Measuring self-care in chronic heart failure : a review of the psychometric properties of clinical instruments

Background : Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care.

Objective : The aim of this study was to identify instruments that measure chronic heart failure (CHF) self-care and demonstrate their psychometric properties.

Methods : A search of Medline, Cumulative Index to Nursing and Allied Health Literature, Medline, PsycArticles, Psychology and Behavioral Sciences Collection, and PsycINFO databases elucidated studies published between January 1980 and February 2009 that measure CHF self-care. The clinical instruments selected were disease-specific measures of CHF self-care behaviors that are promoted in best practice guidelines. Only instruments that reported estimates of reliability and validity were included in this review. Psychometric properties of the instruments were evaluated according to practice guidelines.

Results : The literature search identified 14 instruments published in peer-reviewed journals that measured constructs that predict or correlate to self-care rather than self-care itself. Only 2 disease-specific measures of self-care were identified (Self-care Heart Failure Index [SCHFI] and European Heart Failure Self-care Behavior Scale [EHFScBS]) that have undergone rigorous psychometric testing in CHF populations. Five aspects of validity had been demonstrated with EHFScBS, and 6 aspects of validity had been demonstrated with SCHFI. Two of 3 aspects of reliability have been demonstrated in both instruments.

Conclusion : Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it.

Measuring moral judgement and the implications of cooperative education and rule-based learning

The Defining Issues Test (DIT), developed by Rest (1986), measures a person's level of moral development using hypothetical social dilemmas. Although the DIT is useful for measuring moral development in social settings, it might not adequately capture an individual's moral judgement abilities in solving work-related problems (Weber, 1990; Trevino, 1992; Welton et al., 1994). In the present study, the moral judgement levels of 97 accounting students were measured over a 1 year period using two separate test instruments, the DIT and a context-specific instrument developed by Welton et al. (1994). The test scores are significantly higher on the DIT than the Welton instrument (between the instruments and over time), suggesting that accounting students use higher levels of moral reasoning in resolving hypothetical social dilemmas and lower levels of moral reasoning in resolving context-specific dilemmas. The difference in test scores was highest during cooperative education (work placement programme), implying that the environment is a significant determinant on students' test scores.

Measuring quality of life in alcohol and other drug users - the need for improvement

Objective : The use of Quality of Life (QoL) -related measures in Alcohol and Other Drug-related research has increased dramatically over the past decade. However, there remains a great deal of confusion about which type of QoL measure is most valid, what each constrict actually measures and the ethicality of the process of QoL measurement and its subsequent transfer to monetary value. This is particularly important in regard to subsequent resource allocation on the basis of Quality Adjusted Life Years (QALYs). We aim to review the logic of current QoL -related measurement and determine the most conceptually valid way of measuring QoL.

Methods : This review considers some of the broad principles that concern quality of life assessment. These are discussed in relation to health-related quality of life (HRQoL) and the measurement of subjective well-being.

Results : We argue that there are serious logical and methodological issues concerning HRQoL measurement, to the extent that the instruments may not be regarded as valid measures of life quality as this term is generally understood.

Conclusions : It is recommended that HRQoL measurement be abandoned in favour of three separate forms of measurement as medical symptoms, subjective well-being and specific dimensions of psychological ill-being.

Measuring student engagement : using 'flow' theory to guide question development

In December 2009 the Department of Education, Employment and Workplace Relations (DEEWR) issued a discussion paper, ‘An Indicator Framework for Higher Education Performance Funding’, with the purpose of contributing to the development of indicators for guiding ‘compact’ negotiations between Australian universities and the government. The discussion paper makes it clear that ‘student experience’ will be an important part of the indicators and discusses the possibility that the Government will develop a new
questionnaire to investigate the engagement and satisfaction of students in their first year of study. This paper contributes ideas to assist the development of such an instrument, particularly for the measurement of student engagement. We discuss problems with the predictive validity of existing instruments and argue that predictive validity may be improved by a focus on highly engaging ‘flow-type’ activities. Specifically, we
investigate flow activities in the context of online learning. Our findings suggest that some of the current questions from the Australasian Survey of Student Engagement (AUSSE) do appear to capture flow activities. We also identify gaps in the AUSSE. Finally, we make recommendations about the inclusion of additional items that capture highly engaging, flow activities for either the AUSSE or the Government’s proposed new instrument.

The suitability of polycystic ovary syndrome-specific questionnaires for measuring the impact of PCOS on quality of life in clinical trials

Objectives: Generic patient-reported outcome (PRO) measures underestimate the impact of polycystic ovary syndrome (PCOS) on quality of life (QoL). The aim of this review was to identify PCOS-specific QoL measures and establish whether their development history and measurement properties support their use in clinical trials.

Methods: A systematic search was conducted using terms synonymous with “PCOS” and “QoL.” Following identification of measures, further searches were undertaken using the questionnaire name and abbreviation to explore its use, development history, and demonstrated measurement properties.

Results: Of 56 abstracts screened, 21 reported using PRO measures. One PCOS-specific QoL measure was identified: the PolyCystic Ovary Syndrome Questionnaire (PCOSQ). Nine papers show that the PCOSQ’s development history is somewhat incomplete, and that it does not have good content validity. The PCOSQ subscales demonstrate acceptable levels of reliability (0.70–0.97) and partial known-groups validity as well as convergent/divergent validity with other PRO instruments. Responsiveness
to change is variable and minimally important differences have not been established.

Conclusions: The PCOSQ is the only condition-specific measure of the impact of PCOS on QoL. Additional research is required to ensure its comprehensiveness, sensitivity, and to guide interpretation prior to including in clinical trials.

Measuring postgraduates’ research experiences in an Australian university

This article reviews two instruments which have been used to measure postgraduates’ research experiences in an Australian university; (1) the UK Postgraduate Research Experience Survey (PRES); and (2) the Australian Postgraduate Research Experience Questionnaire (PREQ). A comparative study of PRES and PREQ at an Australian university was carried out in 2011. The data collected by the university using PREQ were used as a reference base to compare the validity of the PRES data gathered by the researchers. The results were then benchmarked against the state of Victoria and Australian national standards.

The potential for measuring ethnicity and health in a multicultural milieu - the case of type 2 diabetes in Australia

Objective
Ethnicity influences health in many ways. For example, type 2 diabetes (T2DM) is disproportionately prevalent among certain ethnic groups. Assessing ethnicity is difficult, and numerous proxy measures are used to capture its various components. Australian guidelines specify a set of variables for measuring ethnicity, and how such parameters should be categorised. Using T2DM data collections as an illustrative example, this study sought to examine how ethnicity is measured in Australian health databases and, by comparing current practice with Australia’s existing benchmark recommendations, to identify potential areas for improvement of the health data landscape.

eVALUate: an evaluation instrument for measuring students’ perceptions of their engagement and learning outcomes

In the current climate in Australian higher education, quality assurance in university teaching is a priority. In particular, the introduction of the Learning and Teaching Performance Fund (LTPF) has refocused attention on universities’ internal student evaluation survey instruments. This paper reports the development, validation and implementation of a new unit survey instrument which prompts students to reflect on what helps their achievement of unit learning outcomes, and to report their levels of motivation, engagement and overall satisfaction with a semester‐long course or unit of study. The instrument (eVALUate) was created from precepts reported in the research literature, current practices in evaluating teaching, and sound quality assurance practices appropriate to a university outcomes‐focused education paradigm.

Adaptation and validation of a survey instrument measuring perceived preparedness of nursing graduates

BACKGROUND: In Australia, a significant percentage of bachelor of nursing students are employed in the aged care sector, or in aged care settings, as assistants in nursing (AINs) or personal care assistants. However the value of aged care in nursing education is often overlooked. AIM: To outline the adaptation and validation of a survey, originally developed for medical graduates, for use with nursing graduates. DISCUSSION: Adaptation of the instrument was undertaken as part of a doctoral study that aimed to explore whether employment as an undergraduate assistant in nursing (AIN) in aged care prepares new graduates for clinical work. CONCLUSION: Outlining each step of the modification process can help nurse researchers who want to adapt existing instruments to meet their research objectives. IMPLICATIONS FOR PRACTICE: Undergraduate AIN employment has the potential to supplement clinical learning without the restrictions inherent in the student role. Furthermore, it has the potential to enhance recruitment and retention in the aged care sector.