Development and evaluation of the cane use cognitive mediator instrument

Background: Canes are among the most underutilized assistive devices for ol der persons. A significant obstacle to understanding cane use behaviors of older adults is the lack of instruments measuring factors that may influenc e seniors' decisions to accept or reject these devices. Objectives: Guided by the Theory of Planned Behavior, this study involved t he development and evaluation of an instrument to measure cognitive determi nants of cane use among community-living older adults. Method: The two-phase design involved: a) instrument formation including it em generation from four focus group interviews with seniors (n = 30), exper t panel evaluation (n = 10), and pilot testing (n = 10); and b) instrument validation in a cross sectional survey (n = 106). Results: Psychometric analyses of survey data provided empirical evidence o f the construct validity and reliability of the instrument. Principal compo nents analysis verified the hypothesized four-factor solution, explaining 6 3.2% of variance. Independent t-tests yielded statistically significant dif ferences (p < 0.001) in mean scores between the two contrasting groups of c ane users (n = 51) and nonusers (n = 55) with respect to each of the four f actors identified. Alpha coefficients of 0.81 to 0.96 indicated high intern al consistency of the instrument. Conclusions: The instrument can be used by clinicians and researchers to as sess seniors' salient beliefs about the consequences of cane use, guide tai lored intervention strategies to promote acceptance and effective use, and evaluate the effectiveness of interventions.