[Introduction to Exploratory Factor Analysis (EFA)]

INTRODUCTION

Exploratory Factor Analysis (EFA) has become one of the most frequently used statistical techniques, especially in the medical and social sciences. Given its popularity, it is essential to understand the basic concepts necessary for its proper application and to take into consideration the main strengths and weaknesses of this technique.

OBJECTIVE

To present in a clear and concise manner the main applications of this technique, to determine the basic requirements for its use providing a description step by step of its methodology, and to establish the elements that must be taken into account during its preparation in order to not incur in erroneous results and interpretations.

METHODOLOGY

Narrative review.

DEVELOPMENT

This review identifies the basic concepts and briefly describes the objectives, design, assumptions, and methodology to achieve factor derivation, global adjustment evaluation, and adequate interpretation of results.

Assessing the reliability and validity of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in Ghanaian medical students

PURPOSE

We investigated the validity and reliability of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in preclinical students in Ghana.

METHODS

The R-SPQ2F was administered to 189 preclinical students of the University for Development Studies, School of Medicine and Health Sciences. Both descriptive and inferential statistics with Cronbach's alpha test and factor analysis were done.

RESULTS

The mean age of the students was 22.69± 0.18years, 60.8% (n=115) were males and 42.3% (n=80) were in their second year of medical training. The students had higher mean deep approach scores (31.23±7.19) than that of surface approach scores (22.62±6.48). Findings of the R-SPQ2F gave credence to a solution of two-factors indicating deep and surface approaches accounting for 49.80% and 33.57%, respectively, of the variance. The scales of deep approach (Cronbach's alpha, 0.80) and surface approach (Cronbach's alpha, 0.76) and their subscales demonstrated an internal consistency that was good. The factorial validity was comparable to other studies.

CONCLUSION

Our study confirms the construct validity and internal consistency of the R-SPQ2F for measuring approaches to learning in Ghanaian preclinical students. Deep approach was the most dominant learning approach among the students. The questionnaire can be used to measure students' approaches to learning in Ghana and in other African countries.

[Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective]

PURPOSE

This study aimed to develop an instrument to assess the quality of childbirth care from the perspective of a mother after delivery.

METHODS

The instrument was developed from a literature review, interviews, and item validation. Thirty-eight items were compiled for the instrument. The data for validity and reliability testing were collected using a questionnaire survey conducted on 270 women who had undergone normal vaginal delivery in Korea and analyzed with descriptive statistics, exploratory factor analysis, and reliability coefficients.

RESULTS

The exploratory factor analysis reduced the number of items in the instrument to 28 items that were factored into four subscales: family-centered care, personal care, emotional empowerment, and information provision. With respect to convergence validation, there was positive correlation between this instrument and birth satisfaction scale (r=.34, p<.001). The internal consistency reliability was acceptable (Cronbach's alpha =.96).

CONCLUSION

This instrument could be used as a measure of the quality of nursing care for women who have a normal vaginal delivery.

Development and validation of a measurement scale to assess nursing students’ readiness for the flipped classroom in Sri Lanka

PURPOSE

The aim of this study was to develop and validate a scale to measure nursing students’ readiness for the flipped classroom in Sri Lanka.

METHODS

A literature review provided the theoretical framework for developing the Nursing Students’ Readiness for Flipped Classroom (NSR-FC) questionnaire. Five content experts evaluated the NSR-FC, and content validity indices (CVI) were calculated. Cross-sectional surveys among 355 undergraduate nursing students from 3 state universities in Sri Lanka were carried out to assess the psychometric properties of the NSR-FC. Principal component analysis (PCA, n=265), internal consistency (using the Cronbach α coefficient, n=265), and confirmatory factor analysis (CFA, n=90) were done to test construct validity and reliability.

RESULTS

Thirty-seven items were included in the NSR-FC for content validation, resulting in an average scale CVI of 0.94. Two items received item level CVI of less than 0.78. The factor structures of the 35 items were explored through PCA with orthogonal factor rotation, culminating in the identification of 5 factors. These factors were classified as technological readiness, environmental readiness, personal readiness, pedagogical readiness, and interpersonal readiness. The NSR-FC also showed an overall acceptable level of internal consistency (Cronbach α=0.9). CFA verified a 4-factor model (excluding the interpersonal readiness factor) and 20 items that achieved acceptable fit (standardized root mean square residual=0.08, root mean square error of approximation=0.08, comparative fit index=0.87, and χ2/degrees of freedom=1.57).

CONCLUSION

The NSR-FC, as a 4-factor model, is an acceptable measurement scale for assessing nursing students’ readiness for the flipped classroom in terms of its construct validity and reliability.

Information before discharge in geriatric patients in Italy: cultural adaptation and validation of the Patient Continuity of Care Questionnaire

Our aim is to culturally adapt the first section of the Patient Continuity of Care Questionnaire (PCCQ) for use among older Italian patients with chronic diseases and to test its psychometric properties. The PCCQ was translated, adapted to the Italian context, and completed by 236 older inpatients with chronic diseases at the point of discharge through a cross-sectional multi-centre validation study. Face and content validity were assessed. Exploratory factor analysis (EFA) with Mplus MLr estimator was conducted. Internal consistency was analysed through Cronbach's alpha and factor score determinacy coefficients. The overall content validity index of the 15-item Italian version of the questionnaire was 0.9. The EFA revealed a four-factor model yielding adequate fit indices. The factor score determinacy coefficients ranged from 0.87 to 0.94. The Cronbach's alpha coefficients ranged from 0.71 to 0.86 showing good reliability. The study provides health professionals with an instrument with adequate psychometric properties to assess patients' perception of the information received before hospital discharge.

A novel tool for evaluating non-cognitive traits of doctor of physical therapy learners in the United States

PURPOSE

The primary aim of this study was to develop a survey addressing an individual's non-cognitive traits, such as emotional intelligence, interpersonal skills, social intelligence, psychological flexibility, and grit. Such a tool would provide beneficial information for the continued development of admissions standards and would help better capture the full breadth of experience and capabilities of applicants applying to doctor of physical therapy (DPT) programs.

METHODS

This was a cross-sectional survey study involving learners in DPT programs at 3 academic institutions in the United States. A survey was developed based on established non-proprietary, non-cognitive measures affiliated with success and resilience. The survey was assessed for face validity, and exploratory factor analysis (EFA) was used to identify subgroups of factors based on responses to the items.

RESULTS

A total of 298 participants (90.3%) completed all elements of the survey. EFA yielded 39 items for dimensional assessment with regression coefficients < 0.4. Within the 39 items, 3 latent constructs were identified: adaptability (16 items), intuitiveness (12 items), and engagement (11 items).

CONCLUSION

This preliminary non-cognitive assessment survey will be able to play a valuable role in DPT admissions decisions following further examination and refinement.

General practitioner-pharmacist collaboration in Germany: an explanatory model

Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor structure of the previously validated Frequency of Inter-professional Collaboration Instrument and the Attitudes Toward Collaboration Instrument in measuring attitudes toward and frequency of collaboration from the general practitioner's perspective in the context of primary care in Germany; to develop an explanatory model which illustrates factors influencing collaboration. Setting The study was conducted in the primary health care sector in Mecklenburg-Western Pomerania, Germany with a cohort of general practitioners. Method The two measures were translated into German and the survey was administered to 1438 practitioners. Exploratory factor analysis was used to assess the structure of the instruments. Structural equation modelling was used to determine how demographic variables and attitudes influence collaborative behaviour. Main outcome measure Outcome measure comprised frequency of and attitudes toward collaboration among German general practitioners and an explanatory model of practitioner-pharmacist collaboration. Results A response rate of 35.9% was achieved. Exploratory factor analysis revealed one factor for the instrument measuring attitudes and two factors for frequency. The factors were interpreted as 'Communication and Collaboration' and 'Pharmacist medication management'. The significant demographic predictors of collaboration were age, population of the surgery's location, distance to the pharmacy, specialty. Conclusion The results provide evidence for the factor structure of both measures in measuring attitudes toward and frequency of collaboration. A model of collaboration in which behaviour and extent of collaboration are directly influenced by individual and context characteristics is supported.

Construct validity test of evaluation tool for professional behaviors of entry-level occupational therapy students in the United States

PURPOSE

This study aimed to test the construct validity of an instrument to measure student professional behaviors in entry-level occupational therapy (OT) students in the academic setting.

METHODS

A total of 718 students from 37 OT programs across the United States answered a self-assessment survey of professional behavior that we developed. The survey consisted of ranking 28 attributes, each on a 5-point Likert scale. A split-sample approach was used for exploratory and then confirmatory factor analysis.

RESULTS

A three-factor solution with nine items was extracted using exploratory factor analysis [EFA] (n=430, 60%). The factors were 'Commitment to Learning' (2 items), 'Skills for Learning' (4 items), and 'Cultural Competence' (3 items). Confirmatory factor analysis (CFA) on the validation split (n=288, 40%) indicated fair fit for this three-factor model (fit indices: CFI=0.96, RMSEA=0.06, and SRMR=0.05). Internal consistency reliability estimates of each factor and the instrument ranged from 0.63 to 0.79.

CONCLUSION

Results of the CFA in a separate validation dataset provided robust measures of goodness-of-fit for the three-factor solution developed in the EFA, and indicated that the three-factor model fitted the data well enough. Therefore, we can conclude that this student professional behavior evaluation instrument is a structurally validated tool to measure professional behaviors reported by entry-level OT students. The internal consistency reliability of each individual factor and the whole instrument was considered to be adequate to good.

Development and initial psychometric evaluation of the computer-based prostate Cancer screening decision aid acceptance scale for African-American men

BACKGROUND

To reliably evaluate the acceptance and use of computer-based prostate cancer decision aids (CBDAs) for African-American men, culturally relevant measures are needed. This study describes the development and initial psychometric evaluation of the 24-item Computer-Based Prostate Cancer Screening Decision Aid Acceptance Scale among 357 African-American men.

METHODS

Exploratory factor analysis (EFA) with maximum likelihood estimation and polychoric correlations followed by Promax and Varimax rotations.

RESULTS

EFA yielded three factors: Technology Use Expectancy and Intention (16 items), Technology Use Anxiety (5 items), and Technology Use Self-Efficacy (3 items) with good to excellent internal consistency reliability at .95, .90, and .85, respectively. The standardized root mean square residual (0.035) indicated the factor structure explained most of the correlations.

CONCLUSIONS

Findings suggest the three-factor, 24-item Computer-Based Prostate Cancer Screening Decision Aid Acceptance Scale has utility in determining the acceptance and use of CBDAs among African-American men at risk for prostate cancer. Future research is needed to confirm this factor structure among socio-demographically diverse African-Americans.

What impacts students' satisfaction the most from Medicine Student Experience Questionnaire in Australia: a validity study

PURPOSE

This study evaluated the validity of student feedback derived from Medicine Student Experience Questionnaire (MedSEQ), as well as the predictors of students' satisfaction in the Medicine program.

METHODS

Data from MedSEQ applying to the University of New South Wales Medicine program in 2017, 2019, and 2021 were analyzed. Confirmatory factor analysis (CFA) and Cronbach's α were used to assess the construct validity and reliability of MedSEQ respectively. Hierarchical multiple linear regressions were used to identify the factors that most impact students' overall satisfaction with the program.

RESULTS

A total of 1,719 students (34.50%) responded to MedSEQ. CFA showed good fit indices (root mean square error of approximation=0.051; comparative fit index=0.939; chi-square/degrees of freedom=6.429). All factors yielded good (α>0.7) or very good (α>0.8) levels of reliability, except the "online resources" factor, which had acceptable reliability (α=0.687). A multiple linear regression model with only demographic characteristics explained 3.8% of the variance in students' overall satisfaction, whereas the model adding 8 domains from MedSEQ explained 40%, indicating that 36.2% of the variance was attributable to students' experience across the 8 domains. Three domains had the strongest impact on overall satisfaction: "being cared for," "satisfaction with teaching," and "satisfaction with assessment" (β=0.327, 0.148, 0.148, respectively; all with P<0.001).

CONCLUSION

MedSEQ has good construct validity and high reliability, reflecting students' satisfaction with the Medicine program. Key factors impacting students' satisfaction are the perception of being cared for, quality teaching irrespective of the mode of delivery and fair assessment tasks which enhance learning.

Assessing the psychometric properties of the Guarding Minds @ Work questionnaire recommended in the Canadian Standard for Psychological Health and Safety in the Workplace

This study examines the item and dimension distribution and factorial reliability and validity of the GM@W questionnaire for assessing the 13 dimensions of the work environment outlined in The Canadian National Standard for Psychological Health and Safety in the Workplace (The Standard). Methods An internet survey of 1,006 Ontario workers was conducted between February 10th and March 5th, 2020. Respondents had to be employed in a workplace with five or more employees. The survey included the 65 items from the GM@W questionnaire, and questions to assess sociodemographic characteristics and employment arrangements. Analyses examined the distribution of scores for items and for overall dimensions. A confirmatory factor analysis (CFA) examined the relationship between the 13 proposed dimensions and each of the 65 questions, using only respondents with complete information (N = 900). Results Low levels of missing responses were observed, although 14 of the 65 items had potential ceiling effects. CFA analyses demonstrated poor fit for the conceptual model linking the 13 dimensions of The Standard to the 65-items. High correlations between dimensions were also noted. The GM@W questionnaire displayed poor discriminant in measuring the specific dimensions proposed in The Standard. Conclusions Our results suggest the GM@W survey is unable to isolate the proposed dimensions of the psychosocial work environment as outlined in The Standard. These limitations are important, as workplaces using the GM@W survey will not be able to identify dimensions of the work environment which require attention or assess changes in particular dimensions over time.

Cross-validation of the Student Perceptions of Team-Based Learning Scale in the United States

PURPOSE

The purpose of this study was to cross-validate the factor structure of the previously developed Student Perceptions of Team-Based Learning (TBL) Scale among students in an entry-level doctor of physical therapy (DPT) program in the United States.

METHODS

Toward the end of the semester in 2 patient/client management courses taught using TBL, 115 DPT students completed the Student Perceptions of TBL Scale, with a response rate of 87%. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were conducted to replicate and confirm the underlying factor structure of the scale.

RESULTS

Based on the PCA for the validation sample, the original 2-factor structure (preference for TBL and preference for teamwork) of the Student Perceptions of TBL Scale was replicated. The overall goodness-of-fit indices from the CFA suggested that the original 2-factor structure for the 15 items of the scale demonstrated a good model fit (comparative fit index, 0.95; non-normed fit index/Tucker-Lewis index, 0.93; root mean square error of approximation, 0.06; and standardized root mean square residual, 0.07). The 2 factors demonstrated high internal consistency (alpha= 0.83 and 0.88, respectively). DPT students taught using TBL viewed the factor of preference for teamwork more favorably than preference for TBL.

CONCLUSION

Our findings provide evidence supporting the replicability of the internal structure of the Student Perceptions of TBL Scale when assessing perceptions of TBL among DPT students in patient/client management courses.

Validation of the Persian version of the Compassionate Care Assessment Tool

OBJECTIVES

The present study aimed to translate and determine the psychometric properties of the Persian version of the Compassionate Care Assessment Tool (CCAT) ©.

METHODS

The study was carried out to translate and validate of the CCAT©. After securing permission from the designer of the tool and translating it, the psychometric properties were determined through examining face validity, construct validity, internal consistency, and test/retest reliability. With regard to construct validity, confirmatory factor analysis was used so that 300 patients in internal and surgery wards were selected by a simple random sampling method from three hospitals. Data were analyzed using SPSS (v.24.0) and LISREL statistical software version 8.8.

RESULTS

The results of the confirmatory factor analysis supported the validity and reliability of the Persian version of the CCAT© and its four factors. The reliability of the tool and internal consistency were confirmed through test/retest method with two weeks' interval. At the two areas of importance and provision of compassionate care, Cronbach's α coefficient equaled to 0.918 and 0.933 and intraclass consistency equaled to 0.848 and 0.907 respectively.

CONCLUSION

The results showed that the Persian version of the CCAT© was adequately valid and reliable for Iranian patients. Given the acceptable psychometric parameters of the tool, using it in future studies to measure importance and provision of compassionate nursing care to Iranian patients at internal and surgery wards is recommended.

Evaluation of factors affecting implant failure: A 13-year retrospective cohort study

Dental implant failure remains a significant concern in oral rehabilitation, with multiple risk factors contributing to early and late implant failure. While numerous studies have examined implant failure rates, limited research distinguishes between early implant failure (EIF) and late implant failure (LIF) based on patient-related, implant-specific, and surgical variables. This study aimed to evaluate the risk factors associated with EIF and LIF and to determine the impact of patient-related, implant-specific, and surgical variables on implant survival. This retrospective cohort study was conducted at Ondokuz Mayıs University. It is based on the treatments provided by an experienced surgeon to individuals who applied for implant treatment between January 2011 and January 2024. This study analyzed 490 patients who met the inclusion criteria out of 3720 who received implant treatment during the relevant years. The patients' ages ranged from 21 to 90, with a mean age of 53.92 ± 13.82 years. Sex, smoking, and implant length (≤10 mm) were identified as risk factors in analyzing parameters affecting EIF, while maxilla, implant length (<8 mm), SLA surface modification, sinus lift procedures, smoking, and short osteointegration duration were identified as risk factors in analyzing parameters affecting LIF. Our findings highlight the distinct risk profiles for EIF and LIF, emphasizing the importance of patient selection, surgical technique, and implant characteristics in optimizing long-term success rates. Recognizing EIF and LIF risk factors enables clinicians to refine treatment protocols and reduce implant failure rates, ultimately improving patient outcomes.

Prevalence of dental caries and associated factors of detention center inmates in South Korea compared with Korea National Health and Nutrition Examination Survey (KNHANES) respondents: a retrospective study

Background

Correctional institution inmates have reduced access to dental care; however, a quantitative assessment of their oral health condition has not yet been performed in South Korea. Therefore, this study aimed to assess dental caries and compare the prevalence of dental caries and associated factors between inmates and the general South Korean population.

Methods

The dental records of two detention centers in South Korea were retrospectively analyzed to assess the clinical oral health condition of inmates using the Decayed, Missing, and Filled Teeth (DMFT) index and self-reported questionnaire. These data were compared with similar data obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) for the general South Korean population.

Results

In total, 642 inmates were analyzed and compared with 13,345 KNHANES participants in the KNHANES. The inmate and KNHANES groups demonstrated significant intergroup differences, with a higher prevalence of untreated caries, DMFT, decayed teeth (DT), and missing teeth (MT) values among the inmates. The prevalence of untreated caries decreased according to the history of dental pain in the inmate group but increased in the KNHANES group. The decrease in DMFT with a history of dental pain was significant only in the inmate group. Furthermore, self-rated oral health was significantly associated with prevalence of untreated caries, DMFT, DT, MT, and filled teeth (FT) in the inmate group but with prevalence of untreated caries, DMFT, DT, and MT in the KNHANES group. It was found that this is because there is an interaction effect by the group.

Conclusions

The oral health of the inmate group was significantly poorer than that of the general group. Since DMFT, DT, MT, and FT values and prevalence of untreated caries in the inmate group were significantly related to their self-rated oral health, suggesting that self-rated oral health should be incorporated into the dental health screenings of correctional institution inmates.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02405-w.

Best-fit model of exploratory and confirmatory factor analysis of the 2010 Medical Council of Canada Qualifying Examination Part I clinical decision-making cases

PURPOSE

This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada Qualifying Examination Part I (MCCQE1) clinical decision-making (CDM) cases. The outcomes of this study have important implications for a range of domains, including scoring and test development.

METHODS

The examinees included all first-time Canadian medical graduates and international medical graduates who took the MCCQE1 in spring or fall 2010. The fit of one- to five-factor exploratory models was assessed for the item response matrix of the 2010 CDM cases. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program Mplus was used for all analyses.

RESULTS

Out of the five exploratory factor analytic models that were evaluated, a three-factor model provided the best fit. Factor 1 loaded on three medicine cases, two obstetrics and gynecology cases, and two orthopedic surgery cases. Factor 2 corresponded to pediatrics, and the third factor loaded on psychiatry cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five-factor discipline models provided the best fit.

CONCLUSION

The results suggest that knowledge of broad disciplinary domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using the criteria of discipline and age.

The validity and reliability of a problem-based learning implementation questionnaire

PURPOSE

The aim of this paper is to provide evidence for the validity and reliability of a questionnaire for assessing the implementation of problem-based learning (PBL). This questionnaire was developed to assess the quality of PBL implementation from the perspective of medical school graduates.

METHODS

A confirmatory factor analysis was conducted to assess the validity of the questionnaire. The analysis was based on a survey of 225 graduates of a problem-based medical school in Indonesia.

RESULTS

The results showed that the confirmatory factor analysis model had a good fit to the data. Further, the values of the standardized loading estimates, the squared inter-construct correlations, the average variances extracted, and the composite reliabilities all provided evidence of construct validity.

CONCLUSION

The PBL implementation questionnaire was found to be valid and reliable, making it suitable for evaluation purposes.

Validation of the 21st Century Skills Assessment Scale for public health students in Thailand: a methodological study

PURPOSE

This study aimed to develop and validate the 21st Century Skills Assessment Scale (21CSAS) for Thai public health (PH) undergraduate students using the Partnership for 21st Century Skills framework.

METHODS

A cross-sectional survey was conducted among 727 first- to fourth-year PH undergraduate students from 4 autonomous universities in Thailand. Data were collected using self-administered questionnaires between January and March 2023. Exploratory factor analysis (EFA) was used to explore the underlying dimensions of 21CSAS, while confirmatory factor analysis (CFA) was conducted to test the hypothesized factor structure using Mplus software (Muthén & Muthén). Reliability and item discrimination were assessed using Cronbach's α and the corrected item-total correlation, respectively.

RESULTS

EFA performed on a dataset of 300 students revealed a 20-item scale with a 6-factor structure: (1) creativity and innovation; (2) critical thinking and problem-solving; (3) information, media, and technology; (4) communication and collaboration; (5) initiative and self-direction; and (6) social and cross-cultural skills. The rotated eigenvalues ranged from 2.12 to 1.73. CFA performed on another dataset of 427 students confirmed a good model fit (χ2/degrees of freedom=2.67, comparative fit index=0.93, Tucker-Lewis index=0.91, root mean square error of approximation=0.06, standardized root mean square residual=0.06), explaining 34%-71% of variance in the items. Item loadings ranged from 0.58 to 0.84. The 21CSAS had a Cronbach's α of 0.92.

CONCLUSION

The 21CSAS proved be a valid and reliable tool for assessing 21st century skills among Thai PH undergraduate students. These findings provide insights for educational system to inform policy, practice, and research regarding 21st-century skills among undergraduate students.

Exploratory factor and confirmatory analyses of the polycystic ovary syndrome health-related quality of life questionnaire (PCOSQ-50)

BACKGROUND

A condition-specific instrument is necessary to measure the health-related quality of life among those with polycystic ovary syndrome (PCOS), the most common chronic endocrinopathy among women. The first instrument was developed in 1988, followed by several revisions. However, further recommendations from all versions include additional application and measurement among different cultural populations of women with PCOS and psychometric testing based on use among larger samples of women with PCOS. Thus, the purpose of this study was to explore the factor structure of the Polycystic Ovary Syndrome Questionnaire (PCOSQ-50) using an international cross-sectional survey data from women with PCOS aged 18-42 years.

METHODS

Using data from the largest known international cross-sectional study of women with PCOS aged 18-42 years (n = 935) to date, exploratory factor and confirmatory analyses were conducted for the PCOSQ-50, followed by factor labeling using a thematic analysis approach.

RESULTS

Respondents were 31.0 ± 5.8 years of age, mostly White (72%), well-educated (56% had a college degree), married (69%), and employed full-time (65%). Three-quarters (74%) of the sample had one or more chronic conditions in addition to PCOS. Approximately 20% of the respondents originated from countries such as the United Kingdom, Australia, South Africa, etc. The PCOSQ-50 demonstrated good reliability but may be best described using a 7-factor model. The 7-factor model revealed goodness-of-fit. Thematic analysis suggested the following labels of those seven factors: hirsutism, fertility, isolation/trepidation, sexual function, self-esteem, emotional, and obesity.

CONCLUSION

More research is needed to adapt the current PCOSQ-50, as well as to create an age-appropriate PCOS-specific HRQoL instrument for peri-postmenopausal women with PCOS.

Short functional geriatric evaluation: Confirmatory factor analysis to assess the multidimensionality of frailty in community-dwelling older adults

This paper explores the ageing population in Italy, where older adults account for more than 14 million individuals (in January 2023) and constitute 24.1 % of the total population. Frailty, a condition encompassing biological, psychological, social, and economic challenges, is recognised as a significant public health issue. The study introduces the Short Functional Geriatric Evaluation (SFGE) as a large-scale screening tool for frailty in community-dwelling older individuals. A Confirmatory Factor Analysis (CFA) was conducted on the SFGE. The CFA scrutinises the construct validity of SFGE using a sample population from the "Long Live the Elderly!" program in Italy. Initial results indicate an acceptable fit, prompting the incorporation of Modification Indices to enhance model performance. The refined CFA demonstrates that the SFGE model effectively captures the multidimensional nature of frailty. The text underscores the timeliness of identifying frailty, emphasising the need for simple, fast, and predictive tools to screen large populations efficiently.

Development and validation of the student ratings in clinical teaching scale in Australia: a methodological study

PURPOSE

This study aimed to devise a valid measurement for assessing clinical students' perceptions of teaching practices.

METHODS

A new tool was developed based on a meta-analysis encompassing effective clinical teaching-learning factors. Seventy-nine items were generated using a frequency (never to always) scale. The tool was applied to the University of New South Wales year 2, 3, and 6 medical students. Exploratory and confirmatory factor analysis (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA], respectively) were conducted to establish the tool’s construct validity and goodness of fit, and Cronbach’s α was used for reliability.

RESULTS

In total, 352 students (44.2%) completed the questionnaire. The EFA identified student-centered learning, problem-solving learning, self-directed learning, and visual technology (reliability, 0.77 to 0.89). CFA showed acceptable goodness of fit (chi-square P<0.01, comparative fit index=0.930 and Tucker-Lewis index=0.917, root mean square error of approximation=0.069, standardized root mean square residual=0.06).

CONCLUSION

The established tool—Student Ratings in Clinical Teaching (STRICT)—is a valid and reliable tool that demonstrates how students perceive clinical teaching efficacy. STRICT measures the frequency of teaching practices to mitigate the biases of acquiescence and social desirability. Clinical teachers may use the tool to adapt their teaching practices with more active learning activities and to utilize visual technology to facilitate clinical learning efficacy. Clinical educators may apply STRICT to assess how these teaching practices are implemented in current clinical settings.

Exploratory Factor Analysis of SCL90-R Symptoms Relevant to Psychosis

OBJECTIVE

Inconsistent results have been reported regarding the symptom dimensions relevant to psychosis in symptoms check list revised (SCL90-R), i.e., "psychoticism" and "paranoid ideation". Therefore, some studies have suggested different factor structures for questions of these two dimensions, and proposed two newly defined dimensions of "schizotypal signs" and "schizophrenia nuclear symptoms". We conducted an exploratory factor analysis on the items of these two dimensions in a general population sample in Iran.

METHOD

A total of 2158 subjects residing in Southern Tehran (capital of Iran) were interviewed using the psychoticism and paranoid ideation questions in SCL90-R to assess severity of these symptom dimensions. Factor analysis was done through SAS 9.1.3 PROC FACTOR using Promax rotation (power=3) on the matrix of "polychoric correlations among variables" as the input data.

RESULTS

Two factors were retained by the proportion criterion. Considering loadings >= 0.5 as minimum criteria for factor loadings, 7 out of 10 questions from psychoticism, and 3 out of 6 questions from paranoid ideation were retained, and others were eliminated. The factor labels proposed by the questionnaire suited the extracted factors and were retained. Internal consistency for each of the dimensions was acceptable (Cronbach's alpha 0.7 and 0.74 for paranoid ideation and psychoticism respectively). Composite scores showed a half-normal distribution for both dimensions which is predictable for instruments that detect psychotic symptoms.

CONCLUSION

Results were in contrast with similar studies, and questioned them by suggesting a different factor structure obtained from a statistically large population. The population in a developing nation (Iran) in this study and the socio-cultural differences in developed settings are the potential sources for discrepancies between this analysis and previous reports.

The psychometric properties of the parenting scale for Spanish mothers with children aged between 2 and 7 years

PURPOSE

This study aimed to evaluate the psychometric properties of the Spanish version of the Parenting Scale in a large sample of Spanish mothers.

DESIGN AND METHODS

A two-stage cross-sectional study of the adaptation and cultural validation of the Parenting Scale in a Spanish-speaking environment. In Stage I, the Parenting Scale was translated and back-translated and its semantic, linguistic and contextual equivalence was assessed. In Stage II, the Spanish-language version was validated after its application to 662 Spanish mothers with healthy children aged between 2 and 7 years. Several factor structure models of the Parenting Scale were compared by confirmatory factor analysis. Convergent validity, internal consistency and test-retest reliability were also examined.

RESULTS

The model of Irvine et al. (1999) presented the best fit to our data. This model demonstrated adequate reliability (internal consistency and stability). The total score and each factor of the Parenting Scale correlated positively with perceived stress in mothers, difficulties in mother-child bonding and child hyperactivity, and negatively with child prosocial behavior.

CONCLUSIONS

The Spanish version of the Parenting Scale is a valid and reliable measure that can be used by healthcare professionals and scientists to assess dysfunctional parenting in Spanish mothers of children aged 2 to 7 years.

PRACTICE IMPLICATIONS

This study will allow the use of the Parenting Scale in epidemiological and cross-cultural studies in a variety of applied contexts. Additionally, health professionals who work with families in Spain will have access to a valid and reliable instrument for the assessment of mothers' parenting styles.

Development and psychometric evaluation of a 360-degree evaluation instrument to assess medical students’ performance in clinical settings at the emergency medicine department in Iran: a methodological study

BACKGROUND

In the Iranian context, no 360-degree evaluation tool has been developed to assess the performance of prehospital medical emergency students in clinical settings. This article describes the development of a 360-degree evaluation tool and presents its first psychometric evaluation.

METHODS

There were 2 steps in this study: step 1 involved developing the instrument (i.e., generating the items) and step 2 constituted the psychometric evaluation of the instrument. We performed exploratory and confirmatory factor analyses and also evaluated the instrument’s face, content, and convergent validity and reliability.

RESULTS

The instrument contains 55 items across 6 domains, including leadership, management, and teamwork (19 items), consciousness and responsiveness (14 items), clinical and interpersonal communication skills (8 items), integrity (7 items), knowledge and accountability (4 items), and loyalty and transparency (3 items). The instrument was confirmed to be a valid measure, as the 6 domains had eigenvalues over Kaiser’s criterion of 1 and in combination explained 60.1% of the variance (Bartlett’s test of sphericity [1,485]=19,867.99, P<0.01). Furthermore, this study provided evidence for the instrument’s convergent validity and internal consistency (α=0.98), suggesting its suitability for assessing student performance.

CONCLUSION

We found good evidence for the validity and reliability of the instrument. Our instrument can be used to make future evaluations of student performance in the clinical setting more structured, transparent, informative, and comparable.

A Confirmatory Factor Analysis of the Structure of Statistics Anxiety Measure: An examination of four alternative models

OBJECTIVE

The aim of this study is to explore the confirmatory factor analysis results of the Persian adaptation of Statistics Anxiety Measure (SAM), proposed by Earp.

METHOD

The validity and reliability assessments of the scale were performed on 298 college students chosen randomly from Tabriz University in Iran. Confirmatory factor analysis (CFA) was carried out to determine the factor structures of the Persian adaptation of SAM.

RESULTS

As expected, the second order model provided a better fit to the data than the three alternative models.

CONCLUSIONS

Hence, SAM provides an equally valid measure for use among college students. The study both expands and adds support to the existing body of math anxiety literature.