCLUSIONS

C-DISCERN is the first simplified Chinese version of the DISCERN instrument. Its validity and reliability have been attested to assess the quality of patient-targeted information for treatment choices.

Psychometric properties of the Chinese version of the preoperative assessment of readiness tool among surgical patients

Background

The evaluation of the surgical readiness of patients plays an important role in clinical care. Preoperative readiness assessment is needed to identify the inadequacy among surgical patients, which provides guide for interventions to improve patients’ preoperative readiness. However, there is a paucity of high-level, quality tool that evaluate surgical readiness of patients in China. The purpose of this study is to translate the Preoperative Assessment of Readiness Tool (PART) into Chinese and determine the reliability and validity of the Chinese version in the population of surgical patients.

Methods

Using a standard translation-backward method, the original English version of PART was translated into Chinese. A convenient sampling of 210 surgical patients was recruited from 6 hospitals in Zhejiang Province to test the psychometric properties of this scale including internal consistency, split-half reliability, content validity, structure validity, and floor/ceiling effect.

Results

A total of 194 patients (92%) completed questionnaires. The Chinese version of PART achieved Cronbach’s alphas 0.948 and McDonald’s omega coefficient 0.947, respectively, for the full scale. The estimated odd-even split-half reliability was 0.959. The scale-level content validity index was 0.867, and the items content validity index ranged from 0.83 to 1.0.The output of confirmatory factor analysis (CFA) revealed a two-factor model (χ2 = 510.96; df = 86; p &lt; 0.001; root mean square error approximation = 0.08) with no floor/ceiling effect.

Conclusion

The Chinese version of PART demonstrated acceptable reliability and validity among surgical patients. It can be used to evaluate patients’ preoperative preparation and help health professionals provide proper preoperative support.

The Effects of Horticultural Therapy on Sense of Coherence among Residents of Long-Term Care Facilities: A Quasi Experimental Design

Promoting positive mental health is crucial for the elderly living in long-term care facilities (LTCFs). This study aims to examine the effectiveness of horticultural therapy on the level of sense of coherence (SOC) among older LTCF residents with relatively normal mental function. With convenient sampling, a total of 86 participants were recruited from 12 LTCFs in northeastern Taiwan. In the experimental group (n = 49), the mean (±standard deviation) score of SOC was 50.45 ± 6.07 at baseline and increased to 56.37 ± 7.20 (p < 0.001) after 12-week horticultural intervention. In contrast, the mean SOC score did not change significantly in the control group (n = 37) during the study period. Generalized estimating equation analysis showed that a significant interaction effect between group and time on the SOC score (p < 0.001). Our findings indicate that horticultural therapy is effective to strengthen the SOC level of older LTCF residents without dementia.

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).

Association Between Sense of Coherence and Frailty: A Cross-Sectional Study in China

PURPOSE

Frailty is an emerging global public health burden. Most existing studies have focused on risk factors for frailty, focusing less on protective factors against frailty. This study aims to examine the association between the sense of coherence (SOC), the most common construct of salutogenesis and frailty status among community-dwelling old adults.

METHOD

A cross-sectional study was conducted among 7,970 old adults aged ≥65 years in three cities in China from June 2019 to October 2020. Frailty was operationalised as the sum of self-reported fatigue, resistance, ambulation, illness, and loss of weight (FRAIL scale). The χ² test was used to analyse the distribution difference of frailty in demographic, behavioural, and SOC levels. Confounder-adjusted multinomial logistic regression was used to examine the association between SOC and frailty.

RESULTS

The prevalence of pre-frailty and frailty was 43.1 and 8.0%, respectively. The results of the confounder-adjusted regression showed that older adults with moderate-level SOC (odds ratio, OR: 0.61, 95% CI: 0.54-0.69) and strong-level SOC (OR: 0.55, 0.48-0.64) had lower odds of being pre-frail compared to those with weak SOC. It also showed that older adults with moderate-level SOC (OR: 0.32, 95% CI: 0.27-0.40) and strong-level SOC (OR: 0.22, 95% CI: 0.16-0.29) had lower odds of being frail compared to those with weak SOC.

CONCLUSION

SOC may be a protective factor against frailty. Improving SOC may be a strategy to prevent frailty among Chinese community-dwelling older adults.

The effects of acculturation and environment on lifestyle behaviors in Korean immigrants: the mediating role of acculturative stress and body image discrepancy

OBJECTIVES

Despite high rates of cardiometabolic diseases in Korean immigrants (KIs), little is known about cultural and environmental factors contributing to lifestyle behaviors. The purpose of this cross-sectional study was to examine the relationships among acculturation, environment, and lifestyle behaviors (dietary behavior, physical activity, and sedentary behavior) through culturally sensitive psychological mediators, body image discrepancy and acculturative stress in middle-aged KIs.

DESIGN

A cross-sectional study was conducted. KIs aged 30-65 years were recruited online and at Korean community centers and churches in the Northeastern US Participants completed validated measures of dietary behavior (the Nutrition Subscale of the Health Promoting Lifestyle Profile (HPLP) II), physical activity (the International Physical Activity Questionnaire (IPAQ) - short form), and sedentary behavior (the Sedentary Behavior Questionnaire). Acculturative stress was measured by the Acculturative Stress Index and body image discrepancy was measured by the Stunkard Figure Rating Scale. Acculturation was defined as a latent variable measured by Korean and American orientation (Vancouver Index of Acculturation), age of immigration to the US, length of residency in the US, and English proficiency. Data were analyzed with structural equation modeling (SEM).

RESULTS

The sample included 361 KIs (mean age = 41.77 ±10.28 years, 48.1% female, and 46.4% overweight or obese). In the SEM model, acculturation had significant indirect effects on dietary behavior, physical activity, and sedentary behavior through body image discrepancy. Acculturative stress mediated the relationship between acculturation and sedentary behavior. Greater environmental support for physical activity and better healthy food accessibility were related to higher levels of physical activity and healthier dietary behavior, respectively.

CONCLUSION

In our study, acculturation and environmental support for physical activity and healthy food simultaneously influenced KIs' lifestyle behaviors. Addressing an unhealthy body image and acculturative stress may be additional strategies for lifestyle intervention programs to prevent cardiometabolic diseases in KIs.

Instrument Context Relevance Evaluation, Translation, and Psychometric Testing of the Diabetes Eating Problem Survey-Revised (DEPS-R) among People with Type 1 Diabetes in China

Background: People with type 1 diabetes are susceptible to disordered eating behaviors. The American Diabetes Association recommends using the Diabetes Eating Problem Survey-Revised (DEPS-R) to screen them. There is no validated diabetes-specific screening measure in China. The objectives were to adapt DEPS-R into Mandarin Chinese and to test its psychometric properties among youths and adults with type 1 diabetes in China, respectively. Methods: This study was conducted in two phases. Phase 1 included context relevance evaluation and instrument translation. Phase 2 was psychometric testing of reliability and construct validity among 89 youths (8~17 years old) and 61 adults with type 1 diabetes. Result: The Context Relevance Index and Translation Validity Index of this instrument were good. Strong internal consistency reliability correlations and convergent validity were demonstrated among youths and adults. Discussion: The Chinese version of the DEPS-R is a valid and reliable tool for screening disordered eating behaviors in Chinese youths and adults with type 1 diabetes. The Context Relevance Index is advocated to evaluate the difference between the context in which an instrument was originally developed and the target context.

Cross-cultural adaptation and validation of the First-Time Fathers Questionnaire in China

OBJECTIVE

The study aimed to cross-culturally adapt and validate the First-Time Fathers Questionnaire (FTFQ) in the cultural context of China.

DESIGN

Prospective validation study.

SETTING

The study was conducted in four public hospitals in Hangzhou, a southeast coastal city of China.

PARTICIPANTS

Four hundred and nineteen first-time fathers (mean age=30.45 years, SD=3.44, range 22-46) whose partners had given birth between July 20 and October 10, 2019.

METHODS

The instrument "First Time Fathers Questionnaire (FTFQ)" was translated and culturally adapted to the Chinese context according to the methodological criteria of the International Society for Pharmacoeconomic and Outcomes Research. The construct-related validity of the instrument was tested through EFA and CFA. Content validity was evaluated with an analysis of the expert judgment. Reliability was assessed based on the internal consistency.

RESULTS

Four domains were identified: "Worry", "Information", "Emotional Support", and "Acceptance", with 19 items and adequate internal reliability (0.86, 0.80, 0.86, and 0.72, respectively) and a total variance of 64.65%. The CFA model showed there is a good fit for the data: X²/df =1.20; RMSA = 0.03; CFI = 0.99; and NFI = 0.93. Additionally, each item achieved an I-CVI ≧0.83, and the S-CVI/Ave = 0.90.

KEY CONCLUSIONS

The Chinese version of the FTFQ is a valid and reliable instrument to assess first-time fathers' experience of childbirth in China.

IMPLICATIONS FOR PRACTICE

This study provides a validated questionnaire that is suitable for the Chinese cultural context. It contributes to the knowledge of first-time fathers' experience of childbirth and facilitate further actions to improve paternal satisfaction and behavior as labour companion.

Gender Differences in Acculturative Stress and Habitual Sleep Duration in Korean American Immigrants

Korean American immigrants (KAIs) face diverse sociocultural stressors in the acculturation process. While stress is known to cause short sleep, little is known about how acculturative stress affects sleep differently for KAI men and women. The purpose of this cross-sectional study was to examine gender differences in the association between diverse domains of acculturative stress and sleep duration among KAIs. Middle-aged KAIs were recruited in community settings and online. KAIs completed validated measures of acculturative stress (homesickness, social isolation, employment barriers, discrimination, civic disengagement, and family problems) and sleep duration. Multiple linear regression analysis was performed and stratified by gender. 343 KAIs participated (mean age = 41 ± 10 years, 47% female, 11% short sleepers [< 6 h]). After adjustment for covariates, higher homesickness (β = - 23.19, p < 0.05) and lower civic disengagement (β = 17.75, p < 0.05) were associated with shorter sleep duration in women, while higher isolation was associated with shorter sleep duration in men (β = - 13.73, p < 0.05). Discussion: Results suggest gender-specific associations between acculturative stress and sleep duration. Future research should take into account gender differences in the experience and effects of acculturative stress when developing interventions to improve sleep health in KAIs.

Psychometric properties of the Danish Hospital Anxiety and Depression Scale in patients with cardiac disease: results from the DenHeart survey

BACKGROUND

Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease.

METHODS

The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach's alpha, and differential item functioning by gender was examined using ordinal logistic regression.

RESULTS

A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach's alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items.

CONCLUSIONS

The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01926145.

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.

Health-related quality of life of living liver donors 1 year after donation

Background

Improving the health-related quality of life (HRQOL) of living liver donors post-donation is an important aspect of care quality. Analyzing the HRQOL of living liver donors prospectively could help improve our understanding of the recovery of HRQOL and help improve the quality of donor care. In this study, we examined the HRQOL of living liver donors at pre-donation and at 1-year post-donation and analyzed the effect of pre- and post-donation factors on the donors' physical and mental HRQOL.

Methods

This was a prospective study. During the enrollment period (August 2013 to December 2015), 68 living liver donors completed the study questionnaires 5 times: at pre-donation and at 1, 3, 6, and 12 months post-donation. The Medical Outcomes Study Questionnaire Short Form-36, which yields both physical (PCS) and mental (MCS) component summary scores, was used to measure the HRQOL. The pre- and post-donation factors included donation ambivalence, recipients' physical condition, post-donation complications, and recipients' survival status.

Results

Participants' mean PCS scores were 43.59 and 56.50 at 1 and 12 months after donation, respectively, whereas their mean MCS scores were 46.89 and 46.28, respectively. The mean PCS score was worse at 1 month after donation but improved significantly over time (P<0.05); conversely, the MCS was quite stable over time (P>0.05). A good PCS score was associated with no surgical complications of donation (coefficient =2.87, P=0.02), whereas a poor MCS score was associated with an education of less than a bachelor's degree (coefficient =-3.60, P=0.004), a higher Model for End-Stage Liver Disease (MELD) score in the recipient (coefficient =-0.13, P=0.03), and recipient death (coefficient =-3.48, P=0.03). Pre-donation ambivalence and sense of coherence were not significant predictors of the PCS or MCS scores.

Conclusions

The impact of living liver donation on HRQOL was strongest in the early stages of the post-surgery period for the physical domain. Health-care professionals should carefully manage and monitor the progress of surgical outcomes, particularly in high-risk groups such as donors with a low education level or donors whose recipients have severe illness or end up dying after the surgery. Doing so may allow for suitable intervention opportunities to improve the HRQOL of living liver donors.

Translation and Adaption of Questionnaires: A Nursing Challenge

Background

Translation of previously developed questionnaires has often been the choice when addressing research to groups whose language is not English. In the translation of health-related questionnaires, it is highly important to assure congruency between the words and their true meaning in the language to which the questionnaire is translated.

Aim

To describe the semantic problems encountered in translating a standardized questionnaire from English (the Identity and Experiences Scale) to Norwegian according to the World Health Organizations translation protocol.

Design

A mixed-method study was used with the formation of four focus groups and a postal survey.

Data sources

Eighteen respondents from a nursing college in Oslo, an aged community in northeast Norway, and a community organization of retired persons in southeast Norway were focus group participants. In sum, 141 persons participated in the postal survey.

Findings

A number of semantical challenges in relation to interpretation and understanding of the meaning and use of words in the Identity and Experiences Scale were found.

Discussion

Words bearing emotional weight and connected to complex operational concepts were found to be problematic. Various American-English colloquial expressions also caused semantical challenges. Other problems were related to sentence structure and grammar form.

Conclusion

Translation, adaptation, and validation of questionnaires or scales for practice and research are very time-consuming and require careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.

Implications for nursing

Translation quality is a methodological issue that nurses need to take seriously. It is highly recommended that nurses follow and document steps in a procedure of forward translation, qualitative reviews of translated items with regard to clarity, common language and conceptual adequacy, back translation, testing on lay panels, and committee review, or a probable variation of this procedure.

Psychometric properties of the Chinese version of the spiritual care-giving scale (C-SCGS) in nursing practice

Background

Spiritual care is defined as recognizing and responding to the needs of the human spirit when the individual is facing trauma, illness, or sadness. Providing spiritual care is one of the core aspects of holistic care, as it is significantly associated with patients’ quality of life. The provision of optimal spiritual care requires good understanding by the nurses. Therefore, it is important to assess this understanding by using a proven, well-validated instrument. The Spiritual Care-Giving Scale (SCGS) is designed to measure nurses’ perceptions of spirituality and spiritual care in Singapore. However, it is unknown whether this scale is valid and reliable for use with nurses in the context of Chinese culture. The purpose of this study is to determine this version’s validity and reliability for use with nurses in China.

Methods

In this quantitative, descriptive, cross-sectional study, after translating the English version of the SCGS into Chinese and making adjustments for culture and values, we assessed the performance of this instrument by administering the C-SCGS to a convenience sample of 400 nurses. The participants also completed the Chinese version of the Spiritual Care Competency Scale (C-SCCS) to assess the concurrent validity of the C-SCGS. The internal consistency and homogeneity of the C-SCGS were also tested, and a factorial analysis was performed.

Results

Completed questionnaires were obtained from 355 participants (response rate: 88.75%). Four factors were confirmed by an exploratory factor analysis (EFA) using Promax with the Kaiser normalization rotation method after the 35-item SCGS was reduced to 34 items, and these factors explained 53.116% of the total variance. The adjusted item–total correlation ranged from 0.527 to 0.760. The Cronbach’s alpha of the factors ranged from 0.836 to 0.941, and the Guttman split-half coefficient was between 0.759 and 0.902. The concurrent validity of the C-SCGS and C-SCCS (r = 0.534, p < 0.01) showed a significant correlation. Nurses’ education showed a significant association with the scores of the C-SCGS.

Conclusion

The C-SCGS was found to be a psychometrically sound measurement to evaluate Chinese-speaking nurses’ perceptions of spirituality and spiritual care.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0662-7) contains supplementary material, which is available to authorized users.

Translation and Cross-cultural Adaptation of the Chinese Version of the Self-care of Hypertension Inventory in Older Adults

BACKGROUND

Hypertension is highly prevalent among the older adults. Self-care is an effective method for the secondary prevention of hypertension, but until now, there has been no specialized instrument to evaluate the ability for self-care in elderly Chinese patients with hypertension.

OBJECTIVES

The aims of this study were to cross-culturally translate the Self-care of Hypertension Inventory into Chinese and apply it to elderly patients with preliminary hypertension.

METHODS

This is a methodological study with steps that included translation, synthesis, back-translation, back-translation review, expert committee review, pretesting, and submission to authors. We conducted preliminary psychometric analyses that included content validity, item-total correlation, internal consistency reliability, principal factor analysis, and test/retest reliability.

RESULTS

The translation equivalence was obtained between the adapted version and the original scale. The item-level content validity index had a range of 0.833 to 1. The scale-level content validity average method and Cronbach α were 0.986 and 0.858 for the total scale, respectively. The test/retest reliability was 0.949. Principal factor analyses showed the presence of 4, 1, and 1 latent factors in 3 separate subscales.

CONCLUSIONS

The Self-care of Hypertension Inventory has been successfully translated and cross-culturally adapted to Chinese. It is suitable for application to elderly Chinese patients with hypertension.

Challenges in adapting a survey: ensuring cross-cultural equivalence

BACKGROUND

The increase in the number of international research studies means more surveys need to be adapted for use in different languages. To obtain valid cross-cultural study results, researchers often use translated surveys.

AIM

To describe the translation process used, and lessons learned by a bilingual English/Mandarin PhD student and her three English-speaking supervisors when developing and translating an English-language survey for use in a study in Taiwan.

DISCUSSION

In evaluating the translation process in this study, the three criteria of content equivalence, semantic equivalence and conceptual equivalence are discussed in relation to the challenges these presented to the research team. Some of the ways the team addressed these challenges are also considered.

CONCLUSION

The time available for the research and the ability of translators need to be assessed when adapting surveys for use in different languages and cultures. Sharing experiences and lessons learned in the translation process was worthwhile, as all members of the research team came away with new knowledge and an understanding of the need to ensure the final version of a translated survey is culturally congruent.

IMPLICATIONS FOR PRACTICE

To accurately translate a survey into another language, it is essential that one of the researchers be fluent in that language. This guarantees the closest fit of content and semantic and conceptual meaning.

Measuring functional, interactive and critical health literacy of Chinese secondary school students: reliable, valid and feasible?

Health literacy is an increasingly important topic in the global context. In mainland China, health literacy measures mainly focus on health knowledge and practices or on the functional domain for adolescents. However, little is known about interactive and critical domains. This study aimed to adopt a skills-based and three-domain (functional, interactive and critical) instrument to measure health literacy in Chinese adolescents and to examine the status and determinants of each domain. Using a systematic review, the eight-item Health Literacy Assessment Tool (HLAT-8) was selected and translated from English to Chinese (c-HLAT-8). Following the translation process, a cross-sectional study was conducted in four secondary schools in Beijing, China. A total of 650 students in Years 7-9 were recruited to complete a self-administered questionnaire that assessed socio-demographics, self-efficacy, social support, school environment, community environment and health literacy. Results showed that the c-HLAT-8 had satisfactory reliability (Cronbach's α = 0.79; intra-class correlation coefficient = 0.72) and strong validity (translation validity index (TVI) ≥0.95; χ²/ df = 3.388, p < 0.001; comparative fit index = 0.975, Tucker and Lewis's index of fit = 0.945, normed fit index = 0.965, root mean error of approximation = 0.061; scores on the c-HLAT-8 were moderately correlated with the Health Literacy Study-Taiwan, but weakly with the Newest Vital Sign). Chinese students had an average score of 26.37 (±5.89) for the c-HLAT-8. When the determinants of each domain of health literacy were examined, social support was the strongest predictor of interactive and critical health literacy. On the contrary, self-efficacy and school environment played more dominant roles in predicting functional health literacy. The c-HLAT-8 was demonstrated to be a reliable, valid and feasible instrument for measuring functional, interactive and critical health literacy among Chinese students. The current findings indicate that increasing self-efficacy, social support and creating supportive environments are important for promoting health literacy in secondary school settings in China.

Translation and validation of the Canadian diabetes risk assessment questionnaire in China

OBJECTIVES

To adapt the Canadian Diabetes Risk Assessment Questionnaire for the Chinese population and to evaluate its psychometric properties.

DESIGN AND SAMPLE

A cross-sectional study was conducted with a convenience sample of 194 individuals aged 35-74 years from October 2014 to April 2015.

METHODS

The Canadian Diabetes Risk Assessment Questionnaire was adapted and translated for the Chinese population. Test-retest reliability was conducted to measure stability. Criterion and convergent validity of the adapted questionnaire were assessed using 2-hr 75 g oral glucose tolerance tests and the Finnish Diabetes Risk Scores, respectively. Sensitivity and specificity were evaluated to establish its predictive validity.

RESULTS

The test-retest reliability was 0.988. Adequate validity of the adapted questionnaire was demonstrated by positive correlations found between the scores and 2-hr 75 g oral glucose tolerance tests (r = .343, p < .001) and with the Finnish Diabetes Risk Scores (r = .738, p < .001). The area under receiver operating characteristic curve was 0.705 (95% CI .632, .778), demonstrating moderate diagnostic value at a cutoff score of 30. The sensitivity was 73%, with a positive predictive value of 57% and negative predictive value of 78%.

CONCLUSIONS

Our results provided evidence supporting the translation consistency, content validity, convergent validity, criterion validity, sensitivity, and specificity of the translated Canadian Diabetes Risk Assessment Questionnaire with minor modifications. This paper provides clinical, practical, and methodological information on how to adapt a diabetes risk calculator between cultures for public health nurses.

Psychometric properties of the Chinese version of Spiritual Index of Well-Being in elderly Taiwanese

Background

Spiritual well-being has become an increasingly important issue for the elderly people. The 12-item Spirituality Index of Well-Being (SIWB) is a well-validated instrument for assessing a patient’s current spiritual state. However, the psychometric properties of the SIWB in the Chinese elderly populations are not known. Therefore, this study translated the SIWB into Chinese and evaluated its psychometric properties.

Methods

The English version of the SIWB was first translated into Chinese based on the Brislin’s translation model. The psychometric properties of the translated version of the SIWB (SIWB-C) was evaluated in 416 elderly Taiwanese recruited using a purposive sampling procedure from a medical center, a long-term care institution, and a community health center. Convergent validity was accessed using Pearson’s correlation coefficients of the SIWB-C, the EQ-5D-3 L health-related quality of life scale, and the Geriatric Depression Scale-5 (GDS-5). Exploratory factor analysis with Varimax rotation was performed to determine the construct validity. Confirmatory factor analysis was conducted for verification of the quality of the factor structures and demonstrating the convergent validity of the SIWB-C. An internal consistency test based on the Cronbach’s alpha coefficient and a stability test based on the Guttman split-half coefficient were also performed. Test-retest reliability was evaluated with intraclass correlation coefficient.

Results

Exploratory factor analysis confirmed the original two-dimensional structure of the scale. Confirmatory factor analysis indicated a well-fitting model and a fine convergent validity of the SIWB-C. The Cronbach’s alpha coefficient and the Guttman split-half coefficient for the SIWB-C were 0.94 and 0.84, respectively. The correlations between the SIWB-C with EQ-5D-3 L and GDS-5 were 0.22 (p < 0.01) and 0.45 (p < 0.05), respectively. The intraclass correlation coefficient of the SIWB-C over a test-retest interval of two weeks was 0.989.

Conclusions

The SIWB-C was found to be a potential useful measure of subjective spiritual well-being in elderly Taiwanese. Its application in assessing the spiritual well-being in Mandarin-speaking elderly population warrants further investigation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0392-1) contains supplementary material, which is available to authorized users.

Resilience Style Questionnaire: Development and Validation Among College Students and Cardiac Patients in Hong Kong

The present research aims to develop and validate a measure of resilience that reflects the influence of Confucian philosophies and Chinese cultural lay beliefs. Based on a representative sample of 1,419 college students from universities and a clinical sample of 214 cardiac patients in Hong Kong, reliability, construct validity, and criterion validity of the Resilience Style Questionnaire (RSQ) were examined. A two-factor structure of the RSQ was explored and validated in both samples. Results showed that the two factors of the RSQ (i.e., perseverance and optimistic approach to life) were significantly associated with a variety of mental health indicators in both samples. Furthermore, the RSQ explained additional variances above and beyond those explained by the Ego-Resiliency Scale, the Sense of Coherence Scale (SOC), and the Connor-Davidson Resilience Scale in multiple mental health indicators among college students and cardiac patients. These findings showed that the RSQ is a reliable and valid tool in assessing resilience among Chinese and other groups influenced by Confucianism.

Cross-cultural validation of the moral sensitivity questionnaire-revised Chinese version

Background:

Ethical issues pose challenges for nurses who are increasingly caring for patients in complicated situations. Ethical sensitivity is a prerequisite for nurses to make decisions in the best interest of their patients in daily practice. Currently, there is no tool for assessing ethical sensitivity in Chinese language, and no empirical studies of ethical sensitivity among Chinese nurses.

Research objectives:

The study was conducted to translate the Moral Sensitivity Questionnaire–Revised Version (MSQ-R) into Chinese and establish the psychometric properties of the Moral Sensitivity Questionnaire–Revised Version into Chinese (MSQ-R-CV).

Research design:

This research was a methodological and descriptive study.

Participants and research context:

MSQ-R was translated into Chinese using Brislin’s model, and the Translation Validity Index was evaluated. MSQ-R-CV was then distributed along with a demographic questionnaire to 360 nurses working at tertiary and municipal hospitals in Changsha, China.

Ethical considerations:

This study was approved by the Institutional Review Boards of Yale University and Central South University.

Findings:

MSQ-R-CV achieved Cronbach’s alpha 0.82, Spearman-Brown coefficient 0.75, significant item discrimination (p < 0.001), and item-total correlation values ranging from 0.524 to 0.717. A two-factor structure was illustrated by exploratory factor analysis, and further confirmed by confirmatory factor analysis. Chinese nurses had a mean total score of 40.22 ± 7.08 on the MSQ-R-CV, and sub-scores of 23.85 ± 4.4 for moral responsibility and strength and 16.37 ± 3.75 for sense of moral burden.

Discussion:

The findings of this study were compared with studies from other countries to examine the structure and meaningful implications of ethical sensitivity in Chinese nurses.

Conclusion:

The two-factor MSQ-R-CV (moral responsibility and strength, and sense of moral burden) is a linguistically and culturally appropriate instrument for assessing ethical sensitivity among Chinese nurses.

Pancreatitis Quality of Life Instrument: A Psychometric Evaluation

OBJECTIVES

Chronic pancreatitis is a significant medical problem that impacts a large number of patients worldwide. In 2014, we developed a disease-specific instrument for the evaluation of quality of life in this group of patients: pancreatitis quality of life instrument (PANQOLI). The goal of this study was to evaluate its psychometric properties: its reliability and its construct validity.

METHODS

This is a cross-sectional multi-center study that involved 12 pancreatic disease centers. Patients who met the inclusion/exclusion criteria for chronic pancreatitis were invited to participate. Those who accepted were asked to complete seven questionnaires/instruments. Only patients who completed the PANQOLI were included in the study. Its reliability and its construct validity were tested.

RESULTS

A total of 159 patients completed the PANQOLI and were included in the study. They had a mean age of 49.03, 49% were male, and 84% were Caucasian. Six of the 24 items on the scale were removed because of lack of inter-item correlation, redundancy, or lack of correlation to quality of life issues. The final 18-item scale had excellent reliability (Cronbach's alpha coefficient: 0.914) and excellent construct validity with good correlation to generic quality of life instruments (SF-12 and EORTC QLQ-C30/QLQ-PAN26) and lack of correlation to non-quality of life instruments (MAST and DAST). Through exploratory factor analysis, the PANQOLI was found to consist of four subscales: emotional function scale, role function scale, physical function scale, and "self-worth" scale.

CONCLUSIONS

PANQOLI is the first disease-specific instrument to be developed and validated for the evaluation of quality of life in chronic pancreatitis patients. It has a unique subscale for "self-worth" that differentiates it from other generic instruments. Studies are currently under way to evaluate its use in other populations not included in this study.

The validity and reliability of the Sense of Coherence scale among Indian university students

Background:

The importance of salutogenesis, with the focus of what creates health rather than what causes diseases, has been highlighted for a long time. This has been operationalized by Aaron Antonovsky as the Sense of Coherence (SOC-13) scale. The aim of this study was to further examine the psychometric properties of the SOC-13 in India.

Methods:

The present study was carried out among second-year degree students at three randomly chosen institutions at Mangalore University. Investigators assessed the appropriateness, relevance, comprehensiveness and understandability of the scale. Further, the scale was assessed by five subject experts. The SOC-13 was then pretested by administering it to peers, individuals and a few of the study subjects. Internal consistency was assessed by Cronbach’s alpha and split-half reliability. Test-retest reliability was assessed by administering the instrument to the same study participants after two weeks. Confirmatory factor analysis employing varimax rotation was employed.

Results:

The SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 ( p < 0.01). Factor analysis revealed a three-factor solution explaining 40.53% of the variation in SOC.

Conclusions:

SOC-13 was found to be a reliable and valid instrument for measuring SOC in an Indian context. The present study contributes to health promotion in an Indian context, and could be useful even in other developing countries and for further research in India.

Evaluating the Cultural Validity of the Stressful Life Events Screening Questionnaire

Measures of psychological trauma are rarely evaluated for validity with disadvantaged populations. The authors used three qualitative methods to assess the cultural validity of the Stressful Life Events Screening Questionnaire (SLESQ) with low-income African American women. Focus groups ( n = 17), cognitive interviews ( n = 20), and videotape reviews of SLESQ interviews were conducted ( n = 16). Focus group participants spontaneously used similar language to the SLESQ items and tended to identify SLESQ events as traumatic. Most items were well understood in the interviews, with some criticism of wording. Tape reviews indicated little wording modification by interviewers. One item showed consistent problems. The interview was revised accordingly.

Sense of Coherence among Older Adult Residents of Long-Term Care Facilities in Taiwan: A Cross-Sectional Analysis

Background

Growing evidence shows that sense of coherence (SOC) is related to health promotion. Knowledge of SOC among older adults in Taiwan is limited. The present study aimed to investigate SOC status and its relationship to personal and environmental factors among older adult residents of long-term care facilities (LTCFs) in northeastern Taiwan.

Methods

This cross-sectional study was performed in Yilan, Taiwan. With face-to-face interviews, we obtained data from 104 LTCF residents (aged 65 years and older) using the Chinese version of Antonovsky's short 13-item SOC scale. We also collected the information on personal characteristics, physical and social environmental resources. Multiple linear regression was used to analyze factors potentially influencing SOC.

Results

Of the participants, the mean score (±standard deviation) of SOC was 58.3 (±8.8), while scores on SOC subscales (comprehensibility, manageability, and meaningfulness) were 23.4 ±4.5, 17.9 ±3.8, and 17.0 ±3.2, respectively. Education level, activities of daily living and number of LTCF staff were found to be independently associated with SOC status after adjusting for demographic characteristics, health status, and environmental resources. In addition, interactions between personal and environmental factors had a crucial influence on SOC status.

Conclusions

Participants in this study had relatively low SOC scores compared to their counterparts in Western countries. In addition to personal factors, environmental factors can play a significant role in SOC status among older adult LTCF residents. Comprehensive evaluation of SOC status should consider person-environment interaction effects.

Translation of the Outcome Questionnaire-45 (OQ) into Japanese: A cultural adaptation

OBJECTIVE

While there are several Japanese, qualitative, case studies examining psychotherapy outcome, there is a growing need for quantitative psychotherapy outcome research in Japan. This study adapted the Outcome Questionnaire-45 (OQ), one of the most common quantitative measures of clinical outcome, for use in Japan.

METHOD

With the help of 6 translators and 116 native Japanese pilot respondents, the original OQ was translated into Japanese following Beaton et al.'s methodology and includes forward translation, synthesis, back translation, and expert committee meetings.

RESULTS

The study produced four pre-final versions, two pretest version, and one pilot version of the Japanese OQ. With permission from the original questionnaire developers, a few items were modified to achieve cultural equivalence. The rigorous translation and adaptation processes, evaluated through the Translation Validity Index and Content Validity Index provided semantic, content, and conceptual equivalence between the English and Japanese versions.

CONCLUSIONS

The current study partially validated the translation equivalence and cultural adaptation of the Japanese OQ. Study limitations and suggestions for further development are discussed.

The effect of cognitive appraisal in middle-aged women stroke survivors and the psychological health of their caregivers: a follow-up study

AIMS AND OBJECTIVES

This study identified the factors that affect health-related quality of life at one and six months post-stroke in women who have undergone a mild stroke and that affect their informal caregivers' psychological health status.

BACKGROUND

Middle-aged women perform the main care roles in a family. When they suffer a stroke, it upsets the equilibrium of their family life.

DESIGN

This is a longitudinal design.

METHODS

This prospective follow-up study recruited 41 middle-aged women stroke survivors (mean age = 54.95, SD = 9.63) and their informal caregivers (mean age = 41.56, SD = 15.93). The Short-Form Health Survey (SF-36) was used to assess stroke survivor's health-related quality of life, and the Chinese Health Questionnaire was used to measure the level of depression of the stroke survivor's informal caregiver. Data were analysed through descriptive statistics, Wilcoxon signed-rank tests and the generalised estimating equation approach for modelling repeatedly measures.

RESULTS

All stroke survivors showed significant improvement in the physical component summary of the health-related quality of life at one and six months after stroke, but there was no significant difference in the mental component summary. In addition, there was no significant difference in the health of the informal caregivers of the women over time. Generalised estimating equation analysis showed that the most important determinant of mental component summary of health-related quality of life among women stroke survivors was cognitive appraisal. The informal caregivers' most important determinants of health status, as measured by level of depression, were their sense of coherence, burden and patients' mental component summary of the health-related quality of life.

CONCLUSION

This study highlights the impact of cognitive appraisal in determining health-related quality of life of women stroke survivors and how it affects their caregivers' mental health.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study may contribute to home care nurses' understanding the importance of the psychosocial impact of the stroke for the survivor and their ability to help the surviving women to promote the confidence needed for self-care, which will contribute to their quality of life and affect their caregivers' health.

Development and validation of the Chinese Version of Spiritual Interests Related Illness Tool for patients with cancer in Taiwan

PURPOSE

The purpose of the study was to develop and validate the Chinese Version of Spiritual Interests Related Illness Tool (C-SpIRIT) for patients with cancer in Taiwan.

METHODS

Translation, adaptation, and content validation were performed based on the 44-item Spiritual Interests Related Illness Tool. The psychometric validation was conducted based on 260 participants who were recruited from the oncology outpatient clinic of a medical center in southern Taiwan. The data were analyzed using exploratory factor analysis, Cronbach's alpha, and Pearson's correlations.

RESULTS

Five subscales (related to beliefs/religion, positive attitudes toward life, love to/from others, seeking for the meaning of life, and peaceful mind) were extracted from an exploratory factor analysis. The five subscales (with 21 items) accounted for 50.43% of the variance. The evidence based on concurrent validity was supported by a significant correlation (r = 0.95) between the 33-itm C-SpIRIT and the 21-item C-SpIRIT. Cronbach's α values (0.73-0.88) demonstrated internal item consistency of the C-SpIRIT.

CONCLUSIONS

This preliminary 21-item and 5-factor constructed C-SpIRIT demonstrated a valid and reliable instrument to assess the spiritual needs of patients with cancer in Taiwan. In addition, it is a handy tool for oncology nursing practitioners to gage their patients' spiritual needs.

Mediating effects of sense of coherence on family caregivers' depressive distress while caring for terminally ill cancer patients

BACKGROUND

The stress and coping theory suggests that the impact of caregiving on caregivers' life depends more on personal psychological resources (ie, sense of coherence [SOC]) than on objective caregiving demands or social resources. However, SOC's mediation roles in helping caregivers cope with the challenges of end-of-life care have never been explored.

OBJECTIVE

The objective of this study was to evaluate the mediation effects of SOC on caregivers' depressive distress while providing end-of-life care.

METHODS

The Center for Epidemiological Studies-Depression Scale scores from a convenience sample of 621 family caregivers were analyzed using structural equation modeling. We used the Sobel test to verify the significance of SOC's mediation effects on the relationships between identified stressors (objective caregiving demands, patient symptom distress), appraisals (confidence in caregiving, subjective caregiving burden), and caregivers' depressive distress.

RESULTS

Sense of coherence mediated effects on relationships between Center for Epidemiological Studies-Depression Scale scores and subjective caregiving burden (P = .000), confidence in caregiving (P = .014), and objective caregiving demands (P = .000). Although the strength of SOC did not attenuate the impact of caregivers' perceived patient symptom distress on caregiver depressive distress, SOC mediated this effect secondarily through appraisals of subjective caregiving burden and confidence in caregiving.

CONCLUSION

Personal psychological resources, as indicated by the strength of personal SOC, significantly mediated the effects of caregiving stressors, appraisals of caregiving confidence, and subjective caregiving burden on depressive distress of family caregivers while providing end-of-life care.

IMPLICATIONS FOR PRACTICE

Nursing interventions to enhance caregivers' SOC may decrease their depressive distress through increasing their confidence in providing end-of-life care and lightening their perceived caregiving burden.

Health-related quality of life and associated factors in Chinese women with cervical cancer: a 9-month follow-up

BACKGROUND

There is a lack of health-related quality of life (HRQOL) studies in Chinese women with cervical cancer.

OBJECTIVE

The objectives of this study were to investigate the HRQOL trajectory in women with cervical cancer in Mainland China in the 9 months following diagnosis and to identify factors that influence HRQOL.

METHODS

Initially, 187 patients with cervical cancer were included in the study, but at each follow-up, the number declined to 128, 112, and 106, respectively. The Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) was used to collect data sequentially at the time of diagnosis (T1) and at 3 (T2), 6 (T3), and 9 months after diagnosis (T4). Medical characteristics, sense of coherence, and social support were included as factors likely to contribute to HRQOL.

RESULTS

Functional Assessment of Cancer Therapy-Cervix ranged in mean from 120.30 at T1 to 126.22 at T4 (P = .001), whereas social/family well-being ranged from 23.56 at T1 to 20.23 at T4 (P = .025). In the stepwise regression with FACT-Cx as the independent variable, sense of coherence entered the equation with the highest standardized coefficients (0.554) at T1 and stage II at T2 and T3 (-0.53 and -0.26, respectively). Satisfaction with family relationships had the second highest standardized coefficient (-0.21) at T3.

CONCLUSIONS

Overall HRQOL improved, although social/family well-being deteriorated. Sense of coherence contributed to HRQOL initially, whereas disease stage and family support did so later on.

IMPLICATIONS FOR PRACTICE

The study highlights the importance of identifying those with a low sense of coherence at the time of diagnosis. Family members should be included in caring process as a vital source of social support.

Instrument translation and initial psychometric evaluation of the Chinese version of the Self-Management of Type 1 Diabetes for Adolescents scale

AIM

To translate the validated measure, Self-Management of Type 1 Diabetes in Adolescents, into the Mandarin Chinese language and to test the psychometric properties of the Chinese version.

BACKGROUND

Although research on self-management of Type 1 diabetes has been increasing over the past 20 years, few health-related instruments have been available in the Chinese language for youth with Type 1 diabetes.

DESIGN

A two-phase design was used in this study, including instrument translation and psychometric testing.

METHODS

The instrument translation, from October 2008-April 2009, included three steps: forward translation, back translation, and comparison of versions via Translation Validity Index - with multiple rounds, group discussion, and achievement of consensus at each step. Psychometric properties of the Chinese version Schilling's Self-Management of Type 1 Diabetes for Adolescents scale was assessed in a convenience sample of 136 Chinese youth (ages 8-19) with Type 1 diabetes between June 2009-August 2009.

RESULTS

The internal consistency and test-retest reliabilities indicated generally good consistency and temporal stability of the Chinese version. Evidence of construct validity and criterion-related validity was obtained via correlations of subscales with established measures of diabetes adherence and quality of life and also with haemoglobin A1c. Results from hypothesis testing also supported construct validity.

CONCLUSION

The Chinese version of Self-Management of Type 1 Diabetes for Adolescents scale is sound and will facilitate cross-cultural studies, while also enabling nurses to monitor and enhance the diabetes self-management of Chinese youth with Type 1 diabetes.

Are perceived stress, depressive symptoms and religiosity associated with alcohol consumption? A survey of freshmen university students across five European countries

BACKGROUND

The aim of this study was to investigate the association of perceived stress, depressive symptoms and religiosity with frequent alcohol consumption and problem drinking among freshmen university students from five European countries.

METHODS

2529 university freshmen (mean age 20.37, 64.9% females) from Germany (n = 654), Poland (n = 561), Bulgaria (n = 688), the UK (n = 311) and Slovakia (n = 315) completed a questionnaire containing the modified Beck Depression Inventory for measuring depressive symptoms, the Cohen's perceived stress scale for measuring perceived stress, the CAGE-questionnaire for measuring problem drinking and questions concerning frequency of alcohol use and the personal importance of religious faith.

RESULTS

Neither perceived stress nor depressive symptoms were associated with a high frequency of drinking (several times per week), but were associated with problem drinking. Religiosity (personal importance of faith) was associated with a lower risk for both alcohol-related variables among females. There were also country differences in the relationship between perceived stress and problem drinking.

CONCLUSION

The association between perceived stress and depressive symptoms on the one side and problem drinking on the other demonstrates the importance of intervention programs to improve the coping with stress.

Assessing linguistic and cultural equivalency of two Chinese-version sexual health instruments among Chinese immigrant youth

This study aimed to evaluate the linguistic and cultural equivalency of two Chinese-version instruments measuring sexual knowledge, attitudes, and behaviors among 10 bilingual and 2 monolingual Chinese immigrant youth aged 13-19 years. We used a rigorous design to translate, back-translate, and pilot test the instruments. Kappa coefficient, percentage agreement, and qualitative feedback from participants were used to examine reliability and validity of the instruments. Telephone interviews revealed that answer discrepancies in different language versions were due to external factors rather than lack of linguistic and cultural equivalency. This study offers preliminary evidence supporting the cultural and linguistic equivalence of two Chinese-version sexual scales.

Translation of the multidimensional health locus of control scales for users of American sign language

This paper describes the translation of the Multidimensional Health Locus of Control (MHLC) scales into American Sign Language (ASL). Translation is an essential first step toward validating the instrument for use in the Deaf community, a commonly overlooked minority community. This translated MHLC/ASL can be utilized by public health nurses researching the Deaf community to create and evaluate targeted health interventions. It can be used in clinical settings to guide the context of the provider-patient dialogue. The MHLC was translated using focus groups, following recommended procedures. 5 bilingual participants translated the MHLC into ASL; 5 others back-translated the ASL version into English. Both focus groups identified and addressed language and cultural problems before the final ASL version of the MHLC was permanently captured by motion picture photography for consistent administration. Nine of the 24 items were directly translatable into ASL. The remaining items required further discussion to achieve cultural equivalence with ASL expressions. The MHLC/ASL is now ready for validation within the Deaf community.

The important role of sense of coherence in relation to depressive symptoms for Taiwanese family caregivers of cancer patients at the end of life

OBJECTIVE

To determine whether the strength of personal coping capability, the sense of coherence (SOC), makes a unique contribution in explaining the extent of depressive symptoms experienced by family caregivers of terminally ill cancer patients.

METHODS

A total of 253 Taiwanese family caregivers of terminally ill cancer patients participated in this survey. Caregiver depressive symptoms were assessed using the CES-D. Potential correlates of depressive symptoms were categorized as: (1) characteristics of the caregivers; (2) demographics and disease-related characteristics of the patients; (3) objective caregiving loads; (4) confidence in end-of-life caregiving; (5) subjective caregiving burden; and (6) SOC.

RESULTS

Family caregivers scored high on the CES-D [mean (S.D.)=22.24 (11.36)]. Results from the R(2) change in the hierarchical multiple regression model indicated that the incremental variance explained by each block of variables for (1) the characteristics of family caregivers, (2) the characteristics of cancer patients, (3) objective caregiving loads, (4) confidence in caregiving, and (5) subjective caregiving burden was 20.5%, 6.8%, 1.5%, 3.7%, and 11.9%, respectively. In the final step of regression, SOC of caregivers increases the explained variation in depressive symptoms by 21.5%.

CONCLUSIONS

This study confirms that, among the independent variables examined in this study, variations in SOC are comparatively important in explaining the variation of depressive symptoms experienced by Taiwanese family caregivers. Developments and evaluations of the effectiveness of clinical interventions aimed at augmenting caregivers' coping capability (such as SOC) to facilitate positive appraisal and finding meaning, to improve understanding of the demands and challenges of caregiving, and to mobilize resources available to manage caregiving tasks are highly recommended.

Promoting public health: benefits and challenges of a Europeanwide research consortium on student health

AIMS

The purpose of this paper is to highlight some of the benefits and challenges when undertaking research across several countries comprising diverse ethnic, lingual and historically different communities.

METHODS

Literature review and experiences of the researchers who participated in the Students' Health Inquiry, as regards the benefits and the challenges that can emerge when conducting collaborative research. The Delphi technique was employed to reach consensus on and prioritise the emerging challenges and suggested solutions.

RESULTS

Challenges of research consortia include the preparatory work before the study, the ownership of the data and dissemination of results, as well as methodological, financial, operational, and structural challenges. These are described, each challenge is further broken down in its subcomponents, examples are given, and potential solutions are suggested.

CONCLUSIONS

If challenges can be prevented or solved, the benefits of research consortia include greater generalisability of findings, and more comprehensive understanding of the issues than would be possible with a single-site study. There is also an increased probability to bring about policy changes and programmatic adjustments. Cross-national research consortia can contribute to reduction in the inequality of resources and research opportunities in the collaborating countries. Research consortia deserve the attention of funding agencies. They are capable of bringing about synergies that result from working collaboratively together of large multi-disciplinary team of investigators who share their strengths, disciplines and expertise in order to bear on the same research issue in multiple countries and diverse populations.