Development and Validation of the Communication Behavior Scale for Nurses Caring for People with Dementia

Jihye Lee; Moonhee Gang

doi:10.4040/jkan.2019.49.1.1

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Lee and Gang: Development and Validation of the Communication Behavior Scale for Nurses Caring for People with Dementia

Original Article

J Korean Acad Nurs 2019;49(1):1-13.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.1.1

Development and Validation of the Communication Behavior Scale for Nurses Caring for People with Dementia

Jihye Lee, Moonhee Gang

College of Nursing, Chungnam National University, Daejeon, Korea

Address reprint requests to : Gang, Moonhee College of Nursing, Chungnam National University, 266 Munwharo, Jung-gu, Daejeon 35015, Korea Tel: +82-42-580-8332 Fax: +82-42-580-8309 E-mail: mhgang@cnu.ac.kr

Received 6 August 2018 Revised 10 December 2018 Accepted 10 December 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to develop and validate the Communication Behavior Scale for nurses caring for people with Dementia (CBS-D).

Methods

Based on communication accommodation theory, the initial items were generated through a literature review and interviews with 20 experts. Content and face validity of the initial items were assessed. Data from 486 nurses caring for people with dementia were analyzed using item analysis, exploratory and confirmatory factor analysis, criterion-related validity, and internal consistency.

Results

The final scale consisted of 18 items and four factors (discourse response management, interpersonal control, emotional expression, and interpretability) that explained 57.6% of the variance. Confirmatory factor analysis indicated that the theoretical model with 18 items satisfied all goodness-of-fit parameters. Criterion-related validity was shown by the Global Interpersonal Communication Competence Scale (r=.506, p<.001). Cronbach's alpha for the total scale was .88.

Conclusion

The CBS-D can be used to measure the communication behavior of nurses caring for people with dementia.

Keywords: Dementia, Communication, Behavior, Nurses, Surveys and Questionnaires

References

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Figure 1.

Flow of this study.

Table 1.

Characteristics of Participants (N=486)

Characteristics	Categories	Data A	Data B	χ²	p
Characteristics	Categories	n	(%)	χ²	p
Gender	Male	9 (3.7)	17 (7.0)	2.60	.107
	Female	234 (96.3)	226 (93.0)
Age (yr)	<30	37 (15.2)	36 (14.8)	0.71	.949
	30~39	57 (23.5)	59 (24.2)
	40~49	68 (28.0)	66 (27.2)
	50~59	69 (28.4)	66 (27.2)
	≥60	12 (4.9)	16 (6.6)
Marriage	Married	176 (72.4)	175 (72.0)	0.01	>.999
	Single	59 (24.3)	60 (24.7)
	Others	8 (3.3)	8 (3.3)
Religion	Protestant	83 (34.2)	78 (32.2)	2.53	.771
	Catholic	39 (16.0)	36 (14.8)
	Buddhist	41 (16.9)	44 (18.0)
	Others	2 (0.8)	6 (2.5)
	None	78 (32.1)	79 (32.5)
Education	Diploma	135 (55.5)	133 (54.8)	7.20	.206
	Bachelor	97 (40.0)	93 (38.2)
	Master	10 (4.1)	17 (7.0)
	Doctor’s degree	1 (0.4)	0 (0.0)
Working organization	Elderly nursing ho	me 3 (1.2)	3 (1.2)	1.53	.673
	Elderly care hospit	al 224 (92.2)	217 (89.3)
	Others^†	16 (6.6)	23 (9.5)
Working pattern	Day work	122 (50.2)	133 (54.7)	7.19	.126
	3 shifts	105 (43.2)	101 (41.6)
	2 shifts	5 (2.1)	5 (2.1)
	Others^††	11 (4.5)	4 (1.6)
Position	Head nurse	62 (25.6)	73 (30.0)	4.08	.395
	Charge nurse	28 (11.5)	16 (6.6)
	Staff nurse	134 (55.1)	135 (55.6)
	Others^§	19 (7.8)	19 (7.8)
Experience in nursing (yr)	≤1	18 (7.4)	11 (4.5)	3.35	.340
	2≤~≤3	20 (8.2)	20 (8.2)
	4≤~≤6	25 (10.3)	18 (7.4)
	≥7	180 (74.1)	194 (79.9)
Experience in nursing for PWD (yr)	≤1	50 (20.6)	36 (14.8)	3.60	.308
	2≤~≤3	52 (21.4)	54 (22.1)
	4≤~≤6	55 (22.6)	52 (21.3)
	≥7	86 (35.4)	101 (41.8)
Hard experience in caring for PWD	Yes	167 (68.7)	168 (69.1)	1.00	.605
	No	76 (31.3)	75 (30.9)
Education experience about	Yes	136 (56.0)	126 (52.0)	0.67	.413
communication with PWD	No	107 (44.0)	117 (48.0)

PWD=people with dementia.

^† Welfare facility for the elderly;

^†† Night or evening keep;

^§ Director of nursing department.

Table 2.

Mean, Communality and Factor Loadings of Items According to the EFA

No	Measure (Item)	M±SD	Communality	Factor1	Factor2	Factor3	Factor4
8	I ask a question of the demented subject to answer easily such as ‘yes /no’.	3.69±0.68	.55	.76	.07	-.06	.18
7	I adjust the volume of the voice and the speed of the speech according to the response of the demented subject.	3.97±0.62	.63	.74	.05	.06	-.14
9	I talk about topics that the demented subject is interested in or is familiar with.	3.72±0.61	.63	.72	-.11	-.14	-.04
6	I repeat the sentence if the demented subject does not respond.	3.97±0.62	.59	.71	-.01	.01	-.14
10	I encourage the demented subject to express using nonverbal communication methods (eg: blinking, gestures, etc.) when it is difficult for the demented subject to communicate through verbal communication.	3.76±0.68	.48	.44	.07	-.08	-.31
13	I tend to treat the demented subject as a child.^†	3.63±0.91	.67	-.01	.83	.07	-.03
14	I tend to say ‘banmal’ to the demented subject.^†	3.60±0.91	.69	-.05	.80	-.12	.00
18	I tend to ignore the behavior or desire of the demented subject.^†	3.53±0.94	.63	.11	.74	.00	-.09
21	I express positive attention with smiling at the demented subject.	3.89±0.64	.62	.13	.05	-.74	.07
15	I give words of praise or encouragement to the demented subject.	3.84±0.57	.49	-.12	-.14	-.69	-.16
19	I have a natural contact (eg: holding hand, etc.) while talking with the demented subject.	3.80±0.68	.49	.13	-.08	-.68	.06
16	I pay attention to the nonverbal message of the demented subject (eg: changes in facial expressions, etc.).	3.83±0.63	.58	.04	-.03	-.62	-.23
22	I maintain a stable emotional state regardless of the emotional changes of the demented subject.	3.72±0.61	.47	.02	.27	-.59	.07
17	I encourage the demented subject to express emotions through realistic questions (‘when, who, what, where, how’) when they are anxious or aggressive.	3.51±0.68	.41	.00	.23	-.50	-.08
1	I tell the demented subject by showing the object (eg: things, photos) directly.	3.51±0.74	.62	.08	.06	-.04	-.79
2	I tell the demented subject clearly while showing my mouth shape.	3.73±0.73	.66	.01	.13	-.03	-.76
3	I see if the demented subject focuses on the conversation while I make eye contact with the demented subject.	3.88±0.64	.61	.18	-.08	-.15	-.62
4	I tell the demented subject one topic at a time.	3.66±0.72	.56	.29	-.00	-.01	-.58
	Eigen value			6.22	1.81	1.25	1.10
	Variance (%)			34.5	10.1	7.0	6.1
	Cumulative Variance (%)			34.5	44.6	51.6	57.6

M=mean; SD=standard deviation; EFA=exploratory factor analysis.

^† Means to recode the reverse-scored items.

Table 3.

SRW, AVE, CR and Model Fitness According to the CFA

Factor	No (Item)	SRW	AVE	CR
Discourse response management	6	.72	.72	.93
	7	.77
	8	.65
	9	.84
	10	.64
Interpersonal control	13^†	.66	.52	.77
	14^†	.80
	18^†	.58
Emotional expression	15	.70	.63	.91
	16	.72
	17	.49
	19	.66
	21	.71
	22	.55
Interpretability	1	.53	.57	.84
	2	.67
	3	.78
	4	.52
Model fitness χ²=214.30 (p<.001), CMIN/DF=1.66, SRMR=.05,
RMSEA=.06, GFI=.91, NFI=.86, CFI=.94

SRW=standardized regression weight; AVE=average variance extracted estimate; CR=construct reliability; CFA=confirmatory factor; SRMR= Standardized root mean-square residual; RMSEA=Root mean square error of approximation; GFI=Goodness of Fit Index; NFI=Normed Fit Index; CFI=Comparative Fit Index.

^† Means to recode the reverse-scored items.

Table 4.

Discriminant Validity by AVE and 95% Confidence Interval

Classification	Discourse response management Ф²	Interpersonal control Ф²		Emotional expression Ф²	Interpretability Ф²	AVE
Discourse response management	1					.72
Interpersonal control	.08 1					.53
Emotional expression	.71^† .06			1		.63
Interpretability	.61 .05			.59^†	1	.57
Criteria				AVE＞Ф²
Factor A		Factor B	Ф (p)	SE	Ф-2×SE	Ф+2×SE
Discourse response management	<–>	Interpersonal control	.28	.02	0.24	0.32
Discourse response management	<–>	Interpretability	.78	.03	0.72	0.84
Discourse response management	<–>	Emotional expression	.84	.02	0.8	0.88
Interpersonal control	<–>	Interpretability	.22	.02	0.18	0.26
Interpersonal control	<–>	Emotional expression	.25	.02	0.21	0.29
Interpretability	<–>	Emotional expression	.77	.02	0.73	0.81

AVE=average variance extracted estimate; SE=standard error; Ф

² =squared correlation; Ф=correlation. The squared correlation is greater than AVE.

Table 5.

Correlation between CBS-D and GICC and Reliability of CBS-D

Factor Name	Global Interpersonal Communication Competence Scale r (p)	Cronbach’s α
Discourse response management	.43 (<.001)	.80
Interpersonal control	.34 (<.001)	.76
Emotional expression	.46 (<.001)	.78
Interpretability	.42 (<.001)	.78
Total	.51 (<.001)	.88

CBS-D=Communication behavior scale of nurses caring for people with Dementia; GICC=Global Interpersonal Communication Competence Scale.

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