Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults
Abstract
:1. Introduction
2. Methods
2.1. Design and Procedure
2.2. Participants
2.3. Measures
2.3.1. Perceived Susceptibility and Severity
2.3.2. Comorbidity and Demographic Characteristics
2.4. Statistical Analysis
3. Results
3.1. Initial Psychometric Properties of the K-ADAS
3.1.1. Construct Validity
3.1.2. Reliability
3.2. Second Psychometric Properties of the Modified K-ADAS
3.2.1. Construct Validity: Factor Analysis
3.2.2. Construct Validity: Known-Relationship Test
3.2.3. Reliability
4. Discussion
Limitations and Implications
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Characteristics | n (%) | Mean ± SD | |
---|---|---|---|
Age (years), range (60–90) | 75.09 ± 7.21 | ||
Gender | Female | 98 (83.1) | |
Marital Status | Married | 46 (39.0) | |
Education | Elementary or lower | 85 (72.0) | |
Middle school | 13 (11.0) | ||
High school and higher | 20 (16.9) | ||
Religion | (Yes) | 78 (66.1) | |
AD awareness | (Yes) | 10 (8.5) | |
Comorbidity, range (0–7) | 1.47 ± 1.25 | ||
Chronic diseases * | Hypertension (Yes) | 65 (55.1) | |
Diabetes (Yes) | 47 (39.8) | ||
Arthritis (Yes) | 38 (32.2) | ||
Gastric disorder (Yes) | 38 (32.2) | ||
Cardiovascular disease (Yes) | 16 (13.6) | ||
Cerebrovascular disease (Yes) | 9 (7.6) | ||
Dyslipidemia (Yes) | 6 (5.1) | ||
Others (Yes) | 46 (39.0) | ||
Perceived susceptibility, range (10–35) | 26.36 ± 6.34 | ||
Perceived severity, range (6–35) | 25.55 ± 6.62 | ||
K-ADAS, range (32–60) | 46.49 ± 5.24 |
Original Subscales | Items | Mean | SD | With 16 Items | With 13 Items | ||
---|---|---|---|---|---|---|---|
Item-Total Correlations | Alpha If Item Deleted | Item-Total Correlations | Alpha If Item Deleted | ||||
Opportunity for Treatment Choices | 1. I have choices about the treatment I would receive at the end of my life. | 3.05 | 0.68 | 0.48 | 0.78 | 0.53 | 0.86 |
2. I would be given choices about the treatment I would receive at the end of my life. | 2.97 | 0.67 | 0.44 | 0.78 | 0.52 | 0.86 | |
3. My doctor would include my concerns in decisions about my treatment at the end of my life. | 2.97 | 0.63 | 0.42 | 0.79 | 0.46 | 0.87 | |
4. If I could not make decisions, my family would be given choices about the treatment I would receive. | 3.08 | 0.60 | 0.38 | 0.79 | 0.41 | 0.87 | |
Impact of Advance Directives on the Family | 5. I think my family would want me to have an advance directive. | 2.97 | 0.67 | 0.56 | 0.78 | 0.58 | 0.86 |
6. Making my end of life treatment wishes clear with an AD would keep my family from disagreeing over what to do if I were very sick and unable to decide for myself. | 2.99 | 0.58 | 0.45 | 0.78 | 0.45 | 0.87 | |
7. * Having an AD would make my family feel left out of caring for me. | 2.66 | 0.73 | −0.08 | 0.82 | - | - | |
8. Making my end of life treatment wishes clear with an advance directive would help to prevent guilt in my family. | 2.84 | 0.61 | 0.45 | 0.78 | 0.48 | 0.87 | |
9. * Making my end of life treatment wishes clear with an AD would have no impact on my family. | 2.62 | 0.67 | 0.15 | 0.80 | - | - | |
10. Having an AD would prevent costly medical expenses for my family. | 3.07 | 0.75 | 0.54 | 0.78 | 0.54 | 0.86 | |
11. Having an AD would make sure that my family knows my treatment wishes. | 2.99 | 0.62 | 0.64 | 0.77 | 0.67 | 0.86 | |
12. My family wants me to have an AD. | 2.73 | 0.69 | 0.66 | 0.77 | 0.66 | 0.86 | |
Effect of an Advance Directive on Treatment | 13. Having an AD would make sure that I get the treatment at the end of my life that I do want. | 2.91 | 0.60 | 0.74 | 0.76 | 0.74 | 0.85 |
14. I trust one of my family or friends to make treatment decisions for me if I cannot make them myself. | 3.02 | 0.60 | 0.48 | 0.78 | 0.51 | 0.86 | |
15. It is better to make an advance directive when you are healthy. | 3.05 | 0.67 | 0.52 | 0.78 | 0.55 | 0.86 | |
Illness Perception | 16. * I am not sick enough to have an advance directive. | 2.57 | 0.72 | −0.21 | 0.83 | - | - |
Total | 2.91 * | 0.66 * | 0.80 | 0.87 * |
Factors (Fs) | Items | Mean (± SD) | Factor 1 | Factor 2 | Factor 3 | |||||
---|---|---|---|---|---|---|---|---|---|---|
F1: Implications for Having an AD | 5. I think my family would want me to have an advance directive. | 2.97 (± 0.67) | 0.72 * | −0.01 | −0.08 | |||||
6. Making my end of life treatment wishes clear with an AD would keep my family from disagreeing over what to do if I were very sick and unable to decide for myself. | 2.99 (± 0.58) | 0.57 * | −0.14 | −0.02 | ||||||
8. Making my end of life treatment wishes clear with an advance directive would help to prevent guilt in my family. | 2.84 (± 0.61) | 0.52 * | 0.10 | −0.01 | ||||||
12. My family wants me to have an AD. | 2.73 (± 0.69) | 0.72 * | −0.03 | 0.09 | ||||||
13. Having an AD would make sure that I get the treatment at the end of my life that I do want. | 2.91 (± 0.60) | 0.85 * | 0.04 | 0.02 | ||||||
14. I trust one of my family or friends to make treatment decisions for me if I cannot make them myself. | 3.02 (± 0.60) | 0.45 * | 0.01 | 0.17 | ||||||
15. It is better to make an advance directive when you are healthy. | 3.05 (± 0.67) | 0.57 * | 0.13 | 0.01 | ||||||
F2: Opportunity for Treatment Choices | 1. I have choices about the treatment I would receive at the end of my life. | 3.05 (± 0.68) | 0.48 * | 0.75 * | 0.01 | |||||
2. I would be given choices about the treatment I would receive at the end of my life. | 2.97 (± 0.67) | 0.47 * | 0.82 * | −0.01 | ||||||
3. My doctor would include my concerns in decisions about my treatment at the end of my life. | 2.97 (± 0.63) | −0.01 | 0.58 * | 0.55 * | ||||||
F3: Family Perspectives on ADs | 4. If I could not make decisions, my family would be given choices about the treatment I would receive. | 3.08 (± 0.60) | 0.02 | −0.04 | 0.61 * | |||||
10. Having an AD would prevent costly medical expenses for my family. | 3.07 (± 0.75) | 0.31 | −0.02 | 0.49 * | ||||||
11. Having an AD would make sure that my family knows my treatment wishes. | 2.99 (± 0.62) | 0.33 | 0.02 | 0.59 * | ||||||
Information criteria: Bayesian (BIC) = 2455.41 | Eigen values | 5.22 | 1.72 | 1.23 | ||||||
Fit Indices from EFA Model | χ2 | df | p | CFI | TLI | SRMR | RMSEA | (RMSEA < 0.05) | RMSEA 90% CI | |
70.04 | 42 | 0.004 | 0.96 | 0.92 | 0.04 | 0.08 | 0.09 | 0.04, 0.11 |
Factors | K-ADAS_F1 | K-ADAS_F2 | K-ADAS_F3 | K-ADAS_Total |
---|---|---|---|---|
Pearson’s r | ||||
K-ADAS_F1 | 1 | |||
K-ADAS_F2 | 0.42 * | 1 | ||
K-ADAS_F3 | 0.32 * | 0.60 * | 1 | |
K-ADAS_Total | 0.68 * | 0.92 * | 0.77 * | 1 |
Illness Perception on EOL Experience | K-ADAS Total | |
---|---|---|
r | p | |
Perceived susceptibility | 0.37 | <0.001 |
Perceived severity | 0.30 | 0.001 |
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Kim, J.; Heo, S.; Hong, S.W.; Kim, H.; Jung, A.; An, M.; Shim, J. Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults. Healthcare 2020, 8, 62. https://doi.org/10.3390/healthcare8010062
Kim J, Heo S, Hong SW, Kim H, Jung A, An M, Shim J. Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults. Healthcare. 2020; 8(1):62. https://doi.org/10.3390/healthcare8010062
Chicago/Turabian StyleKim, JinShil, Seongkum Heo, Sun Woo Hong, HeeRyang Kim, Ahrang Jung, Minjeong An, and JaeLan Shim. 2020. "Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults" Healthcare 8, no. 1: 62. https://doi.org/10.3390/healthcare8010062
APA StyleKim, J., Heo, S., Hong, S. W., Kim, H., Jung, A., An, M., & Shim, J. (2020). Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults. Healthcare, 8(1), 62. https://doi.org/10.3390/healthcare8010062