Advances in nonparametric item response theory for scale construction in quality-of-life research

The forever decision: a qualitative study among survivors of a suicide attempt

Background

Suicide attempts have a profound emotional impact on both individuals and society as a whole. This qualitative study delves into three key aspects: 1) the progression through the suicidal process, 2) the influential factors facilitating the transition from ideation to attempt using the volitional moderators within the integrated motivational-volitional (IMV) model, and 3) preventive strategies impeding this transition from ideation to attempt.

Methods

Between October 1, 2022 and March 7, 2023 we interviewed 27 adults (23 women, four men, mean age 33 years) who attempted suicide within the past 12 months. Participants were recruited through social media and in collaboration with several mental health institutions in the Netherlands. The participants were initially screened and interviewed based on the Pathway to Suicidal Actions Interview. Analysis was performed employing the constant comparative method.

Findings

Despite the heterogeneity of the suicidal process, suicidal thoughts predominately emerged during adolescence (Mdn = 15, M = 17.8). In most participants, planning and preparatory actions occurred long before the attempt, with a median of six years prior to the attempt for the selection of the method. All volitional moderators were observed, although pain sensitivity in particular varied among participants. Access to lethal means and planning emerged as important moderators in the suicidal process. Asking the survivors what could have helped to prevent their attempts, most participants mentioned that they felt their suicidality was not taken seriously enough.

Interpretation

We discussed the significance of planning in the suicidal process, challenges in conceptualizing planning and impulsivity, and individual differences in pain sensitivity. Based on the findings, we underscore the critical need for restricting access to means, giving greater consideration to preparatory actions within the suicidal process, and fostering open dialogues about suicidality.

Funding

This research was funded by ProRail, the Dutch rail infrastructure manager in line with their work on mental health.

Lifetime Violence, Lifetime Discrimination, and Microaggressions in the Lives of LGBT Midlife and Older Adults: Findings from Aging with Pride: National Health, Aging, and Sexuality/Gender Study

Purpose: There is a dearth of research on violence and adverse experiences among LGBT midlife and older adults. The goal of this article was to present tailored measures and investigate the relationship between adverse experiences, health, and age. Methods: Based on the Health Equity Promotion Model, we examined lifetime violence, lifetime discrimination, and contemporary microaggressions among LGBT adults, aged 50 and older, utilizing data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. We examined subgroup differences, the interrelationships between adverse experiences, and the association with health, taking into consideration interactions by age. Results: Distinct aspects of these experiences were effectively captured by tailored measures. Important subgroup differences emerged with high levels of lifetime violence among sexually diverse adults, gay and bisexual men, and transgender adults. Experiences of violence remained a significant predictor across all three health outcomes, after controlling for both lifetime discrimination and microaggressions. Microaggressions had a significant contribution to comorbidity for those with a low level of lifetime violence. The interaction effects suggest that comorbidity increases as the number of lifetime violence experiences increases for those who are younger. As age increased, the lifetime violence effect on comorbidity diminished whereas the microaggressions effect became stronger. Conclusion: Greater attention to the sequelae of lifetime violence and other adverse events among midlife and older adults is needed as well as the development and testing of both downstream and upstream interventions to reduce and mitigate the impact of these experiences on the well-being of LGBT midlife and older adults.

Nursing Profession Self-Efficacy Scale-Version 2: A Stepwise Validation with Three Cross-Sectional Data Collections

BACKGROUND

The nursing professional self-efficacy scale (NPSES) is one of the most used self-reporting tools for assessing nursing self-efficacy. Its psychometric structure was described differently in several national contexts. This study aimed to develop and validate version 2 of the NPSES (NPSES2), which is a brief version of the original scale selecting items that contribute to stably detecting attributes of care delivery and professionalism as descriptors of salient aspects of the nursing profession.

METHODS

Three different and subsequent cross-sectional data collections were employed to reduce the number of items to generate the NPSES2 and validate its new emerging dimensionality. The first (June 2019-January 2020) involved 550 nurses and was used to reduce the number of the original scale items by using a Mokken scale analysis (MSA) to ensure the selection of items consistently with the invariant item ordering properties. The subsequent data collection was performed to conduct an exploratory factor analysis (EFA) involving 309 nurses (September 2020-January 2021), and the last data collection (n = 249) was performed to cross-validate with a confirmatory factor analysis (CFA), the most plausible dimensionality derived from the EFA (June 2021-February 2022).

RESULTS

The MSA led to the removal of twelve items and retention of seven items (Hs = 0.407, standard error = 0.023), which showed adequate reliability (rho reliability = 0.817). The EFA showed a two-factor solution as the most plausible structure (factors loading ranged from 0.673 to 0.903; explained variance = 38.2%), which was cross-validated by the CFA that showed adequate fit indices: χ² (13, N = 249) = 44.521, p < 0.001; CFI = 0.946; TLI = 0.912; RMSEA = 0.069 (90% CI = 0.048-0.084); SRMR = 0.041. The factors were labeled as care delivery (four items) and professionalism (three items).

CONCLUSIONS

NPSES2 is recommended to allow researchers and educators to assess nursing self-efficacy and inform interventions and policies.

Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q) for Adolescents: Validity and Reliability of the Psychological and Social Modules using Mokken Scale Analysis

We examined the construct validity and reliability of the previously developed Psychological and Social modules of the Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q) using Mokken Scale Analysis in a sample of 508 Portuguese adolescents in public schools in Lisbon. We used a retest subsample (n = 73) to calculate the Intraclass Correlation Coefficient. Eight PPLA-Q scales can be interpreted as moderate-to-strong Mokken scales (H = .47-.66) with good total-score reliability (ρ = .83-.94), and moderate-to-excellent test-retest reliability (ICC_95%CI = .51-.95); four scales had an interpretable invariant item ordering. All but the Physical Regulation scale functioned similarly across sex. Scale-scores correlated as expected, with low-to-moderate correlations across domains supporting convergent and discriminant validity. These results support the construct validity and reliability of the PPLA-Q to assess the psychological and social domains of physical literacy in Portuguese adolescents (15-18 years) enrolled in physical education.

Use of Item Response Models in Assessing the Health Literacy Facet Understanding Health Information for Early Childhood Allergy Prevention and Prevention of COVID-19 Infections by Pregnant Women and Mothers of Infants

Abstract. Appropriate parental health literacy (HL) is essential to preventively maintain and promote child health. Understanding health information is assumed to be fundamental in HL models. We developed N = 67 items (multiple-choice format) based on information materials on early childhood allergy prevention (ECAP) and prevention of COVID-19 infections to assess the parental HL facet Understand. N = 343 pregnant women and mothers of infants completed the items in an online assessment. Using exploratory factor analysis for ordinal data (RML estimation) and item response models (1-pl and 2-pl model), we proved the psychometric homogeneity of the item pool. 57 items assess the latent dimension Understand according to the assumptions of the 1-pl model (weighted MNSQ < 1.2; separation reliability = .855). Person parameters of the latent trait Understand correlate specifically with subjective socioeconomic status ( r = .27), school graduation ( r = .46), allergy status ( r = .11), and already infected with COVID-19 ( r = .12). The calibrated item pool provides a psychometrically sound, construct-valid assessment of the HL facet Understand Health Information in the areas of ECAP and prevention of COVID-19 infections.