The Development of the Normalization Assessment Measure (NAM)

Tuesday, 13 July 2010: 3:45 PM

Cynthia O'Neal, PhD
School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX

Learning Objective 1: describe the psychometric properties of the Normalization Assessment Measure.

Learning Objective 2: discuss the contribution of qualitative research to the development of the Normalization Assessment Measure.


Scientific advances have resulted in a society where individuals live longer while managing complex diseases daily.  Individuals often use normalization to adapt to illness effects and consequences.  In normalization, cognitive and behavioral coping strategies are employed to minimize the impact of the illness upon normal life patterns and maintain typical activities.  The current state of the science was based primarily upon qualitative research.  In order to refine the normalization concept and to clarify previous contradictory findings through quantitative research, the development of a normalization measure was needed.  The purpose of this study was to develop a normalization measure and to ascertain the psychometric properties of the 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.  The existing qualitative research was pivotal to the development of the instrument and establishment of validity. Due to the volume of qualitative studies conducted about normalization, formulation of a conceptual framework and subsequent construction of the normalization measure laid the foundation for establishing content, convergent and construct validity.


Content validity was established using experts and focus groups. Findings demonstrated convergent validity with coping measures and discriminant validity with a measure of social desirability. Construct validity was demonstrated 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.


This new internally consistent and valid normalization measure will enable the pursuit of quantitative research directed toward exploring the conditions under which normalization leads to optimum outcomes.