Development of a measure of skin care belief scales for persons with spinal cord injury

King RB, Champion VL, Chen D, Gittler MS, Heinemann AW, Bode RK, Semik P. Development of a measure of Skin Care Belief Scales for persons with spinal cord injury. Objectives: To develop and validate a measure of skin care beliefs and to describe the skin care behaviors of persons with spinal cord injury (SCI). Design: A mixed-methods design was used to develop the Skin Care Beliefs Scales (SCBS). The health belief model framed the hypotheses. Phase 1 included item development, content validity testing, and pilot testing. Phase 2 included testing the scale structure (principal components analysis), internal consistency reliability, test-retest reliability, and relationships between the belief scales and care behaviors. Setting: Two acute rehabilitation hospitals and Internet websites. Participants: Patients with SCI (N=462; qualitative/pilot n=56; psychometric study n=406) participated. Interventions: Not applicable. Main Outcome Measures: The pilot and phase 2 studies, respectively, used 146-item and 114-item versions of the SCBS. A skin care activity log was used to record skin care behaviors. Results: Content validity indicated that the items were relevant and clear. The analysis resulted in 11 independent scales reflecting 3 general beliefs (susceptibility, severity, self-efficacy) and barrier and benefit behavior-specific scales for skin checks, wheelchair pressure reliefs, and turning and sitting times. With the exception of skin check barriers (α=.65), Cronbach alphas of the scale ranged from.74 to.94. Test-retest intraclass correlations were fair to excellent (range,.42-.75). Construct validity was supported. Hierarchical linear regression indicated that turning benefits, barriers, susceptibility, and self-efficacy were significant predictors of turning time. Benefits or barriers were correlated significantly with skin check and pressure relief adherence (ρ range, -.17 to -.33). Self-efficacy was correlated with wheelchair pressure relief (ρ=.18). Skin care behavior adherence varied widely (eg, 0%-100%). Conclusions: The scales showed acceptable reliability and validity. Further testing with larger samples is desirable.