| Purpose Strictly follow scale programming,suitable for colorectal cancer survivors in our country social isolation scale(Social isolation scale for Colorectal cancer survivor,SIS-C),test scale of psychometrics properties,It provides basic tools for clinical science to evaluate the level of patients’ social isolation,explore mechanisms and formulate intervention measures.Methods(1)Formation of item pool: Based on the conceptual model of social isolation,on the basis of literature review and combined with the characteristics of patients with colorectal cancer,an item pool of the social isolation scale for colorectal cancer survivors was constructed;(2)Supplement the contents of the entry pool through semi-structured interview: 9 colorectal cancer patients and 9 experts engaged in cancer treatment/nursing were invited in the semi-structured interview,and themes were extracted through the interview content;(3)Use Delphi method for expert consultation to screen items:Two rounds of Delphi letter consultation invited a total of26 experts in the field of tumor nursing and psychology in China to calculate the mean of importance scores and coefficient of variation of items.Meanwhile,related items were revised according to the revised opinions of experts,and the positive coefficient,authority coefficient,coordination degree of opinions and concentration degree of experts were calculated to evaluate the quality of consultation.A pre-test version of the Social Isolation Scale for colorectal cancer survivors was developed.(4)Small-scale pre-experiment:A pre-test version of the scale was used to select 20 patients with colorectal cancer in the oncology department of a Grade-III hospital in Anhui Province for a small-scale pre-trial.Patients were asked to read and evaluate the clarity,accuracy,difficulty of filling in,whether items need to be added or deleted,and give overall evaluation and opinions.Changes and adjustments were made according to the feedback results of patients.The clinical version of the social isolation Scale for colorectal cancer survivors was developed.(5)Item quantitative screening:It was convenient to select 236 patients with colorectal cancer from three Grade A hospitals in Anhui province,and the clinical test version scale was used for investigation.The obtained data were quantitatively screened by critical ratio method,total correlation method,Cronbach’s α coefficient method,exploratory factor analysis and confirmatory factor analysis.The clinical version of the social isolation Scale for colorectal cancer survivors was developed.(6)Reliability and validity test: The clinical test version of the social isolation scale for colorectal cancer survivors was adopted to facilitate the selection of 245 colorectal cancer patients from three Grade A hospitals in Anhui province for the investigation.Cronbach’s α coefficient and half reliability were used to evaluate the reliability of the scale,and content validity,structure validity and evaluation scale validity were used.Results(1)An item pool consisting of 21 items from two dimensions of social isolation and emotional isolation was formed;(2)Four themes were extracted from the semi-structured interview,namely,theme 1: significant disease burden of colorectal cancer survivors;theme 2: varying degrees of social dysfunction in colorectal cancer survivors;theme 3: complex psychological feelings of colorectal cancer survivors;theme 4: patients with colorectal cancer have great physical and mental pressure and many difficulties in social support.(3)Two rounds of Delphi expert correspondence sent out a total of 26 questionnaires,26 were recovered,and the positive coefficient of the calculated experts was 100%;The expert authority coefficient was 0.842;Kendall ’s W coefficients are 0.220 and 0.229,respectively.The mean scores of importance scores of Delphi items in two rounds ranged from 2.15 to 4.62 and 4.69 to 5.00,and the coefficient of variation scores ranged from 0.17 to 0.44 and 0 to 0.13.In the first round of Delphi expert letter consultation,2 items were deleted,4 items were merged and 7 items were added,forming a total of 24 items to enter the second round of letter consultation.The second round of Delphi expert letter consultation was combined with1 item,and finally formed the pre-test version of the social isolation Scale for colorectal cancer survivors with 23 items.(4)The clinical version of the social isolation scale for colorectal cancer survivors with 23 items was formed without deleting the items in the small scale pre-experiment.(5)The project analysis results showed that the decision values of item 3,item 4 and item 7 were <3.0,and the correlation coefficients were <0.4.Cronbach’s α coefficients increased after deletion,reaching the quantitative screening criteria for items,and were deleted.In exploratory factor analysis,item 1,item 5,item 6 and item 11 were deleted respectively,and a clinical version of the social isolation scale for colorectal cancer survivors with 16 items was finally formed.(6)Cronbach’s α coefficient was 0.958 for the total quantity table,and the Cronbach’s α coefficient for social and affective isolation dimensions were 0.958 and 0.935,respectively.The broken half reliability of the total volume table was 0.923,and the broken half reliability of social and affective isolation dimensions were 0.903 and 0.885,respectively.Content validity ratio(I-CVI)ranged from 0.86 to 1.000,and the average content validity ratio(S-CVI)was 0.956.The fitting indexes of the confirmatory factor analysis model for structural validity X2/df,RMSEA,CFI,IFI,TLI,NFI,RFI,GFI and RMR are respectively:1.800,0.057,0.981,0.981,0.973,0.958,0.941,0.930,0.025,good model fitting.Conclusion The social isolation scale for colorectal cancer survivors developed in this study includes two dimensions: social isolation and emotional isolation,with a total of 16 items.The scale has good psychometric properties and can be used to measure social isolation among Chinese survivors of colorectal cancer. |
