Background

Financial burden in cancer patients has been associated with clinical outcomes like negative quality of life, mortality and symptom burden. The purpose of this study was to develop a new scale for measuring subjective financial distress among radiation oncology patients suitable for Indian healthcare system.

Material and methods

Literature survey and expert opinion were used for scale item generation. Exploratory Factor Analysis (EFA) was performed for factor extraction based on eigenvalues˃1 and the items with factor loadings ˃0.5 were retained. Confirmatory factor analysis (CFA) was performed to test the factor structure and model fit. A Chi-square goodness of fit (χ2 /df) test, and other fit indices were used to determine if the CFA model fits the data adequately.

Results

A total of 17 items were identified for scale development. The preliminary scale was administered to 142 Head & Neck cancer patients. A KMO of 0.862 and a p-value of ˂0.001on Bartlett’s sphericity test indicated the suitability of data to perform the EFA. Three factors were identified (eigenvalues˃1) in EFA explaining 64.6% of the variance and 14 items were retained with factor loadings of ˃0.5. The results of the Chi-square goodness of fit test in CFA were not significant, χ² (71) = 102.224, p ˃0.001 suggesting that the CFA model adequately fits the data and value of χ² (102.224)/df (71) = 1.44 also indicates a good model fit. The values of model fit indices including RMSEA=0.056, CFI=0.97, TLI=0.962, GFI=0.916 and SRMR=0.012 are indicative of a good model fit. The reliability analysis of final 14 items showed a Cronbach’s α of 0.89 indicating very good internal consistency

Conclusion

Based on EFA and CFA, 14 items fitting 3 factors showing very good reliability were retained in the final scale. The three factors were identified as Financial Distress, Coping care/lifestyle and Support Seeking.