Develop and test the reliability and validity of the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract

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Method The interactive model of health behavior is taken as the theoretical framework, and the first draft of the scale was constructed through literature review, qualitative interview and Delphi expert correspondence. From June 2022 to July 2023, convenience sampling was used to select 225 children with congenital cataract who were treated in the ophthalmology clinic and inpatient department of a children's hospital in Guangzhou to conduct a questionnaire survey. The items of the scale were revised and the reliability and validity were tested. Results The postoperative visual rehabilitation compliance scale for children with congenital cataract included 5 dimensions and 18 items. Exploratory factor analysis extracted a total of 5 common factors, and the cumulative variance contribution rate was 68.151%. The item-level content validity index ranged from 0.730 to 1.000. The content validity index of the scale was 0.963. The total Cronbach's α coefficient, split-half reliability and test-retest reliability of the scale were 0.855, 0.778 and 0.859, respectively. Conclusions The postoperative visual function rehabilitation compliance scale for children with congenital cataract has good reliability and validity, which can be used to evaluate the postoperative visual function rehabilitation compliance of children with congenital cataract, and can provide reference for the clinical development of standardized nursing programs for children with congenital cataract. Congenital cataract Visual function rehabilitation Compliance Scale development Reliability Validity Interactive models of health behaviors 1 Introduction Congenital cataract refers to the opacity of the lens in early infancy. The incidence of congenital cataract in China is 0.5‰~5.6‰, and Asia is the most common region of congenital cataract(Lenhart & Lambert, 2022 ). Congenital cataract is mainly treated by surgery to remove the lens(Eibenberger et al., 2021 ), but the postoperative visual recovery depends on long-term systematic visual function rehabilitation(Lagrèze, 2020 ; Stech et al., 2019 ; Yangzes et al., 2019 ). Visual function rehabilitation after congenital cataract surgery includes refractive correction, patching therapy and amblyopia training therapy. The compliance of visual function rehabilitation is the key factor affecting the effect of visual function rehabilitation(Chougule et al., 2018a ; Li et al., 2018 ). High compliance can help to make up for the poor postoperative visual recovery caused by delayed treatment, while low compliance will directly lead to Amblyopia(Bronsard et al., 2008 ; Li et al., 2018 ). Therefore, it is very important to accurately evaluate the postoperative visual function rehabilitation compliance of children and conduct standardized nursing intervention as soon as possible. However, the existing assessment scales related to visual function compliance mainly include self-compiled questionnaires(Cao et al., 2018 ; Chougule et al., 2018b ; Drews-Botsch et al., 2012 ; Pradeep et al., 2014 ). Self-compiled questionnaires are mostly designed by researchers according to the research purpose, and the design lacks theoretical basis. At the same time, the questionnaire is suitable for children with amblyopia and children with patch-up therapy, and lacks specificity for the evaluation of visual function rehabilitation compliance of children with congenital cataract(Wallace et al., 2013 ). In addition, the existing scales lack the evaluation of medical staff, surrounding environment, parents and other aspects of compliance, so the existing scales are difficult to accurately evaluate the postoperative visual function rehabilitation compliance of children with congenital cataract. Interaction Model of Client Health Behavior (IMCHB) is suitable for promoting health behaviors during the transition period and at home, especially for chronic diseases(Cho et al., 2023 ; Kim et al., 2020 ). The rehabilitation of visual function in children with congenital cataract after surgery is mainly completed at home, and it needs long-term adherence to the rehabilitation. In view of this, based on the IMCHB, this study developed the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract and tested its reliability and validity, so as to provide an effective tool for the assessment of postoperative visual function rehabilitation compliance of children with congenital cataract. 2 Methods 2.1 Instrument development 2.1.1 Items generation Cox's Interaction Model of Client Health Behavior (IMCHB) was used to design the item content of postoperative visual function rehabilitation compliance assessment tool for children with congenital cataract, so as to achieve the coverage of compliance by children, caregivers and medical staff. And make it applicable to the nursing of congenital cataract. The treatment compliance of children is affected by the uniqueness of children and the interaction between patients and health educators(Cox, 2003). The uniqueness of children is affected by background elements, intrinsic motivation, cognitive evaluation, and emotional response. Combined with the characteristics of postoperative visual function rehabilitation in children with congenital cataract, five dimensions of the postoperative visual function rehabilitation compliance scale for children with congenital cataract were preliminarily formulated, which were: ① Background factors: family and social factors, environmental resources; ② Intrinsic motivation: patients can feel their own ability and autonomy, and provide them with self-rewards; ③ Cognitive evaluation: patients' perception of their own health status and influencing health behaviors; ④ Emotional response: the emotional experience that affects health behaviors and can hinder or promote cognitive activities; ⑤ Doctor-patient interaction: medical staff provide help with health-related information, professional skills, emotional support and decision control according to the characteristics of children(Cho et al., 2023; Shen et al., 2021; Wei, 2022). "congenital cataract /pediatric cataract /infant /children / pediatrics /visual function rehabilitation /refractive correction /occlusion treatment /amblyopia training /questionnaire /measurement /assessment /scale development /scale customization /scale development /reliability /validity" were used as search terms. CNKI, Wanfang, SinoMed, PubMed, Embase, and Web of Science were searched from the establishment of the database to February 2022. Related literature was read and collected, and a scale pool containing 30 items was initially developed based on Cox's Interaction Model of Client Health Behavior. Using the purposive sampling method and the principle of data saturation, 13 parents of children with congenital cataract who were treated in the ophthalmology clinic and inpatient department of a children's specialized hospital in Guangzhou from February 2022 to April 2022 were selected for semi-structured interviews. Interview Outline: ①How is your child's compliance with visual rehabilitation? What difficulties have you encountered? ②What factors do you think affect your child's compliance? ③What good methods do you have to improve children's compliance with covering treatment? ④What kind of help do you hope to get in the process of helping children with visual function rehabilitation? The research team sorted out and analyzed the interview data, and added 6 items according to the interview content. 2.1.2 The Delphi technique The inclusion criteria of experts were: ① doctors should have master's degree or above, and nurses should have bachelor's degree or above; ② intermediate or above professional title; ③ Engaged in children's ophthalmology work, nursing management, clinical nursing work, psychology and other fields, with more than 10 years of work experience; ④ interested in this study. Consultation questionnaire includes three parts: the letter consultation instructions, the questionnaire and the basic information of the experts. The consultation instructions included the research background, purpose and significance, the definition of related concepts, the introduction of Delphi expert consultation and the instructions for filling in. The items and dimensions of the postoperative visual function rehabilitation compliance scale for children with congenital cataract were listed in the text of the questionnaire. Likert5 scale method was used to evaluate the items and dimensions, which were assigned 1~5 points from "Not important" to "Very important". Content validity was evaluated at the same time. Likert3 scale method was used to evaluate the applicability of each item and dimension, which was assigned 1~3 points from "Not applicable" to "Applicable". Experts were asked to explain why they chose not to apply or apply after modification. The basic information of experts included education background, professional title, research field, and working years. Experts self-rated their familiarity with this research question from four aspects: event experience, theoretical analysis, reference to domestic and foreign literature, and intuitive sense. From April 2022 to June 2022, 15 experts were selected to evaluate the items of the scale. The researchers introduced the purpose, significance, theoretical basis and research methods of this study to experts in detail, and communicated with experts by telephone, WeChat or email to make experts fully understand and pay attention to this study. After two rounds of consultation, the experts' opinions tended to be consistent, and the consultation was finished. The items of the scale were supplemented, deleted and modified according to the criterion of importance assignment mean ≥3.5 and coefficient of variation ≤0.25(Cheon et al., 2022). According to the results of expert consultation, the items were revised and supplemented to form the first draft of the postoperative visual function rehabilitation compliance scale for children with congenital cataract. In the first round of consultation, 2 items were deleted, 3 items were modified, and 1 item was deleted. In the second round of consultation, no item was modified. There were 32 items in the revised scale. 2.1.3 Face validity test Convenience sampling was used to select 30(Younas & Porr, 2018) parents of children with congenital cataract who were treated in the Ophthalmology clinic of a children's hospital in Guangzhou for a pre-survey to evaluate the readability and operability of the scale items in June 2022. Thirty questionnaires were distributed and collected on the spot. The time of 30 caregivers to complete the pre-survey scale was (13.46±8.68) minutes, and 2 items were modified according to the feedback. Inclusion criteria: ① Children with lens opacity at birth or within the first year of life who met the diagnostic criteria of congenital cataract in the 7th edition of Zhufusang Practical Pediatrics; ② children ≤15 years old who need visual rehabilitation training after surgery; ③ The parents of the children agreed to rehabilitation after surgery and signed an informed consent. Exclusion criteria: ① Combined with mental disease, dementia, disturbance of consciousness, etc.; ② Complicated with serious infection and malignant tumor; ③ Retinopathy of prematurity, endophthalmitis, outer exudative retinitis, retinoblastoma and other causes of amblyopia requiring visual function rehabilitation; ④ Incomplete clinical and follow-up data. 2.2 Psychometric tests 2.2.1 Study participants The parents of children with congenital cataract who visited the outpatient and inpatient department of a children's hospital in Guangzhou from July 2022 to July 2023 were selected as the survey objects by the convenient sampling method. The inclusion and exclusion criteria were consistent with those of the pre-survey. According to the calculation method of sample size, the sample size of factor analysis should be 5-10 times of the number of items in the scale, and the sample size required for factor analysis should be more than 200 cases(Seo & Song, 2021; Younas & Porr, 2018). The first draft of the scale had 32 items, and considering 10% inefficiency, the sample size was 225 cases. This study has been approved by the Ethics Committee (2022209A01). 2.2.2. Data collection The general information questionnaire was designed by the research team on the basis of referring to the relevant literature, including the gender, age, type of cataract, complications, age and gender of parents. The initial version of the Postoperative Visual Rehabilitation Compliance scale for Children with Congenital cataract included 5 dimensions and a total of 32 items. Each item was scored by Likert 5-point scale, and "Completely inconsistent" was scored by 1 point, "Less consistent" was scored by 2 points, "Generally consistent" was scored by 3 points, "More consistent" was scored by 4 points, "Completely consistent" was scored by 5 points. Three items including "my child is not willing to accept visual function rehabilitation", "my child has not serious behavior such as stealing and slacking in the visual function rehabilitation", and "it is difficult for me to carry out visual function rehabilitation for my child" were scored in reverse. The researchers introduced the purpose and significance of this study to the parents in uniform instructions. After obtaining their consent, a questionnaire was filled out on the spot. The questionnaires were filled out with one-to-one guidance from the researchers, and the questionnaires were collected on the spot. If there are any missing items, fill in on the spot to ensure the completeness of the data. 2.2.3 Data analysis Frequency analysis method, discrete trend method, critical ratio method, correlation coefficient method, Cronbach's α coefficient, commonality and factor load were used to test the discrimination of each item. Item deletion criteria: ① Frequency analysis method: Responses were focused on specific choices (over 80%) or an option was not answered at all to consider removal. ② Discrete trend method: items with standard deviation < 0.75 should be deleted(Kuramochi et al., 2021). ③ Critical ratio method: the scale scores were sorted from small to large, and the corresponding values of 27% and 73% were used as the upper limit value and the lower limit value for dividing the low group and the high group, respectively, to compare whether there was any difference in the scores of each item between the low group and the high group. If there was no difference in the scores of the two groups, the discrimination of the item was poor, and it was considered to delete. ④ Correlation coefficient method: if the correlation coefficient with the total score of the scale was not statistically significant or less than 0.3, it was considered to delete the items(Cheon et al., 2022). ⑤Cronbach's α coefficient: after removing an item, Cronbach's α coefficient increased greatly, so consider deleting it; ⑥commonality and factor load：the items with factor loading value ≥0.4 were retained. Item-level content validity index (I-CVI) of postoperative visual function rehabilitation compliance scale for children with congenital cataract and scale-level content validity index (S-CVI) . If I-CVI ≥0.70 and S-CVI ≥0.80, the content validity of the scale was good(Cheon et al., 2022). Exploratory Factor Analysis (EFA) was used to test the construct validity of the scale. In the exploratory factor analysis, the Kaiser-Meyer-Olkin (KMO) index and Bartlett’s sphericity test were applied to confirm that the data were appropriate for factor analysis. The KMO index ranged from 0 to 1, with the closer to 1 indicating a stronger correlation between the variables the more suitable for factor analysis; Principal component analysis (PCA) and maximum variation method were used for orthogonal axis rotation. The common factors with eigenvalues > 1 and cumulative variance contribution rate > 40% were selected, and the items with factor loading value ≥0.4 were retained. SPSS25.0 statistical software was used for data processing. Measurement data were expressed as (mean ± standard deviation), enumeration data were expressed as numbers ( percentage), and authority coefficient, effective questionnaire recovery rate, Kendall harmony coefficient and coefficient of variation were expressed as authority coefficient of experts, enthusiasm, coordination degree of opinions and moderation degree of opinions, respectively. P < 0.05 was considered statistically significant. Cronbach's α coefficient and split-half reliability were used to evaluate the internal consistency of the total score and the scores of each dimension of the scale. In the fourth week after the formal investigation, 30 subjects were selected for repeated measurement to evaluate the test-retest reliability of the scale. 3 Results 3.1 Expert correspondence and preliminary survey results A total of 15 experts were selected in this study. Their age was 36~58 (48.06±8.07) years, and their working years in related fields were 13~38 (25.47±8.18) years. There were 8 ophthalmic medical experts and 7 ophthalmic nursing experts. 8 senior titles, 5 associate senior titles and 2 intermediate titles; They came from Shanghai, Guangdong, Yunnan, Hebei, Henan, Fujian and Guangxi in China. The recovery rate of the two rounds of questionnaires was 100%. In the two rounds of expert consultation, the response rate of each question was 93.33%~100% and 100%, and the proportion of experts who put forward constructive revision suggestions was 46.67% (7/15) and 6.67% (1/15), the number of comments was 11 and 1, respectively. A total of 12 expert opinions were received in the two rounds. The expert index judgment coefficient (Ca) was 0.82, the expert index familiarity (Cs) was 0.83, and the expert authority coefficient (Cr) was 0.84. The coordination coefficient of expert opinions was 0.205 (p < 0.001). The coefficient of variation (CV) of experts' scores on the importance of each item was 0.125~0.248. The importance scores of each item ranged from 4.00 to 4.75, and the full score ratio ranged from 0.27 to 0.87. According to the importance of items, the scale was scored and revised by experts. After the discussion of the research team, the experts proposed to ①Add "careless behavior" and revise it to "careless behavior such as slacking and peeking." ② Delete "I will try to communicate with the child and carry out visual function rehabilitation" because most of the children are infants and have no cognitive ability. ③ Supplement I am very concerned about the child's future vision (and willing to work hard for it). ④ Combined the medical staff will regularly ask about my recovery, and the medical staff will regularly evaluate my recovery and give opinions. ⑤ Modify the statement "I can’t help my child to rehabilitate visual function" to "it is difficult for me to rehabilitate my child's visual function". ⑥Modify the statement "The attitudes and views of others around me will affect my enthusiasm for the rehabilitation of my child" to "The attitudes of other parents will affect my enthusiasm for the rehabilitation of my child". After the pre-survey, according to the caregiver's feedback, "My child cannot accept visual function rehabilitation" was revised to "My child is not willing to undergo visual function rehabilitation"; "I think my family life environment is very stable and there is no significant change" was revised to "My child's visual function rehabilitation has no effect on my family life". Finally, a test version of the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract was formed with 32 items. 3.2 General information of respondents A total of 230 questionnaires were distributed and 225 valid questionnaires were collected, with an effective recovery rate of 97.83%. There were 149 males (66.2%) and 76 females (33.8%), with an average age of (4.32±2.72) years. 78 (34.7%) were unilateral and 147 (65.3%) were bilateral. 178 (79.1%) had no complications and 47 (20.9%) had complications. There were 68 fathers (30.2%), 150 mothers (66.7%), and 7 others (3.1%), with an average age of (33.13±5.644) years. 3.3 Results of item analysis Frequency analysis method showed that the response rate of each item of the 32 items in the questionnaire was 100%, and no item had a frequency of more than 80% on an option, and no item had a frequency of 0 on an option. Discrete trend method showed that the standard deviation of 3 items was less than 0.75; Critical ratio method showed that 2 items with no difference between the two groups (p > 0.05); Correlation coefficient method showed that the correlation coefficient between the scores of 7 items and the total score of the scale was less than 0.3; Cronbach's alpha coefficient method showed that no entries met the deletion criteria; commonality and factor load method showed that 2 items <0.4. According to the comprehensive screening strategy, 14 items were finally removed. 3.4 Validity analysis 3.4.1 I-CVI of the Postoperative Visual Rehabilitation Compliance scale for children with congenital cataract ranged from 0.730 to 1.000. The S-CVI was 0.963. 3.4.2 EFA was used to test the construct validity of the scale, and Bartlett's spherical test x 2 value was 2070.843 ( p 0.7, indicating that it was suitable for factor analysis. A total of 5 factors with eigenvalues > 1 were extracted by principal component analysis and maximum variance rotation, and the cumulative variance contribution rate was 68.151%. They were named as background factors, intrinsic motivation, cognitive evaluation, emotional response, and doctor-patient interaction (Table 1). 3.5 Reliability analysis The Cronbach's α coefficient of the scale was 0.855, and the Cronbach's α coefficient of each dimension was 0.850, 0.725, 0.746, 0.720, 0.658. The total split-half reliability of the scale was 0.778, and the split-half reliability of each dimension was 0.787, 0.779, 0.787, 0.646, 0.644. The total test-retest reliability of the scale was 0.859, and the test-retest reliability of each dimension was 0.898, 0.822, 0.740, 0.847, 0.754. 4 Discussion 4.1 The postoperative visual function rehabilitation compliance scale for children with congenital cataract constructed in this study is scientific. Based on the theoretical framework of IMCHB, the first draft of the scale was prepared through literature review and qualitative interviews. The theoretical basis and the formation process of the first draft were scientific and standardized. The items of the scale were adjusted through the Delphi expert consultation method. The 15 experts involved were all experts in related fields with intermediate or above professional titles, and 8 of them had master's degrees or above and had good academic research levels. The positive coefficient of the two rounds of expert consultation was 100%, and the enthusiasm of experts to participate in this study was high. The authority coefficients of experts were 0.84, Cr ≥ 0.8, and the authority of the selected experts was high(Tsukuda et al., 2022). Kendall's harmony coefficient was 0.205 (p < 0.001), and the coefficient of variation was 0.125-0.248, all above 0.25, indicating that the experts' opinions were highly consistent, and the degree of coordination was good. The importance scores of each item ranged from 4.00 to 4.75, all of which were higher than 3.5. The full score ratio ranged from 0.27 to 0.87, all above 0.20, suggesting that the experts had a high degree of concentration on the importance of each item. EFA extracted a total of 5 common factors with characteristic value > 1. The final scale consisted of 5 dimensions, including background factors, intrinsic motivation, cognitive evaluation, emotional response, doctor-nurse interaction, which were in line with the theoretical framework of IMCHB, and the attribution of other dimensions and items were basically consistent with the theoretical hypothesis. The loading value of each item on the common factor was greater than 0.4, indicating that the structure of the scale was stable(Cheon et al., 2022). The cumulative variance contribution rate was 68.151%, indicating that the information contained in the scale could comprehensively reflect the postoperative compliance of children with congenital cataract. The I-CVI was not less than 0.70, and the S-CVI was not less than 0.80, indicating that the scale had good content validity(Seo & Song, 2021). In this study, the I-CVI and S-CVI were 0.730~1.000 and 0.963, respectively, indicating that the postoperative visual function rehabilitation compliance scale for children with congenital cataract had high content validity. The Cronbach's α coefficient of the scale was > 0.8, the Cronbach's α coefficient of each dimension was > 0.6, and the split-half reliability was > 0.7, indicating that the scale had good internal consistency(Feng et al., 2022). The test-retest reliability was > 0.7, indicating that the scale had good cross-time stability and external consistency(Cheon et al., 2022). In conclusion, the development process of the postoperative visual rehabilitation compliance scale for children with congenital cataract is scientific and standardized, and it has good reliability and validity and is scientific. 4.2 The postoperative visual function rehabilitation compliance scale for children with congenital cataract constructed in this study is practical Effective evaluation of postoperative visual function rehabilitation compliance in children with congenital cataract is the basis for standardizating postoperative visual function rehabilitation and promoting visual recovery in children with congenital cataract. Accurate compliance assessment tools are the prerequisite for medical staff to carry out targeted nursing intervention and health guidance. However, at present, there is no assessment scale for compliance of children with congenital cataract, and self-designed questionnaires are mostly used. The questionnaire preparation process is not standardized and rigorous, and the dimension is not comprehensive enough, and the influence of external factors is not considered, but only the cognition and attitude of children and parents are considered(Handa & Chia, 2019; Vagge et al., 2018). The questionnaire compiled in this study includes 5 dimensions, which can reflect the cognition, motivation, emotional response and the interaction between doctors, nurse and patients in the process of visual function rehabilitation of children with congenital cataract in a more comprehensive way, which conforms to the IMCHB. This scale is suitable for dynamic assessment of children's compliance at different time periods during home rehabilitation, and medical staff can identify the internal reasons affecting children's health behavior and compliance behavior with minimum human and material resources, which is conducive to realizing the optimization of self-management of postoperative visual function rehabilitation in children with congenital cataract. In addition, there are a total of 18 items in this study, which takes less time to fill in and is convenient for clinical application. 5 Conclusion The visual function rehabilitation compliance scale for children with congenital cataract developed in this study is scientific and practical, and can be used as a measurement tool for medical staff to continuously and dynamically evaluate the visual function rehabilitation compliance of children with congenital cataract after surgery. The main limitations of this study are as follows: the samples were only from a children's hospital in Guangzhou, and the source of samples was limited; No confirmatory factor analysis was performed. It is suggested that the sample size should be increased in the future, and the relevant visual function rehabilitation compliance scale should be selected as the calibration questionnaire to further verify the structural validity and calibration association validity of this scale. Declarations Funding This work was supported by the Guangzhou Municipal Science and Technology Bureau (No: SL2022A03J01101；No: 202103000088). Competing Interests The authors have no relevant financial or non-financial interests to disclose. Author Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yanan Zhang, Daoman Xiang and Wanhua Xie. The first draft of the manuscript was written by Yanan Zhang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Guangzhou Women and Children's Medical Center. Consent to participate Informed consent was obtained from all individual participants included in the study. Consent to publish All authors agreed with the content and gave explicit consent to submit. Availability of data and materials The data used in this study were collected by field investigation, and all authors agree to provide relevant data as far as possible without affecting the privacy of patients References Bronsard, A., Geneau, R., Shirima, S., Courtright, P., & Mwende, J. (2008). Why are children brought late for cataract surgery? 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An educational intervention to improve adherence to high-dosage patching regimen for amblyopia: a randomised controlled trial [Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't]. Br J Ophthalmol, 98(7), 865–870. http://doi.org/10.1136/bjophthalmol-2013-304187 Seo, K., & Song, Y. (2021). Development and validation of the self-stigma scale in people with diabetes [Journal Article; Research Support, Non-U.S. Gov't]. Nurs Open, 8(3), 1089–1097. http://doi.org/10.1002/nop2.719 Shen, Q., He, P., Wen, M., Yu, J., Chen, Y., Li, J., & Ouyang, X. (2021). Secondary prevention of coronary heart disease: The effect of a nursing intervention using Cox's interaction model of client health behaviour [Journal Article; Randomized Controlled Trial]. Journal of Advanced Nursing, 77(10), 4104–4119. http://doi.org/10.1111/jan.14930 Stech, M., Grundel, B., Daniel, M., Böhringer, D., Joachimsen, L., Gross, N., Wolf, C., Link, H., Gilles, U., & Lagrèze, W. A. (2019). Risk of aphakic glaucoma after pars plana-lensectomy with and without removal of the peripheral lens capsule [Comparative Study; Journal Article]. Eye (Lond), 33(9), 1472–1477. http://doi.org/10.1038/s41433-019-0435-x Tsukuda, M., Ito, Y., Nojima, K., Kayano, T., & Honda, J. (2022). Development and Validation of the COVID-19-Related Stigma Scale for Healthcare Workers (CSS-HCWs) [Journal Article; Research Support, Non-U.S. Gov't; Review]. Int J Environ Res Public Health, 19(15) http://doi.org/10.3390/ijerph19159641 Vagge, A., Gunton, K. B., & Schnall, B. (2018). A pilot study using electronic reminders for amblyopia treatment [Journal Article]. Strabismus, 26(4), 184–190. http://doi.org/10.1080/09273972.2018.1526959 Wallace, M. P., Stewart, C. E., Moseley, M. J., Stephens, D. A., & Fielder, A. R. (2013). Compliance with occlusion therapy for childhood amblyopia [Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't]. Invest Ophthalmol Vis Sci, 54(9), 6158–6166. http://doi.org/10.1167/iovs.13-11861 Wei, G. (2022). Impact of the Interaction Model of Client Health Behavior on the Physical and Psychological Health of Patients with Limb Fracture [Journal Article]. Iranian Journal of Public Health, 51(9), 2060–2068. http://doi.org/10.18502/ijph.v51i9.10561 Yangzes, S., Kaur, S., Gupta, P. C., Sharma, M., Jinagal, J., Singh, J., & Ram, J. (2019). Intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life [Journal Article]. European Journal of Ophthalmology, 29(3), 304–308. http://doi.org/10.1177/1120672118790193 Younas, A., & Porr, C. (2018). A step-by-step approach to developing scales for survey research. Nurse researcher, 26(3), 14–19. http://doi.org/10.7748/nr.2018.e1585 Table Table 1 Exploratory factor analysis results of compliance scale for postoperative visual function rehabilitation in children with congenital cataract (n=225) Item Interaction Intrinsic motivation Emotional reaction Cognitive appraisal Background factor 1.When I did not achieve the expected recovery effect, the medical staff would give me timely guidance 0.84 0.137 0.147 0.254 0.009 2. Medical staff will ask regularly to assess the child's recovery and give advice 0.809 -0.053 0.039 -0.022 0.251 3. I can get timely guidance when I seek help from medical staff for problems in my recovery 0.783 0.224 0.176 0.141 0.019 4. Medical staff will guide and help me with visual rehabilitation methods 0.655 0.28 0.229 0.237 0.027 5. When my child has blurred vision (redness and swelling, wound bleeding and other conditions) I will seek medical attention in time 0.127 0.765 -0.132 0.015 0.085 6. I believe that postoperative visual function rehabilitation can promote visual recovery 0.22 0.701 0.318 0.202 0.066 7. I care very much about my child's vision in the future and am willing to work hard for it 0.208 0.68 0.409 0.018 -0.021 8. I will patiently guide children to cooperate when they resist -0.195 0.641 0.143 0.137 0.32 9. My family members and I have the same view on how to carry out the child's rehabilitation 0.255 0.502 0.377 0.047 -0.112 10. In the process of recovery, I can get encouragement and supervision from my family members 0.211 0.35 0.788 -0.03 0.066 11. When I encounter problems in visual rehabilitation for my child, my family members will assist me 0.12 0.359 0.769 0.026 -0.034 12. I have plenty of time for my child's visual rehabilitation 0.075 -0.19 0.749 0.307 0.168 13. Since the beginning of rehabilitation, my child has been rehabilitating according to the regulations, and sometimes the compliance is poor 0.161 -0.069 0.048 0.841 0.088 14. My child is capable of visual rehabilitation as long as prescribed 0.109 0.179 0.033 0.832 -0.022 15. I can help children complete visual rehabilitation 0.227 0.305 0.284 0.559 0.228 16. I will choose video, painting and other ways to guide children to recover -0.179 0.219 0.089 0.049 0.865 17. I understand the specific methods and processes of children's visual function rehabilitation 0.421 0.046 0.05 0.043 0.67 18. There are patients around me who encourage and communicate with each other about their feelings of visual rehabilitation 0.432 -0.04 -0.025 0.122 0.594 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 19 Oct, 2023 Reviews received at journal 15 Oct, 2023 Reviewers agreed at journal 06 Oct, 2023 Reviewers agreed at journal 05 Oct, 2023 Reviewers invited by journal 05 Oct, 2023 Editor assigned by journal 04 Sep, 2023 Submission checks completed at journal 04 Sep, 2023 First submitted to journal 31 Aug, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3313057","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":230822600,"identity":"f208dcf0-b8e4-4471-83c1-d4abe5c6243e","order_by":0,"name":"Yanan Zhang","email":"","orcid":"","institution":"Guangzhou Women and Children Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yanan","middleName":"","lastName":"Zhang","suffix":""},{"id":230822601,"identity":"25d66a40-4165-43b3-b3cf-2ae0a8348c2d","order_by":1,"name":"Wanhua Xie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYDACZjB5AMhgPnDgQwVJWtjZEg/OOEO8XUAt/DzGh3lbiFBrcJz5mMTPHXcS+5t5PhzgbWCQ5xc7gF+LZDNbmmTvmWeJMw7zbjgguYPBcObsBPxa+Jl5zG7wth1ObABpMTzDkGBwm4AWNmb+bzf/ArXMP8zz4EBiGxFagLaw3QbZsuEwD8OBg8RoAfrF/Lds22HjjYfZDA42nJEg7BeD84cfG75tOyw7D8j4/KfCRp5fmoAWdCBBmvJRMApGwSgYBdgBALZ1Sx97mY74AAAAAElFTkSuQmCC","orcid":"","institution":"Guangzhou Women and Children Medical Center","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Wanhua","middleName":"","lastName":"Xie","suffix":""},{"id":230822602,"identity":"3495aaff-878c-4fc2-a0e8-9fe25d070eb6","order_by":2,"name":"Daoman Xiang","email":"","orcid":"","institution":"Guangzhou Women and Children Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Daoman","middleName":"","lastName":"Xiang","suffix":""}],"badges":[],"createdAt":"2023-08-31 09:44:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3313057/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3313057/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":42817711,"identity":"9341f51f-2df2-4dd5-b77a-9ae32b6f6697","added_by":"auto","created_at":"2023-09-08 09:53:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":253978,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3313057/v1/32acda59-54cc-4f24-9aca-61301c972059.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Develop and test the reliability and validity of the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eCongenital cataract refers to the opacity of the lens in early infancy. The incidence of congenital cataract in China is 0.5\u0026permil;~5.6\u0026permil;, and Asia is the most common region of congenital cataract(Lenhart \u0026amp; Lambert, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Congenital cataract is mainly treated by surgery to remove the lens(Eibenberger et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), but the postoperative visual recovery depends on long-term systematic visual function rehabilitation(Lagr\u0026egrave;ze, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Stech et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Yangzes et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Visual function rehabilitation after congenital cataract surgery includes refractive correction, patching therapy and amblyopia training therapy. The compliance of visual function rehabilitation is the key factor affecting the effect of visual function rehabilitation(Chougule et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018a\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). High compliance can help to make up for the poor postoperative visual recovery caused by delayed treatment, while low compliance will directly lead to Amblyopia(Bronsard et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Therefore, it is very important to accurately evaluate the postoperative visual function rehabilitation compliance of children and conduct standardized nursing intervention as soon as possible. However, the existing assessment scales related to visual function compliance mainly include self-compiled questionnaires(Cao et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Chougule et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018b\u003c/span\u003e; Drews-Botsch et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Pradeep et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Self-compiled questionnaires are mostly designed by researchers according to the research purpose, and the design lacks theoretical basis. At the same time, the questionnaire is suitable for children with amblyopia and children with patch-up therapy, and lacks specificity for the evaluation of visual function rehabilitation compliance of children with congenital cataract(Wallace et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In addition, the existing scales lack the evaluation of medical staff, surrounding environment, parents and other aspects of compliance, so the existing scales are difficult to accurately evaluate the postoperative visual function rehabilitation compliance of children with congenital cataract. Interaction Model of Client Health Behavior (IMCHB) is suitable for promoting health behaviors during the transition period and at home, especially for chronic diseases(Cho et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Kim et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The rehabilitation of visual function in children with congenital cataract after surgery is mainly completed at home, and it needs long-term adherence to the rehabilitation. In view of this, based on the IMCHB, this study developed the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract and tested its reliability and validity, so as to provide an effective tool for the assessment of postoperative visual function rehabilitation compliance of children with congenital cataract.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cp\u003e2.1 Instrument development \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.1.1 Items generation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCox's Interaction Model of Client Health Behavior (IMCHB) was used to design the item content of postoperative visual function rehabilitation compliance assessment tool for children with congenital cataract, so as to achieve the coverage of compliance by children, caregivers and medical staff. And make it applicable to the nursing of congenital cataract. The treatment compliance of children is affected by the uniqueness of children and the interaction between patients and health educators(Cox, 2003). The uniqueness of children is affected by background elements, intrinsic motivation, cognitive evaluation, and emotional response. Combined with the characteristics of postoperative visual function rehabilitation in children with congenital cataract, five dimensions of the postoperative visual function rehabilitation compliance scale for children with congenital cataract were preliminarily formulated, which were: ① Background factors: family and social factors, environmental resources; ② Intrinsic motivation: patients can feel their own ability and autonomy, and provide them with self-rewards; ③ Cognitive evaluation: patients' perception of their own health status and influencing health behaviors; ④ Emotional response: the emotional experience that affects health behaviors and can hinder or promote cognitive activities; ⑤ Doctor-patient interaction: medical staff provide help with health-related information, professional skills, emotional support and decision control according to the characteristics of children(Cho et al., 2023; Shen et al., 2021; Wei, 2022).\u003c/p\u003e\n\u003cp\u003e\"congenital cataract /pediatric cataract /infant /children / pediatrics /visual function rehabilitation /refractive correction /occlusion treatment /amblyopia training \u0026nbsp; /questionnaire /measurement /assessment /scale development /scale customization /scale development /reliability /validity\" were used as search terms. CNKI, Wanfang, SinoMed, PubMed, Embase, and Web of Science were searched from the establishment of the database to February 2022. Related literature was read and collected, and a scale pool containing 30 items was initially developed based on Cox's Interaction Model of Client Health Behavior.\u003c/p\u003e\n\u003cp\u003eUsing the purposive sampling method and the principle of data saturation, 13 parents of children with congenital cataract who were treated in the ophthalmology clinic and inpatient department of a children's specialized hospital in Guangzhou from February 2022 to April 2022 were selected for semi-structured interviews. Interview Outline: ①How is your child's compliance with visual rehabilitation? What difficulties have you encountered? ②What factors do you think affect your child's compliance? ③What good methods do you have to improve children's compliance with covering treatment? ④What kind of help do you hope to get in the process of helping children with visual function rehabilitation? The research team sorted out and analyzed the interview data, and added 6 items according to the interview content.\u003c/p\u003e\n\u003cp\u003e2.1.2 The Delphi technique\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria of experts were: ① doctors should have master's degree or above, and nurses should have bachelor's degree or above; ② intermediate or above professional title; ③ Engaged in children's ophthalmology work, nursing management, clinical nursing work, psychology and other fields, with more than 10 years of work experience; ④ interested in this study.\u003c/p\u003e\n\u003cp\u003eConsultation\u0026nbsp;questionnaire includes three parts: the letter consultation instructions, the questionnaire and the basic information of the experts. The consultation instructions included the research background, purpose and significance, the definition of related concepts, the introduction of Delphi expert consultation and the instructions for filling in. The items and dimensions of the postoperative visual function rehabilitation compliance scale for children with congenital cataract were listed in the text of the questionnaire. Likert5 scale method was used to evaluate the items and dimensions, which were assigned 1~5 points from \"Not important\" to \"Very important\". Content validity was evaluated at the same time. Likert3 scale method was used to evaluate the applicability of each item and dimension, which was assigned 1~3 points from \"Not applicable\" to \"Applicable\". Experts were asked to explain why they chose not to apply or apply after modification. The basic information of experts included education background, professional title, research field, and working years. Experts self-rated their familiarity with this research question from four aspects: event experience, theoretical analysis, reference to domestic and foreign literature, and intuitive sense.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom April 2022 to June 2022, 15 experts were selected to evaluate the items of the scale. The researchers introduced the purpose, significance, theoretical basis and research methods of this study to experts in detail, and communicated with experts by telephone, WeChat or email to make experts fully understand and pay attention to this study. After two rounds of consultation, the experts' opinions tended to be consistent, and the consultation was finished. The items of the scale were supplemented, deleted and modified according to the criterion of importance assignment mean ≥3.5 and coefficient of variation ≤0.25(Cheon et al., 2022). According to the results of expert consultation, the items were revised and supplemented to form the first draft of the postoperative visual function rehabilitation compliance scale for children with congenital cataract. In the first round of consultation, 2 items were deleted, 3 items were modified, and 1 item was deleted. In the second round of consultation, no item was modified. There were 32 items in the revised scale.\u003c/p\u003e\n\u003cp\u003e2.1.3 Face validity test\u003c/p\u003e\n\u003cp\u003eConvenience sampling was used to select 30(Younas \u0026amp; Porr, 2018)\u0026nbsp;parents of children with congenital cataract who were treated in the Ophthalmology clinic of a children's hospital in Guangzhou for a pre-survey to evaluate the readability and operability of the scale items in June 2022. Thirty questionnaires were distributed and collected on the spot. The time of 30 caregivers to complete the pre-survey scale was (13.46±8.68) minutes, and 2 items were modified according to the feedback. Inclusion criteria: ① Children with lens opacity at birth or within the first year of life who met the diagnostic criteria of congenital cataract in the 7th edition of Zhufusang Practical Pediatrics; ② children ≤15 years old who need visual rehabilitation training after surgery; ③ The parents of the children agreed to rehabilitation after surgery and signed an informed consent. Exclusion criteria: ① Combined with mental disease, dementia, disturbance of consciousness, etc.; ② Complicated with serious infection and malignant tumor; ③ Retinopathy of prematurity, endophthalmitis, outer exudative retinitis, retinoblastoma and other causes of amblyopia requiring visual function rehabilitation; ④ Incomplete clinical and follow-up data.\u003c/p\u003e\n\u003cp\u003e2.2 Psychometric tests\u003c/p\u003e\n\u003cp\u003e2.2.1 Study participants\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe parents of children with congenital cataract who visited the outpatient and inpatient department of a children's hospital in Guangzhou from July 2022 to July 2023 were selected as the survey objects by the convenient sampling method. The inclusion and exclusion criteria were consistent with those of the pre-survey. According to the calculation method of sample size, the sample size of factor analysis should be 5-10 times of the number of items in the scale, and the sample size required for factor analysis should be more than 200 cases(Seo \u0026amp; Song, 2021; Younas \u0026amp; Porr, 2018). The first draft of the scale had 32 items, and considering 10% inefficiency, the sample size was 225 cases. This study has been approved by the Ethics Committee (2022209A01).\u003c/p\u003e\n\u003cp\u003e2.2.2. Data collection\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe general information questionnaire was designed by the research team on the basis of referring to the relevant literature, including the gender, age, type of cataract, complications, age and gender of parents.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe initial version of the Postoperative Visual Rehabilitation Compliance scale for Children with Congenital cataract included 5 dimensions and a total of 32 items. Each item was scored by Likert 5-point scale, and \"Completely inconsistent\" was scored by 1 point, \"Less consistent\" was scored by 2 points, \"Generally consistent\" was scored by 3 points, \"More consistent\" was scored by 4 points, \"Completely consistent\" was scored by 5 points. Three items including \"my child is not willing to accept visual function rehabilitation\", \"my child has not serious behavior such as stealing and slacking in the visual function rehabilitation\", and \"it is difficult for me to carry out visual function rehabilitation for my child\" were scored in reverse.\u003c/p\u003e\n\u003cp\u003eThe researchers introduced the purpose and significance of this study to the parents in uniform instructions. After obtaining their consent, a questionnaire was filled out on the spot. The questionnaires were filled out with one-to-one guidance from the researchers, and the questionnaires were collected on the spot. If there are any missing items, fill in on the spot to ensure the completeness of the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.2.3 Data analysis\u003c/p\u003e\n\u003cp\u003eFrequency analysis method, discrete trend method, critical ratio method, correlation coefficient method, Cronbach's α coefficient, commonality and factor load were used to test the discrimination of each item. Item deletion criteria: ① Frequency analysis method: Responses were focused on specific choices (over 80%) or an option was not answered at all to consider removal. ② Discrete trend method: items with standard deviation \u0026lt; 0.75 should be deleted(Kuramochi et al., 2021). ③ Critical ratio method: the scale scores were sorted from small to large, and the corresponding values of 27% and 73% were used as the upper limit value and the lower limit value for dividing the low group and the high group, respectively, to compare whether there was any difference in the scores of each item between the low group and the high group. If there was no difference in the scores of the two groups, the discrimination of the item was poor, and it was considered to delete. ④ Correlation coefficient method: if the correlation coefficient with the total score of the scale was not statistically significant or less than 0.3, it was considered to delete the items(Cheon et al., 2022). ⑤Cronbach's α coefficient: after removing an item, Cronbach's α coefficient increased greatly, so consider deleting it; ⑥commonality and factor load：the items with factor loading value ≥0.4 were retained.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eItem-level content validity index (I-CVI)\u0026nbsp;of postoperative visual function rehabilitation compliance scale for children with congenital cataract and scale-level content validity index (S-CVI)\u0026nbsp;. If I-CVI ≥0.70 and S-CVI ≥0.80, the content validity of the scale was good(Cheon et al., 2022).\u003c/p\u003e\n\u003cp\u003eExploratory Factor Analysis (EFA) was used to test the construct validity of the scale. In the exploratory factor analysis, the Kaiser-Meyer-Olkin (KMO) index and Bartlett’s sphericity test were applied to confirm that the data were appropriate for factor analysis. The KMO index ranged from 0 to 1, with the closer to 1 indicating a stronger correlation between the variables the more suitable for factor analysis; Principal component analysis (PCA)\u0026nbsp;and maximum variation method were used for orthogonal axis rotation. The common factors with eigenvalues \u0026gt; 1 and cumulative variance contribution rate \u0026gt; 40% were selected, and the items with factor loading value ≥0.4 were retained.\u003c/p\u003e\n\u003cp\u003eSPSS25.0 statistical software was used for data processing. Measurement data were expressed as (mean ± standard deviation), enumeration data were expressed as numbers ( percentage), and authority coefficient, effective questionnaire recovery rate, Kendall harmony coefficient and coefficient of variation were expressed as authority coefficient of experts, enthusiasm, coordination degree of opinions and moderation degree of opinions, respectively. P \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eCronbach's α coefficient and split-half reliability were used to evaluate the internal consistency of the total score and the scores of each dimension of the scale. In the fourth week after the formal investigation, 30 subjects were selected for repeated measurement to evaluate the test-retest reliability of the scale.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e3.1 Expert correspondence and preliminary survey results\u003c/p\u003e\n\u003cp\u003eA total of 15 experts were selected in this study. Their age was 36~58 (48.06±8.07) years, and their working years in related fields were 13~38 (25.47±8.18) years. There were 8 ophthalmic medical experts and 7 ophthalmic nursing experts. 8 senior titles, 5 associate senior titles and 2 intermediate titles; They came from Shanghai, Guangdong, Yunnan, Hebei, Henan, Fujian and Guangxi in China. The recovery rate of the two rounds of questionnaires was 100%. In the two rounds of expert consultation, the response rate of each question was 93.33%~100% and 100%, and the proportion of experts who put forward constructive revision suggestions was 46.67% (7/15) and 6.67% (1/15), the number of comments was 11 and 1, respectively. A total of 12 expert opinions were received in the two rounds. The expert index judgment coefficient (Ca) was 0.82, the expert index familiarity (Cs) was 0.83, and the expert authority coefficient (Cr) was 0.84. The coordination coefficient of expert opinions was 0.205 (p \u0026lt; 0.001). The coefficient of variation (CV) of experts' scores on the importance of each item was 0.125~0.248. The importance scores of each item ranged from 4.00 to 4.75, and the full score ratio ranged from 0.27 to 0.87.\u003c/p\u003e\n\u003cp\u003eAccording to the importance of items, the scale was scored and revised by experts. After the discussion of the research team, the experts proposed to ①Add \"careless behavior\" and revise it to \"careless behavior such as slacking and peeking.\" ② Delete \"I will try to communicate with the child and carry out visual function rehabilitation\" because most of the children are infants and have no cognitive ability. ③ Supplement I am very concerned about the child's future vision (and willing to work hard for it). ④ Combined the medical staff will regularly ask about my recovery, and the medical staff will regularly evaluate my recovery and give opinions. ⑤ Modify the statement \"I can’t help my child to rehabilitate visual function\" to \"it is difficult for me to rehabilitate my child's visual function\". ⑥Modify the statement \"The attitudes and views of others around me will affect my enthusiasm for the rehabilitation of my child\" to \"The attitudes of other parents will affect my enthusiasm for the rehabilitation of my child\". After the pre-survey, according to the caregiver's feedback, \"My child cannot accept visual function rehabilitation\" was revised to \"My child is not willing to undergo visual function rehabilitation\"; \"I think my family life environment is very stable and there is no significant change\" was revised to \"My child's visual function rehabilitation has no effect on my family life\". Finally, a test version of the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract was formed with 32 items.\u003c/p\u003e\n\u003cp\u003e3.2 General information of respondents\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 230 questionnaires were distributed and 225 valid questionnaires were collected, with an effective recovery rate of 97.83%. There were 149 males (66.2%) and 76 females (33.8%), with an average age of (4.32±2.72) years. 78 (34.7%) were unilateral and 147 (65.3%) were bilateral. 178 (79.1%) had no complications and 47 (20.9%) had complications. There were 68 fathers (30.2%), 150 mothers (66.7%), and 7 others (3.1%), with an average age of (33.13±5.644) years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.3 Results of item analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrequency analysis method showed that the response rate of each item of the 32 items in the questionnaire was 100%, and no item had a frequency of more than 80% on an option, and no item had a frequency of 0 on an option. Discrete trend method showed that the standard deviation of 3 items was less than 0.75; Critical ratio method showed that 2 items with no difference between the two groups (p \u0026gt; 0.05); Correlation coefficient method showed that the correlation coefficient between the scores of 7 items and the total score of the scale was less than 0.3; Cronbach's alpha coefficient method showed that no entries met the deletion criteria; commonality and factor load method showed that 2 items \u0026lt;0.4. According to the comprehensive screening strategy, 14 items were finally removed.\u003c/p\u003e\n\u003cp\u003e3.4 Validity analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.4.1 I-CVI of the Postoperative Visual Rehabilitation Compliance scale for children with congenital cataract ranged from 0.730 to 1.000. The S-CVI was 0.963.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.4.2 EFA was used to test the construct validity of the scale, and Bartlett's spherical test \u003cem\u003ex\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e value was 2070.843 (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), KMO index was 0.734 \u0026gt; 0.7, indicating that it was suitable for factor analysis. A total of 5 factors with eigenvalues \u0026gt; 1 were extracted by principal component analysis and maximum variance rotation, and the cumulative variance contribution rate was 68.151%. They were named as background factors, intrinsic motivation, cognitive evaluation, emotional response, and doctor-patient interaction (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.5 Reliability analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Cronbach's α coefficient of the scale was 0.855, and the Cronbach's α coefficient of each dimension was 0.850, 0.725, 0.746, 0.720, 0.658. The total split-half reliability of the scale was 0.778, and the split-half reliability of each dimension was 0.787, 0.779, 0.787, 0.646, 0.644. The total test-retest reliability of the scale was 0.859, and the test-retest reliability of each dimension was 0.898, 0.822, 0.740, 0.847, 0.754.\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003e4.1 The postoperative visual function rehabilitation compliance scale for children with congenital cataract constructed in this study is scientific.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the theoretical framework of IMCHB, the first draft of the scale was prepared through literature review and qualitative interviews. The theoretical basis and the formation process of the first draft were scientific and standardized. The items of the scale were adjusted through the Delphi expert consultation method. The 15 experts involved were all experts in related fields with intermediate or above professional titles, and 8 of them had master's degrees or above and had good academic research levels. The positive coefficient of the two rounds of expert consultation was 100%, and the enthusiasm of experts to participate in this study was high. The authority coefficients of experts were 0.84, Cr ≥ 0.8, and the authority of the selected experts was high(Tsukuda et al., 2022). Kendall's harmony coefficient was 0.205 (p \u0026lt; 0.001), and the coefficient of variation was 0.125-0.248, all above 0.25, indicating that the experts' opinions were highly consistent, and the degree of coordination was good. The importance scores of each item ranged from 4.00 to 4.75, all of which were higher than 3.5. The full score ratio ranged from 0.27 to 0.87, all above 0.20, suggesting that the experts had a high degree of concentration on the importance of each item.\u003c/p\u003e\n\u003cp\u003eEFA extracted a total of 5 common factors with characteristic value \u0026gt; 1. The final scale consisted of 5 dimensions, including background factors, intrinsic motivation, cognitive evaluation, emotional response, doctor-nurse interaction, which were in line with the theoretical framework of IMCHB, and the attribution of other dimensions and items were basically consistent with the theoretical hypothesis. The loading value of each item on the common factor was greater than 0.4, indicating that the structure of the scale was stable(Cheon et al., 2022). The cumulative variance contribution rate was 68.151%, indicating that the information contained in the scale could comprehensively reflect the postoperative compliance of children with congenital cataract. The I-CVI was not less than 0.70, and the S-CVI was not less than 0.80, indicating that the scale had good content validity(Seo \u0026amp; Song, 2021). In this study, the I-CVI and S-CVI were 0.730~1.000 and 0.963, respectively, indicating that the postoperative visual function rehabilitation compliance scale for children with congenital cataract had high content validity.\u003c/p\u003e\n\u003cp\u003eThe Cronbach's α coefficient of the scale was \u0026gt; 0.8, the Cronbach's α coefficient of each dimension was \u0026gt; 0.6, and the split-half reliability was \u0026gt; 0.7, indicating that the scale had good internal consistency(Feng et al., 2022). The test-retest reliability was \u0026gt; 0.7, indicating that the scale had good cross-time stability and external consistency(Cheon et al., 2022). In conclusion, the development process of the postoperative visual rehabilitation compliance scale for children with congenital cataract is scientific and standardized, and it has good reliability and validity and is scientific.\u003c/p\u003e\n\u003cp\u003e4.2 The postoperative visual function rehabilitation compliance scale for children with congenital cataract constructed in this study is practical\u003c/p\u003e\n\u003cp\u003eEffective evaluation of postoperative visual function rehabilitation compliance in children with congenital cataract is the basis for standardizating postoperative visual function rehabilitation and promoting visual recovery in children with congenital cataract. Accurate compliance assessment tools are the prerequisite for medical staff to carry out targeted nursing intervention and health guidance. However, at present, there is no assessment scale for compliance of children with congenital cataract, and self-designed questionnaires are mostly used. The questionnaire preparation process is not standardized and rigorous, and the dimension is not comprehensive enough, and the influence of external factors is not considered, but only the cognition and attitude of children and parents are considered(Handa \u0026amp; Chia, 2019; Vagge et al., 2018). The questionnaire compiled in this study includes 5 dimensions, which can reflect the cognition, motivation, emotional response and the interaction between doctors, nurse and patients in the process of visual function rehabilitation of children with congenital cataract in a more comprehensive way, which conforms to the IMCHB. This scale is suitable for dynamic assessment of children's compliance at different time periods during home rehabilitation, and medical staff can identify the internal reasons affecting children's health behavior and compliance behavior with minimum human and material resources, which is conducive to realizing the optimization of self-management of postoperative visual function rehabilitation in children with congenital cataract. In addition, there are a total of 18 items in this study, which takes less time to fill in and is convenient for clinical application.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThe visual function rehabilitation compliance scale for children with congenital cataract developed in this study is scientific and practical, and can be used as a measurement tool for medical staff to continuously and dynamically evaluate the visual function rehabilitation compliance of children with congenital cataract after surgery. The main limitations of this study are as follows: the samples were only from a children's hospital in Guangzhou, and the source of samples was limited; No confirmatory factor analysis was performed. It is suggested that the sample size should be increased in the future, and the relevant visual function rehabilitation compliance scale should be selected as the calibration questionnaire to further verify the structural validity and calibration association validity of this scale.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Guangzhou Municipal Science and Technology Bureau (No: SL2022A03J01101；No: 202103000088).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yanan Zhang, Daoman Xiang and Wanhua Xie. The first draft of the manuscript was written by Yanan Zhang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Guangzhou Women and Children's Medical Center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors agreed with the content and gave explicit consent to submit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study were collected by field investigation, and all authors agree to provide relevant data as far as possible without affecting the privacy of patients\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eBronsard, A., Geneau, R., Shirima, S., Courtright, P., \u0026amp; Mwende, J. (2008). 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Nurse researcher, 26(3), 14\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.7748/nr.2018.e1585\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1 Exploratory factor analysis results of compliance scale for postoperative visual function rehabilitation in children with congenital cataract (n=225)\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"740\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"top\"\u003e\n \u003cp\u003eInteraction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"top\"\u003e\n \u003cp\u003eIntrinsic motivation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"top\"\u003e\n \u003cp\u003eEmotional reaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"top\"\u003e\n \u003cp\u003eCognitive appraisal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"top\"\u003e\n \u003cp\u003eBackground factor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.When I did not achieve the expected recovery effect, the medical staff would give me timely guidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.84\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e2. Medical staff will ask regularly to assess the child\u0026apos;s recovery and give advice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.809\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e3. I can get timely guidance when I seek help from medical staff for problems in my recovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.783\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e4. Medical staff will guide and help me with visual rehabilitation methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.655\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e5. When my child has blurred vision (redness and swelling, wound bleeding and other conditions) I will seek medical attention in time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.765\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e6. I believe that postoperative visual function rehabilitation can promote visual recovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.701\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e7. I care very much about my child\u0026apos;s vision in the future and am willing to work hard for it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.68\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e8. I will patiently guide children to cooperate when they resist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.641\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e9. My family members and I have the same view on how to carry out the child\u0026apos;s rehabilitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.502\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e10. In the process of recovery, I can get encouragement and supervision from my family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.788\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e11. When I encounter problems in visual rehabilitation for my child, my family members will assist me\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.769\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e12. I have plenty of time for my child\u0026apos;s visual rehabilitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.749\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e13. Since the beginning of rehabilitation, my child has been rehabilitating according to the regulations, and sometimes the compliance is poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.841\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e14. My child is capable of visual rehabilitation as long as prescribed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.832\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e15. I can help children complete visual rehabilitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.559\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e16. I will choose video, painting and other ways to guide children to recover\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.865\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e17. I understand the specific methods and processes of children\u0026apos;s visual function rehabilitation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.67\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.760487144790254%\" valign=\"bottom\"\u003e\n \u003cp\u003e18. There are patients around me who encourage and communicate with each other about their feelings of visual rehabilitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.667117726657645%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231393775372124%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.284167794316645%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.148849797023004%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.907983761840324%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.594\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Congenital cataract, Visual function rehabilitation, Compliance, Scale development, Reliability, Validity, Interactive models of health behaviors","lastPublishedDoi":"10.21203/rs.3.rs-3313057/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3313057/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e To develop the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract, and test its reliability and validity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e The interactive model of health behavior is taken as the theoretical framework, and the first draft of the scale was constructed through literature review, qualitative interview and Delphi expert correspondence. From June 2022 to July 2023, convenience sampling was used to select 225 children with congenital cataract who were treated in the ophthalmology clinic and inpatient department of a children's hospital in Guangzhou to conduct a questionnaire survey. The items of the scale were revised and the reliability and validity were tested.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003eThe postoperative visual rehabilitation compliance scale for children with congenital cataract included 5 dimensions and 18 items. Exploratory factor analysis extracted a total of 5 common factors, and the cumulative variance contribution rate was 68.151%. The item-level content validity index ranged from 0.730 to 1.000. The content validity index of the scale was 0.963. The total Cronbach's α coefficient, split-half reliability and test-retest reliability of the scale were 0.855, 0.778 and 0.859, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003eThe postoperative visual function rehabilitation compliance scale for children with congenital cataract has good reliability and validity, which can be used to evaluate the postoperative visual function rehabilitation compliance of children with congenital cataract, and can provide reference for the clinical development of standardized nursing programs for children with congenital cataract.\u003c/p\u003e","manuscriptTitle":"Develop and test the reliability and validity of the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-08 09:44:30","doi":"10.21203/rs.3.rs-3313057/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-10-19T04:30:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-10-15T07:33:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d5077cef-eb09-44ef-af2c-bee83639fe31","date":"2023-10-06T14:32:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"ca4e14c9-cfe1-44ab-8d1d-cda89cda4f14","date":"2023-10-05T12:40:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-10-05T12:27:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-09-05T03:53:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-09-04T12:51:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2023-08-31T09:40:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cbd8e79d-a9a2-485b-b81e-c01d1142b935","owner":[],"postedDate":"September 8th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-06-05T07:50:54+00:00","versionOfRecord":[],"versionCreatedAt":"2023-09-08 09:44:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3313057","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3313057","identity":"rs-3313057","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}