Academic journal article Journal of Nursing Measurement

Psychometric Evaluation of the Appraisal of Health Scale in Stroke Survivors

Academic journal article Journal of Nursing Measurement

Psychometric Evaluation of the Appraisal of Health Scale in Stroke Survivors

Article excerpt

Background/Purpose: Little is known about the cognitive appraisal process influencing poststroke depressive symptoms. Based on a framework derived from Lazarus and Folkman (1984), psychometric properties of the Appraisal of Health Scale (AHS) were tested. Methods: Secondary analysis of data from 394 stroke survivors tested internal consistency reliability and construct validity of the AHS, consisting of 3 subscales (threat, benign, benefit). Results: Cronbach's alphas were satisfactory (threat .92, benign .85, benefit .73). After principal axis factoring, two factors emerged (threat, benefit). Sequential multiple regression accounted for 43% of the variance in depressive symptoms (p < .001), partly explained by the threat and benefit subscales after controlling for depression history, disability, age, social support, self-esteem, and optimism. Conclusion: Threat and benefit AHS subscales demonstrated satisfactory evidence of internal consistency reliability and construct validity in stroke survivors.

Keywords: stroke; psychometrics; stress; appraisal; depression; health

The number of individuals living with stroke-related limitations is increasing as the mortality rate from stroke decreases and the population ages (MacKay & Mensah, 2004; Roger et al., 2011). In the United States, an estimated 795,000 adults suffer a stroke each year (Roger et al.). For a substantial proportion of these survivors, significant adjustments are required across the emotional, physical, and social domains of life (Dowswell et al., 2000; Kelly-Hayes, 2004; King, 1996). Some level of hemiparesis is experienced by 50% of ischemic stroke survivors older than the age of 65 years; another 30% are limited in their mobility; 26% experience difficulty with basic activities of daily living; 19% are unable to communicate normally because of aphasia; and 35% have depressive symptoms (Roger et al.).

Of critical importance is how stroke survivors adapt to these potentially life-changing limitations. Whyte and Mulsant (2002) proposed that the neurological and psychosocial effects of stroke decrease an individual's affective reserve creating vulnerability toward depression. Stroke survivors who report depressive symptoms are at a significantly higher risk of death in the years after stroke even when adjusting for stroke severity and age (House, Knapp, Bamford, & Vail, 2001; Williams, Ghose, & Swindle, 2004). Factors beyond neurological impairment are known to influence stroke survivors' adaptation to the effects of the stroke (Kelly-Hayes et al., 1998; Secrest & Thomas, 1999; Sturm et al., 2002). However, the lack of reliable and valid measurement tools in this population limits our understanding of relationships between stroke survivors' cognitive appraisal of their experience and key outcomes such as the occurrence of depressive symptoms.

The purpose of this secondary analysis was to explore the psychometric properties of the threat, benign, and benefit subscales of Appraisal of Health Scale (AHS) in a sample of mildly impaired stroke survivors who were enrolled in the Randomized Trial of Treatment for Post-Stroke Depression (AIM study; Williams et al., 2007). More specifically, it was hypothesized that the individual subscales would demonstrate evidence of (a) acceptable corrected item-to-total correlations, (b) internal consistency reliability, and (c) construct validity.


The AHS was adapted from the Appraisal of Caregiving Scale (ACS; Oberst, 1991) within the theoretical context of the transaction-based approach to stress, appraisal, and coping (Lazarus, 1966; Lazarus & Folkman, 1984). Within this context, antecedent situational and personality disposition variables are mediated by cognitive appraisal to produce emotional and adaptational outcomes (Lazarus & Folkman). In this study, stroke severity, history of depression, poststroke functional ability, and perceived social support represent the antecedent situation variables; self-esteem and optimism represent the antecedent personality disposition variables. …

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