Derivation of the acceptance and self-worth adjustment scale

Purpose. The original 55-item Nottingham Adjustment Scale (NAS) is a first generation self-report instrument constructed using classical test theory to evaluate adjustment to vision loss. This study assesses the function of the NAS using Rasch analysis in a sample of adults with visual impairment and presents a revised second-generation instrument. Methods. Ninety-nine subjects with established vision loss (median onset 5 years) were administered the NAS. Rasch analysis was performed to: (1) determine optimum response scale function, (2) aid item reduction, (3) determine reliability indices and item targeting, (4) assess unidimensionality using Rasch-based principal component analysis, (5) assess differential item functioning (notable defined as >1.0 logit), and (6) formulate person measures to correlate with Geriatric Depression Scale scores and distance visual acuity to indicate convergent and discriminant validity, respectively. Results. Response categories exhibited underutilization, which when repaired improved response scale functioning and ordered structural calibrations. Misfitting items were removed iteratively until all items had mean-square infit and outfit values of 0.70 to 1.30. However, principal component analysis confirmed insufficient unidimensionality (two contrasts identified, eigenvalues 2.4 and 2.3). Removal of these contrasts and two further iterations restored unidimensionality. Despite item mistargeting (1.58 logits), the revised 19-item instrument demonstrated good person (0.85) and item (0.96) reliability coefficients, good convergent and discriminant validity, and no systematic differential item functioning. The resultant 19-item instrument was termed the Acceptance and Self-Worth Adjustment Scale (AS-WAS). Conclusions. In those with established vision loss, the 19-item Acceptance and Self-Worth Adjustment Scale is a reliable and valid instrument that estimates the level of adjustment concerned with acceptance, attitudes, self-esteem, self-efficacy, and locus of control. An additional measure of depression and anxiety is recommended to assess adjustment in a broader sense. Confirmation of item ordering is required if to be used in those with newly acquired vision loss.