암 재활 측정도구 개발
- 간호대학 간호학과
- Issue Date
- 서울대학교 대학원
- 학위논문 (박사)-- 서울대학교 대학원 : 간호학과 간호학 전공, 2013. 2. 박연환.
- 암 재활은 암 진단과 치료 후 기능 복구를 넘어서서 암 생존자의 목표이자 과정이며 결과까지 포괄하는 건강 중심의 개념이다. 본 연구에서는 암 재활의 주요 속성을 확인하고 이 구성요인에서 도출된 문항으로 포괄적 암 재활 측정도구를 개발하고자 하였다.
본 연구에서는 4단계의 절차를 거쳐 암 재활 측정을 위한 최종도구를 개발하였다. 제 1단계는 초기문항 도출을 위해, 암 재활의 구성요인과 지표 확인을 통해 조작적 정의를 내렸으며, 이에 기반을 둔 개념틀을 구성하여 초기문항을 작성하였다. 제 2단계는 전문가 내용타당도 검정 단계로, 암 생존자를 주로 접하는 간호사와 의사에게 요청하여, 1단계에서 생성된 초기문항이 암 재활의 확인된 구성요인에 속하는지와 각 문항내용이 암 재활에 적정한지 평가를 받았다. 제 3단계는 예비조사 단계로, 2단계를 거쳐 수정된 문항으로 설문지를 작성하여 암 생존자 34명을 대상으로 표면타당도를 검정하고 질답 형식으로 문항을 수정하였다. 제 4단계는 본조사 단계로, 3단계를 거쳐 수정, 보완된 도구를 이용하여 암 생존자 364명을 대상으로 설문을 실시하여, 문항 분석 및 도구의 신뢰도와 타당도를 검정하였다. 이 단계에서 최종적으로 심사위원 5인의 추가 내용타당도 검정을 통해 문구 수정을 거쳐 최종도구가 선정되었다.
연구 결과는 다음과 같았다.
제 1단계에서는 4개 구성요인, 즉 ‘회복’ 요인 28문항, ‘대처’ 요인 11문항, ‘지지’ 요인 16문항, 그리고 ‘성장’ 요인 14문항의 총 69문항의 초기문항을 선정하였다. 제 2단계 전문가 내용타당도 검정 결과 ‘회복’ 28문항, ‘대처’ 10문항, ‘지지’ 12문항, ‘성장’ 14문항 등 총 64개 문항으로 수정되었다. 제 3단계에서 총 63개의 본 조사용 도구가 선정되었다. 제 4단계에서는 확인적 요인분석을 통해 구성타당도를 검증하는 과정에서 40개 문항이 도출되었다. 40개 문항으로 이루어진 요인모형은 양호한 모형 합치도를 보여 주었고 수렴타당도가 검증되었으며, 암 환자의 삶의 질을 측정하는 FACT-G와의 전체 상관이 .68로 준거타당도 또한 검증되었다. 도출된 최종 모형의 40개 문항에 대한 신뢰도는 .81이었다. 최종 심사위원 5인의 내용타당도 검정 과정을 통해 항목 수정을 거쳐 최종 40항목의 도구가 개발되었다.
본 연구에서 개발된 도구는 암 생존자들의 간호 요구 충족 및 삶의 질 향상에 유용한 자료를 수집하는데 활용될 수 있으며, 암 재활 중재의 지표로 활용될 수 있을 것이다. 또한 본 연구를 통해 도출된 구성요인과 척도를 고려하여 간호 중재 결과를 측정할 수 있는 도구로 활용한다면 암 생존자의 독립적인 일상 회복과 생의 전반에 걸친 성장에도 기여할 수 있을 것이다.
The purpose of this study was to develop a valid and reliable Cancer Rehabilitation Scale composed of items from the constructs identified from the definition of the characteristics of cancer rehabilitation.
In this study, the Cancer Rehabilitation Scale was developed through four steps. The first step was to draw the initial items. The operational definition was derived by identifying the constructs and indicators to describe cancer rehabilitation. The initial items were drawn up after composing the conceptual framework based on the operational definition. The second step was to investigate the content validity. The content validity of the initial items were examined based on whether the constructs identified from cancer rehabilitation was included and the content of which is adequate for cancer rehabilitation determined by the nurses and doctors who mainly take care of the cancer survivors. The third step was to perform a pilot survey. The pilot survey was given to 34 cancer survivors with questionnaire including items modified through the former two steps. Next, face validity was evaluated, and the items
were modified in form of questions and answers. The last step was the main survey. The main survey with refined items after the former three steps was distributed to 364 cancer survivors. Item analysis and evaluation of reliability and validity were performed in the survey. The final Cancer Rehabilitation Scale was chosen after deleting items and modifying the final evaluation of content validity by five experts.
The results from this study were as follows. During the first step, the initial items, based on the conceptual framework drawn from the literature review, analysis of existing instrument, and in-depth interviews with cancer survivors and oncology nurses, consisted of 69 items in total with 4 constructs including ‘Recovery’ (28 items), ‘Coping’ (11 items), ‘Support’ (16 items), and ‘Growth’ (14 items). Sixty four items selected after evaluation of content validity by experts were composed of ‘Recovery’ (28 items), ‘Coping’ (10 items), ‘Support’ (2 items), and ‘Growth’ (14 items). In this process, 41 items were modified to simple sentences for the public to understand easily through expert evaluation. During the third step, the amount of time given to the 34-cancer survivors to complete the pilot survey was 14 minutes for each person on average, and Cronbach’s alpha was .82.
After consider the opinions of the participants in the pilot survey, 54 items were modified after two items in the initial scale became one item, one item was deleted, ‘Cancer’ was changed to ‘Disease’, sentences become simple, and so on. In addition, a new item, ‘I can say the experience after diagnosis of disease to others including someone close’ was added reflecting an active suggestion by the subject. Consequently, 63 items in total were selected for the main survey. While analyzing the results of the 63-item survey for 364 cancer survivors during the fourth step, 47 items were drawn through item analysis. Thirty three items were drawn up after confirmatory factor analysis. GFI and RMSEA value of the factor model with 40 items were 0.9 and 0.08, respectively, which indicates good model fitness. Convergent validity was evaluated by AVE value 0.85, and criterion validity was evaluated by total correlation with FACT-G .68. The reliability estimate of the final 40-item model was 0.81. The 40-item, 4-construct, 4-point likert scale was developed through the process of refining the developed scale with evaluation of validity and reliability as stated above. This scale ranges from 0 point to 120 points
the higher point indicates that the degree of cancer rehabilitation is more positive. With additional content validity from five review committee members, 40 items were selected and modified.
This Cancer Rehabilitation Scale was developed in order to include properties of cancer rehabilitation
it could be useful to meet the needs of cancer survivors and improve the quality of their lives. In addition, nurses could use this scale to measure outcomes after nursing intervention considering for properties of cancer rehabilitation in this scale on caring for cancer survivors and their families. This Cancer Rehabilitation Scale could contribute to recovering independent activities of people’s daily lives and the
increase of cancer survivors.