Abstract
The pain assessment instrument was initially developed using an inductive approach of grounded theory technique. The present study utilized methodological triangulation as the research framework for refinement and testing of the instrument. Consistent with this research methodology, both qualitative and quantitative methods were used for data collection, analysis and interpretation.In the qualitative phase, a total of 33 black, white and Hispanic adult males and females in four South Florida hospitals comprised the convenience sample. Focus groups and survey interviews were conducted with study participants experiencing heterogeneous pain in order to standardize the previously researcher-developed instrument. Content analysis of the data validated that the items originally developed on a group of patients experiencing homogeneous pain were consistent with the experience expressed by those in a heterogeneous pain population. Instrument refinement consisted of a minor modification in the wording of one item. The resultant Richards Assessment of Pain (RAP) instrument was then piloted and tested in the quantitative phase of the study.In the quantitative phase, a convenience sample of 200 black, white and Hispanic adult males and females who were experiencing heterogeneous pain problems were recruited from the same four South Florida hospitals. Subjects scored both the RAP and the McGill Pain Questionnaire, and provided sociodemographic information. Exploratory factor analysis demonstrated construct validity, in which a three-factor solution representing 30 of the original 40 items was computed as achieving the most parsimonious fit with the data. This model accounted for 35.8% of the total variance. The factor structure was substantively interpreted as Learning to Live with the Pain, Thinking and Feeling the Pain, and Perceiving Controllability of the Pain. Spearman's rho correlations established concurrent validity of the RAP with the McGill Pain Questionnaire on two of the three factors. Cronbach's alpha demonstrated internal consistency reliability of the 40-item instrument (.8895) as well as of the more parsimonious 30-item instrument (.8912). Analysis of variance identified statistically significant relationships between the RAP factors and the variables of age, SES and cultural background, providing a sociodemographic profile of vulnerability for patients who may be at risk for undermanagement of pain.