Development and Psychometric Evaluation of Cardiac Surgery Stressor Inventory: A Mixed Method Study in an Iranian Context

Abstract

Background: Open-heart surgery is a stressful, life-threatening experience inducing fear and anxiety in many patients and their families. Objectives: The present study was conducted to design an inventory assessing the stressors in open-heart surgery patients and evaluate its psychometric properties. Methods: This study was accomplished in two phases. The first phase involved a qualitative study during which in-depth interviews were carried out with 21 therapists and patients with a history of heart surgery. In addition, the primary items of the inventory were extracted by reviewing the literature and available questionnaires through a qualitative approach. In the second phase, the face, content, and construct validities of the inventory were investigated using the exploratory factor analysis with 360 participants. In addition, the reliability of the developed instrument was examined using Cronbach's alpha and intraclass correlation coefficient (ICC). Results: Based on the findings obtained in the first phase, a pool of items was prepared. The findings of the exploratory factor analysis revealed a five-factor structure that explained 50.45% of the structural variance with a Kaiser-Meyer-Olkin value of 0.921 (P < 0.001). The first (12 items), second (13 items), third (seven items), fourth (eight items), and fifth (10 items) factors were named as "stressors in the intensive care unit", "stressors related to the fear of uncertain future", "internal stressors", "stressors related to treatment team and facilities", and "preoperative stressors", respectively. The Cronbach's alpha coefficient of the final version of the inventory, entailing 50 items, was obtained as 0.87. In addition, the ICC between the test and retest scores was estimated at 0.94. Conclusions: Given the fact that the meaning, concept, and factors associated with any phenomenon are influenced by sociocultural context and they vary from country to country, it is necessary to use a questionnaire designed based on the experiences and concepts expressed by the individuals living in the same context. According to the findings, the developed 50-item Cardiac Surgery Stressor Inventory is a simple, valid, and reliable tool for the measurement of stressors in open-heart surgery patients.