Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication

Empowering precision medicine: Insights from a national survey on pharmacogenomics knowledge, attitudes, and perceptions among community pharmacists in the UAE

Background

Community pharmacists are essential to pharmacogenomics implementation because they can help trainers, clinical advisors, and other medical professionals understand the importance of pharmacogenomics and encourage them to use it in their practice. This study is to evaluate the community pharmacists' understanding, attitudes, and perceptions of pharmacogenomics in the United Arab Emirates (UAE).

Methods

Professionals employed at community pharmacies in Abu Dhabi, Dubai, and the Northern Emirates participated in a cross-sectional study design. From July 2023 to February 2024, five pharmacy students in their last year conducted the survey. The study team employed a structured questionnaire to collect data in addition to conducting in-person interviews. The study questionnaire comprised three distinct sections namely, demographic information, knowledge of pharmacogenomics concepts, and perceptions regarding pharmacogenomics.

Results

A total of 586 pharmacists enrolled in the study. The average knowledge score regarding pharmacogenomics was 75.1 % with a 95 % confidence interval (CI) of [72.4 %, 77.7 %]. The average attitude score toward pharmacogenomics was 67.5 % with a 95 % CI of [66.3 %, 68.7 %]. Better pharmacogenomics knowledge among several groups: independent pharmacies (OR 1.7; 95 % CI 1.2-2.4), Pharmacists in Charge (OR 1.4; 95 % CI 1.3-2.02), pharmacists with 11-15 years of experience (OR 2.1; 95 % CI 1.4-4.2), graduates from international universities (OR 4.6; 95 % CI 1.6-12.9), and those who received training on pharmacogenomics (OR 11.9; 95 % CI 3.3-14.5). Similarly, better attitude scores were observed among independent pharmacies (OR 1.5; 95 % CI 1.1-2.1), Pharmacists in Charge (OR 1.5; 95 % CI 1.07-2.1), pharmacists with 16-20 years of experience (OR 2.1; 95 % CI 1.16-3.7), graduates regional universities (OR 1.47; 95 % CI 1.05-2.1), and those who received training on pharmacogenomics (OR 4.8; 95 % CI 3.2-7.3).

Conclusion

The positive attitudes toward pharmacogenomics that we found in our research indicate that community pharmacists in the United Arab Emirates are beginning to realize the potential advantages of pharmacogenomics in terms of improving patient care. Policies ensuring the privacy and confidentiality of genetic information are also necessary in considering concerns about the availability of genetic test results to insurance companies and potential employers.

Knowledge, perceptions, and readiness of telepharmacy (KPR-TP) questionnaire among pharmacists: Development and psychometric evaluation

INTRODUCTION

The pandemic increased pressure on healthcare services and forced limited care in all health facilities to ensure the care of all patients. Telepharmacy appears as an alternative to the remote pharmacy practice approach through information and communication technologies, but there are no comprehensive tools to measure pharmacists' knowledge, perception, and readiness to implement telepharmacy. This study developed and validated a questionnaire version of the Knowledge, Perceptions, and Readiness of Telepharmacy (KPR-TP) for pharmacists.

METHODS

The KPR-TP assessed three domains: knowledge, perception, and readiness. Its factor structure, reliability, and validity were assessed using 7730 pharmacists from 34 Indonesian provinces. The validity of the model's three-factor structure was assessed using confirmatory factor analysis. Cronbach's alpha and composite reliability were used to validate the consistency of our factors, whereas convergent and discriminant validity established significant relationships between them.

RESULTS

The goodness-of-fit index indicated that the model was economical and reasonable. Furthermore, the correlation between the three domains revealed a significant positive relationship. KRP-TP is a viable instrument for assessing pharmacists' perceptions of telepharmacy in Indonesia.

CONCLUSION

Overall, we discovered that our questionnaire contains critical constructs for assessing a pharmacist's knowledge, perception, and level of readiness to implement telepharmacy. This study will help pharmacists identify appropriate strategies for skill improvement.

Psychometric Measurements of the Adherence to Refills and Medication Scales Among Patients With HIV/AIDS in Indonesia

OBJECTIVE

This study aimed to conduct a psychometric evaluation of the Adherence to Refills and Medications Scale (ARMS) among patients with HIV/AIDS in Indonesia.

METHODS

Psychometric analysis was conducted at 2 hospitals and 7 public health centers at the voluntary counseling and testing clinic. Content validity was measured by assessing the relevance and clarity of each ARMS item. Construct validity was also assessed. Reliability was evaluated using internal consistency and test-retest reliability.

RESULTS

This study involved 11 experts in the assessment of the content validity and 240 participants in the estimation of the construct validity. All ARMS items were generally considered easy to understand and relevant, with scale-level content validity index based on the average method (S-CVI/Ave) of 0.9 (>0.78) and item-level content validity index (I-CVI) in the range from 0.5 to 1 for the relevance level and S-CVI/Ave of 0.95 (>0.78) and I-CVI in the range from 0.8 to 1 for the clarity level. Two items (numbers 2 and 3) were revised based on experts' suggestions to enhance comprehension. Confirmatory factor analysis supported 2 subscales: adherence to taking medications and adherence to refilling prescriptions. Good reliability was supported by internal consistency (Cronbach's α 0.793) and test-retest reliability (intraclass correlation coefficient 0.722) for the overall adherence score.

CONCLUSIONS

The Indonesian version of ARMS is a valid and reliable medication adherence scale when used in Indonesian patients with HIV/AIDS.

Validity and reliability of chemical-based disinfectant use questionnaire in a sample of the Lebanese public community

INTRODUCTION

Worldwide, people heavily use chemical-based disinfectants to prevent the spread of COVID-19 with limited or no safety instructions. Awareness about the safe use of chemical-based disinfectants is highly recommended to limit the spread of COVID-19 and to avoid any health risks when misused, especially in developing countries where a poor healthcare system is prominent. Awareness in this context refers to the understanding and knowledge of proper usage, safety protocols and potential health risks associated with chemical disinfectants. Practices refer to the actual behaviours and actions taken when using disinfectants, including frequency of use, methods of application and adherence to safety guidelines.

OBJECTIVE

The purpose of this paper is to develop a valid and reliable questionnaire to assess the community level of awareness and practice concerning chemical-based disinfectant use during COVID-19 in Lebanon.

DESIGN

The questionnaire was adapted and modified from a previous study held in Iran, in which the questions were generated and developed with content validity ratio and index (CVR and CVI). The study design was divided into the qualitative phase/development of the Disinfectants Use Questionnaire (DUQ) and the quantitative phase/psychometric properties of the DUQ. The questionnaire was subjected to face and content validity tests through expert reviews. Data validation, for 130 participants (80.8% females, 85.5% bachelor's degree and above, 80.8% students and 70.8% aged within 30 years), was examined through psychometric properties at the final stage of the validation. CVI for items (I-CVI), scale-level CVI (S-CVI), universal agreement calculation (S-CVI/UA), S-CVI and the average calculation method (S-CVI/Ave), based on I-CVI and based on proportion relevance, were calculated to determine the content validity.

RESULTS

23 items of the 28-item scale had an I-CVI of 1, and the I-CVI of the remaining five ranged between 0.75 and 0.88. The S-CVI/UA was 0.82 and the S-CVI/Ave was 0.96, which meant that the items were good for the underlying construct. For the psychometric measures, principal axis factoring was performed and the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy, Bartlett's test, eigenvalues and total variances were quite accepted and satisfactory.

CONCLUSION

This study showed that DUQ is a valid and reliable tool for evaluating the community level of awareness and practice concerning chemical-based disinfectant use during COVID-19.

Management of low-level HIV viremia during antiretroviral therapy: Delphi consensus statement and appraisal of the evidence

OBJECTIVE

While antiretroviral therapy (ART) is highly effective, detection of low levels of HIV-1 RNA in plasma is common in treated individuals. Given the uncertainties on the topic, we convened a panel of experts to consider different clinical scenarios, producing a Delphi consensus to help guide clinical practice.

METHODS

A panel of 17 experts in infectious diseases, virology and immunology rated 32 statements related to four distinct scenarios: (1) low-level viremia during stable (≥6 months) first-line ART (≥2 consecutive HIV-1 RNA measurements 50-500 copies/mL); (2) a viral blip during otherwise suppressive ART (a HIV-1 RNA measurement 50-1000 copies/mL with adjacent measurements <50 copies/mL); (3) low-level viral rebound during previously suppressive ART (≥2 consecutive HIV-1 RNA measurements 50-500 copies/mL); (4) residual viremia during suppressive ART (persistent HIV-1 RNA quantification below 50 copies/mL). A systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement, informed the 32 statements. The Delphi procedure was modified to include two voting rounds separated by a moderated group discussion. Grading of Recommendations, Assessment, Development, and Evaluations-based recommendations were developed.

RESULTS

Overall, 18/32 statements (56.2%) achieved a strong consensus, 3/32 (9.4%) achieved a moderate consensus and 11/32 (34.4%) did not achieve a consensus. Across the four scenarios, the panel unanimously emphasised the importance of implementing specific interventions prior to considering therapy changes, including assessing adherence, testing for genotypic drug resistance and scheduling more frequent follow-up visits. Strategies indicated in selected circumstances included therapeutic drug monitoring, quantifying total HIV-1 DNA and evaluating concomitant chronic infections.

CONCLUSIONS

While acknowledging the many uncertainties about source, significance and optimal management of low-level viremia during ART, the findings provide insights to help harmonise clinical practice. There is a need for well-designed randomised studies assessing different interventions to manage low-level viremia and future research regarding its definition.

Cross-cultural adaptation of the Thai Xerostomia Inventory and Summated Xerostomia Inventory

OBJECTIVE

To cross-culturally adapt and validate the Thai version of the Xerostomia Inventory (XI) and Summated Xerostomia Inventory (SXI) for subjective evaluation of oral dryness in Thai middle-aged and older adults.

METHODS

The original English versions of the XI and SXI were cross-culturally translated into Thai. Content validity was examined by the expert panel and 30 pilot subjects. The XI/SXI-Thai were then administered to 200 Thai adults (aged 50 years or older) for further assessment of psychometric properties. The standard question, the Bother Index, and the Xerostomia Questionnaire were used as comparator instruments for the evaluation of criterion and construct validity, respectively. Internal consistency reliability was assessed using Cronbach's alpha.

RESULTS

The final XI/SXI-Thai were found to have good content validity. Both scales were able to distinguish between xerostomia and non-xerostomia groups. We observed moderate to strong correlation between the XI/SXI-Thai and other comparator instruments, reflecting good criterion and construct validity. Cronbach's alpha values were 0.875 and 0.847 for the XI-Thai and SXI-Thai, respectively.

CONCLUSIONS

The XI-Thai and SXI-Thai were found to be valid, reliable, and easily administrable instruments for xerostomia assessment in Thai middle-aged and older individuals in both clinical and research settings.

Practice recommendations for culturally sensitive communication at the end of life in intensive care: A modified eDelphi study

BACKGROUND

Clinicians need specific knowledge and skills to effectively communicate with patients and their family when a patient is dying in the ICU. End-of-life communication is compounded by language differences and diverse cultural and religious beliefs.

AIM

The aim was to develop and evaluate practice recommendations for culturally sensitive communication at the end of life.

METHOD

Modified two-round eDelphi study. An Australian national sample of 58 expert ICU clinicians of nursing and medical backgrounds participated in an online survey to rate the relevance of 13 practice recommendations. Ten clinicians participated in a subsequent expert panel interview to provide face validity and comprehensive details about the practical context of the recommendations. Survey data were analysed using descriptive statistics, interview data using deductive content analysis.

RESULTS

All 13 practice recommendations achieved item content validity index (I-CVI) above 0.8, and scale content validity index (S-CVI) of 0.95, indicating sufficient consensus. Recommendations prioritising use of professional interpreters and nurse involvement in family meetings achieved near perfect agreement amongst participants. Recommendations to facilitate family in undertaking cultural, spiritual and religious rituals and customs, advocate for family participation in treatment limitation discussions, and clinician access to professional development opportunities about culturally sensitive communication also achieved high level consensus.

CONCLUSION

These practice recommendations provide guidance for ICU clinicians in their communication with patients and families from culturally diverse backgrounds.

IMPLICATIONS FOR CLINICAL PRACTICE

Clinicians want practice recommendations that are understandable and broadly applicable across diverse ICU contexts. The high consensus scores confirm these practice recommendations are relevant and feasible to clinicians who provide end-of-life care for patients and their family members. The recommendations also provide clear guidance for ICU leaders, managers and organisational policy makers.

Development and validation of assessment instruments for cervical collar and spinal board placement in simulated environments for nursing students in the care of polytrauma patients

BACKGROUND

Multiple trauma injuries are the leading cause of death and disability in people under the age of 45 and require prompt and specialised care. However, medical and nursing education programmes do not always include specific training in emergency pre-hospital care, resulting in a lack of basic practical skills in trauma management.

OBJECTIVE

To develop and validate two instruments for assessing nursing students' competence in cervical collar and spinal board application in simulated pre-hospital emergency scenarios.

METHOD

This is an instrumental study that involves the development of two assessment instruments and the evaluation of their psychometric properties in a sample of 392 nursing students. Content validity was assessed using expert judgement, by calculating the content validity ratio (CVR) for each item and the scale level content validity index average (S-CVI/Ave) for the instruments. Exploratory factor analysis using the MINRES extraction method and Promax rotation was performed to analyse the performance of the items and structure of the rubrics. Internal consistency was analysed using the Omega coefficient and inter-rater agreement was assessed using Cohen's Kappa coefficient.

RESULTS

Initially, two rubrics were obtained: one with six items for cervical collar placement (S-CVI/Ave = 0.86) and one with nine items for spinal board placement (S-CVI/Ave = 0.81). Both had a single-factor structure, with all items having factor loadings greater than 0.34 for the cervical collar rubric and 0.56 for the spinal board rubric, except for item 2 of the cervical collar rubric (λ = 0.24), which was subsequently removed. The final cervical collar rubric (five items) had an overall internal consistency of 0.84 and the spinal board rubric had an overall internal consistency of 0.90, calculated using the Omega statistic. The weighted Kappa coefficient for each item ranged from acceptable (0.32) to substantial (0.79). These results show that we have successfully developed two sufficiently valid instruments to assess the immobilisation competencies proposed in the objective of the study.

CONCLUSION

Whilst further research is needed to fully establish their psychometric properties, these instruments offer a valuable starting point for evaluating nursing students' competence in cervical collar and spinal board application in simulated pre-hospital scenarios.

Development and validation of a knowledge, attitude, and practice questionnaire regarding exercise and exergames for obese patients with gout

The Knowledge-Attitude-Practice (KAP) Questionnaire could help investigate whether there are misconceptions, positive attitudes, and adequate practice in people with gout about exercise and exergames. The study aims to develop and validate the KAP questionnaire regarding exercise and exergames for obese patients with gout to understand gout 'patients' awareness level of exercise and perception of exergames. The development and validation of the questionnaire involved two phases: (1) development of the instrument and (2) judgment of the instrument through calculating the content validity by the expert panel and using SPSS version 28 to examine the test-retest reliability, internal consistency, and structural validity of the instrument. After the first phase of instrument development, an initial questionnaire consisting of six parts with 35 items was identified. After the content validation of the second phase, 11 items with a content validity ratio (CVR) value below 0.99 were eliminated, 3 items were rephrased, 2 items that mixed two statements were divided, and 15 items were added based on the original instrument. In addition, in the factor analysis, five items within the knowledge domain with factor loadings below 0.4 were removed. The final questionnaire was examined and demonstrated acceptable content validity, test-retest reliability, internal consistency, and construct validity.

Development of knowledge, attitude and practice questionnaires on e-Huffaz ProHealth, a multicomponent lifestyle intervention module among Tahfiz students

e-Huffaz ProHealth is a lifestyle intervention module developed specifically for Tahfiz students. The e-Huffaz ProHealth consists of physical health, nutritional and psychological components. This study aimed to develop the knowledge, attitude and practice (KAP) questionnaires on e-Huffaz ProHealth among Tahfiz students. This cross-sectional pilot study was conducted in 2022. The first phase entailed developing the KAP questionnaires. The second phase involved determining the content validity and face validity. While the third phase involved evaluating the reliability. A total of six experts from public academic institutions participated in the initial evaluation stage to assess validity while five experts were involved in the second stage. Thirty-three and 41 respondents were involved for the face validity and reliability evaluation, respectively. The questionnaires were distributed via Google Docs and hard copies were handed out in person to Tahfiz school teachers and students at Madrasah Tahfiz Al-Amani and Pondok Moden Tahfiz Saadah Addaarain. The findings demonstrated that the Item Content Validity Index (I-CVI) for the three components of the KAP questionnaires at the second stage of evaluation was high (1.0). The scores for the Scale Face Validity Average Index (S-FVI/Average) in assessing the level of clarity and understanding for the three components were 0.89 and 0.88, 0.92 and 0.90, and 0.88 and 0.9, respectively. Meanwhile, the reliability of KAP for physical activity was moderate (0.43), very high (0.91) and high (0.7), respectively. For nutrition, the reliability of KAP was good and acceptable with the values of 0.63, 0.83 and 0.65, respectively. The results of reliability of KAP for psychological well-being was good with the values of 0.54, 0.56 and 0.84, respectively. The KAP questionnaires of e-Huffaz ProHealth was successfully developed with high content validity, good face validity and acceptable reliability. Hence, it can be used for future study to evaluate the effectiveness of e-Huffaz ProHealth among Tahfiz students.

Development and Validation of an Evaluation Questionnaire for the Healthy Early Life Moments in Singapore (HELMS) Program

BACKGROUND/OBJECTIVES

Global fertility rates are declining due to metabolic and mental health challenges in women trying to conceive. The Healthy Early Life Moments in Singapore (HELMS) program aims to address these challenges through mobile health (mHealth)-enabled lifestyle interventions. However, the lack of validated evaluation tools for such programs makes it difficult to assess their feasibility and acceptability. To tackle this, a comprehensive evaluation questionnaire was developed and validated to determine if the HELMS preconception program's implementation outcomes were achieved.

METHODS

The questionnaire development process included a literature review and a two-step validation process: content validation by five content experts and face validation by 20 HELMS participants. Content validation was assessed using the scale content validity index (S-CVI) based on relevance, clarity, simplicity, and ambiguity. Face validation with participants evaluated these criteria and the ease of completing the questionnaire. Internal consistency was assessed using Cronbach's alpha among 49 participants.

RESULTS

The questionnaire achieved good S-CVI values for relevance (0.93), clarity (0.91), simplicity (0.94), and ambiguity (0.71). After expert feedback, the revised version scored highly among HELMS participants for relevance (100%), clarity (95%), simplicity (95%), and non-ambiguity (90%). A Cronbach's alpha of 0.93 indicated good internal consistency.

CONCLUSION

The HELMS evaluation questionnaire shows promise for evaluating similar mHealth-based lifestyle intervention programs globally.

Design and Psychometric Evaluation of Nurses' Mobile Health Device Acceptance Scale (NMHDA-Scale): Application of the Expectation-Confirmation Theory

BACKGROUND

The use of mobile tools in nursing care is indispensable. Given the importance of nurses' acceptance of these tools in delivering effective care, this issue requires greater attention.

OBJECTIVE

This study aims to design the Mobile Health Tool Acceptance Scale for Nurses based on the Expectation-Confirmation Theory and to evaluate it psychometrically.

METHODS

Using a Waltz-based approach grounded in existing tools and the constructs of the Expectation-Confirmation Theory, the initial version of the scale was designed and evaluated for face and content validity. Construct validity was examined through exploratory factor analysis, concurrent validity, and known-group comparison. Reliability was assessed using measures of internal consistency and stability.

RESULTS

The initial version of the scale consisted of 33 items. During the qualitative and quantitative content validity stage, 1 item was added and 1 item was removed. Exploratory factor analysis, retaining 33 items, identified 5 factors that explained 70.53% of the variance. A significant positive correlation was found between the scores of the designed tool and nurses' attitudes toward using mobile-based apps in nursing care (r=0.655, P<.001). The intraclass correlation coefficient, Cronbach α, and ω coefficient were 0.938, 0.953, and 0.907, respectively.

CONCLUSIONS

The 33-item scale developed is a valid and reliable instrument for measuring nurses' acceptance of mobile health tools.

Development of self-administered questionnaire on barriers, prescription practices, and guideline adherence of osteoporosis management among tertiary care clinicians: content validity and reliability analysis

Objective

This study outlined the development of the barriers, prescribing practices, and guideline adherence for osteoporosis management according to the Clinicians' Osteoporosis Questionnaire (COQ) followed by an assessment of the content validity index and reliability test.

Methods

The development of the COQ was performed in two stages. Stage I involved the development of the COQ, and stage II involved judgmental evidence and quantification of the questionnaire. Five panel experts related to the study area and five clinicians participated in the validity of the COQ assessment. Fifty clinicians took part in the reliability test evaluation by filling out the questionnaire twice at 2-week intervals. The content validity index (CVI) and content validity ratio (CVR) were analyzed using Microsoft Excel, while Cohen's kappa statistic was used to determine the test-retest reliability using SPSS version 29.

Results

Forty items and three domains, namely, barriers, prescribing practices, and guideline adherence for osteoporosis management, were identified in the COQ (version 4.0). The scale-level CVI (S-CVI/Ave) for every domain was above 0.9, which is considered acceptable. The CVRs for all the items were above 0.7, except for two items in the barrier domain and two items in the guideline adherence domain. Two items were revised to improve the clarity of the item, and other items were retained based on consensus among the expert panel. Between the test and retest, the reliability of individual items ranged from moderate to almost perfect for the barrier domain (k = 0.42-0.86), prescribing practice domain (k = 0.79-0.87), and guideline adherence domain (k = 0.46-1). None of the items had "fair" or "poor" agreement. Thus, the 40-item COQ (version 4.0) was finalized following the content and face validity analysis.

Conclusions

Through an iterative process, the development and assessment of the COQ showed a high degree of content validity and reliability in measuring the barriers, prescribing practices, and guideline adherence among clinicians managing osteoporosis. Future studies should aim to further validate this instrument across different populations and settings, as well as explore methods to enhance its reliability and validity.

Development and validation of the intention to use the ICD-11 questionnaire in the Malaysian medical records context

As health systems transition to ICD-11, it is essential to gauge the readiness and improve existing transition efforts. Assessing the intention to use ICD-11 and factors influencing it is imperative to encourage the use of ICD-11 among the medical record officers (MROs) and assistant medical record officers (AMROs). This study aims to develop and validate a questionnaire on the factors influencing the intention to use ICD-11 among MROs and AMROs in the Ministry of Health, Malaysia. This study comprised a questionnaire development and validation involving 292 participants nationwide from Ministry of Health Malaysia facilities. The questionnaire was developed based on items adapted from the literature. Forward and backward English-Malay translation was done. Then, the questionnaire was examined for content validity, internal consistency reliability, construct validity, face validity, convergent validity, discriminant validity and confirmatory factor analyses. The final version of the questionnaire consists of eleven domains represented by 50 items. The content validity index and modified kappa were excellent for all domains. The Kaiser-Meyer-Olkin sampling adequacy value was appropriate, with a value of 0.790. The questionnaire also demonstrated good internal consistency reliability with Cronbach's alpha values between 0.850 and 0.992. Confirmatory factor analysis showed a reasonable fit for this eleven-factor model. In conclusion, this questionnaire provides a reliable tool for investigating the intention to use ICD-11 among MROs and AMROs. Positive findings from the psychometric properties support the validity of the questionnaire. This instrument can potentially support personnel in charge of ICD codification, guide the ICD-11 transition at various levels and facilitate research on support dynamics among the MROs and AMROs.

Construction and Initial Examination of Inter-Rater Reliability of a Structured Clinical Interview for DSM-5-TR Sleep Disorders (SCISD) - Kid

STUDY OBJECTIVES

To construct and evaluate the inter-rater reliability of the Structured Clinical Interview for DSM-5-TR Sleep Disorders - Kid (SCISD-Kid).

METHOD

The SCISD-Kid was modeled on the adult SCISD-R and accounted for pediatric developmental and sociocultural factors. Fifty sleep-disturbed children (Mage = 11.9, SD = 2.9) and 50 caregivers responded to the final SCISD-Kid. Video recordings were double-scored to evaluate inter-rater reliability.

RESULTS

The final SCISD-Kid contained approximately 90 questions. Eight of the nine covered disorders had prevalence rates sufficient for analyses for both samples (i.e., k > 2). Inter-rater reliability was examined using Cohen kappa coefficients (κ); reliability estimates ranged from excellent to good. For youth, restless legs syndrome yielded the lowest reliability (.48), while nightmare disorder, narcolepsy, and NREM sleep arousal disorder - sleepwalking type showed the highest reliability (1.00). Across caregivers, NREM sleep arousal disorder - sleep terror type (.49) and hypersomnolence (.54) had the lowest reliability. In contrast, circadian rhythm - delayed sleep phase type, nightmare disorder, and NREM sleep arousal disorder - sleepwalking type showed the highest reliability (1.00).

CONCLUSIONS

The SCISD-Kid is a promising tool for screening sleep disorders. It showed good to excellent reliability across both samples. Next steps for validation will be discussed.

Multidimensional frailty assessment: Development and validation of the Tilburg Frailty Indicator-Indonesia version

The aim of this study was to develop and examine the psychometric properties of the Tilburg Frailty Indicator-Indonesian version (TFI-I). 308 community-dwelling older adults aged ≥60 years participated. The TFI-I exhibited favorable internal consistency (Cronbach's alpha = 0.775) and test-retest reliability (intraclass correlation coefficient = 0.94). The physical, psychological, and social domains of the TFI-I correlated closely with the similar constructs of other scales, including the Short Physical Performance Battery (P < .001), Fried Frailty Phenotype (P < 0.001), Geriatric Depression Scale (P < .001), and the World Health Organization Quality of Life scale (P = 0.041), indicating its favorable construct validity. Significant differences were identified between the robust and frailty groups on the Barthel Index (P = .001) and Lawton Instrumental Activity of Daily Living Scale (P < .001). Overall, the TFI-I is valid and reliable when used to evaluate frailty status in clinical and research settings.

Development and preliminary validation of a questionnaire on the care needs of family carers of older individuals with disabilities in China: a mixed methods study

BACKGROUND

Ensuring the wellness of older individuals with disabilities requires prioritising the care needs of their carers. However, current practice lacks validated tools to measure the needs of carers in home environments. Thus, this study aimed to create and test a questionnaire on the care needs of family carers of older people with disabilities in China.

METHODS

We used a standard development process to generate the questionnaire. The pilot testing included cognitive interviews to ensure interpretation as intended. Furthermore, we used a cross-sectional study method to conveniently select 640 Chinese family carers of older people with disabilities from August 1, 2022, to June 11, 2023, for face-to-face investigation. Exploratory factor analysis (EFA) aided in project reduction and factor estimation, with 30 participants undergoing retest evaluations every two weeks. Confirmatory factor analysis (CFA) assessed the model's structural validity, while internal consistency and retest reliability validated its accuracy.

RESULTS

These tests established the model: content validity, item analysis and EFA. Six factors extracted from the initial analysis explained 62.891% of the observation variance. CFA showed good model fit, and the questionnaire had good reliability and validity. The final questionnaire included 21 items focusing on six dimensions: care assistance (three items), care environment (three items), care information (three items), formal support (four items), care ability (six items) and self-development (two items).

CONCLUSION

The care needs questionnaire effectively evaluates the needs of family carers in their caring activities.

Knowledge and practices of plagiarism among journal editors of Nepal

BACKGROUND

This study was conducted to assess the knowledge and ongoing practices of plagiarism among the journal editors of Nepal.

METHODS

This web-based questionnaire analytical cross-sectional was conducted among journal editors working across various journals in Nepal. All journal editors from NepJOL-indexed journals in Nepal who provided e-consent were included in the study using a convenience sampling technique. A final set of questionnaires was prepared using Google Forms, including six knowledge questions, three practice questions (with subsets) for authors, and four (with subsets) for editors. These were distributed to journal editors in Nepal via email, Facebook Messenger, Viber, and WhatsApp. Reminders were sent weekly, up to three times. Data analysis was done in R software. Frequencies and percentages were calculated for the demographic variables, correct responses regarding knowledge, and practices related to plagiarism. Independent t-test and one-way ANOVA were used to compare mean knowledge with demographic variables. For all tests, statistical significance was set at p < 0.05.

RESULTS

A total of 147 participants completed the survey.The mean age of the participants was found to be 43.61 ± 8.91 years. Nearly all participants were aware of plagiarism, and most had heard of both Turnitin and iThenticate. Slightly more than three-fourths correctly identified that citation and referencing can avoid plagiarism. The overall mean knowledge score was 5.32 ± 0.99, with no significant differences across demographic variables. As authors, 4% admitted to copying sections of others' work without acknowledgment and reusing their own published work without proper citations. Just over one-fifth did not use plagiarism detection software when writing research articles. Fewer than half reported that their journals used authentic plagiarism detection software. Four-fifths of them suspected plagiarism in the manuscripts assigned through their journal. Three out of every five participants reported the plagiarism used in the manuscript to the respective authors. Nearly all participants believe every journal must have plagiarism-detection software.

CONCLUSIONS

Although journal editors' knowledge and practices regarding plagiarism appear to be high, they are still not satisfactory. It is strongly recommended to use authentic plagiarism detection software by the journals and editors should be adequately trained and update their knowledge about it.

Development and Psychometric Validation of Population-Based Knowledge Attitudes and Practices-Questionnaire on Fluoride (PBKAP-QF)

Fluoride exposure is a global public health concern. Understanding the knowledge, attitudes, and practices (KAP) of affected populations is essential for effective community management. This study aimed to develop and validate a KAP questionnaire to assess fluoride and its risk in general population. An extensive literature review and focus group discussions were conducted to construct the questionnaire. Content validity was assessed using the Content Validity Index (CVI) based on expert feedback. Factor analysis was performed for final tool validation, and item characteristics were analyzed using IBM SPSS v. 27 and IBM AMOS v. 26. A total of 300 responses were collected. Initially, 41 items were included in the questionnaire, which were reduced to 25 after expert review. The final version included 19 items, with an I-CVI ranging from 0.80 to 1.00, indicating no issues with item difficulty or discrimination. Cronbach's alpha ranged from 0.88 to 0.90, demonstrating good internal consistency. The Kaiser-Meyer-Olkin (KMO) value was 0.848, and Bartlett's test (χ2 = 6860.978, df = 156, p < 0.01) confirmed data suitability for factor analysis. Three constructs were extracted with factor loadings greater than 0.5. Confirmatory factor analysis demonstrated a good model fit. This study developed and validated a robust 19-item KAP questionnaire for assessing knowledge, attitudes, and practices related to fluoride exposure. The tool demonstrated excellent reliability, validity, and internal consistency, supporting its use in guiding effective community-level management and public health interventions in fluoride-endemic areas.

Exploring physical therapists' approach to addressing home exercise program-related low self-efficacy: knowledge, strategies, and barriers

PURPOSE

Self-efficacy is the strongest predictor of completing home exercise programs (HEPs). How physical therapists address low levels of self-efficacy is unknown. Our objectives were to determine (1) knowledge and confidence in addressing patients' self-efficacy; (2) strategies used to address low self-efficacy; and (3) barriers.

MATERIAL AND METHODS

Licensed physical therapists who are actively treating patients in the United States participated in our mixed-methods study consisting of: (1) a survey on knowledge, barriers, and confidence; and (2) interviews on strategies used to address low self-efficacy. Descriptive statistics were calculated on all quantitative data. Braun and Clarke's 6-phase thematic analysis was used for the qualitative data.

RESULTS

All 37 participants believed that self-efficacy impacts HEP completion. The majority (72.9%) reported addressing low self-efficacy. Barriers that impacted the ability to address low self-efficacy (Theme 1) included lack of knowledge, confidence, tools, guidance, and community resources, patients' past experiences and complexities, inability to follow-up with patients, and reimbursement. Due to these barriers, participants primarily addressed patients' low self-efficacy via communication (Theme 2) and ensuring successful exercise completion (Theme 3).

CONCLUSION

Instead of using Bandura's fours sources of self-efficacy (i.e., mastery experiences, verbal persuasion, vicarious experiences, physiological state), participants verbalized addressing low self-efficacy via communication and successful exercise completion. Thus, implementation studies evaluating strategies to overcome the identified barriers are needed.

Face and content validity of a holistic assessment questionnaire to assess cancer-related fatigue after breast cancer

Background and objective

Cancer-related fatigue (CRF) affects the quality of life after breast cancer. In a previous study, we developed a 72-item questionnaire that assesses CRF from a holistic point of view; named the Holistic Assessment of CRF (HA-CRF) questionnaire. The current study assessed the face and content validity of the HA-CRF questionnaire.

Methods

Using a mixed-method approach, ten breast cancer survivors (BCS) did a cognitive walkthrough of the HA-CRF via an app followed by a semi-structured interview about relevancy and essentiality (qualitative). In addition, ten health care professionals (HCPs) assessed the relevancy, clarity, and essentiality of each item via a questionnaire (quantitative).

Results

BCS indicated minor textual improvement for four items and six items were not completely clear. The app was considered easy to use and the HC-CRF was on average completed in 18 minutes. The HA-CRF questionnaire provided openness about fatigue and gave the feeling of being heard. The items were helpful and induced self-awareness. HCPs indicated 71% of items being very clear or minor revisions proposed by the minority, with 64% of items being essential and 92% considered relevant.

Conclusions

The HA-CRF showed good face and excellent content validity. Further research is needed to assess its ability to monitor in daily life.

The Content Validity of an Instrument That Measures Health-Seeking Behavior for Tuberculosis among People Living with HIV in India

Determinants of health-seeking behavior among people living with HIV (PLHIV) are important. This study aims to develop and assess the content validity of an instrument that measures health-seeking behavior for tuberculosis among PLHIV in India. An instrument was developed using deductive methods and the Modified Andersen's Behavioral Model of Health Services (BMHS). We identified three domains using the BMHS. Ten subject experts validated the tool between June 2022 and August 2022. Lawshe's Content Validity Ratios (CVRs) and Scale Content Validity Indices (CVIs) were computed. The items with CVR and CVI values ≥0.62 were considered for the final tool. The health-seeking behavior among PLHIV, based on the BMHS, identified knowledge regarding TB (domain 1), healthcare accessibility and factors leading to delay in treatment-seeking behavior (domain 2), and client satisfaction regarding diagnostic and treatment-seeking behavior (domain 3). Content Validity Ratios (CVRs) of all the items related to domains 1 and 2 were ≥0.62. The Scale Content Validity Indices (for relevance), i.e., S-CVI (average) and S-CVI (proportional relevance), were ≥0.62 for all domains. The items with CVR and CVI values ≥0.62 in the domains were accepted in the final tool, which contained 69 items.

Development and validation of the Oral Lichen Planus-Disease Activity Scale: a novel tool for comprehensive clinical assessment

OBJECTIVE

To develop and validate the Oral Lichen Planus-Disease Activity Scale (OLP-DAS) for assessing overall disease activity of OLP.

METHODS

The OLP-DAS was created by refining the Thongprasom criteria, incorporating inputs from the literature and expert review, and integrating pain assessment. Content validity was evaluated in a virtual meeting with 8 Oral Medicine specialists. Reliability and validity of the final version were examined. Seventeen OLP subjects were assessed for disease activity by 10 investigators using the OLP-DAS, Oral Disease Severity Score (ODSS), OLP-Investigator Global Assessment (OLP-IGA), and Reticular-Erythema-Ulcerative (REU) scale. Convergent validity was assessed by rating 160 OLP subjects using the OLP-DAS, ODSS, and OLP-IGA. Inter-rater and intra-rater reliability, along with convergent validity, were analyzed using intraclass correlation coefficients (ICCs) and Spearman's rank correlation coefficients (rs).

RESULTS

The final OLP-DAS achieved excellent content validity indices. Inter-rater and intra-rater ICCs for total OLP-DAS scores were 0.93 and 0.96, respectively. Total OLP-DAS scores exhibited strong positive correlations with the ODSS and OLP-IGA (rs = 0.94 and rs = 0.76; P < 0.001, respectively). The OLP Severity Index (OLP-SI), a component of the OLP-DAS, showed very strong positive correlations with OLP disease activity parameters of the ODSS (rs = 0.90; P < 0.001).

CONCLUSIONS

The OLP-DAS is a valid and reliable clinician-reported outcome measure (CROM) for evaluating OLP disease activity.

CLINICAL RELEVANCE

The OLP-DAS, as a standardized CROM for OLP, is valuable for both routine clinical assessments and research applications.

The relationship between fear of COVID-19 and adherence to personal protective measures in a sample of Iranian healthcare providers: a cross-sectional study

BACKGROUND

Studies have been conducted worldwide to investigate the level of adherence to personal protective measures or fear of COVID-19 among healthcare providers. However, few studies have examined the relationship between adherence to personal protective measures and fear of COVID-19. There is also a need for more information on this topic from Iran. This study investigated the relationship between adherence to personal protective measures against COVID-19 and fear of COVID-19 in the healthcare providers at Pastor Hospital of Bam, Iran, in 2022.

METHODS

This cross-sectional study was conducted in August and September 2022 with 199 healthcare providers of Pastor Hospital of Bam, Iran. The study included medical, nursing, and paramedical staff at Pastor Hospital at the time of the study. Incomplete responses and failure to return the questionnaire to the researcher were exclusion criteria. The fear of COVID-19 scale and a checklist of personal protective measures were used to collect data. Descriptive statistics, t-tests, analysis of variance, and Pearson's correlation coefficient were used to analyze the data.

RESULTS

Of the 199 participants, 67.3% were female, and their mean age was 31 ± 4.55 years. The mean score for adherence to personal protective measures was 14.46 ± 3.39 (out of 23), and the mean score for fear of COVID-19 was 17.04 ± 4.58 (out of 35). Adherence to personal protective measures was higher among females than males (14.96 ± 2.99 vs. 13.43 ± 3.92, p = 0.003), in individuals who had attended infection control courses than in those who had not (15.57 ± 2.88 vs. 13.30 ± 3.50, p < 0.001), and in those working in intensive care units than those in other wards (p = 0.009). A positive correlation was found between fear of COVID-19 and adherence to personal protective measures (r = 0.16, p = 0.03).

CONCLUSIONS

Healthcare providers demonstrated average levels of adherence to the personal protective measures and fear of COVID-19. Fear scores were also positively correlated with adherence scores. Specific workshops are necessary to familiarize all healthcare workers with personal protective measures against COVID-19 and universal precautions.

Construction and validation of a scale to assess knowledge, attitude, and practice regarding vascular protection anticipatory to the creation of an arteriovenous fistula

BACKGROUND

The possibility of creating an arteriovenous fistula (AVF) depends on the existence of an arterial-venous network that is in good condition, defined by the size and elasticity of the blood vessels. The knowledge, attitudes, and practices (KAP) toward vascular protection play a crucial role in preserving the vascular network for patients with end-stage renal disease (ESRD), it is observed that there is a significant lack of tools to measure these variables. Thus, the aim of this study is to develop and validate a scale to assess KAP regarding vascular protection anticipatory to the creation of an arteriovenous fistula (the KAP-VPAC-AVF Scale).

METHODS

Initial item development was guided by a literature review and clinical experience, after which the items were improved and perfected through the Delphi process. The content of the scale was judged by an expert panel for content validity. In a convenience sample of 551 patients with ESRD, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to examine the instrument's factor structure.

RESULTS

The KAP-VPAC-AVF Scale encompasses 11 items distributed over three factors: knowledge, attitude, and practice, demonstrated excellent internal consistency (Cronbach's alpha = 0.917) and construct validity, as confirmed by CFA with satisfactory fit indices (χ2/df = 2.394, RMSEA = 0.075, RMR = 0.049, CFI = 0.969, GFI = 0.936, AGFI = 0.892, TLI = 0.957, IFI = 0.970).

CONCLUSION

The KAP-VPAC-AVF Scale is a scientific and effective assessment tool that can evaluate the KAP of ESRD patients regarding measures to preserve the vascular network.

Crossing horizons: unraveling perspectives on enhancing medical students' success through at-risk factor exploration

BACKGROUND

Medical universities often face the ongoing challenge of identifying and supporting at-risk students to enhance retention rates and academic success. This study explores a comprehensive analysis of perceived at-risk factors impeding academic and career aspirations and compares the perspectives of students and faculty in a medical school.

METHODS

We focused on first and second-year medical (MBBS) students and teaching faculty in an international medical college offering a twinning program in India and Malaysia. Our investigation involved a comprehensive assessment of 25 at-risk factors through Likert-type questionnaires distributed to 250 MBBS students and 50 teaching faculty.

RESULTS

Our findings revealed distinct disparities in perceptions between faculty and students regarding mean scores of classroom engagement (p = 0.017), procrastination (p = 0.001), unrealistic goals (p = 0.026), emotional/behavioral problems (p = 0.008), limited key social skills (p = 0.023), and a non-supportive home environment (p = 0.001). These differences underscore the need for increased communication and understanding between faculty and students to address these risk factors effectively. In contrast, no significant disparities were observed among faculty and students' perceptions concerning mean scores of various potential at-risk factors, including academic unpreparedness, cultural/language barriers, individual guidance/mentoring, limited communication skills, racism/sexism, self-confidence, self-respect, self-concept, motivation, underprepared for current academic challenges, self-discipline, negative social network, negative peer culture, transportation time, college financial cost, college evaluation culture bias, broken college relationships, teaching methodology, and learning disabilities. However, varying degrees of influence were perceived by faculty and students, suggesting the importance of individualized support.

CONCLUSION

This study contributes to the academic community by shedding light on the multifaceted nature of at-risk factors influencing student success. It underscores the need for proactive measures and tailored interventions to enhance student retention in higher education and academic achievement, fostering a sustainable foundation for lifelong learning and growth.

Cadaveric Biomechanical Laboratory Research Can Be Quantitatively Scored for Quality With the Biomechanics Objective Basic Science Quality Assessment Tool: The BOBQAT Score

PURPOSE

To develop a quality appraisal tool for the assessment of cadaveric biomechanical laboratory and other basic science biomechanical studies.

METHODS

For item identification and development, a systematic review of the literature was performed. The content validity index (CVI) was used either to include or exclude items. The content validity ratio (CVR) was used to determine content validity. Weighting was performed by each panel member; the final weight was either up- or downgraded to the closest of 5% or 10%. Face validity was scored on a Likert scale ranked from 1 to 7. Test-retest reliability was determined using the Fleiss kappa coefficient. Internal consistency was assessed with Cronbach's alpha. Concurrent criterion validity was assessed against the Quality Appraisal for Cadaveric Studies scale.

RESULTS

The final Biomechanics Objective Basic science Quality Assessment Tool (BOBQAT) score included 15 items and was shown to be valid, reliable, and consistent. Five items had a CVI of 1.0; 10 items had a CVI of 0.875. For weighting, 5 items received a weight of 10%, and 10 items a weight of 5%. CVR was 1.0 for 6 items and 0.75 for 9 items. For face validity, all items achieved a score above 5. For test-retest reliability, almost-perfect test-retest reliability was observed for 10 items, substantial agreement for 4 items, and moderate agreement for 1 item. For internal consistency, Cronbach's alpha was calculated to be 0.71. For concurrent criterion validity, Pearson's product-moment correlation was 0.56 (95% confidence interval [CI] = 0.38-0.70, P = .0001).

CONCLUSIONS

Cadaveric biomechanical and laboratory research can be quantitatively scored for quality based on the inclusion of a clear and answerable purpose, demographics, specimen condition, appropriate bone density, reproducible technique, appropriate outcome measures, appropriate loading conditions, appropriate load magnitude, cyclic loading, sample size calculation, proper statistical analysis, results consistent with methods, limitations considered, conclusions based on results, and disclosure of funding and potential conflicts.

CLINICAL RELEVANCE

Study quality assessments are important to evaluate internal and external validity and reliability and to identify methodological flaws and misleading conclusions. The BOBQAT score will help not only in the critical appraisal of cadaveric biomechanical studies but also in guiding the designs of such research endeavors.

Development and Validation of Knowledge Attitudes and Practices Questionnaire (Nu-KAPQ): for the assessment of Knowledge, Attitudes, and Practices Associated with Arsenic

More than 70 million individuals have been exposed to environmental arsenic toxicity, worldwide. United Nation Children's Fund (UNICEF) policy brief -2018 report to mitigate arsenic in drinking water, emphasizes assessing, and changing the knowledge, attitudes, and practices (KAP) as one of the long-term effective solutions to be implemented as a part of surveillance strategies. This study aims to develop a valid and reliable tool to assess knowledge, attitude, and practices of arsenic and its risk in general health. A cross-sectional survey of N=449 general population was conducted in the outpatient department of Rajendra Memorial Research Institute of Medical Sciences-Indian Council for Medical Research for data collection. The construct validation of the questionnaire was done using Exploratory Factor Analysis, Confirmatory factor analysis. The Item-Content Validity Index(I-CVI) and Scale-Content Validity Index (S-CVI) Kappa scores were used to analyze the content validity of the items. The I-CVI ranges from 0.70 to 1, the and the moderate to high cumulative content validity is S-CVI/Universal Agreement=0.84; S-CVI/Average =0.96. Following the principal component analysis, the cumulative Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) was 0.91 and the three domains in the tool (Kaiser-Meyer-Olkin measure of sampling adequacy for Knowledge (0.917), Attitude (0.825) & Practices (0.80)) were within the acceptable range. The Barret's test for sphericity was (P <0.001) and was highly acceptable. The Confirmatory Factor Analysis model of Nu-KAP has demonstrated excellent model fit where, majority of fit indices has sown good fit (X2/df=1.88, Root Mean Square Error of Approximation = 0.04, Comparative Fit Index=0.98, Goodness of Fit Index = 0.93, and Tucker Lewis Index=0.977). The Cronbach's alpha of 19 item tool was 0.72. The Nu-KAPQ questionnaire demonstrated exceptional validity and reliability while also capturing and integrating all pertinent psychometric analytic domains. Conclusively, this questionnaire can be used to assess psychometric properties associated with arsenic bridging the gap in current research to understand people's perception towards arsenic, since it is a crucial component of arsenic mitigation.

Developing an Instrument to Measure Public Health Nurses' Competence Related to Breastfeeding Beyond 12 Months

BACKGROUND

Health professionals need adequate competence to support breastfeeding beyond infancy. There is no established instrument to measure health professionals' competence regarding long-term breastfeeding. To respond to this shortcoming, the Long-Term Breastfeeding Competence Scale (LBCS) was developed.

RESEARCH AIM

To develop and pilot an instrument that measures public health nurses' competence related to breastfeeding beyond 12 months in order to provide adequate breastfeeding counseling for families.

METHODS

This study was conducted as a cross-sectional online survey on public health nurses working in maternity and/or child health clinics. The relevance and clarity of the LBCS were assessed by an expert panel (N = 6). Public health nurses (N = 197) completed the LBCS, which consisted of a knowledge and skills dimension and an attitude dimension. Descriptive statistics were used to describe the characteristics of the study sample. The conceptual validity of the knowledge and skills dimension was assessed using the dichotomous Rasch analysis, and attitude dimension using the exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha. The distribution of the items was summarized by descriptive statistics.

RESULTS

According to expert panel evaluations, the LBCS was found to meet the requirements for relevance and clarity (S-CVI 0.90). The internal consistency of the instrument was at a good level (α = 0.796) and met the requirements set for a new instrument.

CONCLUSION

The LBCS is appropriate to determine public health nurses' competence related to breastfeeding beyond 12 months. The LBCS can be used to identify the need for education concerning breastfeeding beyond 12 months.

Migraine symptoms and association of triggers, coping strategies and clinical characteristics with COVID-19 diagnosis among university students in Peninsular Malaysia: A cross-sectional study

Introduction

Differentiating between migraine and COVID-19 headaches is essential for better treatment. Evidence-based research during the COVID-19 pandemic has found that university students are more likely to experience migraine. Migraine can affect academic performance, sleep pattern, social and emotional well-being if left untreated or misdiagnosed. This study aimed to determine the prevalence of migraine symptoms and the association of triggers, coping strategies and clinical characteristics with COVID-19 diagnosis.

Methods

This cross-sectional study was conducted across higher educational institutions in Peninsular Malaysia. Convenience sampling was applied to recruit full-time university students. A reliable and validated instrument was used to evaluate demographic data, migraine symptoms, triggers, coping strategies and clinical characteristics of migraine (frequency, intensity, severity and duration) during COVID-19 diagnosis.

Results

The response rate was 98.3%, where 485 out of 493 responses were analysed. The prevalence of migraine was 35.9% (n=174). None of the triggers, coping strategies and clinical characteristics of migraine were significantly associated with COVID-19 diagnosis.

Conclusion

The university students in Peninsular Malaysia showed a considerable prevalence of migraine symptoms. During the pandemic, the common triggers for existing symptoms were stress and a lack of sleep (combined triggers). The coping strategy adopted by most of the university students was lifestyle changes and in the COVID-19 positive group maladaptive coping strategies were adopted indicating the need for further investigation.

Psychometric Properties of the Arabic Version of the Pain Resilience Scale among Lebanese Adults with Chronic Musculoskeletal Pain

Background

The Pain Resilience Scale (PRS), which measures behavioral perseverance and the ability to regulate emotions and cognition despite ongoing pain, lacks an Arabic version.

Objectives

This study aimed to translate, culturally adapt, and validate an Arabic version of the Pain Resilience Scale (PRS-A) among Lebanese adults.

Methods

Phase 1 involved translation and cross-cultural adaptation of the PRS into Arabic. Phase 2 examined the reliability and validity of the PRS-A. A convenience sample of 154 Lebanese adults with chronic musculoskeletal pain completed the PRS-A and self-report measures of pain catastrophizing, pain self-efficacy, pain intensity and interference, depression and anxiety, and quality of life.

Results

The PRS-A yielded a two-factor structure with factor 1 representing "cognitive/affective positivity" and factor 2 representing "behavioral perseverance," accounting for 41.93% and 15.15% of the variance in pain resilience, respectively. Total PRS-A score (M = 33.20 and SD = 9.90) showed significant correlations with pain catastrophizing (M = 27.65, SD = 13.03, and r = -0.52), pain self-efficacy (median = 9.00, IQR = 4, and rho = 0.61), pain intensity (M = 4.50, SD = 2.25, and r = -0.28), pain interference (M = 4.30, SD = 2.89, and r = -0.56), physical (M = 34.95, SD = 9.52, and r = 0.34) and mental (M = 40.08, SD = 12.49, and r = 0.58) health functioning, anxiety (median = 7.00, IQR = 7, and rho = -0.57), and depression (median = 4.00, IQR = 6, and rho = -0.58). PRS-A subscale was also significantly related to all measures except pain intensity, which was correlated with cognitive/affective positivity (r = -0.33) but not behavioral perseverance (r = -0.09). Cronbach's alpha for the PRS-A was 0.87.

Conclusion

The PRS-A demonstrated validity and acceptable reliability among Arab-speaking individuals with chronic musculoskeletal pain, suggesting its potential utility for assessing pain resilience within this population.

Psychometric evaluation of the Chinese version of the resilience scale for parents of children with cancer

Background

Pediatric cancer ranks among the leading causes of mortality in children globally. While serving as primary caregivers, certain parents may experience anxiety, depression, and other related challenges. However, not all parents succumb to such psychological distress. Resilience emerges as a potential protective factor. Assessing parental resilience holds paramount importance for healthcare professionals in identifying issues and offering tailored interventions. Yet, mainland China lacks adequate tools for this assessment. Hence, this study endeavors to translate the Resilience Scale for Parents of Children with Cancer (RSP-CC) into Chinese and scrutinize its psychometric properties.

Methods

From April 2023 to January 2024, a methodological study was conducted in Chengdu, Chongqing, and Jinzhou, China, recruiting 377 eligible parents via convenience sampling for a multicenter cross-sectional survey. The translation process of the RSP-CC adhered rigorously to the Brislin model, involving forward and back-translation, followed by necessary modifications. Item analysis was assessed using the critical ratio and the item-total correlation coefficient. Validity evaluation encompassed content and internal validity assessments. Scale reliability was determined through Cronbach's α coefficient, retest reliability, and split-half reliability coefficients.

Results

The Chinese version of the RSP-CC comprises 4 dimensions and 24 items, explaining a cumulative variance contribution of 63.58%. In this investigation, the content validity index attained a score of 0.97. Exploratory factor analysis (EFA) yielded four factors consistent with the original scale, while confirmatory factor analysis (CFA) indicated satisfactory fit indices. Both Cronbach's α coefficient and retest reliability stood at 0.95, with a split-half reliability coefficient of 0.82.

Conclusion

After rigorous translation and verification, the RSP-CC was adapted in China, demonstrating favorable psychometric characteristics. It stands as an effective instrument for parents of children diagnosed with cancer in China. Additionally, this scale could serve as a crucial tool for clinical staff in formulating specific interventions.

The Knowledge, Attitudes, and Practices of Healthy Eating Questionnaire: a pilot validation study in Chinese families

Introduction

Identifying the knowledge, attitudes, and practices (KAP) gaps of healthy eating can inform the design of effective interventions. This study aimed to test the validity and psychometric properties of a KAP of Healthy Eating Questionnaire (KAP-HEQ) tailored to the Chinese culture.

Methods

The dimensions and potential items of each KAP scale were identified from published KAP and health literacy questionnaires, which were supplemented by the findings of a previous qualitative healthy eating study. Content validity of the KAP-HEQ was evaluated by eight experts and eight Chinese parent-adolescent dyads in Hong Kong through content validity ratio (CVR), content validity index (CVI), and qualitative feedback. The feasibility, construct validity, reliability, and sensitivity of the KAP-HEQ were evaluated in this pilot study among 60 adolescent-parent dyads (120 persons) through an online survey. The first 30 dyads who completed the KAP-HEQ were invited to repeat the KAP-HEQ 2 weeks later to assess the test-retest reliability.

Results

The final 44-item KAP-HEQ was completed in 10-15 min by both adolescents and their adult parents. The CVR ranged from -0.38 to 1, and the CVI ranged from 0.56 to 1. Over 80% of the items achieved convergent validity (a significantly positive correlation with its hypothesized scale) and discriminant validity (a higher correlation with its hypothesized scale than with the other two scales). Cronbach's alpha for the internal consistency of the Overall, Attitude, and Practice scales was >0.7, while that of the Knowledge scale was 0.54. The intraclass correlation coefficient (ICC) on test-retest reliability of the Overall and individual scales were all >0.75 except that of the Knowledge scale (ICC = 0.58). The significant differences in KAP scale scores with small to large effect sizes were found between known groups as hypothesized, except the Attitude score between groups by household income, which supported the sensitivity of the KAP-HEQ.

Conclusion

The KAP-HEQ has shown good validity, reliability, and sensitivity among Chinese adolescents and adults, which can be applied to evaluate KAP status and gaps to inform the design and assess the effectiveness of healthy eating interventions.

Iranian Nurses' Knowledge, Attitude, and Practice of Complementary Therapies for Pain Management

INTRODUCTION

Complementary therapies (CTs) are being increasingly used by people with health issues and recommended by their health care providers. Although there are numerous studies available that address nurses' knowledge and attitudes regarding pain management, there are few that include the use of CTs by nurses in Iran. Therefore, this study was conducted in selected areas of Iran to assess nurses' knowledge, attitudes, and current practice regarding the use of CTs.

METHODS

A cross-sectional study was conducted on a random sample of 850 nurses from various regions of Iran between 2020 and 2022. A questionnaire was used that consisted of seven items addressing demographic characteristics, 15 items to assess knowledge, 25 items to address attitude and 22 items to address the practice of CTs in the area of pain relief. Descriptive and inferential statistics were used to analyze the data.

RESULTS

The participants' mean age was 33.26 ± 7.24 years. Most nurses (89.9%) had not received formal education on CTs. However, 78.6% of nurses reported personal use of CTs, and 62.3% reported using or recommending it to their patients at least once. Regarding the knowledge of CTs, nurses scored 5.81 on a 15 points scale indicating a considerable gap in their knowledge of CTs. Regarding attitudes toward the specific therapies, nurses believed that massage is highly (46.4%) or moderately (31.6%) effective in pain relief. Regarding effectiveness, nurses ranked the following as the top four CTs: music therapy, humor, hydrotherapy, and use of cold / heat.

CONCLUSION

The nurses in this study scored low on knowledge of CTs, meaning that they knew little about CTs. However, they showed a favorable attitude toward CTs and a majority of them had a history of personal use, and recommending some types of CTs to their patients for pain relief. Therefore, it is crucial for nurse managers to provide opportunities to acquire knowledge of CTs. Moreover, nurse educators should advocate for updating nursing curricula to include CTs as an essential component of pain management education.

Psychometric properties of the modified Drug Abuse Screening Test Sinhala version (DAST-SL): evaluation of reliability and validity in Sri Lanka

BACKGROUND

Psychoactive drug use is an important public health issue in Sri Lanka as it causes substantial health, social and economic burden to the country. Screening for substance use disorders in people who use drugs is vital in preventive health care, as it can help to identify problematic use early. Screening can aid in referring those in need, for the most appropriate treatment and care. Thus, preventing them from developing severe substance use disorders with complications. The Drug Abuse Screening Test (DAST-10) is an evidence-based tool widely used to assess the severity of psychoactive drug use. This study aimed to culturally adapt and evaluate the validity and reliability of the Drug Abuse Screening Test (DAST-10) in Sri Lanka.

METHODS

The DAST-10 was culturally adapted, and the nine-item Sinhala version (DAST-SL) was validated using exploratory and confirmatory factor analysis. The validation study was conducted in the Kandy district among people who use drugs, recruited using respondent-driven sampling. Criterion validity of the questionnaire was assessed by taking the diagnosis by a psychiatrist as the gold standard. Cut-off values for the modified questionnaire were developed by constructing Receiver Operating Characteristic (ROC) curves. The reliability of the DAST-SL was assessed by measuring its internal consistency and test re-test reliability.

RESULTS

The validated DAST-SL demonstrated a one-factor model. A cut-off value of ≥ 2 demonstrated the presence of substance use disorder and had a sensitivity of 98.7%, specificity of 91.7%, a positive predictive value of 98.8% and a negative predictive value of 91.3%. The area under the curve of the ROC curve was 0.98. A cut-off score of ≤ 1 was considered a low level of problems associated with drug use. The DAST-SL score of 2-3 demonstrated a moderate level of problem severity, a score of 4-6 demonstrated a substantial level of problems, and a score of ≥ 7 demonstrated a severe level of drug-related problems. The questionnaire demonstrated high reliability with an internal consistency of 0.80 determined by Kuder-Richardson Formula-20 and an inter-class correlation coefficient of 0.97 for test re-test reliability.

CONCLUSION

The DAST-SL questionnaire is a valid and reliable tool to screen for drug use problem severity in people who use drugs in Sri Lanka.

The Pathway to Developing a Competency-based Tool for Entry-level Nursing Simulation: A Delphi Study

BACKGROUND

Simulation-based learning experiences allow undergraduate nursing students to develop competence and confidence through deliberate practice with immediate feedback on the learner's performance through debriefing. With the transition to competency-based nursing education, nursing faculty need more guidance in implementing competency-based evaluations in the simulation setting.

PURPOSE

This Delphi study aims to inform the future development of a competency-based tool - SimComp - based on the American Association of Colleges of Nursing (AACN) Essentials.

METHODS

A Delphi framework was used to recruit expert nursing faculty to complete the surveys via an online platform. Data analysis occurred through open-ended questions and quantitative methods to ensure that the responses from expert panelists were used to form the results.

RESULTS

After four rounds of this Delphi study, a consensus was achieved on 111 appropriate items for assessing competence in the simulation-based learning environment.

CONCLUSION

While further research is warranted, this study provides insight for nursing institutions considering implementing or increasing the use of simulation within their program for competency-based evaluations.

Written Language Practice, Self-Efficacy, and Beliefs: A Survey of Speech-Language Pathologists Working With School-Aged Clients

PURPOSE

This study examined the clinical practice, self-efficacy, and beliefs about assessing and treating written language among speech-language pathologists (SLPs) working with school-aged clients (aged 5-21 years) in school and nonschool settings in the United States.

METHOD

A survey was completed by a nationwide sample of 344 SLPs working with school-aged clients in the United States. Statistical analyses were conducted to determine differences between (a) SLPs' self-efficacy in assessing and treating spoken versus written language and (b) school-based and non-school-based SLPs' clinical practice, self-efficacy, and beliefs about their roles with written language.

RESULTS

All respondents reported significantly lower rates of self-efficacy in assessing and treating written language compared to spoken language, and their self-efficacy had a significant, positive relationship with the amount of clinical time devoted to written language. School-based SLPs devoted a significantly lower percentage of clinical time to written language, had significantly lower self-efficacy in addressing written language, and had lower rates of agreement on statements about their roles and responsibilities with written language compared to non-school-based SLPs. These differences were not found with spoken language. The most prevalent written language needs on respondents' workloads were reported as written expression (69.3%) and reading comprehension (66%).

CONCLUSIONS

School-based and non-school-based SLPs report different levels of clinical time devoted to written language, self-efficacy in addressing written language, and beliefs about their roles in addressing written language. There is a need to investigate the reasons for these differences and the potential impact of preservice and in-service training in ameliorating them.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25511047.

Neuromyelitis optica spectrum disorders registry system in Iran: Validity of data sets

BACKGROUND

A targeted structure for recording, monitoring, and follow-up of patients with neuromyelitis optica spectrum disorders (NMOSD) is in demand. To obtain the correct and uniform standardized information registry system, it is necessary to use a data set that has good validity to help policy-makers systematically plan for improvements in the quality of care. The main goal of the present study was to develop a NMOSD data set for the national registry system in Iran (NMORI) and to evaluate the validity of the presented data set.

METHODS

The NMORI data set consisted of baseline characteristics, disease and exposure history, background and past medical history, diagnosis and treatment, clinical features, imaging, and para-clinical findings. The content validity was evaluated by 18 experts from Iran, Japan, and Denmark by scoring each of the questionnaire items in term of transparency, simplicity, and relevance. According to the points given, the content validity index (CVI) and content validity ratio (CVR) scores were calculated and compared with the critical limit.

RESULTS

The current study was designed as a 125-items data set which was considered valid. In terms of relevance 110 out of 125 items, simplicity 113 out of 125 items, and transparency 123 out of 125 items had Item-CVI>0.79. All Scale-level-CVI values were greater than 0.9, showing noticeable content validity. In this data set, 112 items had CVR > 0.49, which was considered an acceptable level of significance.

CONCLUSION

The implementing of NMORI is important in a developing country such as Iran with significant increasing prevalence of this disease. This registry facilitates a uniform and valid diagnosis and is considered valid for clinical investigation and epidemiological research on NMOSD. Scientists and healthcare policymakers can rely on a validated data set in order to have access to accurate data.

Intensive care unit dignified care: Persian translation and psychometric evaluation

AIM

The present study aimed to evaluate the psychometric properties of the Persian version of the 'Intensive Care Unit Dignified Care Questionnaire (IDCQ)' among Iranian nurses.

DESIGN

A methodological and psychometric study was conducted in 2022, involving nurses from six teaching hospitals in Kermanshah, Western Iran.

METHODS

The IDCQ was translated into Persian using a forward-backward translation method. Construct validity was assessed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), employing a stratified sampling method with 455 critical care nurses. Internal consistency was gauged using Cronbach's alpha coefficient, while reliability was determined through the test-retest method. Analyses were performed using SPSS version 26 and Lisrel version 8 software.

RESULTS

EFA and CFA validated the instrument's two-factor, 17-item structure. The CFA indicated a well-fitting model with fit indices: CFI = 0.93, NNFI = 0.92, GFI = 0.861, RMSEA = 0.051 and SRMR = 0.046. Pearson's correlation coefficient substantiated a significant relationship between the items, subscales and the overall scale. The instrument's reliability was confirmed by a Cronbach's α coefficient of 0.88 and a test-retest reliability of 0.86.

CONCLUSION

The Persian version of the IDCQ, comprising two factors and 17 items, has been validated as a reliable and applicable tool for use within the Iranian nursing community.

The Delphi Method: Developing a Telerehabilitation Practice Guideline for Patients in Indonesia with Long COVID

Telerehabilitation has the potential to help expand the reach of rehabilitation intervention. An online questionnaire-based Delphi method set out to develop a telerehabilitation guideline for patients in Indonesia with Long COVID. A Delphi panel comprised of 24 experts was selected from all relevant disciplines. Over two rounds of Delphi testing, panelists gave opinions and indicated their level of agreement with each recommendation. Key elements of consensus for a telerehabilitation guideline for patients with Long COVID includes: the benefit of telerehabilitation, types of rehabilitation intervention needed, methods of intervention, criteria for home-based self-exercise training, set-up of rehabilitation prescription, exercise monitoring, evaluation of rehabilitation intervention and duration of rehabilitation intervention. Further research is needed to determine the feasibility and effectiveness of this guideline.

A Theory and Evidence-Based Artificial Intelligence-Driven Motivational Digital Assistant to Decrease Vaccine Hesitancy: Intervention Development and Validation

Vaccine hesitancy is one of the top ten threats to global health. Artificial intelligence-driven chatbots and motivational interviewing skills show promise in addressing vaccine hesitancy. This study aimed to develop and validate an artificial intelligence-driven motivational digital assistant in decreasing COVID-19 vaccine hesitancy among Hong Kong adults. The intervention development and validation were guided by the Medical Research Council's framework with four major steps: logic model development based on theory and qualitative interviews (n = 15), digital assistant development, expert evaluation (n = 5), and a pilot test (n = 12). The Vaccine Hesitancy Matrix model and qualitative findings guided the development of the intervention logic model and content with five web-based modules. An artificial intelligence-driven chatbot tailored to each module was embedded in the website to motivate vaccination intention using motivational interviewing skills. The content validity index from expert evaluation was 0.85. The pilot test showed significant improvements in vaccine-related health literacy (p = 0.021) and vaccine confidence (p = 0.027). This digital assistant is effective in improving COVID-19 vaccine literacy and confidence through valid educational content and motivational conversations. The intervention is ready for testing in a randomized controlled trial and has high potential to be a useful toolkit for addressing ambivalence and facilitating informed decision making regarding vaccination.

Development of a real-world simulated instrument for evaluating visuospatial working memory: a preliminary psychometric study on older adults

BACKGROUND

A prevalent challenge in neuropsychological assessment, particularly when utilizing instruments designed for controlled laboratory environments, is that the outcomes may not correspond to an individual's real-life status. Accordingly, assessments of visuospatial working memory (VSWM) conducted in such settings might fail to capture certain facets of this function, as it operates in real life. On the other hand, entirely ecological assessments may risk compromising internal validity. This study aimed to develop an intermediate mode of assessment that measures VSWM in older adults by employing a setting, a task, and a response format that aligns closely with both laboratory and ecological assessments. Furthermore, a preliminary investigation was carried out to study the variations in spatial cognition among different demographic groups.

METHODS

In a two-session study, 77 healthy older adults, eight patients with mild cognitive impairment (MCI), and seven patients with Alzheimer's disease (AD) were recruited to complete the wayfinding questionnaire (WQ), the Corsi block-tapping task (CBTT), and the Spatial Memory Table (SMT). The SMT is a novel instrument developed specifically for this study, aiming to provide a more accurate measure of VSWM performance in older adults' everyday life. Test-retest and split-half reliabilities, as well as the face, content, concurrent, convergent, and known-groups validities, were analyzed to investigate the psychometric properties of the SMT.

RESULTS

The analyses were mainly centered on studying the psychometric properties of the SMT. Test-retest reliability (r = .753, p < .001) and split-half reliability (ρSC = 0.747) were found to be acceptable. Concurrent validity using CBTT (r = .264, p = .021), convergent validity using WQ subscales (navigation and orientation: r = .282, p = .014; distance estimation: r = .261, p = .024), and known-groups validity using the SMT scores among people with MCI and AD (χ2 = 35.194, df = 2, p < .001) were also indicative of the instrument's good validity. Data analysis also revealed acceptable levels of face validity (U = 4.50; p = .095) and content validity (CVR ≥ 0.60). As a result of comparing VSWM and wayfinding variables across genders and education levels, a significant difference was observed for navigation and orientation and spatial anxiety between women and men (p < .05). None of the variables were different among education levels.

CONCLUSION

The SMT was found to be a reliable and valid tool for measuring VSWM performance in older adults. Given these findings, the SMT can be regarded as a measure that sufficiently approximates both laboratory and real-life demands for VSWM. Additionally, the instrument demonstrated a preliminary acceptable capacity to differentiate between healthy individuals and those with MCI and AD.

Development of a questionnaire for patient perception to functional appliances

OBJECTIVE

To developed and evaluate the validity, reliability, and Arabic translation of a questionnaire for preadolescent perception to removable functional appliances.

SUBJECTS AND METHODS

A new questionnaire was drafted based on previously used questionnaires. Twelve orthodontic experts were selected within content and face validity panel and twenty preadolescents wearing functional appliances were participated in the face validation of the questionnaire. Two rounds of content validity were performed with the same experts. The final form of the validated questionnaire was translated from English to Arabic language. The content validity index (CVI) was used for content validity and the Cronbach's alpha test was used to assess the internal consistency reliability of the questionnaire.

RESULTS

During the first round of content validity, 50 items were relevant to the underlying construct (Item-CVI ≥ 0.78), while four items were considered not valid (Item-CVI < 0.78) and the average scale-CVI was 0.93. In terms of face validation by experts, the percentage of agreement was adequate (96.4%). The questionnaire was modified by removing the non-valid items, adding/modifying items, and merging some categories. For second round of content validity, all items were found to be valid (I-CVI ≥ 0.78) and the overall questionnaire had adequate content validity (Scale-CVI/Ave = 0.94). The translated valid questionnaire also achieved a perfect agreement (100%) for face validity by patients. The internal consistency was appropriate (≥ 0.7).

CONCLUSIONS

A new valid, reliable, and translated questionnaire (English and Arabic versions) that cover the majority of aspects of patients' perception during treatment with removable functional appliances has been developed.

Development of a questionnaire for assessing the impact of children's food marketing exposure on diet-related outcomes

Introduction

The Government of Thailand has drafted legislation to protect children from the harmful impact of unhealthy food (including beverages) marketing. Local evidence on Thai children's exposure to, and the impact of, this marketing is necessary to, first, support the adoption of this Law and, second, to contribute to assessing policy implementation and effectiveness. This study aimed to develop and validate a questionnaire for examining Thai children's exposure to unhealthy food marketing and its impact on diet-related outcomes.

Materials and methods

To design the questionnaire, we first conceptualised the range of impacts of unhealthy food marketing on children's diet-related outcomes based on published frameworks. These outcomes related to food brand loyalty, preference, purchase and consumption. We conducted a literature review to gather related questions used in earlier surveys to assess these outcomes. Using these questions, we assessed content validity with five experts. Face validity and reliability were assessed for 32 children. Validity was assessed using Content Validity Index (CVI) and Kappa statistics. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC).

Results

We identified 15 survey questions that had been used to assess the outcomes of interest. The CVI of all questions was 1.0, indicating perfect agreement with each question's relevance by the experts. Most questions were perceived to be easy to read and comprehend, suggesting face validity. Cronbach's alpha and ICC of all questions were both 0.75, demonstrating internal consistency across responses to questions about, separately, brand loyalty, preferences, purchase and consumption.

Conclusion

The final 15-item questionnaire provides a valid and reliable survey instrument for measuring the impact of unhealthy food marketing on children's diet-related outcomes. This instrument will be useful for gathering local evidence on the need for policy reform to protect children from unhealthy food marketing in Thailand. The instrument also provides a cost-effective approach for generating evidence in other jurisdictions to propel policy actions. This is a pilot study and the validity and reliability needs further testing after a larger-scale roll-out.

Psychometric Evaluation of the Bahasa Malaysia Version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema in Patients with Breast Cancer-Related Lymphedema

Background: Breast cancer-related lymphedema (BCRL) is the most prevalent comorbidity that occurs following breast cancer treatments and has negative impact on the patients' quality of life (QoL). The Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL) is a valid and reliable instrument in assessing the QoL of patients with BCRL. However, the Bahasa Malaysia (BM) version is not available yet. This study aimed to translate the Lymph-ICF-UL into BM and to evaluate its validity and reliability. Methods and Results: A forward-backward translation was performed based on Sousa's guideline, and then, the face, content, construct validity, internal consistency, and test-retest reliability were tested. Face validity was assessed by five patients, and content validity was evaluated by six experts. Then, construct validity and internal validity were assessed in 107 patients. Finally, test-retest reliability was analyzed in 21 patients. Two items were eliminated following suggestions from the patients and experts. All patients found the scoring system and items clear and relevant. The results showed sufficient content validity index and modified kappa statistics value. Confirmatory factor analysis showed acceptable fit indices. Cronbach's alpha values ranged from 0.67 to 0.95, intraclass correlation coefficient ranged from 0.88 to 0.99, standard error measurement was 2.29-6.15, and the Bland-Altman plot showed an agreement between two test occasions. Conclusion: These results suggested that the Lymph-ICF-UL BM has good validity and reliability in evaluating the QoL of patients with BCRL in Malaysia.

Preimplementation of Critical Care Early Mobility Clinical Decision Support: A Content Validation Study

Early mobility is a form of critical care rehabilitation ranging from in-bed exercise to ambulation and is known to limit post-intensive-care functional decline. Multiple barriers prevent widespread early mobility implementation. Clinical decision support systems can optimize the decision-making process and overcome barriers to care. However, critical care early mobility clinical decision support does not exist. Our objective was to develop and establish the content validation of the operational definitions for a novel critical care early mobility assessment instrument. Content validation was conducted in two steps: (1) development of operational definitions by the research team and (2) content validation with 10 nurse experts. Quality assessment and suitability of the operational definitions for 30 items, across four safety domains, were assessed using a 7 point-Likert scale. Item content validity index scores ranged from 0.6 to 0.1 after the first validation round. Domains containing items with item content validity index scores less than the lower limit of 0.78 were modified for clarity of language. Item content validity index scores ranged from 0.8 to 1.0, and the scale-level content validity index was 0.93 after the second content validation round. Excellent content validity of the operational definitions was achieved. This is the first methodological step in a larger project to develop clinical decision support for critical care early mobility.

Validating a theory of planned behavior questionnaire for assessing changes in professional behaviors of medical students

Introduction

Teaching professionalism is a fundamental aspect of medical undergraduate education, delivering important domains of professional attitudes, ethics, and behaviors. The effects of educational interventions can be assessed by measuring the change in such domains, but validated assessment tools for these professionalism domains are lacking. In this study, we constructed and conducted expert validation of a modified theory of planned behavior (TPB) questionnaire to assess changes in professional behaviors (PBs) in medical students.

Methods

To validate that, we modified an existing TPB questionnaire, and an 18-item questionnaire was subjected to expert panel evaluation using the content validation method. The clarity and relevance of items were assessed using a four-point rating scale (i.e., 1 = not relevant to 4 = highly relevant). Ratings of experts and free-text comments were analyzed. Quantitative evaluation of relevance and clarity was undertaken through analyses of the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI). A qualitative assessment of the comments of experts was conducted to refine items, any disagreements were discussed, and a consensus decision was developed among authors for item changes.

Results

Quantitative evaluation of the Item-level Content Validity Index (I-CVI) scored 0.9-1 for relevance and 0.7-1 for clarity. Qualitative evaluation resulted in (i) changes to the wording of items (e.g., choices such as "worthless/worthwhile" were replaced with "not important/important"); and (ii) suggestion of the addition of social media in the construct of subjective norms.

Discussion

The proposed tool exhibits content validity and can assess TPB constructs in professionalism education. This study of content validity may help to ensure the modified TPB questionnaire accurately measures the TPB constructs, ensuring its effectiveness in accurately measuring the TPB constructs for PB in diversified educational medical institutions.

The rise of Parkinson's disease is a global challenge, but efforts to tackle this must begin at a national level: a protocol for national digital screening and "eat, move, sleep" lifestyle interventions to prevent or slow the rise of non-communicable diseases in Thailand

The rising prevalence of Parkinson's disease (PD) globally presents a significant public health challenge for national healthcare systems, particularly in low-to-middle income countries, such as Thailand, which may have insufficient resources to meet these escalating healthcare needs. There are also many undiagnosed cases of early-stage PD, a period when therapeutic interventions would have the most value and least cost. The traditional "passive" approach, whereby clinicians wait for patients with symptomatic PD to seek treatment, is inadequate. Proactive, early identification of PD will allow timely therapeutic interventions, and digital health technologies can be scaled up in the identification and early diagnosis of cases. The Parkinson's disease risk survey (TCTR20231025005) aims to evaluate a digital population screening platform to identify undiagnosed PD cases in the Thai population. Recognizing the long prodromal phase of PD, the target demographic for screening is people aged ≥ 40 years, approximately 20 years before the usual emergence of motor symptoms. Thailand has a highly rated healthcare system with an established universal healthcare program for citizens, making it ideal for deploying a national screening program using digital technology. Designed by a multidisciplinary group of PD experts, the digital platform comprises a 20-item questionnaire about PD symptoms along with objective tests of eight digital markers: voice vowel, voice sentences, resting and postural tremor, alternate finger tapping, a "pinch-to-size" test, gait and balance, with performance recorded using a mobile application and smartphone's sensors. Machine learning tools use the collected data to identify subjects at risk of developing, or with early signs of, PD. This article describes the selection and validation of questionnaire items and digital markers, with results showing the chosen parameters and data analysis methods to be robust, reliable, and reproducible. This digital platform could serve as a model for similar screening strategies for other non-communicable diseases in Thailand.

The Chinese version of the general benefit finding scale (GBFS): Psychometric properties in a sample of college students

BACKGROUND

Benefit finding has become a central construct in the evolution of positive psychology and attracted attention in recent literature. This study aimed to translate and validate the General Benefit Finding Scale (GBFS) in Chinese college students.

METHODS

Forward- and back-translation of the GBFS was followed by the assessment of semantic equivalence and content validity. A sample of 589 college students was recruited in China to conduct reliability and validity analysis. The construct validity was assessed using exploratory (EFA) and confirmatory factor analysis (CFA). Concurrent validity was assessed using Pearson's correlation coefficients of the GBFS with the Perceived Stress Scale (PSS) and World Health Organization-Five Well-Being (WHO-5). Internal consistency and two-week test-retest reliability were also evaluated.

RESULTS

The content validity index for each item ranged from 0.83 to 1.00. EFA revealed a six-factor model, which exhibited acceptable goodness of fit in CFA (standardized root mean square residual = 0.031, root mean square error of approximation = 0.059, goodness-of-fit index = 0.860, comparative fit index = 0.904, Tucker-Lewis index = 0.890, chi-squared/degree of freedom = 2.07). The concurrent validity of the GBFS was supported by its statistically significant correlations with PSS (r = -0.271, p<0.001) and WHO-5 (r = 0.354, p<0.001). Moreover, the internal consistency for the overall scale was satisfactory, with Cronbach's α coefficient of 0.93 and McDonald's omega reliability of 0.94. The test-retest reliability was 0.82.

CONCLUSIONS

Although the Chinese version of GBFS was examined in a homogeneous convenience sample of college students, it provides a reliable and valid instrument for assessing benefit finding in the Chinese context.

Development and validation of home-based psychosocial self-management interventions in schizophrenia and related disorders in low-resource settings: A mixed methods approach

Background

Psychosocial interventions, crucial for recovery in patients with schizophrenia, have often been developed and tested in high income countries. We aimed at developing and validating home-based a booklet based psycho-social intervention with inputs from stakeholders: patients, families, and mental health professionals (MHP) for patients with schizophrenia and related disorders in low resource settings.

Methods

We developed a preliminary version of psychosocial intervention booklets based on six themes derived from focus group discussions conducted with patients, families, and MHP. Initially, quantitative assessment of content validity was done by MHP on overall and Content Validity Index of individual items of the specific booklets, followed by in-depth interviews about their views. The booklets were modified based on their inputs. Further, pilot testing of manuals was done on the users - nine pairs of patients and caregivers followed by development of a final version of psycho-social intervention.

Results

The percentage content validity of individual modules and overall booklets was ≥78.5% indicating good validity. Most MHP reported that the manuals were relevant and easy to use but were text-heavy, and lengthy. On pilot testing of modified manuals with patients and their family caregivers, majority (77.8%) of them found booklets useful and suggested that there should be separate booklets for both patients and caregivers for providing information and entering separate response for the activities, integrating helpful tips. Language should be simple. Finally, two sets of booklets ("info book" and "workbook") named 'Saksham' (meaning empowered) were created with specific modules (viz., 'Medicine adherence', 'Daily routine', 'Eating right', 'Physical activity', 'Physical health monitoring', 'Self-reliance', and 'Psychoeducation') for patients and caregivers each, in two languages (Hindi and English).

Conclusion

Booklets with modules for psychosocial interventions for patients with schizophrenia and their caregivers were developed after establishing content validity and pilot testing.