Examples of using ASAS-R in English and their translations into Portuguese
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Ecclesiastic
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Ecclesiastic
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Computer
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Official/political
There were six participants for every five items of the ASAS-R.
The translation and adaptation process of the ASAS-R in Brazil followed the stages recommended in the literature.
Four out of the 15 questions refer to negative aspects ASAS-R 4, 11, 14 and 15.
Item ASAS-R 14 presented the greatest communality; that is, 70.0% of its variance was explained by the factors Table 3.
On the other hand,there was correlation between ASAS-R and DCS scoresr=-0.70; p.
The ASAS-R is answered on a 5-point Likert scale and comprises 15 items with five possible answer choices each, only one being correct.
The factor loads presented values greater than 0.40,except in items ASAS-R 9 and ASAS-R 13.
Hypothesis testing for the factorial composition of the ASAS-R scale was implemented using latent variable structural equations.
Items ASAS-R 2 and 10 should be disregarded because they obtained a high load in more than one factor, though they were allocated to the factor with the highest load.
The Lagrange multiplier test suggested the reallocation of item ASAS-R 8 in factor 1 and item ASAS-R 10 in factor 2.
Authorization to adapt the ASAS-R for Brazil was provided by the author Dr. Valmi D Sousa, in 2009, who signed an agreement form.
Note that all items of the original version presented high factor loads, as well as satisfactory results of item-to-factor correlation,including item ASAS-R 13.
Regarding the modes of reliability assessment for the ASAS-R, test-retest and interobserver analysis were used.
Item ASAS-R 13 was negatively correlated to the entire scale, however, its exclusion was not justifiable, for the alpha was not significantly altered.
The objective of the present study was to translate,culturally adapt and validate the Appraisal of Self-care Agency Scale-Revised ASAS-R to the Portuguese language and Brazilian culture.
We believe that the use of the ASAS-R in Brazil will contribute towards nursing clinical practice and research on health care, especially regarding DM patients.
Therefore, based on psychometric analysis of validation and reliability,a new version with 15 items called Appraisal of Self Care Agency-Revised ASAS-R was established.
In the same manner as in the pretesting phase, ASAS-R item distribution displayed ceiling or floor effects on items ASA-R 4, 7, 11, 12 and 14, except on item 8.
The answer choices on the other extreme of“totally disagree” were:“In my daily activities,I seldom take time to care for myself.” ASAS-R 11; and“I seldom have time for myself” ASAS-R 14.
The results concerning the internal consistency of the ASAS-R original version were: total alpha 0.89 and the alphas among factors were 0.86, 0.83 and 0.79, respectively, the highest total alpha, compared to studies that used the ASAS version with 24 items total from 0.59 to 0.80.
Most correlations among the items of each of the three factors presented moderate to strong magnitude r 0.37 to r 0.64, except forthe items in factor 2“Developing power” ASAS-R 4, 9 and 13, which presented values below 0.30.
Therefore, aiming to continue the psychometric testing of the ASAS-R with a sample of Brazilian individuals with diabetes mellitus, we performed a confirmatory factor analysis of the scale to verify whether its dimensions present reliable and valid representations.
According to the exploratory factor analysis, the reallocation of items in the factors were as follows:factor 1“items ASAS-R 1,2,3,5,8,10”; factor 2“items ASAS-R 4,9,13” and factor 3“items ASAS-R 6,7,11,12,14,15”.
In this sense,based on the revised version, ASAS-R, applied to a sample of Brazilian individuals with diabetes mellitus, this study sought to continue the validation process, analyzing correlations, internal consistency, and the results of the hypothesized model's overall fit, so that these results could be compared with those from the original version.
As shown in table 2,we observed correlations with magnitudes varying from moderate to strong r=0.31 to r=0.69 between 13 items on the ASAS-R, with exception of items ASAS-R 2, 9 and 13, which presented weak correlations r=-0.18 to r=0.22.
The items on the ASAS-R which presented ceiling or floor effects in the testing phase were:“I often lack the energy to take care of myself in the way that I know I should” ASAS-R 4;“If I take a new medication, I obtain information about the side effects to better care for myself” ASAS-R 7; and“I am able to get the information I need, when my health is threatened” ASAS-R 12.
This study is expected to contribute to research addressing the concept of self-care agency and the development of ASAS-R and to favor the monitoring of individuals with DM within the care model of the public Brazilian Health System.
For analyzing the psychometric properties of the translated and adapted ASAS-R, 150 type 2 diabetes mellitus patients participated, all taking insulin and attended to by the three Family Health Strategy units, including those from the pretesting phase who fulfilled the following inclusion criteria: both genders; 18 years of age or older; over one year of having a type 2 diabetes mellitus diagnosis and of being registered in the ESF; using insulin; and a demonstrated capacity to answer the questions on the instrument.
In this step, a new modification was suggested; the interview time for completing theitems was 5 minutes, the preliminary value of the items' internal consistency was satisfactory Cronbach's alpha equal to 0.75 and ceiling and floor effects were observed for items ASAS-R 4, 7, 8, 11, 12 and 14 more than 15% of the answers concentrated in the instrument's lowest or highest possible scores.
The graphical expression of the path diagram, Figure 1,shows the factor loads of the observed variables ASAS-R 1 to ASAS-R 15 in the latent variables Having, Developing and Lacking power for self-care, as well as the co-variances between factors and items variances.