| ObjectivesTo develop a specific medical treatment adherence scale for the end-stage renal disease (ESRD) client with maintenance hemodialysis, and examine the reliability and validity of the scale.MethodsThe scale was developed based on the humanistic theory and the definition of adherence. The scale contained four subscales:dietary adherence, fluid intake adherence, medication adherence and dialysis regimen adherence. Related literature had been extensively reviewed, related instruments developed domestic and abroad already had been refered, and suggestions from experts had been considered before the initial questionnaire formed. The primary scale obtained56items. There are5experts were invited to assess the primary scale twice and it was modified according to experts’suggestions and the modified scale obtained41items.Through a pilot study, deleted1item, and the final scale was established and it consists of40items. There are330clients with the ESRD and maintenance hemodialysis self-reported by the scale,the clients are recuried from5blood purification centers of Xiangya Hospital,the Second Xiangya Hospital,the Third Xiangya Hospital of Central South University and Hunan Province People’s Hospital and Changsha Central Hospital.All data setup the date base through epidata3.1,and was input into SPSS19.0. The item analysis methods included item distribution, coefficient of variation(CV), t-test, Pearson correlation coefficients and factor analysis. The structure validity was examined by exploratory factor analysis and Pearson correlation coefficients. The Criterion-related validity was examined by IDWG among3month, kipping and shortening dialysis sessions and Morisky scale. The content validity was examined by the assessment of experts. Cronbach’a, split reliability and test-retest reliability were used to examine the reliability.Results (1)Item analysis:The final specific medical treatment adherence scale for the ESRD clients with maintenance hemodialysis which was developed. There are23items of the scale were accepted by item analysis and the exploratory factor analysis (EFA), it was derived from56items of the primary scale. The scale consists of4dimensions:dietary adherence (8items), fluid intake adherence (6items), medication adherence (5items) and dialysis regimen adherence (4items). The scale designed as a Likert5scale, each item is wanted to answer in5levels from never do to absolute do, with a point from1to5, so the total score is from23～115, the higher the score the better the adherence.(2) Reliability test:The Cronbach’a of the whole scale was0.877, and the four subscales were0.819,0.838,0.792,0.815respectively. The split reliability of the whole scale was0.881, and the four subscales were0.784,0.846,0.851,0.881respectively. The test-retest reliability of the whole scale was0.943, and the four subscales were0.887,0.894,0.787,0.895respectively.(3) Validity test①Content validity:content validity evaluated using Content Validity Index(CVI)was0.877.②Construct validity:There are4factors developed by EFA, which was basically close to the theoretical construct, and the4factors explained for55.52%variances.③riterion-related validity:the IDWG was negatively associated with the subscale of dietary adherence and fluid intalke adherence (r=0.294～0.349, P<0.01); the subscale of medication adherence positively associated with the Morisky scale (r=0.598,P<0.01); the subscale of dialysis regimen adherence positively associated with the skipping or shortening dialysis sessions (r=0.611,.P<0.01).ConclusionsThe specific medical treatment adherence scale for the ESRD clients with maintenance hemodialysis was successfully developed with a good reliability and validity. It’s a credible, effective assessment tools.The scale is good for assessing the medical treatment adherence of the ESRD clients with maintenance hemodialysis. |
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