Risk Perception Scale Of Disease Aggravation For Older Patients With Chronic Disease: A Scale Development And Application Study

Objectives1.The present study aims to develop the Risk Perception Scale of Disease Aggravation for older patients with chronic diseases,and to conduct validity and reliability tests for the scale.2.This study will explore the levels,latent profiles and influencing factors of risk perception of disease aggravation,which are expected to provide medical workers with more targeted reference basis to improve patients’risk perception of disease aggravation.MethodsThis is a non-experimental study which includes two stages:1.The development,validity and reliability tests for Risk Perception Scale of Disease Aggravation(1)Literature review:We synthesize the research status of risk perception instrument development of disease aggravation,formulate the interviewing guideline,conclude the operational conceptions and theoretical framework.(2)Semi-structured interviews:Colaizzi seven-step analysis method of descriptive phenomenology research is performed by MAXQDA R20.4.0 to explore the intrinsic meaning of risk perception of disease aggravation and conclude the potential items.(3)Expert panel discussion:A nursing educator and two nursing clinical workers are invited to discuss with the researchers to determine the potential dimensions of the scale,the items under each dimension,and the item scoring method.And then,the first draft of the scale is formed.(4)Delphi consultation:Experts are invited to evaluate the importance and relevance of each dimensions and items,mark items that are needed to be deleted and give items that are needed to be added.(5)Pre-investigation:It is conducted by questionnaire and cognitive interview to modify the expression of items.(6)Item analysis,validity and reliability tests:In June 2022,convenience sampling is conducted in three comprehensive hospitals,two community hospitals and one long-term care home in China to recruit 547 older patients with chronic diseases.The item analysis is carried out by applying the discriminant test,correlation coefficient method and homogeneity test.The sample is divided into two subsamples using the SPSS random number table function to conduct exploratory factor analysis(Sample A:273patients)and confirmatory factor analysis(Sample B:274 patients).Indicators of validity and reliability tests including structural validity,convergent validity,discriminant validity,internal consistency reliability and test-retest reliability are conducted by AMOS version25.0 and SPSS version 26.0.2.The levels,latent profiles and influencing factors of risk perception of disease aggravationFrom July to August 2022,convenience sampling is applied in two comprehensive hospitals in China to collect pen-paper questionnaires of 598 older patients with chronic diseases.Questionnaires contain the sociodemographic and disease-related information,and Risk Perception Scale of Disease Aggravation.The variable-centered statistical analysis method is applied to evaluate the overall risk perception level of disease aggravation.The person-centered latent profile analysis and disordered multiple Logistic regression analysis are conducted to explore the potential profile and influencing factors of risk perception of disease aggravation.The above analyses are conducted by SPSS version 26.0 and Mplus version 8.3.Results1.The development,validity and reliability tests for Risk Perception Scale of Disease Aggravation(1)Literature review:A total of 52 papers are screened,which introduce the theories of risk perception and development of the risk perception scale of disease aggravation.(2)Semi-structured interviews:There are 33 participants.A total of 7 themes and 37quotations are concluded from the qualitative analysis.(3)Expert panel discussion:The first draft of scale includes 25 items and 7 domains:symptom perception,affection experience,possible reason,serious outcome,experience of disease aggravation,risk management attitude and risk management behaviour.Items are forward scored by 5-point Likert scale.Each domain is given a separated question to guide patients to answer.(4)Delphi consultation:There are 27 and 21 experts in the two rounds of Delphi consultation.The collecting rates are 54.00%and 77.78%.Opinion submission rates are55.56%and 100%.Authority degrees are 0.859 and 0.876.The revised scale contains 42items and 4 domains:affection experience,possible reason,serious outcome and behaviour control.(5)Pre-investigation:A total of 15 participants are included.The presentation of 7items have been revised.(6)Item analysis,validity and reliability tests:No item is deleted according to item analysis.The two rounds of exploratory factor analysis have extracted four factors accounting for 69.762%and 71.187%of the total variance.A total of 2 items are deleted.The standard fit indices are x~2/df=1.416,RMSEA=0.041,CFI=0.967,NFI=0.903,IFI=0.967 and TLI=0.965,which demonstrate an acceptable model fit.The AVE coefficients of the domains range from 0.622 to 0.725,and the composite reliabilities of the domains range from 0.941 to 0.967,indicating acceptable convergent validity.The domains are significantly related to each other(P<0.001),and the square roots of the AVE coefficients for the four domains are greater than those for the construct correlations,which suggests acceptable discriminant validity.The S-CVI is 0.931,and I-CVIs range from 0.810 to 1.000,which indicates an acceptable content validity.Cronbach’sαcoefficient for the total scale and domains are 0.920-0.973,and the intraclass correlation coefficient for the total scale is 0.840,indicating acceptable internal consistency and test-retest reliability.(7)Scoring method:The total score of the scale is 40-200 points,and higher score indicating higher level of risk perception of disease aggravation.2.The levels,latent profiles and influencing factors of risk perception of disease aggravation(1)Risk perception level of disease aggravation:The total score of scale and the average score of items fail to pass the normality test.Therefore,medians,lower quartiles,and upper quartiles are applied to indicate the scores.The total score of scale is 125.00(107.00,135.00),and the average score of items is 3.13(2.68,3.38).The scores of domains from higher to lower are behaviour control,possible reason,serious outcome and affection experience.(2)Latent profiles of risk perception of disease aggravation:There are four profiles of risk perception of disease aggravation for older patients with chronic diseases:“higher risk perception-lower affection experience”“median risk perception”“lower risk perception”and“higher risk perception-higher serious outcome”.The proportion of“median risk perception”patients is 37.3%,which is the highest.Patients in“median risk perception”have the best risk perception in the four profiles.(3)Influencing factors of the latent profiles:Referring the“median risk perception”profile,patients who are male(OR=3.746,P=0.002)and have longer time since diagnosis(OR=1.162,P<0.001)are more likely to appear in the“higher risk perception-lower affection experience”profile;patients who have primary school or below educational level(OR=7.040,P=0.002)are more likely to appear in the“lower risk perception”profile;patients with higher age(OR=1.134,P=0.023),<30%(OR=36.574,P<0.001)or 30%-50%(OR=14.676,P<0.001)of medical insurance reimbursement,longer time since diagnosis(OR=1.207,P<0.001)are more likely to appear in the“higher risk perception-higher serious outcome”profile.Conclusions1.Risk Perception Scale of Disease Aggravation for older patients with chronic diseases has acceptable validity and reliability,which can be applied in the future cross-sectional and longitudinal studies.2.There are four latent profiles of risk perception of disease aggravation,which influencing factors are different.Targeted interventions can be developed by medical workers to improve older patients’risk perception of disease aggravation.