Validation of functional needs assessment (Chinese version) for people with chronic schizophrenia

Abstract

The purpose of this study is to gather evidence of the construct validity of the Functional Needs Assessment (FNA) by exploring its content-related, substantive, structural, and discriminative evidence in assessing the function of people with chronic schizophrenia in daily living. This research consisted of five stages: 1) to translate the English FNA to Chinese; 2) to identify, by survey, the most important daily activities for people with chronic schizophrenia in Hong Kong; 3) to evaluate the relevance and representativeness of the items and subscales of the FNA by panels of forty occupational therapists; 4) to estimate interrater reliability of the Chinese FNA; and 5) to conduct field test of the Chinese version. A total of 130 people with chronic schizophrenia who either lived independently, in halfway houses, or in long stay care homes were recruited. The factor structure of the Chinese FNA was examined by factor analysis. Results from the survey revealed that the Chinese FNA covered a wide scope of daily activities that were deemed important to people with chronic schizophrenia. The comments collected from the experts in various panels suggested that the items and subscales of the FNA were highly relevant to the people with chronic schizophrenia who either lived independently or in a halfway house. However, its contents were regarded as only moderately relevant to those who stayed in long stay care homes. Results also indicated that the Chinese FNA well represented the construct of functional ability for people with chronic schizophrenia. Interrater reliability estimated by Kendall's Tau correlation coefficients was moderate to excellent (0.65 to 1.00). The factor structure of the Chinese FNA suggested that the 25 subscales were reasonably grouped under a total of two latent factors. Results of item analysis revealed high internal consistency of the scale with Cronbach's alpha = 0.92. The discriminative validity of the Chinese FNA was satisfactory in predicting a total of 70% of the memberships among those who lived independently, in halfway houses, and in long stay care homes. In conclusion, the Chinese FNA was substantiated to be a valid and reliable instrument in the assessment of function of people with chronic schizophrenia. Its translation and the modification of some of the original items improved its clinical usage.