Development and Validation of an Instrument Measuring Self-Care in Persons With a Fecal Ostomy

PURPOSE: The purpose of this study was to describe development of the Specific Self-Care for Ostomized Patients Questionnaire (CAESPO) instrument and evaluate its construct validity, internal reliability, and test-retest reliability (temporal stability). DESIGN: Prospective evaluation of psychometric properties of the instrument. SUBJECTS AND SETTING: The study sample comprised 125 persons (n = 89, 71.2% men) with a temporary (n = 42, 33.6%) and permanent (n = 83, 66.4%) colostomy (n = 102, 81.6%) and ileostomy (n = 23, 18.4%). Their mean age was 66.72 years; all had undergone ostomy surgery at least 3 months prior to study participation. Participants were drawn from 4 acute care facilities in the province of Castellon, Spain. INSTRUMENT: The CAESPO Questionnaire is completed by a nurse or health care provider. It comprises 3 sections: the first queries sociodemographic data, the second queries pertinent clinical data, and the third contains 58 scored items with 4 ordinal responses. Possible cumulative scores ranged from 58 to 232 points; scores are reported based on a derived percentage score that varies from 0 to 100, where a score of 0 indicates lower self-care and 100 indicates a high level of self-care. METHODS: Data were collected at baseline and retesting was completed 6 months later. Internal consistency of the CAESPO was evaluated using the Cronbach coefficient; temporal stability (test-retest reliability) was evaluated using the test-retest procedure; confirmatory factor analysis based on conceptually hypothesized factor structure was performed to evaluate construct validity. RESULTS: Initial assessment of the construct validity of the CAESPO using confirmatory factory analysis revealed a poor fit, resulting in removal of multiple items from each of the subscales owing to low-factor loading values. The final model comprised 58 scored items; it was found to have a good fit based on standard indices (chi(2) = 43.132, P < .001; root mean square error of approximation = 0.155 [0.107-0.204]; Bentler-Bonett normed fit index = 0.957; comparative fit index = 0.967; incremental fit index = 0.968), indicating adequate construct validity. The internal consistency of the CAESPO total score was acceptable at alpha = 0.889. Test-retest reliability (temporal stability) was deemed excellent (alpha = 0.987). CONCLUSIONS: Psychometric tests indicate that the CAESPO is a valid and reliable instrument for measuring self-care in persons living with a fecal ostomy.