Psychometric properties of the Persian version of the Mishel's Uncertainty in Illness Scale in patients with cancer

The effect of an educational program on illness uncertainty in mothers of children with type 1 diabetes: a quasi-experimental study

The mother is traditionally the primary caregiver for the child, and uncertainty is a major source of psychological distress for parents of sick children. As a result, the current study sought to investigate the impact of an educational program on illness uncertainty in mothers of children with insulin-dependent diabetes mellitus (IDDM). This is a quasi-experimental study with a pretest-posttest design, involving 40 mothers of children with IDDM. After visiting the research site and recruiting eligible mothers, the researcher used the purposive sampling method to randomly assign them to one of two intervention and control groups. Taking into account their needs and conditions, mothers were scheduled for at least three sessions, with a 30-minute interval every other day. The data analysis revealed no significant differences between the two groups in terms of child age and gender, mother age and education level, number of children, and duration of diabetes. There was a significant difference in the total score of uncertainty, total score of ambiguity, lack of clarity, lack of information, unpredictability, and their dimensions between mothers of diabetic children before and after the intervention (P=0.02). Based on the findings, it is recommended that the educational needs of children and their mothers be assessed upon admission and that educational content be prepared and taught accordingly, thereby helping to reduce illness uncertainty in mothers.

Translation and psychometric evaluation of the Persian version of the nurses' quality of life scale: a validation study in Iran

BACKGROUND

The quality of life for nurses can be significantly impacted by various occupational factors that Influence their working conditions and professional performance. The current study aimed to translate and validate the Persian version of the Nurses' Quality of Life Scale.

MATERIAL AND METHOD

In this cross-sectional research, the Nurses' Quality of Life Scale (NQOLS) was utilized to assess the quality of life among 500 employed nurses in hospitals in the cities of Gonabad and Sabzevar. The translation process of the NQOLS followed the model proposed by Wild et al. The content validity of the Persian version of the scale was evaluated using the Content Validity Index (CVI) and Content Validity Ratio (CVR). Structural validity was assessed using exploratory and confirmatory factor analyses. Internal consistency reliability was assessed using Cronbach's alpha, while test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC). Data analysis was conducted using SPSS version 26 and LISREL version 8.8 software.

RESULTS

The exploratory factor analysis of the Persian version of NQOLS revealed six factors that accounted for 62.15% of the total variance. The structural validity of the extracted factors was confirmed through confirmatory factor analysis. The Cronbach's alpha coefficient and ICC for the entire questionnaire were 0.91 and 0.95, respectively.

CONCLUSION

The findings of the present study suggest that the Persian version of the NQOLS exhibits sufficient validity and reliability. Therefore, it can be used as an effective tool for measuring and examining the quality of life among nurses in Iran.

Risk and protective factors for resilience among adolescents and young adults with beta-thalassemia major

BACKGROUND

Resilience is the ability to overcome adversity in response to a potentially traumatic event. It can relieve people's discomfort and build personal capacity when facing a stressful situation such as beta thalassemia major. Resilience is a complex and multidimensional concept and is influenced by protective and risk factors. Therefore, the aims of the present study were to (1) investigate the relationship between protective (social support and hope) and risk (uncertainty and defensive coping) factors with resilience and (2) examine the mediating role of courageous coping between these protective and risk factors in resilience.

METHODS

This descriptive-analytical study was performed on 312 adolescents and young adults with beta-thalassemia major aged 12-24 years; they were selected using purposeful sampling from two different outpatient thalassemia clinics in the south of Iran. Data were collected in a face-to-face survey using Zimmet Multidimensional Scale of Perceived Social Support, Herth Hope, Stewart Uncertainty in Illness scale, Jalowiec Coping, and Connor-Davidson resilience Scale from April 2022 to November 2022. The collected data were analyzed using descriptive tests, Pearson correlation, and a structural equation model.

RESULTS

According to the main findings of mediation analysis, courageous coping partially mediated the relationship between social support and resilience [(β = 0.042; 95% BC CI (0.003, 0.131)] and fully mediated the relationship between hope and resilience [(β = 0.166; 95% BC CI (0.031, 0.348)]. In other cases, uncertainty and defensive coping had a direct and indirect effect on resilience, respectively.

CONCLUSION

Based on these results, health professionals and healthcare policymakers should consider this mediator in developing programs to improve resilience. Also, the use of courageous coping could modulate the effect of defensive coping on resilience. Therefore, teaching the use of courageous coping can play an important role in improving resilience.

Effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission of patients with heart failure: protocol for a randomised controlled trial

INTRODUCTION

Heart failure (HF) as a long-term clinical syndrome is associated with inadequate self-care behaviours, a feeling of uncertainty and frequent hospitalisation. In recent years, empowerment has evolved for improving chronic disease management. Nevertheless, there is a lack of studies investigating remote care interventions such as a tele-empowerment programme in patients with HF. Therefore, this protocol proposes a randomised controlled trial which aims to evaluate the effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission in patients with HF.

METHODS AND ANALYSIS

The study is a double-arm and parallel-group randomised controlled trial in which a 10-week intervention, including 6 weeks of a comprehensive tele-empowerment programme and 4 weeks of follow-up, will be compared with usual care. A total of 96 eligible patients with HF will be recruited and randomly assigned to the intervention or control group. The patients in the intervention group will join virtual groups and receive the five-step tele-empowerment programme through the internet. The primary outcomes include self-care behaviours and uncertainty which will be measured with valid instruments at baseline and 10th week. The secondary outcome is the number of patients' hospital readmissions and will be assessed at the end of the study. Descriptive statistics will be used to describe variables. According to the types of variables, appropriate statistical tests including two-sample t-tests, Χ2, analysis of covariance or linear regression will be performed. In addition, standardised intervention effect sizes will be calculated for each outcome.

ETHICS AND DISSEMINATION

The trial has been approved by the Research Ethics Committee of School of Nursing and Midwifery & Rehabilitation at Tehran University of Medical Sciences. In this study, written consent will be obtained from all participants. The results will be presented to representative groups and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

Iranian Registry of Clinical Trials (IRCT20100725004443N30).

Mindfulness-based schema therapy and forgiveness therapy among women affected by infidelity: A randomized clinical trial

OBJECTIVE

Infidelity causes mental health problems, family disruptions, rumination about events and changes in women's beliefs about the disloyal person. This study aimed to compare the effectiveness of mindfulness-based schema (MBS) therapy and forgiveness therapy in emotional responses, cognitive distortions and self-compassion of women affected by infidelity. Method: It was an experimental research with a pretest-posttest and follow-up design. Eighty-one women affected by infidelity were randomly assigned to two experimental groups and one control group. The experimental groups received interventions for ten 90-minute weekly sessions. Participants completed the questionnaires in the pretest, post-test and follow-up. Repeated measures analysis of variance was used for statistical analysis. Results: Both experimental groups were significantly different from the control group (p<.01). Forgiveness therapy was more effective in emotional responses and self-compassion in the post-test (p<.01) and follow-up (p<.001) stages. MBS therapy was more effective in cognitive distortions in the post-test and follow-up stages (p<.001). Participants of experimental groups were responders and satisfied with treatment and had a good therapeutic relationship. Conclusion: Given the type of problems faced by women affected by infidelity, forgiveness therapy and MBS therapy can be used to reduce mental sufferings and communication problems.

Factor analysis of the Korean version of the Illness Cognition Questionnaire for adolescents with chronic illness

Aim

The purpose of this study was to examine the reliability and validity of the Korean version of the Illness Cognition Questionnaire.

Methods

A total of 237 adolescent Participants ages 13–20 years were collected from two hospitals for purposes of the study. The participants were diagnosed with blood cancer, congenital heart disease, paediatric rheumatoid arthritis, multiple sclerosis and diabetes mellitus.

Results

The Illness Cognition Questionnaire is composed of three subscales and 18 items. Exploratory factor analysis and confirmatory factor analysis were performed for all 18 items. The data used in the exploratory factor analysis were obtained from 126 adolescents with blood cancer. The data used for confirmatory factor analysis were obtained from 111 adolescents who had chronic diseases. The three‐factor model of 18 items showed general fitness close to the standard but not a very good fit.

Conclusions

This study indicated that the Korean version of the Illness Cognition Questionnaire is reasonable to use for Korean adolescents with chronic illness. The authors recommend that the meaning of Item 10 be clarified from ‘I have learned to accept the limitations imposed by my illness’ to ‘I have learned to positively accept the limitations imposed by my illness’.

What is already known about this topic?

Illness cognition is the process of evaluating the meaning of a negative event.

Illness cognition has a significant impact on patients' quality of life because it is inherently involved in long‐term stresses caused by chronic or serious illnesses.

What this paper adds?

The Korean version of the Illness Cognition Questionnaire is reliable and valid.

The Korean version of Illness Cognition Questionnaire consisted of three categories of disease awareness: acceptance, helplessness and perceived benefits

The meaning of Item 10 in the Illness Cognition Questionnaire Korean version needs to be clarified as ‘I have learned to positively accept the limitations imposed by my illness’.

The implications of this paper:

The Korean version of the Illness Cognition Questionnaire can be used for adolescent participants experiencing serious or chronic illnesses.

The Korean version of the Illness Cognition Questionnaire can be used in developing the psychological intervention for adolescents with chronic illness.

Validation of the Persian version of family health climate scale (FHC-Scale) in Iranian families

BACKGROUND

Family health is an important issue which has attracted researchers from different fields. The present study aimed to validate the Persian version of the Family Health Climate Scale (FHC-Scale).

METHODS

In this methodological research, a total of 620 individuals presenting to Comprehensive Healthcare centers affiliated with Mashhad University of Medical Sciences and Gonabad University of Medical Sciences were selected through random multistage sampling. Validation of the FHC-Scale was performed. First, the original scale was translated and back-translated. Then its content validity and construct validity were assessed using exploratory and confirmatory factor analysis. Reliability was assessed using internal consistency and stability. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY, USA) and LISREL version 8.5 (SSI Inc., Skokie, IL, USA).

RESULTS

Results of exploratory factor analysis showed that "physical activity" of family health climate scale (FHC-PA) has three dimensions: value, cohesion and information explaining 61.99% of the variance. "Nutrition" of family health climate scale (FHC-NU) had four dimensions of value, communication, cohesion and consensus explaining 66.19% of the variance. Internal consistency of the dimensions of (FHC-PA) ranged 0.82-0.85 and that for FHC-NU ranged 0.82-0.84. Confirmatory factor analysis revealed goodness of fit and confirmed family health climate scale (Nutrition and physical activity).

CONCLUSION

Results of the study revealed that the FHC-Scale has appropriate reliability and validity for Iranian families. Therefore, the Persian version of the scale can be used for assessing health-related aspects of family.

Psychometric Evaluation of the Caring Ability of Family Caregivers of Patients With Cancer Scale-Mothers' Version for the Mothers of Children With Cancer

BACKGROUND

The experience of caring for cancer patients has adverse outcomes for family caregivers. The ability to care for a sick child is affected by the mother's health; to empower mothers, it will be necessary to examine their caring ability.

OBJECTIVE

The aim of this study was to carry out a psychometric evaluation of the Caring Ability of Family Caregivers of Patients With Cancer Scale-Mothers' Version (CAFCPCS-Mothers' Version).

METHODS

The present study is a psychometric evaluation of the CAFCPCS-Mothers' Version. The sample consisted of 196 mothers of children in treatment for cancer selected through convenience sampling. The face, content and construct validity, internal consistency, and stability of the scale were measured. Data were analyzed using the software SPSS 19 and LISREL 8.8.

RESULTS

After removing 2 items during confirmatory factor analysis, the values of root-mean-square error of approximation, comparative fit index, and nonnormed fit index were reported to be 0.066, 0.92, and 0.91, respectively. The Cronbach's α was calculated to be 0.71 and the stability correlation coefficient was 0.75. The final tested scale included 29 items in 5 dimensions: effective role play, fatigue and surrender, trust, uncertainty, and caring ignorance for mothers of children with cancer.

CONCLUSION

The CAFCPCS-Mothers' Version has satisfactory content, face, and construct validity and adequate reliability in terms of internal consistency and stability in a sample of mothers of children receiving treatment for cancer.

IMPLICATION FOR PRACTICE

The CAFCPCS-Mothers' Version can be used to assess the caring ability of Iranian mothers of children with cancer and to determine maternal care needs.

The Effect of Self-Management Education by the Teach-Back Method on Uncertainty of Patients with Breast Cancer: a Quasi-Experimental Study

The present study aimed to determine the effect of self-management education by the teach-back method on uncertainty of patients with breast cancer. This quasi-experimental study (before and after) investigated 50 patients with breast cancer who referred to Surgery Clinic in Kerman from December 2015 to March 2016. The convenient sampling method was used for participants' selection. Participants were randomly divided into intervention and control groups. The questionnaire was completed before and after training by the teach-back method in both groups. Data were analyzed by SPSS software version 20. The results of the study showed that teach-back training in the intervention group improved self-management compared to the control group and the total score decreased from 106 to 73 (p = 0.01). Even after controlling confounders, such as place of residence and history of cancer education, the differences between the above groups remained statistically significant. Self-management education program by the teach-back method can help reduce uncertainty in patients with breast cancer. Therefore, it is recommended to use this educational method to improve self-management and reduce uncertainty in these patients.

An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities

BACKGROUND AND PURPOSE

The Health Risk Screening Tool (HRST) is a 22-item instrument specifically designed to assess the health risk of persons with developmental disabilities. The predictive validity of the HRST was investigated by examining its ability to predict mortality.

METHODS

The sample consisted of 12,582 people with an intellectual or developmental disability residing in Georgia (U.S.). Data were analyzed using survival analysis (Kaplan-Meier estimate and Cox regression) and a binary logistic regression.

RESULTS

All models supported the prognostic value of the six-level health risk classification. The Kaplan-Meier procedure showed clear separation among functions. The Cox proportional hazard regression revealed that hazard is inversely related to the health risk level, even after controlling for potential confounding by gender, ethnicity, and race.

CONCLUSIONS

The HRST can predict mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity.

Development and validation of 'caring ability of family caregivers of patients with cancer scale (CAFCPCS)'

AIM

Family caregivers have limited abilities that make them vulnerable to the care needs of patients. Therefore, it seems necessary to evaluate their caring ability. The aim of this study was to design an instrument for assessing the caring ability of family caregivers of cancer patients.

METHODS

This was a sequential exploratory mixed-method study, carried out in two qualitative and quantitative phases. The concept of caring ability and its dimensions were explained using conventional content analysis in the qualitative phase. The research participants included 41 family caregivers of cancer patients and professional caregivers who were selected using purposeful sampling method until reaching data saturation. The scale items were designed using the results of the qualitative phase of the study, as well as the review of relevant literature. In the quantitative phase, the scale was validated using content and face validity, construct validity, as well as internal consistency and stability.

RESULTS

The primary item pool was prepared in 108 items. Content validity was determined using CVR with a cut-off point (0.62), CVI with a cut-off point (0.8) and kappa coefficient (κ) (>0.75). The validity of 72 items was confirmed. Then, the overlapping items were merged and eventually the 45-item scale entered the face validity stage and five items with an impact factor < 1.5 were omitted. Results of KMO = 0.904 and Bartlett = 6184.012 (p < 0.001) justified the need for factor analysis. Scree plot indicates five factors with eigenvalues above 1 and 67.7% of the total variance, including 'Effective role play, Fatigue and Surrender, Trust, Uncertainty, and Caring ignorance'. Reliability of the 31-item instrument indicated a Cronbach's alpha coefficient of 0.93 and ICC of 0.94.

CONCLUSIONS

Caring abilities scale (CAI) of family caregivers of patients with cancer is a valid and reliable instrument that can assess caregivers' caring ability.

Predictors of uncertainty in parents of children living with chronic conditions

BACKGROUND

Uncertainty in illness implies no meaning has been attributed to an illness event. Although many studies focus on this issue in adults, there is limited research into children with chronic illnesses. Parental uncertainty has been associated with increased risk of post-traumatic stress, which can in turn adversely affect child and parent coping strategies.

AIM

To identify the characteristics of parents who are at greater risk of uncertainty and the associated characteristics of their children's chronic illnesses.

METHOD

An exploratory, cross-sectional study design was adopted across three different sites in the United Arab Emirates. Data were collected from parents who accompanied their children, who were receiving treatment, using a validated, culturally adapted Parent Perception of Uncertainty Scale.

RESULTS

Scores for illness uncertainty ranged from 86.5 to 92.6, on a scale of 31-155, with higher scores indicating greater uncertainty. The highest scores were found in parents of children being cared for in ward settings who had previously been hospitalised, parents of children up to two years of age or those approaching adolescence, fathers, and parents whose first language was Arabic.

CONCLUSION

The groups of parents with the highest illness uncertainty may benefit most from interventions to improve communication and psychological support.

Illness uncertainty, anxiety and depression in Chinese patients with glaucoma or cataract

This study evaluated illness uncertainty, anxiety and depression among glaucoma patients and cataract patients in China. 263 patients with primary glaucoma and 100 patients with age-related cataract were recruited sequentially from Zhongshan Ophthalmic Center between October 2013 and March 2016. All the participants completed questionnaires for socio-demographic information, Mishel Uncertainty in Illness Scale (MUIS) and Hospital Anxiety and Depression Scale (HADS). 25 of the 263 glaucoma patients and 21 of the100 cataract patients finished two copies of the same questionnaires before and after surgery. Statistics were analyzed using SPSS17.0 software. We observed that glaucoma patients had higher MUIS and HADS score than did cataract patients. Multivariate logistic regression analysis indicated risk factors for illness uncertainty, anxiety and depression for glaucoma patients were high HADS score, poor visual acuity (VA) in the better eye and education level respectively. Risk factors for the same parameters of cataract patients were high HADS-A score, poor VA in the better eye and high illness uncertainty respectively. Scores of MUIS and HADS both decreased after surgery, but the change in HADS score among glaucoma patients was not significant. Clinical workers should take these factors into account to improve therapy, especially for glaucoma patients who undergo surgery.

Psychometric Properties of the Farsi Version of “Spiritual Needs Questionnaire” for Cancer Patients in Iran: A Methodological Study

Background and objectives:

Spiritual needs are very important requirements to cancer patients. A valid and reliable instrument is needed for evaluation. This study was conducted to psychometrically evaluate a Spiritual Needs Questionnaire (SpNQ) for cancer patients in Iran.

Methods:

In this study, the methodology and psychometric properties of the Farsi version of the SpNQ (Büssing et al., (2010)) were evaluated, based on the model proposed by Wilde et al., (2005). The study population included cancer patients referred to the largest referral center in Iran. Some 400 subjects were selected. Then, the content, face and construct validity, as well as the internal consistency and reliability of the Farsi version were assessed.

Findings:

In the confirmatory factor analysis, the original four-factor version with 19 phrases was not confirmed. Subsequently, an exploratory factor analysis (EFA) was carried out in which phrases were included in three dimensions (peace and active giving, religion, and existence) that explained 48.1% of the variance. Later, a confirmatory factor analysis (CFA) was conducted, which showed a good fit of the model (CFI=0.94, GFI=0.94, RMSEA=0.071, and AGFI=0.96). Cronbach’s alpha was α=0.91 for the whole SpNQ. Cronbach’s alpha values ranged from 0.76 to 0.86 for the three factors. The intra-class correlation coefficient was ICC=0.82 between two tests performed with a two-week interval.

Conclusion:

The modified Farsi version of the SpNQ shows good psychometric properties for patients and can be used to investigate the spiritual needs of Iranian cancer patients.

Evaluating the Reliability and Validity of the Arabic Version of the Parents Perceptions of Uncertainty Scale (A-PPUS)

BACKGROUND

Uncertainty often accompanies illness and may be a major aversive component of the patients' treatment process. There is evidence that parental uncertainty has a negative impact on their own and on their child's coping strategies and may affect family functioning. Key to the provision of competent care, to address uncertainty, is the use of an appropriate validated assessment tool to understand key parental concerns. The 'Parent Perception of Uncertainty Scale' (PPUS) has been widely used for this purpose.

AIM

This study reports on the validity and reliability testing of the Arabic version of the Parents Perception of Uncertainty Scale (A-PPUS).

METHODS

The scale was translated to Arabic using the translation-back-translation method. Appropriate statistical tests were performed including measurements of internal consistency, item to total scale correlation, and univariate and multivariate analyses.

RESULTS

The study included 240 parents of children with chronic illnesses. Cronbach's alpha coefficient of the whole scale was 0.93. All the items were positively correlated to the total score. The univariate and multivariate analysis supported the previous tests and the assertion that the Arabic version of the PPUS provided a relevant measure of the uncertainty level.

CONCLUSION

This study has identified that the A-PPUS is a reliable tool for parent report of their uncertainty, in the UAE and Arabic population.

The correlation between perceived social support and illness uncertainty in people with human immunodeficiency virus/acquired immune deficiency syndrome in iran

BACKGROUND

Illness uncertainty is a source of a chronic and pervasive psychological stress for people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWH), and largely affects their quality of life and the ability to cope with the disease. Based on the uncertainty in illness theory, the social support is one of the illness uncertainty antecedents, and influences the level of uncertainty perceived by patients.

AIM

To examine uncertainty in PLWH and its correlation with social support in Iran.

MATERIALS AND METHODS

This cross-sectional correlational study was conducted with 80 PLWH presenting to AIDS Research Center, Tehran, Iran in 2013. The data collected using illness uncertainty and social support inventories were analyzed through Pearson's correlation coefficient, Spearman's correlation coefficient, and regression analysis.

RESULTS

The results showed a high level of illness uncertainty in PLWH and a negative significant correlation between perceived social support and illness uncertainty (P = 0.01, r = -0.29).

CONCLUSION

Uncertainty is a serious aspect of illness experience in Iranian PLWH. Providing adequate, structured information to patients as well as opportunities to discuss their concerns with other PLWH and receive emotional support from their health care providers may be worthwhile.

Chronic Sorrow in Mothers of Children With Cancer

Chronic sorrow, a progressive, persistent, and endless feeling of grief, is seen in parents of children with chronic diseases. This study aimed to investigate chronic sorrow in mothers of children with cancer in selected hospitals in Tehran, Iran. It also sought to clarify the relationships between chronic sorrow and some demographic characteristics. In this descriptive, cross-sectional study, 264 mothers attending 3 pediatric teaching hospitals in Tehran were selected using convenience sampling. The subjects completed a demographic questionnaire and Kendall Chronic Sorrow Questionnaire (Persian version). Data were analyzed with descriptive and inferential (Mann-Whitney and Kruskal-Wallis tests) statistics in SPSS 16.0. The mean score on the Kendall Chronic Sorrow Questionnaire was 76.39 ± 15.81. Chronic sorrow was likely present or present in 97.7% of the mothers (n = 252). The mean scores on the Disparity, Sadness, and Getting Along subscales were 30.26 ± 104.209, and 33.38 ± 42.777, respectively, and the mean score for coping was 12.75 ± 11.922. The relationships between most demographic characteristics and scores on the Kendall Chronic Sorrow Questionnaire were not significant. Chronic sorrow is a concept experienced by families of children with cancer. The health care provider’s knowledge about this concept and its components can facilitate the development of better support and treatment programs and lead to improved quality of life for children and their families.

Spiritual needs of cancer patients: a qualitative study

INTRODUCTION

Diagnosis of cancer can cause huge spiritual crisis in a person and affect different aspects of life. At this stage, patients have certain spiritual needs.

AIM

This study was conducted to explain spiritual needs of cancer patients in Iran.

MATERIALS AND METHODS

In this qualitative study, 18 cancer patients, referred to the Cancer Institute of Imam Khomeini Hospital in Tehran were selected using purposive sampling method, and their spiritual needs emerged out of conventional content analysis of interviews conducted with them.

RESULTS

From 1850 initial codes, 4 themes (connection, peace, meaning and purpose, and transcendence) were identified that contained categories of social support, normal behavior, inner peace, seeking forgiveness, hope, acceptance of reality, seeking meaning, ending well, change of life meaning, strengthening spiritual belief, communication with God, and prayer.

CONCLUSIONS

Spiritual needs of cancer patients should be recognized, realized, and considered in care of patients by the medical team. An all-out support of health system policy makers to meet patients' spiritual needs is particularly important.