Sample size requirements for the internal validation of psychiatric scales

Development and evaluation of a food literacy questionnaire for schoolchildren in France

Food literacy is gaining importance in nutrition education programs for children. To date, food literacy assessment tools have been developed in many countries, however, none exist in France. The objectives of this study were to develop a questionnaire and to evaluate its measurement properties among French schoolchildren aged 8-11 years. The questionnaire was developed in three phases: i) item selection (literature review and adaptation or creation of items) and content validity (submission to an expert panel), ii) questionnaire development including a pre-test in a small sample of children (n = 41) and item reduction and dimensionality based on the responses of children who completed the questionnaire in 31 schools between December 2022 and March 2023, and iii) questionnaire evaluation in terms of reliability, validity and acceptability. In total, 1187 responses were included in the analysis. The mean age of the children was 9.6 ± 0.7 years (girls: 51.2%, boys: 48.8%). The development process resulted in a 25-item questionnaire with good acceptability and satisfactory estimated reliability (McDonald omega coefficient = 0.73). Factor evaluation revealed a three-dimensional structure encompassing food and nutrition knowledge, participation in food preparation activities and food habits. To our knowledge, this study was the first to assess food literacy for schoolchildren in France. Our questionnaire can contribute to assess the factors that make food literacy vary, especially regarding socioeconomic variables to target priority populations for nutrition education actions and to describe changes in food literacy scores from a longitudinal perspective.

A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences

BACKGROUND

Clients' adverse experiences during psychotherapy are rarely monitored in clinical practice or research trials. One obstacle here is the lack of a measure to gauge both positive and negative experiences during psychotherapy. We developed and evaluated a new instrument for measuring such experiences.

METHOD

The Positive and Negative Experiences of Psychotherapy (PNEP) questionnaire was developed based on pilot data, a literature review, and two existing scales for measuring primarily adverse experiences during psychotherapy. Mental healthcare clients (N = 200) anonymously completed and evaluated the PNEP. Subsequently, a sample of professionals (N = 34) who underwent psychotherapy in the context of their training filled in the PNEP twice, with a 2-week interval in between.

RESULTS

The positive and negative experiences subscales of the PNEP were found to possess excellent internal consistencies (αs ≥ 0.90). The PNEP test-retest reliability was 0.93 for the positive experiences subscale and 0.78 for the negative experiences subscale. For the positive subscale, four factors were extracted: symptom reduction and positive well-being, high quality of therapy and therapeutic relation, personal growth and acceptance and interpersonal functioning. For the negative subscale, exploratory factor analysis suggested a three-factor solution: escalation of symptoms and emotional distress, low quality of therapy and therapeutic relation and (self-)stigmatization and dependency. Participants related a median of 13 positive and six negative therapy experiences to their most recent treatment. The most frequently endorsed negative experiences were having more negative thoughts and memories, feeling emotionally overwhelmed and an increase in stress due to the therapy. A minority of participants (10.5%) reported no negative treatment experiences.

CONCLUSIONS

In the field of psychotherapy, the evaluation of risks and benefits is crucial for assessing safety and effectiveness. The PNEP could be a promising instrument for achieving this objective, although further research is needed to replicate and expand upon the current findings.

Validation of the postoperative Quality of Recovery-15 questionnaire after emergency surgery and association with quality of life at three months

PURPOSE

The Quality of Recovery-15 (QoR-15) tool, validated for measuring postoperative recovery following scheduled surgeries, has not been psychometrically assessed in emergency contexts. Moreover, the QoR-15's associations with long-term outcomes remain underexplored. This study aimed to confirm the validity and reliability of the QoR-15 following emergency surgery and assess its association with three-month postoperative quality of life.

METHODS

We conducted a prospective cohort study (August 2021-April 2022) on adult patients who underwent emergency surgery. The QoR-15 questionnaire was administered before surgery (H0) and at 24 hr (H24) and 48 hr (H48) after surgery. We examined the H24 score's associations with both the three-month quality of life, as assessed by the EQ-5D scale, and the number of days spent at home at 30 (DAH30) and 90 (DAH90) days.

RESULTS

Of the 375 included patients, 352 (94%) completed the QoR-15 at H24 and 338 (90%) were followed up at three months. The population represented the following diverse surgical specialties: orthopedic (51%), gastrointestinal (27%), urologic (13%), and others (9%). The QoR-15 questionnaire confirmed all psychometric qualities (internal consistency, reproducibility, responsiveness, acceptability, construct, and convergent validities) in the emergency context. The average minimum clinical difference was 8.0 at H24. There was an association between QoR-15 at H24 and the three-month quality of life (r = 0.24; 95% confidence interval [CI], 0.14 to 0.34; P < 0.001), DAH30 (r = 0.33; 95% CI, 0.23 to 0.41; P < 0.001), and DAH90 (r = 0.31; 95% CI, 0.22 to 0.40; P < 0.001).

CONCLUSION

The QoR-15 score is valid for measuring early postoperative recovery after emergency surgery. The H24 score significantly correlated with both the three-month quality of life and the number of days at home.

STUDY REGISTRATION

ClinicalTrials.gov (NCT04845763); first submitted 11 April 2021.

Psychological well-being for cognitively impaired people scale: Assessing reliability and validity of Turkish version

PURPOSE

The aim of the present study was to evaluate the psychometric properties of the Psychological Well-Being of Cognitively Impaired People (PWB-CIP) scale in people with dementia in nursing homes.

METHOD

It was conducted with 70 people with dementia and 12 formal caregivers in two nursing homes. This study used translation and back translation for the scale's language equivalence and expert opinion for content validity. The reliability and validity were tested by exploratory and confirmatory factor analysis, test-retest correlation analyses, and internal consistency.

RESULTS

The PWB-CIP was clustered under two factors. Cronbach's alpha scores for positive affect (α = 0.624), and negative affect (α = 0.822) factors were satisfactory. Confirmatory factor analysis revealed an acceptable level of fit (GFI = 0.905, p < 0.001, CFI = 0.94, RMSEA = 0.067). The test, retests were positively correlated (r: 0.756, p < 0.001).

CONCLUSION

The 9-item PWB-CIP is a valid and reliable instrument for the examined Turkish sample. The PWB-CIP demonstrated robust psychometric properties in the context of nursing homes, indicating its suitability for assessing the well-being of individuals with dementia.

NURSING IMPLICATIONS

The validated PWB-CIP can serve as a valuable tool for nurses and caregivers in evaluating the psychological well-being of cognitively impaired individuals in nursing home settings, enabling targeted interventions to enhance their overall quality of life.

Development and Psychometric Validation of the Body Trust Scale

Interoception (e.g., abilities to recognize/attend to internal sensations) is robustly associated with psychopathology. One form of interoception, body trust, is relevant for the development of disordered eating and suicidal thoughts/behaviors. However, measures of body trust are narrow, despite research suggesting body trust is multifaceted. The aim of this study was to develop a comprehensive measure of body trust: The Body Trust Scale (BTS). 479 U.S. adults completed self-report surveys containing the BTS and psychopathology measures. Exploratory and confirmatory factor analyses revealed a three-factor structure: Comfort with One's Body, Physical Attractiveness, and Comfort with Internal Sensations. Factors showed strong construct, convergent, and divergent validity, as well as moderate predictive validity for suicidal thoughts/non-suicidal self-injury. Furthermore, factors showed strong internal consistency, test-retest reliability, and were invariant across the gender binary. The BTS can be used in research and clinical settings to understand how specific facets of body trust relate to psychopathology.

Development and Validation of the Attitudes towards Social Robots Scale

The idea of artificially created social robots has a long tradition. Today, attitudes towards robots play a central role in the field of healthcare. Our research aimed to develop a scale to measure attitudes towards robots. The survey consisted of nine questions on attitudes towards robots, sociodemographic questions, the SWOP-K9, measuring self-efficacy, optimism, and pessimism, and the BFI-10, measuring personality dimensions. Structural relations between the items were detected using principal components analysis (PCA) with Varimax rotation. Correlations and Analysis of Variance were used for external validation. In total, 214 participants (56.1% female, mean age: 30.8 ± 14.4 years) completed the survey. The PCA found two main components, "Robot as a helper and assistant" (RoHeA) and "Robot as an equal partner" (RoEqP), with four items each explaining 53.2% and 17.5% of the variance with a Cronbach's α of 0.915 and 0.768. In the personality traits, "Conscientiousness" correlated weakly with both subscales and "Extraversion" correlated with RoHeA, while none the subscales of the SWOP-K9 significantly correlated with RoEqP or RoHeA. Male participants scored significantly higher than female participants. Our survey yielded a stable and convergent two-factor instrument that exhibited convincing validity and complements other findings in the field. The ASRS can easily be used to describe attitudes towards social robots in human society. Further research, however, should be carried out to investigate the discriminant and convergent validity of the ASRS.

A multiscale characterization of cortical shape asymmetries in early psychosis

Psychosis has often been linked to abnormal cortical asymmetry, but prior results have been inconsistent. Here, we applied a novel spectral shape analysis to characterize cortical shape asymmetries in patients with early psychosis across different spatial scales. We used the Human Connectome Project for Early Psychosis dataset (aged 16-35), comprising 56 healthy controls (37 males, 19 females) and 112 patients with early psychosis (68 males, 44 females). We quantified shape variations of each hemisphere over different spatial frequencies and applied a general linear model to compare differences between healthy controls and patients with early psychosis. We further used canonical correlation analysis to examine associations between shape asymmetries and clinical symptoms. Cortical shape asymmetries, spanning wavelengths from about 22 to 75 mm, were significantly different between healthy controls and patients with early psychosis (Cohen's d = 0.28-0.51), with patients showing greater asymmetry in cortical shape than controls. A single canonical mode linked the asymmetry measures to symptoms (canonical correlation analysis r = 0.45), such that higher cortical asymmetry was correlated with more severe excitement symptoms and less severe emotional distress. Significant group differences in the asymmetries of traditional morphological measures of cortical thickness, surface area, and gyrification, at either global or regional levels, were not identified. Cortical shape asymmetries are more sensitive than other morphological asymmetries in capturing abnormalities in patients with early psychosis. These abnormalities are expressed at coarse spatial scales and are correlated with specific symptom domains.

Validation of a French questionnaire assessing knowledge of suicide

OBJECTIVES

The objective of this study was to develop and validate the Knowledge of Suicide Scale (KSS), elaborated to assess adherence to myths about suicide.

METHODS

The KSS is a self-questionnaire including 22 statements relating to myths about suicide for which the respondent is asked to rate his degree of adherence on a scale ranging from 0 ("strongly disagree") to 10 ("completely agree"). Using the script concordance test scoring method, the respondents' scores were compared with those of experts to obtain, for each item, a score between 0 (maximum deviation with the experts) and 1 (minimum deviation with the experts). One thousand and thirty-five individuals (222 psychiatric interns, 332 medical interns in the first semester excluding psychiatry and 481 journalism students) were included.

RESULTS

According to the exploratory factor analysis, the KSS is a two-dimensional scale: the first subscale includes 15 items and the second seven items. The tool showed excellent face validity, correct convergent and divergent validities (multi-method multi-feature analyzes), and good internal consistency (Cronbach's alpha coefficient between 0.66 and 0.83 for scales and subscales). The KSS is moderately and negatively correlated with the Stigma of Suicide Scale (r=-0.3). It significantly discriminates groups with different expected levels of knowledge regarding suicide (P<0.001).

CONCLUSIONS

The KSS demonstrated good psychometric properties to measure adherence to myths about suicide. This tool could be useful in assessing the effectiveness of suicide prevention literacy improvement programs.

Development and Validation of the Fearlessness About Suicide Scale

Recent work has identified fearlessness about suicide, rather than fearlessness about death, as more theoretically relevant in the assessment of capability for suicide and thus a more appropriate construct of measurement. The aim of the current project was to develop and validate a scale specifically assessing fearlessness about suicide. Across two studies, support for a 7-item, single-factor structure of the Fearlessness About Suicide Scale (FSS) emerged. The FSS factor structure demonstrated a good fit in the first study and was replicated in the second study. Measurement invariance was examined across those identifying as men and women and found to be comparable. The FSS also demonstrated test-rest reliability and good convergent and divergent validity in community and undergraduate samples. Overall, findings indicate that the FSS has a replicable factor structure that generalizes across those identifying as men and women and may better assess components of capability for suicide than existing scales.

A Short Guide on How to Carry Out Validation of Scales Measuring Health Outcomes

N/a.

Validation of the French version of the Non-Arthritic Hip Score (NAHS) in 113 hip arthroscopy procedures

BACKGROUND

The Non-Arthritic Hip Score (NAHS) used to evaluate the hip in younger patients is a self-administered questionnaire with 20 items in four sections: pain, symptoms, function, and activities. Although used in France, no transcultural version had been validated. The objective of this study was to translate the NAHS into French then assess the validity, reliability, and sensitivity to change of the French-language version (NAHS-Fr) in younger patients with hip conditions other than osteoarthritis.

HYPOTHESIS

The NAHS-Fr demonstrates good validity and reliability when used in younger French-speaking patients with hip pain.

MATERIAL AND METHODS

We conducted a prospective observational study in 105 patients (62 males and 43 females) scheduled for surgery on one or both hips (113 hips in total) to treat cam-type femoro-acetabular impingement or labral lesions. Before and 6 months after surgery, each patient completed the NAHS-Fr and Western Ontario and McMaster Osteoarthritis Index (WOMAC). Statistical tests were done to evaluate validity, reliability, and sensitivity to change, as recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN).

RESULTS

The response rate was 100%, confirming that the NAHS-Fr was easy to use. The NAHS-Fr was both valid and reliable. No ceiling or floor effect was detected for the total NAHS-Fr score. All items had Cronbach alpha coefficients greater than 0.8, indicating good internal consistency. External consistency between the NAHS-Fr and WOMAC was negative (-0.676) due to inversely proportional score indexing. Before surgery, the NAHS-Fr and WOMAC scores were strongly and significantly correlated (p<0.0001). The effect size was greater than 0.8, indicating good sensitivity to the change induced by surgery.

DISCUSSION

These results confirm the study hypothesis: the NAHS-Fr has the same good psychometric characteristics as does the original version and versions in other languages. The NAHS-Fr is useful for evaluating younger patients with non-osteoarthritic hip pain and can be used by French-speaking surgeons in everyday clinical practice.

LEVEL OF EVIDENCE

IV, prospective observational non-comparative cohort study.

Country and sex measurement invariance of the Cannabis abuse screening test (CAST) in European Youth

BACKGROUND

Monitoring the prevalence of problematic cannabis use is an important public health issue. International surveys need invariant measurement tools to allow reliable comparisons across countries and between sexes. The Cannabis abuse screening test (CAST) has been developed for this purpose. This study is the first assessing its country and sex invariance in a sample of European pupils.

METHODS

The data come from the self-administered questionnaires completed in 2019 by pupils aged 15-16 in the European school survey project (Espad). The analytical sample was restricted to the 17 countries where at least 300 pupils reported a previous-year cannabis use (n = 8740); multigroup confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the CAST toward country and sex in the 2019 Espad release.

RESULTS

Configural, metric and scalar invariance toward country hold for the 17 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Italia, Latvia, Poland, Portugal, Slovakia, Slovenia and Spain. Scalar invariance toward sex was met in the 17 countries as a whole and in 11 of the 12 countries where the test could be run. Scalar invariance toward country was met with 6 additional countries comprising at least 250 respondents: Ireland, Lithuania, Malta, Montenegro, the Netherlands and Norway.

CONCLUSION

The CAST is a suitable test for comparing the measurement of problematic cannabis use amongst adolescents in Europe.

Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country

BACKGROUND

Medication errors can often occur due to the patient's inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts.

METHODS

A cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference.

RESULTS

A total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett's test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001).

CONCLUSION

Pictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes.

Improving Children's Mental Health Literacy Through the Cocreation of an Intervention and Scale Validation: Protocol for the CHILD-Mental Health Literacy Research Study

BACKGROUND

Children's mental health is a public health priority, with 1 in 5 European children younger than 12 years having a behavioral, developmental, or psychological disorder. Mental health literacy (MHL) is a modifiable determinant of mental health, promoting psychological well-being and reducing mental health problems. Despite its significance, no interventions or scales currently exist for increasing and measuring MHL in this population.

OBJECTIVE

This study has dual objectives: (1) cocreating and evaluating an intervention on children's MHL, and (2) developing and validating a scale that measures children's MHL.

METHODS

Our study focuses on children aged 9-11 years attending primary school classes in various settings, including urban and rural areas, and priority education zones within a French department. Using a participatory research approach, we will conduct workshops involving children, parents, teachers, and 1 artist to cocreate an intervention comprising multiple tools (eg, a pedagogical kit and videos). This intervention will undergo initial evaluation in 4 classes through observations, interviews, and satisfaction questionnaires to assess its viability. Concurrently, the artist will collaborate with children to create the initial version of the CHILD-MHL scale, which will then be administered to 300 children. Psychometric analyses will validate the scale. Subsequently, we will conduct a cluster randomized controlled trial involving a minimum of 20 classes, using the CHILD-MHL scale scores as the primary end point to evaluate the intervention's efficacy. Additional interviews will complement this mixed methods evaluation. Both the intervention and the scale are grounded in the Child-Focused MHL model.

RESULTS

The first tool of the intervention is the pedagogical kit Le Jardin du Dedans, supported by the public organization Psycom Santé Mentale Info and endorsed by UNICEF (United Nations Children's Fund) France. The second tool is a handbook by the Pan American Health Organization and the World Health Organization, which is addressed to teachers to sensitize them to children's mental health problems. The third is a 5-page supplementary leaflet produced by the nongovernmental organization The Ink Link, which teaches children the notion of MHL. Finally, we produced 56 items of the MHL Scale and listed existing education policies for children's mental health.

CONCLUSIONS

After its robust evaluation, the intervention could be extended to several schools in France. The scale will be the first in the world to measure children's MHL. It will be used not only to evaluate interventions but also to provide data for decision makers to include MHL in all educational policies. Both the intervention and the scale could be translated into other languages.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/51096.

Translation and validation of the French version of the ObsQoR-10 questionnaire for the evaluation of recovery after delivery: the ObsQoR-10-French

Background

The Obstetric Quality of Recovery-10 (ObsQoR-10) is a validated tool for assessing the quality of postpartum recovery. This study aimed to validate the French version of the ObsQoR-10 scale (ObsQoR-10-French).

Methods

After translating the ObsQoR-10 into French, we conducted a psychometric validation involving internal consistency, convergent validity, construct validity, reliability, responsiveness, scaling properties, acceptability, and feasibility. French women who underwent either a vaginal delivery (spontaneous or induced labour), or an emergency or elective Caesarean section (C-section) were prospectively included. They completed the ObsQoR-10-French before delivery and at 24 h (H24) and 48 h (H48) after delivery.

Results

Of the 500 women included, 431 (86%) completed the questionnaire at all three timepoints. A total of 352 women (82%) underwent vaginal delivery (with 228 [53%] experiencing spontaneous labour and 124 [29%] had labour induced), whereas 53 (12%) women underwent an emergency C-section and 26 (6%) an elective C-section. The ObsQoR-10-French demonstrated excellent internal consistency with a Cronbach's coefficient of 0.81, 95% confidence interval 0.78-0.84 at H24. The tool was correlated with an 11-item global health score (P<0.001). Of the list of hypotheses for evaluating the construct validity, 81% were confirmed (negative associations between ObsQoR-10-French and length of labour, hospital stay, the need for a C-section, and the emergency level of the C-section). The Cohen effect size at H24 was 0.58. The intra-class coefficient was 0.90, 95% confidence interval 0.86-0.93 at H24.

Conclusion

The ObsQoR-10-French is a valid and reliable psychometric questionnaire, capable of assessing the quality of postpartum recovery in French-speaking populations.

Clinical trial registration

NCT04489602.

External validation of the parental attitude about childhood vaccination scale

Introduction

Internal validation techniques alone do not guarantee the value of a model. This study aims to investigate the external validity of the Parental Attitude toward Childhood Vaccination (PACV) scale for assessing parents' attitude toward seasonal influenza vaccination.

Methods

Using a snowball sampling approach, an anonymous online questionnaire was distributed in two languages (English and Arabic) across seven countries. To assess the internal validity of the model, the machine learning technique of "resampling methods" was used to repeatedly select various samples collected from Egypt and refit the model for each sample. The binary logistic regression model was used to identify the main determinants of parental intention to vaccinate their children against seasonal influenza. We adopted the original model developed and used its predictors to determine parents' intention to vaccinate their children in Libya, Lebanon, Syria, Iraq, Palestine, and Sudan. The area under the curve (AUC) indicated the model's ability to distinguish events from non-events. We visually compared the observed and predicted probabilities of parents' intention to vaccinate their children using a calibration plot.

Results

A total of 430 parents were recruited from Egypt to internally validate the model, and responses from 2095 parents in the other six countries were used to externally validate the model. Multivariate regression analysis showed that the PACV score, child age (adolescence), and Coronavirus disease 2019 (COVID-19) vaccination in children were significantly associated with the intention to receive the vaccination. The AUC of the developed model was 0.845. Most of the predicted points were close to the diagonal line, demonstrating better calibration (the prediction error was 16.82%). The sensitivity and specificity of the externally validated model were 89.64 and 37.89%, respectively (AUC = 0.769).

Conclusion

The PACV showed similar calibration and discrimination across the six countries. It is transportable and can be used to assess attitudes towards influenza vaccination among parents in different countries using either the Arabic or English version of the scale.

Development and psychometric evaluation of the Man-Made Disaster-Related Distress Scale (MMDS)

Man-made disasters (MMD²) are a widespread cause for psychological burden, both in directly and indirectly affected regions, as currently highlighted by the Russian invasion of Ukraine. Yet, measurement instruments that assess psychological distress associated with MMD are lacking. The study aimed to develop and validate such an instrument in an indirectly affected region. The resulting "man-made disaster-related distress scale" (MMDS) was tested within a German-speaking sample (N = 327). Exploratory and confirmatory factor analysis revealed a two-factorial structure ("Psychological distress" and "Change of existing belief systems") of the MMDS. The confirmatory model had an acceptable to good fit with CFI/TLI higher than 0.90. Internal consistency of the MMDS and its subscales was high with α and ω higher than 0.80. Correlational analyses suggested convergent, discriminant, and criterion validity. Measurement invariance was confirmed for gender and age with a change in CFI smaller than 0.01 but was rejected for educational level. The MMDS resulted in a 14-item assessment instrument based on a 7-point Likert-scale with good psychometric properties. Its administration is readily and economical, yielding the option to be used as a standardized measurement tool.

Predicting health services utilization using a score of perceived barriers to medical care: evidence from rural Senegal

BACKGROUND

Ensuring access to healthcare services is a key element to achieving the Sustainable Development Goal 3 of "promoting healthy lives and well-being for all" through Universal Health Coverage (UHC). However, in the context of low- and middle-income countries, most studies focused on financial protection measured through catastrophic health expenditures (CHE), or on health services utilization among specific populations exhibiting health needs (such as pregnancy or recent sickness).

METHODS

This study aims at building an individual score of perceived barriers to medical care (PBMC) in order to predict primary care utilization (or non-utilization). We estimate the score on six items: (1) knowing where to go, (2) getting permission, (3) having money, (4) distance to the facility, (5) finding transport, and (6) not wanting to go alone, using individual data from 1787 adult participants living in rural Senegal. We build the score via a stepwise descendent explanatory factor analysis (EFA), and assess its internal consistency. Finally, we assess the construct validity of the factor-based score by testing its association (univariate regressions) with a wide range of variables on determinants of healthcare-seeking, and evaluate its predictive validity for primary care utilization.

RESULTS

EFA yields a one-dimensional score combining four items with a 0.7 Cronbach's alpha indicating good internal consistency. The score is strongly associated-p-values significant at the 5% level-with determinants of healthcare-seeking (including, but not limited to, sex, education, marital status, poverty, and distance to the health facility). Additionally, the score can predict non-utilization of primary care at the household level, utilization and non-utilization of primary care following an individual's episode of illness, and utilization of primary care during pregnancy and birth. These results are robust to the use of a different dataset.

CONCLUSION

As a valid, sensitive, and easily documented individual-level indicator, the PBMC score can be a complement to regional or national level health services coverage to measure health services access and predict utilization. At the individual or household level, the PBMC score can also be combined with conventional metrics of financial risk protection such as CHE to comprehensively document deficits in, and progress towards UHC.

Taiwanese Older Adults Prefer to Use Antibiotics and Intravenous Infusion at the End of Life based on a Cartoon Version of the Life Support Preferences Questionnaire

Asians believe discussing death-related topics is inauspicious and may bring bad luck. It is critical to explore the end-of-life care preferences of the Asian elderly with less-threatening tools. The study examined older adults' preferences regarding end-of-life treatments by applying a cartoon version of the Life Support Preferences Questionnaire (LSPQ). A cross-sectional survey was conducted to understand older adults' preferences for end-of-life treatments. A total of 342 older adults participated in the study, comprising 268 elderly patients from a veterans hospital located in northern Taiwan and 74 elderly family members of the patients. Regardless of scenario, cardiopulmonary resuscitation (CPR) had the lowest score, indicating that older adults considered it a less desirable medical treatment. By contrast, antibiotics and intravenous infusions had the highest scores, indicating that older adults tended to prefer them. End-of-life care preferences were significantly different in genders. CPR and surgical preferences of older adults differed significantly with education level. Different demographic characteristics had different end-of-life treatment preferences, and future research may develop advance care planning programs for different attributes. This cartoon version of the LSPQ can help healthcare professionals to understand older adults' preferences for end-of-life care and warrants further empirical research.

Development of an instrument to measure awareness and mitigation of bias in maternal healthcare

BACKGROUND

Implicit bias among maternal healthcare professionals contributes to disrespectful care and racial and ethnic disparities in patient outcomes, and there is growing consensus that implicit bias training is a key component of birth equity initiatives. A requirement for implicit bias training for healthcare professionals has become more widespread, but the impact training has is largely unknown, in part, because of a lack of validated instruments. Therefore, there is an urgent need for a psychometrically valid instrument for use in the evaluation of implicit bias training.

OBJECTIVE

This study aimed to develop a valid and reliable instrument to assess implicit bias awareness and mitigation practices among maternal care professionals and that can be used to evaluate interventions aimed at mitigating such bias in clinical practice.

STUDY DESIGN

We conducted an instrument development and validation study in 3 phases. In phase 1, item development, we generated a 43-item bank from literature and consultation and established content validity with subject matter experts. In phase 2, instrument development, we administered a revised set of 33 items to 307 nurses and midwives and conducted exploratory factor analysis to demonstrate construct validity and reliability. In phase 3, instrument evaluation, we confirmed the factor structure and compared the means of implicit bias training-exposed and -unexposed participants to further demonstrate construct validity with a representative state sample of 2096 maternal healthcare professionals (physicians, midwives, and nurses).

RESULTS

Based on phase 2 results, we retained 23 items for the Bias in Maternal Health Care scale, which showed high internal consistency (Cronbach's alpha, 0.86). We identified 3 subscales, namely a 9-item Bias Awareness subscale (Cronbach's alpha, 0.86), a 7-item Bias Mitigation Practice subscale (Cronbach's alpha, 0.82), and a 7-item Bias Mitigation Self-Efficacy subscale (Cronbach's alpha, 0.81). Validation of the Bias Awareness and Bias Mitigation Practice subscales in phase 3 demonstrated the instrument's high reliability (Cronbach's alpha 0.86 and 0.83, respectively) and discriminating performance among maternal healthcare professionals.

CONCLUSION

We developed a reliable and valid instrument for measuring awareness and mitigation of bias among maternal healthcare professionals. It can be used to evaluate implicit bias training and other bias mitigation interventions in maternal healthcare settings.

A PROACTIVE Coping Scale for U.S. College Students: Initial Evidence and Implications

The present studies report the development of a PROACTIVE coping scale to evaluate actions used by U.S. college students to prevent or prepare for potential future stressors. Results of EFA and CFA using two samples of U.S. college students (total N = 1123) indicated the viability and stability of a 19-item four-factor model of proactive coping: Active Preparation, Ineffective Preparation, Self-Management, and Utilization of Social Resources. The scale demonstrated good psychometric properties, and each factor represents a meaningful and distinctive facet of proactive coping behavior. Concurrent and incremental validity estimates indicated that the subscales of the scale were (a) associated with problem-solving appraisal, future-oriented thoughts, life satisfaction, and optimism in expected ways, and (b) accounted for more variance on life satisfaction beyond the effect of the problem-solving appraisal. The results from this study indicate the importance of broadening coping to include proactive coping and how proactive coping is associated with various psychological outcomes.

Psychometric properties of the German revised version of the eHealth literacy scale in individuals with cardiac diseases: Validation and test of measurement invariance

Background

The internet is most people's primary source of (health) information. However, no validated instrument exists to assess eHealth literacy in the group of patient with cardiac diseases.

Objective

The objective of this study was the evaluation of the psychometric properties of the German revised version of the eHealth literacy scale (GR-eHEALS) in individuals with coronary artery disease (CAD) and congestive heart failure (CHF).

Methods

A cross-sectional study was conducted. N = 455 were included in the statistical analyses. The assessment compromised the GR-eHEALS, medical history, sociodemographic data, and technology-related data. Confirmatory factor analyses, correlational analyses, and tests of measurement invariance were performed.

Results

The two-factorial model reached a good model fit. The sub-scales information seeking and information appraisal, as well as the eHealth literacy total score, reached high reliability coefficients. Construct and criterion validity was fully confirmed For the two-factorial model, measurement invariance up to the scalar level could be confirmed regarding the sociodemographic characteristics sex, age, and educational level.

Conclusions

This study confirmed the two-factor structure, construct, and criterion validity as well as measurement invariance at the scalar level for sex, age, and educational level of the GR-eHEALS scale in a sample of individuals with CAD and CHF.

Validation of the Vanderbilt Responses to Your Child's Speech Rating Scale for Parents of Young Children Who Stutter

PURPOSE

This study reports the development, refinement, and exploration of the psychometric properties of the Vanderbilt Responses to Your Child's Speech (VRYCS) rating scale, a novel measure designed to assess parents' self-perceived responses to the speech of their children who stutter (CWS).

METHOD

Parents of 214 young (ages 2;4[years;months]-5;11) CWS completed the original 40-item version of the VRYCS. Content analyses and an exploratory factor analysis determined the scale's factors and identified specific items corresponding to each. Items that did not load onto the factors were removed and internal consistency was assessed.

RESULTS

The final 18-item VRYCS rating scale includes five factors relating to parents' responses to the speech of their CWS including (a) Requesting Change, (b) Speaking for the Child, (c) Supporting Communication, (d) Slowing and Simplifying, and (e) Responding Emotionally. Reliability was demonstrated, responses by parents of CWS were described, and a revised scoring form developed.

CONCLUSIONS

The VRYCS is a valid and reliable tool for assessing and exploring parents' perceptions of their own responses to the speech of their CWS for clinical and research purposes. Clinical applications of the VRYCS for assessment and treatment of childhood stuttering are discussed.

Development of a knowledge, attitude and practice questionnaire on urine leakage with an indwelling urethral catheter for nurses in China

AIM

A knowledge, attitude and practice questionnaire on urine leakage (UL) with an indwelling urethral catheter (IUC) was developed for nurses in China and validated.

DESIGN

Observational study.

METHODS

A systematic literature review, the Delphi method and focus group evaluation were used to develop the questionnaire, which was administered to 304 registered nurses at two hospitals in Guangdong, China. The validity and reliability of the questionnaire were assessed.

RESULTS

The 27-item questionnaire had four dimensions: knowledge I (aetiology), knowledge II (prevention and treatment), attitude and practice. The questionnaire showed excellent content validity and reliability. Four factors accounted for 70.526% of the variance. The data were well-fitted to the four-factor construct model. The questionnaire can be used to measure the knowledge of UL with an IUC among nurses in China, along with related attitudes and practices. This can improve nursing care of patients with IUCs. No patient or public contribution.

Assessing the dimensionality of scores derived from the Revised Formal Thought Disorder Self-Report Scale in schizotypy

The current work explored the dimensionality and convergent validity of responses to Barrera et al.'s (2015) 29-item Formal Thought Disorder-Self Scale (FTD-SS) obtained in two non-clinical samples. Exploratory factor analyses were conducted in Sample 1 (n = 324), yielding evidence of three correlated factors, although simple structure was not achieved until nine items were removed. Support for the correlated three factors model of responses to the revised 20-item scale (FTD-SS-R) was replicated when a confirmatory factor analysis was conducted in Sample 2 (n = 610). Finally, convergent associations were found between FTD-SS-R scores and scores from other schizotypy measures across both samples, though these measures only explained half of the variance in FTD-SS-R scores. Additional research is needed to evaluate the appropriateness of the items and incremental validity of the scale in non-clinical samples.

University Fairness Questionnaire (UFair): Development and Validation of a German Questionnaire to Assess University Justice-A Study Protocol of a Mixed Methods Study

Distress is a widespread phenomenon in the general population, but also among university students, associated with poorer learning success and negative health consequences. A source of distress might be the experience of injustice. Theoretical and empirical work in the area of perceived fairness in the workplace ("organizational justice") has shown that perceived unfairness is related to various stress indicators and health outcomes. Preliminary evidence indicates that unfairness matters not only in the work context but also in the university context. However, an adapted and validated tool to assess perceived unfairness in the university context is hitherto missing. The goal of the proposed project is therefore to adapt the construct of organizational justice to the university context and to develop a corresponding questionnaire by means of established scientific procedures. An exploratory sequential mixed-methods design is applied in which qualitative and quantitative methods are combined. A valid and practicable measurement instrument ("UFair" University Fairness Questionnaire) will be developed and tested, and the relationship with various health outcomes will be examined. The UFair questionnaire will be made available free of charge to other researchers.

Can the bodily distress syndrome (BDS) concept be used to assess functional somatic symptoms in adolescence?

OBJECTIVE

Bodily Distress Syndrome (BDS) represents a new research concept for adult patients with various functional somatic syndromes. We evaluated the utility of the BDS research concept and the associated BDS-25-checklist as a screening tool for diverse functional somatic symptoms (FSS) in adolescence by investigating: 1) the psychometric and factorial structures of the checklist, 2) symptom cluster patterns and 3) illness classification and associations with emotional psychopathology and sociodemographic factors.

METHODS

This cross-sectional study obtained data from the 16/17-year follow-up (N = 2542) of the general population Copenhagen Child Cohort 2000 (CCC2000). We used self-reported questionnaires to assess physical symptoms (the BDS-25 checklist), overall health (KidScreen), emotional psychopathology (Spence Children's Anxiety Scale; The Mood and Feelings Questionnaire), and illness worry (Whiteley-6 Index), and utilized data from Danish national registers to assess sociodemographic factors.

RESULTS

The BDS-25 checklist items displayed satisfactory psychometric data quality. Factor analyses revealed a similar four-factor model as reported in adults (factor loadings λ ≥0.5), representing distinct BDS symptom clusters: cardio-pulmonary, gastro-intestinal, musculoskeletal and general symptoms. Latent class analyses revealed a model with three latent classes, i.e. probable no to mild BDS, probable moderate, single-organ BDS and probable severe, multi-organ BDS, displaying acceptable class quality (Entropy = 0.904). Trend analyses revealed sociodemographic group differences across latent classes. Increased emotional psychopathology was associated with more pronounced BDS symptoms.

CONCLUSION

Our findings support the BDS concept with four symptom clusters and three illness severity groups (no BDS, single- organ and multi-organ BDS) to screen for FSS in adolescence.

Reliability and validity of the Arabic version of the Consultation and Relational Empathy (CARE) measure

PURPOSE

Empathy is the ability to communicate an understanding of an individual's subjective experience. It plays a vital role in the physician-patient relationship and improves clinical outcomes. This increases the importance of measuring and studying empathy in the clinical setting. The Consultation and Relational Empathy (CARE) is a 10-item questionnaire that measures patient assessment of physician's empathy in primary care. To our knowledge, there are no validated measures of empathy in the clinical setting in Arabic. This study aims at validating the CARE in Arabic.

METHODS

Data collection took place between October 2019 and February 2020. A total of 220 patients completed the questionnaire which consisted of the 10 CARE items, participants' opinions regarding the importance of each item, demographic information, and information about the consultation. The reliability and validity of the Arabic CARE were measured using Cronbach alpha, item-total correlations, and factor analysis. Construct validity was measured based on the overall patient satisfaction, and their satisfaction with the length of the consultation.

RESULTS

High Cronbach alpha and item-total correlation reveal the internal consistency and homogeneity of the Arabic version. Our findings showed significant positive correlations between CARE score and each of the characteristics: overall satisfaction with the consultation, duration of the consultation, patients' satisfaction with consultation duration and whether they would recommend the doctor to others.

CONCLUSION

The Arabic version of the CARE measure appears to be valid and reliable. It is available for use in research, education, and assessment of physicians' empathy.

The validity and reliability of the Arabic version of the ocular surface disease index (OSDI) questionnaire in a sample of the Gazan population: a study from Palestine

PURPOSE

To develop an Arabic version of OSDI for the Gazan population.

METHODS

A cross-sectional observational study was conducted using a convenience sample technique. The translation procedure included five stages: forward translation, revision of translation, backward translation, refinement of translation, and a final test of the pre-final version. The final sets of questionnaires were constructed using an online JotForm platform. The online platform was chosen to automatically calculate the questionnaire's final overall score. Overall, 260 participants were instructed to fill out the English and the Arab-OSDI version twice to conduct the reliability of the translated version and repeatability evaluation.

RESULTS

The mean age of the participants was 33.45 ± 11.74 years old. Cronbach's alpha for all items was greater than 0.80, except for the "blurred vision" and "deteriorating vision" items (0.77 and 0.74, respectively). The mean overall score difference between the English-OSDI and Arab-OSDI was 0.86 based on the Bland-Altman chart. For repeatability, no significant difference in the overall scores between the two repeats of the Arab-OSDI (p = 0.632). The Arab-OSDI overall score (sessions 1 and 2) has a clinical difference (bias) of 0.21. Using the varimax rotation method, only three factors (ocular symptoms, vision-related function, and environmental triggers) had eigenvalues greater than one in the structure of the Arab-OSDI.

CONCLUSION

The Arab-OSDI is an appropriate, reliable, and repeatable tool for the determination of dry eye symptoms, ocular discomfort, and quality of life in the Gazan population. This version could remove the language barrier in answering OSDI items more easily.

Knowledge, attitudes, and behavioral intentions of elderly individuals regarding advance care planning: Questionnaire development and testing

Background

Studies have indicated that the advance care planning knowledge and attitudes of elderly individuals strongly affect their implementation of advance care planning. A measurement with a theoretical base for evaluating elderly individuals’ knowledge, attitudes, and behavioral intentions regarding advance care planning is lacking.

Objectives

To develop a questionnaire and understand elderly individuals’ knowledge, attitudes, and behavioral intentions regarding implementing advance care planning.

Methods

A cross-sectional questionnaire survey was conducted. The content validity index, and statistical methods, including discrimination, factor, and reliability analysis, were adopted for psychometric testing. Descriptive statistics mainly presented data analysis.

Results

401 elderly individuals were recruited from a medical center and one senior activity center. The content validity index was approximately 0.71–0.92 for the developed questionnaires, the Kuder–Richardson formula 20 was 0.84 for advance care planning knowledge, and the Cronbach’s alpha was 0.86, 0.94, 0.76, and 0.92 for attitudes, behavioral intentions, influencing factors, and subjective norms, respectively. The average score for advance care planning knowledge for elderly individuals was 4.42, with a correct answer rate of 49.1%. They lacked knowledge of advance care planning-related legislation. The mean score for attitudes and behavioral intentions was 14.32 and 3.48, respectively. Elderly individuals agreed that advance care planning has benefits but were worried about the emotional distress caused by advance care planning discussions. Elderly individuals with positive behavioral intentions tend to implement advance care planning. Spouses, children, doctors, and nurses are significant reference people for elderly individuals.

Conclusions

The developed questionnaire exhibits good validity and reliability for understanding elderly individuals’ knowledge, attitudes, and behavioral intentions concerning advance care planning. Advance care planning materials or decision aids suitable for elderly individuals must be developed to increase their understanding of advance care planning. Additionally, the role of nurses is indispensable in promoting advance care planning among elderly individuals.

Properties of the Spanish Version of the Place Standard Tool

(1) Background: The social determinants that maintain health inequalities are organized in the physical, social, and economic contexts of neighborhoods and municipalities. Their characteristics influence the behaviors and choices of the people living in them, with an impact on their health and well-being. In recent years, several local applications and urban development tools have been designed to learn how to promote the development of health and wellness environments. Aim: The purpose was to test the properties of the Spanish adaptation of the Place Standard Tool through its implementation in a Valencian community municipality. (2) Methods: Metric properties were analyzed from a sample of 242 participants. Descriptive statistics were used to analyze the sociodemographic data and to describe item responses. Cronbach’s alpha was used to provide a measure of the internal consistency, whereas the Kaiser–Meyer Olkin test was relied upon to study the relationship between different variables. (3) Results: The questionnaire showed an internal consistency index of 0.849 and a KMO of 0.842, with a single factor variance of 81.50%. (4) Conclusions: The Spanish adaptation of the Place Standard Tool is a valid tool for assessing neighborhoods and municipalities with a focus on social determinants of health and equity.

The Road to Cognitive Skill Acquisition: Psychometric Evaluation of the Competencies of Cognitive Therapy Scale

OBJECTIVE

Cognitive therapy (CT) skills are an index of treatment progress. They predict changes in patients' acute depressive symptoms and symptom relapses. However, the psychometric properties of the various measures of CT skills are poorly understood. This study aimed to investigate the factor structure of the Competencies of Cognitive Therapy Scale-Self Report (CCTS-SR) and assess its concurrent validity.

METHODS

The psychometric properties of the CCTS-SR were explored by using data from a panel of online respondents (N=410). The fit of a one-factor solution was explored by using a confirmatory factor analysis. Exploratory bifactor analyses (EBFA) were then conducted to determine other possible factor structures.

RESULTS

The one-factor solution did not fit the data well. Results of the EBFA suggested that the factor structure of the CCTS-SR may be characterized by a single underlying dimension capturing the general use of CT skills as well as by more specific factors the authors labeled "behavioral activation" and "CT comprehension." The variance captured by the factor initially labeled as CT comprehension was correlated with measures of depression and emotional dysregulation, suggesting that these items do not capture CT comprehension and should be removed from the scale.

CONCLUSIONS

The CCTS-SR seems to be characterized by more than a single factor, and items that seemingly compose CT comprehension (i.e., items 13 and 14) may need to be removed. Although the CCTS-SR may be a valid index of therapy progress, more attention needs to be paid to its psychometric properties.

Development of Reliable and Valid Questions to Assess Food Resource Management Behaviors in Adults With Limited Income

OBJECTIVE

Develop reliable, valid questions to assess changes in food resource management (FRM) behaviors in adults with limited incomes.

DESIGN

Questionnaire development using a mixed-methods approach: content validity (subject matter and curricula), face validity, temporal reliability (test-retest), sensitivity to change, and exploratory factor analysis (EFA).

SETTING

Community settings in 12 states.

PARTICIPANTS

Convenience samples of English-speaking Expanded Food and Nutrition Education Program (EFNEP) or EFNEP-eligible adults: 105 (cognitive interviews), 181 (test-retest), 185 (sensitivity), and 389 (EFA) adults.

VARIABLES MEASURED

Behaviors related to FRM skills: planning, shopping, and budgeting.

ANALYSIS

Consistency and agreement in cognitive interviews and temporal reliability; sensitivity at posttest (paired t tests, Wilcoxon signed-rank tests); internal consistency of scales identified in EFA (Cronbach α). P < 0.5.

RESULTS

All questions had acceptable temporal reliability ranges for the intraclass correlation coefficient (0.48-0.74) and Spearman rank-order correlation (0.48-0.73). All questions were sensitive to change at posttest (P < 0.001). Planning and saving scales, revealed by EFA, demonstrated internal consistency (> 0.80 Cronbach α).

CONCLUSIONS AND IMPLICATIONS

The 9 FRM behavior questions have acceptable temporal reliability and content and face validity and can be used nationally by EFNEP to assess participants' self-reported behavior changes. Other nutrition programs with similar audiences and content could use these questions to measure changes in FRM behaviors.

Health Literacy throughout adolescence: Invariance and validity study of three measurement scales in the general population

OBJECTIVE

To simultaneously investigate the psychometric properties of three recently developed health literacy measurement scales throughout adolescence in the general population.

METHODS

French versions of the Health Literacy for School-Aged Children (HLSAC, unidimensional) scale, the Health Literacy Assessment Scale for Adolescents (HAS-A, multidimensional) and the 16-item European Health Literacy Survey questionnaire (HLS-EU-Q16, unidimensional) were completed by 1 444 adolescents in 8th, 9th, 11th grade in general school and 11-12th grade in vocational school. Psychometric properties were studied using confirmatory factor analysis, McDonald's omega coefficient and hypothesis testing.

RESULTS

Structural validity was acceptable (HLS-EU-Q16) to good (HAS-A and HLSAC), no measurement invariance issue was found and internal consistency was acceptable for the three scales (0.68-0.84). Convergent validity was low (Pearson correlation coefficients<0.5) and the only scale for which results were in agreement with a priori hypotheses was the HLSAC.

CONCLUSIONS

Our results were supportive of the use of HLSAC to assess health literacy during adolescence but the HAS-A, with a slightly better structural validity, can also be promoted due to its three measured dimensions.

PRACTICE IMPLICATIONS

The use of these scales in practice will help to focus on health literacy, a critical factor for prevention and health promotion in adolescence.

On the Measurement of Climate Change Anxiety: French Validation of the Climate Anxiety Scale

The notion of climate change anxiety has gained traction in the last years. Clayton & Karazsia (2020) recently developed the 22-item Climate Change Anxiety Scale (CAS), which assesses climate change anxiety via a four-factor structure. Yet other research has cast doubts on the very structure of the CAS by calling either for a shorter (i.e. 13 items) two-factor structure or for a shorter single-factor structure (i.e. 13 items). So far, these three different models have not yet been compared in one study. Moreover, uncertainty remains regarding the associations between the CAS and other psychological constructs, especially anxiety and depression. This project was designed to overcome these limitations. In a first preregistered study (n = 305), we translated the scale into French and tested, via confirmatory factor analyses (CFA), whether the French version would better fit with a four-, two-, or single-factor structure, as implied by previous works. We also examined how the CAS factors related to depression, anxiety, and environmental identity. In a second preregistered study, we aimed at replicating our comparison between the three CFA models in a larger sample (n = 905). Both studies pointed to a 13-item version of the scale with a two-factor structure as the best fitting model, with one factor reflecting cognitive and emotional features of climate change anxiety and the other reflecting the related functional impairments. Each factor exhibited a positive association with depression and environmental identity but not with general anxiety. We discuss how this two-factor structure impacts the conceptualization of climate change anxiety.

Development and validation of the Health Education Adherence Scale for Stroke Patients: a cross-sectional study

Background

Due to the lack of health education adherence assessment tools for stroke patients, the assessment of health education adherence in this population is insufficient, which hinders the prevention and rehabilitation of stroke. This study aims to develop and validate a Health Education Adherence Scale for Stroke Patients (HEAS-SP).

Methods

A cross-sectional design with a purposive sampling method was used for this study. Six hundred and fifty-four eligible participants completed the demographic questionnaire and the HEAS-SP. The data collection lasted for 7 months, from March 1stto September 30th in 2019. Item analysis and exploratory and confirmatory factor analysis were employed to develop and validate the HEAS-SP.

Results

The item analysis, exploratory and confirmatory factor analysis resulted in a 20-item HEAS-SP with 4 domains: medication adherence, diet adherence, rehabilitation exercise adherence, and healthy lifestyle adherence. The four-domain model demonstrated acceptable model fit indexes and the 20-item HEAS-SP demonstrated acceptable reliability and validity.

Conclusion

The 20-item HEAS-SP was shown to have acceptable reliability and validity for assessing health education adherence with respect to diet, medication, rehabilitation exercise and healthy lifestyle in stroke patients, making it a potential basis for developing targeted interventions for stroke patients.

Potential Applications of Artificial Intelligence in Clinical Trials for Alzheimer’s Disease

Clinical trials for Alzheimer’s disease (AD) face multiple challenges, such as the high screen failure rate and the even allocation of heterogeneous participants. Artificial intelligence (AI), which has become a potent tool of modern science with the expansion in the volume, variety, and velocity of biological data, offers promising potential to address these issues in AD clinical trials. In this review, we introduce the current status of AD clinical trials and the topic of machine learning. Then, a comprehensive review is focused on the potential applications of AI in the steps of AD clinical trials, including the prediction of protein and MRI AD biomarkers in the prescreening process during eligibility assessment and the likelihood stratification of AD subjects into rapid and slow progressors in randomization. Finally, this review provides challenges, developments, and the future outlook on the integration of AI into AD clinical trials.

Measuring Electronic Health Literacy: Development, Validation, and Test of Measurement Invariance of a Revised German Version of the eHealth Literacy Scale

Background

The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant.

Objective

The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language.

Methods

Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted.

Results

Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected.

Conclusions

Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy.

Reliability and validity of the repetitive behavior scale-revised for young Chinese children with autism spectrum disorder in Jiangxi Province

Restricted and repetitive behaviors (RRBs) are one of the two main diagnostic features of autism spectrum disorder (ASD). To date, a growing body of research on RRB in children with ASD has recently attracted academic attention. The Repetitive Behavior Scale-Revised (RBS-R) was primarily intended for use in evaluating RRBs observed in ASD. This study recruited 381 Chinese children with ASD aged 2-4 years to measure the reliability and validity of the RBS-R. Confirmatory factor analysis (CFA) was applied to the structuring models of the four proposed structural models, indicating that a 6-factor model demonstrated good internal consistency and the best fit based on common overall fit indices. These findings suggest the utility of the Chinese version of RBS-R.

Development and validation of the Chinese surgical inpatient satisfaction and comfort questionnaire

Patient feedback can provide insights to assess and improve the quality of healthcare. This study aimed to develop a measure of surgical inpatient satisfaction and comfort and examine its acceptability, validity, and reliability among discharged surgical patients.This multicenter, descriptive, cross-sectional study was conducted at three tertiary hospitals in Shaanxi Province, China. A random sample of patients admitted to the surgical inpatient departments of the three hospitals between November and December 2018 was recruited. An analysis was conducted on the acceptability, validity, and reliability of a newly developed measure of satisfaction with surgical inpatient services.A total of 1582 out of 1805 (87.6%) eligible patients completed the questionnaire (average time taken = 17.1 ± 10.3 minutes), which indicated high acceptability. Sociodemographic differences between the participants and non-participants were not significant. Using factor analysis, the following 7 dimensions (number of items: 65, variance explained: 68.0%) were identified: medical care (19 items), nursing care (15 items), environment and logistics (11 items), postoperative and hospitalization experiences (11 items), feeling nervous and afraid (4 items), operating room services (3 items), and visiting (2 items). The latent structure of the assessment was examined and validated using exploratory and confirmatory factor analyses, respectively. All item loadings were >0.4. All dimensions demonstrated satisfactory internal consistency (Cronbach's alphas = 0.83-0.96) and test-retest reliability (intra-class correlation coefficients = 0.77-0.96).The Chinese Surgical Inpatient Satisfaction and Comfort Questionnaire has strong psychometric properties and can be used to assess patient satisfaction with public hospital surgical inpatient services in China. A distinguishing feature of this questionnaire is the inclusion of a subscale that assesses comfort as a dimension of patient satisfaction. Such instruments can be used to identify the factors that should be addressed to improve the quality of patient care. Further research is needed to determine the role of assessment in quality improvement.

Evaluating the Use of Self-reported Measures in Autistic Individuals in the Context of Psychiatric Assessment: A Systematic Review

The current review examined the use of self-report measures in autistic individuals in the context of psychiatric assessments. It focused on inter-rater agreement, internal consistency, test-retest reliability, and criterion validity with clinical diagnoses. It also gathered information on constructs measured, the nature of the samples, and the quality of the studies. Thirty-six out of 10,557 studies met inclusion criteria. We found that the majority of studies (1) targeted young people with average or above average cognitive abilities, (2) measured anxiety symptoms, and (3) evaluated parent-child agreement. More studies are needed on individuals with lower cognitive abilities, adults, and other constructs. Studies assessing criterion validity and test-retest reliability are also needed.

Reliability and Validity Study of the Turkish Version of the COVID-19 Peritraumatic Distress Index

OBJECTIVE

The Coronavirus Disease 2019 (COVID-19) pandemic, affecting people worldwide, negatively affects the mental health of people. During this situation, accurate and reliable tools are needed to evaluate mental state. The aim of this study was to translate the COVID-19 Peritraumatic Distress Index (CPDI) into Turkish, and analyze it for validity and reliability.

METHODS

The original form of the CPDI was translated into Turkish using the back translation method. It was then applied to over 400 individuals, randomly selected from patients and their relatives, between the ages of 18 and 70, who presented to the outpatient clinics of Mustafa Kemal University Research Hospital. Data were collected with a demographic data form. Exploratory and confirmatory factor analyses were done. Construct validity, item content validity index, and content validity were analyzed. Cronbach's alpha vs. Spearman-Brown reliability analyses were done.

RESULTS

Cronbach's alpha coefficient for the CPDI was found to be 0.842, which is quite high. Cronbach's alpha coefficient for the subscales ranged from 0.670 to 0.780. The Spearman-Brown reliability coefficient was 0.730. The confirmatory factor analysis revealed good fit indices (χ2/df = 1.94; root mean square error of approximation = 0.05; Comparative Fit Index = 0.93; Adjusted Goodness of Fit Index and Tucker-Lewis Index = 0.91). The mean total score was 27.26 (SD = 12.28), while the mean subscale scores ranged from 4.83 to 10.26.

CONCLUSION

The Turkish version of the CPDI is valid and reliable, and can be used in studies evaluating the COVID-19 peritraumatic stress.

Reliability and Validity Study of the Turkish Version of the COVID-19 Peritraumatic Distress Index

OBJECTIVE

The Coronavirus Disease 2019 (COVID-19) pandemic, affecting people worldwide, negatively affects the mental health of people. During this situation, accurate and reliable tools are needed to evaluate mental state. The aim of this study was to translate the COVID-19 Peritraumatic Distress Index (CPDI) into Turkish, and analyze it for validity and reliability.

METHODS

The original form of the CPDI was translated into Turkish using the back translation method. It was then applied to over 400 individuals, randomly selected from patients and their relatives, between the ages of 18 and 70, who presented to the outpatient clinics of Mustafa Kemal University Research Hospital. Data were collected with a demographic data form. Exploratory and confirmatory factor analyses were done. Construct validity, item content validity index, and content validity were analyzed. Cronbach's alpha vs. Spearman-Brown reliability analyses were done.

RESULTS

Cronbach's alpha coefficient for the CPDI was found to be 0.842, which is quite high. Cronbach's alpha coefficient for the subscales ranged from 0.670 to 0.780. The Spearman-Brown reliability coefficient was 0.730. The confirmatory factor analysis revealed good fit indices (χ²/df = 1.94; root mean square error of approximation = 0.05; Comparative Fit Index = 0.93; Adjusted Goodness of Fit Index and Tucker-Lewis Index = 0.91). The mean total score was 27.26 (SD = 12.28), while the mean subscale scores ranged from 4.83 to 10.26.

CONCLUSION

The Turkish version of the CPDI is valid and reliable, and can be used in studies evaluating the COVID-19 peritraumatic stress.

Mapping and Crosswalk of the Oxford Hip Score and Different Versions of the Hip Disability and Osteoarthritis Outcome Score

BACKGROUND

Patient-reported outcome measures such as the Oxford-12 Hip Score and Hip Disability and Osteoarthritis Outcome Score (HOOS) are used in daily orthopaedic practice to evaluate patients. Because different studies use different scores, it would be important to build conversion tables between scores (crosswalk) to compare the results of one study with those of another study. Various mapping methods can be used to develop crosswalk tables that convert Oxford-12 scores to the HOOS (and its derivatives, including the HOOS physical function short form, HOOS joint replacement, and HOOS-12) and vice versa. Although prior studies have investigated this issue, they are limited to short forms of the HOOS score. Consequently, they cannot be applied to hip preservation surgery and do not include quality-of-life items, whereas the Oxford-12 Hip Score is used for all hip evaluations.

QUESTIONS/PURPOSES

We prospectively studied the Oxford-12 and HOOS and its derivatives to (1) determine which version of the HOOS has the best mapping with the Oxford-12, (2) define the most-appropriate mapping method using selected indicators, and (3) generate crosswalk tables between these two patient-reported outcome measures.

METHODS

The study enrolled 500 adult patients before primary THA (59% men [294 of 500 patients]) with hip osteoarthritis or avascular necrosis of the femoral head who completed the HOOS and Oxford-12. Patients were recruited from January 2018 to September 2019 in a tertiary-care university hospital, and we included all primary THAs in patients older than 18 years with a BMI lower than 35 kg/m2 and greater than 18 kg/m2. After a minimum of 6 months of follow-up, 39% (195 of 500) of the patients were assessed using the same tools. To determine which version of the HOOS mapped best to the Oxford-12 and what the most-appropriate mapping method was, we used preoperative data from all 500 patients. Because there is no consensus on the method to establish crosswalk, various mapping methods (linear regression, tobit regression, and quantile regression) and equating methods (linear equating and equipercentile method) were applied along with cross-validation to determine which method was the most suitable and which form of the HOOS provided the best result according to different criteria (mean absolute error, r2, and Kolmogorov-Smirnov distance).To generate crosswalk tables, we created a conversion table (between the Oxford-12 and the HOOS form that was chosen after answering our first research question and the method chosen after answering our second question) using preoperative and postoperative data (n = 695). This table was meant to be simple to use and allows easy conversions from one scoring system to another.

RESULTS

The Oxford-12 and HOOS were strongly correlated (Pearson correlation coefficient range 0.586-0.842) for the HOOS subcategories and HOOS physical function, HOOS joint replacement, and HOOS-12. The correlation between the HOOS-12 and Oxford-12 was the strongest (r = 0.825). According to the three different criteria and five methods, the HOOS-12 was the best suited for mapping. The goal was to minimize the mean absolute error (perfect model = 0), have a Kolmogorov-Smirnov distance as close as possible to 0, and have the r2 as close as possible to 1. Regarding the most-suitable method for the crosswalk mapping (research question 2), the five methods generated similar results for the r2 (range 0.63-0.67) and mean absolute error (range 6-6.2). For the Kolmogorov-Smirnov distance, the equipercentile method was the best (Kolmogorov-Smirnov distance 0.04), with distance reduced by 43% relative to the regression methods (Kolmogorov-Smirnov distance 0.07). A graphical comparison of the predicted and observed scores showed that the equipercentile method provided perfect superposition of predicted and observed values after mapping. Finally, crosswalk tables were produced between the HOOS-12 and Oxford-12.

CONCLUSION

The HOOS-12 is the most complete and suitable form of the HOOS for mapping with the Oxford-12, while the equipercentile method is the most suitable for predicting values after mapping. This study provides clinicians with a reliable tool to crosswalk between these scores not only for joint arthroplasty but also for all types of hip surgeries while also assessing quality of life. Our findings should be confirmed in additional studies.

CLINICAL RELEVANCE

The resulting crosswalk tables can be used in meta-analyses, systematic reviews, or clinical practice to compare clinical studies that did not include both outcome scores. In addition, with these tools, the clinician can collect only one score while still being able to compare his or her results with those obtained in other databases and registries, and to add his or her results to other databases and joint registries.

Measuring family-centred care practices in adult intensive care units: The EMPATHIC-F questionnaire

BACKGROUND

Engaging relatives in the care of critically ill patients is associated with better outcomes. It is crucial to empower relatives to provide feedback. Valid satisfaction instruments are essential to identify best practices and areas for improvement.

AIM

The aim of the study was to adapt the Spanish version of the EMpowerment of PArents in The Intensive Care-30 (EMPATHIC-30) questionnaire in adult intensive care units (ICUs) and psychometrically test the EMpowerment of PAtients in The Intensive Care-Family (EMPATHIC-F) questionnaire to measure family satisfaction.

DESIGN

This is a cross-sectional, prospective study conducted in two adult ICUs. Participants were relatives of patients who were discharged alive from the ICUs with an ICU length-of-stay >24 hours. The EMPATHIC-F questionnaire is divided into five domains that are related to the family-centred care principles. Responses are provided on a 6-point ordinal Likert scale, a score of >5 is considered acceptable.

RESULTS

Patients' relatives confirmed the adaptation of the instrument. A total of 262 relatives responded to the EMPATHIC-F questionnaire (97% response rate). The empirical structure of the instrument was established by confirmatory factor analysis confirming 30 statements within five theoretically conceptualized domains: information, care and treatment, family participation, organization, and professional attitude. On item level, two statements scored a mean below 5.0. Cronbach's α at the domain level was between .64 and .75. Congruent validity was adequate between the five domains and four general satisfaction items (r's .26-.54). The non-differential validity was confirmed with no significant effect size between three patients' demographic characteristics and the domains.

CONCLUSIONS

The EMPATHIC-F questionnaire is a reliable and valid quality performance indicator to measure the perceptions of family members in adult ICU settings.

RELEVANCE TO CLINICAL PRACTICE

The EMPATHIC-F questionnaire can be used to benchmark and provides a framework for standardized quality improvement towards the development of a family-centred care philosophy within adult ICUs.

Development and preliminary validation of the patient-reported Chronic Itch Burden Scale assessing health-related quality of life in chronic pruritus

BACKGROUND

Chronic pruritus (CP) significantly affects patients' health-related quality of life (HRQoL). Very few self-reported HRQoL questionnaires exploring CP have been developed according to international guidelines, thus limiting their use in preauthorization trials.

OBJECTIVES

To develop a self-reported HRQoL questionnaire in patients with CP owing to psoriasis, atopic dermatitis, seborrhoeic dermatitis of the scalp or idiopathic dermatitis, and to explore the preliminary psychometric properties of the questionnaire.

METHODS

The study was performed in France. A conceptual framework was developed based on a structured literature review and expert insight, and was improved using three focus groups involving 19 participants. A 50-item questionnaire was created and tested with 21 participants using cognitive debriefings; 11 items were removed. A cross-sectional study including 251 participants was performed to explore the preliminary psychometric properties of the 39-item questionnaire. Dimensionality was explored using principal component analysis. Cronbach's alpha and correlation coefficients (interitem, item-total score and item-dimension score) were measured. The number of items was reduced through expert consensus.

RESULTS

In the 39-item version, three main dimensions were identified (Cronbach's alpha = 0·94) and all correlation coefficients were > 0·34. Upon review, 13 items were deleted owing to poor quality and six items were deleted by the team, generating a 20-item version. The questionnaire's factorial structure was best reflected with a two-dimension solution, i.e. (i) social and emotional repercussions and (ii) relation to others, fear of judgement.

CONCLUSIONS

The Chronic Itch Burden Scale patient-reported questionnaire explores broad aspects of HRQoL that are relevant for patients with various skin diseases. Its good cross-sectional validity makes it useful for trials and practitioners.

Adaptation of the Educational Motivation Scale Into a Short Form With Multigroup Analysis in a Vocational Training and Baccalaureate Setting

The aim of the present study was to adapt the educational motivation scale into an abbreviated version (EMS-SF), in addition to analyzing its psychometric properties for use with vocational training (VT) and baccalaureate students using structural equations. A cross-sectional and ex post facto study was conducted with a sample of 1,159 students from the autonomous community of Andalusia (Spain). IBM SPSS^® and IBM AMOS^® software programs were used for data analysis. With regard to the main outcomes, the scale reflected good fit indices in its short form, presenting a more parsimonious and easily understood questionnaire. The questionnaire was reduced from a total of 28-19 items. In the same way, the number of dimensions was reduced from seven to four, facilitating scale understanding and interpretation according to self-determination theory. As a main finding, it was observed that the most relevant items for baccalaureate students pertained to the pleasure derived from discovering things and to overcoming challenges, whereas in VT students, items pertaining to the satisfaction generated from exerting effort, achieving one's best and being well paid were more relevant. In conclusion, findings urge the need to strengthen intrinsic motivation in VT students with the aim of avoiding demotivation and poor academic performance.

Validation and Test of Measurement Invariance of the Adapted Health Consciousness Scale (HCS-G)

The objective of this study was the translation and validation of a health consciousness scale in order to provide an economically and empirically confirmed measurement of health consciousness, which is associated with health-related behavior. We evaluated this translation on the basis of psychometric testing in a German convenience sample. A cross-sectional online survey (n = 470) was carried out using a translated version of the health consciousness scale, oriented on the basis of international guidelines. As previous studies have not consistently confirmed the factorial structure of the health consciousness scale, we conducted a Confirmatory Factor Analysis to verify its factorial structure. Furthermore, we cross-validated the questionnaire with other scales in order to verify convergent and discriminant validity. The results indicated a two-factor solution for the Health Consciousness Scale-German (HCS-G). The criterion validity was confirmed on the basis of a significantly positive correlation between the HCS-G and health literacy. Furthermore, strict measurement invariance was able to be verified, indicating that the HCS-G is an applicable measurement, regardless of gender. In practical research, this questionnaire can help to assess health consciousness and its influence on health-related constructs. Future studies should consider possible mediating variables between health consciousness and health outcomes.

Development and validation of a short culture-specific food frequency questionnaire for Greek pregnant women and their adherence to the Mediterranean diet

OBJECTIVES

The aim of this study was to develop and evaluate the validity of a short, culture-specific, semiquantitative food frequency questionnaire (FFQ) for Greek dietary habits and among a population of pregnant women, and to assess the adherence of reported nutritional habits to the Mediterranean diet.

METHODS

The validity of the FFQ was assessed by comparing FFQ-derived nutrient intakes against the average of two 24-h dietary recalls of 70 pregnant women. We used appropriate statistical methods to examine the nutrient correlation and level of agreement between the two figures (Pearson or Spearman correlation and Bland-Altman test, respectively). Calculation of the Mediterranean Diet Score was performed to evaluate participants' adherence to the Mediterranean diet.

RESULTS

Statistically significant positive correlations, of medium strength, were observed for almost all macronutrient groups (ρs ranging from 0.326 to 0.538). Dietary fiber intake was the only nutrient where a weak correlation was identified (ρ = -0.106; P > 0.05). Mean intakes, derived from the FFQ, agreed with results from the 24-h recalls based on Bland-Altman analysis, with the agreement ranging between 94.3% and 98.6% for the macronutrient groups under examination. The calculation of the Mediterranean Diet Score revealed that Greek pregnant women's habits are in accordance with the principles of the Mediterranean diet.

CONCLUSIONS

The developed FFQ is a valid tool that could provide reliable nutrient intake assessment in studies monitoring dietary habits of pregnant women, a group where nutritional monitoring is essential but to date remains limited.