Development Of An Instrument To Measure Self-efficacy In Primary Caregivers Of People With Stroke

Objective:To address the shortcomings of current self-efficacy assessment tools for primary caregivers of stroke patients.The scale development process was strictly followed.The aim was to develop a self-efficacy assessment scale for primary caregivers of stroke patients that is culturally and medically appropriate for our country,and to conduct item analysis and reliability testing of the scale.Methods:1.A purposive sampling method in qualitative research was used to conduct semi-structured interviews with primary caregivers of stroke patients in Department of Neurology,a Level 3A hospital in Nanjing,Jiangsu Province.The sample size of the study was based on the principle of saturation of interview information.The interview data were analysed using the Colaizzi seven-step analysis method.The caregiving experiences and inner true feelings of primary caregivers of stroke patients were explored,and the corresponding thematic concepts were condensed to provide reference and reference for exploring the dimensions and item pools of the Self-Efficacy Scale for Primary Caregivers of Stroke Patients.2.Based on self-efficacy theory,the initial pool of items was formed through literature research,combined with the findings of qualitative interviews,and several discussions and refinements of relevant information by the research team(eight experts in their fields of expertise).The initial pool of items was compiled into a Delphi expert correspondence questionnaire.Eighteen experts in the field of stroke treatment and care were invited to evaluate the scale items through two rounds of correspondence,and the items were selected based on the expert correspondence evaluation indicators and expert revision.The above steps were used to construct a pretest scale of self-efficacy for primary caregivers of stroke patients.3.From September 2020 to April 2021,315 primary caregivers of stroke patients from the Department of Neurology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medicine School were selected for clinical administration using a convenience sampling method.The relevant data obtained were collected,processed and analysed.The items of the scale were analysed using the critical ratio method and the correlation coefficient method.Exploratory factor analysis,correlation analysis,content validity index(CVI),Cronbach’s α coefficient,retest reliability,and split-half reliability were used to evaluate the reliability and validity of the scale.Statistical analysis was performed using SPSS 23.0 software.Results:1.Three themes were summarised in this study regarding the experiences and feelings of primary caregivers in caring for stroke patients: feelings of overwhelm in caring for stroke patients,increased awareness of self-care,and perceived social support.2.The positive coefficient of the first round of expert consultation was 83%,three items with a coefficient of variation >0.3 or a mean importance score <3.5 were deleted,and two items with similar meaning were restated and combined after consideration and discussion of the experts’ opinions.The positive coefficient of the second round of expert consultation was 94%,and the experts’ comments were mainly focused on the presentation of the individual items.The initial literature review,qualitative interviews with primary caregivers of stroke patients and two rounds of expert consultation resulted in a 30-item,three-dimensional clinical prediction scale.3.Validity: including content validity and structural validity.Content validity includes scale level content validity index(S-CVI)and entry level content validity index(I-CVI).The I-CVI of this scale ranges from 0.83 to 1.0,all of which are ≥0.78,indicating that the content validity of the 30 items is good;The S-CVI value is 0.95,indicating that the opinions of all participating experts have a high degree of consistency.Structural validity: the analysis of structural validity is conducted under the condition that the requirements of exploratory factor analysis are met,the KMO value >0.7 is suitable for factor analysis,the maximum variance is selected orthogonal rotation,extraction of factors with eigenroots >1,and cumulative variance contribution of common factors >40%.In this study,after the fourth factor analysis,three entries that did not meet the criteria for factor loading values were removed and the remaining 22 items were subjected to exploratory analysis again,where the KMO value was 0.838 and the Barlett’s spherical test was statistically significant.This factor analysis yielded 3 common factors with a cumulative variance contribution of59.623%.The result is a 3-dimensional,22-item primary caregiver self-efficacy scale for stroke patients.4.Reliability: The Cronbach’s α coefficient for the total scale was 0.912 and the Cronbach’s α coefficients for each dimension were 0.900,0.809 and 0.736 respectively,which showed good internal consistency of the scale.In addition,after a two-week interval,30 primary caregivers of stroke patients were selected for remeasurement in this study,with a total retest reliability of 0.901 and retest reliabilities of 0.756 ～ 0.875 for each dimension.Conclusion:1.The Primary Caregiver Self-Efficacy Scale for Patients with Stroke consists of22 items and 3 dimensions.2.The development of a self-efficacy scale for primary caregivers of stroke patients has good reliability and validity,while the content coverage is more comprehensive,tailored,moderate in number of entries and acceptable to primary caregivers.This can be used as an objective instrument to assess the level of self-efficacy of primary caregivers of stroke patients in China.