Development and validation of a social adjustment scale for assessing social morbidity in Chinese women after treatment for breast cancer

Abstract

Objective: To evaluate validity and reliability of social adjust-ment scale (Ch-SAS) for assessing social morbidity in Chinesewomen with BC.Method: Social morbidity is a common problem faced byChinese women after treatment for breast cancer. Using informa-tion gained from the previous qualitative study, a 41-item scale(Ch-SAS) was constructed to measure social adjustment. TheCh-SAS together with 3 measures of treatment decision making,the Medical Interview Satisfaction scale (MISS), and the Gener-alized Self-efficacy scale (SE) were administered to 226 Chinesewomen (mean age 52.32 (SD 11.05) years) diagnosed with breastcancer who were randomly recruited from two regional hospitals.Results: The CH-SAS has five factors, labeled Family relation-ships (10 items), Appearance and body image (7 items), Relation-ships with friends (6 items), Enjoyment of social functioning (4items), and Sexuality (4 items). A sixth factor, Work, (10 items)was deleted due to poor psychometrics. The sub-scales demon-strated adequate internal reliability (Cronbach’sa.63-.93) andgood divergent validity, showing very low correlations with MISS(r-.04 to 0.1) and an appropriate pattern of correlations with SE(r.07 to .30). Good construct validity was evidenced (1) indifferences between surgical types on the Appearance and bodyimage (F3.85, df 3, p.01) and Sexuality (F4.6, df 3, p.004)sub-scales and (2) in negative correlations with perceived difficul-ties in making treatment decisions (r-.14, p.05) and negativeevaluations of treatment outcome (r-.24, p.000), while corre-lating positively with confidence for making right decision (r.31,p.000).Conclusion: The Ch-SAS provides a reliable and culturallyvalid measure of social adjustment in Chinese women with breastcancer. It demonstrates good psychometric properties and appro-priate sensitivity, including to patients’ satisfaction with treatmentdecision.

OBJECTIVE: To evaluate validity and reliability of social adjustment scale (Ch-SAS) for assessing social morbidity in Chinese women with BC. METHOD: Social morbidity is a common problem faced by Chinese women after treatment for breast cancer. Using information gained from the previous qualitative study, a 41-item scale (Ch-SAS) was constructed to measure social adjustment. The Ch-SAS together with 3 measures of treatment decision making, the Medical Interview Satisfaction scale (MISS), and the Generalized Self-efficacy scale (SE) were administered to 226 Chinese women (mean age 52.32 (SD 11.05) years) diagnosed with breast cancer who were randomly recruited from two regional hospitals. RESULTS: The CH-SAS has five factors, labeled Family relationships (10 items), Appearance and body image (7 items), Relationships with friends (6 items), Enjoyment of social functioning (4 items), and Sexuality (4 items). A sixth factor, Work, (10 items) was deleted due to poor psychometrics. The sub-scales demonstrated adequate internal reliability (Cronbach’s a =.63-.93) and good divergent validity, showing very low correlations with MISS (r =-.04 to 0.1) and an appropriate pattern of correlations with SE (r = .07 to .30). Good construct validity was evidenced (1) in differences between surgical types on the Appearance and body image (F = 3.85, df 3, p = .01) and Sexuality (F = 4.6, df 3, p = .004) sub-scales and (2) in negative correlations with perceived difficulties in making treatment decisions (r = -.14, p = .05) and negative evaluations of treatment outcome (r = -.24, p <.000), while correlating positively with confidence for making right decision (r = .31, p <.000). CONCLUSION: The Ch-SAS provides a reliable and culturally valid measure of social adjustment in Chinese women with breast cancer. It demonstrates good psychometric properties and appropriate sensitivity, including to patients’ satisfaction with treatment decision.