Development and Psychometric Testing of a Children's Version of the Herth Hope Index.

Background and Purpose: Hope in children is critical however multidimensional tools to measure hope are almost nonexistent. The aim of study is to develop and psychometrically evaluate a multidimensional children's version of the well-regarded Herth Hope Index for those 8-12 years old. Methods: Phase one; qualitative study of hope in children, construction of the Herth Hope Index - Child Version (HHI-C), and validation by focus groups. Phase two; pilot testing with 22 children. Phase three; psychometric evaluation with 125 children. Results: Cronbach's alpha of 0.856 with 3-week test-retest reliability of 0.966. Construct validity supported factorial isolation of three factors: (a) inner positive readiness; (b) interconnectedness with self and others; (c) temporality and future. Conclusion: Psychometric findings support the use of the HHI-C as a multidimensional tool to measure hope in children.

The association between hope and quality of life in haemodialysis patients.

BACKGROUND: Hope is important for patients with end-stage renal disease receiving haemodialysis (HD) and hope is associated with quality of life (QoL). Studies examining hope among the HD population are limited and, as far as the authors know, have not been undertaken in Jordan. AIMS: To examine levels of hope and QoL and to examine the association between hope and QoL in HD patients in Jordan. METHODS: A cross-sectional design was used. A convenience sample of 202 patients from six different dialysis centres was recruited. The World Health Organization QOL-BREF and the Herth Hope Index were used. FINDINGS: Moderate levels of hope (M=32.3±4.1) were reported. Respondents reported low mean scores for the physical domain of QoL (M=48.3±21.1) but not for the psychological and social relationship domains. Higher hope scores were associated with better QoL. CONCLUSION: The findings suggest a positive relationship between the level of hope and QoL in people receiving HD. Encouraging hope while caring for HD patients in clinical settings may improve their QoL. Understanding the relationship between hope and QoL may help healthcare providers to improve the quality of care for patients and their families.

Construct validity of the Herth Hope Index: A systematic review.

OBJECTIVE: The psychological construct of hope is an important determinant for mental health and well-being. The availability of valid and reliable instruments to measure hope is, therefore, critical. Despite a large number of psychometric studies on the Herth Hope Index (HHI), its construct validity has not yet been determined. Therefore, this paper aimed to conduct a systematic review of the psychometric properties of the HHI. METHODS: Databases such as PubMed, Science Direct, Google Scholar, Magiran, SID, IranDoc, and IranMedex were evaluated systematically using the terms "HHI," "psychometric," "validity," "reliability," and related terms (with the use of OR and AND operators) and no restrictions on the year of publication. A total of 13 eligible studies were found published between 1992 and 2018 in the USA, Portugal, Switzerland, Iran, Germany, Petersburg, Japan, the Netherlands, Lima, Peru, and Norway. The methodology used in the available studies included principal component analysis (n = 6), maximum likelihood estimation (n = 5), and principal axis factoring (n = 1). One study did not point the methodology. RESULTS: Four studies reported the total extracted variances to be less than 50%, six studies reported variance between 50% and 60%, and three papers reported variance that exceeded 60%. Of the papers that examined the factor structure of the HHI, two studies reported a one-factor solution, seven reported two factors, and four reported a three-factor solution. Although the HHI is the most widely translated and psychometrically tested tool in languages other than English, psychometric variations in factor solutions remain inconsistent. CONCLUSION: Findings highlight the need for future research that appraises the validity of the HHI in different countries, and how the measure relates to other scales that evaluate hope.

Cross-cultural adaptation and psychometric properties of the Herth Hope Index in Kinyarwanda: adapting a positive psychosocial tool for healthcare recipients and providers in the Rwandan setting.

BACKGROUND: The lack of culturally appropriate instruments to measure hope across cultural settings is a barrier to assessing and addressing the relationship between hope and health outcomes. The study aim was to adapt and evaluate the psychometric properties of the Herth Hope Index (HHI) in Kinyarwanda in a population of healthcare recipients and healthcare workers in Rwanda. METHODS: A transcultural translation and adaptation of the HHI was conducted using qualitative methods (n = 43) to achieve semantic, content, and technical equivalence. The adapted instrument was administered to a purposive sample (n = 206) of Rwandan healthcare patients and providers. Temporal reliability, internal reliability using Cronbach's alpha, and construct validity using confirmatory factor analysis (CFA) were assessed. RESULTS: The Herth Hope Index-Kinyarwanda (HHI-K) was found to have strong internal consistency (α = 0.85) and test-retest reliability (r = 0.85). The original HHI three-factor structure fit the data well in CFA (normed chi-square = 1.53; root mean square error of approximation = 0.05; standardized root mean square residual = 0.05; comparative fit index = 0.96; Tucker-Lewis Index = 0.95). CONCLUSION: This article presents the first rigorous cultural adaptation of the HHI in a low-income country. The HHI-K has acceptable psychometric properties, resulting in a new useful tool for research, program development, and evaluation in Rwandan healthcare settings. The HHI-K instrument can be used to assess the effectiveness of programs that aim to promote hope and health outcomes across health system- and individual-levels. The process also provides a feasible model for adaptation of a positive psychosocial tool for both patients and providers in low-resource settings.

Relationship Between Spiritual Well-Being and Hope in Patients with Cardiovascular Disease.

Spirituality and hope have been identified as important constructs in health research, since both are thought to enhance a person's ability to cope with the consequences of serious illness. The aim of this study was to examine the relationship between spiritual well-being and hope in patients with cardiovascular disease. Using descriptive, correlational methodology, the investigator gathered data on a convenience sample of 500 patients with cardiovascular disease who were hospitalized in a medical institution in Iran. The study was conducted over a four-month period. Participants completed a demographic questionnaire, the Spiritual Well-Being Scale (SWBS) and the Herth Hope Index (HHI). The mean score on the SWBS and HHI was 86.21 (SD 12.46) and 34.80 (SD 5.05), respectively. Multivariate predictors for spiritual well-being were female gender (p = 0.047), religiosity (p = 0.018), and hope (p < 0.001). Significant predictors of hope were marital status (p < 0.001), educational status (p < 0.001), economic status (p < 0.001), and spiritual well-being (p < 0.001). Findings suggest that multiple factors may impact spiritual well-being and hope. Therefore, this study has implications for those providing care to patients with cardiovascular disease.

Developing the Evidence Base in Pediatric Oncology Nursing Practice for Promoting Health-Related Quality of Life in Pediatric Oncology Patients.

Research has shown that self-esteem and hopefulness are positively related among female childhood cancer survivors (CCS) and contribute to their health-related quality of life (HRQOL). HRQOL remains a significant outcome of treatment for CCS. This study examined the relationships among self-esteem, hopefulness, and HRQOL in young adult female CCS to inform the development of evidence-based practice guidelines for pediatric oncology nursing practice. An online survey was conducted with a sample of young adult female CCS from 58 treatment centers across the United States at 4 time points: at baseline and at 6 weeks, 3 months, and 6 months after initial measurement time. The relationships between self-esteem, hopefulness, and HRQOL were statistically significant (Time 1, P = .05; Times 2, 3, and 4, P = .01) across all measurement times. These findings identify hopefulness and self-esteem as determinants of HRQOL and suggest that caring practices among pediatric oncology nurses that support psychosocial adjustment through promoting self-esteem and hopefulness have the potential to support HRQOL among young adult female CCS. These outcomes support the development of evidence-based practice guidelines to influence HRQOL outcomes among these survivors.

The German Version of the Herth Hope Index (HHI-D): Development and Psychometric Properties.

BACKGROUND: The importance of hope is evident in clinical oncological care. Hope is associated with psychological and also physical functioning. However, there is still a dearth of empirical research on hope as a multidimensional concept. The Herth Hope Index is a reliable and valid instrument for the measurement of hope and is available in many languages. Until now no authorized German translation has been published and validated. METHODS: After translation, the questionnaire was completed by 192 patients with different tumor entities in radiation therapy. Reliability, concurrent validity, and factor structure of the questionnaire were determined. RESULTS: Correlations were high with depression and anxiety as well as optimism and pessimism. As expected, correlations with coping styles were moderate. Internal consistency and test-retest reliability were satisfactory. We could not replicate the original 3-factor model. Application of the scree plot criterion in an exploratory factor analysis resulted in a single-factor structure. CONCLUSIONS: The Herth Hope Index - German Version (HHI-D) is a short, reliable, and valid instrument for the assessment of hope in patient populations. We recommend using only the HHI-D total score until further research gives more insights into possible factorial solutions and subscales.

Recruitment and retention of older adolescent and young adult female survivors of childhood cancer in longitudinal research.

PURPOSE/OBJECTIVES: To describe the challenges encountered in the recruitment and retention of a sample of older adolescent and young adult female survivors of childhood cancer for a longitudinal study testing a targeted psychosocial intervention aimed at enhancing hope. DATA SOURCES: Published literature on constructing longitudinal intervention studies and strategies in the recruitment and retention of childhood cancer survivors in research was used to develop the protocol of this study. DATA SYNTHESIS: Using empirical literature to construct the study's design resulted in achieving certain goals for the design, but not in the recruitment and retention of study participants. Using online technology to deliver the intervention and collect data was efficient and effective. Traditional approaches to recruitment and retention of those survivors, however, were not effective. Use of more novel approaches to enroll study participants demonstrated only modest success. CONCLUSIONS: Additional research is needed on strategies to successfully recruit and retain older adolescents and young adult female survivors of childhood cancer in longitudinal intervention studies. IMPLICATIONS FOR NURSING: The improvement in the psychological well-being of female survivors of childhood cancer remains an important outcome in ongoing care. The need to continue to identify creative and effective ways to recruit and retain those survivors is warranted.

Avaliação da esperança em pacientes com doença crônica e em familiares ou cuidadores / Assessment of hope in patients with chronic illness and their family or caregivers / Evaluación de la esperanza en pacientes con enfermedad crónica y en familiares o cuidadores

OBJETIVOS: Avaliar o escore de esperança entre os três diferentes grupos e suas variáveis sociodemográficas e clínicas e correlacionar esperança com essas variáveis. MÉTODOS: Estudo descritivo com amostra constituída por 131 indivíduos - 47 pacientes oncológicos, 40 pacientes diabéticos e 44 acompanhantes/ familiares/cuidadores - que responderam às Escalas de Esperança de Herth e de Autoestima de Rosenberg, o Inventário de Depressão de Beck, e um instrumento com dados pessoais. RESULTADOS: Não houve diferença nos escores de esperança entre os grupos. A esperança correlacionou-se positivamente com autoestima e negativamente com a depressão. Para pacientes oncológicos, o escore de esperança não se relacionou a nenhuma variável clínica. Para os pacientes diabéticos, as diferentes formas de tratamento e outras comorbidades não influenciaram na esperança. CONCLUSÃO: Os pacientes com doença crônica e seus familiares apresentaram escores altos de esperança. A mensuração da esperança pode melhorar o cuidado de enfermagem.

OBJECTIVES: To evaluate the level of hope among the three different groups and correlate their levels with demographic and clinical variables. METHODS: Descriptive study with a sample of 131 individuals (including 47 cancer patients, 40 diabetic patients and 44 caregivers/ family / caregivers) responding to Hertha's Scale of Hope, Rosenberg's Self-esteem Scale, the Beck Depression Inventory, and an instrument including personal data. RESULTS: There was no difference in hope scores between groups. Hope was positively correlated with self-esteem and negatively correlated with depression. For cancer patients, the hope score was not related to any clinical variable. For diabetic patients, different forms of treatment and other comorbidities were not found to influence hope. CONCLUSION: Patients with chronic disease and their families had high hope scores. The measurement of hope can improve nursing care.

OBJETIVOS: Evaluar el escore de esperanza entre los tres diferentes grupos y sus variables sociodemográficas y clínicas y correlacionar la esperanza con esas variables. MÉTODOS: Estudio descriptivo con una muestra constituida por 131 individuos - 47 pacientes oncológicos, 40 pacientes diabéticos y 44 acompañantes/ familiares/cuidadores - que respondieron a las Escalas de Esperanza de Herth y de Autoestima de Rosenberg, el Inventario de Depresión de Beck, y un instrumento con datos personales. RESULTADOS: No hubo diferencia en los escores de esperanza entre los grupos. La esperanza se correlacionó positivamente con la autoestima y negativamente con la depresión. Para pacientes oncológicos, el escore de esperanza no se relacionó a ninguna variable clínica. Para los pacientes diabéticos, las diferentes formas de tratamiento y otras co-morbidades no influyeron en la esperanza. CONCLUSIÓN: Los pacientes con enfermedad crónica y sus familiares presentaron escores altos de esperanza. La mensuración de la esperanza puede mejorar el cuidado de enfermería.

Cultural adaptation and validation of the herth hope index for portuguese language: study in patients with chronic illness / Adaptação cultural e validação do herth hope index para a língua portuguesa: estudo em pacientes com doença crônica / La adaptación cultural y validación de la herth hope index para portugués: estudio en pacientes con enfermedad crónica

This study aims the cultural adaptation and validation of the Herth Hope Index, an instrument to measure hope. In this methodological study participated 131 individuals: cancer patients, type 2 diabetes patients and their relatives or care providers. The results confirmed reliability of the scale with Cronbach alpha of 0.834. The test-retest verified the reproducibility of the scale. The construct validity was established by convergent validity between the Escala de Esperança de Herth (Brazilian version) and the Rosenberg Self-Esteem Scale, and the divergent validity between the Escala de Esperança de Herth and the Beck Depression Inventory. The factorial analysis confirmed three factors though composition different from the original scale. The psychometric properties of the Escala de Esperança de Herth were confirmed and indicate it has potential to be used to measure hope in the Brazilian population.

Este estudo tem por objetivo a adaptação cultural e validação do Herth Hope Index, um instrumento para mensurar a esperança. Neste estudo metodológico participaram 131 indivíduos: pacientes oncológicos, pacientes com diabetes do tipo 2 e seus familiares ou cuidadores. Os resultados confirmaram a confiabilidade da escala com Alpha de Cronbach de 0,834. O teste-reteste confirmou a reprodutibilidade da escala. A validade de construto foi estabelecida pela validade convergente entre a Escala de Esperança de Herth (versão Brasileira) e a escala de auto-estima de Rosenberg, e a validade divergente entre a Escala de Esperança de Herth e o Inventário de Depressão de Beck. A análise fatorial confirmou três fatores, apesar da composição diferente da escala original. As propriedades psicométricas da Escala de Esperança de Herth foram confirmadas e, portanto, ela pode ser usada para mensurar esperança na população brasileira.

Este estudio tiene como objetivo la adaptación cultural y validación de la escala Herth Hope Index, una herramienta para la medición de la esperanza. Incluyó 131 individuos: pacientes con cáncer, con diabetes del tipo 2 y sus familiares o cuidadores. Los resultados confirmaron la fiabilidad de la escala con Alfa de Cronbach 0,834. El test-retest confirmó la reproducibilidad de la escala. La validez de constructo fue creado por la validez de convergencia entre la escala de la Esperanza Herth (versión brasileña) y la escala de autoestima de Rosenberg, y la validez divergentes entre la escala de la Esperanza Herth y el Inventario de Depresión de Beck. El análisis factorial confirmó tres factores, a pesar de la distinta composición de la escala original. Las propiedades psicométricas de la escala de la Esperanza Herth se han confirmado y, por tanto, se puede utilizar para medir la esperanza en la población brasileña.

Hope as a determinant of mental health recovery: a psychometric evaluation of the Herth Hope Index-Dutch version.

Hope is an important aspect of mental health recovery and a major concern in patients with mental illness. Therefore, an instrument to measure hope could be useful for clinical settings and research. The aim of this study was to develop a Dutch version of the Herth Hope Index (HHI-Dutch) and to evaluate its validity and reliability in a sample of people with severe mental illness. The HHI-Dutch was used in a sample of people with severe mental illness (n=341). A Principal Component Analysis with varimax rotation was performed and identified two factors. The results also showed a Cronbach's alpha of 0.84 for the HHI total score and a test-retest reliability of r=0.79. As for convergent validity, highest correlations were found between hope and health-related self-efficacy beliefs (r=0.72), perceived quality of life (r=0.56) and mental health (r=0.59) and medium correlations between hope and loneliness (r= -0.47), task-oriented coping (r=0.45) and the habit to seek company (r=0.4). As for divergent validity, according to expectations, there was no significant correlation between hope and physical functioning, but there was a positive correlation between hope and general health perception (r=0.34). In conclusion, the HHI-Dutch has shown to be an instrument with adequate psychometrical properties. It is advisable to use the scale as a whole rather than using the subscales. The HHI-Dutch is appropriate for research in the recovery process of people with severe mental illness. Moreover, the study of hope is important for understanding the concept of hope in relation to mental health recovery. The results of this study may be a step forward and a new impulse to stimulate research on the important 'hope' aspect in mental health recovery.

Fostering hope in terminally ill patients.

AIM: To investigate the meaning of hope, identify strategies that terminally ill patients use in maintaining and fostering hope during the final stage of life, explore changes in hope during the dying trajectory and investigate whether the results of a North American study by Herth (1990a), that explored the meaning of hope and identified strategies to promote it, could be replicated in England. METHOD: A total of 16 adults receiving palliative care took part in the study. Cross-sectional data were collected on all participants. Longitudinal data were collected on four of the 16 participants using methodological triangulation, which encompassed a background data form, the Herth Hope Index and a semi-structured interview (Herth 1990a). FINDINGS: Hope remained present regardless of nearness to death. Seven hope-fostering categories and three hope-hindering categories were identified based on interview responses. CONCLUSION: The study supported Herth's original study (Herth 1990a), and could serve as a guide to individual practitioners and the nursing team in developing an environment and interventions that foster hope in people receiving palliative care in any setting.

The concept of hope in nursing 4: hope and gerontological nursing.

This article is the fourth in a series of six that explores the nature of hope, reviews the existing theoretical and empirical work in several discrete areas of nursing and provides case studies to illustrate the role that hope plays in clinical situations. This article focuses on hope within the specialty of gerontological nursing. To date, most of the hope research, using qualitative and quantitative methodologies, has focused on well and chronically ill young or middle-aged adults; very few studies have examined hope in the older adult and specifically how older adults maintain hope in spite of multiple losses and/or changes. Hope has been studied in several elderly populations, including grieving widow(er)s, community-based older persons, persons living in long term care facilities and elders recruited from senior citizen centres. Research findings provide initial direction for the assessment of hope, and a reference for evaluating the effectiveness of these strategies. There remains, however, a need for continuing research in the area of hope in the older adult that is multifaceted and applicable to both practice and education.

The concept of hope in nursing 5: hope and critical care nursing.

This article is the fifth of a series of six that explores the nature of hope, reviews the existing theoretical and empirical work in several discrete areas of nursing, and provides case studies to illustrate the role that hope plays in clinical situations. In this article we focus on hope within the formal area of critical care nursing. The article points out that there is a distinct paucity of theoretical and empirical work on hope in this formal area. A very limited empirical literature exists, and this work has produced some preliminary findings on the nature and range of interventions for inspiring hope in this client group. Interestingly, while the nature of critical illness appears to indicate the need for the individual to draw upon all his/her intra- and interpersonal sources of help and support, and thus similarly draw upon his/her internal and external hope, the substantive issue of hope inspiration in this client group is not well researched. There exists, no doubt, a range of explanations for this disparity and this article outlines two and introduces a third. Yet hope and hope maintenance/inspiration may just be equally relevant and important to people with critical problems as they are to individuals with chronic problems; this view is supported by the limited empirical work in this area. Consequently, there is a clear need for future qualitative and quantitative research, some of which needs to explore the experiences of hope/hoping/hopelessness for people with a range of critical care needs. Furthermore, despite the apparent emphasis on 'high-tech', overt, and tangible practices within some critical care settings, this article would urge practitioners to remain open to the value of the more subtle, less visible, implicit, approaches to inspiring and maintaining hope in these clients.

The concept of hope in nursing 3: hope and palliative care nursing.

This article is the third in a series of six that explores the nature of hope, reviews the existing theoretical and empirical work in several discrete areas of nursing, and provides case studies to illustrate the role that hope plays in clinical situations. This article focuses on hope within the specialty area of palliative care nursing. Nurse researchers have been instrumental in our current early understandings of hope in palliative care. Studies of hope in palliative care, over the past decades, have focused primarily on those individuals in the advanced stages of cancer and the human immunodeficiency virus. Studies using quantitative methodology have focused on exploring hope levels across the dying trajectory and the relationship between hope and other psychosocial variables while those using qualitative methodology have focused on the meaning of hope and elucidating how terminally ill individual maintain and engender their hope. Research supports that the clinician is an instrument through which hope can be assessed and administered. There is a need for further rigorous investigation of the role of hope during the terminal phase of an illness with specific emphasis on capturing the intangible inner experiences of hope and on the validation of interventions/strategies that develop and maintain hope for both the terminally ill person and his/her family caregivers and significant others.

The concept of hope in nursing 1: its origins, background and nature.

Hope has been described in theoretical terms for many years but the recognition of the importance of hope within the practice of nursing is a more recent phenomenon. Despite the recent growth of references to hope within contemporary nursing literature, it is reasonable to suggest that there remain gaps in the substantive knowledge base and that there appears to be room for both additional research and further discursive literature. Accordingly, this series of six articles will explore the nature of hope, review the existing theoretical and empirical work in several discrete areas of nursing, and provide case studies to illustrate the role that hope plays in clinical situations. This article focuses on the origins, background and definitions of hope. The next article will examine hope within mental health nursing, and further articles will focus on hope within palliative care nursing, hope in gerontological nursing and hope in critical and acute care nursing.

The concept of hope in nursing 2: hope and mental health nursing.

This article is the second in a series of six that explores the nature of hope, reviews the existing theoretical and empirical work in several discrete areas of nursing, and provides case studies to illustrate the role that hope plays in clinical situations. In this article we focus on hope within the formal area of psychiatric/mental health nursing. The article points out that there is a limited empirical literature covering several aspects and issues of hope, hopelessness and hope inspiration within the domain of psychiatry. However, despite these studies many questions still remain unanswered. The bulk of this empirical literature focuses on hopelessness, and in the main hopelessness associated with suicide/depression. As a result of these investigations, a range of interventions has been identified for inspiring hope in different client groups with mental health problems, and a summary of these is given. Importantly, however, the basic social process of hope inspiration for each of these client groups is fundamentally the same, in that the process remains subtle, unobtrusive and associated with the therapy/relationship. We conclude by indicating key areas/questions for future research, and raise key questions regarding future policy/education issues.

The concept of hope in nursing 6: research/education/policy/practice.

This article, the last in the series, focuses on future international research, education, policy and practice issues that centre around the concept of hope. While a growing literature is accumulating, it needs to be acknowledged that the area of hope and hope inspiration remains under-researched and is consequently not well understood. However, this article highlights future research questions around hope which have been grouped under the broad headings of: (1) the structure of hope; (2) the assessment of hope; (3) the enhancement of hope; (4) the potential outcomes of hope. The article also declares how our current body of knowledge relating to hope has had limited visibility outside professional journals, has not received the funding necessary, and has not been reflected in relevant policies within our healthcare and educational institutions. If the goal is to conduct interdisciplinary research across countries and to gain a global understanding of hope, then greater resources are needed. There is a need to prepare nurses and other healthcare professionals to deal with the challenge of enhancing and maintaining hope in those that they care for in their practice, as well as in themselves.