Preliminary reliability and validity testing of a self-efficacy questionnaire for Chinese family caregivers

Objectives: To develop and test preliminary reliability and validity of a Self-Efficacy Questionnaire for Chinese Family Caregivers (SEQCFC). Methods: A cross-sectional survey of 196 family caregivers (CGs) of people with dementia (CGs) was conducted to determine the factor structure of a SEQCFC of people with dementia. Following factor analyses, preliminary testing was performed, including internal consistency, 4-week test retest reliability, and construct and convergent validity. Results: Factor analyses with direct oblimin rotation were performed. Eight items were removed and five subscales(selfefficacy for gathering information about treatment, symptoms and health care; obtaining support; responding to behaviour disturbances; managing household, personal and medical care; and managing distress associated with caregiving) were identified. The Cronbach’s alpha coefficients for the whole scale and for each subscale were all over 0.80. The 4-week testretest reliabilities for the whole scale and for each subscale ranged from 0.64 to 0.85. The convergent validity was acceptable. Conclusions: Evidence for the preliminary testing of the SEQCFC was encouraging. A future follow-up study using confirmatory factor analysis with a new sample from different recruitment centres in Shanghai will be conducted. Future psychometric property testings of the questionnaire will be required for CGs from other regions of mainland China.

Assessing the construct validity and reliability of the parental perception on antibiotics (PAPA) scales

Background: The overuse of antibiotics is becoming an increasing concern. Antibiotic resistance, which increases both the burden of disease, and the cost of health services, is perhaps the most profound impact of antibiotics overuse. Attempts have been made to develop instruments to measure the psychosocial constructs underlying antibiotics use, however, none of these instruments have undergone thorough psychometric validation. This study evaluates the psychometric properties of the Parental Perceptions on Antibiotics (PAPA) scales. The PAPA scales attempt to measure the factors influencing parental use of antibiotics in children. Methods: 1111 parents of children younger than 12 years old were recruited from primary schools’ parental meetings in the Eastern Province of Saudi Arabia from September 2012 to January 2013. The structure of the PAPA instrument was validated using Confirmatory Factor Analysis (CFA) with measurement model fit evaluated using the raw and scaled χ2, Goodness of Fit Index, and Root Mean Square Error of Approximation. Results: A five-factor model was confirmed with the model showing good fit. Constructs in the model include: Knowledge and Beliefs, Behaviors, Sources of information, Adherence, and Awareness about antibiotics resistance. The instrument was shown to have good internal consistency, and good discriminant and convergent validity. Conclusion: The availability of an instrument able to measure the psychosocial factors underlying antibiotics usage allows the risk factors underlying antibiotic use and overuse to now be investigated.

Validity of a self-report recall tool for estimating sedentary behaviour in adults

BACKGROUND Sedentary behavior is continuing to emerge as an important target for health promotion. The purpose of this study was to determine the validity of a self-report use of time recall tool, the Multimedia Activity Recall for Children and Adults (MARCA) in estimating time spent sitting/lying, compared with a device-based measure. METHODS Fifty-eight participants (48% female, [mean±standard deviation] 28±7.4 years of age, 23.9±3.05 kg/m2) wore an activPAL device for 24-h and the following day completed the MARCA. Pearson correlation coefficients (r) were used to analyse convergent validity of the adult MARCA compared with activPAL estimates of total sitting/lying time. Agreement was examined using Bland-Altman plots. RESULTS According to activPAL estimates, participants spent 10.4 hr/day [standard deviation (SD)=2.06] sitting or lying down while awake. The correlation between MARCA and activPAL estimates of total sit/lie time was r=0.77 (95% confidence interval = 0.64-0.86; p<0.001). Bland-Altman analyses revealed a mean bias of +0.59 hr/day with moderately wide limits of agreement (-2.35 hours to +3.53 hr/day). CONCLUSIONS This study found a moderate to strong agreement between the adult MARCA and the activPAL, suggesting that the MARCA is an appropriate tool for the measurement of time spent sitting or lying down in an adult population.

The validity of the GENEActiv wrist-worn accelerometer for measuring adult sedentary time in free living

OBJECTIVES Based on self-reported measures, sedentary time has been associated with chronic disease and mortality. This study examined the validity of the wrist-worn GENEactiv accelerometer for measuring sedentary time (i.e. sitting and lying) by posture classification, during waking hours in free living adults. DESIGN Fifty-seven participants (age=18-55 years 52% male) were recruited using convenience sampling from a large metropolitan Australian university. METHODS Participants wore a GENEActiv accelerometer on their non-dominant wrist and an activPAL device attached to their right thigh for 24-h (00:00 to 23:59:59). Pearson's Correlation Coefficient was used to examine the convergent validity of the GENEActiv and the activPAL for estimating total sedentary time during waking hours. Agreement was illustrated using Bland and Altman plots, and intra-individual agreement for posture was assessed with the Kappa statistic. RESULTS Estimates of average total sedentary time over 24-h were 623 (SD 103) min/day from the GENEActiv, and 626 (SD 123) min/day from the activPAL, with an Intraclass Correlation Coefficient of 0.80 (95% confidence intervals 0.68-0.88). Bland and Altman plots showed slight underestimation of mean total sedentary time for GENEActiv relative to activPAL (mean difference: -3.44min/day), with moderate limits of agreement (-144 to 137min/day). Mean Kappa for posture was 0.53 (SD 0.12), indicating moderate agreement for this sample at the individual level. CONCLUSIONS The estimation of sedentary time by posture classification of the wrist-worn GENEActiv accelerometer was comparable to the activPAL. The GENEActiv may provide an alternative, easy to wear device based measure for descriptive estimates of sedentary time in population samples

Resilience in chronic disease : the relationships among risk factors, protective factors, adaptive outcomes, and the level of resilience in adults with diabetes

Background: There are innumerable diabetes studies that have investigated associations between risk factors, protective factors, and health outcomes; however, these individual predictors are part of a complex network of interacting forces. Moreover, there is little awareness about resilience or its importance in chronic disease in adulthood, especially diabetes. Thus, this is the first study to: (1) extensively investigate the relationships among a host of predictors and multiple adaptive outcomes; and (2) conceptualise a resilience model among people with diabetes. Methods: This cross-sectional study was divided into two research studies. Study One was to translate two diabetes-specific instruments (Problem Areas In Diabetes, PAID; Diabetes Coping Measure, DCM) into a Chinese version and to examine their psychometric properties for use in Study Two in a convenience sample of 205 outpatients with type 2 diabetes. In Study Two, an integrated theoretical model is developed and evaluated using the structural equation modelling (SEM) technique. A self-administered questionnaire was completed by 345 people with type 2 diabetes from the endocrine outpatient departments of three hospitals in Taiwan. Results: Confirmatory factor analyses confirmed a one-factor structure of the PAID-C which was similar to the original version of the PAID. Strong content validity of the PAID-C was demonstrated. The PAID-C was associated with HbA1c and diabetes self-care behaviours, confirming satisfactory criterion validity. There was a moderate relationship between the PAID-C and the Perceived Stress Scale, supporting satisfactory convergent validity. The PAID-C also demonstrated satisfactory stability and high internal consistency. A four-factor structure and strong content validity of the DCM-C was confirmed. Criterion validity demonstrated that the DCM-C was significantly associated with HbA1c and diabetes self-care behaviours. There was a statistical correlation between the DCM-C and the Revised Ways of Coping Checklist, suggesting satisfactory convergent validity. Test-retest reliability demonstrated satisfactory stability of the DCM-C. The total scale of the DCM-C showed adequate internal consistency. Age, duration of diabetes, diabetes symptoms, diabetes distress, physical activity, coping strategies, and social support were the most consistent factors associated with adaptive outcomes in adults with diabetes. Resilience was positively associated with coping strategies, social support, health-related quality of life, and diabetes self-care behaviours. Results of the structural equation modelling revealed protective factors had a significant direct effect on adaptive outcomes; however, the construct of risk factors was not significantly related to adaptive outcomes. Moreover, resilience can moderate the relationships among protective factors and adaptive outcomes, but there were no interaction effects of risk factors and resilience on adaptive outcomes. Conclusion: This study contributes to an understanding of how risk factors and protective factors work together to influence adaptive outcomes in blood sugar control, health-related quality of life, and diabetes self-care behaviours. Additionally, resilience is a positive personality characteristic and may be importantly involved in the adjustment process among people living with type 2 diabetes.

Validation of the Australian Propensity for Angry Driving Scale (Aus-PADS)

The present study used a university sample to assess the test-retest reliability and validity of the Australian Propensity for Angry Driving Scale (Aus-PADS). The scale has stability over time, and convergent validity was established, as Aus-PADS scores correlated significantly with established anger and impulsivity measures. Discriminant validity was also established, as Aus-PADS scores did not correlate with Venturesomeness scores. The Aus-PADS has demonstrated criterion validity, as scores were correlated with behavioural measures, such as yelling at other drivers, gesturing at other drivers, and feeling angry but not doing anything. Aus-PADS scores reliably predicted the frequency of these behaviours over and above other study variables. No significant relationship between aggressive driving and crash involvement was observed. It was concluded that the Aus-PADS is a reliable and valid tool appropriate for use in Australian research, and that the potential relationship between aggressive driving and crash involvement warrants further investigation with a more representative (and diverse) driver sample.

Customer-oriented deviance (COD) : a conceptualisation, development and validation of a behavioural measure

Frontline employee behaviours are recognised as vital for achieving a competitive advantage for service organisations. The services marketing literature has comprehensively examined ways to improve frontline employee behaviours in service delivery and recovery. However, limited attention has been paid to frontline employee behaviours that favour customers in ways that go against organisational norms or rules. This study examines these behaviours by introducing a behavioural concept of Customer-Oriented Deviance (COD). COD is defined as, “frontline employees exhibiting extra-role behaviours that they perceive to defy existing expectations or prescribed rules of higher authority through service adaptation, communication and use of resources to benefit customers during interpersonal service encounters.” This thesis develops a COD measure and examines the key determinants of these behaviours from a frontline employee perspective. Existing research on similar behaviours that has originated in the positive deviance and pro-social behaviour domains has limitations and is considered inadequate to examine COD in the services context. The absence of a well-developed body of knowledge on non-conforming service behaviours has implications for both theory and practice. The provision of ‘special favours’ increases customer satisfaction but the over-servicing of customers is also counterproductive for the service delivery and costly for the organisation. Despite these implications of non-conforming service behaviours, there is little understanding about the nature of these behaviours and its key drivers. This research builds on inadequacies in prior research on positive deviance, pro-social and pro-customer literature to develop the theoretical foundation of COD. The concept of positive deviance which has predominantly been used to study organisational behaviours is applied within a services marketing setting. Further, it addresses previous limitations in pro-social and pro-customer behavioural literature that has examined limited forms of behaviours with no clear understanding on the nature of these behaviours. Building upon these literature streams, this research adopts a holistic approach towards the conceptualisation of COD. It addresses previous shortcomings in the literature by providing a well bounded definition, developing a psychometrically sound measure of COD and a conceptually well-founded model of COD. The concept of COD was examined across three separate studies and based on the theoretical foundations of role theory and social identity theory. Study 1 was exploratory and based on in-depth interviews using the Critical Incident Technique (CIT). The aim of Study 1 was to understand the nature of COD and qualitatively identify its key drivers. Thematic analysis was conducted to analyse the data and the two potential dimensions of COD behaviours of Deviant Service Adaptation (DSA) and Deviant Service Communication (DSC) were revealed in the analysis. In addition, themes representing the potential influences of COD were broadly classified as individual factors, situational factors, and organisational factors. Study 2 was a scale development procedure that involved the generation and purification of items for the measure based on two student samples working in customer service roles (Pilot sample, N=278; Initial validation sample, N=231). The results for the reliability and Exploratory Factor Analyses (EFA) on the pilot sample suggested the scale had poor psychometric properties. As a result, major revisions were made in terms of item wordings and new items were developed based on the literature to reflect a new dimension, Deviant Use of Resources (DUR). The revised items were tested on the initial validation sample with the EFA analysis suggesting a four-factor structure of COD. The aim of Study 3 was to further purify the COD measure and test for nomological validity based on its theoretical relationships with key antecedents and similar constructs (key correlates). The theoretical model of COD consisting of nine hypotheses was tested on a retail and hospitality sample of frontline employees (Retail N=311; Hospitality N=305) of a market research panel using an online survey. The data was analysed using Structural Equation Modelling (SEM). The results provided support for a re-specified second-order three-factor model of COD which consists of 11 items. Overall, the COD measure was found to be reliable and valid, demonstrating convergent validity, discriminant validity and marginal partial invariance for the factor loadings. The results showed support for nomological validity, although the antecedents had differing impact on COD across samples. Specifically, empathy and perspective-taking, role conflict, and job autonomy significantly influenced COD in the retail sample, whereas empathy and perspective-taking, risk-taking propensity and role conflict were significant predictors in the hospitality sample. In addition, customer orientation-selling orientation, the altruistic dimension of organisational citizenship behaviours, workplace deviance, and social desirability responding were found to correlate with COD. This research makes several contributions to theory. First, the findings of this thesis extend the literature on positive deviance, pro-social and pro-customer behaviours. Second, the research provides an empirically tested model which describes the antecedents of COD. Third, this research contributes by providing a reliable and valid measure of COD. Finally, the research investigates the differential effects of the key antecedents in different service sectors on COD. The research findings also contribute to services marketing practice. Based on the research findings, service practitioners can better understand the phenomenon of COD and utilise the measurement tool to calibrate COD levels within their organisations. Knowledge on the key determinants of COD will help improve recruitment and training programs and drive internal initiatives within the firm.

Validation of the WHOQOL-BREF among women following childbirth

Background: There is an increasing interest in measuring quality of life (QOL) in clinical settings and in clinical trials. None of the commonly used QOL instrument have been validated for use postnatally. Aim: To assess the psychometric properties of the 26-item WHOQOL-BREF among women following childbirth. Methods: Using a prospective cohort design we recruited 320 women within the first few days of childbirth. At six weeks postpartum, participants were asked to complete the WHOQOL-BREF, the Edinburgh Postnatal Depression Index and the Australian Unity Wellbeing Index. Validation of the WHOQOL-BREF included an analysis of internal consistency, discriminate validity, convergent validity and an examination of the domain structure. Results: 221 (69.1%) women returned their six-week questionnaire. All domains of the WHOQOL-BREF met reliability standards (alpha coefficient exceeding 0.70). The questionnaire discriminated well between known groups (depressed and non-depressed women. P = <0.000) and demonstrated satisfactory correlations with the Australian Unity Wellbeing index (r = >0.45). The domain structure of the WHOQOL-BREF was also valid in this population of new mothers, with moderate to high correlation between individual items and the domain structure to which the items were originally assigned. Conclusion: The WHOQOL-BRF is well-accepted and valid instrument in this population and may be used in postnatal clinical settings or for assessing intervention effects in research studies.

A validated self-administered female pelvic floor questionnaire

Introduction and hypothesis: The aim of this study was to validate a self-administered version of the already validated interviewer-administered Australian pelvic floor questionnaire. Methods: The questionnaire was completed by 163 women attending an urogynecological clinic. Face and convergent validity was assessed. Reliability testing and comparison with the interviewer-administered version was performed in a subset of 105 patients. Responsiveness was evaluated in a subset of 73 women. Results: Missing data did not exceed 4% for any question. Cronbach’s alpha coefficients were acceptable in all domains. Kappa coefficients for the test–retest analyses varied from 0.64–1.0. Prolapse symptoms correlated significantly with the pelvic organ prolapse quantification. Urodynamics confirmed the reported symptom stress incontinence in 70%. The self and interviewer administered questionnaires demonstrated equivalence. Effect sizes ranged from 0.6 to 1.4. Conclusions: This self-administered pelvic floor questionnaire assessed pelvic floor function in a reproducible and valid fashion and due to its responsiveness, can be used for routine clinical assessment and outcome research.

Are Active Australia physical activity questions valid for older adults?

Objective The Active Australia Survey (AAS) is used for physical activity (PA) surveillance in the general Australian adult population, but its validity in older adults has not been evaluated. Our aim was to examine the convergent validity of the AAS questions in older adults. Design The AAS was validated against pedometer step counts as an objective measure of PA, self-reported physical function, and a step-test to assess cardiorespiratory fitness. Method Participants were community-dwelling adults, aged 65-89 y, with the ability to walk 100 m. They completed a self-administered AAS and the step-test in one interview. One week earlier, they completed the Short Form-36 physical function subscale. Between these two interviews, they each wore a YAMAX Digiwalker SW200 pedometer and recorded daily steps. Using the AAS data, daily walking minutes and total PA minutes (walking, moderate-intensity PA and vigorous-intensity PA) were compared with the validity measures using Spearman rank-order correlations. Fifty-three adults completed the study. Results Median daily walking minutes were 34.2 (interquartile range [IQR] 17.1, 60.0), and median daily total PA minutes were 68.6 (IQR 31.4, 113.6). Walking and total PA minutes were both moderately correlated with pedometer steps (Spearman correlation r=0.42, p=0.003, for each) but not with step-test seconds to completion (r=-0.11, p=0.44; r=-0.25, p=0.08, respectively). Total PA minutes were significantly correlated with physical function scores (r=0.39, p=0.004), but walking minutes were not (r=0.15, p=0.29). Conclusions This initial examination of the psychometric properties of the AAS for older adults suggests that this surveillance tool has acceptable convergent validity for ambulatory, community-dwelling older adults.

Rating counselor - client behavior in online counseling: Development and preliminary psychometric properties of the Counseling Progress and Depth Rating Instrument

Although there are widely accepted and utilized models and frameworks for nondirective counseling (NDC), there is little in the way of tools or instruments designed to assist in determining whether or not a specific episode of counseling is consistent with the stated model or framework. The Counseling Progress and Depth Rating Instrument (CPDRI) was developed to evaluate counselor integrity in the use of Egan's skilled helper model in online counseling. The instrument was found to have sound internal consistency, good interrater reliability, and good face and convergent validity. The CPDRI is, therefore, proposed as a useful tool to facilitate investigation of the degree to which counselors adhere to and apply a widely used approach to NDC

The Multidimensional Loss Scale : validating a cross cultural instrument for measuring loss in Burmese refugees

The Multidimensional Loss Scale: Initial Development and Psychometric Evaluation The Multidimensional Loss Scale (MLS) represents the first instrument designed specifically to measure loss in refugee populations. Researchers developed initial items of the Multidimensional Loss Scale to assess Experience of Loss Events and Loss Distress in a culturally sensitive manner across multiple domains (social, material, intra-personal and cultural). A sample of 70 recently settled Burmese adult refugees completed a battery of questionnaires, including new scale items. Analyses explored the scale’s factor structure, internal consistency, convergent validity and divergent validity. Principal Axis Factoring supported a five-factor model: Loss of Symbolic Self, Loss of Interdependence, Loss of Home, Interpersonal Loss, and Loss of Intrapersonal Integrity. Chronbach’s Alphas indicated satisfactory internal consistency for Experience of Loss Events (.85) and Loss Distress (.92). Convergent and divergent validity of Loss Distress were supported by moderate correlations with interpersonal grief and trauma symptoms and weak correlations with depression and anxiety. The new scale was well received by people from refugee backgrounds and shows promise for application in future research and practice

Self-proxy agreement and weekly school travel behaviour in a sectarian divided society

Proxy reports from parents and self-reported data from pupils have often been used interchangeably to identify factors influencing school travel behaviour. However, few studies have examined the validity of proxy reports as an alternative to self-reported data. In addition, despite research that has been conducted in a different context, little is known to date about the impact of different factors on school travel behaviour in a sectarian divided society. This research examines these issues using 1624 questionnaires collected from four independent samples (e.g. primary pupils, parent of primary pupils, secondary pupils, and parent of secondary pupils) across Northern Ireland. An independent sample t test was conducted to identify the differences in data reporting between pupils and parents for different age groups using the reported number of trips for different modes as dependent variables. Multivariate multiple regression analyses were conducted to then identify the impacts of different factors (e.g. gender, rural–urban context, multiple deprivations, and school management type, net residential density, land use diversity, intersection density) on mode choice behaviour in this context. Results show that proxy report is a valid alternative to self-reported data, but only for primary pupils. Land use diversity and rural–urban context were found to be the most important factors in influencing mode choice behaviour.

An instrument to measure adherence to weight loss programs : the Compliance Praxis Survey-Diet (COMPASS-Diet)

Adherence to behavioral weight loss strategies is important for weight loss success. We aimed to examine the reliability and validity of a newly developed compliance praxis-diet (COMPASS-diet) survey with participants in a 10-week dietary intervention program. During the third of five sessions, participants of the “slim-without-diet” weight loss program (n = 253) completed the COMPASS-diet survey and provided data on demographic and clinical characteristics, and general self-efficacy. Group facilitators completed the COMPASS-diet-other scale estimating participants’ likely adherence from their perspective. We calculated internal consistency, convergent validity, and predictive value for objectively measured weight loss. Mean COMPASS-diet-self score was 82.4 (SD 14.2) and COMPASS-diet-other score 80.9 (SD 13.6) (possible range 12–108), with lowest scores in the normative behavior subscale. Cronbach alpha scores of the COMPASS-diet-self and -other scale were good (0.82 and 0.78, respectively). COMPASS-diet-self scores (r = 0.31) correlated more highly with general self-efficacy compared to COMPASS-diet-other scores (r = 0.04) providing evidence for validity. In multivariable analysis adjusted for age and gender, both the COMPASS-diet-self (F = 10.8, p < 0.001, r2 = 0.23) and other (F = 5.5, p < 0.001, r2 = 0.19) scales were significantly associated with weight loss achieved at program conclusion. COMPASS-diet surveys will allow group facilitators or trainers to identify patients who need additional support for optimal weight loss.

Development of the child abuse and neglect reporting self-efficacy questionnaire for nurses

Taiwan nurses are mandated to report known or suspected child abuse and neglect (CAN), and self-efficacy is known to have an important influence on professional behaviors. The aim of this study was to develop and test the CAN reporting self-efficacy (CANRSE) scale as a measure of nurses’ self-efficacy to report CAN. A sample of 496 nurses from Southern Taiwanese hospitals used the CANRSE scale. The psychometric evaluation of the scale included content validity, exploratory and confirmatory factor analyses, convergent validity, as well as Cronbach’s α and test−retest reliability. Satisfactory internal consistency (Cronbach’s α = 0.92) and test−retest reliability were demonstrated. Confirmatory factor analysis supported the proposed models as having acceptable model fit. Exploratory factor analysis and regression analyses showed that the CANRSE scale had good construct validity and criterion-related validity, respectively. Convergent validity was tested using the general self-efficacy scale and was found to be satisfactory (r = 0.53). The results indicate the CANRSE is reliable and valid, and further testing of its predictive validity is recommended. It can be used to examine the influence of professional self-efficacy in recognizing and reporting CAN cases and to evaluate the impact of training programs aimed at improving CAN reporting.