Development and validation of an observer-rated scale for self-care behaviors among mildly to moderately disabled...

To develop and validate an observer-rated scale for assessing self-care behaviors among community-dwelling older adults with mild to moderate disabilities (CDESBS-MMD), addressing the critical need for nursing-specific assessment tools beyond one-dimensional or solely self-reported instruments for geriatric nursing practice.

A two-phase study was conducted. Phase 1 involved instrument development grounded in Orem's self-care theory, including literature review, qualitative interviews, Delphi expert consultation, and pilot testing. Phase 2 evaluated psychometric properties using a sample of 500 community-dwelling older adults in Wenzhou, China (March-May 2024). Exploratory factor analysis (EFA; n = 185) was used to determine the item structure, followed by confirmatory factor analysis (CFA; n = 315) to validate model fit, and reliability and validity testing.

The final scale includes 19 items across six dimensions: personal hygiene, nutrition and rest, safety, social interaction, medication and health management, and activity and rehabilitation behaviors. These factors explain 59.281 % of total variance. The scale demonstrates good internal consistency (Cronbach's α=0.780) and excellent test-retest reliability [ICC(3.1)=0.934].

The CDESBS-MMD is the first comprehensive observer-rated scale for assessing self-care behaviors among community-dwelling older adults with mild to moderate disabilities. It provides clinically meaningful support for nurses to identify care needs, guide individualized interventions, and improve the efficiency of community care resource allocation.