| Objectives:Based on the conceptual framework of the health belief model and the review of the available literature on toileting behaviors, we aimed to develop and validate an instrument, the women’s belief of toileting behavior scale, to assess women’s self-belief about various toileting behavior, and to facilitate further study exploring influencing factors of women’s toileting behavior by supplying a standardized tool.Methods:To capture the multiple dimensions of the health belief model and the definition of the toileting behavior, the content of the belief scale was delineated through the steps of developing cognitive scales postulated by Lynn.636female nurses in3hospitals were enrolled by multistage convenience sampling and administered paper-and-pencil survey. Content validity analysis, descriptive analysis, item analysis, exploratory factor analysis, and reliability analysis of the scale were performed among235data of the trial test by SPSS13.0. Through the analysis of which, the items and the dimensions of the scale were simplified and established respectively. Confirmatory factor analysis, composite reliability and criterion-related validity analysis were carried out among the other401data by Amos19.0as well as SPSS13.0.Results:1. Content validity analysis demonstrated that the initial women’s belief of toileting behavior scale had acceptable content validity with item content validity index within0.83～1, scale content validity index valued0.96.2. Item analysis and exploratory factor analysis showed that the scale was composed of24items, belonging to five dimensions. Principal component analysis with varimax rotation revealed that item factor loadings of corresponding dimension were within0.582～0.873,5dimensions explained61.342%of the variance.3. Reliability analysis of the scale indicated that the Cronbach’s a coefficients, corrected split-half reliability, and test-retested reliability (in2weeks apart) of5dimensions were as follows:dimension one,0.768,0.828,0.884; dimension two,0.905,0.939,0.907; dimension three,0.817,0.833,0.917; dimension four,0.754,0.795,0.964; dimension five,0.593,0.610,0.881. Besides dimensions five, the reliability indexes of all the other four dimensions were above0.60. The Cronbach’s a coefficient of dimension5was similar to0.60which was still acceptable. All the reliability indexes indicated five dimensions’good internal consistency and stability.4. Confirmatory factor analysis of the scale showed that the correlation between dimension five and three had no statistical significance which differed from the result of exploratory factor analysis. Estimated reflective loadings of all the items were above0.35. Fit indexes was considered to be of good suitability with chi-square, χ2=420.393; degree of freedom, df=234; Goodness of Fit Index, GFI=0.919; Normed Fit Index, NFI=0.912; Incremental Fit Index, IFI=0.959; Comparative Fit Index, CFI=0.959; Root mean square error of approximation, RMSEA=0.045. All these indexes totally represented the good construct validity of the scale.5. Composite reliabilities of five dimensions were as follows:dimension one,0.7442; dimension two,0.915;dimension three,0.846; dimension four,0.805; dimension five,0.633. All composite reliabilities of the five dimensions were acceptable with values totally above0.60.6. Criterion-related validity analysis tested by difference comparison showed that there was significant difference of dimension one and dimension two between urinary tract infection group and non-urinary tract infection group with P=0.000and P=0.005, dimension three between abnormal toileting posture group and normal toileting posture group with P<0.10respectively. These results indicated the reasonable criterion-related validity of the scale.Conclusions:1. The women’s belief of toileting behavior scale is composed of24items belonging to5dimensions, they were perceived susceptibility of lower urinary tract symptoms(4items), perceived severity of lower urinary tract symptoms(11items), benefits on the persistent normal voiding behavior(3items), factors impeding normal toileting style(3items) and self-efficacy of persisting normal toileting style(3items).2. The women’s belief of toileting behavior scale has satisfying psychological assessment indexes and can be applied to test women’s belief of toileting behavior. |
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