| Background:The incidence of inflammatory bowel disease(IBD)has increased year by year in China.Patients' emotional and mental health,social competence and outlook on life have changed by the chronic course of the disease.Mixed design was used in this study to explore the understanding and experience of disease resilience of patients with IBD and to develop the resilience scale for IBD patients(RS-IBD)in China.Objectives:1.Semi-structured interviews were used to explore the experience of disease resilience during the disease course of IBD and extract the themes of resilience to construct inflammatory bowel disease resilience model,which could provide a theoretical basis for the development of resilience evaluation tool for IBD patients.2.Based on the inflammatory bowel disease resilience model,the results of qualitative research were combined with literature analysis and expert consultation,so as to construct RS-IBD.The reliability and validity of the scale were tested by clinical empirical study to provide a tool for clinical evaluation and intervention.Methods:1.Referring to related literature,semi-structured interview outline was developed on Kumpfer's resilience framework.The purpose sampling and theoretical sampling methods were used to select IBD patients in First Affiliated Hospital of Nanjing Medical University and Nanjing Military Region General Hospital to carry on interview.The sample size was determined according to the data saturation method.After the patient signing the informed consent,the researcher conducted an interview with the patient and recorded the entire process by voice recorder as well as the observation method.The recordings were transcribed verbatim into a manuscript within 24 hours.Directed content analysis approach was used to analysis data,extract theme and construct the inflammatory bowel disease resilience model.2.The theoretical dimension of RS-IBD was constructed based on the inflammatory bowel disease resilience model as well as literature review.The results of qualitative research were used as the main source of the items pool.The pool was expanded by the combination of qualitative research results with the items from the existing resilience scales,which were obtained by systematic retrieval of the relevant databases.The research group(including 3 postgraduates and 1 professor of nursing)conducted a number of discussions on the scale dimension and items.Meanwhile,20 patients were selected to evaluate the items to ensure that the language of the items were suitable for IBD patients.By ways above,the initial RS-IBD was formed.3.The Delphi expert consultation method was employed.14 experts comes from digestion,education and psychological field were invited to evaluate items of the scale.According to the importance of the items,the coefficient of variation as well as the expert opinions,the items were modified,deleted and supplemented to form the clinical text version of RS-IBD.4.Clinical survey was conducted on 143 patients with IBD in four hospitals of Jiangsu with convenient sampling method.SPSS20.0 was used to delete items and divided dimensions of the scale.The reliability of the scale was measured by Cronbach's ? coefficient.The factor analysis and the pearson correlation of each dimension and total scale were used to verify the structural validity of the scale.The self-efficacy scale of the inflammatory bowel disease and the hospital anxiety and depression scale were picked to test the calibration validity.Results:1.A total of 15 patients with IBD were interviewed,the disease resilience experience are roughly consistent with Kumpfers' resilience framework,but also has its unique codes.Inflammatory bowel disease resilience model consists of four main themes: the complicated factors in the environment,environmental perception and transformation,personality traits and resilience-related coping.Combining the results of qualitative study with literature review,a pool with 87 items was formed.The initial RS-IBD consisted of 63 items was obtained after items pool was revised according to the results of the brainstorming of research group and pre-experiment.2.The results of the two-round expert consultation showed that the Cr were 0.85.20 items of RS-IBD were deleted due to the importance of the items <4.0 or the coefficient of variation > 0.3.The initial RS-IBD has 19 entries,which the mean importance value are <4.0,1 item coefficient of variation> 0.3,to be deleted.Then,a total of 17 items were modified according to the expert's opinion to form a clinical test version RS-IBD of 43 items.3.The results of the items analysis showed that items 4,20,21,31,33,34 didn't meet more than half of the six indicators,which including CR,the correlation and rectified correlation between the items and the total score,and the Cronbach's ?Values after the title items were deleted,commonality,and factor load.After deleted the six items above,the RS-IBD consisted of 37 items.Three rounds of factor analysis were performed,and 12 items which did not meet the criteria were deleted and then obtained a scale containing 25 items.The results of the fourth round of factor analysis showed that,the cumulative variance contribution rate of the RS-IBD was 64.698%.The RS-IBD was divided into six dimensions,including disease self-management,the positive coping with difficulty,the positive cognition,the emotional control,the family support and the patient support.All 25 items were single load and the factor loads ranged from 0.483 to 0.808.4.The total Cronbach's ? value of the RS-IBD is 0.941 and the Cronbach's ? values of six dimensions ranged from 0.743 to 0.833,which indicated that the scale has good internal consistency and reliability.The results of exploratory factor analysis showed that the factor load of each items was more than 0.40.All items were high loaded in single dimension and cumulative variance contribution rate was 64.698%.Meanwhile,the correlation coefficient of each dimension and total score were 0.629~ 0.775 and 0.373 ~ 0.613,P <0.01.Results above proved the RS-IBD has good structural validity.Furthermore,the RS-IBD total scores and dimensions scores were positively correlated with the self-efficacy scale of the inflammatory bowel disease total score as well as its dimensions scores(r=0.316~0.591,P<0.01)and negatively correlated with the hospital anxiety and depression scale total score as well as its dimensions scores(r=-0.653~-0.207,P <0.01).Conculsions:1.The disease resilience model constructed in this study can accurately reflect the resilience experience among the inflammatory bowel disease patients,providing a basis for future research on the mechanism of resilience and the formulation of interventions.2.The RS-IBD is composed of 25 items,including six dimensions: disease self-management(4 items),the positive coping with difficulty(6 items),the positive cognition(5 items),the emotional control(4 items),the family support(3 items)and the patient support(3 items),which has good reliability and validit and can effectively analyze the disease resilience level of IBD patients.The scale can be used as a measurement tool in research and practice,and it can also provide training content basis and effect assessment tools for interventional research that promotes disease recovery in IBD patients. |
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