2.50
Hdl Handle:
http://hdl.handle.net/10755/157365
Type:
Presentation
Title:
COMPARING THE SYMPTOM CLUSTERS OF TWO CHRONIC DISEASES USING SEM
Abstract:
COMPARING THE SYMPTOM CLUSTERS OF TWO CHRONIC DISEASES USING SEM
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Sousa, Karen, RN
P.I. Institution Name:University of Colorado Denver
Title:Professor
Contact Address:13120 E. 19th Ave., Campus Box C288-04, Aurora, CO, 80045, USA
Co-Authors:Ehri Ryu
PURPOSE: The purpose of this presentation is to compare symptom clusters in persons living with Rheumatoid Arthritis and HIV.
BACKGROUND: Rheumatoid Arthritis (RA) and HIV are chronic illnesses with constellations of symptoms, the management of which is important for quality of life. An important barrier to symptom management is the lack of research describing symptom clusters. The evaluation of symptom clusters has been described as a means to in-depth understanding of the relationships between and among symptoms. Structural Equation Modeling (SEM) is a statistical methodology that takes a confirmatory approach to multivariate analysis. It is a comprehensive process for testing hypotheses about relationships among measured and latent variables. The Sign and Symptom Checklist for Persons with HIV Disease (SSC-HIV), developed by Holzemer and colleagues, provides an operational definition for the measurement model representing symptom clusters for persons living with HIV. However, there is no analogous measurement model for individuals living with RA. In this study, a tentative structure was developed and tested.
Participants: The sample for patients living with RA is 901 women from the Arthritis, Rheumatism, and Aging Information Databank. These individuals have a diagnosis of RA and their average age is 61.57 (SD=12.26) years. The sample for the HIV patients came from the AIDS Time-Oriented Health Outcome Study Databank. Their average age is 39.35 (SD=8.13) years.
METHODS: Review of the literature did not identify a hypothesized structure to represent symptom status that would be applicable for individuals living with RA. Consequently, we developed a structure that was subsequently cross-validated in a second sample. The first step of this strategy was to randomly divide the data into two samples of approximately equal size. The process involved exploratory and confirmatory factor analysis. SEM was also used to test an hypothesized relationship among symptom clusters based on the SSC-HIV, which suggested a second-order factor structure. Analysis was conducted using MPLUS and the estimator used was the weighted least square parameter (WLSM). This estimator uses a diagonal weight matrix with robust standard errors and a mean-adjusted chi-square test statistic. It is appropriate for categorical data on symptoms which were measured as present or not present. Several goodness of fit indices were used for assessing the model fit.
RESULTS: This analysis confirmed a two-factor solution for individuals living with RA (RMSEA = .049, SRMR = .093, CFI = .95) and a second-order factor solution with six first-order factors for individuals living with HIV (RMSEA = .036, SRMR = .061, CFI = .99).
IMPLICATIONS: Symptom management involves (a) identifying and recognizing symptoms, (b) appropriately interpreting the symptoms, (c) monitoring and evaluating the symptoms, (d) selecting strategies that relieve the symptoms to enhance the patient's functioning and well-being, and (e) evaluating the effectiveness of these strategies. Symptom management is an important outcome for nursing practice and integral to evaluating the efficacy of nursing interventions. The use of valid conceptual models provides a context to guide the development of appropriate strategies for care. Implications and strategies related to the two different symptom constellations will be discussed.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleCOMPARING THE SYMPTOM CLUSTERS OF TWO CHRONIC DISEASES USING SEMen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157365-
dc.description.abstract<table><tr><td colspan="2" class="item-title">COMPARING THE SYMPTOM CLUSTERS OF TWO CHRONIC DISEASES USING SEM</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Sousa, Karen, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Colorado Denver</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">13120 E. 19th Ave., Campus Box C288-04, Aurora, CO, 80045, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">karen.sousa@ucdenver.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Ehri Ryu</td></tr><tr><td colspan="2" class="item-abstract">PURPOSE: The purpose of this presentation is to compare symptom clusters in persons living with Rheumatoid Arthritis and HIV.<br/>BACKGROUND: Rheumatoid Arthritis (RA) and HIV are chronic illnesses with constellations of symptoms, the management of which is important for quality of life. An important barrier to symptom management is the lack of research describing symptom clusters. The evaluation of symptom clusters has been described as a means to in-depth understanding of the relationships between and among symptoms. Structural Equation Modeling (SEM) is a statistical methodology that takes a confirmatory approach to multivariate analysis. It is a comprehensive process for testing hypotheses about relationships among measured and latent variables. The Sign and Symptom Checklist for Persons with HIV Disease (SSC-HIV), developed by Holzemer and colleagues, provides an operational definition for the measurement model representing symptom clusters for persons living with HIV. However, there is no analogous measurement model for individuals living with RA. In this study, a tentative structure was developed and tested.<br/>Participants: The sample for patients living with RA is 901 women from the Arthritis, Rheumatism, and Aging Information Databank. These individuals have a diagnosis of RA and their average age is 61.57 (SD=12.26) years. The sample for the HIV patients came from the AIDS Time-Oriented Health Outcome Study Databank. Their average age is 39.35 (SD=8.13) years. <br/>METHODS: Review of the literature did not identify a hypothesized structure to represent symptom status that would be applicable for individuals living with RA. Consequently, we developed a structure that was subsequently cross-validated in a second sample. The first step of this strategy was to randomly divide the data into two samples of approximately equal size. The process involved exploratory and confirmatory factor analysis. SEM was also used to test an hypothesized relationship among symptom clusters based on the SSC-HIV, which suggested a second-order factor structure. Analysis was conducted using MPLUS and the estimator used was the weighted least square parameter (WLSM). This estimator uses a diagonal weight matrix with robust standard errors and a mean-adjusted chi-square test statistic. It is appropriate for categorical data on symptoms which were measured as present or not present. Several goodness of fit indices were used for assessing the model fit.<br/>RESULTS: This analysis confirmed a two-factor solution for individuals living with RA (RMSEA = .049, SRMR = .093, CFI = .95) and a second-order factor solution with six first-order factors for individuals living with HIV (RMSEA = .036, SRMR = .061, CFI = .99).<br/>IMPLICATIONS: Symptom management involves (a) identifying and recognizing symptoms, (b) appropriately interpreting the symptoms, (c) monitoring and evaluating the symptoms, (d) selecting strategies that relieve the symptoms to enhance the patient's functioning and well-being, and (e) evaluating the effectiveness of these strategies. Symptom management is an important outcome for nursing practice and integral to evaluating the efficacy of nursing interventions. The use of valid conceptual models provides a context to guide the development of appropriate strategies for care. Implications and strategies related to the two different symptom constellations will be discussed.<br/></td></tr></table>en_GB
dc.date.available2011-10-26T19:48:27Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:48:27Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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