Breast Cancer Related Lymphedema Self-Care Scale

Abstract

The Breast Cancer Related Lymphedema Self-Care Scale (Deveci et al., 2023) was developed to assess self-care practices in women experiencing breast cancer-related lymphedema (BCRL). The need for this measure arose from a gap in existing tools specifically designed to evaluate self-care behaviors in lymphedema patients. The development process began with an extensive literature review, yielding an initial pool of 100 items. Lymphedema experts then assessed the content validity, leading to a refined 41-item draft. Following a piloting phase, the scale was administered to women with BCRL attending an outpatient lymphedema clinic in Turkey through face-to-face interviews. The scale’s structure was subsequently determined through exploratory and confirmatory factor analyses, resulting in a 31-item scale with a four-factor structure. Comprehensive reports on the scale’s reliability and validity have been provided.

Keywords

Activity and Disease Process Management, Breast Cancer Related Lymphedema, Patient Self-Care, Pressure Management, Protection, Self-Care Practices, Sustainability.

Authors

Deveci, Zeynep; Karayurt, Özgül; Bilik, Ozlem; Eyigör, Sibel

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Purpose

The primary purpose of the Breast Cancer Related Lymphedema Self-Care Scale is to meticulously assess the self-care practices undertaken by women afflicted with breast cancer-related lymphedema. This assessment aims to provide a comprehensive understanding of how these individuals manage their condition through self-care interventions.

Validity

The validity of the Breast Cancer Related Lymphedema Self-Care Scale was rigorously evaluated through both construct validity and content validity assessments.

Construct Validity: The construct validity was established using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), which helped in identifying and confirming the underlying theoretical constructs measured by the scale.

Content Validity: Content validity was assessed using the Item-Content Validity Index (I-CVI) and the Scale-Content Validity Index (S-CVI). The I-CVI for individual items was higher than 0.78, and the S-CVI for the overall scale was higher than 0.90, indicating that the items effectively measure the intended domain of breast cancer-related lymphedema self-care, as per established guidelines (Polit & Beck, 2006).

Reliability

The reliability of the Breast Cancer Related Lymphedema Self-Care Scale was assessed through internal consistency and split-half reliability methods.

Internal Consistency: The overall internal consistency of the scale, as measured by Cronbach’s alpha coefficient, was 0.82. For its subscales, the Cronbach’s alpha coefficients ranged from 0.62 to 0.86, indicating good to acceptable internal consistency across the different dimensions of self-care.

Split-half Test: The split-half reliability, assessed using the Spearman Brown coefficient, was found to be 0.88, further supporting the scale’s consistency and stability.

Factor Analysis

Factor analysis was extensively used to determine the underlying structure of the Breast Cancer Related Lymphedema Self-Care Scale.

Exploratory Factor Analysis (EFA): A principal component analysis was initially conducted to identify the factors or subdimensions within the scale. This analysis revealed 12 factors with eigenvalues greater than one. However, the scree plot indicated a clear four-factor structure as the most appropriate and parsimonious explanation for the scale’s underlying structure. A subsequent re-analysis, focusing on these four factors, demonstrated that they collectively explained 43.62% of the total variance. During this process, items with factor loadings below 0.30 (specifically Items 40, 23, 17, 21, 22, 30, 36, and 25) were excluded from the final scale to enhance its factorial purity.

Confirmatory Factor Analysis (CFA): Following the EFA, a confirmatory factor analysis was performed to validate the proposed four-factor structure. The fit indices obtained from the CFA were largely indicative of a good model fit. Key fit indices included: χ2 = 603.62 (p < .01), df = 408, resulting in a χ2 /df ratio of 1.47. Other significant fit indices were RMR = 0.27, SRMR = 0.08, RMSEA = 0.048, GFI = 0.86, AGFI = 0.83, CFI = 0.90, IFI = 0.90, NFI = 0.87, and TLI = 0.85. These values generally suggest that the proposed four-factor model provides a good fit to the observed data.

Instrument: Breast Cancer Related Lymphedema Self-Care Scale

Test Type: The Breast Cancer Related Lymphedema Self-Care Scale is an original instrument designed as an Inventory/Questionnaire.

Format: The items within the scale are scored on a four-point Likert scale, allowing for nuanced responses regarding self-care practices. The administration method for this scale is electronic.

Language Available: The language in which the scale is currently available is English. The specific location of the test items is referenced in the original publication as 2023-30309-022, Table 2, Page 227.

Population Group: The scale is designed for use with the human population, specifically adult females. The target group includes outpatients.

Age Group: The scale is applicable across various adult age groups, including Young Adulthood (18-29 years), Thirties (30-39 years), Middle Age (40-64 years), and Aged (65 years and older), encompassing all individuals 18 years and older.

Population Details: The study participants were women with breast cancer-related lymphedema. The research was conducted in Turkey, with respondents recruited from an Lymphedema (LE) outpatient clinic.

Test Methodology: The development and validation of the Breast Cancer Related Lymphedema Self-Care Scale involved a comprehensive range of psychometric methodologies, including: Test Validity (overall), Construct Validity, Content Validity, Test Reliability (overall), Internal Consistency, Split-Half Reliability, Factor Analysis, Confirmatory Factor Analysis, Exploratory Factor Analysis, and Principal Component Analysis.

Keywords

Breast Cancer Related Lymphedema Self-Care, Self-Care Practices, Lymphedema Management, Patient Self-Care, Breast Cancer Survivors.

Authors

Deveci, Zeynep

• Author ORCID Identifier: orcid.org/0000-0002-7383-5135

• Affiliation: Pamukkale University, Faculty of Health Science Nursing Department

• Email Address: [email protected]

• Correspondence Address: Pamukkale University, Faculty of Health Science, Nursing Department, 3rd floor no. C3-10, Pamukkale, Turkey, 20160

Karayurt, Özgül

• Affiliation: Izmir University of Economics, Faculty of Health Science Department of Nursing

• Email Address: No data is Available

Bilik, Ozlem

• Affiliation: Dokuz Eylul University, Nursing Faculty Surgical Nursing Department

• Email Address: No data is Available

Eyigör, Sibel

• Affiliation: Ege University Faculty of Medicine Department of Physical Therapy and Rehabilitation

• Email Address: No data is Available

Permissions & Fee and Test Year

Permissions: The Breast Cancer Related Lymphedema Self-Care Scale may be used for research and teaching purposes.
Commercial Use: No data is Available
Fee: There is no fee associated with the use of this scale.
Test Year: The scale was developed and published in 2023.

References

Deveci, Z., Karayurt, Ö., Bilik, O., & Eyigör, S. (2023). Development of the Breast Cancer Related Lymphedema Self-Care Scale. Clinical Nursing Research, 32(1), 221–232. doi.org/10.1177/1054773820947980

Items of the Breast Cancer Related Lymphedema Self-Care Scale

The Breast Cancer Related Lymphedema Self-Care Scale consists of 31 items. These items are structured around four distinct factors or subscales, which collectively measure various aspects of self-care practices in women with breast cancer-related lymphedema.

Factors and Subscales:

• Protection: This factor likely encompasses items related to protective measures taken by individuals to prevent lymphedema exacerbation or complications.

• Activity and disease process management: This factor would include items pertaining to how individuals manage their daily activities and the progression of their lymphedema condition.

• Pressure management: This factor focuses on practices related to managing pressure on the affected limb, which is crucial in lymphedema care (e.g., compression garments, proper limb positioning).

• Sustainability: This factor likely addresses the long-term adherence to self-care practices and the sustained effort in managing lymphedema over time.

Protection

1. I protect my arm from excessive heat and cold.

2. I protect my affected arm from infections (bites of dogs and cats, having manicure, etc.).

3. I lift weights with my affected arm.

4. I measure blood pressure on my affected arm.

5. I give blood from my affected arm, have injection.

6. I observe my affected arm in terms of infection symptoms such as redness, temperature increases, and swelling.

7. I do housework that requires repetitive work such as cleaning the windows, carpets, ironing.

8. I sleep on my affected arm at nights.

9. I wear tight clothes to wrap my affected arm.

10. I wear ring, tag, etc. accessories on my affected arm.

Activity and Disease Process Management

1. I wear gloves when I do house and garden work.

2. I lift my affected arm up with certain intervals during daytime.

3. I do my exercises as I am instructed.

4. When I have lymphedema, I apply lymph massage myself.

5. I apply moisturizer to my affected arm.

6. I apply arm measurements alone at home.

7. I go to lymphedema follow-ups with intervals recommended to me.

8. I can sustain my self-care while I am working.

9. I carry antibiotic cream in case there might be cuts in my affected arm.

10. I know what to do when I have redness, swelling and/or temperature increase.

11. I know what to do to avoid the progression of lymphedema.

12. I try to obtain more information to do my self-care better.

Pressure Management

1. I wear pressure cuff when I do exercises.

2. I wear pressure cuff every day or apply bandage.

3. I know where to buy lymphedema materials when I need them.

4. I know how to wash and maintain the pressure cuff.

Sustainability

1. I only do self-care practices when I am at home.

2. I delay self-care practices when I am ill.

3. When my family asks for something from me, I prioritize them.

4. I can only apply self-care practices when my housework is finished.

5. Lymphedema self-care is a burden for me.

6. I delay doing things I know that are useful for my self-care.

7. I try to gain more information to do my self-care better.

Note: Items are scored on a four-point Likert scale to evaluate the self-care practices and sustainability statements (4 = always, 3 = often, 2 = occasionally, and 1 = none). Items 25-31 are scored with the following response options: 4 = I completely agree, 3 = I agree, 2 = I don’t agree, and 1 = I don’t agree at all. Items 4, 5, 6, 8, 9, 10, 11, 26, 27, 28, 36, 37, and 38 are scored in the reverse order.