Development of a self-management scale for patients with liver cirrhosis

Abstract

Introduction: Liver cirrhosis comprises one of the representative chronic liver diseases, being known as a disease with fatal complications. Although mortality is reducing with the development of medications that treat the causes of liver disease, the incidence of liver cirrhosis is still increasing. Furthermore, during the transition from the compensation stage to the decompensation stage, liver cirrhosis can lead to severe and potentially life-threatening complications. Self-management is a form of an active patient participant, and it is important for patients with liver cirrhosis to maintain and improve their lives, health, and well-being. However, there has been no scale to assess the comprehensive aspects of self-management among patients with liver cirrhosis. The purpose of this study was to develop and validate a self-management scale for patients with liver cirrhosis for measuring the self-management level. Methods: The present methodological study was conducted in two phases consisting of eight stages based on the process of scale development by DeVellis using the data from cirrhotic patients at a tertiary hospital in Seoul. In the development phase, the initial items were derived from a literature review and in-depth interviews with 10 individuals with cirrhosis. The content was validated by 10 experts and a preliminary survey of 20 patients was conducted between June and July 2020 from the outpatient clinic of the hospital. In the evaluation phase, 169 outpatients for exploratory factor analysis and 126 patients in the online survey for confirmatory factor analysis participated for the construct validation. Reliability test was conducted using Cronbach’s alpha coefficient and concurrent validation was performed to assess the correlation between the developed self-management scale and the Chronic Disease Self-Efficacy Scale. Results: Among a total of 33 items on the preliminary scale, 25 items were selected during item analysis. Five factors with 21 items were extracted with 61.1% of the total variance in exploratory factor analysis from the data of 169 patients with liver cirrhosis: symptom management (6 items), liver cirrhosis-specific lifestyle management (5 items), general lifestyle management (4 items), medical treatment compliance (3 items), and family support (3 items). The model of the final self-management scale with 21 items was analyzed using confirmatory factor analysis with the data from 126 patients, and the model fit was confirmed to be a good with a root mean square error of approximation (RMSEA) of 0.059 and a standardized root mean square residual (SRMR) of 0.070. The correlation coefficients between factors ranged from 0.33 to 0.58. The concurrent validity of the proposed scale was confirmed via the correlation with the Chronic Disease Self-Efficacy Scale (r=0.47, p<.01). The scale had a Cronbach's α value of 0.90, thus confirming its reliability. Conclusions: The self-management scale for patients with liver cirrhosis consisted of five factors with 21 items, with scoring based on a 5-point Likert scale. The results of this study indicate that the proposed self-management scale for the patients is valid and reliable. This scale will be useful for identifying the self-management level of patients with liver cirrhosis and developing strategies to improve the self-management behaviors of this population.