Date on Master's Thesis/Doctoral Dissertation

5-2007

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Cooperating University

University of Kentucky

Department

Social Work

Committee Chair

Faul, Anna

Author's Keywords

Scale development; Validation; Health-related; Socioeconomic well-being; Cancer; Quality of life

Subject

Cancer--Patients--Economic conditions

Abstract

The impact of socioeconomic status on the diagnosis, treatment, survival, and overall quality of life in persons with cancer has been well documented. Yet, many studies overlook the relevance of socioeconomic factors when measuring the impact of cancer care. A multitude of tools exist for the measuring of health-related quality of life (QOL) in oncology, but the majority do not recognize socioeconomic well-being as a relevant domain. The FACT-G, perhaps the most often used measure of QOL in oncology, measures the domains of physical, functional, social/family, and emotional well-being as core measures with optional instruments available to address spiritual well-being and concerns related to specific cancer sites. The purpose of this dissertation was to develop and validate a theory-based subscale measuring the construct of socioeconomic well-being to be included as a core domain of the FACT-G. Theories of socioeconomic status and related well-being were explored. The Ecological Theory of Germain and Gitterman (1996) and James Coleman's theory of social class (1990) were used as the basis for construct definition and item development. Following expert review, the proposed measure, a demographic questionnaire, and other instruments necessary for the validation study were mailed to a random sample of 1200 persons diagnosed with cancer between 1/1/2004 and 12/30/2007 and listed on the Tumor Registry of the James Graham Brown Cancer Center (JGBCC) and the University of Louisville Hospital. The study was approved by the University of Louisville, JGBCC, and University Hospital oversight committees for protection of human subjects. Classical measurement theory directed the analysis of the proposed instrument. This iterative process included analysis of reliability via the Cronbach alpha, evaluation of corrected item total correlations and factor loadings, and analysis of content and construct validity at the item level via principal component analysis. This process resulted in one scale measuring overall socioeconomic well-being with two subscales (Material Capital and Social Capital) and a total of 17 items. Convergent and discriminant construct validity at the scale level was then established by comparing the new subscales and total scale to three sets of variables hypothesized to have differing degrees of correlation with the scales (Class I, II, and III criterion variables). Incremental validity was evaluated using a hierarchical regression model. The resulting instrument for the measurement of health-related socioeconomic well-being could be used as a core component of the FACT-G or a stand alone measure, and is appropriate for application in both clinical and research settings.

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