71 Development and validation of the COCINL scale assessing family resilience in the NICU among parents of preterm infants

Abstract

Abstract Background Given the negative impact of parental distress on preterm infants and their families, examining the role of family resilience in the neonatal intensive care unit (NICU) is a promising avenue for promoting parental mental health while remaining consistent with family-centered care. A tool to assess NICU family resilience is essential to guide care and research, yet none specifically adapted for the neonatal context exists to date according to a recent systematic review. Objectives Therefore, the aim of this study was to develop and validate a new scale, the COCINL scale, designed to measure family resilience in the context of neonatal care among French-speaking parents of preterm infants. Design/Methods This methodological design study was carried out in four successive phases: (I) compilation of an item pool (II) mixed-method evaluation of content validity (clarity, relevance, representativeness) involving 12 experts, (III) pre-testing and electronic administration of the COCINL scale, along with a measure of psychological distress (Kessler-6) and an open-ended self-report question on family resilience to parents of preterm infants (n=88) and (IV) psychometric testing of the COCINL scale (internal consistency, construct validity, exploratory sensitivity and specificity). Parents of preterm infants and experts were recruited by convenience sampling from two urban, level III NICUs. Results From a pool of 112 items, 55 items were favorably evaluated after content validation (S-CVI>0.95). Based on preliminary interitem correlations and internal consistency results, the COCINL scale was shortened to 42 items and divided in four subscales. High internal consistency is also shown in subscales (0.796 to 0.908) and total scale (0.937) Cronbach’s alphas. The COCINL scale displays adequate construct validity, as determined by the Pearson correlation obtained between scores of family resilience and psychological distress (r=-0.236, p=0.027). Strong in between correlations of the four subscales and with the COCINL total score (0.732 to 0.851), further indicated good construct validity. Exploratory sensitivity and specificity analysis revealed the COCINL scale compares to participants' self-reported perception of family resilience (AUC 0.754). Conclusion The COCINL scale has shown strong evidence of validity and internal consistency. Thus, the scale can be recommended for research use as a measure of family resilience in the neonatal context. Still, additional evidence of its validity and reliability should be compiled before clinical use is considered. The COCINL scale could potentially support the development, evaluation and implementation of nursing interventions consistent with the family-centered care approach being promoted in NICUs across Canada and worldwide.