Development And Application Of Stroke High-risk Screening Intention Scale

ObjectivesThe aim of this study was to develop and test the reliability of the Stroke High Risk Screening Intention Scale,which provides a scientific and reliable tool for measuring residents’stroke high risk screening intention.A cross-sectional survey was conducted to describe the current situation of stroke screening intention in the community and to investigate the factors affecting stroke screening intention.Methods1.Based on the theory of planned behavior,a pool of entries for the High Risk Stroke Screening Intention Scale was formed through literature review and brainstorming.Five stroke clinical or community nursing experts were selected and 2 rounds of expert evaluation were conducted to analyze the content validity of the entries and the content validity of the scale,resulting in the Stroke High Risk Screening Intention Scale(beta version).The reliability test was performed using SPSS 22.0 and jamovi 2.3.18 software to analyze Cronbach’s alpha coefficient and Mc Donald’s Omega coefficient,and 50 of the samples were marked with contact numbers or addresses and measured again at an interval of 7-14 days to test the retest reliability of the scale.For validity tests,SPSS 22.0 was used for item analysis,exploratory factor analysis,parallel analysis and minimum mean bias correlation test,and AMOS 24.0 was used for validation factor analysis.2.Using a convenience sampling method,community residents aged 35 years and older in Guangdong Province were selected as the respondents for a cross-sectional survey using the General Information Questionnaire,the Stroke Health Knowledge Scale,the Trust in Community Health Services Scale,the Perceived Social Support Scale,and the Stroke High-Risk Screening Intention Scale developed in this study.Statistical analysis was performed using SPSS 22.0,using frequencies and percentages to describe sociodemographic information;means±standard deviations to describe the scores of high-risk stroke screening intention,social support,stroke health knowledge,and trust in community health services;independent samples t-test or one-way ANOVA to compare the differences in the scores of high-risk stroke screening intention among residents with different characteristics,and Correlation analysis was conducted to explore the correlation between the intention to screen for stroke and the variables;factors affecting the intention to screen for stroke were analyzed by multiple linear regression.Results1.This study finally formed a stroke high-risk screening intention scale with 25 items in four dimensions,including positive attitude,negative attitude,subjective norm and perceived behavior control.The first cross-sectional survey returned 537 valid questionnaires,and exploratory factor analysis was performed,which showed that the cumulative explained variance of the scale was 55.898%,with entry factor loadings ranging from 0.525 to 0.821.The results of the parallel analysis showed that the structure of the entire scale explained the largest amount of variance in screening intention when the fixed factor was 4.The least parallel bias correlation test showed that the smallest bias correlation coefficient was obtained when the factor was set to 4.The second cross-sectional survey returned 250 valid questionnaires,and the model fit results of the validated factor analysis were:χ~2/df=1.786,RMSEA=0.056,GFI=0.874,NFI=0.920,IFI=0.963,TLI=0.958,CFI=0.963,AGFI=0.846.The results of the reliability test showed that Cronbach’s alpha coefficient of the scale was 0.901,retest reliability was 0.810,I-CVI was 0.8 to 1.0,S-CVI/UA was 0.93,and S-CVI/Ave was 0.99.2.On the basis of 250 data from the second cross-sectional survey,we continued to collect questionnaires in 643 cases,i.e.,a total of 893 questionnaires were distributed and827 valid questionnaires(92.61%)were returned to analyze the current situation and factors influencing the intention of high-risk stroke screening.The total score of stroke high-risk screening intention of community residents in Guangdong province was(101.50±14.581).The scores for each dimension were(29.32±4.82)for positive attitude,(19.32±4.94)for negative attitude,(20.78±3.58)for subjective norms,and(32.47±5.65)for perceived behavioral control.The total score of stroke risk screening intention of 500 residents(60.46%)was≥100,which was at a high level;327 residents(39.54%)had a high-risk screening intention of stroke<100,which was at a medium or low level.The results of univariate analysis showed that the residents’gender,residence status,prevalence of hypertension and hyperlipidemia,lack of exercise,frequency of physical examination,whether they knew the high-risk screening for stroke,whether the community had carried out the high-risk screening for stroke,whether they had done the high-risk screening,and lifetime risk perception of stroke affected the residents’screening intention,and the differences were statistically significant(P<0.05).Multiple linear regression results show that,Gender,hypertension,hyperlipidemia,physical inactivity,community risk screening for stroke,lifetime risk perception of stroke,perceived social support score,community medical service trust score,stroke health knowledge score had statistically significant effects on residents’intention to screen for stroke risk(adjusted R~2=0.282,P<0.05).Conclusion1.This study resulted in a high-risk stroke screening intention scale with 7 items on the positive attitude dimension,5 items on the negative attitude dimension,5 items on the subjective normative dimension,and 8 items on the perceptual behavior control dimension,for a total of 25 items.The scale was scored on a 5-point Likert scale from“disagree to agree”,with items 8 to 12 being scored inversely.The results of this study showed that the scale has good reliability and validity and can be used to measure the residents’intention to screen for stroke at high risk.2.This study suggests that the overall intention of community residents in Guangdong Province for high-risk stroke screening is high,but the intention of some residents still needs to be improved.It is suggested that the community should focus on the male residents with low screening intention and enhance the knowledge of stroke health,especially the risk factors,to help them understand their own stroke risk and the importance of high-risk screening.Interpersonal networks should emphasize the role of social support in promoting the intention of screening,and expand the publicity at the social level to create an atmosphere of universal participation in screening,so that more residents can participate in high-risk stroke screening.National policy should increase investment in screening equipment and facilities,and emphasize the development of medical and nursing personnel to improve the capacity of community-based high-risk stroke screening and enhance the trust of residents in community-based health services,thus effectively increasing the intention of residents to participate in high-risk stroke screening.