{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:45:56Z","timestamp":1792565156591,"version":"4.5.0"},"reference-count":35,"publisher":"Belitung Raya Foundation","issue":"5","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"This study was supported by a Grant-in-Aid for Scientific Research from the\nJapan Society for the Promotion of Science","award":["23K10254"],"award-info":[{"award-number":["23K10254"]}]}],"content-domain":{"domain":["belitungraya.org"],"crossmark-restriction":true},"short-container-title":["Belitung Nurs J"],"abstract":"<jats:p>Background: Autism spectrum disorder (ASD) is associated with substantial challenges for children and their families. Mothers of children with ASD may experience considerable parenting-related stress, particularly when they face difficulties in understanding and responding to their children\u2019s behavioral and communication characteristics. In home-visit nursing, empowerment-oriented approaches that support mothers\u2019 coping abilities and self-efficacy are important; however, a scale for assessing these support practices has not yet been sufficiently developed.\nObjective: This study aimed to conceptualize empowerment-oriented support practices for mothers of school-aged children with ASD in the context of home-visit nursing and to develop a corresponding measurement scale.\nMethods: This study was conducted in two phases. Preliminary scale items were generated through semi-structured interviews with home-visit nurses, followed by expert evaluation of content validity and a nationwide questionnaire survey. Exploratory factor analysis and examinations of the reliability and validity of the scale were subsequently conducted.\nResults: Exploratory factor analysis identified a three-factor structure comprising 14 items: (1) educational support to enhance mothers\u2019 sense of coping capability, (2) reframing support aimed at restoring confidence, and (3) partnership building through empathic engagement. The Kaiser\u2013Meyer\u2013Olkin value was 0.817, factor loadings ranged from 0.48 to 0.95, average variance extracted (AVE) ranged from 0.41 to 0.44, composite reliability (CR) ranged from 0.73 to 0.78, Cronbach\u2019s alpha was 0.874, and cumulative variance explained was 49.2%. The AVE values were below the recommended threshold of 0.50, indicating limited support for convergent validity. Discriminant validity was also not fully supported.\nConclusion: The scale developed in this study should be regarded as a preliminary measurement framework for organizing empowerment-oriented support practices provided by home-visit nurses to mothers of school-aged children with ASD, drawn from educational, cognitive, and relational perspectives. Given the limitations in convergent and discriminant validity, and the absence of confirmatory factor analysis using an independent sample, the scale should not currently be used for individual nurse evaluation, performance benchmarking, or quality assurance. Further psychometric validation using larger and more diverse samples, independent-sample confirmatory factor analysis, hypothesis testing with theoretically relevant external measures, and longitudinal studies is required.<\/jats:p>","DOI":"10.33546\/bnj.4751","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T05:52:29Z","timestamp":1792561949000},"page":"620-631","update-policy":"https:\/\/doi.org\/10.33546\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a scale to measure empowerment approaches of visiting nurses supporting mothers of school-aged children with autism spectrum disorder"],"prefix":"10.33546","volume":"12","author":[{"given":"Yuki","family":"Kamada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narumi","family":"Fujino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Fujimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaomi","family":"Furuno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19163","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"162867","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https:\/\/doi.org\/10.1176\/appi.books.9780890425596","DOI":"10.1176\/appi.books.9780890425596"},{"key":"162868","doi-asserted-by":"crossref","unstructured":"Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa","DOI":"10.1191\/1478088706qp063oa"},{"key":"162869","doi-asserted-by":"crossref","unstructured":"Chan, K. K. S., & Lam, C. B. (2016). Parental maltreatment of children with autism spectrum disorder: A developmental-ecological analysis. Research in Autism Spectrum Disorders, 32, 106\u2013114. https:\/\/doi.org\/10.1016\/j.rasd.2016.09.006","DOI":"10.1016\/j.rasd.2016.09.006"},{"key":"162870","doi-asserted-by":"crossref","unstructured":"Curley, M. A., Hunsberger, M., & Harris, S. (2013). Psychometric evaluation of the Family-Centered Care Scale for pediatric acute care nursing. Nursing Research, 62(3), 160\u2013168. https:\/\/doi.org\/10.1097\/NNR.0b013e318286d64b","DOI":"10.1097\/NNR.0b013e318286d64b"},{"key":"162871","doi-asserted-by":"crossref","unstructured":"DePape, A.-M., & Lindsay, S. (2015). Parents\u2019 experiences of caring for a child with autism spectrum disorder. Qualitative Health Research, 25(4), 569\u2013583. https:\/\/doi.org\/10.1177\/1049732314552455","DOI":"10.1177\/1049732314552455"},{"key":"162872","unstructured":"Dunst, C. J., & Trivette, C. M. (1996). Empowerment, effective helpgiving practices and family-centered care. Pediatric Nursing, 22(4), 334\u2013337, 343. https:\/\/pubmed.ncbi.nlm.nih.gov\/8852113\/"},{"key":"162873","doi-asserted-by":"crossref","unstructured":"Fang, Z., Barlow, J., & Zhang, C. (2022). Parenting programs that address physical abuse in childhood for families of children with developmental disabilities in mainland China: Systematic review and meta-regression. Trauma, Violence, & Abuse, 23(2), 457\u2013475. https:\/\/doi.org\/10.1177\/1524838020915599","DOI":"10.1177\/1524838020915599"},{"key":"162874","doi-asserted-by":"crossref","unstructured":"Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39\u201350. https:\/\/doi.org\/10.1177\/002224378101800104","DOI":"10.1177\/002224378101800104"},{"key":"162875","doi-asserted-by":"crossref","unstructured":"Foster, K., Maybery, D., Reupert, A., Gladstone, B., Grant, A., Ruud, T., Falkov, A., & Kowalenko, N. (2016). Family-focused practice in mental health care: An integrative review. Child & Youth Services, 37(2), 129\u2013155. https:\/\/doi.org\/10.1080\/0145935X.2016.1104048","DOI":"10.1080\/0145935X.2016.1104048"},{"key":"162876","doi-asserted-by":"crossref","unstructured":"Gibson, C. H. (1991). A concept analysis of empowerment. Journal of Advanced Nursing, 16(3), 354\u2013361. https:\/\/doi.org\/10.1111\/j.1365-2648.1991.tb01660.x","DOI":"10.1111\/j.1365-2648.1991.tb01660.x"},{"key":"162877","doi-asserted-by":"crossref","unstructured":"Gibson, C. H. (1995). The process of empowerment in mothers of chronically ill children. Journal of Advanced Nursing, 21(6), 1201\u20131210. https:\/\/doi.org\/10.1046\/j.1365-2648.1995.21061201.x","DOI":"10.1046\/j.1365-2648.1995.21061201.x"},{"key":"162878","doi-asserted-by":"crossref","unstructured":"Global Burden of Disease Study 2021 Autism Spectrum Collaborators. (2025). The global epidemiology and health burden of the autism spectrum: Findings from the Global Burden of Disease Study 2021. The Lancet Psychiatry, 12(2), 111\u2013121. https:\/\/doi.org\/10.1016\/S2215-0366(24)00363-8","DOI":"10.1016\/S2215-0366(24)00363-8"},{"key":"162879","doi-asserted-by":"crossref","unstructured":"Guastaferro, K., & Shipe, S. L. (2024). Child maltreatment types by age: Implications for prevention. International Journal of Environmental Research and Public Health, 21(1), 20. https:\/\/doi.org\/10.3390\/ijerph21010020","DOI":"10.3390\/ijerph21010020"},{"key":"162880","doi-asserted-by":"crossref","unstructured":"Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the working alliance inventory. Psychotherapy Research, 16(1), 12\u201325. https:\/\/doi.org\/10.1080\/10503300500352500","DOI":"10.1080\/10503300500352500"},{"key":"162881","unstructured":"Japanese Nursing Association. (2014). Home visiting nursing survey report [in Japanese]. https:\/\/nurse.repo.nii.ac.jp\/record\/2000278\/files\/homonjittai.pdf"},{"key":"162882","doi-asserted-by":"crossref","unstructured":"Kataoka, Y., & Adachi, K. (2023). Development of a parental empowerment scale during the child-rearing stage. Journal of the Japanese Society of Nursing Science, 43(6), 864\u2013876. https:\/\/doi.org\/10.5630\/jans.43.864","DOI":"10.5630\/jans.43.864"},{"key":"162883","doi-asserted-by":"crossref","unstructured":"Kilincaslan, A., Kocas, S., Bozkurt, S., Kaya, I., Derin, S., & Aydin, R. (2019). Daily living skills in children with autism spectrum disorder and intellectual disability: A comparative study from Turkey. Research in Developmental Disabilities, 85, 187\u2013196. https:\/\/doi.org\/10.1016\/j.ridd.2018.12.005","DOI":"10.1016\/j.ridd.2018.12.005"},{"key":"162884","doi-asserted-by":"crossref","unstructured":"Koren, P. E., DeChillo, N., & Friesen, B. J. (1992). Measuring empowerment in families whose children have emotional disabilities: A brief questionnaire. Rehabilitation Psychology, 37(4), 305\u2013321. https:\/\/doi.org\/10.1037\/h0079106","DOI":"10.1037\/h0079106"},{"key":"162885","doi-asserted-by":"crossref","unstructured":"Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012). Family-centered care: Current applications and future directions in pediatric health care. Maternal and Child Health Journal, 16(2), 297\u2013305. https:\/\/doi.org\/10.1007\/s10995-011-0751-7","DOI":"10.1007\/s10995-011-0751-7"},{"key":"162886","doi-asserted-by":"crossref","unstructured":"Lai, W. W., Goh, T. J., Oei, T. P., & Sung, M. (2015). Coping and well-being in parents of children with autism spectrum disorders (ASD). Journal of Autism and Developmental Disorders, 45(8), 2582\u20132593. https:\/\/doi.org\/10.1007\/s10803-015-2430-9","DOI":"10.1007\/s10803-015-2430-9"},{"key":"162887","doi-asserted-by":"crossref","unstructured":"MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84\u201399. https:\/\/doi.org\/10.1037\/1082-989X.4.1.84","DOI":"10.1037\/1082-989X.4.1.84"},{"key":"162888","unstructured":"Ministry of Health Labour and Welfare. (2024a). 2022 overview of welfare administration report (child welfare-related) [in Japanese]. https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/gyousei\/222\/dl\/kekka_gaiyo.pdf"},{"key":"162889","unstructured":"Ministry of Health Labour and Welfare. (2024b). 2022 survey report on psychiatric home-visit nursing for individuals with high support needs in the community [in Japanese]. https:\/\/www.mhlw.go.jp\/content\/12200000\/001113536.pdf"},{"key":"162890","doi-asserted-by":"crossref","unstructured":"Mokkink, L. B., Elsman, E. B. M., & Terwee, C. B. (2024). COSMIN guideline for systematic reviews of patient-reported outcome measures version 2.0. Quality of Life Research, 33(11), 2929\u20132939. https:\/\/doi.org\/10.1007\/s11136-024-03761-6","DOI":"10.1007\/s11136-024-03761-6"},{"key":"162891","unstructured":"Nachshen, J. S. (2004). Empowerment and families: Building bridges between parents and professionals, theory and research. Journal on Developmental Disabilities, 11(1), 67\u201375."},{"key":"162892","doi-asserted-by":"crossref","unstructured":"Nicholas, D. B., Muskat, B., Zwaigenbaum, L., Greenblatt, A., Ratnapalan, S., Kilmer, C., Craig, W., Roberts, W., Cohen-Silver, J., Newton, A., & Sharon, R. (2020). Patient- and Family-Centered Care in the Emergency Department for Children With Autism. Pediatrics, 145(Suppl 1), S93\u2013s98. https:\/\/doi.org\/10.1542\/peds.2019-1895L","DOI":"10.1542\/peds.2019-1895L"},{"key":"162893","doi-asserted-by":"crossref","unstructured":"Nurhidayah, I., Nurhaeni, N., Allenidekania, A., & Gayatri, D. (2023). A systematic review of experimental studies on the impact of empowerment-based interventions on child and parent outcomes in the pediatric oncology setting. Journal of Multidisciplinary Healthcare, 16, 3717\u20133735. https:\/\/doi.org\/10.2147\/jmdh.S436394","DOI":"10.2147\/JMDH.S436394"},{"key":"162894","doi-asserted-by":"crossref","unstructured":"Roquette Viana, C., Caldeira, S., Louren\u00e7o, M., & Sim\u00f5es Figueiredo, A. (2021). Parenting of children with autism spectrum disorder: A grounded theory study. Healthcare, 9(7), 872. https:\/\/www.mdpi.com\/2227-9032\/9\/7\/872","DOI":"10.3390\/healthcare9070872"},{"key":"162895","doi-asserted-by":"crossref","unstructured":"Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal of Medical Education, 2, 53\u201355. https:\/\/doi.org\/10.5116\/ijme.4dfb.8dfd","DOI":"10.5116\/ijme.4dfb.8dfd"},{"key":"162896","doi-asserted-by":"crossref","unstructured":"van der Put, C. E., Assink, M., Gubbels, J., & Boekhout van Solinge, N. F. (2018). Identifying effective components of child maltreatment interventions: A meta-analysis. Clinical Child and Family Psychology Review, 21(2), 171\u2013202. https:\/\/doi.org\/10.1007\/s10567-017-0250-5","DOI":"10.1007\/s10567-017-0250-5"},{"key":"162897","doi-asserted-by":"crossref","unstructured":"Vernhet, C., Dellapiazza, F., Blanc, N., Cousson-G\u00e9lie, F., Miot, S., Roeyers, H., & Baghdadli, A. (2019). Coping strategies of parents of children with autism spectrum disorder: A systematic review. European Child & Adolescent Psychiatry, 28(6), 747\u2013758. https:\/\/doi.org\/10.1007\/s00787-018-1183-3","DOI":"10.1007\/s00787-018-1183-3"},{"key":"162898","doi-asserted-by":"crossref","unstructured":"Wakimizu, R., Yamaguchi, K., & Fujioka, H. (2017). Family empowerment and quality of life of parents raising children with Developmental Disabilities in 78 Japanese families. International Journal of Nursing Sciences, 4(1), 38\u201345. https:\/\/doi.org\/10.1016\/j.ijnss.2016.12.004","DOI":"10.1016\/j.ijnss.2016.12.004"},{"key":"162899","doi-asserted-by":"crossref","unstructured":"Weiss, J. A., Cappadocia, M. C., MacMullin, J. A., Viecili, M., & Lunsky, Y. (2012). The impact of child problem behaviors of children with ASD on parent mental health: The mediating role of acceptance and empowerment. Autism, 16(3), 261\u2013274. https:\/\/doi.org\/10.1177\/1362361311422708","DOI":"10.1177\/1362361311422708"},{"key":"162900","unstructured":"World Health Organization. (2023). Autism. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/autism-spectrum-disorders"},{"key":"162901","doi-asserted-by":"crossref","unstructured":"Zimmerman, M. A. (2000). Empowerment Theory. In J. Rappaport & E. Seidman (Eds.), Handbook of Community Psychology (pp. 43\u201363). Springer US. https:\/\/doi.org\/10.1007\/978-1-4615-4193-6_2","DOI":"10.1007\/978-1-4615-4193-6_2"}],"container-title":["Belitung Nursing Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4751\/1440","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4751\/1463","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4751\/1440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:17:13Z","timestamp":1792563433000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/view\/4751"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":35,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10,21]]}},"URL":"https:\/\/doi.org\/10.33546\/bnj.4751","relation":{},"ISSN":["2477-4073"],"issn-type":[{"value":"2477-4073","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]},"assertion":[{"value":"2026-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-20","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}