Validation of a PRECEDE Model-based instrument for assessing environmental, educational and ecological factors related to self-care behaviors among patients with Rheumatoid Arthritis in Hamadan city, 2017

Abstract

Introduction In many studies, the key factor in successful management of rheumatoid arthritis (RA) is the involvement of patients for correct self-care behavior. Health care providers need access to a standard instrument for measuring self-care behaviors and related factors in these patients. In the present study, we aimed to validate a PRECEDE Model-based instrument to assess behavioral, environmental, educational and ecological factors among patients with Rheumatoid Arthritis. Methods and materials This study was performed on 450 patients with RA who were referred to rheumatology clinics of Hamedan State hospitals, which were obtained through simple sampling.The instrument was a PRECEDE Model-based questionnaire that was completed through interview and data was analyzed using SPSS version 22. Reliability, Face Validity, Content Validity Index (CVI), and Content Validity Ratio (CVR) were reviewed. The first draft instrument was pilot tested among a sample of 40 RA patients. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to determine the construct validity and structure factors of the questionnaire. Results The age of participants ranged from 18 to 84 years (Mean = 53, SD = 13). Internal consistency was very satisfactory in most construction instrument. Cronbach's alpha coefficient varied from 0.69 to 0.90 in instrument structures. Moreover, the results of CVI and CVR and face validity in the present study ensured the simplicity, clarity and relevancy of the instrument In the re-test and in-class correlation coefficients (56) with confidence intervals of 95% (Confidence Intervals: CI), ICC ≥ 0.70, it was seen in all the structures of this instrument that confirmed the repeatability of this test. The factor analysis Using the Principle Component Analysis (PCA) with varimax and oblimin rotation extracted seven factors for self-care behaviors, four factors for environmental factors, four factors for predisposing factors (awareness, self-efficacy and attitude), two factors for reinforcing factors (supporting family behaviors), one factors for enabling factors And four factors for awareness factors. The confirmatory factor analysis showed that most of the questions have a significant factor burden on the related variable, and the factor structure of the instrument and the construct validity is desirable. Pearson correlation coefficient showed a significant relationship between all variables with self-care behaviors, between variables of enabling, social support and self-efficacy with environmental factors, and between variables of social support and self-efficacy with enabling factors, and between variables of self-efficacy with social support and between variables of Awareness with attitudes and environmental factors.

Conclusion The present study provided an appropriate instrument for assessing behavioral, environmental, educational and ecological factors in RA patients in Iranian society, so that the instrument showed appropriate reliability, reliability, simplicity, functionality and Comprehensive attention to the educational needs of health promotion field based on The PRECEDE model.