ABSTRACT
Aim
This study was conducted to evaluate the Turkish validity and reliability of the Caregiver Contribution to Self-care in Ostomy Patient Index, to evaluate the relatives of patients with stoma who contributed to their self-care in Turkish society, and to contribute to the literature of the measurement tool.
Materials and Methods
This methodological type of research was carried out between September 2020 and January 2021 in a state and a university hospital in Tekirdağ. The research sample consisted of 223 individuals who contributed to the self-care of individuals with colostomy, ileostomy and urostomy, who applied for outpatient control. In the analysis of the data, descriptive statistics, language and content validity, confirmatory factor analysis (CFA), item analysis, internal consistency and test-retest methods were used.
Results
The Content Validity Index was 0.99 and Cronbach’s alpha 0.890. According to the CFA, fit indices were within acceptable limits and all items were statistically significant in the 3 sub-dimensions of the scale. As in the original version of the scale, item 18, which was not statistically significant, was not included in the analysis and was accepted as an addition. The correlation between test-retest and scale items was 0.983 for the whole scale and between 0.973 and 0.987 for the sub-dimensions.
Conclusion
At the end of the study, it was determined that the scale was suitable for Turkish society and was valid and reliable in Turkish.
INTRODUCTION
A stoma is the opening that is most often created due to cancer and connects an organ to the skin1. Colostomy, ileostomy, and urostomy are the most common types of stoma, in which evacuation is provided by this surgical way to the abdominal wall2, 3.
The stoma has a negative impact on the quality of life by changing the daily life activities, body image and interpersonal relationships of the individual. As a result of this effect, new social, economic, emotional, and physiological priorities may emerge for the individual4. As a result of studies, it has been reported that the daily activities of individuals with stoma are limited by approximately 3.46 times and that approximately 30-60% of individuals with stoma experience complications in and around the stoma after surgery. The training and counseling of nurses play an important role in helping individuals cope with these problems that reduce their quality of life, adapt to the stoma, and gain self-care skills5. In addition, attention is drawn to the importance of social support resources, especially family members, in adapting the individual to a challenging new lifestyle6.
Although self-care skills are carried out by the patient, as the word means, individuals often need the contributions of their families and relatives in this regard7. Families take an active role in giving advice on self-care skills of individuals with a stoma, making new decisions about the individual’s health status and helping them to cope with their negative feelings about this situation, helping them to fulfill their self-care skills, and performing these skills instead of the individual when necessary6, 8. Contribution to self-care can be determined by using valid and reliable tools in the evaluation of families and relatives who play an active role in the care of individuals with a stoma, and supportive training can be planned when necessary. Thus, a positive effect can be achieved in the adaptation process and quality of life of individuals with a stoma6, 7.
There is no valid and reliable scale for Turkish society in Turkish language to evaluate the relatives who participate in the care of individuals with a stoma and contribute to their self-care. As a result of this study, it is thought that this deficiency will be eliminated. The aim of this study, which was planned in methodological type, was to evaluate the Turkish validity and reliability of the “Caregiver Contribution to Self-care in Ostomy Patient Index” and to evaluate the families and relatives of patients with a stoma who contributed to their self-care in Turkish society.
MATERIALS AND METHODS
The study was planned in methodological type for the purpose of psychometric evaluation of the instrument.
The study was carried out between September 2020 and January 2021 in the general surgery, gastroenterology surgery and urology outpatient clinics of a state and a university hospital in Tekirdağ province. In order to evaluate the validity and reliability of a scale in different languages and cultures, it is recommended that the sample size should be 5-10 times the number of scale items9. The scale in this study consists of 22 items. The research sample consisted of 223 individuals who contributed to the self-care of individuals with colostomy, ileostomy and urostomy, who applied for outpatient control.
Instruments
As data collection tools, an 11-item “Information Form for the Caregiver of the Individual with Ostomy” and the 22-item “Caregiver Contribution to Self-care in Ostomy Patient Index” were used.
The Information Form for the Caregiver of the Individual with Ostomy consists of questions about the sociodemographic characteristics of the family and relatives who contribute to the care of the individual with a stoma.
The “Caregiver Contribution to Self-care in Ostomy Patient Index” scale, developed in English by Villa et al. (2019)7, consists of 22 items and 3 sub-dimensions. Scale items are evaluated with a 5-point Likert-type. The first sub-dimension is “Caregiver Contribution to Self-care Maintenance”, consisting of 9 items. The second sub-dimension is “Caregiver Contribution to Self-care Monitoring”, consisting of 8 items, and the third sub-dimension is “Caregiver Contribution to Self-care Management”, consisting of 5 items. The 18th item of the scale, which evaluates the state of experiencing complications, has a low factor load and was accepted as an add-on. The highest 110 points are obtained from the scale, and it is stated that as the total score from the scale increases, self-care also increases7.
Study Procedures
The study sample consisted of individuals over the age of 18 years, who supported the care of the individual with a stoma (colostomy, ileostomy, or urostomy), who spoke, read and wrote in Turkish, did not have a cognitive problem that prevented them from expressing themselves, did not have a serious psychiatric diagnosis, and gave written consent to participate in the study. The data were collected by the researcher by face-to-face interview method, giving each individual approximately 30 minutes.
RESULTS
Among the individuals participating in the study, 52% (n=116) were between the ages of 45 and 59 years; 64.6% (n=144) were female; 74% (n=165) were married, 36.3% (n=81) were middle school graduates, 62.3% (n=139) were not working, and 77.6% (n=173) were living with an individual with a stoma; 65% (n=145) of stomas belonged to individual’s spouse and 42.2% (n=94) supported the care of the individual with stoma for 1-5 months; and 79.8% (n=178) received ostomy care training. In addition, 53.8% (n=120) of individuals with stoma had colostomy and the reason for ostomy opening in 70.9% (n=158) was cancer (Table 1).
In the validity analysis, the CVI value of the scale was found to be 0.99 in line with the expert opinions. As a result of CFA, c2/sd=3.349 values were between 2 and 5 and goodness of fit index (GFI), Tucker-Lewis Index (TLI), comparison of model fit indices (CFI), adjusted goodness of fit index (AGFI) values were above 0.900 (Table 2). All items were included in 3 sub-dimensions with statistical significance and the 18th item was accepted as an add-on as it was in the original version of the scale (Figure 1, Figure Table 3).
According to the reliability analysis statistics, the Cronbach’s alpha coefficients were 0.890 for the overall scale, 0.867 for the “Caregiver Contribution to Self-care Maintenance” sub-dimension, 0.921 for the “Caregiver Contribution to Self-care Monitoring” sub-dimension, and 0.458 for the “Caregiver Contribution to Self-care Management” sub-dimension, respectively. As a result of the reliability analysis, the item correlation value of the 18th item was negative, so it was excluded from the analysis and the results in Table 4 were obtained by performing the reliability analysis again. According to the findings, all corrected item correlation values of the sub-dimensions were found to be positive. In addition, it was observed that there was no significant increase in the reliability coefficients when the item was deleted in the sub-dimensions of the Caregiver Contribution to Self-care in Ostomy Patient Index. According to the findings obtained in the final analysis stage, all questions were included in the analysis, as in the original version of the Caregiver Contribution to Self-care in Ostomy Patient Index. With the test-retest method, the Pearson and Spearman correlation coefficient (r-value) was found to be between 0.973 and 0.987 for the sub-dimensions of the scale and 0.983 for the whole scale (Table 5).
DISCUSSION
In this study, the validity and reliability of a scale that evaluates the contribution of families and relatives to the self-care of individuals with a stoma in the Turkish language and Turkish society were examined. The sub-dimensions of the scale in its original form were prepared on the basis of Riegel et al. (2012)21 “Middle-range Theory of Self-care of Chronic Illness”. In the scale that evaluates the contributions of the families and relatives of individuals with a stoma, the first part of the scale, “Self-care Maintenance” is about daily routine behaviors; the second part “Self-care Monitoring” is about recognizing the stoma and its surroundings; and the third part, “Self-care Management”, deals with recognizing problems and intervening behaviors7.
The back-translation method was used in the language adaptation of the scale and a common translation text was created. The CVI value of 0.99 in this study showed that language and content validity were appropriate13. Also, construct validity of the scale was tested using CFA. In this study, fit indices (c2/sd=3.349 value below 5 and GFI, TLI, CFI and AGFI criteria above 0.900) showed acceptable fit. The factor loads of the items were found to be above 0.30 and their t-values above 2.56, at the level of 0.01, which was statistically significant. These results found that the items were correctly included in the original scale dimensions and were collected in 3 sub-dimensions9, 12, 16, 19-20.
In this study, Cronbach’s alpha reliability coefficient was found to be 0.890 in the overall scale and in the range of 0.458-0.921 in the sub-dimensions of the scale. The overall scale was highly reliable. In addition, in the item-total score analysis, it was concluded that the correlation coefficient of all items was above 0.30 and there would be no increase in the Cronbach’s alpha value when the item was deleted. As a result of the analysis, the Pearson and Spearman correlation coefficients of the sub-dimensions were found to be between 0.973 and 0.987. Accordingly, the sub-dimensions of the scale were highly reliable and did not change over time9, 17.
The similarities of the original version of the scale with our study are that the scale items consist of 3 sub-dimensions, the CVI is 0.93 and the Cronbach’s alpha is 0.972 in the internal consistency analysis.
Study Limitations
The most important limitation of our study is that it was conducted with families and relatives who contributed to the care of individuals with stoma in two public hospitals in Turkey. However, the validity and reliability of the scale in Turkish has been ensured and it is recommended to be used in other studies in Turkish society.
CONCLUSION
Individuals with stoma often need the support of their relatives in order to maintain their self-care. There is no valid and reliable scale in Turkish language to evaluate the relatives who participate in the care of individuals with a stoma and contribute to their self-care. As a result of the research, it has been determined that the “Caregiver Contribution to Self-care in Ostomy Patient Index” is a valid and reliable scale for Turkish society in the Turkish language. This scale can be used as a guide in the evaluation of families and relatives who contribute to the self-care of individuals with a stoma in Turkish society.
Acknowledgement
We thank Villa et al., who developed the scale, for permitting to adapt the Caregiver Contribution to Self-care in Ostomy Patient Index into Turkish. The authors thank the experts who contributed with their opinions and the individuals who agreed to participate in the study.
Ethics
Ethics Committee Approval: Study procedures were reviewed and approved by the Non-interventional Clinical Research Ethics Committee of Tekirdağ Namık Kemal University Faculty of Medicine on August 27, 2020, with the decision number of 2020.195.08.04.
Informed Consent: Written and verbal consent was obtained from individuals who agreed to participate in the study.