A Turkish Validity and Reliability Study of the Chronic Disease Adaptation Scale

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Methods This methodological study was conducted between July 2024 and July 2025, involving 518 chronic patients who visited the internal medicine outpatient clinic of a university hospital. Data were collected using the "Personal Information Form" and the CIAS. Results According to confirmatory factor analysis, the factor loadings of the scale ranged from 0.300 to 0.850, and a five-dimensional structure was confirmed. The scale's fit indices were “ X² = 495.17, df = 140 (p < 0.05), X²/df = 3.53, RMSEA = 0.070, CFI = 0.94, SRMR = 0.057, TLI = 0.92, RMR = 0.044, and AIC = 652.03 ”. The overall Cronbach’s α coefficient of the scale was 0.80, and for the sub-dimensions, it ranged between 0.67 and 0.80. The validity and reliability of CIAS were proven without any changes to its original form. Conclusion This study determined that the adapted CIAS consists of five subscales and 19 items, is compatible with Turkish culture, and is a valid and reliable scale. Adaptation Chronic Disease Nursing Patient. Validity Reliability Figures Figure 1 Introduction Despite advances in medical technology and treatment methods in the 21st century, chronic diseases continue to be a global health problem. According to the World Health Organisation (WHO) 2023 report, 74% of deaths worldwide are caused by chronic disease[ 1 ]. In Turkey as well, chronic diseases such as cardiovascular diseases, diabetes, and chronic respiratory diseases are significant causes of mortality and morbidity[ 2 ]. Due to advancements in healthcare services and increasing life expectancy, many people will live with one or more chronic diseases[ 3 ]. The long-term course of chronic diseases deeply affects not only patients' physical health but also their psychosocial well-being, requiring a multidisciplinary management approach[ 1 ]. Individuals with chronic diseases face various challenges, such as disease symptoms, the treatment process, restrictions in daily life, deterioration in family relationships, changes in body image, weakened coping skills, negative changes in lifestyle, loss of self-confidence, concerns about death, and questioning the meaning of life. Such experiences can significantly affect an individual's ability to adapt to their illness[ 4 ]. Adaptation is a complex and dynamic process that requires cognitive, emotional, and behavioural efforts[ 5 ]. Adjustment is a key element in the management of chronic diseases and is the process of accepting changes from the internal and external environment. [ 6 ] 6 6 6 6 66 Adjustment to chronic diseases is the process by which individuals take their illness, participate in treatment and care processes, and learn to live with the disease[ 7 ] Adaptation to chronic illness is essential because a lack of adaptation can lead to various psychological and social difficulties in patients [ 5 ]. Chronic illness enables individuals to adapt to their condition, understand their situation, and make informed decisions about how to proceed.[ 6 ] The adaptation process can often be frightening and challenging for individuals with chronic illnesses[ 5 ]. Therefore, nurses should identify patients' levels of adaptation, the adaptation difficulties they encounter, and the underlying causes of these difficulties, and then plan, implement, and evaluate solution-focused nursing interventions. Nursing interventions aimed at addressing compliance problems facilitate the individual's acceptance of their illness, support their active participation in the treatment process, contribute to the sustainability of their social relationships, and help them set new goals in their lives [ 6 ]. To plan nursing interventions aimed at reducing or eliminating adaptation problems observed in chronic patients, it is first necessary to identify these problems[ 6 ]. In Turkey, Atik and Karatepe (2016) developed the "Scale Development Study: Adaptation to Chronic Illness," and Vicdan and Birgili (2018) developed the " Adaptation to Chronic Diseases Scale(ACIS)"[ 6 , 8 ]. Atik and Karatepe (2016) evaluated the adaptation to chronic illnesses by addressing the physiological, psychological, and social dimensions of individuals with chronic diseases, while ACIS also evaluated the spiritual (moral) dimension in addition to the physiological, psychological, and social dimensions of patients.[ 6 ] “ The Chronic Illness Adjustment Scale (CIAS) ” was developed to address the need for a disease adjustment scale that is valid for individuals with various types of chronic diseases. The aim of developing this tool was to create an acceptable alternative to disease-specific and context-specific tools. CIAS can explain behavioural and emotional dimensions together. CIAS also includes positive adaptation indicators such as optimism, hope, reinterpretation, and coping mechanisms. It not only identifies problems but also highlights the individual's strengths [ 9 ]. Additionally, CIAS is concise and time-efficient, comprising approximately 19 items. This study aims to demonstrate that CIAS is a valid and reliable measurement tool for the chronic patient population in Turkey. The results of this study will help healthcare professionals assess the adaptation levels of individuals with chronic illnesses and develop evidence-based interventions to enhance adaptation. Additionally, it will provide an essential contribution to research on adherence in chronic diseases for researchers. Research questions • Is the Chronic Disease Adherence Scale valid? • Is the Chronic Disease Adherence Scale reliable? Materıals and Methods Design This study was methodologically designed to examine the validity and reliability of the Turkish version of the Chronic Disease Adjustment Scale. Participants and Sample There were a total of 950 individuals who were included in the study population. These patients were seen at the outpatient clinic for internal medicine at a university hospital between the months of July 2024 and July 2025. The sample consisted of patients who met the study criteria (aged 18 years or older, diagnosed with a chronic illness at least 6 months prior, no history of psychiatric disorders, and capable of communicating effectively) and agreed to participate in the study during the specified dates. In studies with a methodological design, the sample size is determined based on the total number of items in the scale used. While the subject-item ratio is generally recommended to be 10:1 in the literature, it is reported that this ratio can be reduced, but should be maintained at least at a 2:1 level. [ 10 , 11 ]In this context, a sample size of at least 95 and up to 190 participants is required for the 19-item Chronic Disease Compliance Scale. During the research process, 320 patients did not meet the criteria, and 112 patients declined to participate, resulting in a final sample of 518 patients. Data Collection Tools Data were collected using the "Personal Information Form" and the "Chronic Illness Adjustment Scale (CIAS)". Personal Information Form The form includes questions about the patients' age, education level, gender, marital status, current chronic illnesses, employment status, the year of diagnosis and substance use status. Chronic Illness Adjustment Scale (CIAS) : CIAS was developed by Padhy et al. in 2023 to assess the adaptation of individuals with chronic illnesses to their condition [ 9 ]. The scale consists of 19 items. It is a 4-point Likert scale, with items ranging from "Never" (1) to "Always" (4). The scale has five subscales. The subscales are: Illness denial behaviour (items 1–4), Illness-compliant behaviour (items 5–8), Strategic positive engagement (items 9–12), Emotional support for illness (items 13–15), and Emotional engagement (items 16–19). Items 1–4 and 16–19 are reversed. As the scale score increases, compliance with chronic illnesses increases. The values of Cronbach's alpha range from 0.76 to 0.91 in the scale that was initially proposed. Adaptation Process Language and Content Validity : In this study, a systematic approach consisting of five stages ("forward translation, expert review, back translation, pre-testing, and final version") was used in accordance with WHO translation guidelines [ 12 ]. With regard to this particular scope, CIAS was translated into Turkish by two specialists in the language. It was then distributed to ten experienced nurses who specialize in internal medicine. In order to evaluate the content and scope validity of the scale, it was requested that experts provide their thoughts. "The Content Validity Index (CVI)" was utilized in order to evaluate the opinions of the specialists. An evaluation of the expert opinions was conducted using the Davis technique, as stated by Çapık et al. (2018) [ 13 ] Experts were requested to rank each item on a scale from one to four in order to identify the degree of consistency that exists between the original English items of the scale and their Turkish translations, as well as to evaluate the ease with which the statements were rendered. The scoring system was described in the following manner: "1 point: not suitable, 2 points: somewhat suitable (revision of the statement is necessary), 3 points: quite suitable (suitable but minor changes are necessary), 4 points: highly suitable." From the total number of experts, the CVI value was determined by dividing the number of experts who assigned three and four points to the items on the scale by the total number of experts. A number of adjustments were made to the items on the scale in response to the comments and suggestions that were received from the specialists. The scale was then translated back into English by a third party who was not involved in the initial translation process. This was done after the necessary modifications had been made. The final version of the scale was delivered to the researcher who was responsible for developing the scale, and the researcher received positive comments regarding the appropriateness of the scale. Following the completion of this step, the scale was tested on twenty people who were suffering from chronic illnesses in order to assess whether or not it was applicable to patients. The results of the interviews demonstrated that the scale form was easily comprehensible. The study did not take into account this particular data. Construct Validity : When it comes to analyzing scale structures, one of the fundamental goals of factor analysis is to ensure that construct validity is maintained. Confirmatory factor analysis (CFA) was utilized in this investigation to investigate construct validity. This was done after confirming that linguistic equivalence and content validity were first established. CFA is a method that is used to evaluate whether the items that make up the factors are sufficiently related to the relevant variables and to generate validity evidence, particularly in situations when scales that were produced in one culture are converted to be used in other cultures[ 14 ]. Prior to doing factor analysis, "the Kaiser-Meyer-Olkin (KMO)" sample adequacy test and "Bartlett's Sphericity Test" were utilized in order to ascertain whether or not the data were suitable for analysis. According to Secer (2020), a KMO value that is greater than 0.60 and a Bartlett test that is statistically significant both suggest that the sample is sufficient and that the data set is appropriate for perform factor analysis. In the process of DFA, fit indices were investigated in order to ascertain the structure that was best suitable for the scale. The following fit indices were utilized: "the Relative Chi Square Index (CMIN/DF), the Root Mean Square Error of Approximation (RMSEA), the Comparative Fit Index (CFI), the Tucker Lewis Index (TLI), the Standardized Root Mean Square Residual (SRMR), and the Root Mean Square Residual (RMR)"[ 15 , 16 ]. Listed below are the acceptable levels of fit that can be achieved: "CMIN/DF is less than 5, RMSEA is less than 0.08, CFI and TLI are greater than 0.90, and SRMR and RMR are less than 0.08" [ 11 , 17 ] A further requirement is that the factor loadings of the items must be more than 0.30. It is regarded to be moderate for factor loadings to fall between 0.30 and 0.59, whereas factor loadings that are at or above 0.60 are considered to be high [ 14 ]. Reliability Analyses Internal consistency coefficients, item-total correlations, and test-retest correlations were investigated in order to conduct the reliability analysis of the Turkish version of the CIAS. The Cronbach's Alpha coefficient for the scale as a whole was ≥ .70, item-total correlations were > .30, and test-retest correlations, measured with a two-week interval, were > .70, all of which were determined to be acceptable levels [ 11 , 18 ]. The coefficient indicating internal consistency shows whether the items measure the same concepts and whether the items are actually related to what is being measured. The reliability coefficient of a measurement tool should be as close to 1 as possible to be considered an indicator of sufficient reliability. For the purpose of determining the reliability of the scale, the Cronbach's alpha coefficient and the McDonald's Omega reliability analysis methodology were utilized. A reliability coefficient above 0.70 is considered sufficient for the scale to be considered reliable[ 11 , 19 ]. The item-total correlation coefficient is a commonly used indicator in item selection analyses to understand the degree to which scale items are related to the scale as a whole. A high correlation coefficient for an item indicates that the measured item has a high correlation with the theoretical structure of that item and is sufficiently effective in measuring the desired behaviour. It is recommended that the item-total correlation coefficient of measurements obtained from a scale be > .30[ 20 ]. Test-retest measurements evaluate the consistency of an instrument over time and are one of the most commonly used reliability analyses. The closer the correlation coefficient approaches 1, the higher the reliability of a measurement tool is considered to be. To determine whether measurements obtained from a scale remain unchanged over time, the correlation coefficients between the obtained test-retest scores must show a positive, high-level relationship, and this score must be at least 0.70 for acceptability [ 11 ] 111111111111 (Seçer, 2020) 1110 (Seçer, 2020)(Seçer, 2020)[ 11 ] In addition, the intraclass correlation coefficient (ICC) was utilized in the process of administering test-retest assessments. "The Interpersonal Correlation coefficient (ICC)" value can range from 0 to 1, with the closer the value is to 1, the more consistent the measurements are[ 21 ] Statistical Analysis Both SPSS 27 and LISREL were utilized in order to carry out the analysis of the data. In order to examine the data, descriptive statistical methods such as frequency, percentage, mean, and standard deviation were utilized. A thorough analysis was performed on the item-total correlation values as well as the total Cronbach's alpha coefficients of the scale items. In order to determine whether or not the scale possessed construct validity, the data were imported into the LISREL computer, and a number of different fit indices were investigated. McDonald's Omega and Cronbach's alpha coefficient reliability analysis were both computed in order to determine the degree to which the scale may be relied upon effectively. In addition, the test-retest approach was utilized in order to investigate the time-dependent consistency characteristic of the scale. The results that were deemed statistically significant were those with a p-value less than 0.05. Research Ethics The Ethics Committee of a university (2024/03–16) gave their approval, and the hospital where the research was carried out gave their institutional authorization. Both of these approvals were received. Regarding the adaptation of CIAS to Turkish, official permission was received from the owner of the scale through the use of email. In compliance with the principles outlined in the Helsinki Declaration on Human Rights, the research was carried out according to the guidelines. After providing participants with an explanation of the goal of the study, written informed consent was obtained from each and every participant. Results Table 1 Demographic Characteristics of Participants Characteristics Number (n = 518) Gender Female Male 284 234 54.8 45.2 Marital status Married Single 370 148 71.4 28.6 Educational status Illiterate Literate Primary Secondary education High school Bachelor's degree and above 108 94 106 66 95 44 20.8 18.1 20.5 12.7 18.3 9.5 Employment status Yes No 132 386 25.5 64.5 Income status Less than income Equal to income Income exceeds expenses 186 290 42 35.9 56 8.1 Name of existing chronic disease Heart disease DM Hypertension Cancer Gastrointestinal diseases Respiratory diseases Kidney failure Rheumatic diseases Neurological diseases 55 130 108 48 32 59 15 27 44 10.6 25.1 20.8 9.3 6.2 11.4 2.9 5.2 8.5 Dependency status Independent Partially dependent Fully dependent No 352 131 35 68.0 25.3 6.8 Mean ± SD Min-Max Age (years) 55.14 ± 18.38 18–83 Diagnosis duration (years) 7.71 ± 6.71 1–4 DM = Diabetes mellitus; HT = Hypertension Among the participants, the age range was from 18 to 83 years old, with the average age being 55.14 ± 18.38 years. There were 54.8% of female participants, 71.4% of married participants, 20.8% of illiterate participants, 64.5% of unemployed participants, 56% of participants had an income that was equal to their expenses, 25% of participants had diabetes as their existing chronic disease, and 68% of participants were independent. Furthermore, it is worth noting that the duration of diagnosis varied from one to forty years, with an average of 7.71 years, with a standard deviation of 6.71 years (Table 1 ). Findings Related to Validity Content Validity According to the findings of the research, "the item-level content validity index (I-CVI)" varied from 0.90 to 1.00, whereas "the scale-level content validity index (S-CVI)" was determined to be 0.96. Construct Validity Before beginning the structural validity study, the KMO and Bartlett's Sphericity Test was utilized to determine whether or not the sample size was appropriate and whether or not the data set was suitable for analysis. The KMO value was found to be 0.792 after being determined. The outcome of the Bartlett's Sphericity Test was found to be statistically significant (x2 = 3564.322; p < 0.001). Without using AFA, a DFA analysis was carried out in order to successfully verify the validity of the existing five-subdimension structure that had 19 elements. Based on the findings of the DFA study, it was determined that the factor load values varied from 0.300 to 0.850, which is evidence that the structure consists of five subdimensions (Table 2 ). Table 2 Average and DFA Factor Loadings Results Scale Items Mean ± SD Factor Loadings F1 F2 F3 F4 F5 Item 1 3.24.± 0.85 0.79 Item 2 3.19± 0.87 0.82 Item 3 3.06 ± 0.85 0.69 Item 4 2.69± 1.003 0.580 Item 5 2.07± 0.748 0.520 Item 6 2.82± 0.839 0.840 Item 7 2.64± 0.874 0.780 Item 8 2.31± 0.801 0.680 Item 9 2.42± 0.946 0.850 Item 10 1.97± 0.984 0.600 Item 11 2.31± 0.818 0.41 Item 12 1.97 ± 0.984 0.310 Item 13 2.31± 0.858 0.740 Item 14 2.62± 0.925 0.710 Item 15 2.47± 0.831 0.720 Item 16 2.77± 0.729 0.750 Item 17 2.77± 0.792 0.540 Item 18 2.69± 0.796 0 Item 19 2.49± 0.932 0.3 Confirmatory Factor Analysis According to the results of the analysis, the DFA fit index values were obtained as follows. "X 2 = 495.17 df = 140 (p<0.05), X 2 /df = 3.53, RMSEA = 0.070, CFI = 0.94, SRMR = 0.057, TLI = 0.92, RMR = 0.044, and AIC = 652.03" (Table 3 ). Figure 1 depicts the PATH diagram that was developed throughout the process of doing the confirmatory factor analysis. Table 3 Confirmatory Factor Analysis Results Fit criteria Found Appropriate Acceptable Result x 2 /df ( CMIN/DF) 3.5 <2 < 5 Acceptable fit RMSEA 0.07 <0.05 0.95 > 0.90 Acceptable fit SRMR 0.057 < 0.05 < 0.08 Acceptable fit RMR 0.044 < 0.05 0.95 > 0.90 Acceptable fit AIC 595.17 "CFI: Comparative Fit Index; RMSEA: Root Mean Square Error of Approximation; RMR: Root Mean Square Residual; SRMR: Standardised Root Mean Square Residual; TLI: Tucker Lewis Index; AIC: Akaike Information Criterion" Table 4 Correlation values, reliability values Scale and sub-dimensions F1 F2 F3 F4 F5 CIAS Total α Ω F1 1 0.806 0.806 F2 0.463** 1 0.796 0.806 F3 0.261** 0.377** 1 0.714 0.676 F4 0.027 0.275** 0.335 1 0.766 0.768 F5 0.292** 0.163** 0.014 -0.140** 1 0.675 0.676 CIAS Total 0.710** 0.765** 0.660 0.454** 0.428 1 0.807 0.774 "**Correlation is significant at the 0.01 level (2-tailed); F: Factor; CIAS = Chronic Illness Adjustment Scale Factor 1. Illness denial behaviour: Factor 2. Illness-compliant behaviour: Factor 3. Strategic positive engagement: Factor 4. Emotional support for illness: Factor 5. Emotional engagement" After looking at Table 4 , it was discovered that there is a strong association between the different subscales of the scale. Based on the modest correlations that were found, it was clear that there was no issue with multiple linkages between the subscales. Findings Related to Reliability A calculation was made to determine the Cronbach's alpha coefficient for the scale. The value of the Cronbach's alpha coefficient for the "F1" subscale of the scale was 0.806, while the value for the "F2" subscale was 0.796, the value for the "F3" subscale was 0.714, the value for the "F4" subscale was 0.766, the value for the "F4" subscale was 0.796, the value for the "F5" subscale was 0.768, and the total Cronbach's alpha value for the scale was 0.807. Moreover, the Omega reliability values of the scale were as follows: 0.806 for the "F1" subscale, 0.806 for the "F2" subscale, 0.676 for the "F3" subscale, 0.768 for the "F4" sub-dimension, 0.676 for the "F5" sub-dimension, and 0.774 for the total scale were the results (Table 4 ). During the research process, test-retest measurements were administered to 30 participants at 15-day intervals to assess the scale's reliability over time. The correlation coefficients observed were r = 0.979 for the CIAS total, r = 0.959 for the "F1" subscale, and r = 0.992 for the "F2" subscale. These correlation values are statistically significant (p 0.05). Additionally, the Intraclass Correlation Coefficients (ICC) values obtained for the purpose of assessing test-retest reliability ranged from 0.909 to 0.970. Table 5 Test-retest results and mean scores (n = 50) Scale and sub-dimensions Scale Score Means Analysis Results ICC First Implementation X ± SD Second Implementation X ± SD r p t p F1 3.41 ± 0.56 3.46 ± 0.57 0.949** 0.000 -1.941 0.058 . 0.974 F2 3.21 ± 0.72 3.16 ± 0.69 0.960** 0.000 1.75 0.086 0.979 F3 3.21 ± 0.51 3.16 ± 0.48 0.914** 0 1.852 0.070 0.955 F4 3.10 ± 0.86 3.03 ± 0.87 0.761** 0.000 0.788 0.435 0.864 F5 3.12 ± 0.71 3.10 ± 0.68 0.824** 0.000 0.340 0.735 0.903 CIAS Total 3.21 ± 0.34 3.19 ± 0.31 0.828** 0.000 0.956 0.344 0.904 "**Correlation is significant at the 0.01 level (2-tailed); F: Factor; p < 0.05; ; r = Pearson Correlation Coefficient; t = Paired sample t test; ICC = Intraclass Correlation Coefficient; F: Factor; CIAS = Chronic Illness Adjustment Scale Factor 1. Illness denial behaviour: Factor 2. Illness-compliant behaviour: Factor 3. Strategic positive engagement: Factor 4. Emotional support for illness: Factor 5. Emotional engagement" Discussion Chronic diseases are long-term and often lifelong health problems that significantly affect not only individuals' physiological conditions but also their psychological, social, and emotional adjustment processes. The adaptation process in individuals with chronic diseases directly affects their ability to cope with the disease, their quality of life, and their overall psychosocial functioning. Therefore, measuring individuals' levels of adaptation to chronic diseases has become an essential need in both clinical practice and scientific research. CIAS is a measurement tool that evaluates individuals' coping and adaptation processes with chronic disease in a multidimensional manner[ 9 ]. In this study, the validity and reliability of the Turkish version of CIAS were evaluated. The findings indicate that the scale is a valid and reliable tool for assessing psychosocial adaptation in individuals with chronic disease. Content validity is an evaluation conducted in scale adaptation studies to establish the conceptual integrity of the translation and ensure consistency between the original scale and the adapted language[ 22 , 23 ]. This evaluation assesses the extent to which each item in the scale fulfils its intended purpose.[ 22 , 23 ]. To ensure the content validity of the scale, the I-CVI and S-CVI values must be 0.80 or above[ 24 , 25 ]. In line with this result, it was determined that the I-CVI values at the item level ranged between 0.90 and 1.00, while the S-CVI value was 0.96 in the current study. A review of the literature revealed that the obtained values are pretty high and that the Turkish content of the scale is sufficient in terms of scope[ 24 , 26 ] The results obtained, in line with expert opinions, indicate that the scale is suitable for assessing psychosocial adaptation in individuals with chronic illnesses and that there is strong consensus among experts[ 27 ]. To determine the validity of the structure and the adequacy of the data, KMO and Bartlett's Sphericity Test were performed before DFA. To indicate that the results are sufficient, Bartlett's sphericity test must be significant (p 0.60 [ 20 , 28 ]. In this study, the KMO value was found to be 0.792, and the Bartlett's sphericity test (x² = 3564.322; p < 0.001) was significant. In other words, the database and research sample used for factor analysis are sufficient. Factor analysis is performed to evaluate whether the items in the measurement tool represent a single group. [ 29 – 31 ] According to the analysis results, items with high correlations are grouped under a single factor[ 32 ]. DFA analysis was conducted without AFA to validate the measurement tool, which consists of 19 items and five sub-dimensions. Items with factor load values below 0.30 were removed from the scale. However, since the factor load values were between 0.300 and 0.850 in the DFA analysis of the current study, no items were removed[ 33 ]. The DFA conducted a test of construct validity, which revealed that the scale is consistent with the original structure. In the present study, the fit indices were considered in accordance with DFA to assess the suitability of the data. In the literature, a value of x2/df ≤ 3 indicates an excellent fit, while a value of RMSEA ≤ 0.07 is considered acceptable [ 11 , 15 – 17 ]. The fit indices obtained are within the limits accepted in the literature. This finding supports that the Turkish version of CIAS has a valid factor structure consisting of five sub-dimensions, similar to the original scale. In the current study, Cronbach's α internal consistency coefficient, item-total correlation, and test-retest analysis were used to evaluate the adaptation of CIAS into Turkish. The overall internal consistency coefficient of the CIAS ranged from 0.675 to 0.796 for the subscales and was determined as 0.807 for the total scale. According to the literature, the reliability of the scale increases as the Cronbach’s α value approaches [ 11 , 19 ]. The Cronbach’s α internal consistency coefficient of the original scale was determined as 0.70[ 9 ]. Within the scope of these results, it was determined that the current study's results are similar to those of the original research. CIAS was applied to 30 individuals at 15-day intervals for test-retest analysis. A positive, advanced, and statistically significant relationship was determined for CIAS (r = 0.828, p = 0.000). This result shows that CIAS can provide consistent measurements over time. On the other hand, the ICC value was examined to determine test-retest reliability, yielding a result of 0.904. According to the literature, an ICC value of 0.90 or above indicates excellent reliability [ 21 ]. In light of this information, the scale demonstrates reliability in repeated applications. Limitations of the study The current study is limited by the time frame in which the data were collected and the sample size achieved during this period. The study findings are based on patients' self-reports. Since self-report data rely on individuals' subjective perceptions, they may affect the reliability of the responses. Conclusion The Turkish version of the CIAS, consisting of 19 items and five dimensions, adapted in this study, is a valid, reliable, and useful measurement tool for assessing the psychosocial adjustment levels of individuals with chronic diseases. It can be effectively used in clinical practice to plan individualised interventions and monitor patients' adjustment processes. Furthermore, this culturally adapted scale can make significant contributions to chronic disease management studies in Turkey in both research and application areas. Declarations Conflict of interest statement All authors approve that they do not have any financial and personal relationships with other people, or organizations, that could inappropriately influence (bias) this research and this manuscript. Ethics approval and consent to participate The Ethics Committee of a university (2024/03–16) gave their approval, and the hospital where the research was carried out gave their institutional authorization. Both of these approvals were received. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution Author contributorshipGBT: Conceptualization, Methodology, Investigation, Writing – original draft, Writing – review & editing. Supervision -ZÖ: Conceptualization Investigation, Writing – original draft,Writing – BÇ: Conceptualization Investigation, Writing – original draft,Writing – Acknowledgement The authors are grateful to all participants who agreed to participate voluntarily in this study. Data Availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References WHO. Noncommunicable diseases. World Health Organization. https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1 . In; 2023. TÜİK. Ölüm ve Ölüm Nedeni İstatistikleri. 2023. https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2023-53709 . In; 2024. Suls J, Green PA, Boyd CM, Multimorbidity. Implications and directions for health psychology and behavioral medicine. Health Psychol. 2019;38:772. Özdemir Ü, Taşçı S. Kronik hastaliklarda psikososyal sorunlar ve bakim. ERÜ Sağlık Bilimleri Fakültesi Dergisi. 2013;1:57–72. 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Using multivariate statistics Boston. MA: Allyn and Bacon. 2007;5: 2007. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155–63. Jesus LM, Valente AR. Cross-cultural adaptation of health assessment instruments. Univ Aveiro Portugal. 2016;8:1–5. Yeşilyurt S, Çapraz C. Ölçek geliştirme çalışmalarında kullanılan kapsam geçerliği için bir yol haritası. Erzincan Üniversitesi Eğitim Fakültesi Dergisi. 2018;20:251–64. Gökdemir F, Yılmaz T. Likert tipi ölçekleri kullanma, modifiye etme, uyarlama ve geliştirme süreçleri. J Nursology. 2023;26:148–60. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;29:489–97. Guntoro TS, Putra MFP. Development and validation mental training model: Mental Toughness Training Circle (MTTC). F1000Research. 2023;12:169. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30:459–67. Kürtüncü M, Arslan N. Çocuklar için yeme davranışları ölçeğinin Türkçe geçerlik ve güvenirliği. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi. Elektronik Dergisi. 2020;13:267–74. Ferrando PJ, Lorenzo-Seva U, Bargallo-Escriva MT. Gulliksen’s pool: A quick tool for preliminary detection of problematic items in item factor analysis. PLoS ONE. 2023;18:e0290611. Ferrando PJ, Lorenzo-Seva U, Hernández-Dorado A, Muñiz J. Decalogue for the factor analysis of test items. Psicothema. 2022;34:7. Ferrando PJ, Lorenzo-Seva U. Assessing the quality and appropriateness of factor solutions and factor score estimates in exploratory item factor analysis. Educ Psychol Meas. 2018;78:762–80. Gorsuch RL. Factor analysis: Classic edition. Routledge; 2014. Taljaard H, Sonnenberg NC, Reis TL. The development of a scale for measuring voluntary simplistic clothing consumption in the South African emerging market context. In: International Textile and Apparel Association Annual Conference Proceedings: Iowa State University Digital Press; 2018. Additional Declarations No competing interests reported. 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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-7543946","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":523411978,"identity":"f573ca40-67c6-44c0-ab7d-653d072b6f64","order_by":0,"name":"Gülcan BAHÇECİOĞLU TURAN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYDACdgYGZgaGA3IGYJ6BBRFamCFajA1AFIOBBPFaEjeAtTAQoUXemfnZ44KaO+nb2fuPbvhRIMHA396dgFeL4WE2c+MZx57l7uw5zHazB+gwiTNnN+DX0szDJs3Ddjh3w41kths8QC0GErnEaPl3ON0AqOXmH2K0yDMDtfC2HU4AablNlC0GzGxm0jP7DhtuOHPY7LaMgQQPQb/Itzc/ky74dlje4Hjjs5tv/tjI8bf3ErDlAJoAD17lYFsaCCoZBaNgFIyCEQ8AKGFEDkcal2AAAAAASUVORK5CYII=","orcid":"","institution":"Fırat University","correspondingAuthor":true,"prefix":"","firstName":"Gülcan","middleName":"BAHÇECİOĞLU","lastName":"TURAN","suffix":""},{"id":523411979,"identity":"056ee08f-b265-4291-a5f0-b55b7941bef8","order_by":1,"name":"Zülfünaz ÖZER","email":"","orcid":"","institution":"Istanbul Sabahattin Zaim University","correspondingAuthor":false,"prefix":"","firstName":"Zülfünaz","middleName":"","lastName":"ÖZER","suffix":""},{"id":523411980,"identity":"da361aaa-ffe0-49f8-8296-889ad53531a9","order_by":2,"name":"Bahar 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11:30:56","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103939,"visible":true,"origin":"","legend":"","description":"","filename":"98fa2bb2b7a54db9b1936d309d5097ee1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7543946/v1/8c1fdab2c39be728f35250bb.xml"},{"id":92800102,"identity":"82220dc9-03e2-43a7-817c-74c60f1a7c80","added_by":"auto","created_at":"2025-10-05 11:30:56","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112340,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7543946/v1/7ca8c7ce4f3386556fbc85d4.html"},{"id":92800097,"identity":"3b2b26bf-2fa2-4ec0-a467-63fa3410fc95","added_by":"auto","created_at":"2025-10-05 11:30:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":72890,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePath Diagram Regarding the Factor Structure of the Scale\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7543946/v1/25f1ad61422ac23081461385.png"},{"id":98813923,"identity":"6c09ce05-2ace-4f28-9ca1-98757a657a58","added_by":"auto","created_at":"2025-12-22 16:07:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1204007,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7543946/v1/dee77594-f8ae-4de5-8106-4a7964c1a11a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Turkish Validity and Reliability Study of the Chronic Disease Adaptation Scale","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite advances in medical technology and treatment methods in the 21st century, chronic diseases continue to be a global health problem. According to the World Health Organisation (WHO) 2023 report, 74% of deaths worldwide are caused by chronic disease[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Turkey as well, chronic diseases such as cardiovascular diseases, diabetes, and chronic respiratory diseases are significant causes of mortality and morbidity[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Due to advancements in healthcare services and increasing life expectancy, many people will live with one or more chronic diseases[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The long-term course of chronic diseases deeply affects not only patients' physical health but also their psychosocial well-being, requiring a multidisciplinary management approach[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIndividuals with chronic diseases face various challenges, such as disease symptoms, the treatment process, restrictions in daily life, deterioration in family relationships, changes in body image, weakened coping skills, negative changes in lifestyle, loss of self-confidence, concerns about death, and questioning the meaning of life. Such experiences can significantly affect an individual's ability to adapt to their illness[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Adaptation is a complex and dynamic process that requires cognitive, emotional, and behavioural efforts[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Adjustment is a key element in the management of chronic diseases and is the process of accepting changes from the internal and external environment. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] \u003csup\u003e6 6 6 6 66\u003c/sup\u003e Adjustment to chronic diseases is the process by which individuals take their illness, participate in treatment and care processes, and learn to live with the disease[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Adaptation to chronic illness is essential because a lack of adaptation can lead to various psychological and social difficulties in patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eChronic illness enables individuals to adapt to their condition, understand their situation, and make informed decisions about how to proceed.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] The adaptation process can often be frightening and challenging for individuals with chronic illnesses[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, nurses should identify patients' levels of adaptation, the adaptation difficulties they encounter, and the underlying causes of these difficulties, and then plan, implement, and evaluate solution-focused nursing interventions. Nursing interventions aimed at addressing compliance problems facilitate the individual's acceptance of their illness, support their active participation in the treatment process, contribute to the sustainability of their social relationships, and help them set new goals in their lives [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. To plan nursing interventions aimed at reducing or eliminating adaptation problems observed in chronic patients, it is first necessary to identify these problems[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In Turkey, Atik and Karatepe (2016) developed the \"Scale Development Study: Adaptation to Chronic Illness,\" and Vicdan and Birgili (2018) developed the \" Adaptation to Chronic Diseases Scale(ACIS)\"[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Atik and Karatepe (2016) evaluated the adaptation to chronic illnesses by addressing the physiological, psychological, and social dimensions of individuals with chronic diseases, while ACIS also evaluated the spiritual (moral) dimension in addition to the physiological, psychological, and social dimensions of patients.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] \u0026ldquo;\u003cem\u003eThe Chronic Illness Adjustment Scale (CIAS)\u003c/em\u003e\u0026rdquo; was developed to address the need for a disease adjustment scale that is valid for individuals with various types of chronic diseases. The aim of developing this tool was to create an acceptable alternative to disease-specific and context-specific tools. CIAS can explain behavioural and emotional dimensions together. CIAS also includes positive adaptation indicators such as optimism, hope, reinterpretation, and coping mechanisms. It not only identifies problems but also highlights the individual's strengths [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Additionally, CIAS is concise and time-efficient, comprising approximately 19 items. This study aims to demonstrate that CIAS is a valid and reliable measurement tool for the chronic patient population in Turkey. The results of this study will help healthcare professionals assess the adaptation levels of individuals with chronic illnesses and develop evidence-based interventions to enhance adaptation. Additionally, it will provide an essential contribution to research on adherence in chronic diseases for researchers.\u003c/p\u003e\n\u003ch3\u003eResearch questions\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u0026bull; Is the Chronic Disease Adherence Scale valid?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026bull; Is the Chronic Disease Adherence Scale reliable?\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Materıals and Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eThis study was methodologically designed to examine the validity and reliability of the Turkish version of the Chronic Disease Adjustment Scale.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants and Sample\u003c/h3\u003e\n\u003cp\u003eThere were a total of 950 individuals who were included in the study population. These patients were seen at the outpatient clinic for internal medicine at a university hospital between the months of July 2024 and July 2025. The sample consisted of patients who met the study criteria (aged 18 years or older, diagnosed with a chronic illness at least 6 months prior, no history of psychiatric disorders, and capable of communicating effectively) and agreed to participate in the study during the specified dates. In studies with a methodological design, the sample size is determined based on the total number of items in the scale used. While the subject-item ratio is generally recommended to be 10:1 in the literature, it is reported that this ratio can be reduced, but should be maintained at least at a 2:1 level. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]In this context, a sample size of at least 95 and up to 190 participants is required for the 19-item Chronic Disease Compliance Scale. During the research process, 320 patients did not meet the criteria, and 112 patients declined to participate, resulting in a final sample of 518 patients.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eData were collected using the \"Personal Information Form\" and the \"Chronic Illness Adjustment Scale (CIAS)\".\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePersonal Information Form\u003c/strong\u003e\u003cp\u003eThe form includes questions about the patients' age, education level, gender, marital status, current chronic illnesses, employment status, the year of diagnosis and substance use status.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eChronic Illness Adjustment Scale (CIAS)\u003c/b\u003e: CIAS was developed by Padhy et al. in 2023 to assess the adaptation of individuals with chronic illnesses to their condition [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The scale consists of 19 items. It is a 4-point Likert scale, with items ranging from \"Never\" (1) to \"Always\" (4). The scale has five subscales. The subscales are: Illness denial behaviour (items 1\u0026ndash;4), Illness-compliant behaviour (items 5\u0026ndash;8), Strategic positive engagement (items 9\u0026ndash;12), Emotional support for illness (items 13\u0026ndash;15), and Emotional engagement (items 16\u0026ndash;19). Items 1\u0026ndash;4 and 16\u0026ndash;19 are reversed. As the scale score increases, compliance with chronic illnesses increases. The values of Cronbach's alpha range from 0.76 to 0.91 in the scale that was initially proposed.\u003c/p\u003e\n\u003ch3\u003eAdaptation Process\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eLanguage and Content Validity\u003c/b\u003e: In this study, a systematic approach consisting of five stages (\"forward translation, expert review, back translation, pre-testing, and final version\") was used in accordance with WHO translation guidelines [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. With regard to this particular scope, CIAS was translated into Turkish by two specialists in the language. It was then distributed to ten experienced nurses who specialize in internal medicine. In order to evaluate the content and scope validity of the scale, it was requested that experts provide their thoughts. \"The Content Validity Index (CVI)\" was utilized in order to evaluate the opinions of the specialists. An evaluation of the expert opinions was conducted using the Davis technique, as stated by \u0026Ccedil;apık et al. (2018) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Experts were requested to rank each item on a scale from one to four in order to identify the degree of consistency that exists between the original English items of the scale and their Turkish translations, as well as to evaluate the ease with which the statements were rendered. The scoring system was described in the following manner: \"1 point: not suitable, 2 points: somewhat suitable (revision of the statement is necessary), 3 points: quite suitable (suitable but minor changes are necessary), 4 points: highly suitable.\" From the total number of experts, the CVI value was determined by dividing the number of experts who assigned three and four points to the items on the scale by the total number of experts. A number of adjustments were made to the items on the scale in response to the comments and suggestions that were received from the specialists. The scale was then translated back into English by a third party who was not involved in the initial translation process. This was done after the necessary modifications had been made. The final version of the scale was delivered to the researcher who was responsible for developing the scale, and the researcher received positive comments regarding the appropriateness of the scale. Following the completion of this step, the scale was tested on twenty people who were suffering from chronic illnesses in order to assess whether or not it was applicable to patients. The results of the interviews demonstrated that the scale form was easily comprehensible. The study did not take into account this particular data.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConstruct Validity\u003c/b\u003e: When it comes to analyzing scale structures, one of the fundamental goals of factor analysis is to ensure that construct validity is maintained. Confirmatory factor analysis (CFA) was utilized in this investigation to investigate construct validity. This was done after confirming that linguistic equivalence and content validity were first established. CFA is a method that is used to evaluate whether the items that make up the factors are sufficiently related to the relevant variables and to generate validity evidence, particularly in situations when scales that were produced in one culture are converted to be used in other cultures[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Prior to doing factor analysis, \"the Kaiser-Meyer-Olkin (KMO)\" sample adequacy test and \"Bartlett's Sphericity Test\" were utilized in order to ascertain whether or not the data were suitable for analysis. According to Secer (2020), a KMO value that is greater than 0.60 and a Bartlett test that is statistically significant both suggest that the sample is sufficient and that the data set is appropriate for perform factor analysis. In the process of DFA, fit indices were investigated in order to ascertain the structure that was best suitable for the scale. The following fit indices were utilized: \"the Relative Chi Square Index (CMIN/DF), the Root Mean Square Error of Approximation (RMSEA), the Comparative Fit Index (CFI), the Tucker Lewis Index (TLI), the Standardized Root Mean Square Residual (SRMR), and the Root Mean Square Residual (RMR)\"[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Listed below are the acceptable levels of fit that can be achieved: \"CMIN/DF is less than 5, RMSEA is less than 0.08, CFI and TLI are greater than 0.90, and SRMR and RMR are less than 0.08\" [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] A further requirement is that the factor loadings of the items must be more than 0.30. It is regarded to be moderate for factor loadings to fall between 0.30 and 0.59, whereas factor loadings that are at or above 0.60 are considered to be high [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eReliability Analyses\u003c/strong\u003e\u003cp\u003eInternal consistency coefficients, item-total correlations, and test-retest correlations were investigated in order to conduct the reliability analysis of the Turkish version of the CIAS. The Cronbach's Alpha coefficient for the scale as a whole was \u0026ge;\u0026thinsp;.70, item-total correlations were \u0026gt;\u0026thinsp;.30, and test-retest correlations, measured with a two-week interval, were \u0026gt;\u0026thinsp;.70, all of which were determined to be acceptable levels [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The coefficient indicating internal consistency shows whether the items measure the same concepts and whether the items are actually related to what is being measured. The reliability coefficient of a measurement tool should be as close to 1 as possible to be considered an indicator of sufficient reliability. For the purpose of determining the reliability of the scale, the Cronbach's alpha coefficient and the McDonald's Omega reliability analysis methodology were utilized. A reliability coefficient above 0.70 is considered sufficient for the scale to be considered reliable[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The item-total correlation coefficient is a commonly used indicator in item selection analyses to understand the degree to which scale items are related to the scale as a whole. A high correlation coefficient for an item indicates that the measured item has a high correlation with the theoretical structure of that item and is sufficiently effective in measuring the desired behaviour. It is recommended that the item-total correlation coefficient of measurements obtained from a scale be \u0026gt;\u0026thinsp;.30[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Test-retest measurements evaluate the consistency of an instrument over time and are one of the most commonly used reliability analyses. The closer the correlation coefficient approaches 1, the higher the reliability of a measurement tool is considered to be. To determine whether measurements obtained from a scale remain unchanged over time, the correlation coefficients between the obtained test-retest scores must show a positive, high-level relationship, and this score must be at least 0.70 for acceptability [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003csup\u003e111111111111\u003c/sup\u003e(Se\u0026ccedil;er, 2020)\u003csup\u003e1110\u003c/sup\u003e(Se\u0026ccedil;er, 2020)(Se\u0026ccedil;er, 2020)[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] In addition, the intraclass correlation coefficient (ICC) was utilized in the process of administering test-retest assessments. \"The Interpersonal Correlation coefficient (ICC)\" value can range from 0 to 1, with the closer the value is to 1, the more consistent the measurements are[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eBoth SPSS 27 and LISREL were utilized in order to carry out the analysis of the data. In order to examine the data, descriptive statistical methods such as frequency, percentage, mean, and standard deviation were utilized. A thorough analysis was performed on the item-total correlation values as well as the total Cronbach's alpha coefficients of the scale items. In order to determine whether or not the scale possessed construct validity, the data were imported into the LISREL computer, and a number of different fit indices were investigated. McDonald's Omega and Cronbach's alpha coefficient reliability analysis were both computed in order to determine the degree to which the scale may be relied upon effectively. In addition, the test-retest approach was utilized in order to investigate the time-dependent consistency characteristic of the scale. The results that were deemed statistically significant were those with a p-value less than 0.05.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch Ethics\u003c/h3\u003e\n\u003cp\u003e The Ethics Committee of a university (2024/03\u0026ndash;16) gave their approval, and the hospital where the research was carried out gave their institutional authorization. Both of these approvals were received. Regarding the adaptation of CIAS to Turkish, official permission was received from the owner of the scale through the use of email. In compliance with the principles outlined in the Helsinki Declaration on Human Rights, the research was carried out according to the guidelines. After providing participants with an explanation of the goal of the study, written informed consent was obtained from each and every participant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic Characteristics of Participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003eNumber (n\u0026thinsp;=\u0026thinsp;518)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e284\u003c/p\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e54.8\u003c/p\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e370\u003c/p\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003cp\u003eBachelor\u0026apos;s degree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003cp\u003e386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003cp\u003e64.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eLess than income\u003c/p\u003e\n \u003cp\u003eEqual to income\u003c/p\u003e\n \u003cp\u003eIncome exceeds expenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e35.9\u003c/p\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName of existing chronic disease\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHeart disease\u003c/p\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003cp\u003eGastrointestinal diseases\u003c/p\u003e\n \u003cp\u003eRespiratory diseases\u003c/p\u003e\n \u003cp\u003eKidney failure\u003c/p\u003e\n \u003cp\u003eRheumatic diseases\u003c/p\u003e\n \u003cp\u003eNeurological diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003cp\u003e25.1\u003c/p\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDependency status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIndependent\u003c/p\u003e\n \u003cp\u003ePartially dependent\u003c/p\u003e\n \u003cp\u003eFully dependent\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e352\u003c/p\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e68.0\u003c/p\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 54.5012%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMin-Max\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e55.14\u0026thinsp;\u0026plusmn;\u0026thinsp;18.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 54.5012%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis duration (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 29.6837%;\"\u003e\n \u003cp\u003e7.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eDM\u0026thinsp;=\u0026thinsp;Diabetes mellitus; HT\u0026thinsp;=\u0026thinsp;Hypertension\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAmong the participants, the age range was from 18 to 83 years old, with the average age being 55.14\u0026thinsp;\u0026plusmn;\u0026thinsp;18.38 years. There were 54.8% of female participants, 71.4% of married participants, 20.8% of illiterate participants, 64.5% of unemployed participants, 56% of participants had an income that was equal to their expenses, 25% of participants had diabetes as their existing chronic disease, and 68% of participants were independent. Furthermore, it is worth noting that the duration of diagnosis varied from one to forty years, with an average of 7.71 years, with a standard deviation of 6.71 years (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eFindings Related to Validity\u003c/h2\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003eContent Validity\u003c/h2\u003e\n \u003cp\u003eAccording to the findings of the research, \u0026quot;the item-level content validity index (I-CVI)\u0026quot; varied from 0.90 to 1.00, whereas \u0026quot;the scale-level content validity index (S-CVI)\u0026quot; was determined to be 0.96.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eConstruct Validity\u003c/h2\u003e\n \u003cp\u003eBefore beginning the structural validity study, the KMO and Bartlett\u0026apos;s Sphericity Test was utilized to determine whether or not the sample size was appropriate and whether or not the data set was suitable for analysis. The KMO value was found to be 0.792 after being determined. The outcome of the Bartlett\u0026apos;s Sphericity Test was found to be statistically significant (x2\u0026thinsp;=\u0026thinsp;3564.322; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Without using AFA, a DFA analysis was carried out in order to successfully verify the validity of the existing five-subdimension structure that had 19 elements. Based on the findings of the DFA study, it was determined that the factor load values varied from 0.300 to 0.850, which is evidence that the structure consists of five subdimensions (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAverage and DFA Factor Loadings Results\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eScale\u003c/p\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eFactor Loadings\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF5\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.24.\u0026plusmn; 0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.19\u0026plusmn; 0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.69\u0026plusmn; 1.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.07\u0026plusmn; 0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.82\u0026plusmn; 0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.840\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.64\u0026plusmn; 0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.31\u0026plusmn; 0.801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.680\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.42\u0026plusmn; 0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.97\u0026plusmn; 0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.31\u0026plusmn; 0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.31\u0026plusmn; 0.858\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.62\u0026plusmn; 0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.47\u0026plusmn; 0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.77\u0026plusmn; 0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.750\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.77\u0026plusmn; 0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.69\u0026plusmn; 0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem 19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.49\u0026plusmn; 0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eConfirmatory Factor Analysis\u003c/h2\u003e\n \u003cp\u003eAccording to the results of the analysis, the DFA fit index values were obtained as follows. \u0026quot;X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;495.17 df\u0026thinsp;=\u0026thinsp;140 (p\u0026amp;lt;0.05), X\u003csup\u003e2\u003c/sup\u003e/df\u0026thinsp;=\u0026thinsp;3.53, RMSEA\u0026thinsp;=\u0026thinsp;0.070, CFI\u0026thinsp;=\u0026thinsp;0.94, SRMR\u0026thinsp;=\u0026thinsp;0.057, TLI\u0026thinsp;=\u0026thinsp;0.92, RMR\u0026thinsp;=\u0026thinsp;0.044, and AIC\u0026thinsp;=\u0026thinsp;652.03\u0026quot; (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the PATH diagram that was developed throughout the process of doing the confirmatory factor analysis.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eConfirmatory Factor Analysis Results\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFit criteria\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFound\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAppropriate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAcceptable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResult\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e/df (\u003cstrong\u003eCMIN/DF)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026amp;lt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable fit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026amp;lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable fit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable fit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable fit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExcellent compliance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable fit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e595.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cem\u003e\u0026quot;CFI: Comparative Fit Index; RMSEA: Root Mean Square Error of Approximation; RMR: Root Mean Square Residual; SRMR: Standardised Root Mean Square Residual; TLI: Tucker Lewis Index; AIC: Akaike Information Criterion\u0026quot;\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation values, reliability values\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScale and sub-dimensions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCIAS\u003c/p\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026alpha;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eΩ\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.463**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.261**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.377**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.275**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.292**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.163**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.140**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCIAS Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.710**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.765**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.454**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\u0026quot;**Correlation is significant at the 0.01 level (2-tailed); F: Factor; CIAS\u0026thinsp;=\u0026thinsp;Chronic Illness Adjustment Scale\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eFactor 1. Illness denial behaviour: Factor 2. Illness-compliant behaviour: Factor 3. Strategic positive engagement: Factor 4. Emotional support for illness: Factor 5. Emotional engagement\u0026quot;\u003c/p\u003e\n \u003cp\u003eAfter looking at Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, it was discovered that there is a strong association between the different subscales of the scale. Based on the modest correlations that were found, it was clear that there was no issue with multiple linkages between the subscales.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eFindings Related to Reliability\u003c/h2\u003e\n \u003cp\u003eA calculation was made to determine the Cronbach\u0026apos;s alpha coefficient for the scale. The value of the Cronbach\u0026apos;s alpha coefficient for the \u0026quot;F1\u0026quot; subscale of the scale was 0.806, while the value for the \u0026quot;F2\u0026quot; subscale was 0.796, the value for the \u0026quot;F3\u0026quot; subscale was 0.714, the value for the \u0026quot;F4\u0026quot; subscale was 0.766, the value for the \u0026quot;F4\u0026quot; subscale was 0.796, the value for the \u0026quot;F5\u0026quot; subscale was 0.768, and the total Cronbach\u0026apos;s alpha value for the scale was 0.807. Moreover, the Omega reliability values of the scale were as follows: 0.806 for the \u0026quot;F1\u0026quot; subscale, 0.806 for the \u0026quot;F2\u0026quot; subscale, 0.676 for the \u0026quot;F3\u0026quot; subscale, 0.768 for the \u0026quot;F4\u0026quot; sub-dimension, 0.676 for the \u0026quot;F5\u0026quot; sub-dimension, and 0.774 for the total scale were the results (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eDuring the research process, test-retest measurements were administered to 30 participants at 15-day intervals to assess the scale\u0026apos;s reliability over time. The correlation coefficients observed were r\u0026thinsp;=\u0026thinsp;0.979 for the CIAS total, r\u0026thinsp;=\u0026thinsp;0.959 for the \u0026quot;F1\u0026quot; subscale, and r\u0026thinsp;=\u0026thinsp;0.992 for the \u0026quot;F2\u0026quot; subscale. These correlation values are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). No statistically significant difference was found between the test-retest measurement results (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Additionally, the Intraclass Correlation Coefficients (ICC) values obtained for the purpose of assessing test-retest reliability ranged from 0.909 to 0.970.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTest-retest results and mean scores (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eScale and sub-dimensions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eScale Score Means\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAnalysis Results\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eICC\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFirst\u003c/p\u003e\n \u003cp\u003eImplementation\u003c/p\u003e\n \u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSecond\u003c/p\u003e\n \u003cp\u003eImplementation\u003c/p\u003e\n \u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.949**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.960**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.979\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.914**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.761**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eF5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.824**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCIAS Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.828**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.904\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003e\u0026quot;**Correlation is significant at the 0.01 level (2-tailed); F: Factor; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; ; r\u0026thinsp;=\u0026thinsp;Pearson Correlation Coefficient; t\u0026thinsp;=\u0026thinsp;Paired sample t test; ICC\u0026thinsp;=\u0026thinsp;Intraclass Correlation Coefficient; F: Factor; CIAS\u0026thinsp;=\u0026thinsp;Chronic Illness Adjustment Scale\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eFactor 1. Illness denial behaviour: Factor 2. Illness-compliant behaviour: Factor 3. Strategic positive engagement: Factor 4. Emotional support for illness: Factor 5. Emotional engagement\u0026quot;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eChronic diseases are long-term and often lifelong health problems that significantly affect not only individuals' physiological conditions but also their psychological, social, and emotional adjustment processes. The adaptation process in individuals with chronic diseases directly affects their ability to cope with the disease, their quality of life, and their overall psychosocial functioning. Therefore, measuring individuals' levels of adaptation to chronic diseases has become an essential need in both clinical practice and scientific research. CIAS is a measurement tool that evaluates individuals' coping and adaptation processes with chronic disease in a multidimensional manner[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In this study, the validity and reliability of the Turkish version of CIAS were evaluated. The findings indicate that the scale is a valid and reliable tool for assessing psychosocial adaptation in individuals with chronic disease.\u003c/p\u003e\u003cp\u003eContent validity is an evaluation conducted in scale adaptation studies to establish the conceptual integrity of the translation and ensure consistency between the original scale and the adapted language[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This evaluation assesses the extent to which each item in the scale fulfils its intended purpose.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. To ensure the content validity of the scale, the I-CVI and S-CVI values must be 0.80 or above[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In line with this result, it was determined that the I-CVI values at the item level ranged between 0.90 and 1.00, while the S-CVI value was 0.96 in the current study. A review of the literature revealed that the obtained values are pretty high and that the Turkish content of the scale is sufficient in terms of scope[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] The results obtained, in line with expert opinions, indicate that the scale is suitable for assessing psychosocial adaptation in individuals with chronic illnesses and that there is strong consensus among experts[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo determine the validity of the structure and the adequacy of the data, KMO and Bartlett's Sphericity Test were performed before DFA. To indicate that the results are sufficient, Bartlett's sphericity test must be significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and the KMO value must be \u0026gt;\u0026thinsp;0.60 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In this study, the KMO value was found to be 0.792, and the Bartlett's sphericity test (x\u0026sup2; = 3564.322; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was significant. In other words, the database and research sample used for factor analysis are sufficient. Factor analysis is performed to evaluate whether the items in the measurement tool represent a single group. [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] According to the analysis results, items with high correlations are grouped under a single factor[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. DFA analysis was conducted without AFA to validate the measurement tool, which consists of 19 items and five sub-dimensions. Items with factor load values below 0.30 were removed from the scale. However, since the factor load values were between 0.300 and 0.850 in the DFA analysis of the current study, no items were removed[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The DFA conducted a test of construct validity, which revealed that the scale is consistent with the original structure. In the present study, the fit indices were considered in accordance with DFA to assess the suitability of the data. In the literature, a value of x2/df\u0026thinsp;\u0026le;\u0026thinsp;3 indicates an excellent fit, while a value of RMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.07 is considered acceptable [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The fit indices obtained are within the limits accepted in the literature. This finding supports that the Turkish version of CIAS has a valid factor structure consisting of five sub-dimensions, similar to the original scale.\u003c/p\u003e\u003cp\u003eIn the current study, Cronbach's α internal consistency coefficient, item-total correlation, and test-retest analysis were used to evaluate the adaptation of CIAS into Turkish. The overall internal consistency coefficient of the CIAS ranged from 0.675 to 0.796 for the subscales and was determined as 0.807 for the total scale. According to the literature, the reliability of the scale increases as the Cronbach\u0026rsquo;s α value approaches [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The Cronbach\u0026rsquo;s α internal consistency coefficient of the original scale was determined as 0.70[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Within the scope of these results, it was determined that the current study's results are similar to those of the original research. CIAS was applied to 30 individuals at 15-day intervals for test-retest analysis. A positive, advanced, and statistically significant relationship was determined for CIAS (r\u0026thinsp;=\u0026thinsp;0.828, p\u0026thinsp;=\u0026thinsp;0.000). This result shows that CIAS can provide consistent measurements over time.\u003c/p\u003e\u003cp\u003eOn the other hand, the ICC value was examined to determine test-retest reliability, yielding a result of 0.904. According to the literature, an ICC value of 0.90 or above indicates excellent reliability [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In light of this information, the scale demonstrates reliability in repeated applications.\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eLimitations of the study\u003c/h2\u003e\u003cp\u003eThe current study is limited by the time frame in which the data were collected and the sample size achieved during this period. The study findings are based on patients' self-reports. Since self-report data rely on individuals' subjective perceptions, they may affect the reliability of the responses.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Turkish version of the CIAS, consisting of 19 items and five dimensions, adapted in this study, is a valid, reliable, and useful measurement tool for assessing the psychosocial adjustment levels of individuals with chronic diseases. It can be effectively used in clinical practice to plan individualised interventions and monitor patients' adjustment processes. Furthermore, this culturally adapted scale can make significant contributions to chronic disease management studies in Turkey in both research and application areas.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest statement\u003c/h2\u003e\u003cp\u003eAll authors approve that they do not have any financial and personal relationships with other people, or organizations, that could inappropriately influence (bias) this research and this manuscript.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThe Ethics Committee of a university (2024/03\u0026ndash;16) gave their approval, and the hospital where the research was carried out gave their institutional authorization. Both of these approvals were received.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor contributorshipGBT: Conceptualization, Methodology, Investigation, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. Supervision -Z\u0026Ouml;: Conceptualization Investigation, Writing \u0026ndash; original draft,Writing \u0026ndash; B\u0026Ccedil;: Conceptualization Investigation, Writing \u0026ndash; original draft,Writing \u0026ndash;\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors are grateful to all participants who agreed to participate voluntarily in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. Noncommunicable diseases. 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In: International Textile and Apparel Association Annual Conference Proceedings: Iowa State University Digital Press; 2018.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"health-and-quality-of-life-outcomes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hqlo","sideBox":"Learn more about [Health and Quality of Life Outcomes](http://hqlo.biomedcentral.com)","snPcode":"12955","submissionUrl":"https://submission.nature.com/new-submission/12955/3","title":"Health and Quality of Life Outcomes","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adaptation, Chronic Disease, Nursing, Patient. Validity, Reliability","lastPublishedDoi":"10.21203/rs.3.rs-7543946/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7543946/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to adapt the Chronic Illness Adjustment Scale, developed by Padhy et al. in 2023, into Turkish and to evaluate its validity and reliability for assessing the adaptation of individuals with chronic illnesses to their condition.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis methodological study was conducted between July 2024 and July 2025, involving 518 chronic patients who visited the internal medicine outpatient clinic of a university hospital. Data were collected using the \"Personal Information Form\" and the CIAS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAccording to confirmatory factor analysis, the factor loadings of the scale ranged from 0.300 to 0.850, and a five-dimensional structure was confirmed. The scale's fit indices were \u0026ldquo;\u003cem\u003eX\u0026sup2; = 495.17, df\u0026thinsp;=\u0026thinsp;140 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), X\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.53, RMSEA\u0026thinsp;=\u0026thinsp;0.070, CFI\u0026thinsp;=\u0026thinsp;0.94, SRMR\u0026thinsp;=\u0026thinsp;0.057, TLI\u0026thinsp;=\u0026thinsp;0.92, RMR\u0026thinsp;=\u0026thinsp;0.044, and AIC\u0026thinsp;=\u0026thinsp;652.03\u003c/em\u003e\u0026rdquo;. The overall Cronbach\u0026rsquo;s α coefficient of the scale was 0.80, and for the sub-dimensions, it ranged between 0.67 and 0.80. The validity and reliability of CIAS were proven without any changes to its original form.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study determined that the adapted CIAS consists of five subscales and 19 items, is compatible with Turkish culture, and is a valid and reliable scale.\u003c/p\u003e","manuscriptTitle":"A Turkish Validity and Reliability Study of the Chronic Disease Adaptation Scale","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-05 11:30:51","doi":"10.21203/rs.3.rs-7543946/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-10T11:16:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-07T09:11:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-07T01:30:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241122143688419433221037921795570728359","date":"2025-09-23T19:43:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233654131251354066290230317843764062243","date":"2025-09-23T13:27:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-21T13:43:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-10T04:01:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-10T04:00:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Health and Quality of Life Outcomes","date":"2025-09-05T11:46:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"health-and-quality-of-life-outcomes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hqlo","sideBox":"Learn more about [Health and Quality of Life Outcomes](http://hqlo.biomedcentral.com)","snPcode":"12955","submissionUrl":"https://submission.nature.com/new-submission/12955/3","title":"Health and Quality of Life Outcomes","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"027d9596-83a2-468b-b050-541a26069693","owner":[],"postedDate":"October 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:01:25+00:00","versionOfRecord":{"articleIdentity":"rs-7543946","link":"https://doi.org/10.1186/s12955-025-02465-w","journal":{"identity":"health-and-quality-of-life-outcomes","isVorOnly":false,"title":"Health and Quality of Life Outcomes"},"publishedOn":"2025-12-17 15:57:11","publishedOnDateReadable":"December 17th, 2025"},"versionCreatedAt":"2025-10-05 11:30:51","video":"","vorDoi":"10.1186/s12955-025-02465-w","vorDoiUrl":"https://doi.org/10.1186/s12955-025-02465-w","workflowStages":[]},"version":"v1","identity":"rs-7543946","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7543946","identity":"rs-7543946","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}