Structure and conceptualization of acceptance: a split-sample exploratory and confirmatory factor analysis approach to investigate the multidimensionality of acceptance of spinal cord injury
Keywords:spinal cord injuries, factor analysis, statistical, behaviour, acceptance processes
Objective: To determine the multidimensionality of acceptance of spinal cord injury (SCI).
Participants: Adults with SCI who were admitted to an SCI centre between 1991 and 2020.
Methods: All eligible participants (n=686) were invit-ed to complete a survey via REDCap. A 4-dimensional model was hypothesized, which included “Accepting Reality”, “Value Change”, “Letting Go of Control” and “Behavioural Engagement”. Items from 3 accept-ance scales were selected to collectively reflect these 4 dimensions: (i) Spinal Cord Lesion-related Coping Strategies Questionnaire, (ii) Coping Orientations to Problems Experienced, and (iii) a modified Acceptance and Action Questionnaire. A split-sample principal component analysis (PCA) and confirmatory factor analysis (CFA) approach was used.
Results: Complete data were provided by 431 participants (62.8%). A PCA on sub-sample one suggest-ed a 4-factor model based on eigenvalues ≥ 1, corresponding to the hypothesized model of acceptance. A CFA on sub-sample 2 showed good model fit, adding further support to the model.
Conclusion: These findings suggest that acceptance is a multidimensional construct with 4 facets that represent distinct, but interconnected, psychological processes. This model of acceptance can be used as a framework for future research and clinical practice to deepen our understanding of acceptance processes following severe injuries, such as SCI.
Acceptance has long been considered a core principle of adjustment in rehabilitation psychology. However, several distinct ways of defining and measuring acceptance exist in the literature. The aim of this study was therefore to explore the nuances of acceptance by combining these different definitions in a multidimensional model of acceptance, and testing it empirically. The sample included 431 adults with spinal cord injury who responded to 3 acceptance questionnaires that defined acceptance differently. The statistical analysis showed that acceptance should be regarded a multidimensional construct with 4 facets: “Accepting Reality”, “Value Change”, “Letting Go of Control” and “Behavioral Engagement”. These facets of acceptance reflect distinct, but interconnected, psychological processes, which necessitates a shift in how researchers and healthcare professionals approach this complex topic. We need to be mindful of these nuances in our understanding of acceptance, but also in our measurement strategy and communication with other professionals and patients.
National Spinal Cord Injury Statistical Center. Facts and Fig.s at a Glance. Birmingham, AL; 2016. Available from: https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%202020.pdf.
Heinemann AW, Wilson CS, Huston T, Koval J, Gordon S, Gassaway J, et al. Relationship of psychology inpatient rehabilitation services and patient characteristics to outcomes following spinal cord injury: the SCIRehab Project. J Spinal Cord Med 2012; 35: 578–592.
Wright BA. Physical disability: a psychosocial approach. 2nd edn. New York: Harper & Row; 1983.
Dunn DS, Ehde DM, Wegener ST. The foundational principles as psychological lodestars: theoretical inspiration and empirical direction in rehabilitation psychology. Rehabil Psychol 2016; 61: 1–6.
Aaby A, Ravn SL, Kasch H, Andersen TE. The associations of acceptance with quality of life and mental health following spinal cord injury: a systematic review. Spinal Cord 2020; 58: 130–148.
Torgerson WS. Theory and methods of scaling. Theory and methods of scaling. Oxford: Wiley; 1958.
Keany KC, Glueckauf RL. Disability and value change: an overview and reanalysis of acceptance of loss theory. Rehabil Psychol 1993; 38: 199–210.
Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer Publishing Co.; 1984.
Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989; 56: 267–283.
Elfström ML, Rydén A, Kreuter M, Taft C, Sullivan M. Relations between coping strategies and health-related quality of life in patients with spinal cord lesion. J Rehabil Med 2005; 37: 9–16.
Hayes SC. Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavioral and Cognitive Therapies – Republished Article. Behav Ther 2016; 47: 869–885.
Harris R. ACT made simple: An easy-to-read primer on acceptance and committment therapy. Oakland, CA: New Harbinger Publications; 2011.
Wolgast M. What Does the Acceptance and Action Questionnaire (AAQ-II) really measure? Behav Ther 2014; 45: 831–839.
Prochaska JO, DiClemente CC. The transtheoretical approach. In: Norcross JC, Goldfried MR, editors. Handbook of psychotherapy integration. New York City, USA: Basic Books; 1992, p. 300–334.
Harris PA, Taylor R, Thielke R, Payne J, Gonzales N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.
Elfström ML, Kennedy P, Lude P, Taylor N. Condition-related coping strategies in persons with spinal cord lesion: a cross-national validation of the Spinal Cord Lesion-related Coping Strategies Questionnaire in four community samples. Spinal Cord 2007; 45: 420–428.
Ben-Zur H, Rappaport B, Ammar R, Uretzky G. Coping Strategies, Life style changes, and pessimism after open-heart surgery. Health Soc Work 2000; 25: 201–209.
Bouchard G, Guillemette A, Landry-Léger N. Situational and dispositional coping: an examination of their relation to personality, cognitive appraisals, and psychological distress. Eur J Pers 2004; 18: 221–238.
Prelow HM, Tein J-Y, Roosa MW, Wood J. Do coping styles differ across sociocultural groups? The role of measurement equivalence in making this judgment. Am J Community Psychol 2000; 28: 225–244.
Kennedy P, Lowe R, Grey N, Short E. Traumatic spinal cord injury and psychological impact: a cross-sectional analysis of coping strategies. Br J Clin Psychol 1995; 34: 627–639.
Elfström ML, Kreuter M, Persson L-O, Sullivan M. General and condition-specific measures of coping strategies in persons with spinal cord lesion. Psychol Health Med 2005; 10: 231–242.
Paker N, Bugdayci D, Kesiktas N, Sahin M, Elfström ML. Reliability and validity of the Turkish version of spinal cord lesion-related coping strategies. Spinal Cord 2014; 52: 383–387.
Saurí J, Umaña MC, Chamarro A, Soler MD, Gilabert A, Elfström ML. Adaptation and validation of the Spanish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL CSQ-S). Spinal Cord 2014; 52: 842–849.
Saffari M, Pakpour AH, Yaghobidoot M, Al Zaben F, Koenige HG. Cross-cultural adaptation of the spinal cord lesion-related coping strategies questionnaire for use in Iran. Injury 2015; 46: 1539–1544.
Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods 1999; 4: 272–299.
IBM Corp. Select cases: Random sample. 2016 [Cited 2021 Sep 02] Available from: https://www.ibm.com/docs/en/spss-statistics/24.0.0?topic=cases-select-random-sample.
Field A. Discovering statistics using IBM SPSS Statistics. 4th edn. London: Sage Publications; 2013.
Kline RB. Principles and practice of structural equation modeling. 3rd edn. New York: The Guilford Press; 2011.
Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model A Multidiscip J 1999; 6: 1–55.
Ferrin JM, Fong Chan, Chronister J, Chiu C-Y. Psychometric validation of the Multidimensional Acceptance of Loss Scale. Clin Rehabil 2011; 25: 166–174.
Hashemzadeh M, Rahimi A, Zare-Farashbandi F, Alavi-Naeini A, Daei A. Transtheoretical model of health behavioral change: a systematic review. Iran J Nurs Midwifery Res 2019; 24: 83–90.
Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. 2nd edn. New York: Guilford Press; 2012.
van Leeuwen C, Edelaar-Peeters Y, Peter C, Stiggelbout A, Post M. Psychological factors and mental health in persons with spinal cord injury: an exploration of change or stability. J Rehabil Med 2015; 47: 531–537.
Nordin L, Rorsman I. Cognitive behavioural therapy in multiple sclerosis: a randomized controlled pilot study of acceptance and commitment therapy. J Rehabil Med 2012; 44: 87–90.
Fashler SR, Weinrib AZ, Azam MA, Katz J. The use of acceptance and commitment therapy in oncology settings: a narrative review. Psychol Rep 2017; 121: 229–252.
Hinkin TR. A Review of scale development practices in the study of organizations. J Manage 1995; 21: 967–988.
de Rooij M, Weeda W. Cross-Validation: a method every psychologist should know. Adv Methods Pract Psychol Sci 2020; 3: 248–263.
Anderson JC, Gerbing DW. Structural equation modeling in practice: a review and recommended two-step approach. Psychol Bull 1988; 103: 411–423.
Hak T, van der Veer K, Jansen H. The Three-Step Test-Interview (TSTI): an observation-based method for pretesting self-completion questionnaires. Surv Res Methods 2008; 2: 143–150.
Rigshospitalet. Fakta om rygmarvsskade. 2020 [cited 2021 Jun 17]. Available from: https://www.rigshospitalet.dk/afdelinger-og-klinikker/neuro/rygmarvsskader/undersogelse-og-behandling/Sider/fakta-om-rygmarvsskade.aspx
How to Cite
Copyright (c) 2021 Anders Aaby, Sophie Lykkegaard Ravn, Helge Kasch, Tonny Elmose Andersen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.