| Objective : To develop the knowledge and practice questionnaire of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer with good reliability and validity,so as to provide a measurement tool to evaluate the prevention of lower limb lymphoedema in patients with postoperative radiotherapy for cervical cancer;To understand the prevention of lower limb lymphedema in patients with postoperative radiotherapy for cervical cancer,and accurately identify the high-risk group of lower limb lymphedema,so that medical staff can provide timely preventive intervention.The Inner experience and nursing needs of lower limb lymphoedema prevention in patients with postoperative radiotherapy for cervical cancer were summarized through qualitative interview,Through the combination of quantitative research,qualitative research,results of expert meetings,a preventive intervention program for lower limb lymphedema in patients with postoperative radiotherapy for cervical cancer has been proposed,aiming at providing a reference for clinical nurses to guide the prevention of lower limb lymphedema in patients with postoperative radiotherapy for cervical cancer.Methods:A mixed-methods studyPart I: Preparation of knowledge and behavior questionnaire of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer.In strict accordance with the guidelines compiled by psychological measurement tools and on the basis of literature review,the dimensions and initial items of the lower limb lymphedema,prevention knowledge and practice questionnaire for patients with postoperative radiotherapy for cervical cancer was constructed.Five experts were invited to conduct two rounds of screening and evaluation of the items and dimensions,and the knowledge and practice questionnaire for the prevention of lower limb lymphedema for patients with postoperative radiotherapy for cervical cancer was adjusted and revised again after a preliminary investigation.The reliability and validity of the knowledge and practice questionnaire were tested.Convenience sampling method was adopted to continuously select patients meeting the inclusion and exclusion criteria who received postoperative radiotherapy for cervical cancer in three grade-A hospitals from March 2021 to December 2021 as research objects.SPSS26.0 and AMOS24.0 software were used to data analysis.Correlation coefficient method and decision value method were used to analyze item of the knowledge and practice questionnaire.Content validity index CVI was used to test the content validity of the knowledge and practice questionnaire.Exploratory factor analysis and confirmatory factor analysis were used to evaluate the structural validity of the knowledge and practice questionnaire.Internal consistency reliability and retest reliability were used to test the reliability of the knowledge and practice questionnaire.Part II: Investigation and analysis of influencing factors of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer.The prevention knowledge and practice questionnaire of lower limb lymphedema in patients with postoperative radiotherapy for cervical cancer was used.The research tools included: general data knowledge and practice questionnaire and the prevention knowledge and practice questionnaire of lower limb lymphedema in patients with postoperative radiotherapy for cervical cancer.Using the convenience sampling method,patients who met the inclusion and exclusion criteria for postoperative radiotherapy for cervical cancer from January 2022 to October 2022 were continuously selected as the study subjects.The survey data were analyzed to evaluate the current situation of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer and to analyze the influencing factors.Part III: Qualitative study on Inner experience and nursing needs of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer.This part uses the method of describing the nature of the study,using the purpose sampling method combined with the most differentiated sample sampling strategy,and selected 11 patients with cervical cancer who met the criteria of postoperative radiotherapy to conduct face-to-face semi-structured interview.Content analysis was used to analyze the inner experience and nursing needs of patients with cervical cancer with postoperative radiotherapy.Part IV: Construction of intervention plan for prevention of lower limb lymphedema in patients with postoperative radiotherapy for cervical cancer.Based on the empowerment theory,the preventive intervention program of lower extremity lymphedema in patients with cervical cancer was initially constructed through the best evidence summary method of evidence-based care,combined with quantitative research and qualitative research.On this basis,the expert meeting was held,and according to the results of expert discussion,the preliminary preventive intervention program was further modified and improved,and the final draft of the preventive intervention program for lower limb lymphoedema in patients with postoperative radiotherapy for cervical cancer was formed.Results:Part I: Preparation of knowledge and behavior questionnaire of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer(1)Results of knowledge and practice questionnaire development: The knowledge and practice questionnaire for the prevention of lower extremity lymphedema in cervical cancer patients receiving postoperative radiotherapy finally included 5dimensions and 26 items.The 5 dimensions were lower extremity lymphedema prevention knowledge(8 items),lower extremity lymphedema prevention skills(4items),lower extremity lymphedemaprevention movement(3items),lower extremity protection in the prevention of lower extremity lymphedema(7 items)and psychological adjustment in the prevention of lower extremity lymphedema(4 items).(2)Results of item analysis: The correlation coefficients between the item scores and the total score of the knowledge and practice questionnaire for the prevention of lymphedema in postoperative radiotherapy patients with cervical cancer ranged from0.509 to 0.694,and the difference was statistically significant(P < 0.05).The cut-off values ranged from 8.2 to 14.166 and the difference was statistically significant(P <0.05).(3)Content validity test results: items of the lower extremity lymphedema prevention knowledge and practice questionnaire for postoperative radiotherapy patients with cervical cancer.The level content validity index(I-CVI)was between 1 and 0.8,and the scale-level content validity index(S-CVI/Ave)was 0.973.(4)Construct validity results: The knowledge and practice questionnaire with 31 items and 5 factors was formed by exploratory factor analysis and accumulatedThe contribution rate was 68.319%.Confirmatory factor analysis showed that the loading coefficient of each factor in the knowledge and practice questionnaire was above 0.4,the CR value was greater than 0.7,the AVE value was greater than 0.6,and the square root of AVE of each dimension was greater than the absolute value of the correlation coefficient between each variable,and each fitting index met the requirements.(5)Results of reliability test: The overall Cronbach’s α coefficient of the lower extremity lymphedema prevention knowledge and practice questionnaire for postoperative radiotherapy patients with cervical cancer was 0.938,and the Cronbach’s α coefficient of the five dimensions was between 0.804 and 0.926.The total test-retest reliability of the knowledge and practice questionnaire was 0.812,and the test-retest reliability of the five dimensions are above 0.7.Part II: Investigation and analysis of influencing factors of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer.(1)Quantitative study results: The mean score of lower limb lymphoedema prevention knowledge and practice questionnaire in patients with postoperative radiotherapy for cervical cancer was scored as(90.748 ± 19.962);(2)Results of univariate analysis: the difference of age,occupation,educational background,monthly family income,medical Payment method and residence in patients with cervical cancer(P <0.05);(3)Results of multivariate analysis: age,occupation,educational background,and monthly family income,medical Payment method,and living conditions were all entered into the multiple linear regression equation.It indicates that the above variables are influencing factors for the level of lower extremity lymphoedema prevention in patients with postoperative radiotherapy for cervical cancer.Part III: Qualitative study on Inner experience and nursing needs of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer.In this study,11 patients with postoperative radiotherapy for cervical cancer were included in semi-structured interviews to extract the influencing factors and care needs of lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer.The influencing factors include two subthemes:hindering factors(insufficient awareness,insufficient knowledge and skills of prevention,the financial burden of the family and their own psychological burden)and facilitators(clear purpose,fair income,social support and access to professional guidance);Nursing needs include professional knowledge requirements(professional knowledge prevention knowledge related knowledge,home care knowledge and obtain professional reliable information access),professional skills requirements(master lower limb lymphedema Prevention skills and relieve Psychological stress skills)and social su PPort needs(family support,Patient support and economic support)three subthemes.Part IV: Construction of intervention plan for prevention of lower limb lymphedema in patients with postoperative radiotherapy for cervical cancer.Under the guidance of empowerment theory,combined with the quantitative research results,qualitative research results and the best evidence-based care,the preventive intervention program of lower limb lymphoedema in postoperative radiotherapy patients with cervical cancer was initially constructed.Seven experts were invited to participate in the expert meeting for the lower limb lymph of postoperative radiotherapy patients for cervical cancer The oedema prevention intervention program was evaluated.The experts put forward 11 suggestions,and the final intervention program of lower limb lymphedema in postoperative radiotherapy patients with cervical cancer included 4 modules(Professional knowledge module,professional skills module,social support module and self-enabling module),10 topics and 21 intervention contents.Conclusion :(1)The knowledge and practice questionnaire for lower limb lymphedema prevention in patients with postoperative radiotherapy for cervical cancer has good reliability and validity and can be used as a tool to evaluate the prevention level of lower limb lymphoedema prevention in patients with cervical cancer postoperative radiotherapy in clinical work.(2)The overall level of lower extremity lymphedema prevention in patients with cervical cancer postoperative radiotherapy is low,so it is necessary to strengthen the health education on the prevention of lower extremity lymphedema in patients with cervical cancer postoperative radiotherapy to reduce the incidence of lower extremity lymphedema.The factors influencing the prevention level of lower limb lymphedema in postoperative radiotherapy patients with cervical cancer include age,occupation,educational background,monthly family income,medical payment method and living conditions,which suggest that nursing staff should pay attention to the health education of high-risk groups under the influence of the above factors during the health education of lower limb lymphedema prevention.(3)The hindering factors and promoting factors for the prevention of lower extremity lymphedema in postoperative radiotherapy patients with cervical cancer were defined as well as the nursing needs of patients.It can lay the foundation for the construction of a demand-oriented preventive intervention program for lower limb lymphedema in patients with postoperative radiotherapy for cervical cancer,thus improving the pertinence and feasibility of the preventive intervention program.(4)In this study,an intervention program for the prevention of lower limb lymphedema for postoperative radiotherapy for cervical cancer patients was constructed,which consisted of 4 modules(professional knowledge module,professional skill module,social support module and self-empowerment module),10 themes and 22 intervention contents.This program can provide reference for clinical nurses to guide the prevention of lower limb lymphedema for postoperative radiotherapy for cervical cancer patients. |
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