MEASUREMENT TOOL FOR INDONESIAN HOME DWELLING OLDER ADULTS: ANALYSIS OF
III. RESULTS AND DISCUSSION
Five experts reviewed the initial item pool (CDS-I original version). These experts were asked to qualitatively and quantitatively evaluate the newly developed instrument. The feedback from expert 4 and 5 was not too extensive, meaning they mostly agreed with the original items of the scale. Some of the items that they questioned were items 1, 2, and 21, consideration related to this issue was made when revising them. However, expert 1, 2, 3 gave more resourceful suggestions, this is most likely due to the loss of meaning that took place during the translation. When the scale was translated into Indonesian most of the items were not in the layperson language, so it would be difficult for the older adult to understand. Therefore, the recommendation from the experts to change the items to be more appropriate for the elderly was accepted.
The experts reviewed the 72-item CDS-I (original version), most of them rated 63 items 3 or 4. Therefore, the calculation of CVI in this process was:
CVI=140=0.875 72
The other method to determine CVI is using the Content Validity Index for Items (I-CVI), which has been used in this study to determine which item to keep and which to discard. Items with I-CVI’s no lower than 0.78 were retained (Polit, Beck, & Owen, 2007). The scale CVI’s were 0.8 and higher, therefore at this stage 9 items were subject to elimination. However, CVI is not the only criteria used to discard items.
All comments and suggestions were reviewed and items were revised if suggestion appeared to be congruent with the purpose of the instrument and did not change the meaning, when placed in the Likert scale format (DeVellis, 2012).
After the items were revised, consultation with two Indonesian experts was performed. Expert #2 reported that the items were now simpler but still too many.
Expert #1, on the other hand suggested adding several items to the scale, because those added items were common activities performed by Indonesian elderly. Despite a contrasting suggestion, the suggestion of expert #1 was chosen because in the first stage of item generation it is better to have more items as they is expected to reduce in number in the subsequent steps. The final determination of item inclusion was based on the I-CVI and all experts’ comments resulting in 13 items being deleted (9 items for low I-CVI < 0.8, and 4 items for redundancy). Seven items were added to the scale based on expert #1 suggestions. Thus, resulting in 67 items from 72 items, see table 1.
Development of Care Dependency Measurement Tool for Indonesian…
Table 17.1 Care Dependency Scale for Indonesian Older Adults
No Items Com-
pletely A lot
Some- time
A little
Not at all Activity
Mobility
1 How capable are you to go to places outside home by foot unaccompanied
2 How capable are you to go to places that must be reached by the vehicle alone
3 Are you able to walk around inside your house unaided
4 How capable are you to move from one place to another without help
5 Are you able to stand up from sitting without help from others
Preventing fall/injury/harm
6 Could you reach items placed high without help 7 Do you need help from others to take care of
you while you were in the bathroom 8 Are you able to going up and down stairs
independently
9 Are you able to avert if an oncoming vehicle is approaching
Exercise and Physical Activity
10 Are you able to raise your arm over your head without difficulty
11 Are you able to raise your arm to the side of your body without difficulty
12 Are you able to move your arm to the front of your body without difficulty
13 Could you curl your arm effortless 14 Could you curl your knee without difficulty 15 Are you able to exercise brisk walk around your
house without company
16 Do you need help with doing light house chores e.g., raking leaves, sweeping floor
Nutrition
Managing Food Intake
17 Are you able to serve your own food without the help of others
18 Are you capable of cooking your own food 19 Could you eat your meal by yourself 20 Do you drink if reminded
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Challenges in Nursing Education and Research
No Items Com-
pletely A lot
Some- time
A little
Not at all Exercising Dietary Control Practices
21 Do you need to be reminded to eat on schedule every day
22 Are you able to drink 8–10 glass of water every day
Skin and Hygiene Maintaining Skin Integrity
23 Are you able to prevent skin dryness
24 Do you have the ability to select soap that keep your skin moist
25 Do you need help from others to apply oil/lotion to your body
Maintaining Personal Hygiene
26 Are you able to cleanse your mouth by yourself 27 Are you able to dressed and undressed by
yourself
28 Are you able to clean your whole body by yourself
29 Are you able to wash your hair at least once a week
30 Are you able to clean your ear by yourself Psychosocial
Communication
31 Do you need help from others to clarify your words when speaking
32 Do you understand the conversations of others without assistance
33 Could you use mobile phone without trouble Managing Worry and Stress
34 Do you rely on the help of others in times of stress
35 How capable you are to anticipate stressful events that are going to happen
36 How difficult for you to recognize the source of your stress
37 When you’re in stressful situation how easy for you to get support from your family and friends Maintaining Social Interaction
38 Do you need help to invite friends to come to your house
39 Are you able to exchange information with friends and family without the help of others
Development of Care Dependency Measurement Tool for Indonesian…
No Items Com-
pletely A lot
Some- time
A little
Not at all 40 Are you able to visit friends and relatives by
yourself
41 Are you able to attend activities in the community (e.g., arisan gampong, pengajian, rapat gampong))
Spiritual
Connecting with God
42 Do you need help to determine the direction of the qibla
43 Could you perform wudhu without help 44 Are you able to determine the time for shalat 45 Are you able to read the Qur’an by yourself Connecting with Others
46 Are you capable of visiting friends and relatives when they are sick or passed away by yourself 47 Do you need help from others to attend religious
activities e.g., wirid/pengajian/ceramah (Islamic lecture)
Sleep and Rest
48 Are you able to arrange time to rest 49 Do you need others to help you sleep well 50 Could you recognize your sleeping problem 51 When you cannot sleep, can you provide your
own remedy to help you sleep
52 Are you capable of providing comfortable environment for you to sleep
Elimination
Maintaining Normal Elimination Pattern 53 Are you able to defecate without straining 54 Do you need to be reminded to eat high fibers
food
55 Are you capable of controlling your bladder 56 Are you capable of controlling your bowel
movement
Maintaining Sanitary Condition
57 Are you able to reach the toilet without wetting yourself
58 Do you need help from others to clean yourself after urinate/defecate
59 Are you able to arrange trip to the toilet regularly
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Challenges in Nursing Education and Research
No Items Com-
pletely A lot
Some- time
A little
Not at all Health Care Practices
Maintaining Healthy Behavior
60 Are you able to prepare the concoction drink to control your blood pressure by yourself 61 Do you depend on other to remind you to check
your blood pressure regularly
62 Are you able to get your prescribed medicines by yourself
63 Do you able to supervise your own medications (types of drugs, time and dose) by yourself Getting Health Related Information
64 Are you able to look for health related information by yourself
65 Are you able to find out information about modern medicines and traditional medicines that related to your condition
66 Are you able to talk to the doctor (or other health care providers) by yourself
67 Do you find it difficult for you to make decision related to your own health care without the help of others
Present paper demonstrates quantities indices for content validity a new instrument and outlines them during design and psychometrics of care dependency measurement for Indonesian older adult living in the community. It should be said that validation is a lengthy process, in the first-step of which, the content validity should be studied, and the following analyses should be directed include reliability evaluation (through internal consistency and test-retest), construct validity (through factor analysis) and criterion-related validity (Grant & Davis, 1997).