| ObjectiveThis study aims to develop and validate the scale of caring ability of caregivers of children with type 1 diabetes in China context,providing a meaningful instrument to quantify the caring level for caregivers of children with type 1 diabetes.Methods1.Item pool development: By searching databases at home and abroad,reviewing domestic and foreign expert consensus on type 1 diabetes in children,guidelines,the development of the chronic disease caregiver care ability scale for children,caregiver skill model and competency theory related literature,and initially construct scale dimension and item pool;through semi-structured interviews,explore and understand the care status and obstacle factors of caregivers of children with T1 DM.The Colizzi seven-step analysis method and NVivo 12.0 software were used for organizing and analyze the interview data and supplementary item tool.2.Form the scale:(1)Expert inquiry: 20 experts from 7 provinces and cities across the country were invited to complete two rounds of Delphi expert inquiry to evaluate the initial dimension division and item content of the scale.(2)Pre-investigation: Using objective sampling method,30 caregivers of children with type 1 diabetes were selected as subjects for pre-survey.The objective of this survey is to verify content clarity and to optimize the content and language of the scale item to make it more suitable for caregivers of children with type 1diabetes.(3)Item analysis: From April to May in 2021,Convenience sampling method was used to select 276 caregivers of children with type 1 diabetes who were from a grade A tertiary hospital in Shandong Province for a cross-sectional survey.The aim was to screen item and then develop the formal scale of caring ability of caregivers of children with type 1 diabetes.3.Reliability and Validity analysis: from June to August in 2021,403 caregivers of children with type 1 diabetes were conveniently selected from three grade A tertiary hospitals in Shandong Province and Fujian Province as projects,reliability and validity analysis were test using psychometric techniques(internal consistency,test-retest reliability,composite reliability,content validity,construct validity,convergent validity,and discriminant validity).Results1.A total of 63 children’s type 1 diabetes guidelines,expert consensus and relevant effective literature were obtained.A total of 15 caregivers of children with type 1 diabetes were interviewed,and 5 themes were extracted,namely lack of professional technical support,negative emotions,lack of disease-related care knowledge,care burden,and family conflict.Based on the caregiver skills model,an original 45 items from 6 dimensions were generated from literature review,semi structured interviews.2.(1)Delphi expert inquiry: The questionnaire recovery rates of the two rounds of experts were 95.0% and 84.2% respectively,and the authority coefficients were 0.876 and 0.881 respectively.In round 1,The average score of each item ranged from 3.93 to 4.94,the full mark ratio ranged from 0.44 to 0.94.In round 2,the average score of each item ranged from4.06 to 5.00,the full mark ratio ranged from 0.41 to 1.00.After two rounds of the Delphi process,the initial scale consisted of 45 items,five dimensions.the CR for all item in the two rounds of expert inquiry were less than 0.25,the Kendall coordination coefficient W were 0.15 and 0.16 respectively.After two rounds of expert inquiry,merged "family relationships" into "Manage family and social resources",deleted 4 items,added 5 items,and merged 1 item,forming an initial scale of 45 items with 5 dimensions.(2)Pre-investigation: caregivers felt that the language of the scale items was clear,and could understand the content of the item better,indicating that the scale was suitable for the investigation of caregivers of children with type 1diabetes.(3)Item analysis: according to the screening criteria,after discussion by the expert group,9 items were deleted: A4,A6,A13,B15,B22,B25,C34,C37,and E41.The final scale is composed of 5 dimensions and 36 items.3.(1)Reliability results: the excellent internal consistency(Cronbach’s α = 0.95),and the Cronbach’s α of the five dimensions ranged from 0.83 to 0.97;the scale test-retest reliability was 0.93,and the 5 dimensions test-retest reliability ranged from 0.74 to 0.96,the combinatorial reliability of each dimension ranged from 0.81 to 0.97,indicate a satisfactory reliability of the scale.(2)Validity results: the item content validity index(I-CVI)of the scale ranged 0.85 ～ 1.00,Scale Content Validity Index(S-CVI)exceeded 0.97,indicting a good content validly.Except that the Ave value of dimension one "knowledge and attitude" was 0.45,the AVE of the other dimensions was greater than 0.5,the results of the Chi-square difference test showed that the 5dimensions were all significant between the two models,that the scale had good aggregation validity and discriminative validity.Confirmatory factor analysis results showed that GFI is0.83,NFI is 0.89 within the acceptable range,and the rest of the indicators meet the requirements of the theoretical values,indicating that the theoretical model of the scale fits well.Conclusion1.This study is the first to develop and validate the caregiver care ability scale for children with type 1 diabetes.This scale is composed of 36 items and 5 dimensions: knowledge and attitude,basic care skills,self-quality,self-emotion management,family,and social resource management.These 5 dimensions cover the basic skills and expansion ability of children with type 1 diabetes care,and comprehensively evaluate the care ability of caregivers of children with type 1 diabetes.2.The statistical indicators of the scale in this study are in line with the scale psychometric standards,indicating that the scale has good reliability and validity,good scientific and high reliability. |
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