Setting, sample and participants
Bhaktapur Cancer Hospital (BCH), Bhaktapur, Nepal and Bisweswar Prasad Koirala Memorial Cancer Hospital(BPKMCH), Bharatpur, Chitwan, Nepal Cancer Hospital & Research Centre; Harisiddhi, National Hospital &Cancer Centre; Jawalakhel, Kathmandu Cancer Center; Tathali, Nepal were selected as the setting of the study. The population of the study consisted of patients diagnosed with cervical cancer and they were under treatment in selected hospital[12, 20]. The sample size was 340 as per rule of thumb at least 10 subjects per item of the instrument scale along with item analysis and exploratory factor analysis is suggested[21, 22]. Data were collected from patients' diagnosed with cervical cancer , undertaking cancer therapy, physically and mentally able to complete the questionnaire and able to understand the Nepali language[23, 24] from May 2020 to September 2020.
Process / Procedure
This study was formally approved by the School of Nursing & Health, Zhengzhou University, Henan China and Nepal Health Research Council. The eligible respondents were identified by the main researcher and trained survey interviewer nurses (Nurse having Bachelor degree) from in and outpatient departments of selected hospitals. The eligible respondents were informed about the purpose of the study and also assured the standard of care would not modify irrespective whether they participated in the study or not. After getting informed consent from the eligible respondents, they were requested to complete a set of self-report questionnaires on the same day either at the hospital (inpatients) or at home (outpatients). The main researcher and trained survey interviewer nurses checked the questionnaire thoroughly immediately after returning the questionnaire by the respondents to avoid the missing response. Participants who did not return the questionnaire were followed by phone a call.
Measures
Development of the SCNS-SF34-N (Nepali)
SCNS-SF 34 is recognized as a valid and reliable need assessment tool for identifying the supportive care needs through a self-reporting questionnaire regarding patients' perceived supportive care needs [25, 6, 26]. It assesses the existing need and the degree of need for supportive care on the last one month of 34 items by using five point and two level response scale (1—no need, not applicable; 2—no need, satisfied; 3—low need; 4—moderate need; 5—high need). The initial response scale comprises of two broad categories of need, i.e. 'no need' and 'need'. The "no need" scale is additionally subdivided into two categories namely "not applicable and satisfied". Not applicable indicates there were no problems to the patient on the related item and satisfied indicates that for that particular item patient needed support but this support was managed by himself. The "need" scale is additionally subdivided into three categories namely 'low need', 'moderate need' and 'high need' representing the level of supportive care need [6].The 34 items are categorized in 5 domains (psychological needs (10 items), healthcare system and information needs (11 items), physical and daily living needs (5 items), patient care and support needs (5 items) and sexuality needs (3 items). A high score in the tool indicates that perceived supportive care need is high level [6].
Beaton's guideline was used to develop the SCNS-SF34-N (Nepali).it includes the seven scientific stage namely: 1. Translation into the target language 2. Synthesis of the forward translations 3. Backward translations, 4. Consensus conference, 5. pretest patient survey, 6. Approval of research team 7. approval of original authors [27, 28, 9]. Content validity was assessed by consulting 10 experts working and educating in oncology and research area, clarity of the questionnaire was assessed by consulting 15 respondents using Likert scale [12]. Correlation of the questionnaire was assessed employing the test-retest method by consulting 50 respondents[18].
The preliminary final version was pretested among 34(10% of the total sample) cervical cancer patients in Nepal to determine the understanding level, word appropriateness, identification of offensive or aggressive words, identification of simple words and acceptability of the translated questionnaire[27] .
Comparative measures for validity testing
To allow comparisons within each item, inter item correlation was assessed for the establishment of convergent validity through Spearman's rank correlation coefficients in between each item of SCNS-SF34-N [29, 30, 31].
Sociodemographic and clinical characteristics
The sociodemographic characteristics included the data about age, education, marital status, economic status, dietary status, family type, relationship status. The clinical characteristics included disease stage, treatment modalities, duration of disease.
Statistical analysis
Statistical Package for Social Science(SPSS) version 20(IBM, NY, USA) was used for the analysis of collected data. Sociodemographic and clinical characteristics of the respondents were analyzed by using descriptive statistics (frequency, percentage, mean, standard deviation)[9, 18].
Exploratory factor analysis (EFA, principal component analysis with varimax rotation) was used for the examination of factor validity. To test the suitability of the data for EFA, The Kaiser-Mayer-Olkin (KMO) and Bartlett's tests were used to identify the sample adequacy and appropriateness of sample size respectively[18].
The suitable parameter of KMO statistic (0.917), exceeded the threshold of 0.5, and Bartlett's test was significant (chi2 = 26,958.140, p <0.001), which indicates that the data were suitable for factor analysis[9].
Factor loadings >0.4 and Eigenvalues >1.0 were taken into consideration for acceptance. Items were recognized to the factor with the priority of highest loading and the factor structure was calculated for the explanation of the variance. floor and ceiling effect occurred if more than 50% of the participants attained the lowermost (0) or uppermost (100) score for each factor. [32, 19, 9]. Cronbach's alpha with a coefficient value >0.7 considered as acceptable which was calculated through internal consistency[32, 19, 9, 14, 13].
For the assessment of convergent validity, Spearman's rank correlation coefficients test was used between each item of SCNS-SF34-N (Nepali) [29, 30, 31].
For the assessment of discriminant validity, independent –sample t test was used to test the differences in the mean score for each domain between numerous subgroups of participants with different sociodemographic and clinical characteristics[19, 13, 33, 9].