JKEP (JURNAL KEPERAWATAN)
Vol 9.
No 2.
November 2024 ISSN: 2354-6042 (Prin.
ISSN: 2354-6050 .
Psychometric Analysis of Validity and Reliability of The Indonesian Version of The Modified Fatigue Impact Scale in Chronic Disease Patients Heny Rostini1*.
Yani Sofiani1.
Fitrian Rayasari1.
Rohman Azzam1.
Widya Astuti2 Fakultas Ilmu Keperawatan.
Universitas Muhammadiyah Jakarta.
Indonesia Rumah Sakit Penyakit Infeksi Prof.
Dr.
Sulianti Saroso.
Indonesia *email: henyrostini@gmail.
Article history Posted.
Sept 09th, 2024 Reviewed.
Nov 04th, 2024 Received.
Nov 20th, 2024 Copyright A 2024 Authors This work is licensed under a Creative Commons Attribution-ShareAlike 4.
International License.
ABSTRACT
Fatigue is a lack of physical or mental energy that can be felt by individuals and can disrupt daily activities.
Fatigue causes a constant decrease in vitality, a lack of energy, and prevents sleep gaps from being filled, ultimately leading to a decline in productivity and quality of life.
The prevalence of fatigue in chronic patients varies, as there is no specific data available.
However, the prevalence of fatigue depends on the chronic disease in question, such as chronic kidney disease, diabetes mellitus, and heart disease.
To obtain a valid and reliable Indonesian version of the MFIS instrument that can measure fatigue in patients with chronic diseases.
The sampling technique used was based on the population, using a non-probability sampling method with purposive sampling.
The population in this study consisted of patients with chronic diseases (Diabetes Mellitus.
Congestive Heart Failure.
Strok.
The population was 244 respondents .
respondents for language comprehension, 30 respondents for validity and reliability testing, and 210 respondents for the final instrument tes.
The validity test results, with a sample of .
=210 respondent.
, showed a loading factor value greater than 0.
indicating that all MFIS items were valid and highly correlated.
The reliability test .
=210 respondent.
yielded a CronbachAos Alpha coefficient of 0.
This study demonstrates that the Indonesian version of the MFIS instrument is valid and highly correlated.
This instrument can be used to identify fatigue in chronic diseases and can serve as a guideline for nurses to implement fatigue interventions, thus helping to reduce and address fatigue issues in patients with chronic diseases.
Keywords : Chronic disease.
Fatigue.
MFIS.
Validity.
Reliability ABSTRAK Kelelahan merupakan kekurangan energi fisik atau mental yang dapat dirasakan orang dan dapat mengganggu aktivitas sehari-hari.
Kelelahan menyebabkan penurunan vitalitas yang konstan.
JKEP (Jurnal Keperawata.
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Prevalensi kelelahan pada pasien kronis, namun tidak ada data yang khusus, tergantung penyakit kronis yang dimaksud, namun prevalensi kelelahan tergantung pada penyakit yang diderita seperti penyakit gagal ginjal kronik, diabetes mellitus, penyakit jantung.
Tujuan untuk memperoleh instrumen MFIS valid dan reliable dalam bahasa Indonesia serta dapat mengukur kelelahan pada pasien penyakit kronis.
Teknik pengambilan sampel yang digunakan berdasarkan populasi, dengan cara menggunakan Teknik non probability samping dengan metode purposive sampling.
Populasi dalam penelitian ini adalah pasien dengan penyakit kronis (Diabetes Melitus.
Congestive Heart Failure.
Strok.
Populasinya 244 responden .
responden untuk pemahaman bahasa, 30 responden uji validitas dan reliabilitas dan 210 responden uji akhir instrumen.
Hasil uji validitas penelitian dengan jumlah .
=210 responde.
menghasilkan nilai loading factor lebih dari 0,135 sehingga dinyatakan semua pertanyaan MFIS valid dan berkolerasi tinggi.
Hasil Uji Reabilitas .
=210 responde.
nilai koefisien CronbachAos Alpha yaitu 0,869.
Penelitian ini menunjukkan uji validitas instrument MFIS versi Bahasa Indonesia dinyatakan valid dan berkolerasi tinggi.
Instrument ini dapat digunakan untuk mengidentifikasi kelelahan pada penyakit kronis, dan dijadikan pedoman pada perawat untuk melakukan intervensi kelelahan sehingga dapat mengurangi dan mengatasi masalah kelelahan pada pasien penyakit kronis.
Kata Kunci : Penyakit kronis.
Kelelahan.
MFIS.
Validitas.
Reliabitas INTRODUCTION Chronic disease is a health condition that prevalence of stroke also rose from 7A to persists for more than six months, caused by 9A.
In DKI Jakarta, the Ministry of genetic, physiological, environmental, and Health .
reported an incidence of behavioral factors.
According to the World diabetes mellitus at 3.
4%, heart disease at Health Organization .
, the global 9%, and stroke at 4.
07% in 2018.
Chronic diseases cause a range of health issues, approximately 41 million cases each year, impacting not only physical but also which accounts for 74% of worldwide psychological, economic, and social well- Seventeen million people die from Health problems associated with chronic diseases before reaching the age of chronic diseases include pain and fatigue 70, with 86% of these premature deaths (Kartika occurring in low- and middle-income Ramdhanie, 2018.
Romero et al.
, 2.
In Indonesia, the Ministry of These Health .
reported that the incidence of chronic diseases has increased significantly complaints of fatigue.
Nugraha year by year.
For instance, the prevalence of diabetes mellitus rose from 6.
9% in 2013 to 5% in 2018, while heart disease increased 5% in 2013 to 1.
5% in 2018.
The Fatigue is a subjective, unpleasant feeling of physical and psychological exhaustion, which prevents patients from carrying out normal activities.
It manifests as weakness.
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 257- 271 limited energy, and a pervasive, prolonged Trust, translating the 21 items in the MFIS sense of tiredness (Matura et al.
, 2018.
(Modified Fatigue Impact Scal.
instrument Noor, 2018.
Nugraha, 2.
Data on fatigue in chronic disease is variable meaning and content, in accordance with depending on the specific condition.
Fatigue Mapi prevalence is estimated to range from 60% translation process was divided into nine to 97% (Karadag & Samancioglu Baglama, procedural steps:
Indonesian Research Trust The In patients with diabetes mellitus.
Obtaining permission from the 60% experience symptoms of fatigue (Seo original author and Mapi Research et al.
, 2.
, while 80% of patients with Trust, heart failure report fatigue (Virani et al.
Translating the original language into Indonesian.
Conducting the first expert panel to Fatigue in patients with chronic diseases can be measured using the MFIS (Modified Fatigue Impact Scal.
, which assesses fatigue symptoms.
This questionnaire has been validated, especially for patients with multiple sclerosis (Maisel et al.
, 2.
discuss the translations by two translators with the researcher and relevant experts Pilot testing the instrument for METHOD Research Design This study employs a psychometric research design, adapting an instrument to measure fatigue in patients with chronic diseases, specifically those diagnosed with diabetes mellitus, stroke, or congestive heart failure (CHF) for at least six weeks.
Data collection took place from November 2023 to January 2024 in the cardiology, internal medicine, and neurology clinics at Gatot Soebroto Army Hospital.
This research method is based on a questionnaire adopted from Mapi Research Conducting back translation.
Holding a second expert panel.
Validating the instrument with 30 Performing test-retest Collecting data for cross-cultural Indonesian version of the MFIS instrument among chronic disease Since the MFIS contains 21 items, a total of 210 respondents were required JKEP (Jurnal Keperawata.
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200Ae0.
399 is very low, <0.
400Ae permission from the original author and 599 is moderate, 0.
600Ae0.
799 is high, and 800Ae1.
000 is very high.
submitting a request to Mapi Research Trust to translate the 21 questions in the MFIS Ethical Considerations instrument into Indonesian without altering The ethical approval number from the its intended meaning and content, in Institutional accordance with Mapi Research Trust 1665/F9-UMJ/XI/2023, with special terms The translation process followed number 90975 from Mapi Research Trust.
Review
Board
(IRB)
the specified procedures.
This instrument
comprises 21 questions using a 5-point
RESULTS
Likert scale, where 0 represents "never," 1 Characteristics of Respondents represents "rarely," 2 "sometimes," 3 The average age of respondents falls within "often," and 4 "almost always.
" Items with the pre-elderly range .
ges 45-.
, with the a loading factor value of less than 0.
361 are youngest respondent being 40 years old and considered invalid and, therefore, require the oldest 68 years old.
Based on age group revision to re-evaluate the structure by classifications from the Ministry of Health, rephrasing the questions without changing the sample was largely dominated by pre- their meaning.
elderly individuals, totaling 102 people .
6%).
In terms of gender, the majority of Fatigue measured by the MFIS instrument respondents were female .
%), while among patients with Diabetes Mellitus, males comprised 30%.
Regarding health stroke, and CHF was used to test the validity conditions, 50.
5% of respondents had of the Indonesian version of the instrument, diabetes mellitus, 15.
7% had congestive which had not previously been adapted into heart failure (CHF), and 33.
8% had Indonesian.
The next step is psychometric analysis, including validity and reliability tests.
Validity was assessed using the Pearson Product Moment test, and reliability was measured using Cronbach's alpha test.
The Cronbach's alpha reliability scale is as Concerning employment, the largest group consisted of unemployed respondents or homemakers .
%).
Educationally, the majority were high school graduates .
3%), followed closely by those with a diploma or bachelor's degree .
8%).
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2 November 2024 hlm 257- 271 Karakteristik Responden Rata Ae rata usia : pralansia, dengan usia termuda 40 tahun dan usia tertua 68 Tahun Usia Responden A Dewasa .
-45 tahu.
A Pralansia .
-59 tahu.
A Lansia > 60 tahun Jenis Kelamin
A Laki-laki A Perempuan Penyakit A Diabetes Melitus
A Congestive Heart Failure A Stroke
Pekerjan A TNI
A Pensiunan A Wiraswasta
A Karyawan A Tidak Bekerja /Ibu Rumah Tangga
Pendidikan A SD
A SMP
A SMA
A Diploma/Sarjana Frekuensi Persen (%) In the first validity test .
, it was revise the structural test for these items found that questions 4, 7, and 21 had .
uestions 4, 7, and .
by rephrasing loading factor values of less than the questions without changing their 361, indicating that they were not original meaning.
Therefore, it was necessary to JKEP (Jurnal Keperawata.
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Sebelum Direvisi 4 saya ceroboh dan tidak 7 Saya kurang termotivasi untuk melakukan apa pun yang membutuhkan upaya 21 Saya perlu istirahat lebih sering atau untuk waktu yang lebih lama Setelah Direvisi Saya ceroboh dan tidak terkoordinasi Saya kurang bersemangat untuk membutuhkan usaha fisik
Saya butuh istirahat lebih banyak dan lebih lama Keterangan Pertanyaan 1
0,405
Valid
Pertanyaan 2
0,383
Valid
Pertanyaan 3
0,434
Valid
Pertanyaan 4
0,450
Valid
Pertanyaan 5
0,380
Valid
Pertanyaan 6
0,373
Valid
Pertanyaan 7
0,380
Valid
Pertanyaan 8
0,375
Valid
Pertanyaan 9
0,479
Valid
Pertanyaan 10
0,574
Valid
Pertanyaan 11
0,418
Valid
Pertanyaan 12
0,514
Valid
Pertanyaan 13
0,497
Valid
Pertanyaan 14
0,740
Valid
Pertanyaan 15
0,686
Valid
Pertanyaan 16
0,406
Valid
Pertanyaan 17
0,625
Valid
Pertanyaan 18
0,662
Valid
Pertanyaan 19
0,526
Valid
Pertanyaan 20
0,452
Valid
Pertanyaan 21
0,381
Valid Results of the Reliability Test .
The Cronbach's Alpha coefficient value was 0.
838 for the 21 items in the Loading Factor Valid/Tidak Valid MFIS instrument, indicating that the instrument has high reliability.
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Keterangan Loading Factor
Valid/Tidak Valid
Pertanyaan 1
0,379
Valid
Pertanyaan 2
0,383
Valid
Pertanyaan 3
0,368
Valid
Pertanyaan 4
0,153
Tidak Valid
Pertanyaan 5
0,392
Valid
Pertanyaan 6
0,412
Valid
Pertanyaan 7
0,349
Tidak Valid
Pertanyaan 8
0,364
Valid
Pertanyaan 9
0,490
Valid
Pertanyaan 10
0,568
Valid
Pertanyaan 11
0,374
Valid
Pertanyaan 12
0,511
Valid
Pertanyaan 13
0,518
Valid
Pertanyaan 14
0,725
Valid
Pertanyaan 15
0,689
Valid
Pertanyaan 16
0,395
Valid
Pertanyaan 17
0,689
Valid
Pertanyaan 18
0,662
Valid
Pertanyaan 19
0,538
Valid
Pertanyaan 20
0,473
Valid
Pertanyaan 21
0,223
Tidak Valid The validity test of the Indonesian .
version of the MFIS instrument on 210 concluded that all MFIS items are valid respondents revealed that all questions, and exhibit a high correlation.
from number 1 to 21, had a loading Results Moment Validity Test .
Therefore, .
ccording to the r table, df-.
with Case Processing Summary Valid
Cases Excluded Total
No Keterangan Pertanyaan 1
Pertanyaan 2
Pertanyaan 3
Pertanyaan 4
Pertanyaan 5
Pertanyaan 6
Pertanyaan 7
Pertanyaan 8
Pertanyaan 9
Pertanyaan 10
Pertanyaan 11
Pertanyaan 12
Pertanyaan 13
Pertanyaan 14
Pertanyaan 15
Pertanyaan 16
Pertanyaan 17
Pertanyaan 18
Pertanyaan 19
Pertanyaan 20
Pertanyaan 21
r-tabel
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
0, 135
Loading Factor
0,476
0,422
0,513
0,475
0,498
0,297
0,492
0,485
0,554
0,637
0,546
0,554
0,641
0,642
0,615
0,383
0,589
0,662
0,649
0,509
0,482
Valid/Tidak Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Pearson Product JKEP (Jurnal Keperawata.
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=210 210 respondents are valid, and none are categorized as Excluded.
To determine The Case Processing Summary results show that the row "Cases Valid" indicates trustworthy and consistent, or reliable, you that the number of respondents is 210, with can refer to the Reliability Statistics table.
a percentage of 100%.
This means that all Results of the MFIS instrument reliability test.
Case Processing Summary Valid Cases Excluded Total Uji Reability Instrument MFIS CronbachAos alpha Keterangan 0,869 Reliabel Case Processing Summary Valid Cases Excluded Total Based on the output of the Case Processing DISCUSSION Summary, it can be seen that the Cronbach's Univariate Alpha coefficient is 0.
869 for the 21 items The average age of the respondents falls within the pre-elderly age group, with the It can be concluded that the youngest being 40 years old and the oldest MFIS instrument has high reliability.
This being 68 years old.
Looking at the is in line with the study by Dewi & characteristics of the respondents in this Sudaryanto .
, which states that study, the majority are in the pre-elderly reliability testing of a research instrument is and elderly age groups, as these age groups used to determine whether a questionnaire experience gradual loss of physical and used for data collection can be considered psychological abilities.
This is consistent with the study by yIkerstedt et al.
which showed that aging has a positive Cronbach's Alpha value is greater than effect on fatigue.
In terms of gender, 60, it can be concluded that the variable is women, particularly housewives, are more reliable or consistent in measuring.
dominant than men.
This is due to MFIS Cronbach's Alpha biological factors, including menstruation JKEP (Jurnal Keperawata.
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2 November 2024 hlm 257- 271 and pregnancy, as well as social contexts According American Heart .
, caring for childre.
, which can lead to Association (AHA).
Congestive Heart increased fatigue in women compared to Failure (CHF) is also associated with men (Wylie et al.
, 2.
Fatigue in women fatigue, occurring when the heart is unable is sometimes associated with hormonal to pump enough blood to meet the body's changes during perimenopause, which is As a result, blood is redirected from linked to the pre-elderly age group in this less vital organs and muscles to the heart and brain (Uzochukwu Ibe, 2.
The most common symptoms of CHF are This study took samples from patients Diabetes Mellitus.
Congestive Heart Failure (CHF), and Stroke, with a minimum diagnosis of 6 Among Diabetes Mellitus patients, those who often experience fatigue are those with type 1 or type 2 diabetes.
This is related to inflammation, body mass index, shortness of breath and fatigue, which is another common symptom.
CHF patients experience fatigue because they have difficulty carrying out daily activities and may experience shortness of breath during physical activity and weakness in the legs while walking, also due to the side effects of heart medications such as beta blockers (Uzochukwu Ibe, 2.
associated with the disease (Kalra & Sahay.
The pathophysiology of fatigue is Fatigue in stroke patients, particularly post- closely related to Diabetes Mellitus, as it stroke patients, ranges from mild to severe, involves biochemical and ionic changes in and the intensity of fatigue seems unrelated the muscles, which impact the electrical to the severity or type of stroke (Tyrrell & properties and contractility of these organs.
Smithard, 2.
Physical factors such as Depleted substrates, high hydrogen ion muscle weakness and emotional changes levels, and the presence of inorganic like depression, low self-esteem, and phosphates and potassium are involved in anxiety due to their illness are the main the pathogenesis of fatigue.
However, contributors to fatigue in post-stroke sarcoplasmic reticulum, associated with a reduction in ATP synthesis, may lead to fatigue (Kalra & Sahay, 2.
Bivariate In the validity test of the MFIS (Modified Fatigue Impact Scal.
instrument in the Indonesian version, administered to 210 JKEP (Jurnal Keperawata.
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2 November 2024 hlm 257- 271 respondents with 21 items, 10 respondents results show that it has high construct for each question, it was found that all the validity and reliability.
The instrument was tested using the item-total Pearson's Product Moment in SPSS.
The MFIS instrument, a psychometric assessment tool, is designed to measure constructs The purpose of the MFIS instrument is to provide researchers with information by collecting subjective data, which can then be analyzed quantitatively and interpreted to assess the impact of progressive, and degenerative diseases Research validity testing to determine whether the tool measures what it is intended to According to Ghozali .
, validity testing is used to measure the validity of a questionnaire.
A questionnaire is said to be valid if the questions can reveal what the questionnaire intends to measure.
A questionnaire is considered reliable if a respondent's answers are consistent or stable over time.
Reliability refers to the predictability, and accuracy of a test.
measurement with high reliability is one (Lopes et al.
, 2.
that produces dependable data.
The MFIS instrument has been cross- Limitations of the Study culturally tested in countries such as The researcher did not include an Belgium.
Italy.
Slovenia, and Spain, and item related to the stage/ severity of has been validated as an accurate tool for the disease that could influence identifying the impact of fatigue (Kos et al.
In this study, the MFIS instrument A limitation during data collection was adapted culturally through back was that the researcher was assisted translation and expert panel review, which by a research assistant, a nurse aligns with research by Schiehser .
3 in working in the clinic, in gathering Lopes et al.
, 2.
, where MFIS was the data English Portuguese CONCLUSION healthcare professionals.
In this study, the Based on the results of the study, the MFIS instrument was adapted for the following conclusions can be drawn:
Indonesian culture and language, and the The respondent characteristics in this study showed that the most dominant JKEP (Jurnal Keperawata.
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6%),
This study can serve as valuable input for respondent being 40 years old and the patients and their families regarding the oldest 68 years old.
The most fatigue experienced by family members dominant gender was female .
%), with chronic illnesses.
It highlights the and the most dominant occupation familyAos role in caregiving, acting as was housewife .
%).
As for the disease characteristics, the majority initiators, caregivers, coordinators, and of respondents had Diabetes Mellitus .
5%).
In the validity test of the Indonesian version of the MFIS instrument on 210 respondents, it was found that all questions from 1 to 21 had a loading factor greater than 0.
ased on the r-table, df-.
, indicating that all MFIS items were valid and highly correlated.
The output of the Case Processing Summary showed that the Cronbach's Alpha coefficient value was 0.
869 for the 21 items, which can be concluded that the MFIS instrument has high For Healthcare Professionals This MFIS instrument, allowing them to intervene and address fatigue issues, thereby reducing and managing fatigue in patients with chronic For Future Researchers This instrument can be used to identify degenerative diseases, as well as in the patientAos The use of the validated and SUGGESTIONS reliable Indonesian version of the MFIS For Educational Institutions instrument can be employed in future This study is expected to provide insights for educational institutions, enabling them to further develop the MFIS instrument in future research.
studies to assess fatigue levels in chronic patients beyond diabetes mellitus.
CHF, and stroke.
ACKNOWLEDGMENTS
The researcher would like to express gratitude to the supervising professors, their JKEP (Jurnal Keperawata.
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REFERENCES