Scale development: ten main limitations and recommendations to improve future research practices

Development and psychometric properties of the Balance in Daily Life (BDL) scale in a population of frail older people

BACKGROUND

Balance disorders in older people cause falls, which can have serious functional and economic consequences. No existing scale relates fall risk to daily life situations. This study describes the development, psychometric properties and construct validity of the Balance in Daily Life (BDL) scale, comprising seven routine tasks including answering a phone, carrying a heavy bag, and sitting down and getting up from a chair.

METHODS

Frail patients aged 65 years or more were prospectively recruited from the geriatric rehabilitation department of a French university hospital. Inclusion criteria included autonomous walking over 20 m and modified Short Emergency Geriatric Assessment score 8-11. Patients with motor skills disorders and comprehension or major memory difficulties were excluded. Patients were assessed on Day 3 and Day 30 with the Balance in Daily Life scale, Timed Up and Go, one-leg stance time, sternal nudge and walking-while-talking tests. The scale was assessed for acceptability, quality, unidimensionality, internal consistency, reliability, temporal stability, responsiveness and construct validity.

RESULTS

140 patients (83 ± 6 years) were recruited, of whom 139 were assessed at Day 0 and 133 at Day 30. Acceptability was satisfactory (134/139 patients completed the test), quality assessment showed a slight floor effect (6 % of patients with minimal score) and evaluation of item redundancy found no strong correlation (Spearman <0.7). Unidimensionality was verified (Loevinger H coefficient > 0.5 for all items except item 6 = 0.4728). Internal consistency was good (Cronbach alpha = 0.86). Reliability and temporal stability were excellent (ICC = 0.97 and ICC = 0.92). Responsiveness was verified by significant score change p < 0.0001 between Day 0 and Day 30 (decreased by 1 [0; 2] point), in line with other score changes. Construct validity revealed that the Balance in Daily Life scale was convergent with results of the timed up-and-go and one-leg stance time (p < 0.0001 for both) and tended to be higher for participants who had not fallen in the previous 6 months (p = 0.0528). The new questionnaire was divergent to sternal nudge tests (p = 0.0002) and not related to the walking-while-talking test (p = 0.5969).

CONCLUSION

The Balance in Daily Life scale has good psychometric properties for this population. Its simplicity and innovative nature mean that it can be applied in institutions while being easily modifiable to domestic settings. Study registration on clinicaltrials.gov: NCT0334382.

Conducting cross-cultural, multi-lingual or multi-country scale development and validation in health care research: A 10-step framework based on a scoping review

Background

Valid, reliable and cross-cultural equivalent scales and measurement instruments that enable comparisons across diverse populations in different countries are important for global health research and practice. We developed a 10-step framework through a scoping review of the common strategies and techniques used for scale development and validation in a cross-cultural, multi-lingual, or multi-country setting, especially in health care research.

Methods

We searched MEDLINE, Embase, and PsycINFO for peer-reviewed studies that collected data from two or more countries or in two or more languages at any stages of scale development or validation and published between 2010-22. We categorised the techniques into three commonly used scale development and validation stages (item generation, scale development, and scale evaluation) as well as during the translation stage. We described the most commonly used techniques at each stage.

Results

We identified 141 studies that were included in the analysis. We summarised 14 common techniques and strategies, including focus groups or interviews with diverse target populations, and involvement of measurement experts and linguists for item content validity expert panel at the item generation stage; back-and-forth translation, collaborative team approach for the translation stage; cognitive interviews and different recruitment strategies and incentives in different settings for scale development stage; and three approaches for measurement invariance (multigroup confirmatory factor analysis, differential item functioning and multiple indicator multiple causes) for scale evaluation stage.

Conclusions

We provided a 10-step framework for cross-cultural, multi-lingual or multi-country scale development and validation based on these techniques and strategies. More research and synthesis are needed to make scale development more culturally competent and enable scale application to better meet local health and development needs.

Understanding psychological outcomes following exposure to potentially morally injurious events in animal care: development of the Moral Distress-Posttraumatic Growth Scale for Veterinary Professionals

AIMS

To generate a taxonomy of potentially morally injurious events (PMIE) encountered in veterinary care and develop an instrument to measure moral distress and posttraumatic growth following exposure to PMIE in the veterinary population.

METHODS

Development and preliminary evaluation of the Moral Distress-Posttraumatic Growth Scale for Veterinary Professionals (MD-PTG-VP) employed data from veterinary professionals (veterinarians, veterinary nurses, veterinary technicians) from Australia and New Zealand across three phases: (1) item generation, (2) content validation, and (3) construct validation. In Phase 1 respondents (n = 46) were asked whether they had experienced any of six PMIE and to identify any PMIE not listed that they had experienced. In Phase 2 a different group of respondents (n = 11) assessed a list of 10 PMIE for relevance, clarity and appropriateness. In Phase 3 the final instrument was tested with a third group of respondents (n = 104) who also completed the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), a measure of posttraumatic stress, and the Stress-Related Growth Scale-Short Form (SRGS-SF) a measure of perceived posttraumatic growth. Spearman's correlation coefficients were calculated between respondent scores on each of the MD-PTG-VP subscales, the SPRINT, and the SRGS-SF to assess construct validity.

RESULTS

A 10-item taxonomy of PMIE encountered in veterinary care was generated in Phase 1. Items were deemed relevant, clear and appropriate by veterinary professionals in Phase 2. These were included in the developed instrument which measures frequency and impact of exposure to 10 PMIE, yielding three subscale scores (exposure frequency, moral distress, and posttraumatic growth). Assessment of construct validity by measuring correlation with SPRINT and SRGS-SF indicated satisfactory validity.

CONCLUSIONS

The MD-PTG-VP provides an informative tool that can be employed to examine professionals' mental health and wellbeing following exposure to PMIE frequently encountered in animal care. Further evaluation is required to ascertain population norms and confirm score cut-offs that reflect clinical presentation.

CLINICAL RELEVANCE

Once fully validated this instrument may be useful to quantify the frequency and intensity of positive and negative aspects of PMIE exposure on veterinary professionals so that accurate population comparisons can be made and changes measured over time.

Measuring the psychological burden of women with pelvic floor complaints: The psychometric characteristics of a new instrument

Background

To be able to optimize pelvic healthcare, it would be helpful to specifically assess women's psychological burden with pelvic floor complaints. In the absence of such an instrument, a new instrument was developed to measure this burden in women who seek help. In previous research, a comprehensive overview was yielded of women's restrictions and distress with pelvic floor complaints, and a conceptual model was developed of seven types of distress that were reflected by 33 statements. The present study was performed to investigate the psychometric properties of the new instrument, termed the Pelvic Floor Complaint-related Psychological Burden Inventory (PFC-PBI).

Methods

In an online survey data was collected from women with and without pelvic floor complaints on the 33 statements. The internal consistency of the types of distress was tested using item-total correlation analysis, Principal Component and Confirmatory Factor Analyses were performed, and the convergent and divergent validity of the types of distress was examined against existing questionnaires using the Multi-Trait Multi-Method methodology.

Results

Based on the factor analyses, a 10-item instrument was tested. Outcomes show excellent internal consistency of this instrument, comprising a single component. The PFC-PBI demonstrated satisfactory convergent and divergent validity.

Conclusions

This new measure appears to be a promising tool to inventory the psychological burden of women suffering from pelvic floor complaints. Research into its further development, implementation, and clinical use appears warranted.

Deglutologist Practices and Perceptions of the Penetration-Aspiration Scale: A Survey Study

Successful dysphagia management requires accurate, succinct diagnosis and characterization of swallowing safety impairments. However, the Penetration-Aspiration Scale (PAS) remains the only available tool developed exclusively for assessment of airway protection. To best support efforts to advance the field's understanding of swallowing safety, it is crucial to understand current clinician practice patterns, perceptions, and accuracy regarding the PAS. A 46-item survey was developed and distributed to deglutologists internationally examining: (1) Demographics; (2) Scale Practices; (3) Swallowing Safety Priorities; (4) Scale Perceptions; and (5) Accuracy. The first four sections consisted of questionnaires. In the optional fifth section, respondents were asked to score five videos of swallows collected via videofluoroscopy and previously PAS-scored by two trained raters. In total, 335 responses were analyzed. The majority of respondents self-reported PAS training (84%); 90% of untrained respondents were receptive to training. Respondents reported using the PAS "always" (40%) or "frequently" (29%), and that the PAS carries "a great deal of" weight in assessment (40%). Reported application of the PAS was heterogeneous, with the most common approach being "single worst score per unique presentation" (45%). Most respondents (64%) prioritized a parameter not captured by the PAS. Untrained respondents were significantly more confident with PAS ratings than trained respondents (X2 = 7.47; p = 0.006). Of 1460 PAS ratings provided, 364 of them were accurate (25%) when compared to ratings by trained lab members. Results of this survey reflect ubiquitous use of the PAS, unmet needs for assessment of swallowing safety, low accuracy despite generally high confidence, and heterogenous training that does not correspond to confidence. This emphasizes the need for additional training in clinical application of the PAS as well as development of novel metrics to optimize assessments of swallowing safety.

Navigating the decision-making landscape of AI in risk finance: Techno-accountability unveiled

The integration of artificial intelligence (AI) systems has ushered in a profound transformation. This conversion is marked by revolutionary extrapolative capabilities, a shift toward data-centric decision-making processes, and the enhancement of tools for managing risks. However, the adoption of these AI innovations has sparked controversy due to their unpredictable and opaque disposition. This study employs the transactional stress model to empirically investigate how six technological stressors (techno-stressors) impact both techno-eustress (positive stress) and techno-distress (negative stress) experienced by finance professionals and experts. To collect data for this research, an e-survey was distributed to a diverse group of 251 participants from various sources. The findings, particularly the identification and development of techno-accountability as a significant factor, contribute to the risk analysis domain by improving the failure mode and effect analysis framework to better fit the rapidly evolving landscape of AI-driven innovations.

The Development of the Attachment Defenses Questionnaire (ADQ-50): A Preliminary Examination of Reliability, Validity, and Factor Structure

This paper marks the initial phase in the development of the Attachment Defenses Questionnaire (ADQ-50), a self-report tool crafted to assess defense mechanisms associated with attachment processes, catering to both clinical and research contexts. Anchored in the theoretical framework of attachment theory, the ADQ posits that an individual's internalized attachment style plays a influential role in predicting their defense mechanisms. The paper outlines the comprehensive development and refinement process of the ADQ-50. In Study 1 a preliminary 176-item version of the ADQ was examined. Data was collected online drawing from participants sourced from Prolific and undergraduate students (N = 1994). Study 2 further refined the ADQ, evaluating its initial convergent validity with a diverse participant pool (N = 726), including undergraduates, Prolific contributors, general practice medical patients, and individuals from social media. Exploratory factor analysis revealed a robust ten-factor structure, resulting in a 50-item scale aligning with theoretical expectations and demonstrating good psychometric properties. Findings, limitations, strengths and future research directions are discussed. We posit that the ADQ holds great potential to deepen our comprehension of defense mechanisms linked to attachment, with wide-ranging implications for clinical practices.

The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale

OBJECTIVE

Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale.

METHODS

The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire.

RESULTS

The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good - excellent (α = 0.74-0.93) internal consistency and moderate - good (ICC = 0.64-0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis.

CONCLUSIONS

The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.

A digital health intervention to support patients with chronic pain during prescription opioid tapering: a pilot randomised controlled trial

Introduction

Recent changes in opioid prescribing guidelines have led to an increasing number of patients with chronic pain being recommended to taper. However, opioid tapering can be challenging, and many patients require support.

Objectives

We evaluated the feasibility, acceptability, and potential efficacy of a codesigned digital health intervention to support patients with chronic pain during voluntary prescription opioid tapering.

Methods

In a pilot randomised controlled trial, participants received a psychoeducational video and 28 days of text messages (2 SMS/day) in addition to their usual care (intervention) or usual care alone (control). The feasibility, acceptability, and potential efficacy of the intervention were evaluated. The primary outcome was opioid tapering self-efficacy. Secondary outcomes were pain intensity and interference, anxiety and depression symptom severity, pain catastrophising, and pain self-efficacy.

Results

Of 28 randomised participants, 26 completed the study (13 per group). Text message delivery was high (99.2%), but fidelity of video delivery was low (57.1%). Most participants rated the messages as useful, supportive, encouraging, and engaging; 78.5% would recommend the intervention to others; and 64.2% desired a longer intervention period. Tapering self-efficacy (Cohen d = 0.74) and pain self-efficacy (d = 0.41) were higher, and pain intensity (d = 0.65) and affective interference (d = 0.45) were lower in the intervention group at week 4.

Conclusion

First evidence supports the feasibility, acceptability, and potentially efficacy of a psychoeducational video and SMS text messaging intervention to support patients with chronic pain during voluntary prescription opioid tapering. Definitive trials with longer intervention duration are warranted.

Oversharing on Social Media: Anxiety, Attention-Seeking, and Social Media Addiction Predict the Breadth and Depth of Sharing

Oversharing on social media by adolescents is a considerable problem in the digital age, and has the potential to instigate online shaming, cyberbullying, identity theft, and other security risks. To date, oversharing has not been comprehensively studied and there is scarce understanding of the possible psychological conditions that may underlie this maladaptive online behavior. This study aimed to measure online oversharing and its potential psychological correlates among adolescents. Data were collected from 352 Iranian adolescent social media users (270 girls and 82 boys; Mage = 16.38, SD = 1.71). The Online Oversharing Inventory, developed for this study, demonstrated unidimensionality and excellent internal consistency. Further results showed that boys overshared significantly more on social media than girls did. Anxiety, attention-seeking, and social media addiction were significantly associated with elevated levels of online oversharing. Results show that the Online Oversharing Inventory is a brief and robust tool for the assessment of high frequency self-disclosure on social media. The findings suggest that anxiety, attention-seeking, and problematic use of social media may predispose adolescents to overshare personal information online.

Development of a Medical Social Media Ethics Scale and Assessment of #IRad, #CardioTwitter, and #MedTwitter Posts: Mixed Methods Study

BACKGROUND

Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified.

OBJECTIVE

We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter.

METHODS

A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ2 tests with Yates correction.

RESULTS

The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns.

CONCLUSIONS

The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities.

Psychometric Evaluation of the Food Life Questionnaire-Short Form among Brazilian Adult Women

Measures of beliefs and attitudes toward food have generally been limited to the measurement of more pathological eating attitudes (e.g., disordered eating). The Food Life Questionnaire (FLQ) and its short form (FLQ-SF) were developed to examine attitudes toward a broader range of foods; however, the factor structure of the FLQ-SF was not confirmed in any study with young women. In the present study, we performed a psychometric evaluation of the Brazilian Portuguese translation of the FLQ-SF in a sample of 604 women. We evaluated the factor structure using a two-step, split-sample exploratory and confirmatory factor analytic approach. Results supported a four-factor structure (i.e., weight concern, diet-health orientation, belief in a diet-health linkage, and food and pleasure) with 18 items (χ2/df = 2.09; CFI = 0.95; TLI = 0.94; RMSEA = 0.05 (90% CI = 0.04; 0.06; p > 0.05); and SRMR = 0.08). Additionally, we found good internal consistency for all FLQ-SF subscales (McDonald's ω = 0.79-0.89) and convergent validity with measures of feelings, beliefs, and behaviors involved in food attitudes. Collectively, these results support the use of the FLQ-SF in Brazilian women and provide a foundation to expand the literature on beliefs and attitudes toward food in this population.

The Breast-Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects on screening in rural communities

PURPOSE

Develop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia.

METHODS

Survey items describing 7 domains of imaging facility qualities were developed and tested in the Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. Medicare claims data (2016-2018) were obtained on catchment area mammogram services. Construct validity was examined from associations with facility affiliation, community characteristics, mammogram screening uptake, and market reach. Analyses were performed with t-tests and ANOVA.

RESULTS

A total of 192 (of 377) sites completed the survey. Five factors were initially selected in exploratory factor analysis (FA) and refined in confirmatory FA: capacity, outreach & marketing, operational support, radiology review (NNFI = .94, GFI = 0.93), and diagnostic services (NNFI = 1.00, GFI = 0.99). Imaging capacity and diagnostic services were associated with screening uptake, with capacity strongly associated with catchment area demographic and economic characteristics. Imaging facilities in economically affluent versus poorer areas belong to larger health systems and have significantly more resources (P < .001). Facilities in economically distressed locations in Appalachia rely more heavily on outreach activities (P < .001). Higher facility capacity was significantly associated (P < .05) with larger catchment area size (median split: 48.5 vs 51.6), mammogram market share (47.4 vs 52.7), and screening uptake (47.6 vs 52.4).

CONCLUSIONS

A set of 18 items assessing breast imaging services and facility characteristics was obtained, representing policies and practices related to a facility's catchment area size, market share, and mammogram screening uptake.

Assessing the Structural Validity of the Knee Injury and Osteoarthritis Outcome Score Scale

BACKGROUND

The Knee Injury and Osteoarthritis Outcome Score (KOOS) scale is used to assess patient perspectives on knee health. However, the structural validity of the KOOS has not been sufficiently tested; therefore, our objective was to assess the KOOS in a large, multi-site database of patient responses who were receiving care for knee pathology.

METHODS

A cross-sectional study was conducted using the Surgical Outcome System (SOS) database. A confirmatory factor analysis (CFA) was conducted to assess the proposed five-factor KOOS using a priori cut-off values. Because model fit indices were not met, a subsequent exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting four-factor structure (i.e., KOOS SF-12) was then assessed using CFA and subjected to multigroup invariance testing.

RESULTS

The original KOOS model did not meet rigorous CFA fit recommendations. The KOOS SF-12 did meet model fit recommendations and passed all invariance testing between intervention procedure, sex, and age groups.

CONCLUSION

The KOOS failed to meet model fit recommendations. The KOOS SF-12 met model fit recommendations, maintained a multi-factorial structure, and was invariant across all tested groups. The KOOS did not demonstrate sound structural validity. A refined KOOS SF-12 model that met recommended model fit indices and invariance testing criteria was identified. Our findings provide initial support for a multidimensional KOOS structure (i.e., KOOS SF-12) that is a more psychometrically sound instrument for measuring patient-reported knee health.

The hidden curriculum across medical disciplines: an examination of scope, impact, and context

Background

While research suggests that manifestations of the hidden curriculum (HC) phenomenon have the potential to reinforce or undermine the values of an institution, very few studies have comprehensively measured its scope, impact, and the varied clinical teaching and learning contexts within which they occur. We explored the HC and examined the validity of newly developed constructs and determined the influence of context on the HC.

Methods

We surveyed medical students (n =182), residents (n =148), and faculty (n = 140) from all disciplines at our institution between 2019 and 2020. Based on prior research and expertise, we measured participants' experience with the HC including perceptions of respect and disrespect for different medical disciplines, settings in which the HC is experienced, impact of the HC, personal actions, efficacy, and their institutional perceptions. We examined the factor structure, reliability, and validity of the HC constructs using exploratory factor analysis Cronbach's alpha, regression analysis and Pearson's correlations.

Results

Expert judges (physician faculty and medical learners) confirmed the content validity of the items used and the analysis revealed new HC constructs reflecting negative expressions, positive impacts and expressions, negative impacts, personal actions, and positive institutional perceptions of the HC. Evidence for criterion validity was found for the negative impacts and the personal actions constructs and were significantly associated with the stage of respondents' career and gender. Support for convergent validity was obtained for HC constructs that were significantly correlated with certain contexts within which the HC occurs.

Conclusion

More unique dimensions and contexts of the HC exist than have been previously documented. The findings demonstrate that specific clinical contexts can be targeted to improve negative expressions and impacts of the HC.

Satisfaction with asynchronous e-learning: An exploratory factor analysis of the Learner Satisfaction with Asynchronous e-Learning (LSAeL) instrument

AIM

To describe the development and psychometric testing of the Learner Satisfaction with Asynchronous e-Learning (LSAeL) instrument.

BACKGROUND

Existing satisfaction with e-learning instruments may not accurately evaluate learner satisfaction with constructs associated with asynchronous e-learning.

DESIGN

Methodological study.

METHODS

Content, face and construct validity of the instrument were evaluated using a two-stage process. A five-member expert panel evaluated the instrument's content and face validity. A content validity index and a modified kappa co-efficient was used to calculate the content validity of individual test items and the global instrument and to adjust for chance agreement between raters. These data were then reviewed and individual items were removed, retained or refined accordingly. Using an empirically informed wholly asynchronous e-learning program 237 nursing students from a regional university in New South Wales, Australia completed the 35 item LSAeL instrument. An exploratory factor analysis (EFA) was then conducted to explore the dimensionality of the instrument.

RESULTS

Exploratory factor analysis identified a seven-factor solution with 30 items, explaining an 86.1% of the total variance, was the best fit for the data.

CONCLUSION

The study demonstrates that the construct validity of the LSAeL instrument is acceptable. Instrument development is an iterative process and further testing with other cohorts and in other settings is required.

Validation of the Short Version (TLS-15) of the Triangular Love Scale (TLS-45) across 37 Languages

Love is a phenomenon that occurs across the world and affects many aspects of human life, including the choice of, and process of bonding with, a romantic partner. Thus, developing a reliable and valid measure of love experiences is crucial. One of the most popular tools to quantify love is Sternberg's 45-item Triangular Love Scale (TLS-45), which measures three love components: intimacy, passion, and commitment. However, our literature review reveals that most studies (64%) use a broad variety of shortened versions of the TLS-45. Here, aiming to achieve scientific consensus and improve the reliability, comparability, and generalizability of results across studies, we developed a short version of the scale-the TLS-15-comprised of 15 items with 5-point, rather than 9-point, response scales. In Study 1 (N = 7,332), we re-analyzed secondary data from a large-scale multinational study that validated the original TLS-45 to establish whether the scale could be truncated. In Study 2 (N = 307), we provided evidence for the three-factor structure of the TLS-15 and its reliability. Study 3 (N = 413) confirmed convergent validity and test-retest stability of the TLS-15. Study 4 (N = 60,311) presented a large-scale validation across 37 linguistic versions of the TLS-15 on a cross-cultural sample spanning every continent of the globe. The overall results provide support for the reliability, validity, and cross-cultural invariance of the TLS-15, which can be used as a measure of love components-either separately or jointly as a three-factor measure.

Development and validation of the Cultural Responsiveness Assessment Measure (CRAM): A self-reflection tool for mental health practitioners when working with First Nations people

BACKGROUND

The purpose of this study was to develop and to validate a measure of cultural responsiveness that would assist mental health practitioners across a range of disciplines, in Australia, to work with Indigenous clients.

AIM

The Cultural Responsiveness Assessment Measure (CRAM) was developed to provide a tool for practitioners and students to evaluate their own culturally responsive practice and professional development.

METHOD

Following expert review for face validity the psychometric properties of the measure were assessed quantitatively, from the responses of 400 mental health practitioners.

RESULTS

Confirmatory Factor Analysis yielded a nine factor, 36 item instrument that demonstrated strong convergent and discriminant validity as well as test-retest reliability.

CONCLUSIONS

It is anticipated that the CRAM will have utility as both a learning tool and an assessment measure, for mental health practitioners to ensure that services are culturally responsive for Aboriginal and Torres Strait Islander people.

The Gender Euphoria Scale (GES): a protocol for developing and validating a tool to measure gender euphoria in transgender and gender diverse individuals

Background

Gender euphoria (i.e., a positive feeling associated with one's gender identity, expression, or affirmation) is widely discussed among transgender and gender diverse (hereafter referred to as trans) individuals. However, as a construct, gender euphoria has never been formally measured and has rarely been empirically studied. Hence, this protocol paper illustrates our process for developing and validating a new tool to measure gender euphoria, known as the Gender Euphoria Scale (GES), for use with trans populations.

Methods

Deductive methods including findings from previous research and a review of existing measures, together with inductive methods such as expert feedback and focus groups with trans individuals, were used to generate a preliminary item pool for the GES. Pilot testing with trans community members and mental health clinicians was then used to refine items and develop a preliminary scale. Trans participants involved in an ongoing longitudinal study (TRANSform) were invited to complete the scale alongside measures of personality and gender factors to assess validity. Participants were then invited to complete the scale two weeks after initial completion to assess the test-retest reliability of the scale. The next stage in the scale development process will be to examine the dimensionality of the GES using exploratory factor analytic techniques. The scale will then be assessed for internal consistency, temporal stability, discriminant validity, and convergent validity.

Conclusion

This paper outlines the development and characterization of a novel tool to measure gender euphoria for the first time. The GES will facilitate research opportunities to better understand the nature of gender euphoria and its influences, and may be used clinically to examine relationships between gender euphoria and gender affirming interventions. Hence, we expect the GES to make a significant contribution to both research and clinical practice with trans communities.

Limitations in Medical Research: Recognition, Influence, and Warning

Background

As the number of limitations increases in a medical research article, their consequences multiply and the validity of findings decreases. How often do limitations occur in a medical article? What are the implications of limitation interaction? How often are the conclusions hedged in their explanation?

Objective

To identify the number, type, and frequency of limitations and words used to describe conclusion(s) in medical research articles.

Methods

Search, analysis, and evaluation of open access research articles from 2021 and 2022 from the Journal of the Society of Laparoscopic and Robotic Surgery and 2022 Surgical Endoscopy for type(s) of limitation(s) admitted to by author(s) and the number of times they occurred. Limitations not admitted to were found, obvious, and not claimed. An automated text analysis was performed for hedging words in conclusion statements. A limitation index score is proposed to gauge the validity of statements and conclusions as the number of limitations increases.

Results

A total of 298 articles were reviewed and analyzed, finding 1,764 limitations. Four articles had no limitations. The average was between 3.7% and 6.9% per article. Hedging, weasel words and words of estimative probability description was found in 95.6% of the conclusions.

Conclusions

Limitations and their number matter. The greater the number of limitations and ramifications of their effects, the more outcomes and conclusions are affected. Wording ambiguity using hedging or weasel words shows that limitations affect the uncertainty of claims. The limitation index scoring method shows the diminished validity of finding(s) and conclusion(s).

Psychometric Properties of a Cyberaggression Measure in Mexican Students

Cyberaggression is an important problem today; it can affect adolescents in different ways. Therefore, reliable and valid measures are necessary to better study the phenomenon. The aim of the present study was to generate validity and reliability evidence for a Spanish-language cyberaggression scale from Garaigordobil, (2017) in a population of 1695 adolescents from northwestern Mexico (51.5% female) between 12- and 15-years-of-age. The results of this study contribute to the research and focus on cyberaggression in adolescents in Mexico. The measure used in this paper detects the different roles, including the bystander, rigorously testing the reliability and validity of the measure, providing a solid tool to evaluate cyberaggression in the Mexican context and guide evidence-based interventions and policies in educational settings.

Developing the pediatric surgery patient satisfaction scale and assessment of its validity and reliability

Aim of this study was to develop a patient satisfaction scale for needs and expectations of pediatric surgery patients and to propose a new measurement tool in this field. Population of study consisted of all patients between May 2018 and February 2020 at a pediatric surgery service of a university hospital in Turkey. A pool of 70 items was prepared for scale. Two items were removed in line with expert opinions and suggestions. As a result of content validity and test application, 36 items were removed, and scale was revised. Data were transferred to SPSS Statistics 23 and AMOS 22 program. After evaluating scope validity of scale, Content Validity, Structural Validity, Exploratory Factor Analysis, and finally Reliability Analysis were examined. As a result of the analyses, 32 items with eight sub-dimensions were obtained from scale. Eight-factor scale explained 60.42% of total variance. Cronbach Alpha internal consistency of scale was found to be 0.88. Item factor loads of scale were created and the reliability of scale were obtained at desired level. The scale is suitable for patients aged 6 to 18 years old.

Results From a Multimethod Exploratory Scale Development Process to Measure Authoritarian Provider Attitudes in Democratic Republic of Congo and Togo

BACKGROUND

Health care providers' actions can significantly influence clients' experiences of care, adherence to recommendations, and likelihood of re-engaging with health services. There are currently no validated scales that measure provider attitudes that could affect service delivery in multiple health areas.

METHODS

We developed provider attitude measures in 3 phases. In phase 1 (2019), survey items were developed based on literature reviews, and quantitative items were tested through a health facility survey conducted in the Democratic Republic of the Congo (DRC). Health care providers (N=1,143) completed a 23-question survey focused on 3 subdomains: provider perceptions of clients, provider roles, and gender roles. In phase 2 (2021), cognitive interviews were administered to 17 health care providers in DRC to assess and improve respondents' understanding and interpretation of questionnaire items and response options. In phase 3 (2021), 52 family planning providers were sampled from urban health facilities in Togo to retest and validate the improved measures.

RESULTS

Phase 1 showed the provider attitude items had low scale reliability, and 8 survey items had low variability. In phase 2, results from the cognitive interviews of the 21 items retained from phase 1 found 16 questions were not well understood or had low response variability and thus modified, and 4 survey items were added to test different iterations of specific survey items. In phase 3, exploratory factor analysis resulted in 1 provider attitude scale of 14 items reflecting authoritarian attitudes related to the 3 initial subdomains.

CONCLUSION

This research highlights the importance of iteration and testing during scale development, implementable even across geographic locations. Provider behavior change programming should consider how authoritarian provider attitudes pertaining to professional roles, their clients, and gender norms may interact and influence the quality of health services provided.

Development of a tool for assessing the performance of long-term care systems in relation to care transition: Transitional Care Assessment Tool in Long-Term Care (TCAT-LTC)

BACKGROUND

Improving the quality and safety of care transitions is a priority in many countries. Carrying out performance measurements play a significant role in improving quality of decisions undertaken by different actors involved in reforms. Therefore, the main objective of this paper is to present the development of an evaluation tool for assessing the performance of long-term care systems in relation to care transition, namely the Transitional Care Assessment Tool in Long-Term Care (TCAT-LTC). This study is performed as part of a larger European TRANS-SENIOR project.

METHODS

The development of the TCAT-LTC involved three steps. First, we developed a conceptual model based on Donabedian's quality framework and literature review. Second, we carried out a thorough process of item pool generation using deductive (systematic literature review) and deductive-inductive methods (in-depth interviews) with experts in the field of long-term care. Third, we conducted preliminary validation of the tool by asking experts in research and practice to provide an opinion on a tool and to assess content validity. Future fourth step will involve a tool's pilot with country experts from Germany, the Netherlands and Poland.

RESULTS

By applying methodological triangulation, we developed the TCAT-LTC, which consists of 2 themes, 12 categories and 63 items. Themes include organizational and financial aspects. Organizational aspects include categories such as communication, transfer of information, availability and coordination of resources, training and education of staff, education/support of the patient/informal caregiver, involvement of the patient/informal caregiver, telemedicine and e-Health, and social care. Financial aspects include categories such as primary care, hospital, and long-term care. We also present the instructions on the application of the TCAT-LTC.

CONCLUSIONS

In this paper, we presented the development of the TCAT-LTC evaluation tool for assessing the performance of long-term care systems in relation to care transition. The TCAT-LTC is the first tool to assess the performance of long-term care systems in relation to care transition. Assessments can be carried out at the national and international level and enable to monitor, evaluate, and compare performance of the long-term care systems in relation to care transition within and across countries.

From qualitative data to a measurement instrument: A clarification and elaboration of choices made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0

PURPOSE

To clarify and elaborate on the choices that were made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale 3.0 (POSAS 3.0), based upon the rich information obtained from patients during focus groups and pilot tests.

METHODS

The discussions described in this paper are a reflection of the focus group study and pilot tests that were conducted in order to develop the Patient Scale of the POSAS3.0. The focus groups took place in the Netherlands and Australia and included 45 participants. Pilot tests were performed with 15 participants in Australia, the Netherlands, and the United Kingdom.

RESULTS

We discussed the selection, wording and merging of 17 included items. Additionally, the reason for exclusion of 23 characteristics are given.

CONCLUSION

Based upon the unique and rich material of patient input obtained, two versions of the Patient Scale of the POSAS3.0 were developed: the Generic version, and the Linear scar version. The discussions and decisions taken during the development are informative for a good understanding of the POSAS 3.0 and are indispensable as a background for future translations and cross-cultural adaptations.

Principal component analysis: development and initial validation of the mirror effects inventory

BACKGROUND

Mirroring is a specific phenomenon that occurs in groups. People observe others enacting different roles in given situations, whereby concretizing the role of the observing aspect of their self as if looking in a mirror. Individuals could acquire emotional, cognitive, imaginative, behavioral, and interpersonal experiences through this process of mirroring; that is, "mirror effects." Given that there are very few comprehensive scales capable of evaluating mirror effects, the Mirror Effects Inventory (MEI) was developed to measure experiences after participating in counseling education. This study describes the development of the MEI based on an interpersonal perspective and aimed to validate this scale.

METHODS

The development and validation of the MEI involved a seven-stage process that utilized both qualitative and quantitative methods. Former students who studied counseling (N = 24) were surveyed via semi-structured telephone interviews. A subjective perceived scale (the MEI) was then constructed. The MEI was administered to part-time university students (N = 221) studying counseling courses. Psychometric tests were performed to examine its validity and reliability. Validation of the MEI included examining correlations between three types of mirror effects and age differences and educational attainment.

RESULTS

The PCA revealed three types of mirror effects: general, positive, and negative. These components accounted for 53.82% of the total variance. Reliability estimates measured using Cronbach's alpha of .88 indicated that the items were internally consistent. The findings showed that as the general mirror effect increased, there was a corresponding increase in the positive mirror effect and a decrease in the negative mirror effect. However, an increase in positive mirror effects was associated with an increase in negative mirror effects.

CONCLUSIONS

The development of a reliable and valid measure of mirror effects has benefits and implications for counseling education and clinical practice. Further empirical research could contribute to resolving the controversies concerning the basic conceptual understanding of MEI.

Cultural adaptation and validation of the Arabic version of the short 12-item stroke-specific quality of life scale

Background

Given the excessive length and inconsistent validity of the existing long stroke-specific quality of life (SS-QOL) scales, there is a need to validate a shorter measuring tool. The aim of this study was to validate the Arabic version of the short 12-item SS-QOL (SS-QOL-12-AR) and examine its validity measures and psychometric properties. Additionally, the study aimed to assess the QOL after stroke and identify the sociodemographic and clinical factors that influence it in Lebanon.

Methods

A cross-sectional study was conducted. The SS-QOL-12-AR structure was validated, and its reliability and internal consistency were assessed. The scale's specificity and sensitivity were evaluated and then compared with those of other SS-QOL scales. The correlation between each item and the overall scale were examined, and its convergent validity was evaluated.

Results

A total of 172 stroke survivors were included. The SS-QOL-12-AR structure was validated with a solution of two factors, with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.850 and a significant Bartlett's test of sphericity (p < 0.001). The Cronbach's alpha of the scale was 0.917. According to ROC curve analysis, the optimal cut-off point for distinguishing between lower and better QOL was 32.50. At this cut-off, the sensitivity and specificity were 70.0% and 71.2%, respectively. The area under the curve was 0.779 (95% CI 0.704-0.855, p < 0.001). The SS-QOL-12-AR demonstrated a strong and highly significant correlation with existing versions of the SS-QOL, confirming its convergent validity. 61.6% of stroke survivors had a lower QOL, which was significantly associated with poor stroke prognosis, increased physical dependence, current smoking, and alcohol abstinence.

Conclusion

The SS-QOL-12-AR exhibits strong validity and reliability, demonstrating excellent psychometric properties. The scale holds potential for application in clinical practice and research settings, enabling the measurement of stroke-related consequences and evaluation of management outcomes.

Development and validation of the intellectual property services scale in China

Existing studies have emphasized the crucial role of intellectual property services (IPS) in the advancement of science and technology, but there was still a lack of a valid scale for assessing IPS. Accordingly, this study aimed to develop a reliable instrument to fill this gap. A three-step process of scale development was described: item generation through grounded theory research (n = 14), scale development through exploratory factor analysis (n = 219) and scale assessment through confirmatory factor analysis (n = 191). By analyzing and coding the interview data drawn from IPS agencies in China, the study verified that IPS could be represented as a three-dimensional construct consisting of vocational skills services (VSS), commercial operation services (COS), and value-added business services (VBS). The subsequent exploratory factor analysis and confirmatory factor analysis were conducted to test and modify the IPS scale with 11 items was shown to have acceptable internal consistency reliability, as well as convergent and discriminant validity. The IPS scale could serve as an operational tool for IPS practitioners to measure and identify the problems of service quality and service mode. Additionally, it held significant theoretical value and practical implications for the advancement of intellectual property services industry in China.

The development and validation of a multidimensional organisational trust measure

Motivation for the study

Workplaces are changing with employees increasingly working remotely and flexibly, which has created larger physical distance between team members. This shift has consequences for trust research and implications for how trust is built and maintained between employees and leaders.

Research design

Three studies collectively aimed to demonstrate how employee trust in leaders has adapted to a hybrid work environment. A validation of a seminal multidimensional employee trust in leaders measure was conducted. Also, an alternative multidimensional measure was developed, piloted, and then validated using exploratory and confirmatory factor analyses.

Main findings

Findings showed the Affective and Cognitive Trust scale not to be sufficiently reliable or valid after testing with a sample working in a hybrid model of virtual and face to face work environments. However, the new measure demonstrated good reliability and validity.

Implication

Findings reinforced that there are behavioural and relational elements to organisational trust, and there are two discreet dimensions to trustworthy behaviour: communication and authenticity.

Psychological impact of cancer scale: Turkish validity and reliability study

BACKGROUND

In the diagnosis and treatment of cancer, it is important to evaluate the com-ponents of psychological adjustment. Considering the key role of nurses in providing care to patients, it is important to evaluate patients, to determine high-risk patients and to use tools with acceptable validity and reliability to develop care plans.

AIM

To analyze the Turkish validity and reliability of The Psychological Impact of Cancer Scale (PICS).

METHODS

This methodological study was conducted with 257 cancer patients admitted to the oncology-haematology clinic and outpatient clinic of a University Hospital between February and October 2021. After the translation process of the scale, content and construct validity were conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was examined with construct validity, while item analyses and internal consistency analysis were conducted for reliability.

RESULTS

Analyses and assessment results showed that the content validity index of the scale was 0.96. In the exploratory factor analysis of the Turkish adaptation study, total variance rate explained was found as 84.98%. Factor loads of all items were between 0.82 and 0.94. It was found that Cronbach Alpha values were between 0.860 and 0.930 and total scale Cronbach Alpha value was 0.844. EFA and CFA showed that Turkish form of 12-item and 4-factor. The Psychological Impact of Cancer Scale was confirmed with no changes to the original scale. CFA revealed good fit indices.

CONCLUSION

Turkish PICS is a valid and reliable measurement tool for the evaluation of individual’s psychological response to cancer diagnosis and treatment and for being used in clinical practice.

Using the design-thinking method to develop and validate a peer evaluation scale for team-based learning (PES-TBL) for nursing students

BACKGROUND

Peer evaluation in team-based learning provides meaningful information about the learning process and dynamics. Despite the importance of peer evaluation in learner-centred learning, there is a lack of valid and reliable scales that reflect students' experiences in the classroom.

OBJECTIVES

To develop and validate a peer evaluation scale for team-based learning.

DESIGN

A cross-sectional methodological study.

SETTING

Four universities located in Gwangju, Republic of Korea.

PARTICIPANTS

Eight nursing students exposed to team-based learning voluntarily participated in a design-thinking project, and eight nursing professors were selected for content validity. For the validation of the Scale, 722 nursing students were randomly selected.

METHODS

The design-thinking method was implemented to develop the Scale, and a questionnaire was used to assess the Scale's construct validity and reliability. The construct validity was examined in a split-half analysis with exploratory and confirmatory factor analyses. Cronbach's alpha, McDonald's omega, and composite reliability were investigated for the peer evaluation scale for team-based learning.

RESULTS

A 12-item tool, with each item using a 5-point scale for peer evaluation, was developed through the empathise, define, ideate, prototype, and test stages of the design-thinking method. Exploratory factor analysis identified three factors from the 12 items: responsibility, initiative, and collaboration. Confirmatory factor analysis demonstrated that the tool had acceptable convergent and discriminant validity, thus confirming good construct validity. All values for reliability were >0.70.

CONCLUSIONS

This study was noteworthy in that it employed the design-thinking method to reflect learners' opinions in developing a peer evaluation instrument. Moreover, the study demonstrated adequate evidence of reliability and validity. Consequently, the developed Scale can be effectively applied to team-based learning assessments for nursing students.

Psychometric properties of the online Satisfaction with Life Scale in university students from a low-income region

PURPOSE

To test the feasibility, reliability, and validity of the Satisfaction with Life Scale (SWLS) in an online format in university students from a low-income region.

METHODS

This was a psychometric study, involving a study of reliability (n = 117) and validity (n = 195) in university students from a region with a Gini index of 0.56. The scale was applied at two time points with an interval of 2 weeks. This scale measures satisfaction with life based on five statements and responses ranging from 1 to 7 (strongly disagree to strongly agree). We conducted the reliability assessment using temporal stability and internal consistency and construct validity assessment by internal structure solution.

RESULTS

All SWLS items showed acceptable (rho > 0.30) and significant (p < 0.05) temporal stability and acceptable internal consistency (alpha > 0.70). In construct validity (internal structure), we identified a factor with an explained variance of 59.0% in the exploratory factor analysis. Additionally, in the confirmatory factor analysis, we identified a one-factor structure solution for SWLS with an acceptable model fitting (chi-square/degrees of freedom [X²/df] = 6.53; Tucker-Lewis Index [TLI] = 0.991; Comparative Fit Index [CFI] = 0.996; root mean square error of approximation [RMSEA] = 0.040; standardized root mean-squared residual [SRMR] = 0.026).

CONCLUSION

The Satisfaction with Life Scale, in the online format, is a reliable and valid tool for university students in a low-income context.

Seizure severity assessment tools for adult epilepsy patients: A systematic review

INTRODUCTION

Seizure outcomes from antiseizure medication (ASM) therapy can be measured across various domains using assessment tools. The available tools may contain an array of different components or items. Seizure severity assessment, as opposed to seizure frequency count may have been a more accurate measurement in determining the effectiveness of ASM therapy. This study aimed to review studies developing seizure severity assessment tools for adults with epilepsy, describe the development methods and validation, and compare the list of items in these tools.

METHODS

The systematic search utilized established databases such as Scopus, Ovid, Web of Science, Medline, Wiley Online, and Cochrane Library. Studies published from inception to December 15, 2022, were selected. Publications describing the development of tools to measure seizure severity among adult epilepsy patients were included. Outcome measures including the tool's content, development methods, validity, and reliability assessments were compared.

RESULTS

The search produced eight publications describing the development of eight seizure severity assessment tools. One of these tools is part of a multidimensional assessment of the overall impact of epilepsy. The frequently used method in the initial development was the qualitative method (n = 6) where two publications reanalyzed the items from previous studies. Face validity was the most common validation test conducted (n = 4). At least one reliability assessment was conducted for each of the tools, most commonly by the test-retest method (n = 6) and inter-rater reliability (n = 5). All of these tools cover the components of pre-ictal (warning/aura), ictal, and postictal (recovery) events.

CONCLUSION

The identified tools described the assessment of seizure severity using various subscales. The emergence of new methods in quantifying seizure severity unfolds opportunities in discovering more comprehensive assessments of seizure severity in both clinical trials and daily clinical practice.

The flipped learning perception scale: A validity and reliability study

This study aims to develop a scale to determine preservice science teachers' perceptions of flipped learning. The present study uses the survey design, a quantitative research method. For content validity, the authors created an item pool of 144 items based on the literature. After being checked by experts, the item pool dropped to 49 items for the five-point Likert-type draft scale. The current study has preferred cluster sampling due to generalization concerns. The accessible population of the study is the preservice science teachers in Türkiye's provinces of Kayseri, Nevsehir, Nigde, Kırsehir, and Konya. We administered the draft scale to 490 preservice science teachers, which is the recommended 10 times the number of items. We also performed explanatory and confirmatory factor analyses to check the scale's construct validity. We ultimately obtained a four-factor structure with 43 items that explain 49.2% of the variance in scores and found the correlation between the criterion and draft scales to be greater than .70, thus ensuring criterion validity. We calculated Cronbach's alpha and composite reliability coefficients to check the reliability of the scale and determined the reliability coefficients for both the overall scale and the sub-factors to be greater than 0.70. As a result, we have obtained a scale consisting of 43 items and four dimensions that explains 49.2% of the variance. This data collection tool can be used by researchers and lecturers to determine preservice teachers' perceptions toward flipped learning.

Development of a scale to assess the determinants of positive coping in parents of children with intellectual disability

Identifying the determinants of positive coping is a critical step in empowering the parents of children with intellectual disability. In this context, this study aims to develop a scale to assess the determinants of positive coping. Accordingly, culturally relevant items were pooled, got validated by experts and refined. The scale was administered to 150 parents of children with intellectual disability. Factor analysis done through polychoric correlation helped reduce the items. Cronbach's alpha coefficients were established for reliability testing. The validity of the new scale was examined with the subjective wellbeing on a visual analogue scale and Family Interview for Stress and Coping in Mental Retardation. The new scale has a Cronbach's alpha of 0.71 and an intraclass correlation of 0.64. After factor analysis, 12 items were retained in the final version. This study also identified specific factors associated with positive coping. The new scale can be used with parents of children with intellectual disabilities to identify the determinants of positive coping.

Development and initial validation of questionnaire on predictors for the use of hearing protection devices among noise exposed manufacturing workers in Tanzania: A methodological study

Introduction

The use of hearing protection devices (HPDs) has been an intervention of choice in many workplaces such as in the construction industry for quite some time due to impractical effects of engineering and administrative interventions. Questionnaires for assessment for HPDs use among construction workers have been developed and validated in developed countries. However, there is limited knowledge of the same, among manufacturing workers in developing countries that are assumed to have a different culture, work organizations and production processes.

Methods

We conducted a stepwise methodological study to develop a questionnaire to predict the use of HPDs among noise exposed workers in manufacturing factories in Tanzania. The questionnaire included 24 items and was developed through rigorous and systematic procedures involving three steps; (i) item formulation that involved two experts, (ii) expert content review and item rating that involving eight experts with vast experience in the field, and (iii) a field pre-test that involved 30 randomly selected workers from a factory with similar characteristics as a planned study site. A modified Pender's Health Promotion Model was adopted in the questionnaire development. We analyzed the questionnaire in terms of content validity and item reliability.

Results

The 24 items were categorized into seven domains i.e., perceived self-efficacy, perceived susceptibility, perceived benefits, perceived barriers, interpersonal influences, situational influences and safety climate. The score for content validity for each item was satisfactory as the content validity index ranged between 0.75 to 1.00 for clarity, relevance, and essentiality criteria. Similarly, the scores for the content validity ratio (for all items) were 0.93, 0.88 and 0.93 for clarity, relevance, and essentiality, respectively. In addition, the overall value for Cronbach's alpha was 0.92 with domain coefficients: perceived self-efficacy 0.75; perceived susceptibility 0.74; perceived benefits 0.86; perceived barriers 0.82; interpersonal influences 0.79; situational influences; 0.70; and safety climate 0.79. The mean inter-item correlation was 0.49 suggesting good internal consistency.

Discussion and conclusion

The developed and preliminary validated questionnaire can be used to predict the HPDs use among noise exposed manufacturing factory workers. Future surveys using this questionnaires warranted for further validation of the scale developed.

Perceived Body Image towards Disordered Eating Behaviors and Supplement Use: A Study of Mauritian Gym-Goers

Purpose: Individuals with body image distortions tend to develop an obsession with calorie intake and weight, leading to compounded coping strategies such as modified eating behaviors, supplement use, and excessive exercise. In the local context, little is known about the equation connecting body image to improper eating behaviors and other potential coping mechanisms. This study primarily aims at critically identifying the nexus between features of disordered eating behavior including supplement use, and body image. Methodology: A probabilistic randomized sample of 305 gym members was assessed based on their level of body satisfaction and its influence on their eating habits and supplement use through a structured survey. Findings: Only 37% of the participants were satisfied with their body image. The results concurred with the notion of a poor body image influencing body esteem (χ2 (10) = 137.21, p < 0.05; Cramer V = 0.474). While exercise motivated the use of supplements, a significant relationship was also observed between disordered eating habits and supplement use (χ2 (4) = 48.63, p < 0.05; Cramer V = 0.399). A predictive model was successfully drawn inclusive of the disordered eating behaviors dimensions as a potent predictor of body image (χ2 (56) = 397.12, p < 0.001. Implications: This study presents an in-depth analysis of the magnitude of disordered eating behaviors with respect to individuals in the local fitness industry, and the need for professional support programs toward the re-alignment of body image in an effort to curtail the development of eating disorders in Mauritian gym-goers.

Body Image Assessment Tools in Pregnant Women: A Systematic Review

Pregnancy is a remarkable time and generates several changes in women in a short period. Body image is understood as the mental representation of the body itself, and, although bodily changes are considered healthy, they can impact pregnant women's body image. Problems related to body image during pregnancy can affect the health of the mother and fetus; thus, it is essential for health professionals to detect potential disorders as soon as possible. The objective of this systematic review was to identify instruments for assessing body image in pregnant women, highlighting their main characteristics. To this end, we applied the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to searches in the EMBASE, PubMed, and American Psychological Association databases from 5 January to 10 August 2021. We included studies on adult pregnant women without comorbidities in the validation and adaptation of (sub)scales that analyze components of body image. We excluded studies that considered nonpregnant, adolescent, postpartum, and/or clinical populations, as well as smoking/drug use studies that were not validation studies or did not assess any aspect of body image. We investigated the quality of the studies using the Quality Assessment Tool for Studies with Diverse Designs. In all, we examined 13 studies. The results point to a growing concern over body image during pregnancy, as there has been an increase in the number of validation and adaptation studies involving scales for different cultures that scrutinize different constructs. The findings suggest that the listed instruments be used in future research.

Translation, Cultural Adaptation and Validation of the Nurses Self-Concept Instrument (NSCI) to Spanish

Professional self-concept in nurses is understood as the way nurses think and feel about themselves in their nursing role and is both a predictor of quality of care and a protective factor against burnout. The aim of this study was to translate, culturally adapt and validate the Spanish version of the Nurses Self-Concept Instrument in a sample of 483 Spanish registered nurses. In addition, we analyzed gender differences in its dimensions in the same sample. Internal reliability was evaluated using Cronbach's Alpha, while construct validity was assessed using both exploratory and confirmatory factor analysis. The differences between groups were analyzed using the Mann-Whitney U test. Factor distribution was different from the original model. A gender gap was observed in the Nurse Thinking and Perception of Capabilities dimensions with higher values in the women group, while in the Leadership dimension, higher values were observed in the men group. While the Spanish version of the Nurses Self-Concept Instrument is a valid and reliable tool to measure this construct, the differences in its dimensions lead to a deeper understanding of the cultural differences in the construction of professional self-concept.

Examining concurrent validity and item selection of the Session Wants and Needs Outcome Measure (SWAN-OM) in a children and young people web-based therapy service

BACKGROUND

Single-session mental health interventions are frequently attended by children and young people (CYP) in both web-based and face-to-face therapy settings. The Session "Wants" and "Needs" Outcome Measure (SWAN-OM) is an instrument developed in a web-based therapy service to overcome the challenges of collecting outcomes and experiences of single-session therapies (SSTs). It provides pre-defined goals for the session, selected by the young person prior to the intervention, on which progress toward achievement is scored at the end of the session.

OBJECTIVE

The objective of this study was to evaluate the instrument's psychometric properties, including concurrent validity against three other frequently used outcome and experience measures, at a web-based and text-based mental health service.

METHODS

The SWAN-OM was administered for a period of 6 months to 1,401 CYP (aged 10-32 years; 79.3% white; 77.59% female) accessing SST on a web-based service. Item correlations with comparator measures and hierarchical logistic regressions to predict item selection were calculated for concurrent validity and psychometric exploration.

RESULTS

The most frequently selected items were "Feel better" (N = 431; 11.61%) and "Find ways I can help myself" (N = 411; 11.07%); unpopular items were "Feel safe in my relationships" (N = 53; 1.43%) and "Learn the steps to achieve something I want" (N = 58; 1.56%). The SWAN-OM was significantly correlated with the Experience of Service Questionnaire, particularly the item "Feel better" [rs₍₁₀₉₎ = 0.48, p < 0.001], the Youth Counseling Impact Scale, particularly the item "Learn the steps to achieve something I want" [rs₍₂₂₎ = 0.76, p < 0.001], and the Positive and Negative Affect Schedule, particularly the items "Learn how to feel better" [rs₍₂₂₎ = 0.72, p < 0.001] and "Explore how I feel" [rs₍₇₀₎ = -0.44, p < 0.001].

CONCLUSION

The SWAN-OM demonstrates good concurrent validity with common measures of outcome and experience. Analysis suggests that lesser-endorsed items may be removed in future iterations of the measure to improve functionality. Future research is required to explore SWAN-OM's potential to measure meaningful change in a range of therapeutic settings.

Perception of Nurses' Support among Family Members of Hospitalized Patients in A Tertiary Health Facility in South-West, Nigeria

Introduction

Family members of hospitalized patients are often faced with challenges and may experience difficulty in coping without appropriate support. The aim of this study was to assess hospitalized patients' family members' perception of nurses' support.

Methods

A cross-sectional descriptive design was utilized. A total of 138 family members of hospitalized patients in a tertiary health facility were selected using a purposive sampling technique. Data were collected with an adopted structured questionnaire. Analyses of data were performed using frequency, percentage, mean, standard deviation, and multiple regression. The level of significance was set at 0.05 (p < .05. Also, age, gender, and type of family were the predictors of emotional support (R2 = 84, F(6, 131) = 5.92, p < .05.

Results

Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as "Preparation," "Welcomed and wanted" and "Supervision experiences". A conceptual model of clinical placement elements conducive to nursing students' learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed.

Conclusion

A significant number of families of hospitalized patients reported poor perception of cognitive, emotional, and overall support from nurses. Adequate staffing is a prerequisite for effective family support. Nurses also need appropriate training in providing family support. The focus of family support training should emphasize practices that nurses can use in everyday interactions with patients and family members.

How we compare: A new approach to assess aspects of the comparison process for appearance-based standards and their associations with individual differences in wellbeing and personality measures

We introduce a novel approach to assess habitual comparison processes, while distinguishing between different types of comparison standards. Several comparison theories (e.g., social) suggest that self-evaluations use different standards to inform self-perception and are associated with wellbeing and personality. We developed the Comparison Standards Scale for Appearance (CSS-A) to examine self-reported engagement with social, temporal, criteria-based, dimensional, and counterfactual comparisons for upward and downward standards in relation to appearance. The scale was completed by three hundred participants online alongside measures of appearance schemas, social comparison evaluations, depression, anxiety, stress, self-esteem, physical self-concept, narcissism, and perfectionism. The CSS-A was found to reliably assess individual differences in upward and downward comparison frequency and affective impact for multiple comparison standards. In line with theory, CSS-A upward comparisons were more frequent than downward comparisons and coincided with negative (versus positive) affective impact. Comparison intensity (i.e., comparison frequency × discrepancy) predicted negative and positive affective impact for upward and downward comparisons, respectively. This relationship was partially mediated by appearance concern for upward comparisons (a composite of appearance schemas and physical self-concept), yet moderated by negativity for downward comparisons (a composite of depression, anxiety, stress, and self-esteem). We offer a framework for measuring the comparison process that warrants further research on underlying comparison processes, for which the CSS(-A) and experience sampling methods should serve as useful tools.

Cumulative lifetime stressor exposure and health in elite athletes: the moderating role of perfectionism

Although greater lifetime stressor exposure has been associated with physical and mental health issues in the general population, relatively little is known about how lifetime stressors impact the physical and mental health of elite athletes or the factors moderating this association. Given that many elite athletes show signs of perfectionism, and that this trait has been linked with ill-health, it is possible that perfectionism may moderate the lifetime stressor-health relationship. To test this possibility, we examined how cumulative lifetime stressor exposure was associated with general mental and physical health complaints in elite athletes, and the extent to which these associations were moderated by perfectionism. Participants were 110 elite athletes (64 female; M age = 29.98 years, SD = 10.54) who completed assessments of lifetime stressor exposure, physical health, psychological distress, and perfectionism. As hypothesised, hierarchical regression analyses revealed that experiencing more severe lifetime stressors was related to poorer physical and mental health. Furthermore, self-oriented perfectionism moderated the association between lifetime stressor count and severity and physical health, but not mental health. Overall, these data demonstrate stressor-specific effects among elite athletes and highlight the potential importance of assessing lifetime stressor exposure and perfectionistic tendencies in order to improve athlete health and well-being.

Empirical development and verification of career well-being scale for teachers in Taiwan: Implications for workplace counseling

As it is one decade since the establishment of Kidd's model, an analysis of the career well-being (CWB) experienced by Eastern workers is both timely and necessary. To this end, we conducted a series of logical investigations of CWB in Taiwanese school teachers. Study 1 was conducted to conceptualize the main features of CWB (n = 135), and Study 2 was conducted using exploratory factor analysis to determine the validity of a four-factor measurement structure (n = 191). In Study 3, tests were completed to confirm the factor structure of the CWB (n = 533). Accordingly, we established a theory-based CWB measurement approach, and statistical analysis verified the convergent, divergent, and criterion validity of our CWB measurement model. Exploratory structural equation modeling rather than confirmatory factor analysis is recommended in discussions of CWB theory and practice in educational contexts. However, because our sample solely comprised Taiwanese teachers, our results are not generalizable to other occupations or cultures, even Eastern or Chinese-derived cultures. Implications for both theory and workplace counseling practice are presented.

The influence of students' sense of social connectedness on prosocial behavior in higher education institutions in Guangxi, China: A perspective of perceived teachers' character teaching behavior and social support

The objective of this study is to examine the sense of social connectedness (SSC) and prosocial behavior (PB) of students in Guangxi higher education institutions in China and to further understand the factors influencing PB of higher education students. In this study, a total of 1,007 students were sampled from 8 Guangxi higher vocational schools through purposive sampling using questionnaires, of which 676 (67.1%) were male students and 331 (32.9%) were female students. This study further enriches self-determination theory by exploring the effects of teachers' character teaching behaviors and social support on PB, using the SSC as an intrinsic motivation. In addition, the results of the study revealed that SSC, perceived teacher character teaching behaviors and perceived social support (PSS) were positively related to students' PB. SSC affects PB not only directly, but also indirectly through the mediating role of perceived teacher character teaching behavior and perceived teacher support. Teacher character teaching behaviors and PSS also play a chain mediating role in the relationship between SSC and PB. Finally, this study provides strategies to optimize school character management for higher education students in order to meet their basic psychological needs and thus promote the production of PB.

Psychometric properties of the eating disorder examination questionnaire among Brazilian cisgender gay and bisexual adult men

OBJECTIVE

One of the most widely used assessment tools for disordered eating attitudes and behaviors, the Eating Disorder Examination Questionnaire (EDE-Q), has not yet been evaluated in Brazilian cisgender gay and bisexual men-an at-risk population given the extent of minority stressors in Brazilian culture. The present study aimed to assess the psychometric properties of the EDE-Q among Brazilian cisgender gay and bisexual adult men.

METHOD

The Brazilian EDE-Q was administered to a sample of 1409 gay and bisexual adult men, along with measures of self-objectification, body-ideal internalization, drive for muscularity, muscle dysmorphia symptoms, and body appreciation. The factor structure of the Brazilian EDE-Q was assessed using a two-step, split-sample exploratory (EFA; n = 704) and confirmatory factor analytic approach (CFA; n = 705). Additionally, convergent validity, internal consistency, and 2-week test-retest reliability were assessed.

RESULTS

Findings from an EFA and CFA revealed a one-factor structure with 22 items and adequate internal consistency (ω = .92, 95% CI = [.91, .93]). Moreover, the scale demonstrated good 2-week test-retest reliability (ICC = .86, 95% CI = [.82, .88], p < .001). The EDE-Q scores showed positive associations with self-objectification, body-ideal internalization, muscle dysmorphia symptoms, and drive for muscularity, as well as a negative association with body appreciation.

DISCUSSION

Results provide support for the use of the EDE-Q using a one-factor structure in Brazilian cisgender gay and bisexual adult men and give insights for future studies on eating disorders in sexual minorities in Latin America.

PUBLIC SIGNIFICANCE

The Eating Disorder Examination Questionnaire (EDE-Q) is one of the most widely used self-report measures of eating disorder symptoms. However, there is a lack of research on the validity and reliability of the EDE-Q in Latin American countries. This study evaluated the validity and reliability of the EDE-Q in Brazilian cisgender gay and bisexual adult men. Our findings give insights for future studies on eating disorders in sexual minorities in Latin America.

The development and validation of a family functioning measure for Aboriginal and Torres Strait Islander adults

Background

Family and kinship networks are a key aspect of culture for Aboriginal and Torres Strait Islander peoples from Australia. They are intrinsically connected to good health and wellbeing, and cultural knowledge exchange. However, despite the known importance of family and kinship networks in Aboriginal and Torres Strait Islander cultures, and the move towards family-centred approaches in healthcare service provision, there is no validated, national measure of family functioning for Aboriginal and Torres Strait Islander peoples. A valid tool to measure family functioning is necessary in order to better understand what fosters good family functioning, and to inform and develop programs and healthcare interventions.

Methods

Mayi Kuwayu: the National Study of Aboriginal and Torres Strait Islander Wellbeing is a longitudinal cohort study of Aboriginal and Torres Strait Islander adults aged 16 years and over. An existing family functioning scale was modified for use in the Mayi Kuwayu Study to measure family functioning at the national Aboriginal and Torres Strait Islander population level. This study used a national sample of Aboriginal and Torres Strait Islander adults (N = 8705, ≥16 years) for the psychometric assessment of the modified Mayi Kuwayu Study Family Functioning Measure. This involved face validity, acceptability, internal consistency/reliability, construct validity, and convergent and divergent validity testing.

Results

Participants in this study were 8705 Aboriginal and Torres Strait Islander peoples, with a mean age of 48 years, who primarily live in regional Australia (47.3%). The Mayi Kuwayu Family Functioning Measure demonstrated face validity for family functioning and had good internal consistency/reliability (Cronbach’s alpha > 0.90). Construct validity results were mixed, with an indication of uni-dimensionality (with one component explaining 59.5% of variance), but some item redundancy and inconsistency in responding patterns among groups of respondents. Balancing psychometric properties with Aboriginal and Torres Strait Islander expert and end-user feedback of the measure indicate that the full scale should be retained. Finally, the measure demonstrated strong convergent and divergent validity, with prevalence ratios exhibiting dose-response relationships between family functioning and conceptually related outcomes (convergent validity) and conceptually unrelated outcomes (divergent validity).

Conclusion

The Mayi Kuwayu Family Functioning Measure is a valid measure of family functioning in the Aboriginal and Torres Strait Islander adult population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14363-7.

Assessment of measurement invariance of psychometric tool for pharmaceutical sales executives: implications for social and behavioural pharmacy research

Objectives

To assess the measurement invariance quality of a short-item employee work assessment questionnaire across key subgroups of pharmaceutical executives.

Methods

A cross-sectional study with data collected using a nine-item structured questionnaire randomly administered to 406 pharmaceutical executives in Nigeria. Structural equation modelling using Analysis of Moment Structures (AMOS) version 24, and criteria for invariance were absolute change in goodness-of-fit criteria and chi-square test at P &lt; 0.05.

Key findings

Results showed gender [men (n = 293, 72%), women (n = 113, 28%)], [pharmacist (n = 117, 28.8%, non-pharmacist (n = 289, 71.2%)], company type [indigenous (n = 249, 61%), multinational (n = 157, 39%)], and industry experience [low experience; ≤10 years (n = 363, 89%), high experience: ≥10 years (n = 43, 11%)]. Model-fit and construct validity of the instrument were satisfactory. Configural, metric, scalar, and residual invariance of the instrument were confirmed across gender, professional training, and experience levels. Only configural and metric invariance were attained for company type.

Conclusions

The developed questionnaire is adequate for assessing pharmacy workforce perception across multiple demographic groups. Invariance testing and reporting are beneficial in social, administrative, and behavioural pharmacy research.

Chinese Translation and Psychometric Testing of the Simplified Version of Social Support Scale for Physical Activity

Purpose

Sallis et al’s social support scale for physical activity (SSSPH) is one of the most widely used scales to measure exercise-related social support yet has never been translated and validated in Chinese. The current study aims to simplify, translate, and validate a short form of SSSPH in a Chinese population.

Patients and Methods

A simplified Chinese version of the SSSPH (SSSPH-SC) retaining 6 items was achieved after the translation and back-translation process, which showed good content validity. The scale was then assessed among a convenience sample of 266 Chinese adults from various backgrounds. Internal consistency was tested by calculating Cronbach’s α. The a priori two-factor structure was tested with confirmatory factor analysis (CFA). Concurrent validity was examined by investigating the correlation of the SSSPH-SC with general social support, quality of life, and self-rated health.

Results

The SSSPH-SC full scale and subscales showed good internal consistency with Cronbach’s alpha ranging from 0.87 to 0.92. The CFA supported the a priori two-factor structure: family support and friend support, with χ2/df=2.93, CFI = 0.98, TLI = 0.98, RMSEA = 0.07, SRMR = 0.035. The concurrent validity of the SSSPH-CS was further supported by its significant positive correlations with social support (r=0.26, p<0.001), quality of life (r=0.25, p<0.001), and self-rated general health depression (r=0.23, p<0.001).

Conclusion

The SSSPH-SC had good reliability and validity and could be used as a simple and effective tool for assessing social support for physical activity in Chinese adults. The scale can be used as an effective tool to guide future health promotion programs as well as an evaluation tool to assess intervention effects.