| ObjectiveBased on the theory of social support,in order to provide measurement tools for clinical nurses or nutritional team members to evaluate the effect of home enteral nutrition support with dysphagia patients in stroke,the scale for the home enteral nutrition with dysphagia patients in stroke involving informational support,material support,emotional support and value support was compiled,the reliability and validity of the scale were tested as well in this study.Methods1.Based on social support theory,in order to identify the scale dimensions,according to the research content,through the literature review,the Chinese databases such as CNKI,Weipu,Wanfang and the English databases such as Pub Med,Web of Science and Cochrane etc were searched with subject headings such as"social support theory","social support","stroke","dysphagia","swallowing disorders","enteral nutrition","home enteral nutrition","scale development",etc.Eventually the informational support,material support,emotional support and value support were identified to be scale dimensions.2.Stroke patients with dysphagia visiting the Enteral Nutrition Clinic of one 3a hospital of Hohhot,Inner Mongolia from Apr.2022 to May 2022 who had experience in HEN or their main caregivers were selected to participate the semi-structured interviews by convenient sampling method.Interview sample size was based on the principle of information saturation.After interviewing the content analysis method was utilized to analyze the data and refine the interview topics so as to provide a reference for the construction of HEN support evaluation scale for stroke patients with dysphagia.3.The Delphi method was used.Scale items were modified according to the results of two rounds of expert consultations.The initial assessment scale for the Home Enteral Nutrition support with dysphagia patients in stroke in 4 dimensions with a total of 28 items was formed.4.A pre-trial is performed using an initial scale prior to clinical investigation.Then clinical investigation involving 315 patients or their main caregivers was conducted through convenience sampling method.The dispersion degree method and the critical ratio method were used to screen the items to form the final scale.The internal consistency reliability and external stability reliability were calculated so that can evaluate the reliability of the final scale.Content validity and structural validity were utilized to evaluate the validity of the final scale.Results1.Scale compilation results:Based on the theory of social support,after literature review,it is determined that the construction of scale items is carried out from the dimensions of informational support,material support,emotional support and value support.2.Semi-structured interview results:three themes were identified:family support,lack of care experience and increasing uncertainty of the disease.3.Expert consultation results:the experts’positive coefficient in the first round of expert consultation is 100%.The experts’positive coefficient in the second round is 100%.The two rounds of expert judgment(Ca)were respectively 0.94 and 0.95 and the two rounds of expert familiarity(Cs)were respectively 0.85 and 0.91 as well as the two rounds of expert authority coefficient(Cr)were respectively 0.89 and 0.93.The two rounds of expert inquiry Kendall coordination coefficients were respectively 0.326 and 0.265.After the two rounds of expert consultation,the original scale entries were retained,forming a preliminary scale containing 30 items.4.After pre-trial involving 12 study subjects,the professional language expression and wording of the scale were modified to form a scale with 30 items in 4 dimensions.After screening the items of the scale,a formal evaluation scale for the HEN support with dysphagia patients in stroke finally formed involving a total of 30 items in 4 dimensions including informational support,material support,emotional support and value support.5.The results of reliability and validity test:the overall Cronbach’sαof the scale was0.956,the Cronbach’sαof each dimension were respectively 0.917,0.764,0.835 and 0.862;the Cronbach’sαin the first half of the scale was 0.912,and the Cronbach’sαin the second half was 0.915.the Spearman-Brown coefficient was 0.947.the retest reliability of the scale was 0.892 and the retest reliability of each dimension of scale was respectively 0.726,0.738,0.723 and 0.721.The scale S-CVI I-CVI were 0.900 and 0.83-1.Confirmatory factor analysis showed that x~2/df was 1.095,RMSEA was 0.018,TLI,CFI,IFI,RFI and NFI were more than0.900 respectively,all of which indicated showed that the scale had good reliability and validity.The AVE and CR values were calculated by factor loading values and the results showed that the AVE of factor 2 and factor 3 was less than 0.5,which was indicating that the items in factor 2 and factor 3 had poor fitting with the factor.Therefore,the 7 items with small factor loading values in factor 2 and factor 3 were deleted and calculated again.AVE and CR values had met standard values,which was indicating that the four factors fit well with the items as well as the scale had good structural validity.In summary,the formal scale had good reliability and validity.Conclusions1.The formal evaluation scale of HEN support effect with dysphagia patients in stroke compiled in this study has a total of 23 items in 4 dimensions.2.This scale had good reliability and validity,which can provide a measurement basis for clinical nurses to evaluate the effect of HEN support in dysphagia patients with stroke. |
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