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Reliability and Validity of a Chinese-Version Normalization Assessment Measure for Primary Caregivers of Children With Cancer

Tsai, Su-Hui, MSN, RN; Chang, Nien-Tzu, PhD, RN; Cheng, Su-Fen, PhD, RN; Lee, Ya-Ling, DNSc, RN

doi: 10.1097/NCC.0000000000000697
Article: PDF Only

Background Normalization” refers to the process whereby a household with a chronically ill member returns to a normal life to reduce its distress. There has been no valid and reliable instrument to investigate such normalization in Taiwan.

Objective The aims of this study were to develop and validate a Chinese version of the Normalization Assessment Measure for Caregivers of Children With Cancer (NAM-CCC).

Methods Translation and revision of the Normalization Assessment Measure into Chinese. Psychometric testing was conducted on 241 caregivers of children with cancer who were treated at a medical center in northern Taiwan.

Results The Cronbach’s α of the NAM-CCC (Chinese version) was .93. The construct validity was analyzed by exploratory factor analysis, and 1 factor was extracted. The known group validity indicated that the rate of normalization is higher in the follow-up stage than in the treatment stage (P < .00). The criterion-related validity of the Taiwan version of the World Health Organization Quality of Life assessment is 0.475 (P < .01). The content validity is 0.88 to 0.99.

Conclusion The results indicate that the NAM-CCC possesses good reliability and validity when administered to caregivers of children with cancer in Taiwan.

Implications for Practice The instrument can be used to measure normalization in the caregivers of children with cancer. In addition, it will help us understand what support these individuals require to construct normal lives.

Author Affiliations: Department of Nursing, Tri-Service General Hospital (Ms Tsai); and School of Nursing, National Defense Medical Center, Taipei (Ms Tsai); Department of Nursing, Fu Jen Catholic University Hospital & Fu Jen Catholic University, New Taipei (Dr Lee); and School of Nursing, College of Medicine, National Taiwan University (Drs Lee and S.-F. Chang); and Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences (Dr N.-T. Cheng), Taipei, Taiwan, Republic of China.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Ya-Ling Lee, DNSc, RN, Department of Nursing, Fu Jen Catholic University Hospital & Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City, Taiwan 243, Republic of China (;

Accepted for publication October 30, 2018.

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