Does Acquiescence Affect Individual Items Consistently?

Use and efficacy of dry-mouth interventions in Sjögren's disease patients and possible association with perceived oral dryness and patients' discomfort

OBJECTIVES

Sjögren's disease (SjD) patients use various interventions to relief their oral dryness. However, the use and efficacy of these interventions have only partially been evaluated. The present study aims to investigate whether there is an association between the perceived oral dryness and discomfort of SjD patients and their use of specific interventions.

MATERIALS AND METHODS

A cross-sectional study was performed among SjD patients, who completed several questionnaires to assess the severity of their oral dryness and an inventory of dry-mouth interventions. The perceived efficacy of each intervention was reported on a 5-point Likert-scale.

RESULTS

The questionnaires were returned by 92 SjD patients. For relief of oral dryness, they mostly used "eating fruit", "drinking tea", "moistening the lips", "drinking water, and "drinking small volumes" (> 50%). Three interventions had a frequency of use ranging from 2-6 times/day, whereas, "drinking water" and "drinking small volumes" showed higher frequencies (> 14). The highest overall efficacy (≥ 3.5) was reported for "chewing gum" and "using a mouth gel". Furthermore, various dry-mouth interventions showed significant associations with oral dryness scores and/or patients' discomfort. For example, "drinking small volumes" and "using XyliMelts" were associated with the Bother Index score.

CONCLUSION

Great variation was found in the use of dry-mouth interventions by the participants and the severity of the oral dryness and/or patients' discomfort seemed to affect their choice of intervention. Notably, the mostly used interventions did not show the highest reported efficacy.

CLINICAL RELEVANCE

These findings might help SjD patients and clinicians in their choice of effective dry-mouth interventions.

The Impact of Item Feature and Response Preference in a Mixed-Format Design

A combination of positively and negatively worded items (termed a mixed-format design) has been widely adopted in personality and attitude assessments. While advocates claim that the inclusion of positively and negatively worded items will encourage respondents to process the items more carefully and avoid response preference, others have reported that negatively worded (NW) items may induce a nuisance factor and contaminate scale scores. The present study examined the extent of the impact of the NW-item feature and further investigated whether a mixed-format design could effectively control acquiescence and the preference for extreme response options using two datasets (Attitude toward Peace Walls, and International Personality Item Pool). A proposed multidimensional item response model was implemented to simultaneously estimate the impact of item feature and response preference. The results suggested that NW items induced an impact on item responses and that affirmative preference was negligible, regardless of the proportion of NW items in a scale. However, participants' extremity preference was large in both balanced and imbalanced mixed-format designs. It concludes that the impact of the NW-item feature is not negligible in a mixed-format scale, which exhibits good control of acquiescence but not extremity preference.

Torn Between Valences: Mixed Emotions Predict Poorer Psychological Well-Being and Job Burnout

Conflicting perspectives on whether mixed emotions are adaptive states which promote integrative processes or uncomfortable states which are agonizing make divergent predictions on whether mixed emotions in daily life are conducive towards psychological well-being. We examined this across three studies. Study 1 (N = 335, 135 males; M _age = 41.31) examined associations between state mixed emotions and psychological well-being. Study 2 (N = 389; 160 males; M _age = 40.86) examined associations between workplace-specific mixed emotions and workplace ill-being assessed based on burnout. Both direct measures and indirect measures were examined in Study 1 and 2, allowing some comparison of methodological issues related to their predictive validity. Study 3 (N = 3444; 1587 males; M _age = 55.34) examined bidirectional relationships between an index of emotional ambivalence and psychological well-being about ten years later, controlling for baselines. Demographic covariates, positive emotions, and negative emotions were controlled for in all studies. Analyses were performed using latent variable structural equation modelling. After adjusting for all covariates, the direct measures of mixed emotions predicted poorer psychological well-being (Study 1) and greater burnout (Study 2). However, indirect measures were found to suffer from relatively greater multicollinearity and poorer predictive validity upon controlling for positive and negative emotions. In Study 3, emotional ambivalence predicted poorer long-term psychological well-being, while psychological well-being also predicted lower emotional ambivalence, supporting bidrectionality. The findings provide preliminary evidence that naturalistically experienced mixed emotions may be conflicting and unpleasant, with potentially negative implications for psychological well-being over and above positive and negative emotions.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-021-00493-z.

Construct validity of the anglicised FACE-Q skin cancer module

OBJECTIVES

The FACE-Q Skin Cancer module is a patient-reported outcome measure (PROM) for facial skin cancer. It has been anglicised for the UK population and undergone psychometric testing using classical test theory. In this study, further evaluation of construct validity using Rasch measurement theory and hypothesis testing was performed.

METHODS

Patients were prospectively recruited to the Patient-Reported Outcome Measures In Skin Cancer Reconstruction (PROMISCR) study and asked to complete the anglicised FACE-Q Skin Cancer module. The scalability and unidimensionality of the data were assessed with a Mokken analysis prior to Rasch analysis. Response thresholds, targeting, fit statistics, local dependency, and internal consistency were examined for all items and subscales. Four a priori hypotheses were tested to evaluate the convergent and divergent validity. We additionally hypothesised that the median 'cancer worry' score would be lower in post-operative than pre-operative patients.

RESULTS

239 patients self-completed the questionnaire between August 2017 and May 2019. Of the ten subscales assessed, five showed relative fit to the Rasch model. Unidimensionality was present for all five subscales, with most demonstrating ordered item thresholds and appropriate fit statistics. Two items in the 'cancer worry' subscale had either disordered or very close response thresholds. Subscales of the FACE-Q Skin Cancer module demonstrated convergent and divergent validity with relevant Skin Cancer Index comparators (p < 0.001). Median 'cancer worry' was lower in post-operative patients (44 vs 39, p < 0.001).

CONCLUSION

The anglicised FACE-Q Skin Cancer module shows psychometric validity through hypothesis testing, and both classical and modern test theory.

The Influence of Item Characteristics on Acquiescence among Latino Survey Respondents

Acquiescence is often defined as the systematic selection of agreeable ("strongly agree") or affirmative ("yes") responses to survey items, regardless of item content or directionality. This definition implies that acquiescence is immune to item characteristics; however, the influence of item characteristics on acquiescence remains largely unexplored. We examined the influence of eight item characteristics on acquiescence in a telephone survey of 400 Latinos and non-Latino whites: qualified wording, mental comparisons, negated wording, unfamiliar terms, ambiguous wording, knowledge accessibility, item length, and polysyllabic wording. Negated and ambiguous wording was associated with reduced acquiescence for the full sample, as well as subsamples stratified by ethnicity and sociodemographic characteristics. This effect was strongest among younger, more educated, and non-Latino white respondents. No other item characteristics had a significant influence on respondent acquiescence. Findings from this study suggest that acquiescence may be affected by interactions between respondent and item characteristics.

Validating mental health assessment in Kenya using an innovative gold standard

With the growing burden of mental health disorders worldwide, alongside efforts to expand availability of evidence-based interventions, strategies are needed to ensure accurate identification of individuals suffering from mental disorders. Efforts to locally validate mental health assessments are of particular value, yet gold-standard clinical validation is costly, time-intensive, and reliant on available professionals. This study aimed to validate assessment items for mental distress in Kenya, using an innovative gold standard and a combination of culturally adapted and locally developed items. The mixed-method study drew on surveys and semi-structured interviews, conducted by lay interviewers, with 48 caregivers. Interviews were used to designate mental health "cases" or "non-cases" based on emotional health problems, identified through a collaborative clinical rating process with local input. Individual mental health survey items were evaluated for their ability to discriminate between cases and non-cases. Discriminant survey items included 23 items adapted from existing mental health assessment tools, as well as 6 new items developed for the specific cultural context. When items were combined into a scale, results showed good psychometric properties. The use of clinically rated semi-structured interviews provides a promising alternative gold standard that can help address the challenges of conducting diagnostic clinical validation in low-resource settings.

Adapting culturally appropriate mental health screening tools for use among conflict-affected and other vulnerable adolescents in Nigeria

BACKGROUND

The Boko Haram insurgency has brought turmoil and instability to Nigeria, generating a large number of internally displaced people and adding to the country's 17.5 million orphans and vulnerable children. Recently, steps have been taken to improve the mental healthcare infrastructure in Nigeria, including revamping national policies and initiating training of primary care providers in mental healthcare. In order for these efforts to succeed, they require means for community-based detection and linkage to care. A major gap preventing such efforts is the shortage of culturally appropriate, valid screening tools for identifying emotional and behavioral disorders among adolescents. In particular, studies have not conducted simultaneous validation of screening tools in multiple languages, to support screening and detection efforts in linguistically diverse populations. We aim to culturally adapt screening tools for emotional and behavioral disorders for use among adolescents in Nigeria, in order to facilitate future validation studies.

METHODS

We used a rigorous mixed-method process to culturally adapt the Depression Self Rating Scale, Child PTSD Symptom Scale, and Disruptive Behavior Disorders Rating Scale. We employed expert translations, focus group discussions (N = 24), and piloting with cognitive interviewing (N = 24) to achieve semantic, content, technical, and criterion equivalence of screening tool items.

RESULTS

We identified and adapted items that were conceptually difficult for adolescents to understand, conceptually non-equivalent across languages, considered unacceptable to discuss, or stigmatizing. Findings regarding problematic items largely align with existing literature regarding cross-cultural adaptation.

CONCLUSIONS

Culturally adapting screening tools represents a vital first step toward improving community case detection.

Why do Latino Survey Respondents Acquiesce? Respondent and Interviewer Characteristics as Determinants of Cultural Patterns of Acquiescence among Latino Survey Respondents

Research indicates that Latino survey respondents are more likely to acquiesce than non-Latino European Americans, thereby decreasing the potential for measurement invariance across cultural groups. In order to better understand what drives this culturally patterned response style, we examined the influence of respondent and interviewer characteristics on acquiescence. Data were obtained from a telephone survey of 400 Mexican American, Puerto Rican, Cuban American, and non-Latino European American respondents and a self-administered survey of 21 interviewers. Higher acquiescence was associated with several respondent characteristics: older age, lower education, stronger Latino cultural orientation, Spanish use, Latino ethnicity, and, among Latinos, Cuban American ethnicity. In contrast, acquiescence was not influenced by respondent-interviewer social distance, social deference, or interviewer characteristics (e.g., education, gender, acculturation, interviewer experience). These findings indicate that acquiescence differs across Latino ethnic subgroups and that respondent and language factors are more influential determinants of acquiescence than survey interviewers.

A New Model for Acquiescence at the Interface of Psychometrics and Cognitive Psychology

When measuring psychological traits, one has to consider that respondents often show content-unrelated response behavior in answering questionnaires. To disentangle the target trait and two such response styles, extreme responding and midpoint responding, Böckenholt ( 2012a ) developed an item response model based on a latent processing tree structure. We propose a theoretically motivated extension of this model to also measure acquiescence, the tendency to agree with both regular and reversed items. Substantively, our approach builds on multinomial processing tree (MPT) models that are used in cognitive psychology to disentangle qualitatively distinct processes. Accordingly, the new model for response styles assumes a mixture distribution of affirmative responses, which are either determined by the underlying target trait or by acquiescence. In order to estimate the model parameters, we rely on Bayesian hierarchical estimation of MPT models. In simulations, we show that the model provides unbiased estimates of response styles and the target trait, and we compare the new model and Böckenholt's model in a recovery study. An empirical example from personality psychology is used for illustrative purposes.

Further Considerations in Using Items With Diverse Content to Measure Acquiescence

To measure the response style of acquiescence, researchers recommend the use of at least 15 items with heterogeneous content. Such an approach is consistent with its theoretical definition and is a substantial improvement over traditional methods. Nevertheless, measurement of acquiescence can be enhanced by two additional considerations: first, to ensure that it is not confounded with item valence, equal numbers of positively and negatively phrased items should be used; second, the validity of acquiescence scores can be substantially improved when derived from more than 15 items: about twice that number appears to be the minimum. These issues are illustrated empirically and recommendations are made for research practice.