Care Needs for Organ Transplant Recipients Scale: Development and psychometric testing

Abstract

Background Needs assessment can determine how large the gap is between needs and available services; however, no tools are available to assess the unmet needs of renal transplant recipients. Objectives The aim of this study was to develop the Care Needs for Organ Transplant Recipients Scale (CNOTRS) and examine its psychometric properties. Design A cross‐sectional design for instrument development and psychometric testing. Participants In total, 217 renal transplant recipients were recruited through convenience sampling. Methods An initial 36‐item CNOTRS was developed after a comprehensive literature review. After the CNOTRS was tested through content validity and face validity, the factor structure was explored using exploratory factor analysis (EFA). Convergent validity was examined using Pearson's correlation between the CNOTRS and Hospital Anxiety and Depression Scale (HADS). Known‐group validity was tested by comparing CNOTRS scores of patients grouped based on whether they had experienced complications or rejection. Results Twenty‐eight items with three factors (namely daily care and social interaction needs, psychological needs, and health system and service needs) were identified in EFA by parallel analysis and Velicer's MAP test. The psychological needs domain had a stronger positive correlation with the HADS than the other two domains. The known‐group validity was supported as a significant association between complications or rejection occurrence and unmet needs. The Cronbach's α of the CNOTRS was 0.94. Conclusions The CNOTRS demonstrated satisfactory reliability and validity to assess the care needs for renal transplant recipients and can assist health care professionals to tailor more personalised care for their individual needs.

Unmet Care Needs and Related Factors of Spouses of Liver or Kidney Transplant Recipients

“…Future studies should recruit more participants to verify the reliability of the depression subscale of the HADS among transplant recipients. Fourth, the CNOTRS, as the instrument for measuring recipients’ unmet care needs in this study, exhibited satisfactory reliability and validity through meticulous psychometric properties testing when used to assess kidney transplant recipients in the original study (Chang et al, 2020). Our study is the first to use the CNOTRS to measure the unmet care needs in liver transplantation recipients (Cronbach’s α 0.91) and the recipients’ spouses (Cronbach’s α 0.94) showing good internal consistency.…”

“…Consistent with the previous study (Rodrigue et al, 2011), we found that spouses need to assist recipients in facing the psychological distress of transplantation; the concern of disease recurrence (Q3) and uncertainty about the future (Q4) are especially burdensome concerns. Recipients who experienced organ rejection and complications within 6 months of transplantation reported having high anxiety and depression (Chang et al, 2020); the occurrence of complications related to transplantation such as severe infection (Bourlon et al, 2020), malignancies (Bardou et al, 2019), and rejection (Bardou et al, 2019) is the greatest challenge in posttransplant care. To decrease psychological unmet needs and levels of anxiety and depression among recipients and spouses, health care providers must instruct them in self-management skills, common complications after transplantation, and recognizing early signs and symptoms of complications (Been-Dahmen et al, 2018).…”

“…For each item, two dimensions—the level of need and the level of satisfaction—are assessed using a 5-point Likert scale ranging from 0 to 4. Each item is scored by multiplying the scores of the two dimensions, which yields the level of unmet needs; higher scores indicate greater unmet care needs (Chang et al, 2020). The CNOTRS was completed by both recipients and their spouses in this study.…”

“…The CNOTRS is a 28-item scale with good reliability and validity; it is used to assess three domains of unmet care needs of solid organ transplant recipients: daily care and social interaction needs, psychological needs, and health system and service needs (Chang et al, 2020). For each item, two dimensions-the level of need and the level of satisfaction-are assessed using a 5-point Likert scale ranging from 0 to 4.…”

“…Further, recipients must attend follow-up appointments and make lifestyle modifications for infection control, nutrition balance, physical activity, and exercises (Demet et al, 2018). These behaviors and the stress they entail may result in unmet care needs among recipients during the long-term recovery process (Chang et al, 2020); therefore, recipients still require close observation of their health and psychological conditions. Transplant and the subsequent recovery period not only affect the recipients, much of healthcare was family-based and greater reliance on family members support (Shih et al, 2010).…”