PhD in Nursing Science Program

Cynthia Ann Schnetter O'Neal

The Development of the Normalization Assessment Measures


Dissertation under the direction of Professor Kenneth Wallston


Normalization is an adaptation mode commonly used among individuals and families experiencing chronic illness. Normalization occurs when individuals use cognitive and behavioral coping strategies in order to maintain typical life patterns despite the effects of the chronic illness. Due to the lack of a quantitative measure for normalization, the current state of the science is based primarily upon qualitative research. In order to further refine the normalization concept and to clarify previous contradictory findings, an instrument to measure normalization was needed. The purpose of this dissertation was to: (1) develop a normalization measure; and (2) ascertain the psychometric properties of the developed instrument. A 20 item normalization measure was developed (alpha = .86) utilizing a cross-sectional design with a sample of 152 individuals diagnosed with at least one of four conditions: rheumatoid arthritis, osteoarthritis, lupus, and fibromyalgia. Content validity was established using previous research findings, an expert panel and focus groups. Convergent validity was demonstrated by positive relationships between the normalization measure and (1) problem focused coping and (2) sick role nonacceptance. Additionally, convergent validity was established by a negative relationship between the normalization measure and emotion focused coping. Discriminant validity was determined by a nonsignificant relationship between the normalization measure and a measure of social desirability bias. Construct validity was evident by correlations between the normalization measure and measures for the following constructs based on the conceptual framework for normalization: perceived control, illness intrusiveness, quality of life, and social ties. Higher normalization scores correlated with higher perceived control scores, greater quality of life scores, increased social ties scores and lower illness intrusiveness scores. Thus, this new internally consistent and valid measure of normalization will facilitate the use of quantitative research for further exploring the conditions under which normalization leads to optimum outcomes.