Statistical Validation of the Self-Harm Antipathy Scale-Japanese Version (SHAS-J)

ISSN: 2167-1168

Journal of Nursing & Care

  • Short Communication   
  • J Nurs Care 2017; 6:434, Vol 6(6)
  • DOI: 10.4172/2167-1168.1000434

Statistical Validation of the Self-Harm Antipathy Scale-Japanese Version (SHAS-J)

Aoki Yoshimi* and Harumi Katayama
Fundamental Nursing Department, Hamamatsu University School of Medicine, Japan
*Corresponding Author: Aoki Yoshimi, Fundamental Nursing Department, Hamamatsu University School of Medicine, Japan, Tel: +81 53-435-2111, Email: [email protected]

Received Date: Nov 01, 2017 / Accepted Date: Nov 15, 2017 / Published Date: Nov 23, 2017

Abstract

Aim: This study aimed to determine the reliability and validity of the Self-Harm Antipathy Scale-Japanese Version (SHAS-J).
Methods: A self-administered questionnaire was distributed to 764 nurses working in 32 emergency departments across Japan and 302 (39.5%) of them responded effectively. The questionnaires collected demographic data about the nurses and the SHAS-J. Data were evaluated with Cronbach’s alpha along with exploratory factor, confirmatory factor, and correlation analyses.
Results: Factor analysis of the SHAS-J resulted in extraction of four factors. The four factors comprised “low empathic practice competence”, “care futility”, “lack of active understanding” and “ignorance about rights and responsibilities”. Cronbach’s alpha for the four factors were 0.83-0.54.
Conclusion: The reliability and validity of the SHAS-J were approximately verified.

Keywords: Antipathy; Nursing care; Statistical validation; Self-injury

Background

Suicide rates in Japan are high compared with other countries [1] and have become a serious social problem. Patients who attempt suicide require care-based sympathy from a nurse [2]. However, caring for patients who attempt suicide or self-harm is difficult for nurses working in an emergency setting, and this situation is not beneficial to patients [3,4]. In Japan, no measures are currently in place to evaluate negative feelings such as antipathy in patients who engage in selfinjury. Therefore, to help evaluate the difficulties associated with such patients encountered by nurses, a reliable Japanese version of the Self- Harm Antipathy Scale (SHAS) developed in the U.K. is needed.

Aim

This study aimed to determine the reliability and validity of the SHAS-Japanese Version (SHAS-J).

Method

An anonymous self-report questionnaire survey was conducted on 764 nurses working in emergency departments in Japan. The questionnaires collected demographic data about the nurses and the SHAS-J. To assess the concept validity of the SHAS-J, exploratory factor analysis was used to verify the factor structure, and covariance structure analysis using confirmatory factor analysis was used to verify the factor structure between the original SHAS and the SHAS-J and confirm the conformance. Data were analyzed using SPSS (Ver. 22 for Windows) and Amos (Ver. 22 for Windows). In translation to Japanese of the original SHAS, the original author Patterson was already retired and the authorship Whittington received license and translation permission. The original version of the SHAS was translated into Japanese by a certified translator. This study was approved by the ethics committee of Hamamatsu University School of Medicine (E 14-240) [5].

Results

The questionnaire was distributed to 764 nurses working in 32 emergency departments across Japan; 302 (39.5%) responses were received. The mean age of the respondents was 34.8 years (standard deviation=7.4 years). As shown in Table 1, the largest number of respondents were members of the High care units (73 persons; 24.2%), followed by the Intensive care units (65 persons; 21.5%).

Factors Mean ± SD (n) %
Female 249 82.5
Male 53 17.5
Age average 348 ± 74  
Years of work as nurses average 127 ± 72  
Years of work as emergency department  nurses average 59 ± 49  
Department in which you work    
First-line treatment 45 14.9
Intensive Care Units 65 21.5
High Care Units 73 24.2
General Ward 31 10.3
Other Emergency service overlap 7 2.3
Overlap 78 25.8
Unknown 3 1

Table 1: The nurses demographic data, n=302.

Validation of reliability

Cronbach’s α coefficient for each SHAS-J factor ranged from 0.83 to 0.54 (Table 2).

S. No.   Ceiling effect Floor effect Item-total correlation Inter-item correlation
1 People who self-harm are usually trying to get sympathy from others 5.8 3.2 0.37 -0.12~0.46
2* People should be allowed to self-harm in a safe environment 7.2 4.9 0.12 0.12~0.42
3* A rationale person can self-harm 5.6 2.3 0.23 -0.11~0.19
4 Self-harming clients do not respond to care 4.3 1.5 0.53 -0.12~0.58
5 When individuals self-harm. It is often to manipulate carers 5.1 2.6 0.14 -0.21~0.25
6 People who self-harm are typically trying to get even with someone 4.1 1.8 0.16 -0.14~0.34
7 A self-harming client is complete waste of time 4.0 1.3 0.58 -0.19~0.58
8* An individual has the right to self-harm 6.4 3.5 0.21 -0.15~0.42
9 Self-harm is a serious moral wrong doing 5.4 2.7 0.25 0.11~0.28
10 There is no way of reducing self-harm behaviours 4.5 2.0 0.38 -0.13~0.5
11 People who self-harm lack solid religious convictions 4.5 2.2 0.30 0.13~0.29
12* Self-harm may be a form of reassurance for the individual that they are really alive and human 5.2 2.6 0.24 0.12~0.32
13* Self-harming individuals can learn new ways of coping 5.1 2.7 0.27 -0.12~0.26
14* Acts of self-harm are a form of communication to their situation 5.3 2.7 0.20 -0.21~0.39
15 A self-harming client is a person who is only trying to get attraction 5.2 2.8 0.51 -0.12~0.47
16 Self-harming clients have only themselves to blame for their situation 4.3 2.0 0.39 -0.17~0.41
17* For some individuals self-harm can be a way of relieving tension 5.0 2.7 0.28 -0.12~0.39
18* Self-harming clients have a great need for acceptance and understanding 4.5 2.2 0.08 -0.1~0.27
19* A self-harming client deserves the highest standards of care on every occasion 5.3 2.5 0.36 -0.12~0.31
20* I listen fully to self-harming clients problems and experiences 4.5 2.1 0.29 -0.12~0.31
21* I feel concern for the self-harming clients 5.0 2.5 0.53 -0.13~0.53
22 I feel critical towards self-harming clients 5.3 2.7 0.64 -0.12~0.53
23* I demonstrate warmth and understanding to self-harming clients in my care 4.6 2.6 0.52 -0.13~0.53
24* I help self-harming clients feel positive about themselves 5.0 2.9 0.47 -0.22~0.51
25 I feel to blame when my clients self-harm 6.4 3.7 -0.16 -0.19~-0.1
26* I acknowledge self-harming clients qualities 5.1 3.2 0.34 -0.15~0.51
27* I find it rewarding to care for self-harming clients 6.2 3.8 0.58 0.12~0.57
28* I can really help self-harming clients 6.3 4.0 0.38 0.13~0.57
29 I would feel ashamed if a member of my family engaged in self-harm 5.4 2.3 0.28 0.13~0.3
30* I am highly supportive to clients who self-harm 6.3 4.0 0.51 0.13~0.52
*Statements in the questionnaire that have been reverse scored

Table 2: Result of item analysis of “SHAS-J” (30 item).

Validation of validity

Regarding the 30 items on the original SHAS, the ceiling and floor effects, Item-Total correlation, and inter-item correlation were confirmed, but it was decided that the content of the item was not excluded considering the contents of the item (Table 2). In the same way as the original SHAS, a factor analysis was performed using the varimax rotation, and four factors were extracted. After excluding six items with a factor loading of 0.35 or less were excluded (Items 3, 13, 18, 19, 20 and 25), the resulting scale was named the SHAS-J (Table 3). The first and third factors were reverse-scored items. The first factor consisted of seven items, such as “I find it rewarding to care for selfharm patients” and “I try to help self-harm patients feel positive about them”, so it was named “Low Empathic practice competence”. The second factor consisted of 11 items, such as “A self-harm patient is someone who is only trying to get attention” and “A self-harm patient is a complete waste of time”, so it was named “Care futility”. The third factor consisted of three items, such as “Acts of self-harm are a form of communication about their situation” and “For some individuals, selfharm can be a way of relieving tension”, so it was named “Lack of active understanding”. The fourth factor consisted of three items, such as “People should be allowed to engage in self-harm in a safe environment” and “An individual has the right to engage in self-harm”, so it was named “Rights and responsibilities”. Then, to examine the validity of the constitutive concept, the factor structure of the SHAS-J was analyzed. In terms of compatibility, for the four-factor model of the SHAS-J, the GFI=0.85, AGFI=0.82, CFI=0.37 and RMSEA=0.06. In terms of the compatibility of the six-factor model, which was assumed to have the same factor structure as the original SHAS, the GFI=0.85, AGFI=0.81, CFI=0.21 and RMSEA=0.07.

S. No Factor Loading
  Factor 1 Factor 2 Factor 3 Factor 4
Factor 1: Low empathic practice competence
27* I find it rewarding to care for self-harming clients 0.725 0.255 0.095 0.035
24* I help self-harming clients feel positive about themselves 0.655 0.136 0.058 0.027
23* I demonstrate warmth and understanding to self-harming clients in my care 0.646 0.145 0.133 0.013
26* I acknowledge self-harming clients qualities 0.636 -0.073 0.033 0.106
28* I can really help self-harming clients 0.612 0.158 -0.012 0.032
30* I am highly supportive to clients who self-harm 0.574 0.207 0.106 0.14
21* I feel concern for the self-harming clients 0.565 0.283 0.166 -0.07
Factor 2: Care futility
15 A self-harming client is a person who is only trying to get attraction 0.217 0.632 -0.025 0.118
7 A self-harming client is complete waste of time 0.374 0.609 0.119 0.01
4 Self-harming clients do not respond to care 0.307 0.601 0.103 -0.136
16 Self-harming clients have only themselves to blame for their situation 0.429 0.543 0.117 0.166
22 I feel critical towards self-harming clients 0.13 0.53 0.026 -0.011
10 There is no way of reducing self-harm behaviours 0.15 0.499 0.158 -0.112
1 People who self-harm are usually trying to get sympathy from others 0.147 0.499 -0.106 0.1
6 People who self-harm are typically trying to get even with someone -0.131 0.491 -0.139 -0.009
11 People who self-harm lack solid religious convictions -0.025 0.39 0.096 0.055
29 I would feel ashamed if a member of my family engaged in self-harm 0.075 0.383 0.01 0.026
5 When individuals self-harm. It is often to manipulate carers 0.069 0.369 -0.317 -0.058
Factor 3: Lack of active understanding
14* Acts of self-harm are a form of communication to their situation 0.099 -0.038 0.655 0.048
17* For some individuals self-harm can be a way of relieving tension 0.147 0.059 0.561 0.01
12* Self-harm may be a form of reassurance for the individual that they are really alive and human 0.075 0.078 0.462 0.1
Factor 4: Ignorance about rights and responsibilities
2* People should be allowed to self-harm in a safe environment 0.104 -0.088 -0.014 0.647
8* An individual has the right to self-harm 0.067 0.003 0.276 0.598
9 Self-harm is a serious moral wrong doing 0.023 0.31 0.025 0.421
  Cronbach α 0.83 0.8 0.6 0.54
  Cumulative Proportion % 14.2 27.61 33.07 37.62
*statements in questionnaire that have been reverse scored
The result of principal factor method Varimax rotation was shown
The enclosure of numbers shows the factor loading with the highest factor

Table 3: Resurt of factor analysis of “SHAH-J”.

Discussion

Cronbach’s α coefficient for each factor of the SHAS-J ranged from 0.83 to 0.54, which is the same as that for the original SHAS, thereby confirming the internal consistency of the SHAS-J. The reliability of the SHAS-J was also confirmed using Cronbach’s α. The results of the exploratory factor analysis showed that the SHAS-J had a four-factor structure and was not completely consistent with the six-factor structure of the original SHAS. The reason for the difference in the factor structure between the original SHAS and the SHAS-J was thought to be the cultural differences between Japan and the U.K. in terms of religion and individual rights and responsibilities. However, although the SHAS-J has a different factor structure than does the original SHAS, the measurable content of both scales are considered similar. These results suggest that the SHAS-J has good reliability and validity, but back-translation should be carried out the in future.

It is important that nurses empathize with their patients, but it is difficult for nurses do it [2,4]. Rogers reported that to sense the client’s private world as if it were your own, but without ever losing the “as if ” quality – this is empathy and this seems essential to therapy. Item of “Lack of active understanding” is indicated “empathy” [6] and considered that it is significant attitudes in understanding self-harm patients.

References

Citation: Yoshimi A, Katayama H (2017) Statistical Validation of the Self-Harm Antipathy Scale-Japanese Version (SHAS-J). J Nurs Care 6: 434. Doi: 10.4172/2167-1168.1000434

Copyright: © 2017 Yoshimi A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

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