Journal of Advanced Nursing

Development and Psychometric Testing of a Low Extremity Lymphedema Risk Management Behaviours Questionnaire for Patients With Gynecologic Cancer

ABSTRACT

Background

Lower extremity lymphedema (LEL) is a debilitating complication for patients with gynecologic cancer. A series of strategies have been recommended to mitigate the risk of LEL and improve patient outcomes; however, investigation into LEL risk management behaviours in this population is limited, and the absence of reliable and valid tools is an important reason.

Aims

To develop and evaluate the psychometric properties of the lower extremity lymphedema risk management behaviours questionnaire (LELRMBQ) for Chinese patients with gynaecologic cancer.

Design

This was a methodological study.

Methods

Initial items were generated using a literature review. The initial LELRMBQ was refined, and its content validity was evaluated by conducting two rounds of expert consultation and a pilot study. Psychometric testing of 389 participants recruited by convenience sampling was conducted from December 2022 to June 2023. Exploratory factor analysis (EFA; subsample 1, N = 158) and confirmatory factor analysis (CFA; subsample 2, N = 231) were performed separately to determine the multi-dimensional structure of the questionnaire. Known-group validity, internal consistency reliability, and test–retest reliability were also evaluated.

Results

A total of 25 items with satisfactory content validity were included in psychometric testing. The EFA identified a four-factor structure, comprising 18 items, which explained 74.49% of the total variance. The CFA supported this structure with acceptable fit indices. Known-group validity was partially supported by significant differences in total LELRMBQ scores among groups with different education levels, residence, cancer type, and LEL awareness. Internal consistency and temporal stability were acceptable.

Conclusions

The 18-item LELRMBQ demonstrated sufficient reliability and validity as a tool for measuring LEL risk management behaviours in patients with gynaecologic cancer.

Implications for the Profession and/or Patient Care

The LELRMBQ has potential applicability in assessing LEL risk management behaviours, identifying gaps in educational practices, tailoring effective interventions, and evaluating intervention effectiveness.

Reporting Method

This manuscript followed the STROBE guidelines.

Patient or Public Contribution

Patients with gynecologic cancer participated in this study and provided the data through the survey.