Scale construction utilising the Rasch unidimensional measurement model: A measurement of adolescent attitudes towards abortion

The Legality of Labor and Perceptions of Deservingness of Rights and Services for Sex Workers

Access to social services like healthcare, education, housing, and welfare are integral to creating an equitable society. While many populations inherently benefit from these services, sex workers are often denied these rights and services because of the nature of their work. The purpose of this study was to examine perceptions of deservingness of sex workers for a wide range of rights and services. This study distinguished those attitudes across legal and illegal forms of sex work, identified attitudinal and demographic correlates associated with those perceptions, and examined potential interactions between respondents' gender and age. Participants included a nationwide sample of adults from the USA (n = 549). Results indicated that participants perceived legal sex work as more deserving of rights and services compared to illegal sex work. Perceptions of deservingness were associated with attitudes toward abortion, LGBTQ+ rights, and perceptions of government legitimacy. Overall, older individuals were less willing to extend rights and services to sex workers and women were more likely to perceive sex workers as deserving of rights and services. There was an interaction between gender and age. For illegal sex work, gender differences in perceptions converged as participants aged, whereas for legal sex work, gender differences were exacerbated with age, with men reporting particularly restrictive perceptions of deservingness.

Evaluation of the German Version of the Keratoconus Outcomes Research Questionnaire

PURPOSE

To translate, validate, and evaluate the psychometric properties of the German version of Keratoconus Outcomes Research Questionnaire (KORQ).

METHODS

This prospective study included 3 phases. In phase 1, the KORQ was translated in a standardized way; in phase 2, Rasch validation was performed; in phase 3, the validated questionnaire was evaluated in a separate patient cohort. All patients answered the German KORQ. Scheimpflug imaging (Pentacam) and optical coherence tomography scans (MS-39) were conducted. Corneal imaging measurements were correlated with patient-reported outcome measures.

RESULTS

After standardized translation, 100 patients self-administered the German KORQ. Rasch analysis was conducted for psychometric testing of the KORQ. Based on the results of the Rasch analysis, the original German version of the KORQ was modified and any items showing a misfit were excluded. This resulted in a new shortened version of the KORQ, which was evaluated in 30 patients. The revised German KORQ met the criteria of Rasch analysis and showed excellent internal consistency reliability and convergent validity. The correlation between the KORQ score and various clinical measurements was examined using Spearman correlation. A significant moderate correlation was observed between the D (r = 0.237; P = 0.006) and Kmax (r = 0.162; P = 0.065) values of Pentacam. Inverse correlations were observed for thinnest pachymetry measured with MS-39 (r = -0.167; P = 0.058) and best corrected visual acuity (r = -0.210; P = 0.016).

CONCLUSIONS

The shortened German KORQ met the assumptions of the Rasch model and displayed satisfactory psychometric properties. The German KORQ could be adopted as a powerful patient-reported outcome measures tool for German-speaking patients with keratoconus in the future.

Validation of a new glucocorticoid-specific Patient-Reported Outcome Questionnaire (the Steroid PRO)

OBJECTIVES

Glucocorticoids used in the treatment of inflammatory rheumatic conditions can impact on health-related quality of life. An underpinning qualitative study developed a long-list of candidate items for a treatment-specific patient-reported outcome (PRO) measure. The objective of this paper is to determine scale structure and psychometric properties of the Steroid PRO.

METHODS

A cross-sectional survey of adults from the UK, USA, Australia and New Zealand, taking glucocorticoids for a rheumatic disease. Initial survey collected demographics, clinical information, 40 Steroid PRO candidate items and EuroQol-5 Dimensions- 5 levels (EQ-5D-5L). Follow-up, 3-5 days later, collected Steroid PRO candidate items and a condition-change ('transition') question. Analysis included Rasch measurement model, exploratory factor analysis (EFA), and hypothesis testing for discriminative validity, convergence validity and test-retest reliability.

RESULTS

Total responses 946: UK n=743 (79%); USA n=139 (15%); Australia/New Zealand n=64 (7%); mean age 57.6 (SD=13.6); 833 (88%) women. Participants with inflammatory arthritis n=197 (21%), connective tissue disease and/or vasculitis n=402 (42%), giant cell arteritis and/or polymyalgia rheumatica n=347 (37%). Twenty-five items were removed due to lack of fit to Rasch model. Of the remaining items, EFA suggested four subscales: Social impact (4 items); Impact on appearance (3 items); Psychological impact (5 items); Treatment concerns (3 items). Rasch modelling supported a four-subscale structure and total score, confirming construct validity and reliability. Hypothesis testing confirmed discriminant and convergence validity. Intraclass correlation coefficient (total score) was 0.809 demonstrating excellent (test-retest) reliability.

CONCLUSIONS

The Steroid PRO is a 15-item, valid and reliable scale for measuring the impact of glucocorticoid therapy in people with rheumatic diseases.

Rasch analyses of the Quick Inventory of Depressive Symptomatology Self-Report in neurodegenerative and major depressive disorders

Background

Symptoms of depression are present in neurodegenerative disorders (ND). It is important that depression-related symptoms be adequately screened and monitored in persons living with ND. The Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) is a widely-used self-report measure to assess and monitor depressive severity across different patient populations. However, the measurement properties of the QIDS-SR have not been assessed in ND.

Aim

To use Rasch Measurement Theory to assess the measurement properties of the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) in ND and in comparison to major depressive disorder (MDD).

Methods

De-identified data from the Ontario Neurodegenerative Disease Research Initiative (NCT04104373) and Canadian Biomarker Integration Network in Depression (NCT01655706) were used in the analyses. Five hundred and twenty participants with ND (Alzheimer's disease or mild cognitive impairment, amyotrophic lateral sclerosis, cerebrovascular disease, frontotemporal dementia and Parkinson's disease) and 117 participants with major depressive disorder (MDD) were administered the QIDS-SR. Rasch Measurement Theory was used to assess measurement properties of the QIDS-SR, including unidimensionality and item-level fit, category ordering, item targeting, person separation index and reliability and differential item functioning.

Results

The QIDS-SR fit well to the Rasch model in ND and MDD, including unidimensionality, satisfactory category ordering and goodness-of-fit. Item-person measures (Wright maps) showed gaps in item difficulties, suggesting poor precision for persons falling between those severity levels. Differences between mean person and item measures in the ND cohort logits suggest that QIDS-SR items target more severe depression than experienced by the ND cohort. Some items showed differential item functioning between cohorts.

Conclusion

The present study supports the use of the QIDS-SR in MDD and suggest that the QIDS-SR can be also used to screen for depressive symptoms in persons with ND. However, gaps in item targeting were noted that suggests that the QIDS-SR cannot differentiate participants falling within certain severity levels. Future studies would benefit from examination in a more severely depressed ND cohort, including those with diagnosed clinical depression.

A psychometric evaluation of Chinese chronic hepatitis B virus infection-related stigma scale using classical test theory and item response theory

Purpose

To validate the hepatitis B virus infection-related stigma scale (HBVISS) using Classical Test Theory and Item Response Theory in a sample of Chinese chronic HBV carriers.

Methods

Feasibility, internal consistency reliability, split-half reliability and construct validity were evaluated using a cross-sectional validation study (n = 1,058) in Classical Test Theory. Content validity was assessed by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. The Item Response Theory (IRT) model parameters were estimated using Samejima's graded response model, after which item response category characteristic curves were drawn. Item information, test information, and IRT-based marginal reliability were calculated. Measurement invariance was assessed using differential item functioning (DIF). SPSS and R software were used for the analysis.

Results

The response rate reached 96.4% and the scale was completed in an average time of 5 min. Content validity of HBVISS was sufficient (+) and the quality of the evidence was high according to COSMIN criteria. Confirmatory factor analysis showed acceptable goodness-of-fit (χ ²/df = 5.40, standardized root mean square residual = 0.057, root mean square error of approximation = 0.064, goodness-of-fit index = 0.902, comparative fit index = 0.925, incremental fit index = 0.926, and Tucker-Lewis index = 0.912). Cronbach's α fell in the range of 0.79-0.89 for each dimension and 0.93 for the total scale. Split-half reliability was 0.96. IRT discrimination parameters were estimated to range between 0.959 and 2.333, and the threshold parameters were in the range-3.767 to 3.894. The average score for test information was 12.75 (information >10) when the theta level reached between-4 and + 4. The IRT-based marginal reliability was 0.95 for the total scale and fell in the range of 0.83-0.91 for each dimension. No measurement invariance was detected (d-R ² < 0.02).

Conclusion

HBVISS exhibited good feasibility, reliability, validity, and item quality, making it suitable for assessing chronic Hepatitis B virus infection-related stigma.

Design and study of psychometric properties of the Community Attitude to Abortion Scale (CAAS) with the Chilean population: Autonomy and Stigma

Introduction

Attitudes toward abortion are related to structural, cultural, and direct gender-based violence. This violence can affect women's mental, physical and reproductive health. Therefore, it is essential to know the nature of community attitudes toward abortion. Since we currently do not have an instrument that measures attitudes towards abortion in Chile, we set the objective of this study to design the Community Attitude to Abortion Scale (CAAS) and analyze its psychometric properties in a Chilean community population.

Methods

This work is an instrumental design study. Using a sampling of panelists by sociodemographic quotas, we obtained a sample of 1,223 participants with a mean age of 36.7 years (SD = 13.56).

Results

As a result, we obtained a scale of 18 items and two correlated factors, Autonomy and Stigma. This structure fits better as an Exploratory Structural Equations Model (ESEM). Both factors have excellent internal consistency. In addition, we obtained evidence of concurrent and discriminant validity: The scores on the factors of the Universal Religious Involvement Scale (I-E12) correlated negatively with Autonomy and positively with Stigma; participants with low levels of identification with a right-wing political orientation, with high levels of identification with a leftwing, pro-feminist, pro-LGBTQ +, and pro-euthanasia political orientation, obtained higher mean scores on Autonomy and lower on Stigma.

Discussion

The CAAS is an adequate tool for use with the Chilean community population, with evidence of consistency and validity. La CAAS is the first tool to measure attitudes to abortion in this country.

Rasch analysis and differential item functioning of English language anxiety scale (ELAS) across sex in Egyptian context

BACKGROUND

English language anxiety (ELA) is a prevalent phenomenon in language education. It is one of the most commonly investigated non-linguistic variables in studies of language learning. Accordingly, numerous studies have paid great attention to the factors leading to FLA.

METHODS

As instruments of ELA have not been subjected to a rigorous test of item response theory (IRT), this study conducted such analysis using the Rasch rating scale model. ELAS scale developed using classical testing theory (CTT), which consists of 32 items measuring four sub-scales (listening, speaking, reading and writing anxiety), was analysed using IRT. WINSTEPS software and SPSS version 26 were used to examine the psychometric properties, sex differential item functioning (DIF) and Rasch analysis of the ELAS in the Egyptian context. A total of 604 participants were recruited for data collection.

RESULTS

The main findings indicated that the scale yielded a good approximation of Rasch assumptions and appears to be a valid and reliable tool. DIF was computed using the Mantel-Haenszel (MH) method and Welch's t-test, which indicated that no sex bias was detected for any item of the ELAS.

CONCLUSIONS

This paper presents a promising ELA instrument characterized by adequate validity, reliability and objectivity in addition to potential for precise use in comparison between males and females because it is invariant across sex.

Measurement Properties of the Health Literacy Questionnaire in the Understanding Multiple Sclerosis Massive Open Online Course Cohort: A Rasch Analysis

Background:

Objective:

Methods:

Key Results:

Conclusion:

Plain Language Summary:

Adaptation and validation of a computer-assisted language learning attitude questionnaire in a Vietnamese EFL context: A comparison between online and paper modes of administration

The article reports on the validation of a computer-assisted language learning (CALL) attitude questionnaire and discusses differences between online and paper modes of administration, drawing on a sample of 1,769 Vietnamese undergraduates. Exploratory and confirmatory factor analyses were conducted to explore and assess the factor structure of the CALL instrument and specify the equivalence between the two versions of the questionnaire. Rasch model analysis was used to evaluate the overall fit and construct uni-dimensionality of the instrument. The findings of the study suggested a six-factor structure for the adapted questionnaire as well as both reliability and validity in the Vietnamese context. No significant difference was found between the two modes of administration as regards the construct and item levels of the questionnaire, although the paper-version was superior to the online version according to results from the Rasch model analysis. Hence, the instrument can be used in online and paper modes to measure Vietnamese tertiary students’ attitudes to the integration of technology into language learning. The study finds that further research is called for if the two modes of administration of the questionnaire are used in other contexts for teaching English as a foreign language (EFL).

Development of novel clinical examination scales for the measurement of disease severity in Creutzfeldt-Jakob disease

OBJECTIVE

To use a robust statistical methodology to develop and validate clinical rating scales quantifying longitudinal motor and cognitive dysfunction in sporadic Creutzfeldt-Jakob disease (sCJD) at the bedside.

METHODS

Rasch analysis was used to iteratively construct interval scales measuring composite cognitive and motor dysfunction from pooled bedside neurocognitive examinations collected as part of the prospective National Prion Monitoring Cohort study, October 2008-December 2016.A longitudinal clinical examination dataset constructed from 528 patients with sCJD, comprising 1030 Motor Scale and 757 Cognitive Scale scores over 130 patient-years of study, was used to demonstrate scale utility.

RESULTS

The Rasch-derived Motor Scale consists of 8 items, including assessments reliant on pyramidal, extrapyramidal and cerebellar systems. The Cognitive Scale comprises 6 items, and includes measures of executive function, language, visual perception and memory. Both scales are unidimensional, perform independently of age or gender and have excellent inter-rater reliability. They can be completed in minutes at the bedside, as part of a normal neurocognitive examination. A composite Examination Scale can be derived by averaging both scores. Several scale uses, in measuring longitudinal change, prognosis and phenotypic heterogeneity are illustrated.

CONCLUSIONS

These two novel sCJD Motor and Cognitive Scales and the composite Examination Scale should prove useful to objectively measure phenotypic and clinical change in future clinical trials and for patient stratification. This statistical approach can help to overcome obstacles to assessing clinical change in rapidly progressive, multisystem conditions with limited longitudinal follow-up.

Validation of the Moral Reasoning Questionnaire against Rasch Measurement Theory

To support teachers in facilitating students’ moral reasoning development as specified within the Singapore Ministry of Education Character and Citizenship Education curriculum, the Moral Reasoning Questionnaire (MRQ) was developed and underwent preliminary validation. Based upon expert reviews, cognitive interviews and a classical test theory-based factor analytic approach, the development and preliminary validation found evidence (i.e., content appropriateness, response processes and internal structure) to support the validity and reliability of the MRQ. This study aims to extend the validation by examining the purported MRQ items and scale at a deeper level on the Rasch Measurement Theory, given that it is the only model that presents appropriate properties of interval measurement on a log-linear scale. The Rasch analysis found anomalies including differential item functioning and disordered thresholds in the initial set of items. Upon remediation and a second Rasch analysis, the MRQ responses were consistent with that expressed by the Rasch model (i.e., an item with an endorsability higher than what a respondent would tend to endorse would have a lower probability of being endorsed than an item exhibiting an endorsability below what that respondent would tend to endorse) and hence, there was sufficient evidence to support measurement invariance, and that MRQ scores could be concluded to characterise persons invariantly across a continuum.

Attitudes towards abortion in male and female adolescents with diverse sexual and pregnancy experiences: a cross-sectional study

Background Research focused on adolescents' attitudes towards abortion is limited, and validated scales are not routinely used. A greater understanding of adolescents' attitudes towards abortion could better inform the sexuality education strategies targeted at this age group.

METHODS

A cross-sectional survey was completed by 1470 adolescents (437 males, 1033 females) aged 12-19 years and living in Perth, Australia. Participants were recruited from secondary schools, antenatal clinics and termination clinics to capture varying experiences of sexual activity and pregnancy. Survey items investigated abortion attitudes, sexual behaviour and pregnancy history alongside other demographic and psychosocial factors. Analyses included comparative means and adjusted linear regressions.

RESULTS

Sexually active participants (n = 554) and females reporting a previous abortion (n = 196) held more supportive attitudes towards abortion (P < 0.001 for both). Among sexually active females, more supportive attitudes were held by those reporting a previous abortion (β = 2.60, 95% confidence interval 0.93-4.27, P = 0.002), later age (≥16 years) at first vaginal intercourse (P < 0.001), use of oral contraception at last sex (P = 0.029), previous condom use (P < 0.001) and/or three or more oral sex partners in the previous 12 months (P = 0.005). For sexually active males, more supportive attitudes were reported by those whose female partners had used oral contraception at last sex (P = 0.013) or ever (P = 0.017). Multivariable analyses indicated that other correlates, including risky sexual behaviour, had minimal or no effect on attitudes.

CONCLUSIONS

Adolescents' attitudes towards abortion appear to be influenced by their ability to personalise and contextualise the effect of a pregnancy. Associations between less-effective contraceptive use and reduced support for abortion may be explained by a diminished perceived risk of parenthood. Educational strategies should acknowledge and respond to differences in abortion attitudes as adolescents commence and navigate sexual relationships.

Development of Attribution-Based Scales Associated With Proactive, Reactive, and Acquisitive Offending

This study outlines the development of attribution scales to assess the antecedent processes of proactive, reactive, and acquisitive offending. Empirical keying, internal consistency, and item performance were the three test development strategies. Six samples (total N = 1,527) from parole, university, probation, and prison were used. The Proactive scale (10 items) reflected coldness and distance between offender and victims, the Reactive scale (10 items) reflected recklessness and excuses for violent behavior, and the Acquisitive scale (15 items) reflected less negative views of crime and choices. Convergent and discriminant validities were demonstrated by the Proactive scale stronger correlations with planning items, the Reactive scale stronger correlations with affective and person-based items, and the Acquisitive scale stronger correlations with other-based motives. Linking Proactive, Reactive, and Acquisitive scales to an offense provides psychological meaning that can benefit assessment and interventions.

An Assessment of the Psychometric Properties of the GHQ-12 in an English Population of Autistic Adults Without Learning Difficulties

Valid and reliable tools to measure mental health are a key requirement to developing a robust evidence base on mental health difficulties and autism. There are several reasons why mental health measures developed for the neurotypical population may not be valid and reliable when used with autistic adults. Using data collected from a national evaluation of community-based, specialist autism provision in England, this study assessed the psychometric properties of the General Health Questionnaire (GHQ-12) in a population of autistic adults without learning difficulties. We examined the measure’s acceptability, reliability and internal construct validity. The GHQ-12 was found to have good psychometric properties in this population. This provides first evidence that this measure can be used with autistic adults without LD.

Rasch Analysis of Work-Family Conflict Scale Among Chinese Prison Police

As a special group of police officer, prison police have to endure more work stress and have significant work-family conflict, which may lead to more physical and mental health problems and need to be noticed by the society. The Work-Family Conflict Scale (WFCS) is a brief self-report scale that measures the conflict that an individual experiences between their work and family roles and the extent they interfere with one another. However, there is limited data on the scale's psychometric properties. The aim of this study was to examine the dimensionality and reliability of the Chinese version of the WFCS. The study sample was made up of a total of 717 Chinese prison police (64.7% male, M = 41.73 years, SD = 8.30 years). The Rasch Rating Scale Model (RSM) was used to determine the latent structure and estimate the quality of items and reliability of scale. The principle component analysis (PCA) showed that the assumption of unidimensionality was fulfilled. The infit and outfit mean square (MNSQ) statistics (0.84-1.47) were of a reasonable range, and point-measure correlations (0.64-0.79) indicted good model fit of each item. The item-person separation and reliability indices both met psychometric standards, illustrating good reliability. The person-item map indicated acceptable fit of items and persons, suggesting an alignment between persons and items. In addition, no evidence emerged of differential item functioning across different gender groups. Overall, the WFCS has good reliability and validity, and can be used to accurately evaluate the level of work-family conflict in Chinese prison police.

Language equivalence of the modified falls efficacy scale (MFES) among English- and Spanish-speaking older adults: Rasch analysis

BACKGROUND

To investigate item-level measurement properties of the Modified Falls Efficacy (MFES) Scale among English- and Spanish-speaking urban-dwelling older adults as a means to evaluate language equivalence of the tool.

METHODS

Secondary analysis of survey data from 170 English (n = 83) and Spanish (n = 87) speaking older adults who reported to the emergency department of a quaternary medical center in New York City between February 2010 and August 2011. The Rasch rating scale model was used to investigate item statistics and ordering of items, item and person reliability, and model performance of the Modified Falls Efficacy Scale.

RESULTS

The Modified Falls Efficacy Scale, for English- and Spanish-speakers, demonstrated acceptable fit to the Rasch model of a unidimensional measure. While the range of the construct is more limited for the Spanish group, the interval between tasks are much closer, reflecting little to no construct under-representation.

CONCLUSION

There is rationale for continued testing of a unidemsional English- and Spanish-MFES among urban community-dwelling older adults. Large-scale international studies linking the unidemsional MFES to patient outcomes will support the validity of this tool for research and practice.

Rasch analysis of the PANSS negative subscale and exploration of negative symptom trajectories in first-episode schizophrenia - data from the OPTiMiSE trial

The observed heterogeneity in negative symptom treatment response may be partly attributable to inadequate measurement tools or limitations in methods of analysis. Previous Item Response Theory models of the Positive and Negative Syndrome Scale (PANSS) have only examined samples of chronic patients and with mixed results. We examined the scalability of the negative subscale embedded in the PANSS and subsequently explored negative symptom trajectories across four weeks of amisulpride treatment. Data were derived from the OPTiMiSE trial comprising 446 patients with first-episode schizophrenia or schizophreniform disorder. Using the Rasch Model to examine psychometric properties of the PANSS negative subscale, we found that the composite score across items was not an adequate measure of negative symptom severity. Consequently, we chose an exploratory statistical approach involving Principal Component Analysis which yielded one significant component clustering into two significant symptom trajectories: 1) Subtle but constant decrease in negative symptom severity (N = 323; 72%), and 2) symptom instability across visits (N = 19; 4%). Explorative analytic methods as presented here may pave the way for more efficient and sensitive methods of analyzing negative symptom response in research and in clinical practice.

Validation of data using RASCH analysis in a tool measuring changes in critical thinking in nursing students

BACKGROUND

In Australia there is no national examination to assess student competency with respect to critical thinking skills on graduation from undergraduate registered nurse program.

OBJECTIVES

To describe the use of Rasch analysis for the validation of a tool that measures critical thinking in nursing students in Australia.

DESIGN

A cross sectional survey was used to assess students' critical thinking.

SETTINGS

One Australian university.

PARTICIPANTS

Seventy-four first year and third year nursing students participated in the project.

METHODS

Nursing students at one university were requested to undertake a multiple choice question survey to determine their level of critical thinking. The survey tool was validated using Rasch analysis software.

RESULTS

Rasch analysis enabled identification of the difficulty of each question, enabling the assessment to identify difference between students and for each student cohort. The use of Rasch analysis demonstrated marked differences in the students' critical thinking abilities, showing higher levels of critical thinking for third year students with greater ability to answer the more difficult questions.

CONCLUSION

Rasch analysis enables the matching of test questions to the cognitive skill level of students, and is a useful tool for validating multiple choice questionnaires. Use of this method of analysis can provide a robust assessment in which questions are matched to the level of the learner and enable differentiation between high and low achieving students.

Validation of the Indonesian version of the Safety Attitudes Questionnaire: A Rasch analysis

Introduction

Safety climate, which provides a snapshot of safety culture, is rarely measured in Indonesian healthcare organisations because there are no validated surveys that can be administered in its native language, Bahasa Indonesia. The objectives of this study were to translate and linguistically adapt the Safety Attitudes Questionnaire into Bahasa Indonesia, and investigate the internal construct validity and reliability of the translated survey.

Methods

The Safety Attitudes Questionnaire was translated into Indonesian language through forward and backward translation. The internal construct validity and reliability of the translated survey was assessed using Rasch analysis which examines overall model fit, unidimensionality, response format, targeting, internal consistency reliability and item bias.

Results

A total of 279 nurses (response rate 82%) completed the Indonesian version of the Safety Attitudes Questionnaire. Most respondents were Division 2 registered nurses (n = 209; 75%), female (n = 174; 62%), and aged less than 30 years (n = 187; 67%). All six domains of the Indonesian version of the Safety Attitudes Questionnaire demonstrated unidimensionality (t-test less than 0.05 threshold value). However, suboptimal targeting (ceiling effect) was observed in all domains, and had at least one misfitting item (item fit residual beyond ±2.5) Item bias was also evident in most domains.

Conclusion

This study has translated and validated an Indonesian version of the Safety Attitudes Questionnaire for the first time. Whilst there was general support to sum items to obtain domain scores, further work is required to refine the response options as well as the wording and number of items in this survey to improve its overall measurement properties.

A Rasch Analysis Validation of the Maslach Burnout Inventory-Student Survey with Preclinical Medical Students

Construct: Burnout is a psychological construct characterized by emotional exhaustion that arises from an excess of physical, emotional, and social demands over an extended period. Symptoms of burnout include withdrawal or disengagement from work. Burnout has become an important public health concern due to its association with severe negative consequences across numerous professions.

BACKGROUND

The most widely used instrument for measuring burnout is the Maslach Burnout Inventory (MBI). An adaptation of the MBI, the MBI-Student Survey (MBI-SS), was developed for college students. The MBI-SS consists of 15 items covering 3 domains of burnout: exhaustion, cynicism (CY), and professional efficacy (PE). Although studies have confirmed the validity of the MBI-SS for college student populations, studies of its use with medical students are limited. The purpose of this study was to employ the Rasch model to examine the psychometric properties of the MBI-SS when used with a population of preclinical medical students.

APPROACH

Data were collected from 787 medical students who answered the MBI-SS at the conclusion of their 1st year. A maximum likelihood exploratory factor analysis for ordinal data confirmed the hypothesized three factor structure of the MBI-SS. Subsequently, a Rasch analysis was employed to further evaluate the measurement properties of MBI-SS. We used the Rasch Rating Scale model to investigate the extent to which the three MBI subscales conformed to proper measurement characteristics, including comprehensive coverage of person ability and item difficulty along the latent continuum.

RESULTS

Most of the 15 items on the MBI-SS effectively fit the Rasch Rating Scale Model, with minimal measurement error. Respondents effectively used the full range of the rating scale for all 15 items. Two subscales (PE and CY) contained items that were difficult for respondents to endorse, resulting in significant gaps along the measurement continuum. The CY subscale exhibited a slight floor effect. The 3 subscales showed good person reliability, good real-item reliability, and good person separation.

CONCLUSIONS

The Rasch analysis confirmed that the MBI-SS works well for measuring burnout among preclinical medical students. However, the Rasch analysis was able to identify that additional items are needed to improve the performance of MBI-SS. New items would be targeted at reducing the floor effect for the CY subscale and filling the other gaps in measurement along the latent continuum for the PE and CY subscales.

First reported implementation of a German-language progress test in an undergraduate dental curriculum: A prospective study

INTRODUCTION

Progress testing is a special form of longitudinal and feedback-oriented assessment. Even though well established in human medical curricula, this is not the case in dental education. The aim was the prospective development and implementation of the first reported German-language Dental Progress Test (DPT) for the undergraduate dental curriculum at the Medical University of Graz, Austria.

MATERIAL AND METHODS

Participation in DPT was compulsory for all dental students in terms 7-12 (years 4-6). Three tests, each consisting of 100 items out of a pool of 375, were administered within 3 consecutive terms in 2016 and 2017. Rasch analyses were used to evaluate the questionnaire and identify misfitting items.

RESULTS

In the item responses, 59.7% were "correct," 27.0% were "false" and 13.3% were answered with "don't know," with similar results at all 3 time points. The assumption of parallel ICC was met (T1: χ²  = 51.071, df = 74, P = .981; T2: χ²  = 57.044, df = 67, P = .802; T3: χ²  = 58.443, df = 72, P = .876) and item difficulties for the thematic fields were similarly distributed across the latent dimensions.

CONCLUSION

The newly introduced DPT is appropriate for testing dental students and is well balanced for the tested target group.

Validity of the Food Insecurity Experience Scale for Use in Sub-Saharan Africa and Characteristics of Food-Insecure Individuals

BACKGROUND

The Food Insecurity Experience Scale (FIES) is a UN FAO-Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested.

OBJECTIVES

We aimed to 1) assess the validity of FIES for use in SSA, 2) determine the prevalence of FI by country, age group, and gender, and 3) examine the sociodemographic and economic characteristics of individuals with FI.

METHODS

The Rasch modeling procedure was applied to data collected by GWP in 2014 and 2015 on 57,792 respondents aged ≥19 y in SSA.

RESULTS

FIES largely met the Rasch model assumptions of equal discrimination and conditional independence. However, 34.3% of countries had high outfits (≥2.0) for the item "went without eating for a whole day." Four countries had significant correlations for the items "were hungry but did not eat" and "ran out of food." The overall prevalence of severe FI (SFI) was 36.4%, ranging from 6.0% in Mauritius to 87.3% in South Sudan. Older adults were at significantly higher risk of SFI than younger adults (38.6% and 35.8%, respectively, P < 0.0001), and women more than men (37.3% and 35.4%, respectively, P < 0.0001). Higher proportions of individuals with SFI were rural residents, less educated, lower income, unemployed, and lived in households with many children under the age of 15 y.

CONCLUSIONS

FIES has acceptable levels of internal validity for use in SSA. However, the item "went without eating for a whole day" may need cognitive testing in a few SSA countries. For countries with correlated items, 1 of the items may be excluded.

The Portuguese Rheumatoid Arthritis Impact of Disease (RAID) score and its measurement equivalence in three countries: validation study using Rasch Models

Purpose

The Rheumatoid Arthritis Impact of Disease (RAID) score assesses seven impact domains of interest for people with RA. This study aimed to test patients’ understanding of the Portuguese RAID and evaluate its cross-cultural validity for use in Portugal.

Methods

This was a mixed methods study comprising two phases: (i) cognitive debriefing to determine patient’s comprehension of the Portuguese RAID and (ii) cross-cultural validation using Rasch analysis. Construct validity was determined by fit to the model, invariance culture (compared with France and UK datasets) and evidence of convergent and divergent validity.

Results

Patients’ input (n = 38) led to minor changes in the phrasing of two items to ensure conceptual equivalence between the Portuguese and the original RAID. In Rasch analysis (n = 288), two items ‘Sleep’ and ‘Physical well-being’ in the Portuguese dataset did not adequately fit the model specifications, suggesting multidimensionality (sleep—not necessarily associated with RA) and redundancy (physical well-being overlapping with functional disability). Despite the imperfections, the scale had high internal consistency, evidence of convergent and divergent validity and invariance to culture (compared to France n = 195 and UK n = 205 datasets). The scale was well targeted for patients with different levels of disease impact.

Conclusions

The RAID has been successfully adapted into Portuguese and it can be used with confidence in clinical practice. Further research will be required to ensure it captures the full range of sleep problems in RA. Meanwhile, data across the three countries (Portugal, France and the UK) are comparable except for the two items (sleep and physical well-being).

Electronic supplementary material

The online version of this article (10.1007/s11136-018-1959-4) contains supplementary material, which is available to authorized users.

Validation of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QoL) and the adjusted DSWAL-QoL (aDSWAL-QoL) using item analysis with the Rasch model: a pilot study

BACKGROUND

The Swallowing Quality-of-Life Questionnaire (SWAL-QoL) is considered the gold standard for assessing health-related QoL in oropharyngeal dysphagia. The Dutch translation (DSWAL-QoL) and its adjusted version (aDSWAL-QoL) have been validated using classical test theory (CTT). However, these scales have not been tested against the Rasch measurement model, which is required to establish the structural validity and objectivity of the total scale and subscale scores. Thus, the purpose of this study was to examine the psychometric properties of these scales using item analysis according to the Rasch model.

METHODS

Item analysis with the Rasch model was performed using RUMM2030 software with previously collected data from a validation study of 108 patients. The assessment included evaluations of overall model fit, reliability, unidimensionality, threshold ordering, individual item and person fits, differential item functioning (DIF), local item dependency (LID) and targeting.

RESULTS

The analysis could not establish the psychometric properties of either of the scales or their subscales because they did not fit the Rasch model, and multidimensionality, disordered thresholds, DIF, and/or LID were found. The reliability and power of fit were high for the total scales (PSI = 0.93) but low for most of the subscales (PSI < 0.70). The targeting of persons and items was suboptimal. The main source of misfit was disordered thresholds for both the total scales and subscales. Based on the results of the analysis, adjustments to improve the scales were implemented as follows: disordered thresholds were rescaled, misfit items were removed and items were split for DIF. However, the multidimensionality and LID could not be resolved. The reliability and power of fit remained low for most of the subscales.

CONCLUSIONS

This study represents the first analyses of the DSWAL-QoL and aDSWAL-QoL with the Rasch model. Relying on the DSWAL-QoL and aDSWAL-QoL total and subscale scores to make conclusions regarding dysphagia-related HRQoL should be treated with caution before the structural validity and objectivity of both scales have been established. A larger and well-targeted sample is recommended to derive definitive conclusions about the items and scales. Solutions for the psychometric weaknesses suggested by the model and practical implications are discussed.

Scoring and psychometric validation of the 'Determinants of Intentions to Vaccinate' (DIVA©) questionnaire

Background

Primary care physicians (PCPs) play a key role regarding vaccination in France. The aims of the present study were to define the scoring rules and to assess the measurement properties of the ‘Determinants of Intentions to Vaccinate’ (DIVA^©) questionnaire that aims to assess PCPs’ attitudes and beliefs toward vaccination.

Methods

The DIVA questionnaire was derived from a literature review and PCPs focus groups. Scoring and early validation of the DIVA questionnaire were determined during a cross-sectional study conducted in France. During the study, PCPs had to complete the DIVA questionnaire for any of the six vaccine-preventable diseases (VPDs) to which they were randomly assigned (measles, pertussis, pneumococcus infection, seasonal influenza, human papillomavirus -HPV- infection and tetanus). Descriptive analyses of items and the analysis of the grouping of items into domains were conducted. Internal consistency reliability and construct validity was assessed according to each VPD.

Results

The DIVA questionnaire was completed by 1,069 PCPs and was well accepted. The ‘Commitment of the PCP to the vaccination approach’ score showed very good internal consistency reliability (Cronbach’s alpha >0.70 overall and for each VPD). The construct validity of the DIVA questionnaire was confirmed.

Conclusions

The DIVA questionnaire is a valid and reliable measure of PCPs’ attitudes and beliefs toward vaccination.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0539-3) contains supplementary material, which is available to authorized users.

Brazilian adolescents' knowledge and beliefs about abortion methods: a school-based internet inquiry

Background

Internet surveys that draw from traditionally generated samples provide the unique conditions to engage adolescents in exploration of sensitive health topics.

Methods

We examined awareness of unwanted pregnancy, abortion behaviour, methods, and attitudes toward specific legal indications for abortion via a school-based internet survey among 378 adolescents aged 12–21 years in three Rio de Janeiro public schools.

Results

Forty-five percent knew peers who had undergone an abortion. Most students (66.0%) did not disclose abortion method knowledge. However, girls (aOR 4.2, 95% CI 2.4-7.2), those who had experienced their sexual debut (aOR1.76, 95% CI 1.1-3.0), and those attending a prestigious magnet school (aOR 2.7 95% CI 1.4-6.3) were more likely to report methods. Most abortion methods (79.3%) reported were ineffective, obsolete, and/or unsafe. Herbs (e.g. marijuana tea), over-the-counter medications, surgical procedures, foreign objects and blunt trauma were reported. Most techniques (85.2%) were perceived to be dangerous, including methods recommended by the World Health Organization. A majority (61.4%) supported Brazil’s existing law permitting abortion in the case of rape. There was no association between gender, age, sexual debut, parental education or socioeconomic status and attitudes toward legal abortion. However, students at the magnet school supported twice as many legal indications (2.7, SE.27) suggesting a likely role of peers and/or educators in shaping abortion views.

Conclusions

Abortion knowledge and attitudes are not driven simply by age, religion or class, but rather a complex interplay that includes both social spaces and gender. Prevention of abortion morbidity and mortality among adolescents requires comprehensive sexuality and reproductive health education that includes factual distinctions between safe and unsafe abortion methods.

The development of the MACE work-family enrichment instrument

Orientation: An instrument based on a theoretical model is necessary to measure the positive side of the work-family interface.Research purpose: To develop items for measurement of work-family enrichment based on the elements contained within a theoretical model and to evaluate the latent trait functioning of these items.Motivation for the study: Major limitations exist regarding the conceptualisation and scale development of the positive side of the work-family interface.Research design, approach, and method: A quantitative research approach using scale development procedures was employed to develop the 95-item instrument. A cross-sectional survey design was used to collect data randomly from selected employees; data were processed using Rasch analysis.Main findings: The five-category scale works well for the most part, although a four-category scale could be considered. Thirty-five items either over-fitted or under-fitted the work-family enrichment model. Person ability was measured in the low to middle ranges of work-family enrichment. Participants’ experience of work-family enrichment could be represented accurately. Sub-scale items displayed misfit, bias or both.Practical/managerial implications: The developed instrument can be investigated further to identify work-family enrichment factors that can measure workers’ experience of enrichment in their work and family domains.Contribution/value-add: This study furthers theory building and empirical research in industrial psychology, by developing a new theory-based measuring instrument for the positive side of the work-family interface in the South African context. This study expanded on the model proposed by Greenhaus and Powell, by including all five categories of resources gains. Furthermore, the total of the resources was diversified, since some of the content of these resources encompasses multiple meanings.