| ObjectivesThis study aimed to:(1)construct CRF comprehensive screening scale(CRF-CSS)and provide guidance for tailored self-management of CRF among CSs;(2)evaluate reliability and validity of CRF-CSS,thus to provide a reliable and valid instrument for measuring CRF and its Treatable Influencing Factors.MethodsA mixed approach was applied to develop CRF-CSS.The process was divided into two phases.In phase one:Literature retrieval and research,brainstorming,Delphi method,cognitive interviewing and pilot study had been conducted to construct and revise indicators of CRF-CSS.In Phase two:Questionnaire survey was conducted among CSs.Item analysis were used to select and optimize indicators.Cronbach’sαwas calculated for reliability analysis.Validity analysis included concurrent validity and structural validity.Descriptive statistical analysis,Reliability analysis,Pearson correlation coefficient analysis and Exploratory Factor Analysis of scale were preformed through SPSS 26.0.Confirmatory Factor Analysis was conducted using AMOS 24.0.ResultsPhase one:Construction of CRF-CSS.(1)Literature study:According to literature review,two subscales were conducted,with five level-one indicators and 18 level-two indicators.A total of 93 level-three indicators(item pool)were constructed by referring to relevant literatures and scales.(2)Brainstorming:Four meetings were held with five research team members.After intense discussion,82 indicators were selected and one indicator was added,resulting in the preliminary scale version 1.(3)Delphi Method:(1)Two rounds expert consultation(N=12)were performed,with a 100%response rate.Mean values of expert authoritative coefficient were all 0.94;(2)Standard Deviation of expert evaluation on the importance or clarity of the scale were 0.67,0.85and 0.43;Coefficient of Variation relatively were 0.15,0.21 and 0.09;Kendall’s W value were from 0.471 to 0.571(P<0.05);(3)Mean score on importance,or clarity of indicators of expert evaluation were 4.17,4.78 and 4.53;Item-content validity index(I-CVI)and Scale-level CVI universal agreement(S-CVI/UA)were all 0.98.Adjusted mean value of Kappa was from 0.91～1.Considering specific comments from experts and group discussion,21 indicators were added,3indicators were deleted,and 45 indicators were modified from this stage,resulting in the preliminary scale version 2.(4)Cognitive interview:CSs(N=18)were recruited with convenience sampling.Results indicated difference in understanding content of scale between researcher and participants.After analysis of subjects’understanding and discussion with research group,one indicator was deleted,23 indicators were modified,resulting in the preliminary scale version 3.(5)Pilot test:CSs(N=35)were recruited through convenience sampling.Results showed that feasibility of scale was good,with a recovery rate of 88.57%.The average time for completing a scale was about 20 minutes.Six indicators were modified,resulting in the preliminary scale version 4.Phase two:Reliability and validity evaluation of CRF-CSS.(1)Descriptive analysis:A total of 551 valid questionnaires were analyzed from a total of568 eligible participants,giving a response rate of 97.0%.The average score of CRF-CSS were10.29±3.93 and 50.47±11.74,respectively.In the influencing factors subscale,the average score of physical activity status,sleep status,nutritional status and cognitive emotion status dimension were 33.44±20.67,68.38±8.96,62.26±1.77,and 39.52±13.36,respectively.(2)Item analysis:Based on results from six item analysis methods and specialized knowledge,21 indicators were removed and modified.Optimized indicators were selected,resulting in preliminary scale version 5 scale with five dimensions and 30 items.(3)Reliability:Cronbach’s alpha coefficients of symptom subscale was 0.728;Cronbach’s alpha coefficients of influencing factors subscale and four dimensions ranged from 0.624 to 0.733respectively.(4)Validity:(1)Correlation coefficient between CRF-CSS and criterion-related validity was from 0.337 to 0.862(p<0.001),besides indicators“hypnotics”,“Dietary intake”,and“cognition emotion status”;(2)Direct Oblimin Method was used to extract common factor.In the CRF symptom subscale,one common factor was extracted,and total variance explained rate was59.229%.In the treatable influencing factors subscale,six common factors were extracted and total variance explained rate was 57.625%.Factor loading of indicators were more than 0.50;(3)In the symptom subscale,revised model fitχ~2/df=0.274,RMSEA<0.001,CFI=0.976,IFI=1.000,TLI=1.000,ECVI=0.067 and PNFI=0.166;In the influencing factor subscale,revised model fitχ~2/df=1.472,RMSEA=0.041,CFI=0.926,IFI=0.929,TLI=0.907,ECVI=1.386 and PNFI=0.645.Conclusion(1)The construction process of CRF-CSS involving panel discussion,experts and participants evaluation was suggested to be scientific and feasible.(2)Preliminary scale version 5 scale indicated a relatively good validity and reliability in its initial version,which requires further improvement in future study. |
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