The impact on families with hospitalized children : development of a Hospitalization Impact and Coping Scale on families (HICS)

Abstract

The aim of this study was to deepen understanding of the dimensions that underlie the concept of hospitalization impact and coping of families with hospitalized children, through in-depth interviews with parents and developing a multidimensional measuring scale for clinical use in the Chinese community. With increased awareness of the psychological trauma to children caused during hospitalization, practices have now shifted towards family-centered care and parental participation. Pioneer studies in parental involvement in hospitalized childcare have highlighted parental stresses, but with limited knowledge about its related patterns and severity. The coping strategies believed to have a mediating effect on stresses have not been thoroughly evaluated regarding pattern and effectiveness. The Hospitalization Impact and Coping Scale (HICS) was designed to measure the parental perception of the hospitalization impacts and their perceived effectiveness of coping strategies of the family, which is viewed within the concept of the Double ABCX model. The HICS was developed in two phases: Phase One for item generation through interviewing parents with hospitalized children, literature review, content validity testing and a pilot study; and Phase Two for testing the psychometric properties of the HICS, such as internal consistency, reliability, construct validity and factor structures. A convenience sample of 218 Chinese parents (52% mothers, 26.6% father, and 20.6% joint participation with consensus) was recruited in China. In the final 51-item scale, the HICS demonstrated excellent internal consistency in both sub-scales (Cronbach’s alpha values of the impact sub-scale = 0.94 and coping sub-scale = 0.84). All six domains of the impact sub-scale demonstrated excellent internal reliability (Cronbach’s alpha values ranged from 0.77 - 0.86), and the four domains of the coping sub-scale demonstrated satisfactory to good internal reliability with Cronbach’s alpha values ranging from 0.62 to 0.71. The construct validity was established through the convergent validity approach. Using exploratory factor analysis (EFA), six factors were extracted from the impact sub-scale contributing to 63.48% variance. The six factors are psychological, social, physical, health service utilization, family and burden impacts. Four factors were extracted from the coping sub-scale, namely, effort to maintain positive and active parental care; attempts to readjust mental stability; utilizing internal and external resources; and maximizing quality and quantity of childcare. These factors contributed to 58.47% variance of the coping sub-scale. Confirmatory factor analysis (CFA) was used to validate the six-factor impact subscale model (RMSEA = 0.06, CFI = 0.839, and TLI = 0.828) and the four-factor coping subscale model (RMSEA = 0.067, CFI = 0.863, and TLI = 0.833). These CFA fit indices provided confirmatory evidence for the factor structures of both subscales. Preliminary psychometric properties of HICS show its potential for a valid and reliable assessment of families at risk for nursing attention. However, generalization may only be useful in pediatric settings. The parental perception may not reflect all family members but it should not be de-valued because if one member suffers, it affects the family system as a whole. Further studies in other populations would help the future development of HICS.