Abstract
Strabismus is an ocular misalignment which impacts one’s well-being and health-related quality of life. Strabismus is an umbrella term to many types of eye misalignments and the influence on well-being varies by different types and symptoms of strabismus. The influence of strabismus has been widely studied internationally in the fields of ophthalmology and orthoptics, but studies in terms of psychosocial health and support, or in nursing science are limited. Nationally the topic has not been studied before and this was the first study in the Finnish context. The overall purpose of this study was to describe and explain the health-related quality of life (HRQOL) in strabismic adults and to provide recommendations for psychosocial support to strabismic adults. The main goals were to increase knowledge of the influence of strabismus on one’s health-related quality of life with the public and multidisciplinary healthcare professionals, and to develop care, including psychosocial care, to enhance HRQOL among strabismic adults.
This study consisted of both quantitative and qualitative methodology in two phases. Both phases had two sub-studies each. The first sub-study aimed to translate and culturally adapt the Adult Strabismus Questionnaire (AS-20) into Finnish and evaluate the psychometric properties of the Finnish AS-20. The second sub-study examined associations between HRQOL and socio-demographic, self-reported strabismus-related and orthoptic status factors in Finnish strabismic adults using the AS-20. The third sub-study described the strabismic adults’ experiences of psychosocial influences of strabismus, and the fourth their expectations for psychosocial support. In the summary, research findings were synthesised and consolidated into recommendations for psychosocial support to strabismic adults.
The research data included cross-sectional survey and clinical patient data (n=137), and semi-structured interview data (n=12) of strabismic adults who had been referred to university hospital’s ophthalmology clinic for treatment of their ocular misalignment. In the quantitative phase, psychometric properties of internal consistency, convergent validity and construct validity of the newly translated Finnish AS-20 were evaluated. Evaluation was conducted in three different structures of the measure: the original AS-20, the original AS-20 with Finnish additions, and the refined AS-20. Data were described using descriptive statistics and the associations were evaluated between socio-demographic, self-reported strabismus-related and orthoptic status variables, and HRQOL using Cross- tabulation and Chi-square test, and non-parametric methods. Inductive content analysis was used for analysing the qualitative data.
Translation of the Finnish AS-20 was clear and understandable, and the Finnish additions were relevant to the measure. All three structures were internally consistent and reliable as shown by Cronbach alpha values. The convergent validity, assessed by Spearman’s correlation coefficients, showed low to moderate positive correlations between the structures and one item of Satisfaction with Life Scale. The construct validity, evaluated by confirmatory factor analysis, was the most satisfactory for the refined AS-20 structure. Patients had both psychosocial and functional struggles with strabismus, although interaction subscale showed surprisingly high scores indicating high HRQOL. Patient’s age was significantly associated to HRQOL, and the younger participants had lower HRQOL in self-perception subscale than the older participants.
In the qualitative phase, the participants shared their experiences of psychosocial influences of strabismus and their expectations for psychosocial support from healthcare professionals. Participants described feeling challenged in social situations and struggled with mental well-being. These showed as stress in social situations, pressure in interactions, and emotional and psychological burdens of strabismus. The patients felt that psychosocial support would be needed, and they expected education of strabismus, genuine encounters with strabismus experts, accessible support and available peer support.
The proposed theoretical recommendations were synthesised and consolidated from the findings of all four sub-studies. The synthesised research evidence was deductively reflected, and recommendations were adapted into the Timing it Right framework with strabismic adults’ care process. An understanding of the clinical patient services aided composition of the framework. The study results can be utilised for education of the general public and healthcare professionals in increasing awareness and development of clinical care, including psychosocial care and support for strabismic adults.
This study consisted of both quantitative and qualitative methodology in two phases. Both phases had two sub-studies each. The first sub-study aimed to translate and culturally adapt the Adult Strabismus Questionnaire (AS-20) into Finnish and evaluate the psychometric properties of the Finnish AS-20. The second sub-study examined associations between HRQOL and socio-demographic, self-reported strabismus-related and orthoptic status factors in Finnish strabismic adults using the AS-20. The third sub-study described the strabismic adults’ experiences of psychosocial influences of strabismus, and the fourth their expectations for psychosocial support. In the summary, research findings were synthesised and consolidated into recommendations for psychosocial support to strabismic adults.
The research data included cross-sectional survey and clinical patient data (n=137), and semi-structured interview data (n=12) of strabismic adults who had been referred to university hospital’s ophthalmology clinic for treatment of their ocular misalignment. In the quantitative phase, psychometric properties of internal consistency, convergent validity and construct validity of the newly translated Finnish AS-20 were evaluated. Evaluation was conducted in three different structures of the measure: the original AS-20, the original AS-20 with Finnish additions, and the refined AS-20. Data were described using descriptive statistics and the associations were evaluated between socio-demographic, self-reported strabismus-related and orthoptic status variables, and HRQOL using Cross- tabulation and Chi-square test, and non-parametric methods. Inductive content analysis was used for analysing the qualitative data.
Translation of the Finnish AS-20 was clear and understandable, and the Finnish additions were relevant to the measure. All three structures were internally consistent and reliable as shown by Cronbach alpha values. The convergent validity, assessed by Spearman’s correlation coefficients, showed low to moderate positive correlations between the structures and one item of Satisfaction with Life Scale. The construct validity, evaluated by confirmatory factor analysis, was the most satisfactory for the refined AS-20 structure. Patients had both psychosocial and functional struggles with strabismus, although interaction subscale showed surprisingly high scores indicating high HRQOL. Patient’s age was significantly associated to HRQOL, and the younger participants had lower HRQOL in self-perception subscale than the older participants.
In the qualitative phase, the participants shared their experiences of psychosocial influences of strabismus and their expectations for psychosocial support from healthcare professionals. Participants described feeling challenged in social situations and struggled with mental well-being. These showed as stress in social situations, pressure in interactions, and emotional and psychological burdens of strabismus. The patients felt that psychosocial support would be needed, and they expected education of strabismus, genuine encounters with strabismus experts, accessible support and available peer support.
The proposed theoretical recommendations were synthesised and consolidated from the findings of all four sub-studies. The synthesised research evidence was deductively reflected, and recommendations were adapted into the Timing it Right framework with strabismic adults’ care process. An understanding of the clinical patient services aided composition of the framework. The study results can be utilised for education of the general public and healthcare professionals in increasing awareness and development of clinical care, including psychosocial care and support for strabismic adults.
| Original language | English |
|---|---|
| Place of Publication | Tampere |
| Publisher | Tampere University |
| ISBN (Electronic) | 978-952-03-3744-5 |
| ISBN (Print) | 978-952-03-3743-8 |
| Publication status | Published - 2025 |
| Publication type | G5 Doctoral dissertation (articles) |
Publication series
| Name | Tampere University Dissertations - Tampereen yliopiston väitöskirjat |
|---|---|
| Volume | 1157 |
| ISSN (Print) | 2489-9860 |
| ISSN (Electronic) | 2490-0028 |
