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The secondary outcome measures used in this study are presented in Table 14 below:

Table 14 – Secondary Outcome Measures Outcome Measure Description

Emotional Support Questionnaire - Social Adjustment Scale (Weissman and Bothwell, 1976)

The Emotional Support Questionnaire was based on three items from the Social Adjustment Scale (Weissman and Bothwell, 1976) and was used to measure the effects of breast cancer and mastectomy on the emotional support and adjustment required by the patient (Zemore and Shepel, 1989). This questionnaire comprised of three questions focusing on whether the participant can talk to a friend, a relative or a spouse / partner, and it measures how much emotional support is accessible to the participant while also evaluating their support network. Although these questions only measure one type of social support, it was proposed that specifically this type of support would be helpful for cancer

170 Outcome Measure Description

patients, as well as being the type of support that would be difficult for them to access (Wortman and Dunkel‐Schetter, 1979). This was also deemed the case with women

experiencing low mood by the research team. There are five options to choose from (scoring 1-5) and the questionnaire is scored by taking an average of the three scores. The higher the score indicates better adjustment. There was a high correlation between the Social Adjustment Scale Self-Report and Social Adaptation Self-Evaluation Scale for social functioning.

(r=0.62) (Weissman et al., 2001) and the test, re-test

reliability for this subscale is good (r = .89) (Zakowski et al., 2003) but only a subscale of the measure was used in this study. Hospital Anxiety and Depression Scale (HADS) (Zigmond and Snaith, 1983)

This is a self-report measure where patients self-rate their experience of anxiety and depression over the past week. The fourteen statements can be divided into two subscales, half of which focus on generalised anxiety and half on depression (such as the inability to enjoy oneself or take pleasure in everyday things enjoyed normally). The items are scored on a scale of 0-3. The maximum score is 42, a score of 11+ indicates high levels of anxiety and / or depression. This is a validated measure used by researchers and other healthcare

171 Outcome Measure Description

specialists within a hospital setting (Razavi et al., 1990). The sensitivity and specificity for both anxiety and depression is highly correlated with the General Health Questionnaire at .80 and the measure performs effectively assessing the symptoms of anxiety and depression in psychiatric, primary care patients and also within the general population (Bjelland et al., 2002). The Parenting Sense of Competence Scale (Rogers and Matthews, 2004)

This measure is a self-report designed to measure parents’ satisfaction and efficacy in their parenting role. The sixteen items can be divided into two subscales, one half examining satisfaction and the other half-examining self-efficacy. The items are scored on a 6-point Likert scale. The lower the score indicating low levels of satisfaction and / or self- efficacy. The satisfaction scale examines parenting

frustration, anxiety and motivation while the efficacy items look at capability, competence and problem-solving abilities. This is a validated measure and also used to score mothers and fathers separately (Gilmore and Cuskelly, 2009). There was a significant negative correlation between the Parenting Sense of Competence scores and the Depression, Anxiety and Stress Scale for mothers (and were quite low <.20). Reliability estimates for mothers on the satisfaction subscale were .77 and for self-efficacy they were .78. The scores for

172 Outcome Measure Description

fathers were .80 for the satisfaction subscale, .82 for the efficacy Subscale (Rogers and Matthews, 2004).

Generalised Self- Efficacy

Questionnaire (Schwarzer and Jerusalem, 1995)

This measure comprises a 10-item scale designed to assess optimistic self-beliefs to cope with different difficult life demands. It is scored using a 4-point Likert scale and explores how an individual copes with life on a daily basis (i.e. ‘I am confident that I deal efficiently with unexpected events’). The lower the score indicating low levels of self- efficacy. It has been used in many studies and translated into thirty different languages (Schwarzer et al., 1997). Validity and reliability of the measure ranges from .76 to .90

(Jerusalem et al., 1992). The Infant Temperament Questionnaire (Carey and McDevitt, 1978)

This measure comprises a 10-item questionnaire measuring the temperament of the infant, each item being rated on a 3- point scale ranging from desirable temperaments to not so desirable temperaments. A lower score indicates a better parental perception of temperamental disposition. The scoring ranging from 10-30. The use of this measure in this study enabled the research team to be aware of the child’s temperament. The test-retest reliability ranges from .74 to .81 (Sanson et al., 1987).

173 Outcome Measure Description

Health Status Questionnaire (Ware Jr et al., 1996)

The original Health Status Questionnaire comprises of 36- items. For this study, the Short-form version comprising of 12 items was used. The questions focus on the participant’s views of their own mental health (MCS) and how they are able to carry out their usual activities (PCS). The different sections have different scoring mechanisms and higher scores indicate an improvement. It is used widely to access the health of an individual in various settings (i.e. elderly, those managing a chronic illness). The median scores for the coefficients is .67 (PCS) and 0.93 (MCS). The test-test reliability for the short-form was .89 (PCS) and .77 (MCS) in the UK (Ware et al., 1996). The internal reliability of this measure ranges from .77 to .91 (Bousquet et al., 1994).

Dyadic

Adjustment Scale (Spanier, 1988)

This measure is also known as the Couples Questionnaire. The Dyadic Adjustment Scale (DAS) scale is a self-report measure of relationship adjustment, it is used in determining the degree of dissatisfaction couples could be experiencing in their relationship by scoring the extent of agreement or disagreement between the couple. The DAS comprises thirty- six questions with some dichotomous questions, some questions scored on a 5-point Likert scale and one multiple- choice question (scoring range 0-5). The lower the scoring the fewer disagreements within the relationship. The use of

174 Outcome Measure Description

this measure in this study highlighted the participant’s perceptions about their relationship with their partner / spouse, by exploring how these perceptions impact on their parenting abilities, it is possible to gain a clearer picture of where the problems are rooted. Construct validity was highly correlated with the Marital Adjustment Scale at .86 amongst married couples and .88 amongst divorced couples (Spanier, 1988). Internal reliability of the DAS for each of the subscales is as follows: “affectional expression (4 items, .70), cohesion (5 items, .83), consensus (13 items, .91), Satisfaction (10 items, .87)”, and total DAS score is .95 (Carey et al., 1993). Cronbachs Alpha indicates a total reliability score of .96 (Spanier, 1988)

Peer-support Evaluation

Inventory (Dennis 2003a)

The Peer-Support Evaluation Inventory (PSEI) was developed by Dennis et al., (2002) to measure the

participant’s experience of receiving peer-support. The PSEI comprises of four subscales: 1) Supportive Interactions, 2) Relationship Qualities: 3) Perceived Benefits of Peer-Support and 4) Maternal Satisfaction. The subscales are all rated on a 5-point Likert scale, from 1=strongly disagree to 5=strongly agree. Higher scores indicate higher levels of supportive interactions, perceived benefits and satisfaction. The Cronbach’s alpha coefficients for the subscales in the

175 Outcome Measure Description

original study were: supportive interactions = 0.91, relationship qualities = 0.93, perceived benefits of peer- support = 0.97 and maternal satisfaction = 0.94.

A ‘Service Use’ Questionnaire

This measure was developed to collect data on public service utilisation by study participants. The unit costs for the public services were obtained from national databases by the economists within the team. The types of public services included in this measure are GP surgery visits, GP practice nurse, Social Worker contacts, psychologist, hospital in- patient stay etc. This measure was developed in-house at the University of Warwick.