Adaptation and validation of the Chinese version of the Sleep Quality Questionnaire

Cross-cultural adaptation and psychometric properties of the Chinese version of the Intermittent Self-Catheterization Questionnaire (ISC-Q)

Background

The intermittent self-catheterization questionnaire (ISC-Q) is a valid and reliable tool to assess the quality of life (QOL) in patients with neurogenic lower urinary tract dysfunction (NLUTD) who engage in ISC. The aim of this research is to culturally adapt the ISC-Q and evaluate its psychometric properties within the Chinese patient population.

Methods

The cross-sectional research was meticulously conducted in two pivotal stages: initially, the focus was on cross-cultural adaptation, followed by an extensive phase of psychometric testing. This comprehensive analysis involved 405 Chinese patients with NLUTD who use ISC. Various analyses, including evaluations of the floor and ceiling effects, item analysis, content validity, exploratory and confirmatory factor analysis (EFA and CFA), assessments of convergent, discriminant, and criterion validity. Additionally, Cronbach's alpha was utilized to determine internal consistency, and test-retest reliability was measured using the intraclass correlation coefficient (ICC).

Results

No floor and ceiling effects were observed. The content validity index was 0.967. The EFA identified four factors, accounting for 64.953% of the total variance, and this four-factor structure was confirmed by the CFA. The fit indices in CFA were favorable, with χ2/df = 1.999, root mean square error of approximation = 0.070, comparative fit index = 0.916, Tucker-Lewis index = 0.900, goodness-of-fit index = 0.863, and incremental fit index = 0.917. The average variance extracted for the four factors ranged from 0.466 to 0.565, with composite reliability values ranging from 0.776 to 0.859. The ISC-Q showed a positive correlation with the intermittent self-catheterization acceptance questionnaire (r = 0.557, P < 0.001). The ICC overall Cronbach's alpha coefficient for the questionnaire was 0.821, and the for test-retest reliability was 0.951 (95% CI [0.900-0.976] P < 0.001).

Conclusion

The validity and reliability of the Chinese version of the ISC-Q have been verified, making it suitable for measuring the QOL in NLUTD patients who practice ISC.

Longitudinal measurement invariance and psychometric properties of the Patient Health Questionnaire-Four in China

BACKGROUND

Depression and anxiety symptoms among medical students are often a concern. The Patient Health Questionnaire-Four (PHQ-4), an important tool for depression and anxiety screening, is commonly used and easy to administer. This study aimed to assess and update the longitudinal measurement invariance and psychometric properties of the simplified Chinese version.

METHODS

A three-wave longitudinal survey was conducted among healthcare students using the PHQ-4. Structural validity was based on one-factor, two-factor, and second-order factor models, construct validity was based on the Self-Rated Health Questionnaire (SRHQ), Sleep Quality Questionnaire (SQQ), and Rosenberg Self-Esteem Scale (RSES), and longitudinal measurement invariance (LMI), internal consistency, and test-retest reliability were based on structural consistency across three time points.

RESULTS

The results of the confirmatory factor analysis indicated that two-factor model was the best fit, and LMI was supported at three time points. Inter-factor, factor-total, and construct validity correlations of the PHQ-4 were acceptable. Additionally, Cronbach's alpha, McDonald's omega, and the intraclass correlation coefficient demonstrated acceptable/moderate to excellent reliability of the PHQ-4.

CONCLUSIONS

This study adds new longitudinal evidence that the Chinese version of the PHQ-4 has promising LMI and psychometric properties. Such data lends confidence to the routine and the expanded use of the PHQ-4 for routine screening of depression and anxiety in Chinese healthcare students.

A longitudinal examination of the measurement properties and invariance of the Sleep Condition Indicator in Chinese healthcare students

BACKGROUND

The Sleep Condition Indicator (SCI), an insomnia measurement tool based on the updated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria with sound psychometric properties when applied in various populations, was evaluated here among healthcare students longitudinally, to demonstrate its measurement properties and invariance in this particularly high-risk population.

METHODS

Healthcare students of a Chinese university were recruited into this two-wave longitudinal study, completing the simplified Chinese version of the SCI (SCI-SC), Chinese Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration (RU_SATED-C) scale, Chinese Patient Health Questionnaire-4 (PHQ-4-C), and sociodemographic variables questionnaire (Q-SV) between September and November 2022. Structural validity, measurement invariance (MI), convergent and discriminant validity, internal consistency, and test-retest reliability of the SCI-SC were examined. Subgroups of gender, age, home location, part-time job, physical exercise, and stress-coping strategy were surveyed twice to test cross-sectional and longitudinal MI.

RESULTS

We identified 343 valid responses (62.9% female, mean age = 19.650 ± 1.414 years) with a time interval of seven days. The two-factor structure was considered satisfactory (comparative fit index = 0.953-0.989, Tucker-Lewis index = 0.931-0.984, root means square error of approximation = 0.040-0.092, standardized root mean square residual = 0.039-0.054), which mostly endorsed strict invariance except for part-time job subgroups, hence establishing longitudinal invariance. The SCI-SC presented acceptable convergent validity with the RU_SATED-C scale (r ≥ 0.500), discriminant validity with the PHQ-4-C (0.300 ≤ r < 0.500), internal consistency (Cronbach's alpha = 0.811-0.835, McDonald's omega = 0.805-0.832), and test-retest reliability (intraclass correlation coefficient = 0.829).

CONCLUSION

The SCI-SC is an appropriate screening instrument available for assessing insomnia symptoms among healthcare students, and the promising measurement properties provide additional evidence about validity and reliability for detecting insomnia in healthcare students.

Assessing psychometric properties and measurement invariance of the Sleep Quality Questionnaire among healthcare students

OBJECTIVE

The sleep of healthcare students is worth discovering. Mental health and self-rated health are thought to be associated with sleep quality. As such, valid instruments to assess sleep quality in healthcare students are crucial and irreplaceable. This study aimed to investigate the measurement properties of the Sleep Quality Questionnaire (SQQ) for Chinese healthcare students.

METHODS

Two longitudinal assessments were undertaken among healthcare students, with a total of 595, between December 2020 and January 2021. Measures include the Chinese version of the SQQ, Patient Health Questionnaire-4 (PHQ-4), Self-Rated Health Questionnaire (SRHQ), and sociodemographic questionnaire. Structural validity through confirmatory factor analysis (CFA) was conducted to examine factor structure of the SQQ. T-tests and ANOVAs were used to examine sociodemographic differences in sleep quality scores. Multi Group CFA and longitudinal CFA were respectively used to assess cross-sectional invariance and longitudinal invariance across two-time interval, i.e., cross-cultural validity. Construct validity, internal consistency, and test-retest reliability were correspondingly examined via Spearman correlation, Cronbach's alpha and McDonald's omega, and intraclass correlation coefficient. Multiple linear regression analysis was performed to examine incremental validity of the SQQ based on the PHQ-4 and SRHQ as indicators of the criterion variables.

RESULTS

CFA results suggested that the two-factor model of the SQQ-9 (item 2 excluded) had the best fit. The SQQ-9 scores differed significantly by age, grade, academic stage, hobby, stress coping strategy, anxiety, depression, and self-rated health subgroups. Measurement invariance was supported in terms of aforesaid subgroups and across two time intervals. In correlation and regression analyses, anxiety, depression, and self-rated health were moderately strong predictors of sleep quality. The SQQ-9 had good internal consistency and test-retest reliability.

CONCLUSION

Good measurement properties suggest that the SQQ is a promising and practical measurement instrument for assessing sleep quality of Chinese healthcare students.

Sleep quality and subjective well-being in healthcare students: examining the role of anxiety and depression

Objective

Sleep issues, negative emotions, and health conditions are commonly co-occurring, whereas their associations among healthcare students have yet to be elucidated. This study aimed to examine whether anxiety and depression mediate the relationship between sleep quality and subjective well-being in healthcare students.

Methods

A cross-sectional survey was conducted among Chinese healthcare students (N = 348). A battery of paper-and-pencil questionnaires-the Sleep Quality Questionnaire (SQQ), World Health Organization-Five Well-Being Index (WHO-5), and Patient Health Questionnaire-4 (PHQ-4) were applied. Descriptive analysis with means (standard deviations) and counts (proportions), Spearman correlation analysis between the SQQ, WHO-5, and PHQ-4, and mediation analysis via structural equation models were performed.

Results

Correlation analysis revealed statistically significant associations between sleep quality, anxiety and depression, and well-being among healthcare students. Mediation analysis identified that poor sleep quality produced relatively low levels of self-reported well-being, which were entirely attributable to anxiety and depression.

Conclusion

Sleep quality was associated with subjective well-being, and this interrelationship was fully mediated by anxiety and depression. Interventions aimed at promoting sleep quality of healthcare students may contribute to promoting their well-being by reducing anxiety and depression.

The RU_SATED as a measure of sleep health: cross-cultural adaptation and validation in Chinese healthcare students

BACKGROUND

The RU_SATED scale is a multidimensional instrument measuring sleep health, consisting of Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration dimensions. We adapted and validated the Chinese RU_SATED (RU_SATED-C) scale.

METHODS

The RU_SATED-C scale was developed through a formal linguistic validation process and was validated in an observational longitudinal survey design. Healthcare students completed the RU_SATED scale, Sleep Quality Questionnaire, and Patient Health Questionnaire-4 among two sites of Hangzhou and Ningbo, China. Psychometric assessments included structural validity, longitudinal measurement invariance, convergent and divergent validity, internal consistency, and test-retest reliability.

RESULTS

A total of 911 healthcare students completed the RU_SATED-C scale at baseline (Time 1, T1) and follow-up (Time 2, T2) with an average time interval of 7 days + 5.37 h. Confirmatory factor analysis (CFA) confirmed a single-factor model and resulted in an acceptable model fit. The two-factor model previously found in the Japanese version fit better than the one-factor model, whereas the one-factor model fit had a better fit than the two-factor model found in the English version. Longitudinal CFA resulted in negligible changes in fit indices for four forms of increasingly restrictive models and supported that a single-factor model was equivalent over time. The data also endorsed longitudinal measurement invariance among the two-factor models found in the English and Japanese samples. The RU_SATED-C scale total score displayed a moderately strong negative correlation with sleep quality; however, negligible associations were observed with anxiety and depression. Ordinal Cronbach's alpha and Ordinal McDonald's omega at T1 and T2 ranged from suboptimal to acceptable. The RU_SATED-C scale and all items were significantly correlated across time intervals.

CONCLUSION

The RU_SATED-C scale is an easy-to-use instrument with potentially valid data for the measurement of multidimensional sleep health. Use of the RU_SATED-C scale can help raise awareness of sleep health and could pave the way for important efforts to promote healthy sleep.

Depression and Anxiety Mediate the Association between Sleep Quality and Self-Rated Health in Healthcare Students

OBJECTIVES

This study aimed to investigate factors associated with sleep quality in healthcare students and to determine whether depressive and anxiety symptoms may explain some of the associations between sleep quality and self-rated health.

STUDY DESIGN

This is a cross-sectional study at wave one.

METHODS

A total of 637 healthcare students were recruited via a stratified random sampling method in Hangzhou, China. The Sleep Quality Questionnaire (SQQ) and the four-item Patient Health Questionnaire (PHQ-4) were used to assess sleep quality and depressive and anxiety symptoms, respectively. Self-rated health was assessed via a self-developed questionnaire of both physical and psychological health. Structural equation modeling was used to examine the direct and indirect effects of sleep quality on self-rated health through depressive and anxiety symptoms.

RESULTS

Students engaged in part-time employment (p = 0.022), with poor perceived employment prospects (p = 0.009), and who did not participate in recreational sports (p = 0.008) had worse sleep quality. Structural equation modeling revealed a significant total effect of sleep quality on self-rated health (b = 0.592, p < 0.001), a significant direct effect of both sleep quality and depressive and anxiety symptoms on self-rated health (b = 0.277, 95% CI: 0.032-0.522), and a significant indirect effect of sleep quality on self-rated health through depressive and anxiety symptoms (b = 0.315, 95% CI: 0.174-0.457).

CONCLUSIONS

Depressive and anxiety symptoms partially explain the association between sleep quality and self-rated health. Intervening upon sleep quality, depressive, and anxiety symptoms may bolster the self-rated health of healthcare students.

Rasch Modelling to Assess Psychometric Validation of the Knowledge about Tuberculosis Questionnaire (KATUB-Q) for the General Population in Indonesia

OBJECTIVE

This study aims to validate and evaluate the psychometric properties of the knowledge about tuberculosis questionnaire (KATUB-Q) for the general population in Indonesia.

METHODS

The KATUB-Q consists of three domains: general knowledge, transmission, and treatment, with 20 dichotomous items. Rasch analysis through WINSTEPS was used.

RESULTS

A total of 504 respondents from 34 provinces in Indonesia completed the survey. Based on the model fit statistics, 3 misfit items were deleted and 17 items were used. Item and person reliability, as well as Cronbach's Alpha values were 0.99, 0.63, and 0.73, respectively, which means they achieved the minimum acceptable limit of 0.6. Based on the results, Indonesia's Person ability analysis indicated a high level of knowledge. KATUB-Q has no significant bias item based on sex found in the differential item functioning analysis.

CONCLUSION

KATUB-Q has 17 items with a valid and reliable instrument; hence, it can be used to measure the knowledge about TB in the general population.

PRACTICE IMPLICATIONS

The unidimensional structure of the core items of the KATUB-Q provides empirical evidence for using the sum score of the items in practice to evaluate the effectiveness of TB education in the general population.