The present study is a methodological study that examines the psychometric properties of the Coercion Experience Scale in patients with mental disorders hospitalized in Fatemi Hospital in Ardabil province. Patients aged 18 years and older, without mental illnesses threatening cognitive status, were included in the study. Data were collected from June to March 2022 from patients with mental disorders admitted to the psychiatric department of Fatemi Hospital in Ardabil province. The number of samples is almost 7 times the number of items [19] in the tool, which is 264.
Tool
The tool included demographic questions and the coercion experience scale, which were translated and back-translated according to Wild et al.'s method [20] after obtaining permission from the tool designer [18]. Then the final tool was used to collect information. After explaining the objectives of the study to the patients, it was conducted in the form of an interview. The Experience of Threat instrument was a 35-item tool designed to measure patients' experiences of coercive measures. The first two items were 0-100 visual analog scales, which were intended to assess the extent to which the patients recall compulsive actions (item 1) and the extent to which they were stressful (item 2). The rest of the items were according to a 5-point Likert scale, which included the following dimensions: humiliation, physical side effects, interpersonal separation, negative environmental effects, fear, and coercion, which had a score of 0–4 [18].
Study Design
To determine the psychometric properties of the instrument, content, and face validity, construct validity (exploratory factor analysis and confirmatory factor analysis), and Cronbach's alpha were checked for reliability. To check the validity of the content, the opinions of 10 professors and experts in the field of psychometrics and psychology were used. To determine the face validity and answer the question of whether the scale of experience of coercion in mental patients apparently has validity or not. and in order to increase the credibility of the content, the process of determining face validity was carried out. This work was investigated by 15 patients with mental disorders and through face-to-face interviews. In this way, the items (questions) were scored on a Likert scale on a Likert scale in terms of the level of difficulty, appropriateness and ambiguity, ease of completing the tool, readability, easy understanding, grammar, writing style, and spelling. Face validity was determined by two quantitative and qualitative methods. In the qualitative method, the aim was to determine the appropriateness and relevance of the items, the ambiguity and insufficient perceptions, and the difficulty of understanding the concepts. In the quantitative method, the item impact formula was used to determine validity. In this method, the participants scored each item in terms of importance on a 5-point Likert scale (from very important to not important at all).
Impact Score = Frequency (%)×Importance
The meaning of frequency was the proportion of people who chose very important and important options, and the meaning of importance was the average score of each item from all respondents. If the impact score was greater than 1.5, the item was recognized as suitable for further analysis and was retained. All items had an impact score of more than 1.5. Also, the construct validity method was used using exploratory and confirmatory factor analysis. Cronbach's alpha was also used to determine the reliability of the tool.
Data Analysis
It was done with descriptive tests (mean, median, frequency, percentage, and standard deviation) and inferential tests (correlation and structural equation modeling) using SPSS version 22 and LISREL version 8.8 software.