Development of an irrational cognition assessment tool in burned patients and evaluation of its iyavivnadytidilavability

Abstract

Background Victims of burn events are susceptible to psychological disorders more than other patients. Irrational beliefs is one the complications of disfigurement due to burning which cause psychological problems, unusual behaviors, emerging and continuing depression; and disorder in communication. Therefore, present study was performed to develop and evaluate a scale for assessing irrational thoughts among burned patients. The secondary objective of this study was to determinate predictors of irrational beliefs among burn patients in Iran. Methods The present study was a psychometric study which was performed in several stages such as investigating similar or related scales, interviewing with patients and psychologists. Three hundred twenty nine burned patients were recruited from Tehran, Tabriz and Kermanshah provinces of Iran during the period between June 2014 and June 2015. Content validity was calculated by modified Kappa based on relevance and clarity. The reliability of the scale was measured using Cronbach‟s Alpha and Intraclass Correlation Coefficient (ICC). To determine the construct validity, exploratory factor analysis approach using maximum likelihood extraction with varimax rotation was conducted. Items were selected or deleted based on uniqueness and experts suggestions. Also, Derriford Appearance Scale59 (DAS59) was used to assess convergent validity. To identify predictors of irrational thoughts, both bivariate and multivariate analysis method were conducted. In multivariate linear regression, forward strategy was used for building the model. Preliminary variable selection for model design was based on a P<0.2 and final decision for keeping the variables in the model was based on a P< 0.05. Results Modified Kappa was calculated 0.80 and 0.91 for relevance and clarity. The Cronbach‟s Alpha for overall scale, subscale 1 and 2 were 0.89, 0.88 and 0.8 respectively. Test–retest reliability was also acceptable (ICC = 0.80). The best solution from the maximum likelihood analysis of the 39 items of the scale revealed two factors corresponding to the two subscales with 14 items that subscale12 (Self-Acceptance) consisted of 10 statements accounting for 60% of the variance (eigenvalue= 5.04) and subscale2 (Distastefulness and Pity) consisted of 4 statements accounting for 40% of the variance (eigenvalue= 1.53). Also, significant positive correlation was found between the two questionnaires (developed scale and DAS59) (r = 0.65 and p <0.001). The results of bivariate analysis showed that body location burned (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), marital status, urbanities, age group, geographical areas, etiology of burning and intent of injury had significant relationships with irrational thoughts. (P< 0.05) Using forward linear regression, being female (P= 0.017), being single (P< 0.05), geographical areas (being Fars((P= 0.013); being Kurd ((P= 0.049); other culture (P= 0.004)), burning with flame (P= 0.017), body location burned (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body) (P= 0.009), and intentional injury (P= 0.014) were significant predictors of the SITB. The models predicted 15.5 percent (p < 0.05) of irrational thoughts. Conclusion The results indicate that SITB reflects acceptable levels of validity and reliability which may be used to assess irrational thoughts among Iranian patients. Moreover, the testing populations of both patients with burned faces and patients with other burned body parts indicates that the scale is applicable for patients‟ burn disfigurements on any part of their bodies. On the other hand, considering to irrational thoughts and development of facilities for screening is necessary. Also, consultation with mental health experts after burn injuries is highly recommended.