2. Who are the intended participants?
3. Is the sample size adequate to produce accurate results? (Not in a pilot test).
4. What is the number of questions on the initial scale/instrument before any psychometric testing?
5. Did the authors use test-retest for reliability comparing for stability over time?
6. What is the Cronbachs a reported for the instrument as a whole and for any factors (subscales)?
7. How were the different kinds of validity measured? What validity measures did the author(s) report?
8. On the final instrument what were the final # questions?
E46 Vol. 38 No. 1 January 2011 Oncology Nursing Forum
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L ung cancer is the leading cause of cancer deaths
in men and women in the United States (Centers
for Disease Control and Prevention 2010).
Compared to patients with other types of cancer
patients with lung cancer experience the
greatest amount of psychological distress (Else-Quest
LoConte Schiller & Hyde 2009; Holland et al. 2010;
Zabora BrintzenhofeSzoc Curbow Hooker & Piantadosi
2001) and have a higher risk for psychological
distress during and after treatment (Akin Can Aydiner
Ozdilli & Durna 2010; Carlsen Jensen Jacobsen Krasnik
& Johansen 2005). Psychological distress is a strong
predictor of lung cancer mortality (Hamer Chida &
Health-related stigma (HRS) is a perceived stigma that
has been defined as a personal experience characterized
by exclusion rejection blame or devaluation that
results from anticipation of an adverse judgment. This
judgment is based on an enduring feature of identity
conferred by a health issue; the judgment is medically
unwarranted and may adversely affect health status
(Weiss & Ramakrishna 2006). HRS has been associated
with an increase in the stress associated with illness
and contributes to psychological physical and social
morbidity (Major & OBrien 2005). HRS has been extensively
studied in patients with HIV and AIDS mental
illness epilepsy and physical disability (Van Brakel
2006) but not in patients with lung cancer.
Stigma in lung cancer is based on the belief that the
patients behavior was the cause of the cancer (i.e. by
smoking). Few studies have examined the presence of
HRS in patients with lung cancer or its effect on patient
outcomes because tools to measure lung cancer stigma
did not exist (Van Brakel 2006). In one study of the
meaning of illness women with lung cancer experienced
a range of disruptions in quality of life (QOL)
Measuring Stigma in People With Lung Cancer:
Psychometric Testing of the Cataldo Lung Cancer
Janine K. Cataldo RN PhD Robert Slaughter PhD Thierry M. Jahan MD
Voranan L. Pongquan RN MPH and Won Ju Hwang RN MPH
Purpose/Objectives: To develop an instrument to measure
the stigma perceived by people with lung cancer based on
the HIV Stigma Scale.
Design: Psychometric analysis.
Setting: Online survey.
Sample: 186 patients with lung cancer.
Methods: An exploratory factor analysis with a common
factor model using alpha factor extraction.
Main Research Variables: Lung cancer stigma depression
and quality of life.
Findings: Four factors emerged: stigma and shame social
isolation discrimination and smoking. Inspection of unrotated
first-factor loadings showed support for a general
stigma factor. Construct validity was supported by relationships
with related constructs: self-esteem depression social
support and social conflict. Coefficient alphas ranging from
0.750.97 for the subscales (0.96 for stigma and shame
0.97 for social isolation 0.9 for discrimination and 0.75
for smoking) and 0.98 for the 43-item Cataldo Lung Cancer
Stigma Scale (CLCSS) provided evidence of reliability. The
final version of the CLCSS was 31 items. Coefficient alpha
was recalculated for the total stigma scale (0.96) and the
four subscales (0.97 for stigma and shame 0.96 for social
isolation 0.92 for discrimination and 0.75 for smoking).
Conclusions: The CLCSS is a reliable and valid measure
of health-related stigma in this sample of people with lung
Implications for Nursing: The CLCSS can be used to
identify the presence and impact of lung cancer stigma and
allow for the development of effective stigma interventions
for patients with lung cancer.
and more than a third of the sample associated lung
cancer with negative meaning (Sarna et al. 2005). The
purpose of this study was to psychometrically develop
and evaluate an instrument to measure stigma as perceived
by patients with lung cancer.
Oncology Nursing Forum Vol. 38 No. 1 January 2011 E47
HRS refers to a perceived stigma that is both a
trait and the outcome of being known to possess that
trait (Heijnders & Van Der Meij 2006). The effects of
perceived stigma depend on whether patients hold
themselves or if others hold the patients responsible
for the disease and whether the disease leads to serious
disability disfigurement lack of control or disruption
of social interactions (LoConte Else-Quest Eickhoff
Hyde & Schiller 2008). The association of stigma with
HIV and AIDS has been well established.
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