Development and Psychometric Evaluation of Healthcare Access Measures among Women with Ovarian Cancer.
Development and Psychometric Evaluation of Healthcare Access Measures among Women with Ovarian Cancer.
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卵巢癌流行病学、医疗保健可获得性和差异研究旨在从可获得性、可负担性、可获得性、容纳性和可接受性五个特定维度表征卵巢癌(OC)黑人、西班牙裔和白人患者的医疗可获得性，以评估HCA对治疗质量、支持性护理和生存的影响，并探索可能导致OC差异的生物学机制。目前，还没有经过验证的仪器来经验性地测量所有的HCA维度。为了在不同癌症幸存者中确定HCA的特征，有必要开发可靠的、与内容相关的、具有跨文化适用性的综合测量方法。因此，本研究的目标是：(1)在Penchansky和Thomas框架的指导下，开发一个针对HCA的综合调查工具；(2)评估两个领域(适应性和可接受性)的因素结构、信度和心理测量学特性，这两个领域只能从患者报告的调查数据中进行评估。目前还没有经过验证的测量医疗服务可获得性(HCA)的工具。本研究旨在为癌症存活者开发具有凝聚力的HCA工具，并评估需要患者报告的调查数据的两个HCA领域--可接受性和适应性--的因素结构、可靠性和心理测量特性。方法：本研究报告了来自三种一般方法的数据：(1)通过对32名癌症幸存者(63%的黑人，18%的西班牙裔)进行焦点小组的概念启发，以了解新的HCA调查项目的发展；(2)通过对7名卵巢癌幸存者(n=3名黑人，n=1名西班牙裔)的认知访谈和对54名卵巢癌幸存者(74%的白人，14%的黑人)的初步测试，完善新的调查项目；(3)对333名卵巢癌幸存者(82%的白人，13%的黑人)的可接受性和容纳性进行心理测量评估。使用验证性因子分析方法对每个HCA维度的多个模型结构进行评估，并对所选模型的综合信度进行估计。结果：在焦点小组讨论中，癌症幸存者表达了跨越多个HCA领域的癌症治疗的挑战，其中可接受领域(患者与提供者互动的质量)在所有种族群体中最突出。缺乏同理心、同情心和糟糕的沟通使提供者的专业、经验或声誉的积极方面黯然失色。对新的HCA调查项目的认知访谈和试点测试有助于澄清具体项目的语言，并完善实施调查的招募和同意程序。在心理测量评估中，住宿领域(服务的便利性和组织)由两个因素构成：对护理的满意度和获得支助服务的机会(比较契合指数(CFI)=0.99)。在可接受性领域，所有适合度指数都支持保留五因素高阶模型(CFI=0.96)。在双因素适应模型和高阶可接受性模型中，所有潜在因素的综合信度估计为0.80。结论：经验证据支持使用自我报告的调查项目来衡量容纳性和可接受性的标准化测量的实用性，这将有助于更好地描述不同癌症幸存者的HCA维度。
The Ovarian Cancer Epidemiology, Healthcare Access and Disparities study aims to characterize healthcare access (HCA) across five specific dimensions—Availability, Affordability, Accessibility, Accommodation and Acceptability—among Black, Hispanic and White patients with ovarian cancer (OC) to evaluate the impact of HCA on quality of treatment, supportive care and survival, and explore biological mechanisms that may contribute to OC disparities. Currently, there are no validated instruments for empirically measuring all HCA dimensions. To characterize HCA among diverse cancer survivors, there is a need to develop reliable, content-relevant, and comprehensive measures that have cross-cultural applicability. Thus, the goal of the present study was to: (1) develop a comprehensive survey instrument for HCA, guided by the Penchansky and Thomas framework; and (2) evaluate the factor structure, reliability, and psychometric properties of two domains (Accommodation and Acceptability) that are only estimable from patient-reported survey data. There are no validated instruments for measuring healthcare access (HCA). This study aimed to develop a cohesive HCA instrument for cancer survivors and evaluate the factor structure, reliability, and psychometric properties of two HCA domains—Acceptability and Accommodation—that require patient-reported survey data. Methods: This study reports data from three general methodological approaches: (1) concept elicitation using focus groups with 32 cancer survivors (63% Black, 18% Hispanic) to inform the development of new HCA survey items; (2) refining the new survey items using cognitive interviews with seven ovarian cancer survivors (n = 3 Black, n = 1 Hispanic) and pilot testing with 54 ovarian cancer survivors (74% White, 14% Black); and (3) psychometric evaluation of the Acceptability and Accommodation items among 333 ovarian cancer survivors (82% White, 13% Black). Multiple model structures were assessed for each HCA dimension using confirmatory factor analysis methods, and composite reliability was estimated for selected models. Results: In focus group discussions, cancer survivors expressed challenges navigating cancer treatment across multiple HCA domains, with the Acceptability domain (quality of patient–provider interaction) being the most salient across all racial groups. Lack of empathy, compassion, and poor communication overshadowed positive aspects of providers’ specialty, experience, or reputation. Cognitive interviews and pilot testing of new HCA survey items helped to clarify the language of specific items and refine the recruitment and consent process for implementation of the survey. In psychometric evaluation, the Accommodation domain (convenience and organization of services) was best accounted for by a two-factor structure: satisfaction with care and access to support services (comparative fit index (CFI) = 0.99). For the Acceptability domain, all fit indices supported the retention of a five-factor higher-order model (CFI = 0.96). Composite reliability estimates were >0.80 for all latent factors in the two-factor Accommodation model and the higher-order Acceptability model. Conclusions: Empirical evidence supports the utility of standardized measures of Accommodation and Acceptability using self-reported survey items, which will contribute to the better characterization of HCA dimensions among diverse cancer survivors.
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影响因子：
2.9
作者：
Akinyemiju T;Deveaux A;Wilson L;Gupta A;Joshi A;Bevel M;Omeogu C;Ohamadike O;Huang B;Pisu M;Liang M;McFatrich M;Daniell E;Fish LJ;Ward K;Schymura M;Berchuck A;Potosky AL
通讯作者：
Potosky AL
影响因子：
3
作者：
ANDERSEN, R;ADAY, LA
通讯作者：
ADAY, LA
影响因子：
3.6
作者：
Arora, Neeraj K.;Rutten, Lila J. Finney;Hawkins, Robert P.
通讯作者：
Hawkins, Robert P.
影响因子：
9.8
作者：
Harrison RF;Fu S;Sun CC;Zhao H;Lu KH;Giordano SH;Meyer LA
通讯作者：
Meyer LA
影响因子：
2.6
作者：
Mollica, Michelle;Nemeth, Lynne
通讯作者：
Nemeth, Lynne