Development of an Instrument to Measure Self-Care Agency in Adolescents.

Abstract

The purpose of this research was to develop a valid, reliable instrument by which to measure self-care agency in adolescents. It is anticipated that the instrument will provide a means of assessing the capability or agency of adolescents to act in behalf of their own health and thus will provide direction for nursing intervention with adolescent clients. The theoretical works of Orem and the Nursing Development Conference Group in nursing, and of Erikson, Piaget, Kohlberg and Tanner in human development, served as the major bases from which this research was derived. Drawing upon the works of these theorists, four major components of self-care agency were identified--a cognitive component, an affective/moral component, a physical component, and a psychosocial component. Strengths and limitations in self-care agency related to each of these components were specified. The instrument developed in this study was designed to empirically test this conceptualization of self-care agency in adolescents. Once these major components of self-care agency in adolescents were conceptualized and the related self-care strengths and limitations specified, self-report questionnaire items were developed to measure each aspect. Both an instrument containing items scaled at an interval level of measurement and an instrument with the same items converted to a Likert scale were developed and administered through a public school system to a convenience sample of adolescents aged fourteen to eighteen years. The two different forms of the instrument were developed so that the interval data required for factor analysis were available, a Likert form that is easier to respond to was available for later use, and information regarding stability of responses was available for determination of instrument reliability. Data from the two instruments were collected at approximately the same time from subjects. Items found to be stable across instrument forms were retained. The data were r and omly divided into two groups and both data sets subjected to factor analysis for the purpose of identifying components of self-care agency. A comparison of the factor analyses from the two data sets was then done to check instrument reliability. The factors which appeared in both analyses were retained for use in the final statement. Six factors, or components of self-care agency in adolescents were identified from the analyses. Those factors reflect ego strength and health decision-making capability, valuing of health, health knowledge, physical energy levels, feelings, and attention to health. The final instrument is a Likert scale questionnaire containing 35 items related to the six components of self-care agency. Internal consistency and stability across alternate forms were demonstrated. Content validity and a degree of construct validity were also demonstrated for the instrument. A scoring system utilizing a subscore for each factor or component of self-care agency was developed. This research has yielded new knowledge regarding the phenomenon of self-care agency. In addition, a valid, reliable instrument was developed for use in clinical assessment with adolescent clients and for future use in clinical intervention studies. Since the reliability and validity estimates are based on responses of one selected group of adolescents, caution should be observed in its use until further testing has been done.