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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2022

Open Access 01-12-2022 | Tuberculosis | Research

Development and validation of self-management scale for tuberculosis patients

Authors: Jin Li, Liwen Zhang, Jiani Zhou, Geng Wang, Rui Zhang, Jiaqing Liu, Shili Liu, Yong Chen, Song Yang, Quan Yuan, Ying Li

Published in: BMC Infectious Diseases | Issue 1/2022

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Abstract

Background

Tuberculosis remains a major threat to global public health. Regarding its control, directly observed therapy is not suitable as a global strategy for all tuberculosis patients. Self-management may be an important patient-centered tuberculosis case management supplement to directly observed therapy. However, there is currently no well-established instrument for measuring the self-management of tuberculosis patients. This study aimed to develop and validate a self-management scale for tuberculosis patients.

Methods

We developed an initial scale based on the tuberculosis health promotion indicators framework developed by our research group. After item analysis and two rounds of exploratory factor analysis, a final version of the scale was developed. A survey of 462 tuberculosis patients was conducted to develop and validate this scale. Cronbach’s α and intraclass correlation coefficients were used to assess reliability, and Pearson’s correlation coefficients were used to evaluate content validity. Fit indices, convergent validity, and discriminant validity were evaluated using confirmatory factor analysis to determine the construct validity of the scale.

Results

The scale was composed of 17 items in three dimensions (“adherence to treatment behavior,” “transmission prevention behavior,” and “supportive therapy behavior”). These three dimensions explained 76.60% of the variance. Cronbach’s α of the scale was 0.905, and the intraclass correlation coefficient was 0.897. Additionally, Pearson’s correlation analysis showed that each item was strongly correlated with the dimension to which it belonged (r = 0.849–0.915, p < 0.01). Most fit indices (Comparative Fit Index, Normed Fit Index, Incremental Fit Index, Goodness of fit index) reached the recommended threshold, and the average variance extracted values of the three dimensions were higher than 0.5. The values of the square root of the average variance extracted within each dimension were greater than the correlation between dimensions, and all heterotrait–monotrait values were below 0.85.

Conclusions

The self-management scale for tuberculosis patient demonstrated good reliability and validity and could be used as an instrument to evaluate the self-management of patients. Additionally, it could be used to develop evidence-based self-management interventions and evaluate those interventions.
Literature
1.
2.
World Health Organization. Treatment of tuberculosis: guidelines for national programmes. Geneva: World Health Organization; 1997.
3.
4.
Li Y, Ehiri J, Oren E, Hu D, Luo X, Liu Y, Li D, Wang Q. Are we doing enough to stem the tide of acquired MDR-TB in countries with high TB burden? Results of a mixed method study in Chongqing, China. PLoS ONE. 2014;9(2): e88330.PubMedPubMedCentralCrossRef
5.
Hou WL, Song FJ, Zhang NX, Dong XX, Cao SY, Yin XX, Liu JN, Lu ZX. Implementation and community involvement in DOTS strategy: a systematic review of studies in China. Int J Tuberc Lung Dis. 2012;16(11):1433.PubMedCrossRef
6.
Centers for Disease Control and Prevention Essential components of a tuberculosis prevention and control program. Recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Recomm Rep. 1995; 44(RR-11):1–16.
7.
Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev. 2006;2:CD003343.
8.
Zwarenstein M, Schoeman JH, Vundule C, Lombard CJ, Tatley M. Randomised controlled trial of self-supervised and directly observed treatment of tuberculosis. Lancet (London, England). 1998;352(9137):1340–3.CrossRef
9.
Browne SH, Umlauf A, Tucker AJ, Low J, Moser K, Gonzalez Garcia J, Peloquin CA, Blaschke T, Vaida F, Benson CA. Wirelessly observed therapy compared to directly observed therapy to confirm and support tuberculosis treatment adherence: a randomized controlled trial. PLoS Med. 2019;16(10): e1002891.PubMedPubMedCentralCrossRef
10.
Chen J, Wang Y, Hu DY. The role of DOT in in tuberculosis control. Foreign Med Sci-Soc Med. 2005;22(4):166–70.
11.
Pu J. Research on community TB management and current situation in Chongqing and Guizhou, China under New TB Prevention and Treatment System. Master: Army Medical University; 2019.
12.
Sagbakken M, Frich JC, Bjune GA, Porter JD. Ethical aspects of directly observed treatment for tuberculosis: a cross-cultural comparison. BMC Med Ethics. 2013;14:25.PubMedPubMedCentralCrossRef
13.
World Health Organization. Towards people-centred health systems: an innovative approach for better health outcomes. Copenhagen: WHO; 2013.
14.
World Health Organization. Global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva: WHO; 2014.
15.
Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002;48(2):177–87.PubMedCrossRef
16.
Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1–7.PubMedCrossRef
17.
National Institutes of Health Patient-centered communication in cancer care. Promoting healing and reducing suffering. National Cancer Institute, US Department of Health and Human Services, National Institutes of Health, 2007.
18.
Lenferink A, Effing T, Harvey P, Battersby M, Frith P, Van Beurden W, Job VDP, Paap MCS. Construct validity of the Dutch version of the 12-item partners in health scale: measuring patient self-management behaviour and knowledge in patients with chronic obstructive pulmonary disease. PloS One. 2016;11(8).
19.
Rhee H, Allen J, Mammen J, Swift M. Mobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study. Patient Prefer Adherence. 2014;8:63–72.PubMedPubMedCentralCrossRef
20.
Bourbeau J, Farias R, Li PZ, Gauthier G, Battisti L, Chabot V, Beauchesne MF, Villeneuve D, Côté P, Boulet LP. The Quebec Respiratory Health Education Network: integrating a model of self-management education in COPD primary care. Chron Respir Dis. 2018;15(2):103–13.PubMedCrossRef
21.
Li R, Liang N, Bu F, Hesketh T. The effectiveness of self-management of hypertension in adults using mobile health: systematic review and meta-analysis. JMIR Mhealth Uhealth. 2020;8(3).
22.
Lo SHS, Chang AM, Chau JP. Stroke self-management support improves survivors’ self-efficacy and outcome expectation of self-management behaviors. Stroke. 2018;49:758–60.PubMedCrossRef
23.
Bourbeau J, Farias R, Li PZ, Gauthier G, Battisti L, Chabot V, et al. The Quebec Respiratory Health Education Network: integrating a model of self-management education in COPD primary care. Chron Respir Dis. 2018;15(2):103–13.PubMedCrossRef
24.
Sinclair KA, Makahi EK, Shea-Solatorio C, Yoshimura SR, Townsend CK, Kaholokula JK. Outcomes from a diabetes self-management intervention for Native Hawaiians and Pacific people: partners in care. Ann Behav Med. 2013;45(1):24–32.PubMedCrossRef
25.
Pu J, Chen W, Jiang WX, Xing W, Liang S, Wang G, Liu S, Wu H, Li Y, Tang S. Is tuberculosis patients management improved in the integrated TB control model in West China? A survey in Guizhou Province, China. Infect Dis Poverty. 2019;8(1):55.PubMedPubMedCentralCrossRef
26.
Xing W, Zhang R, Jiang W, Zhang T, Pender M, Zhou J, Pu J, Liu S, Wang G, Chen Y, Li J, Hu D, Tang S, Li Y. Adherence to multidrug resistant tuberculosis treatment and case management in Chongqing, China—a mixed method research study. Infect Drug Resistance. 2021;14:999–1012.CrossRef
27.
Meng W, Xin Y. Efficacy analysis of self-management in tuberculosis. Chin J Pharm Econ. 2014;9(11):187–8.
28.
Tan SQ, Guan CJ, Chen N. Effects of WeChat continuous nursing on self—management ability and disease cognition degree in the initial treatment of patients with pulmonary tuberculosis. Chin Med Pharm. 2018;16(8):103–5.
29.
He Y, Chen RJ, Zhuang RZ, Liang ZQ, Li XZ. Correlation between daily self-management level and individual factors in patients with refractory pulmonary tuberculosis. J Qilu Nurs. 2016;22(7):49–51.
30.
Cheng RX, Li J, Zhang HY, Xu J. Application of self-management intervention in clinical nursing of patients with primary pulmonary tuberculosis. Ningxia Med J. 2016;38(9):859–60.
31.
Kim E, Ndege PK, Jackson E, Clauw DJ, Ellingrod VL. Patient perspectives on medication self-management in rural Kenya: a cross-sectional survey. Int J Qual Health Care. 2019;31(5):353–8.PubMedCrossRef
32.
Pehlivan ŞA, PurutcuoĞlu E, Duyan G, Duyan V. The determination of self-control skill of tuberculosis patients according to some variables. Soc Work Health Care. 2015;54(7):615–32.PubMedCrossRef
33.
Harandi TF, Mahmoodi Z, Ghavidel N, Sharifipour Z. Factors affecting self-management in Iranian tuberculosis patients: A path analysis model. Can J Respir Ther. 2021;57:73–8.PubMedPubMedCentralCrossRef
34.
Zou XR, Yin FM. The application of the intervention model of behavior change on self-management in patients with pulmonary tuberculosis. Chin Nurs Manage. 2015;6:744–7.
35.
Dong YK, Zhao J, Yang HY, Wang LH. Effect analysis of self-management in patients with pulmonary tuberculosis. Chin J PHM. 2019;35(2):223–5.
36.
Tan DX, Wang B, Li XH, Li MY, Zhang DD, Cai XN, Tang C, Zhang GL, Yan YQ, Xu YH. Reliability and validity of Health Self—management Assessment Scale for Elderly Patients with Tuberculosis. Chin General Pract. 2017;20(3):4299–303.
37.
Wang ZX. The research on the development and application of self-discipline scale of TB patients treated at home. ShanDong University; 2016.
38.
Li Y, Ehiri J, Hu D, Zhang Y, Wang Q, Zhang S, Cao J. Framework of behavioral indicators for outcome evaluation of TB health promotion: a Delphi study of TB suspects and TB patients. BMC Infect Dis. 2014;16(14):268.CrossRef
39.
Wu ML. Statistical analysis practices in questionnaire development. Chongqing: Chongqing University Press; 2010. p. 158–265.
40.
Hutcheson GD,Sofroniou N.The multivariate social scientist:introductory statistics using generalized linear models.Sage,1999.03
41.
Kaiser HF. Coefficient alpha for a principal component and the Kaiser-Guttman rule. Psychol Rep. 1991;68:855–8.CrossRef
42.
Tavakol M, Dennick R. Making sense of Cronbach’s alpha. J Int Assoc Med Sci Educ. 2011;2:53–5.CrossRef
43.
Sushil S, Verma N. Questionnaire validation made easy. Eur J Sci Res. 2010;46:172–8.
44.
Liu ZH, Liu P. 3rd edn. Publishing House of Electronics Industry; Beijing: 2010. PASW/SPSS statistics Chinese edition statistical analysis course [in Chinese].
45.
Leidy NK, Revicki DA, Geneste B. Recommendations for evaluating the validity of quality of life claims for labeling and promotion. Value Health. 1999;2(2):113–27.PubMedCrossRef
46.
Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
47.
Minichiello V, Sullivan G, Greenwood K, Axford R, eds. Handbook of Research Methods in Health Sciences. Addison Wesley Longman Australia Pty Limited: Sydney; 1999.
48.
Sando D, Ratcliffe H, McDonald K, Spiegelman D, Lyatuu G, Mwanyika-Sando M, Emil F, Wegner MN, Chalamilla G, Langer A. The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania. BMC Pregnancy Childbirth. 2016;16(1):236.PubMedPubMedCentralCrossRef
49.
Okafor II, Ugwu EO, Obi SN. Disrespect and abuse during facility-based childbirth in a low-income country. Int J Gynaecol Obstet. 2015;128(2):110–3.PubMedCrossRef
50.
Schermelleh-Engel K, Moosbrugger H. Evaluation the fit of structural equation model: tests of significance and descriptive goodness-of–fit measures. MPR Online. 2003;8:23–74.
51.
Fornell C, Larcker DF. Structural equation models with unobservable variables and measurement error: algebra and statistics. J Mark Res. 1981;18:382–8.CrossRef
52.
Henseler J, Ringle CM, Sarstedt M. A new criterion for assessing discriminant validity in variance-based structural equation modeling. J Acad Mark Sci. 2015;43:115–35.CrossRef
53.
Fu C, Wang G, Shi X, Cao F. Social support and depressive symptoms among physicians in tertiary hospitals in China: a cross-sectional study. BMC Psychiatry. 2021;21(1):217.PubMedPubMedCentralCrossRef
54.
Zhang L, Xing W, Zhou J, Zhang R, Cheng Y, Li J, Wang G, et al. Characteristics of tuberculosis patients in the integrated tuberculosis control model in Chongqing, China: a retrospective study. BMC Infect Dis. 2020;20(1):576.PubMedPubMedCentralCrossRef
55.
Munro BH. Statistical methods for health care research. Philadelphia: Lippincott Williams & Wilkins; 2004.
56.
Bijani M, Rakhshan M, Fararouei M, Torabizadeh C. Development and psychometric assessment of the triage nurses’ professional capability questionnaire in the emergency department. BMC Nurs. 2020;19:82.PubMedPubMedCentralCrossRef
57.
Melaku T, Chelkeba L, Mekonnen Z. Clinical care & blood pressure control among hypertensive people living with human immune deficiency virus: prospective cohort study. Ann Med Surg (Lond). 2020;54:114–24.CrossRef
58.
Wang XH, Pang JH, Lin L, Xu Y, Jiang Q, Wang Q, Lu GY, Wang NS. Development and Testing of Self-Management Scale for PD Patients. Perit Dial Int. 2015;35(3):342–50.PubMedPubMedCentralCrossRef
59.
Lorig K, Stewart AL, Ritter LP, Gonzalez VM, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks: Sage; 1996.CrossRef
60.
61.
62.
63.
Zumla A, Ibrahim A, Mario R, Michael H, Lucica D, Mchugh TD, Bertel SS, Helen C, Nathan F, Ruth MN. Drug-resistant tuberculosis–current dilemmas, unanswered questions, challenges, and priority needs. J Infect Dis. 2012;205(Suppl 2):S228–40.PubMedCrossRef
64.
WHO Tuberculosis Programme: Framework for Effective Tuberculosis Control. World Health Organization, 1994.
65.
66.
van den Boogaard J, Msoka E, Homfray M, Kibiki GS, Heldens JJ, Felling AJ, Aarnoutse RE. An exploration of patient perceptions of adherence to tuberculosis treatment in Tanzania. Qual Health Res. 2012;22(6):835–45.PubMedCrossRef
67.
68.
69.
Schulman-Green D, Jaser SS, Park C, Whittemore R. A metasynthesis of factors affecting self-management of chronic illness. J Adv Nurs. 2016;72(7):1469–89.PubMedPubMedCentralCrossRef
70.
dos Santos MA, Albuquerque MF, Ximenes RA, Lucena-Silva NL, Braga C, Campelo AR, Dantas OM, Montarroyos UR, Souza WV, Kawasaki AM, Rodrigues LC. Risk factors for treatment delay in pulmonary tuberculosis in Recife. Brazil BMC Public Health. 2005;5:25.PubMedCrossRef
71.
72.
Lin X, Yu M, Jelinek GA, Simpson-Yap S, Neate S, Nag N. Greater engagement with health information is associated with adoption and maintenance of healthy lifestyle behaviours in people with MS. Int J Environ Res Public Health. 2020;17(16):5935.PubMedCentralCrossRef
73.
Marx RG, Menezes A, Horovitz L, Jones EC, Warren RE. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol. 2003;56:730–5.PubMedCrossRef
74.
Allen M, Yen W. Introduction to measurement theory. Brooks/Cole: Monterey; 1979.
75.
Falleti MG, Maruff P, Collie A, Darby DG. Practice effects associated with the repeated assessment of cognitive function using the CogState battery at 10-minute, one week and one month test-retest intervals. J Clin Exp Neuropsychol. 2006;28:1095–112.PubMedCrossRef
76.
Nunnally JC, Bernstein IH. Psychopsychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
77.
Wheaton B, Muthén B, Alwin DF, Summers GF. Assessing reliability and stability in panel models. In: Heise DRT, editor. Sociological methodology. San Francisco: Jossey-Bass; 1977.
78.
Browne M, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park: Sage; 1993. p. 136–62.
79.
Kai W, Fangyao C, Ming T. DO Biostatistics. A new corrected-fit index OCGFIU for model evaluation in structural equation modeling. Chin J Health Stat. 2018;35(3):349–54.
80.
Baumgartner H, Homburg C. Applications of structural equation modeling in marketing and consumer research: a review. Int J Res Mark. 1996;13(2):139–61.CrossRef
81.
Guo S, Armstrong R, Waters E, Sathish T, Alif SM, Browne GR, Yu X. Quality of health literacy instruments used in children and adolescents: a systematic review. BMJ Open. 2018;8(6):e020080.PubMedPubMedCentralCrossRef
82.
83.
Acosta-Prado JC, López-Montoya OH, Sanchís-Pedregosa C, Zárate-Torres RA. Human resource management and innovative performance in non-profit hospitals: the mediating effect of organizational culture. Front Psychol. 2020;11:1422.PubMedPubMedCentralCrossRef
84.
Chin W. Issues and opinion on structural equation modeling. Manag Inf Syst Q. 1998;22(1):7–16.
85.
Van De Wetering R. IT-enabled clinical decision support: an empirical study on antecedents and mechanisms. J Healthc Eng. 2018;2018:1–10.CrossRef
86.
Henseler J, Ringle CM, Sarstedt M. A new criterion for assessing discriminant validity in variance-based structural equation modeling. J Acad Mark Sci. 2015;43(1):115–35.CrossRef
Metadata
Title
Development and validation of self-management scale for tuberculosis patients
Authors
Jin Li
Liwen Zhang
Jiani Zhou
Geng Wang
Rui Zhang
Jiaqing Liu
Shili Liu
Yong Chen
Song Yang
Quan Yuan
Ying Li
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07483-3

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