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.

Development of an instrument for the analysis of problem gambling counselling practice

This article provides an overview of the development and validation of a Counsellor Task Analysis (Problem Gambling) [CTA (PG)] instrument undertaken in order to document the activities of counsellors in problem gambling services. The CTA (PG) aims to provide a broad overview of the complexity of the counsellor's role; specify the range of tasks they perform; and document the relationship between the frequency of task performance and the counsellor's beliefs about the importance of the tasks performed.

The CTA (PG) instrument addresses nine dimensions of practice activity through nine subscales, all of which demonstrate internal consistency. It appears to be a strong instrument in terms of its measurement error characteristics for recommending its use with counsellors engaged in the field of gambling. The CTA (PG) gives counsellors the opportunity to document their practice and theories in use when dealing with a problem gambler, a member of the problem gambler's family and the community at large. The psychometric findings reported in this article should be viewed as the preliminary results of an ongoing research effort and further psychometric testing is anticipated.

Yoga as a preventative and treatment for depression, anxiety and stress

With the dual aims of better understanding the contribution of Yoga to positive mental health and exploring links between yogic philosophy and psychological theory, researchers at Deakin University in Melbourne, Australia, conducted a study on Yoga as a preventative and treatment for symptoms of mental illness. The Yoga classes were designed as a six-week program incorporating breathing techniques (prânâyâma), exercises for strength, vitality, and flexibility (âsanas), guided relaxation (yoga-nidrâ), and meditation. The aim of this process was to enhance self-awareness, encourage the perspective that emotional states are somewhat transient, and encourage a self-accepting and calm attitude through concentrating on synchronizing gentle movements and breathing. By developing calmness, selfacceptance, a balanced perspective, and enhanced concentration it was hypothesized that participants in the six-week Yoga program would strengthen their resistance to emotional distress. Psychometric testing was carried out to assess symptoms of stress, anxiety, and depression across three groups: regular Yoga practitioners, beginners entering the program, and people who did not practice Yoga, and these tests were re-administered after six weeks. In addition, a strong sense of intrinsic spiritual experience has been cited as a possible buffer to stress, anxiety, and depression and has been associated with decreased frequency of medical symptoms. All participants were therefore also assessed on their sense of intrinsic spirituality, but not on religious beliefs. At the end of six weeks, the Yoga beginners group showed lower average levels of symptoms of depression, anxiety, and stress than at commencement, but levels were stable for regular Yoga practitioners and people who did not practice Yoga. In addition, beginners showed growth in their self-reported level of intrinsic spiritual experience.

Development of a multi-dimensional measure of resilience in adolescents : the adolescent resilience questionnaire

Background: The concept of resilience has captured the imagination of researchers and policy makers over the past two decades. However, despite the ever growing body of resilience research, there is a paucity of relevant, comprehensive measurement tools. In this article, the development of a theoretically based, comprehensive multidimensional measure of resilience in adolescents is described.

Methods: Extensive literature review and focus groups with young people living with chronic illness informed the conceptual development of scales and items. Two sequential rounds of factor and scale analyses were undertaken to revise the conceptually developed scales using data collected from young people living with a chronic illness and a general population sample.

Results: The revised Adolescent Resilience Questionnaire comprises 93 items and 12 scales measuring resilience factors in the domains of self, family, peer, school and community. All scales have acceptable alpha coefficients. Revised scales closely reflect conceptually developed scales.

Conclusions: It is proposed that, with further psychometric testing, this new measure of resilience will provide researchers and clinicians with a comprehensive and developmentally appropriate instrument to measure a young person’s capacity to achieve positive outcomes despite life stressors.

The Utopian (R)evolution

The Utopian (R)evolution proposes that the utopian fantasy precedes ideology and that utopian literature has evolved from being a tool of wish-fulfilment to becoming one of traversal. Into the Machine combines an electronic reading environment, psychometric testing, and a branching utopian narrative to imagine the next step in this evolution.

Testing the psychometric properties of Clary's volunteer motivation scale with online panel members

Academic researchers, industry and policy-makers are increasingly using online panels as a means for data collection for their research. Online panels are frequently constituted by volunteers who can choose to accept offers to participate in research (cf. voluntary opt-in Cooper 2000). This research focuses on the importance volunteering as the primary reason as to why individuals decide to become panel members. In so doing, we tested the psychometric properties of Clary et al. 's (1998) Volunteer Functions Inventory (VFI) making use of confirmatory factor analyses and ascertained that the dimensions exhibit adequate levels of reliability and validity in an online panel member's milieu.

Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses

Objective
Health literacy refers to an individual's ability to seek, understand, and use health information. A range of indices exist that purport to measure health literacy across individuals and populations. This study aimed to review the development and content of existing indices and to critically appraise their properties.

Study Design and Setting
Using standardized search terms, published generic health literacy indices (1990–2008) were identified. Using a methodological framework, each was evaluated for purpose, validity (face, content, construct), reliability, responsiveness, feasibility, and generalizability.

Results
Nineteen instruments were evaluated. Three measurement approaches were identified: direct testing of individual abilities, self-report of abilities, and population-based proxy measures. Composition of underlying constructs and content varied widely across instruments, and none appeared to fully measure a person's ability to seek, understand, and use health information. The content was focused primarily on reading comprehension and numeracy; scoring categories were poorly defined and may not be mutually exclusive, and few indices had been assessed for reliability.

Conclusion
Health literacy is not consistently measured, making it difficult to interpret and compare health literacy at individual and population levels. Empirical evidence demonstrating validity and reliability of existing indices is required, and more comprehensive health literacy instruments need to be developed.

A protocol for advanced psychometric assessment of surveys

Background and Purpose. In this paper, we present a protocol for advanced psychometric assessments of surveys based on the Standards for Educational and Psychological Testing. We use the Alberta Context Tool (ACT) as an exemplar survey to which this protocol can be applied.

Methods. Data mapping, acceptability, reliability, and validity are addressed. Acceptability is assessed with missing data frequencies and the time required to complete the survey. Reliability is assessed with internal consistency coefficients and information functions. A unitary approach to validity consisting of accumulating evidence based on instrument content, response processes, internal structure, and relations to other variables is taken. We also address assessing performance of survey data when aggregated to higher levels (e.g., nursing unit).

Discussion. In this paper we present a protocol for advanced psychometric assessment of survey data using the Alberta Context Tool (ACT) as an exemplar survey; application of the protocol to the ACT survey is underway. Psychometric assessment of any survey is essential to obtaining reliable and valid research findings. This protocol can be adapted for use with any nursing survey.

Field-testing of the rapid assessment of disability questionnaire

The Rapid Assessment of Disability (RAD) questionnaire measures the magnitude and impact of disability and aims to inform the design of disability inclusive development programs. This paper reports the psychometric evaluation of the RAD.