Development of a Measure of Self-advocacy Among Female Cancer Survivors

摘要

Background: The Female Self-Advocacy in Cancer Survivorship (FSACS) Scale is a new measurement tool designed to address the increasing need for cancer survivors to participate in and lead there care in face of barriers. Pilot work has demonstrated the FSACS Scale’s content validity and reliability.udPurpose: This purpose of this study was to evaluate the construct validity of the FSACS Scale. This instrumentation study evaluates the construct validity of the FSACS Scale as evidenced by: (I) Internal structure consistent with the underlying model of self-advocacy; (II) Sensitivity to differences between known groups; (III) Relationships between self-advocacy and key predictors (openness and conscientiousness; information engagement; social support) and outcomes (symptom distress and healthcare utilization); (IV) Relationships between FSACS subscales and related concepts (patient activation; self-advocacy within the HIV/AIDS population); and (V) Relationships between FSACS scores and criterion measures.udMethods: A mixed-mode (online or mailed) cross-sectional survey design was used. Women with a history of an adult diagnosis of invasive cancer were recruited from two patient registries and seven advocacy organizations. Instrument selection and analyses to evaluate construct validity were based on the American Educational Research Association’s instrumentation guidelines. Analyses included an exploratory factor analysis, t-tests, and bivariate correlations. udResults: A total of N = 315 adult female cancer survivors completed the survey. Evidence from all five construct validity hypotheses supports the construct validity of the FSACS Scale. The FSACS Scale factor analysis confirmed the three underlying dimensions of self-advocacy resulting in a 20-item measure explaining 45.87% of the variance in responses with subscales’ Cronbach’s alphas between 0.791 and 0.850. While able to detect differences between women with low and high levels of education, the scale did not differentiate between recent and long-term survivors. Predictor and outcome variables performed as expected. The FSACS subscales were more highly correlated with these outcomes than the measure of self-advocacy for HIV/AIDS.udConclusion: Results support that the FSACS Scale is a theoretically-grounded measure of self-advocacy that can be used by clinicians and researchers to identify women at-risk for the poor outcomes associated with low self-advocacy.