Development and testing of the Inner Strength Questionnaire

Journal of Cultural Diversity, Spring, 2003 by Gayle Roux, Kristi Lewis, Janet Younger, Catherine Dingley

Abstract. The aim of this research brief is to describe the results of psychometric, evaluation of a new instrument to measure inner strength in women with chronic illness. Inner strength is defined as a central human resource that promotes well-being and healing (Roux, Dingley, & Bush, 2002). The instrument can be used in clinical settings to examine women s inner strengths associated with cognitive, social, physical, and mental needs to improve health outcomes and enhance well-being. The theory of inner strength has important implications for health care providers to improve health outcomes and symptom management for women living with chronic illness.

Key Words: Development, Testing, Inner Strength Questionnaire

Item Development and Initial Instrument Testing

The items for the Inner Strength Questionnaire (ISQ) were generated using results of qualitative studies in women with chronic illness that have been conducted over 12 years (Dingley, Roux, & Bush, 2000; Dingley, Bush, & Roux, 2001; Koob, Roux, & Bush, 2002; Roux, Bush, Dingley, 2001; Roux, Dingley, & Bush, 2002). Using results of these studies, items were generated to measure the five hypothesized dimensions of inner strength: knowing and searching, connectedness, physical self-spirit, and mental self-spirit, and the new normal. Tests of face and content validity were conducted with professional experts and clients prior to administration.

Connectedness Scale

Initially, the connectedness scale of the instrument was pilot tested on a sample of 207 community members. Since this scale was the longest and had sensitive questions regarding spirituality, it was pilot tested before evaluating the entire instrument. Principal component analysis demonstrated two factors: spiritual connectedness and connectedness with self and others. Six items were deleted, with a final version of 19 items. A Cronbach's alpha for this sample was .89. The coefficient alpha for the spirituality subscale of the connectedness scale was .95.

The Inner Strength Questionnaire

Following evaluation of the connectedness scale, the psychometric properties of the entire ISQ were tested on women with major chronic health conditions. The sample included 154 women aged 22-83 residing in 14 states in the Midwest and Mid-Atlantic. African American women comprised 35% of the sample. Participants reported having the following chronic health conditions: breast cancer, diabetes, heart disease, osteoporosis, and transplantation. Using principal component analysis with varimax rotation, the theoretical components of the ISQ were evaluated. Using an eigenvalue of 1.0, the factors were analyzed to minimize multicollinearity and maximize parsimony. Scree plots were examined.

The scree plot and the pattern of loading demonstrated four extracted factors. All 37 items had loadings >.40 on each factor. Each scale had a Cronbach's alpha >.80: Knowing and Searching .83, Connectedness. 89, Physical self-spirit .87, and Mental self-spirit .87. The reliability of the entire ISQ was .86. The total variance explained was 50%.

With the exception of one concept, the factor pattern was congruent with the grounded theory. The items reflecting "living a new normal" did not load on one factor, and thus, was hypothesized to be an outcome or consequence of inner strength.

The instrument has promising psychometric properties. Further research with larger samples is currently being conducted on women with breast cancer. The ISQ is specifically distinct from other instruments in that it measures support and physical, mental, and spiritual behaviors. The ISQ is available to other researchers by contacting the principal author.

REFERENCES

Dingley, C.E., Roux, G., & Bush, H.A. (2000). Inner strength: A concept analysis. Journal of Theory Construction & Testing, 4 (2), 30-35.

Dingley, C., Bush, H., & Roux, G. (2001). Inner strength in women recovering from coronary artery disease: A grounded theory. Journal of Theory Construction & Testing, 5 (2), 45-52

Koob, P., Roux, G., & Bush, H. (2002). Inner strength in women dwelling in the world of multiple sclerosis. International Journal of Human Caring 6(2), 21-28.

Roux, G., Bush, H., & Dingley, C. (2001). Inner strength in women with breast cancer. Journal of Theory Construction & Testing 5(1), 19-27.

Roux, G. Dingley, C., & Bush, H. (2002). Inner strength in women: Metasynthesis of qualitative findings in theory development. Journal of Theory Construction & Testing, 6(1), 4-15.

Gayle Roux, Ph.D, RN, CNS, NP-C is an Assistant Professor, School of Nursing, Virginia Commonwealth University, Richmond, VA. She may be contacted via email at gmroux@vcu.edu. Kristi Lewis is a doctoral student at Virginia Commonwealth University, kllewis@vcu.edu. Janet Younger, Ph.D., PNP, is the Associate Dean of Undergraduate and Graduate Nursing Program at Virginia Commonwealth University, younger@hsc.vcu.edu. Catherine Dingley, MSN, RN, CS, FNP, is a Research Assistant and Doctoral Student in Nursing at the University of Colorado Health Science Center, cdingley@aol.com.