Brief instruments for measuring nutrition literacy - the Nutrition Health Literacy Scale and the Self-Perceived Food Literacy Scale Short Form

BACKGROUND

A healthy diet is a critical factor in maintaining long-term health. In addition to a health-promoting food environment, the nutrition health literacy (NHL) and food literacy (FL) of the population are important in this context. This paper describes the development and validation of two short instruments to measure the nutrition literacy of the population, used in the Austrian Nutrition Literacy Survey 2021.

METHODS

An instrument to measure NHL (Nutrition Health Literacy Scale; NHLS) has been adapted and further developed. To measure FL, the Self-perceived Food Literacy Scale by Poelman et al. has been modified and shortened (SPFL-SF). Validation of the instruments was based on data from a web survey conducted in Austria in 2021 with almost 3,000 participants aged 18 years and older. Exploratory and confirmatory factor analyses were performed to assess the factorial validity/dimensionality of the instruments. Additionally, internal consistency was assessed using Cronbach's alpha, ordinal alpha, and McDonald's omega.

RESULTS

Both instruments demonstrate excellent data-model fit. The NHLS also shows excellent internal consistency (α = 0.91), while the SPFL-SF displays a sufficient internal consistency for all (α between 0.70 and 0.89) but one sub-dimension (resisting temptation α = 0.61). Furthermore, the distribution of the items indicates that the measures are understandable and suitable, as evidenced by the absence of missing values in the sample. In addition, the items of both instruments differ in their level of difficulty or agreement.

CONCLUSIONS

The NHLS and SPFL-SF are reliable and valid instruments for measuring NHL and FL in the general adult population. The brief instruments measuring the different aspects of nutrition literacy can be easily used in nutritional or evaluation studies. Further work is required to investigate other aspects of validity.

Intergenerational mental health effects of traumatic victimization in Nepal: A 3-D theory study

BACKGROUND

Intergenerational transmission of trauma is a major focus of international research. Epigenetic, complex-trauma, and intergenerational abuse pattern transmission theoretical explanations all have existing empirical support. Three-D theory argues that in addition to trauma victimization severity, victimization invasiveness and exploitativeness have important independent effects. Moreover, 3-D theory claims that a positive 3-way interaction occurs between trauma victimization invasiveness, exploitativeness, and severity. This study examines the 3-D hypotheses in the context of intergenerational trauma effects on adolescent depression symptoms and suicidal ideation in generation two. Three-D theory may play a particularly important role in intergenerational trauma effects for female victims in the context of conservative South Asian sex role norms.

OBJECTIVE

Test for main effects, two-way, and three-way interaction effects of invasiveness, exploitativeness, and severity of traumatic victimization on intergenerational transmission to adolescent depression and suicidal ideation in generation two. Pathways from maternal depression and borderline personality symptoms as well as physical and sexual abuse and neglect of the adolescent child were also tested.

PARTICIPANTS

and setting. Participants were a nationally representative, random, multi-stage cluster sample of 1089 Nepali mothers and their 15-17 year old adolescent children.

METHODS

Regression models with adjustments for clustering within municipality were used to test the hypotheses.

RESULTS

One in four Nepali adolescents had considered suicide; more than half had high depression scores. A three-way interaction effect between maternal trauma invasiveness, exploitativeness, and severity was positively associated with adolescent depression symptoms. A two-way interaction effect between exploitativeness and severity of maternal trauma was positively associated with adolescent suicidal ideation. Maternal depression, BPD symptoms, and very severe physical abuse of the adolescent were also associated with adolescent depression symptoms.

CONCLUSION

Further research is needed to measure and investigate invasiveness, exploitativeness, and severity of traumatic victimization as they bear on intergenerational transmission of trauma. Examination of intergenerational transmission of self-concept as a potential vector is recommended.

Translation, Cross-Cultural Adaptation, and Validation of Measurement Instruments: A Practical Guideline for Novice Researchers

Cross-cultural validation of self-reported measurement instruments for research is a long and complex process, which involves specific risks of bias that could affect the research process and results. Furthermore, it requires researchers to have a wide range of technical knowledge about the translation, adaptation and pre-test aspects, their purposes and options, about the different psychometric properties, and the required evidence for their assessment and knowledge about the quantitative data processing and analysis using statistical software. This article aimed: 1) identify all guidelines and recommendations for translation, cross-cultural adaptation, and validation within the healthcare sciences; 2) describe the methodological approaches established in these guidelines for conducting translation, adaptation, and cross-cultural validation; and 3) provide a practical guideline featuring various methodological options for novice researchers involved in translating, adapting, and validating measurement instruments. Forty-two guidelines on translation, adaptation, or cross-cultural validation of measurement instruments were obtained from "CINAHL with Full Text" (via EBSCO) and "MEDLINE with Full Text". A content analysis was conducted to identify the similarities and differences in the methodological approaches recommended. Bases on these similarities and differences, we proposed an eight-step guideline that includes: a) forward translation; 2) synthesis of translations; 3) back translation; 4) harmonization; 5) pre-testing; 6) field testing; 7) psychometric validation, and 8) analysis of psychometric properties. It is a practical guideline because it provides extensive and comprehensive information on the methodological approaches available to researchers. This is the first methodological literature review carried out in the healthcare sciences regarding the methodological approaches recommended by existing guidelines.

A scale for measuring nursing digital application skills: a development and psychometric testing study

BACKGROUND

The adoption of digitization has emerged as a new trend in the advancement of healthcare systems. To ensure high-quality care, nurses should possess sufficient skills to assist in the digital transformation of healthcare practices. Suitable tools have seldom been developed to assess nurses' skills in digital applications. This study aimed to develop the Nursing Digital Application Skill Scale (NDASS) and test its psychometric properties.

METHODS

The Nursing Digital Application Skill Scale was developed in three phases. In Phase 1, an item pool was developed based on previous literature and the actual situation of nursing work. Phase 2 included 14 experts' assessment of content validity and a focus group interview with 30 nurses to pretest the scale. In phase 3, 429 registered nurses were selected from March to June 2023, and item analysis, exploratory factor analysis, and confirmatory factor analysis were used to refine the number of items and explore the factor structure of the scale. Additionally, reliability was determined by internal consistency and test-retest reliability.

RESULTS

The final version of the NDASS consisted of 12 items. The content validity index of NDASS reached 0.975 at an acceptable level. The convergent validity test showed that the average variance extracted value was 0.694 (> 0.5) and the composite reliability value was 0.964 (> 0.7), both of which met the requirements. The principal component analysis resulted in a single-factor structure explaining 74.794% of the total variance. All the fitting indices satisfied the standard based upon confirmatory factor analyses, indicating that the single-factor structure contributed to an ideal model fit. The internal consistency appeared high for the NDASS, reaching a Cronbach's alpha value of 0.968. The test-retest reliability was 0.740, and the split-half coefficient was 0.935.

CONCLUSION

The final version of the NDASS, which possesses adequate psychometric properties, is a reliable and effective instrument for nurses to self-assess digital skills in nursing work and for nursing managers in designing nursing digital skill training.

Development and validation of a subjective end-of-life health literacy scale

Personal health literacy is the ability of an individual to find, understand, and use information and services to inform health-related decisions and actions for oneself and others. The end of life is commonly characterized by the occurrence of one or several diseases, the use of many different types of healthcare services, and a need to make complex medical decisions that may involve challenging tradeoffs, such as choices between quality and length of life. Although end-of-life care issues concern most people at some point in life, individuals' competencies to deal with those questions have rarely been explored. This study aims to introduce, develop, and validate an instrument to measure individuals' self-assessed competencies to deal with end-of-life medical situations, the Subjective End-Of-Life Health Literacy Scale (S-EOL-HLS), in a sample of older adults aged 50+ living in Switzerland who participated in wave 8 (2019/2020) of the Survey of Health, Ageing, and Retirement in Europe. The S-EOL-HLS uses a series of questions on self-rated difficulties in understanding end-of-life medical jargon, defining in advance which end-of-life medical treatments to receive or refuse, and communicating related choices. Aside from conducting exploratory and confirmatory factor analysis to evaluate the construct validity, we compared measurements from the S-EOL-HLS to respondents' general health literacy measured with the European Health Literacy Survey questionnaire. We obtained a three-factor model with acceptable fit properties (CFI = 0.993, TLI = 0.992, RMSEA = 0.083, SRMR = 0.061) and high reliability (α = 0.93). The partial associations between the health literacy scores from the two scales and respondents' sociodemographic characteristics were similar; however, individuals with higher end-of-life health literacy scores appeared to have more positive attitudes towards end-of-life care planning outcomes. The S-EOL-HLS demonstrates reliable and consistent results, making the instrument suitable for older adults in population surveys.

Development and Validation of Questionnaire to Measure Parents' Knowledge, Attitude, and Practice on Self-Medication of Children with Antibiotics in Bandung, Indonesia

Purpose

This study aimed to develop and validate a questionnaire to measure the knowledge, attitude, and practice of parents regarding antibiotic use in Indonesian children using structural equation modeling (SEM) analysis.

Methods

The instrument development process was conducted from January 5 to 19, 2023, using the following steps: 1) literature review and item development, 2) internal review and refinement, 3) structural model analysis, and 4) measurement models' reliability and validity. A convenience sample was used to recruit parents as participants from Arcamanik District, Bandung, Indonesia. A total of 83 respondents completed the on-site interview questionnaire. Furthermore, statistical analyses were performed using SPSS Version 21.0 and Analysis of Moment Structures (AMOS) Version 26.0.

Results

The content validity for the scales was over 50%, and the reliabilities for the 38 items of the questionnaire were above 0.6, respectively. The suitability of the model was assessed, and the findings showed parameters for indicators: chi-square = 0.0004, CFI = 0.977, RMSEA = 0.044, CMIN/DF = 1.162, AGFI = 0.651, TLI = 0.973, and NFI = 0.860. The GFI parameter did not fit with the output value of 0.718, while the convergent and divergent validity of scores provided evidence in the expected direction.

Conclusion

This psychometric development study provides preliminary evidence that the 38-item scales were reliable and valid for assessing knowledge, attitude, and practice toward parents in the self-medication of antibiotics in children.

Development and Psychometric Evaluation of the Children's Illness-Related Concerns Scale

BACKGROUND

Despite the effect of maternal breast cancer on many children, there is no valid or reliable quantitative measure of the concern that children attribute to their mothers' disease, which constrains both science and clinical practice.

OBJECTIVES

This study aimed to develop and psychometrically evaluate the initial measures of child-reported, illness-related concerns associated with maternal cancer.

METHODS

The study was conducted in three phases: scoping review, item extraction from a battery of items obtained from school-aged children about general issues related to their mothers' breast cancer, and testing of the three proposed structural models of these extracted items using confirmatory factor analysis. The scoping review yielded five categories of illness-related concerns: altered family routines, uncertainty, concerns about illness contagion, maternal death, and maternal well-being. To reflect these five categories, 18 items were extracted from a 93-item questionnaire completed by 202 school-aged children regarding their mothers' breast cancer. Next, three structural models were hypothesized to assess the construct validity of illness-related concerns: five-, three-, and one-factor models. Confirmatory factor analysis was used to test and compare the models.

RESULTS

The five-factor model best fit the data, and each factor showed adequate internal consistency reliability. These findings align with the a priori five-factor model informed by the scoping review.

CONCLUSION

The results provide initial evidence of the construct validity of the 18-item Children's Illness-Related Concerns Scale, which can be used to assess children's concerns and inform future intervention studies.

How attention factors into executive function in preschool children

Executive Function consists of self-regulation processes which underlie our ability to plan, coordinate, and complete goal-directed actions in our daily lives. While attention is widely considered to be central to the emergence and development of executive function during early childhood, it is not clear if it is integral or separable from other executive function processes. Previous studies have not addressed this question satisfactorily because executive function and attention are multidimensional constructs, but they are often studied without differentiating the specific processes that are tested. Moreover, some studies consist of only one task per process, making it difficult to ascertain if the pattern of results is attributable to different processes or more simply to task variance. The main aim of this study was to more fully investigate how attention factored into the underlying structure of executive function in preschool children. Preschool children (n = 137) completed a battery of tasks which included executive function (i.e., response inhibition, working memory) and attentional control (i.e., sustained attention, selective attention) processes; there were two tasks per process. Confirmatory factor analyses (CFA) were conducted to test which of three models fit the data best: (1) a unitary one-factor model with attention loading onto the same factor as other executive function processes, (2) a two-factor model with attention loading onto a separate factor than other executive function processes, or (3) a three-factor model with attention, response inhibition, and working memory as separate factors. Fit indices and model comparisons indicated that the two-factor model fit the data best, suggesting that attentional control and executive function were related, but separable. Although this study is not the first to advocate for a two-factor model during the preschool years, it is the first to suggest that the two factors are attentional control and executive function, not working memory and response inhibition. One important implication of these findings is that a complete assessment of executive function during the preschool years necessitates measuring not only response inhibition and working memory, but attentional control as well.

Modelling the sustainability of a primary school digital education curricular reform and professional development program

Sustaining changes in teachers' practices is a challenge that determines the success of curricular reforms, from which Digital Education (DE) is not exempt. As the literature on sustainability is considered "scarce" and "scattered", long-term studies modelling the factors impacting teachers' sustained uptake of DE pedagogical content are lacking. Thus, we investigate whether and how 287 in-service teachers sustained a primary school DE curricular reform over a year after they completed their two-year DE professional development program. We model the sustainability of the reform through Structural Equation Modelling, and identify critical sustainability-factors. The validated Sustainable Adoption of Digital Education (SADE) model confirms that sustainability in the fourth year of the reform depends on perceived usefulness of teaching the new content, ease of implementation, and access to sufficient support in schools. Such factors should thus be evaluated, accounted for in the implementation phase of the reform, and sustained over time. The findings confirm that the DE curricular reform model contributes to positive self-efficacy to teach DE, provides sufficient in-school support, and promotes increasing adoption over time. However, as teachers' practices have not yet stabilised, and teachers may still adopt more to cover the breadth of DE-concepts, it is important to remain attentive to remaining sustainability barriers: lack of time, effort required to teach DE with teachers preferring to delegate, and lack of student-learning evidence, the latter being a significant challenge to address in the literature. These barriers must therefore be jointly addressed by researchers and practitioners in the field in order to promote the sustainability of the reform.

Comparing the psychometric properties of two primary school Computational Thinking (CT) assessments for grades 3 and 4: The Beginners' CT test (BCTt) and the competent CT test (cCTt)

Introduction

With the increasing amount of research around Computational Thinking (CT) and endeavors introducing CT into curricula worldwide, assessing CT at all levels of formal education is of utmost importance to ensure that CT-related learning objectives are met. This has contributed to a progressive increase in the number of validated and reliable CT assessments for K-12, including primary school. Researchers and practitioners are thus required to choose among multiple instruments, often overlapping in their age validity.

Methods

In this study, we compare the psychometric properties of two of these instruments: the Beginners' CT test (BCTt), developed for grades 1-6, and the competent CT test (cCTt), validated for grades 3-4. Classical Test Theory and Item Response Theory (IRT) were employed on data acquired from 575 students in grades 3-4 to compare the properties of the two instruments and refine the limits of their validity.

Results

The findings (i) establish the detailed psychometric properties of the BCTt in grades 3-4 for the first time, and (ii) through a comparison with students from the same country, indicate that the cCTt should be preferred for grades 3-4 as the cCTt is able to discriminate between students of low and medium ability. Conversely, while the BCTt, which is easier, shows a ceiling effect, it is better suited to discriminate between students in the low ability range. For these grades, the BCTt can thus be employed as a screening mechanism to identify low ability students.

Discussion

In addition to providing recomendations for use of these instruments, the findings highlight the importance of comparing the psychometric properties of existing assessments, so that researchers and practitioners, including teachers and policy makers involved in digital education curricular reforms, may take informed decisions when selecting assessments.

Understanding the perceived behavior of public utility bus passengers during the era of COVID-19 pandemic in the Philippines: Application of social exchange theory and theory of planned behavior

Over the years, passengers in the Philippines have relied on public utility bus (PUB) to reach a destination. However, PUB has been greatly affected by the adverse effects of the coronavirus disease (COVID-19) outbreak. Therefore, the study analyzed passengers' behavior using PUB during the COVID-19 pandemic by integrating social exchange theory (SET) and the theory of planned behavior (TPB). A total of 505 PUB users completed the online questionnaire containing sixty-seven (67) measures. Through confirmatory factor analysis - structural equation modeling (CFA-SEM), all the twelve (12) hypotheses were found significant. Accessibility, safety, economic benefit, and crisis management had a significant and positive influence on passengers' trust. Moreover, passengers' trust produced a significant positive influence on attitude, subjective norm, and perceived behavioral control. Additionally, attitude, subjective norm, and perceived behavioral control generated a significant positive influence on the intention to use PUB. Furthermore, perceived behavioral control had a significant positive influence on perceived passenger behavior. Lastly, the intention to use PUB developed a substantial and positive influence on perceived passenger behavior. PUB companies and policymakers can utilize these findings to develop additional PUB reforms for the benefit of passengers, drivers, operators, companies, and the government during the COVID-19 pandemic.

Validation of the Malay Version of the Shame and Stigma Scale among Cancer Patients in Malaysia

The assessment of stigma among cancer patients is of the utmost importance as stigma may lead to various psychological sequelae and a lower quality of life. This study aimed to translate the English version of the Shame and Stigma Scale (SSS) into Malay and validate the Malay version of the SSS (SSS-M) to assess the degree of stigma among cancer patients in Malaysia. Initially, the concurrent translation and back translation of the SSS-M were performed, and the face and content validity were assessed. Subsequently, the SSS-M was administered to a total of 234 patients with mixed types of cancer to assess its reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity), and conduct an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The SSS-M total score registered a good internal consistency (a Cronbach's α of 0.881) and test-retest reliability (an intraclass correlation coefficient of 0.876, p < 0.001). The EFA and CFA confirmed that the SSS-M consisted of 16 items in 3 domains. Its convergent and discriminant validity were achieved. Hence, the SSS-M demonstrated good psychometric properties and is available for use to assess stigma among cancer patients in Malaysia.

Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS19-Q12 Instrument in Seventeen Countries

BACKGROUND

For improving health literacy (HL) by national and international public health policy, measuring population HL by a comprehensive instrument is needed. A short instrument, the HLS₁₉-Q12 based on the HLS-EU-Q47, was developed, translated, applied, and validated in 17 countries in the WHO European Region.

METHODS

For factorial validity/dimensionality, Cronbach alphas, confirmatory factor analysis (CFA), Rasch model (RM), and Partial Credit Model (PCM) were used. For discriminant validity, correlation analysis, and for concurrent predictive validity, linear regression analysis were carried out.

RESULTS

The Cronbach alpha coefficients are above 0.7. The fit indices for the single-factor CFAs indicate a good model fit. Some items show differential item functioning in certain country data sets. The regression analyses demonstrate an association of the HLS₁₉-Q12 score with social determinants and selected consequences of HL. The HLS₁₉-Q12 score correlates sufficiently highly (r ≥ 0.897) with the equivalent score for the HLS₁₉-Q47 long form.

CONCLUSIONS

The HLS₁₉-Q12, based on a comprehensive understanding of HL, shows acceptable psychometric and validity characteristics for different languages, country contexts, and methods of data collection, and is suitable for measuring HL in general, national, adult populations. There are also indications for further improvement of the instrument.

HLS19-NAV-Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries

To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019-2021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data-model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial.

Validation of the Short-Test of Functional Health Literacy in Adults for the Samoan Population

BACKGROUND

Health literacy encompasses various levels of communication for an individual, provider, and an organization. Validated and reliable tools have been developed to assess health literacy; however, there is a paucity of tools available to assess health literacy in native languages for indigenous and racial/ethnic minority populations.

OBJECTIVE

This article shares the process taken to translate and evaluate validation and reliability of the Short Test of Functional Health Literacy in Adults for use with the Samoan population.

METHODS

Respondent-driven sampling was used to collect data from 1,543 adults age 45 years and older in American Samoa. A confirmatory factor analysis using a two-factor model for validation was conducted.

KEY RESULTS

The validation results indicated a "good fit" in multiple indices and Cronbach's alpha indicated high internal consistency in both the English and Samoan languages.

CONCLUSIONS

Developing culturally validated and reliable health literacy assessment tools is important to help health care professionals decrease health disparities and address inadequate health literacy in all cultures. [HLRP: Health Literacy Research and Practice. 2022;6(4):e247-e256.] Plain Language Summary: The INSPIRE project studied the Short Test of Functional Health Literacy in Adults (STOFHLA) tested on the American Samoan population age 50 years and older. The results would show if the STOFHLA is a valid tool to measure functional health literacy in American Samoa adults.

Development of a motivation-based tool to facilitate individualized self-management interventions for adolescents with asthma

OBJECTIVE

To develop a questionnaire for segmenting adolescents with asthma into archetypes based on their motivations for individualized self-management interventions.

METHODS

A prospective observational study using segmentation methodology. First, adolescents created photo diaries followed by in-person semi-structured interviews to develop a pool of candidate items for identifying and describing archetypes. Second, quantitative methods were used to test the pool of items to determine which ones best identified each archetype.

RESULTS

Six archetypes based on motivations were identified and described: goal oriented visionaries; mentors and helpers; influencers; discouraged adolescents; dependent adolescents; and shame avoiders. A questionnaire with 63 candidate items was administered to 201 adolescents. Confirmatory factor analysis resulted in a 17-item questionnaire that identified the archetypes.

CONCLUSION

This study is the first step towards applying a segmentation methodology to facilitate the application of interventions during a clinic visit to increase adherence. It has shown that a relatively short questionnaire can be used to identify archetypes based on motivations.

PRACTICE IMPLICATIONS

The 17-item questionnaire could provide a framework and direction for healthcare professionals to customize existing adherence interventions, such as motivational interviewing, to different segments of adolescents. It would be especially helpful in primary care settings where time is limited.

Impacts of Corporate Social Responsibility on Employees’ Mental Fatigue: Employees’ Ethical Perspective

With the rise of cost of living and coronavirus disease 2019 (COVID-19) global pandemic therewithal, finding reliable measures to reduce employees’ mental fatigue has become a great challenge. In this context, scholars have mainly focused on solutions for relieving employees’ mental fatigue from the perspective of human resource management but barely from employees’ ethical perspectives and that of internal and external corporate social responsibility (CSR) and employees’ ethics. This study uses hierarchical regression analysis and attempts to formulate and analyze the relationship between CSR, perceptions of corporate hypocrisy, and employees’ mental fatigue along with the mediating role of ethical egoism and altruistic choice. It also conceptualizes models and develops various hypotheses and theoretical logic. A total of 250 questionnaires were distributed, and 176 valid responses were subsequently gathered. The results show that employees’ mental fatigue significantly reduces when either internal or external CSR has a positive impact on employees’ altruistic choice and significantly increases either internal or external CSR has a negative effect on ethical egoism. Similarly, reducing perceptions of corporate hypocrisy can enhance the positive impact of external CSR on altruistic choice, which consequently reduces employees’ mental fatigue.

Development and Validation of a Questionnaire to Measure Digital Skills of Chinese Undergraduates

To keep sustainable development in a digital society, it is essential for young people to possess certain digital skills. Levels of the digital skills of Chinese undergraduates take a certain role in the process of educational digitalization promoted by the Chinese government, becoming an important concern for Chinese universities and policymakers. However, few valid and reliable instruments are available for the assessment of the digital skills of undergraduates in China. Thus, developing, and testing the reliability and validity of a questionnaire to measure the digital skills of Chinese undergraduates are necessary. Based on previous literature and situations in the Chinese educational context, this study developed and validated a questionnaire to assess the digital skills of Chinese undergraduates. Through factor analysis approaches, the internal factor structure of the questionnaire was explored, and its reliability and validity were verified. Development and validation of a questionnaire, in which 6 factors were extracted, were described: access to and management of digital content, use of digital means, communication of digital content, creation of digital content, digital empathy, and digital safety. The questionnaire was applied to the first sample of 222 undergraduates and the second sample of 231 undergraduates selected randomly from a university located in the east of China. An exploratory factor analysis (EFA) through SPSS 26.0 with the first sample was used to determine the internal factor structure of the whole questionnaire, which showed the expected congruency between items and dimensions. Then a confirmatory factor analysis (CFA) through Mplus 8.3 with the second sample was utilized to check model-data fit of the questionnaire, which showed a good fit between them. Convergent validity and discriminant validity of the questionnaire were also verified. The resulting questionnaire emerged as a useful tool for carrying out nationwide studies on digital skills in higher education generally or in different disciplines specifically in China in the future.

How we continue bonds with deceased persons: The proximity-seeking behavior scale

Continuing bonds is a multifaceted process, encompassing perceptions, beliefs, illusions and hallucinations, and overt behaviors. We developed the Proximity-Seeking Behavior Scale (PSBS) to assess overt behavior to continue bonds with the deceased person. We had 694 bereaved adults complete an online survey. Exploratory and confirmatory factor analyses yielded a one-factor model for PSBS items. PSBS reliability was good. PSBS scores correlated positively with rumination and yearning, feeling connected to the deceased person, and prolonged grief and depression symptoms. The PSBS appears a reliable and valid instrument to assess proximity-seeking behaviors.

Fear of hypoglycemia in children with type 1 diabetes and their parents: Validation of the Italian version of the Hypoglycemia Fear Survey for Children and for Parents

BACKGROUND

Currently, Italian versions of the Hypoglycemia Fear Survey for Children (CHFS) and for Parents (PHFS) quantifying Fear of Hypoglycemia (FoH) in pediatric diabetes are not available.

OBJECTIVE

To validate the Italian version of the CHFS and PHFS.

SUBJECTS AND METHODS

One hundred and seventy-four children with type 1 diabetes aged 6-18 and 178 parents completed the CHFS and PHFS, the PedsQL 3.0 Diabetes module and the KIDSCREEN-10. Internal consistency was good (α = 0.85 for CHFS, α = 0.88 for PHFS); validity was supported by correlations of CHFS total score (CHFS-T r = -0.50; p < 0.001, CI = -0.62 to -0.35) and Worry subscale (CHFS-W r = -0.49; p < 0.001, CI = -0.62 to -0.32) with measures of health-related quality of life (QoL), which were not related to PHFS scores. Factor analyses justified the structure and the separate scoring of Behavior and Worry subscales. Children's age was negatively correlated with CHFS-T (r = -0.16; p = 0.03, CI = -0.36 to 0.00), CHFS-W (r = -0.29; p = 0.02, CI = -0.39 to -0.07), PHFS-T (r = -0.20; p = 0.006, CI = -0.35 to -0.04), PHFS-B (r = -0.30; p = 0.001, CI = -0.43 to -0.17). Mean (SD) item scores of CHFS-T (1.47 ± 0.56 vs. 1.27 ± 0.57; p < 0.05) and CHFS-W (1.20 ± 0.73 vs. 0.96 ± 0.68; p < 0.05) were higher in children with HbA1c ≥7.5%. Higher levels of distress for upsetting hypoglycemia were associated with lower child's QoL scores as perceived by children (Peds-QL: 72.6 ± 12.8 vs. 80.4 ± 11.9; p < 0.001) and parents (Peds-QL: 70.6 ± 13.8 vs. 75.8 ± 12.9; p < 0.05).

CONCLUSION

The Italian version of CHFS and PHFS appears to be a valid measure to assess FoH in clinical practice and factor analysis supports separate scoring for the Worry and Behavior subscales.

Validity and Reliability of the Baby and Child Eating Behavior Questionnaire, Toddler Version (BEBQ-Mex and CEBQ-T-Mex) in a Low Sociodemographic Sample Recruited in a Mexican Hospital

The objective of this study was to validate and measure the internal reliability of the Baby and Child Eating Behavior Questionnaires for Toddlers (BEBQ-Mex and CEBQ-T-Mex), that evaluate appetitive trait (ATs). Mothers recruited from a public hospital in Guadalajara, Mexico, completed the BEBQ-Mex or CEBQ-T-Mex along with information on sociodemographic characteristics. Internal reliability of the BEBQ-Mex was sufficient for Food Responsiveness (FR) (Cronbach α = 0.82), while Enjoyment of Food (EF) and Satiety Responsiveness (SR) showed poor reliability (α = 0.56) and Slowness in Eating (SE) had unacceptable reliability (a = 0.36). All reliability values for the CEBQ-T-Mex were acceptable (>0.70), except for SE (α = 0.64). Confirmatory factor analysis (CFA) revealed an adequate model fit for the BEBQ-Mex, except the SE subscale. CFA for the CEBQ-T-Mex confirmed the six-factor structure. Mothers of a low sociodemographic background were unable to recognize their infants' ATs; the BEBQ-Mex partly met the criteria for validity and reliability. Mothers from similar sociodemographic characteristics were more able to recognize the ATs of their toddlers than their infants; the CEBQ-T-Mex was found to be a valid and reliable tool. Findings support the need to help mothers' ability to recognize their infants' ATs, which have been previously associated with weight and growth.

Development and criterion validity of the COVID-19 anxiety and fear assessment scale: a cross sectional study

BACKGROUND

The emergence of the new severe acute respiratory syndrome coronavirus 2, which causes COVID-19 disease, has been a major public health challenge and an increase in the feeling of uncertainty of the population, who is also experiencing an increase in levels of anxiety and fear regarding the COVID-19 disease.

OBJECTIVE

The objective of the study was the construct and criterion validation of the Escala de evaluación de la Ansiedad y MIedo a COVID-19 (AMICO, for its acronym in Spanish) to measure both constructs in the general Spanish population.

METHODS

Descriptive study of psychometric validation. A field study was carried out to execute univariate and bivariate analyses, in addition to the exploratory and confirmatory factorial analysis of the scale. For the criteria validity study, the State-Trait Anxiety Inventory (STAI) and sensitivity and specificity values were calculated.

RESULTS

The study sample was composed of 1036 subjects over 18 years of age, who resided in Spain, where 56.3% were women with a mean age of 48.11 years (SD = 15.13). The study of construct validity reported two factors and 16 items, with a Cronbach's alpha value of 0.92. The scale was concurrently valid with the used gold standard and obtained sensitivity values of 90.48% and specificity values of 76%.

CONCLUSIONS

The AMICO scale is valid and reliable for assessing the level of anxiety and fear of COVID-19 in the adult Spanish population and is highly sensitive.

Validation of the Turkish version of the power of food scale in adult population

PURPOSE

The Power of Food Scale (PFS) is a tool for measuring the hedonic impact of food environments rich in palatable foods. The purpose of this study was to validate the Turkish version of PFS (PFS-Tr) in a large adult population.

METHODS

Data were obtained from 505 Turkish adults aged between 19 and 64 years. The PFS-Tr and Dutch Eating Behavior Questionnaire (DEBQ) were completed by all participants.

RESULTS

PFS-Tr compared with the original English version of PFS, items 5 and 13, which showed the highest error covariance under the food available factor. To provide general criteria, items 5 and 13 were removed. After these two items were removed, the Cronbach's alpha coefficient was 0.922 for PFS-Tr and Cronbach's alpha values for "food available", "food present", and "food taste" were found to be 0.849, 0.797, and 0.82, respectively. Besides, the Cronbach's alpha coefficient was 0.93 for DEBQ. In addition, a linear association was found between BMI and mean score of PFS-Tr with a model fit (R² = 0.02) and PFS-Tr was positively correlated with DEBQ (r 0.497 p < 0.001).

CONCLUSION

This is the first study that validates and reports the Turkish version of PFS and the results of our study show that PFS-Tr is a valid and reliable tool for determining the tendency for the hedonic hunger in Turkish adult population.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Individual differences in avoiding feelings of disgust: Development and construct validity of the disgust avoidance questionnaire

We developed and examined the construct validity of the Disgust Avoidance Questionnaire (DAQ) as a measure of people’s inclination to prevent experiencing disgust (disgust prevention) and to escape from the experience of disgust (disgust escape). In a stepwise item-reduction (Study 1; N = 417) using Exploratory Factor Analysis (EFA) based on a 4-subscale distinction (behavioral prevention, cognitive prevention, behavioral escape, cognitive escape), we selected 17 items from a pool of potential items. In order to incorporate the conceptual overlap between dimensions of disgust avoidance, focus (prevention vs. escape), and strategy (behavioral avoidance vs. cognitive avoidance), we specified an adapted model. In this model, we allowed each item to load on one type of dimension and one type of strategy, resulting in four overlapping factors (prevention, escape, behavioral avoidance, cognitive avoidance). Evaluation of this overlapping 4-factor model (Study 2; N = 513) using Exploratory Structural Equation Modeling (ESEM) and Confirmatory Factor Analysis (CFA) showed promising model fit indices, factor loadings, factor correlations, and reliability estimates for three of the four factors (prevention, behavioral avoidance, cognitive avoidance). Those three subscales also showed good convergent validity. In contrast, the results related to the escape factor may call the suitability of self-report to assess disgust escape into question. In light of the exploratory nature of the project, future examinations of the DAQ’s validity and applicability to more diverse samples are essential. A critical next step for future research would be to examine the DAQ’s criterion validity and the distinctive roles of the DAQ subscales in (clinical) psychological constructs and processes.

Designing a national model for assessment of nursing informatics competency

Background

Due to the need for informatics competencies in the field of nursing, the present study was conducted to design a psychometric instrument to determine the qualification of informatics competencies of employed nurses in educational care centers.

Methods

The questionnaire was made by reviewing existing scientific resources and assessment tools. Two hundred nurses were selected using simple random sampling. Structural equation modeling was used using the measurement model technique and the average variance was calculated. Linear structural relations (LISREL) software was used to test the assumptions and correlations of the model.

Results

Findings showed relatively good estimation in the fit of first-order measurement model. The informatics knowledge subscale with a determining rate of 0.90 had the greatest explanatory effect among the subscales and informatics skill with a determining rate of 0.67 and basic computer skill with a determining rate of 0.60 were observed. The second-order measurement model of fitness indicators showed that the three factors can well explain the multidimensional construct of informatics competency.

Conclusions

The designed tool can be used to develop educational strategies in relation to nursing students in the field of informatics and prepare them in the rich environment of information technology, which can be helpful in training nursing instructors.

Validation of the Death and Dying Distress Scale in patients with advanced cancer

BACKGROUND

Distress about dying and death is an important clinical and research outcome in advanced cancer. A 15-item Death and Dying Distress Scale (DADDS) measure has undergone preliminary validation, but full validation in a large sample has not previously been reported. We investigated its psychometric characteristics and responsiveness to a therapeutic intervention.

METHODS

This is a secondary analysis of baseline data obtained from a randomized controlled trial of psychotherapeutic intervention for patients with advanced cancer. Participants (n = 386) completed the DADDS, and measures of depression, anxiety, demoralization, quality of life (including preparation for end of life), spirituality, attachment security, and symptom burden.

RESULTS

A confirmatory factor analysis revealed factors related to "Finitude" and to "Dying." Both factors showed good internal consistency (Cronbach α = 0.861-0.949). DADDS scores were significantly higher in females, those with lower income and not working. Construct validity was demonstrated by a positive correlation between DADDS and demoralization (r = 0.569-0.679), and a negative correlation with preparation for the end of life (r = -0.475 to -0.678). At 6 months, intervention participants with moderate DADDS scores at baseline reported significantly lower DADDS scores on both factors compared to usual care.

CONCLUSIONS

The DADDS is a valid and brief two-factor measure that assesses distress related to the shortness of time and to the process of dying. The total and factor scores have utility in the clinical and research assessment of death-related distress in patients with advanced cancer.

Breast cancer screening beliefs questionnaire: psychometric properties of the Persian version

BACKGROUND

Valid and reliable instruments are needed to assess such beliefs, attitudes, and knowledge. This study aimed to translate Breast Cancer Screening Beliefs Questionnaire into Persian and evaluate its psychometric properties among Iranian women.

METHODS

In this methodological study, the twelve-item Breast Cancer Screening Beliefs Questionnaire was translated into Persian and filled out by 1256 Iranian women. Face, content, convergent, and discriminant validity were evaluated and exploratory and confirmatory factor analyses were performed for construct validity evaluation. Reliability was also evaluated through calculating Cronbach's alpha, McDonald's omega, Average inter-item correlation, and test-retest intraclass correlation coefficient and finally, composite reliability was estimated.

RESULTS

Three factors were extracted in factor analysis which included screening attitude, screening knowledge and perception, and screening practice. These factors explained 55.71% of the total variance of breast cancer screening beliefs. This three-factor model was confirmed in confirmatory factor analysis based on model fit indices (PCFI = 0.703, PNFI = 0.697, CMIN/DF = 2.127, RMSEA = 0.30, GFI = 0.980, AGFI = 0.998, and CFI = 0.991). Convergent and discriminant validity were also confirmed. Composite reliability and test-retest intraclass correlation coefficient were more than 0.7.

CONCLUSION

With a three-factor structure, the Persian Breast Cancer Screening Beliefs Questionnaire has acceptable validity and reliability and hence, can be used to evaluate Iranian women's breast cancer screening beliefs.

The Twin Relationship Questionnaire

Abstract. Twins’ relationships evoke critical dilemmas for parents and teachers regarding raising and educating their twins. The current study provides comprehensive psychometric information about the Twin Relationship Questionnaire (TRQ; Fortuna, Goldner, & Knafo, 2010 ) as examined in nine samples, using mothers’ and fathers’ reports on 1,560 pairs of twins, tested in five measurement points from age 3 to age 9. On half of the subsamples, we conducted principal component analyses (PCA), whereas on the other subsamples, we conducted confirmatory factor analyses (CFA). Five factors were found in the PCA and confirmed by the CFA: conflict, closeness, dependence, dominance, and rivalry. All scales showed adequate internal consistencies and corrected item-total correlations. Correlation matrixes between scales demonstrate a triad of conflict, rivalry, and dominance scales, as opposed to the dyad of closeness and dependence. As evidence for the TRQ’s reliability and validity, we report the degree of agreement between mothers and fathers, the 10-month stability of mothers’ reports, and the associations of the TRQ subscales with experimentally assessed prosocial behaviors between the twins at age 6.5, and with the twins’ reports on their closeness at age 11. The replication of the findings across ages and raters reinforces the reliability and validity of the questionnaire.

Psychometric properties and factor structure of the Korean version of the screen for child anxiety related emotional disorders (SCARED)

BACKGROUND

The aim of this study was to examine the psychometric properties of the Korean version of Screen for Child Anxiety Related Emotional Disorders (SCARED) on a sample of Korean youths and to examine the cross-cultural differences in adolescents' anxiety.

METHODS

Our study included 147 adolescents (ages 12-17, 92 girls), 93 with major depressive disorder and 54 as controls. Participants were evaluated using the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), SCARED, Child Behavior Checklist (CBCL), Disruptive Behavioral Disorder Scale (DBD) and Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS). Pearson's r and Cronbach's α values of the SCARED were calculated, and exploratory factor analysis was conducted.

RESULTS

The Korean SCARED scores were correlated with the total anxiety scores of K-SADS-PL (r = 0.74) and the CBCL anxious/depressed subscale scores (r = 0.35). Results showed a five-factor structure with good internal consistency, in which some items were loaded on different factors compared to previous studies.

CONCLUSIONS

The Korean SCARED demonstrated promising psychometric properties, and could be a valid scale for screening anxiety symptoms in primary care. The fact that different items comprised the factors may reflect the cultural difference between United States and Korea in experiencing anxiety.

Exploration of Factor Structure and Measurement Invariance by Gender for a Modified Shortened Adapted Social Capital Assessment Tool in India

Social capital is defined as the nature of the social relationship between individuals or groups and the embedded resources available through their social network. It is considered as a critical determinant of health and well-being. Thus, it is essential to assess the performance of any tool when meaningfully comparing social capital between specific groups. Using measurement invariance (MI) analysis, this paper explored the factor structure of the social capital of men and women measured by a modified Shortened Adapted Social Capital Assessment Tool (SASCAT-I) in rural Uttar Pradesh (UP), India. The study sample comprised 5,287 men (18-101 years) and 7,186 women (15-45 years) from 6,218 randomly selected households who responded to SASCAT-I during a community-level cross-sectional survey. Social capital factor structure was examined by both exploratory and confirmatory factor analysis (CFA), and MI across genders was investigated using multigroup CFA. While disregarding gender, four unique factors (Organizational Participation, Social Support, Trust, and Social Cohesion) represented the structure of social capital. The MI analysis presented a partial metric-invariance indicating factor loadings for Organizational Participation and Social Support were the same across genders. The gender-stratified analysis demonstrated that a four-factor solution was best fitted for both men and women. Men and women of rural UP interpreted social capital differently as the perception of Trust and Social Cohesion varied across genders. For any future applications of SASCAT-I, we recommend gender-stratified factor analysis to quantify social capital's measure, acknowledging its multidimensionality.

Meditation Experience and Mindfulness Are Associated with Reduced Self-Reported Mind-Wandering in Meditators—A German Version of the Daydreaming Frequency Scale

Mind-wandering or daydreaming can be described as spontaneous thoughts that are independent of the task at hand and the current sensory information. Mindfulness, defined as the ability to focus on the present moment with an accepting attitude towards the present experience, is considered to be the opposite of mind-wandering. We aimed at assessing how long-term meditation practice influences mind-wandering in everyday life and to which extent mind-wandering and self-reported aspects of mindfulness are conceptually linked. We first investigated the factorial structure of a German version of the Daydreaming Frequency Scale (DDFS) in a student population. Then we applied this version in meditators to a) investigate the relationship between meditation experience and reported levels of mind-wandering in daily life and b) explore how different facets of mindfulness, assessed with the Freiburg Mindfulness Inventory (FMI), relate to mind-wandering. Using a correlational design, we show that, among meditators, more meditation practice in years accounts for less self-reported mind-wandering in daily life. There was a negative association between mindfulness (FMI) and mind-wandering (DDFS). Our results provide evidence for clarifying the relationship between, meditation experience, mindfulness and mind-wandering and further validate the use of the FMI as a sensitive tool for assessing a two-factor structure of mindfulness.

Thai adaptation and reliability of three versions of the Barratt Impulsiveness Scale (BIS 11, BIS-15, and BIS-Brief)

Long, short, and brief versions of the Barratt Impulsiveness scale (BIS-11, BIS-15, and BIS-Brief) were tested in an adult Thai population. The BIS-11T and BIS-15T were translated, back-translated, and administered to a non-clinical population (n = 305) of native Thai speakers who returned 2 weeks later for re-test. BIS-Brief-T psychometrics were calculated post-hoc. Impulsivity scores were normally distributed for the BIS-11T and BIS-15T, but not BIS-Brief-T. Excellent internal consistency was observed, with Cronbach's alpha coefficients above 0.80 for all translated instruments: BIS-11T (α = 0.86), BIS-15T (α = 0.81), BIS-Brief-T (α = 0.81). A total of 260 participants completed both instruments (85%), with test-retest reliability exceeding r = 0.81. All three instruments were highly correlated (r = 0.83-0.89). Confirmatory factor analysis supports a three factor structure (attention, motor, non-planning) for BIS-15T and two factor structure for BIS-11T. BIS scales can support measurement of a range of impulsivity scores in an adult Thai population, though predictive validity of these scales remains unexplored.

Examining the dimensionality of the Fear of Cancer Recurrence Inventory

OBJECTIVE

Fear of cancer recurrence (FCR) is a common concern among cancer survivors, and the Fear of Cancer Recurrence Inventory (FCRI) is a frequently used measure to assess FCR. Given that the dimensionality of FCR has received recent debate, the overall goal of this secondary analysis was to re-examine the dimensionality of the FCRI using confirmatory factor analyses (CFA) to compare models of FCR, using data from a large sample of cancer survivors.

METHODS

Three models of FCR (including unidimensional and multidimensional models of the FCRI) were informed by the literature and proposed a priori. Separate CFAs were conducted to test the fit of each model to the data, and models with acceptable fits were compared.

RESULTS

Of all the tested FCR models, a multidimensional first-order model aligned with the originally developed 7-subscale FCRI revealed the best fit to the data (χ²  = 3359.135, P < .0001, df = 795, RMSEA = 0.057 [0.055, 0.059], CFI = 0.897, TLI = 0.888). When this 7-factor structure was loaded onto a single, second-order factor of overall FCR, the model fit statistics were slightly poorer (χ²  = 3459.632, P < .0001, df = 807, RMSEA = 0.058 [0.056, 0.060], CFI = 0.893, TLI = 0.886). However, the difference between the models was significant (chi-square difference = 103.142, P < .0001, df = 12) indicating that the first-order model was a better fit to the data.

CONCLUSIONS

These results align with empirical and theoretical literature that supports the use of the FCRI as a multidimensional scale. Implications of results are discussed in light of FCR conceptualization and measurement.

Functional equivalence and validity of religiousness indicators in cross-cultural comparative surveys

Cross-cultural comparative surveys have become an important tool to investigate social attitudes across different countries. However, this methodology is confronted with a number of challenges. One of the core problems is the functional equivalence of the concepts and indicators used. In this article, we study this problem in regard to the investigation of religiousness in three prominent surveys, the World Value Survey, the International Social Survey Programme, and the Religion Monitor. Our contribution starts with the fundamental question of the intercultural meaning of single items that are commonly used for the measurement of religiosity. From the comparison of the linguistic formulation of these items in different languages and across the three surveys, we obtain evidence of whether the concept of religiousness has the same meaning in different countries and to what extent the results depend on the formulation of the item. Subsequently, we use confirmatory factor analysis to test whether two religiousness scales derived from the International Social Survey Programme are structurally equivalent across countries. In the final step, we proceed to a substantive analysis, comparing religiousness scales from the three surveys in order to examine to what extent scales that claim to measure the same construct in fact produce similar results when applied to different countries. Our findings suggest that the paradigm of “asking the same questions” is difficult to apply and problematical with respect to some core indicators of individual religiousness and that questionnaires that are based on the Western concept of religion will lead to biased results when applied to worldwide cross-cultural comparison.

Addressing challenges of validity and internal consistency of mental health measures in a 27- year longitudinal cohort study - the Northern Swedish Cohort study

Background

There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today’s standard) from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort.

Methods

All pupils in the last year of compulsory school in Luleå in 1981 (n = 1083) form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981) until the age of 43 (in 2008). We created and tested the following composite measures from self-reports at each follow-up: depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time.

Results

As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions) are likely to have acceptable factorial invariance as well as internal consistency over time.

Conclusions

Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research.