| Objective:To develop a care ability scale for primary family caregivers of children with liver transplantation in line with Chinese cultural background,test the reliability and validity of the scale,and provide a meaningful assessment tool for quantifying the care ability level of primary family caregivers of children with liver transplantation.Methods:By literature review and semi-structured interviews,the item pool of care ability scale of main caregivers in families of children with liver transplantation was constructed.After two rounds of Delphi expert consultation and small sample pre-experiment,the initialization scale was formed.A questionnaire survey was conducted among 200 primary family caregivers of children with liver transplantation from organ transplant department of a three-A hospital in Shenyang and Tianjin.Item screening used answer distribution analysis,critical ratio method,correlation coefficient method,Cronbach coefficient method,commonality and factor load.The validity of the scale was evaluated by content validity,structural validity and criterion-related validity.The reliability of the scale was evaluated by Cronbach’sαcoefficient,split-half coefficient and retest reliability.A total of 217 primary family caregivers of children with liver transplantation were selected for confirmatory factor analysis.Results:1.By referring to relevant literature and related tools at home and abroad,20 scale items were extracted;Eleven primary family caregivers of children with liver transplantation were interviewed,and four themes were extracted,including cognitive experience,emotional experience,care knowledge and skills,and care attitude;Based on Farran’s care ability theory model and competency theory,the results of literature review and semi-structured interviews were combined to form an item pool containing 6dimensions and 39 items.2.(1)Delphi expert inquiry:Seventeen experts from five provinces and cities were invited to conduct two rounds of expert letters,and the effective recovery rate of the questionnaire was 100%.The authority coefficients of the two expert consultations were0.85 and 0.84 respectively.In round 1,the average score of each item ranged from 3.76 to5.00,the full mark ratio ranged from 0.24 to 1.00.In round 2,the average score of each item ranged from 3.59 to 4.94,the full mark ratio ranged from 0.18 to 0.94;the Kendall coordination coefficient W were 0.302 and 0.253 respectively.After two rounds of expert consultation,7 items were deleted and compiled into an initial scale containing 5dimensions and 32 items.(2)Pre-investigation:The 18 primary family caregivers of children with liver transplantation thought that the questionnaire was clear and easy to understand.(3)Item analysis:According to the screening criteria,2 items were deleted to form a formal scale of care ability of family primary caregivers of children with liver transplantation,including 5 dimensions and 30 items.3.(1)Validity results:The content validity index of the scale was ranged 0.88 to 1.00,and the average content validity index was 0.96.2.Exploratory factor analysis extracted 5common factors,and formed 29 items and 5 dimensions(disease cognition,daily life care behavior and attitude,basic knowledge and skills of nursing for children with liver transplantation,recognition and response of complications,and caregiver execution).The care ability scale for primary caregivers of children with liver transplantation explained70.926%of the variance.Confirmatory factor analysis was used for structural validity analysis.Since the initial model results showed that the factor loads(standardized regression coefficients)of items 6 and 14 were less than 0.5,they were deleted.The fitting results after deletion showed that chi-square/degree of freedom(χ~2/df)=1.838,root mean square error of approximation(RMSEA)=0.062,goodness of fit index(GFI)=0.843,adjusted goodness of fit index(AGFI)=0.805,comparative fit index(CFI)=0.918,incremental fit index(IFI)=0.919,and standardized residual root mean square(SRMR)=0.066,which were all within the acceptable range.Finally,the final version of the primary caregivers’care ability scale for children with liver transplantation including 5 dimensions and 27 items was formed.The criterion-related validity was-0.488(P<0.01).(2)Reliability results:The total Cronbach’sαcoefficient of the scale was 0.956,and the Cronbach’sαcoefficients of each dimension were ranged 0.774 to 0.953;the Spearman-Brown split-half reliability coefficient was 0.899,and the Spearman-Brown split-half coefficients of each dimension were ranged 0.690 to 0.944.The overall test-retest reliability of the questionnaire was 0.937,and the test-retest reliability of each dimension was 0.683～0.931,which was greater than 0.7,indicating that the reliability of the scale was good.Conclusion:1.In this study,the main family caregivers’care ability scale for liver transplant children included 5 dimensions and 27 items,which included disease cognition,daily life nursing behavior and attitude,basic knowledge and skills of liver transplant children’s care,complication identification and response,and caregiver’s executive ability.2.The statistical indicators of the care ability assessment scale for family primary caregivers of children with liver transplantation prepared in this study all meet the psychometric criteria of the scale,indicating that the scale has good reliability and validity and can be used to evaluate the care ability of family primary caregivers of children with liver transplantation in China. |
