Structural equation modeling of the medical outcome study: Short Form 36 (SF-36)

The factorial validity of the SF-36 was evaluated using confirmatory factor analysis (CFA) methods, structural equation modeling (SEM), and multigroup structural equation modeling (MSEM). First, the measurement and structural model of the hypothesized SF-36 was explicated. Second, the model was tested for the validity of a second-order factorial structure, upon evidence of model misfit, determined the best-fitting model, and tested the validity of the best-fitting model on a second random sample from the same population. Third, the best-fitting model was tested for invariance of the factorial structure across race, age, and educational subgroups using MSEM.^ The findings support the second-order factorial structure of the SF-36 as proposed by Ware and Sherbourne (1992). However, the results suggest that: (a) Mental Health and Physical Health covary; (b) general mental health cross-loads onto Physical Health; (c) general health perception loads onto Mental Health instead of Physical Health; (d) many of the error terms are correlated; and (e) the physical function scale is not reliable across these two samples. This hierarchical factor pattern was replicated across both samples of health care workers, suggesting that the post hoc model fitting was not data specific. Subgroup analysis suggests that the physical function scale is not reliable across the "age" or "education" subgroups and that the general mental health scale path from Mental Health is not reliable across the "white/nonwhite" or "education" subgroups.^ The importance of this study is in the use of SEM and MSEM in evaluating sample data from the use of the SF-36. These methods are uniquely suited to the analysis of latent variable structures and are widely used in other fields. The use of latent variable models for self reported outcome measures has become widespread, and should now be applied to medical outcomes research. Invariance testing is superior to mean scores or summary scores when evaluating differences between groups. From a practical, as well as, psychometric perspective, it seems imperative that construct validity research related to the SF-36 establish whether this same hierarchical structure and invariance holds for other populations.^ This project is presented as three articles to be submitted for publication. ^

Coloured Letters and Numbers (CLaN): A reliable factor-analysis based synaesthesia questionnaire

Synaesthesia is a heterogeneous phenomenon, even when considering one particular sub-type. The purpose of this study was to design a reliable and valid questionnaire for grapheme-colour synaesthesia that captures this heterogeneity. By the means of a large sample of 628 synaesthetes and a factor analysis, we created the Coloured Letters and Numbers (CLaN) questionnaire with 16 items loading on 4 different factors (i.e., localisation, automaticity/attention, deliberate use, and longitudinal changes). These factors were externally validated with tests which are widely used in the field of synaesthesia research. The questionnaire showed good test–retest reliability and construct validity (i.e., internally and externally). Our findings are discussed in the light of current theories and new ideas in synaesthesia research. More generally, the questionnaire is a useful tool which can be widely used in synaesthesia research to reveal the influence of individual differences on various performance measures and will be useful in generating new hypotheses.

The Coin Rotation Task: A Valid Test for Manual Dexterity in Multiple Sclerosis

BACKGROUND: Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS). Therefore, convenient, quick and validated tests for manual dexterity in MS patients are needed. OBJECTIVE: The aim of this study was to validate the Coin Rotation task (CRT) to examine manual dexterity in patients with MS. DESIGN: Cross-sectional study. METHODS: 101 outpatients with MS were assessed with the CRT, the Expanded Disability Status Scale (EDSS), the Scale for the assessment and rating of ataxia (SARA), the Modified Ashworth Scale (MAS), and their muscle strength and sensory deficits of the hands were noted. Concurrent validity and diagnostic accuracy of the CRT were determined by comparison with the Nine Hole Peg Test (9HPT). Construct validity was determined by comparison with a valid dexterity questionnaire. Multiple regression analysis was done to explore correlations of the CRT with the EDSS, SARA, MAS, muscle strength and sensory deficits. RESULTS: The CRT correlated significantly with the 9HPT (r=.73, p<.0001) indicating good concurrent validity. The cut-off values for the CRT relative to the 9HPT were 18.75 seconds for the dominant (sensitivity: 81.5%; specificity 80.0%) and 19.25 seconds for the non-dominant hand (sensitivity: 90.3%; specificity: 81.8%) demonstrating good diagnostic accuracy. Furthermore, the CRT correlated significantly with the dexterity questionnaire (r=-.49, p<.0001) indicating moderate construct validity. Multiple regression analyses revealed that the EDSS was the strongest predictor for impaired dexterity. LIMITATIONS: Mostly relapsing-remitting MS patients with an EDSS up to 7 were examined. CONCLUSIONS: This study validates the CRT as a test that can be used easily and quickly to evaluate manual dexterity in patients with MS.

BMZI-HEA. Adaption des Berner Motiv- und Zielinventars im Freizeit- und Gesundheitssport für Menschen im höheren Erwachsenenalter

Die Förderung regelmäßiger Bewegungs- und Sportaktivitäten bei älteren Menschen gewinnt zunehmend an Bedeutung. Für eine effiziente Bewegungs- und Sportförderung werden zielgruppenspezifische Maßnahmen gefordert. Sportbezogene Motive und Ziele von Älteren werden aktuell selten systematisch in die Konzeption von Interventionen miteinbezogen, wenngleich sie für das Wohlbefinden und die Aufrechterhaltung des Sportverhaltens eine zentrale Rolle einnehmen. Das bereits bestehende BMZI ermöglicht die Individualdiagnose von Motiven und Zielen im Freizeit- und Gesundheitssport bei Personen im mittleren Erwachsenenalter. Der vorliegende Beitrag zielt auf eine Adaption des Fragebogens für Menschen im höheren Erwachsenenalter. Das BMZI-HEA deckt mit insgesamt 27 Items folgende Motive und Ziele ab: Figur/Aussehen, Kontakt, Wettkampf/Leistung, Alltagskompetenz/Gesundheit, Positive Bewegungserfahrungen, Kognitive Funktionsfähigkeit, Stimmungsregulation. Der Fragebogen wurde an drei Stichproben explorativ und konfirmatorisch überprüft. Der globale Modell-Fit des BMZI-HEA ist als zufriedenstellend zu beurteilen. Die erwartungskonformen Zusammenhänge mit der Selbstkonkordanz verweisen auf eine gute Konstruktvalidität des Instruments. Das BMZI-HEA empfiehlt sich als ökonomisches Instrument für die Individualdiagnose der psychischen Handlungsvoraussetzungen für das Sporttreiben von Menschen im höheren Erwachsenenalter.

In Richtung "Komplexe PTBS": die deutsche Version des Trauma Symptom Inventory (TSI) zur Erfassung komplexer Traumafolgen.

Die Studie überprüfte die deutsche Übersetzung des Trauma Symptom Inventory (TSI) von Briere [1], das die Komplexe PTB-Symptomatik erfassen soll. Das TSI war Teil einer Testbatterie, welche weiter den Childhood Trauma Questionnaire, Short Screening Scale, Short Form Health Survey, Geriatrische Depressionsskala und das Mini International Neuropsychiatric Interview enthielt. Untersucht wurde eine Stichprobe von N=116 älteren Personen (Altersbereich: 59-98 Jahre; 40,5% Frauen) mit einer Häufung potentiell traumatischer Erfahrungen in der Kindheit. Die deutsche Version des TSI zeigte eine adäquate interne Konsistenz, überwiegend gute Trennschärfen und Schwierigkeitsindizes sowie eine gute Kriteriums- und Konstruktvalidität. Hinsichtlich faktorieller Validität konnte ein Validierungsmodell [2] aus dem europäischen Raum tendenziell besser repliziert werden, als das amerikanische Originalmodell von Briere. Das TSI erwies sich als reliables, ökonomisches und teilweise valides Instrument zur Erfassung der Komplexen PTB-Symptomatik.

Construction and first validation of the comprehensive inventory of mindfulness (CHIME)

Introduction: Measuring trait mindfulness and change in mindfulness may be a crucial prerequisite for the evaluation and further development of mindfulness based interventions for the treatment of mental disorders. This endeavour is nontrivial as current measures cover varying aspects and mindfulness and may have problems regarding validity. This presentation describes the development and validation of a questionnaire for the comprehensive assessment of mindfulness: the Comprehensive Inventory of Mindfulness Experiences (CHIME). Method: The factor structure, reliability, and validity of the CHIME were established in a community sample (N = 298) and a sample of MBSR group participants (N = 161). Results: Factor-analytical procedures supported an eight-factor structure. The structure was tested in a further confirmatory sample (N = 202). The questionnaire and its subscales exhibited good reliability (internal consistency and retest-reliability). Analysis of the measurement invariance of the single items over groups differing in age, gender, meditation experience, and symptom load pointed to the absence of systematic differences in the items' semantic understanding. Parameters reflecting construct validity, criterion validity, and incremental validity as well as change sensitivity were all at least satisfactory. Conclusions: The CHIME is a self-report measure with favorable psychometric properties based on all aspects of mindfulness that are included in current mindfulness scales. This scale may be helpful in the evaluation and further development of mindfulness based interventions.

Assessing Difficulties in Career Decision Making Among Swiss Adolescents with the German My Vocational Situation Scale

Assessing problems in career decision making among adolescents is important for career guidance and research. The present study is the first to investigate among Swiss adolescents the factor structure and convergent validity in relation to personality of the German-language adaptation of the My Vocational Situation Scale. Two preliminary studies (N = 217) suggested that using a 5-point Likert scale response format would increase scale reliability. The confirmatory factor analyses in the main study with two cohorts (n = 341, eighth grade; n = 303, eleventh grade) confirmed that four main factors, which assess problems with identity, decision making, information, and perceived barriers, underlie the data. The barriers factor was differentiated into aspired vocation and personal situation. Construct validity was supported by significant relationships between favorable personality characteristics (emotional stability, extraversion, agreeableness, conscientiousness, generalized self-efficacy, and internal locus of control) and fewer problems. The results suggest that the vocational identity and barriers scales can be fruitfully applied to research on and the practice of career counseling with adolescents.

Measuring Intensity of End of Life Care: A Systematic Review.

BACKGROUND Many studies have measured the intensity of end of life care. However, no summary of the measures used in the field is currently available. OBJECTIVES To summarise features, characteristics of use and reported validity of measures used for evaluating intensity of end of life care. METHODS This was a systematic review according to PRISMA guidelines. We performed a comprehensive literature search in Ovid Medline, Embase, The Cochrane Library of Systematic Reviews and reference lists published between 1990-2014. Two reviewers independently screened titles, abstracts, full texts and extracted data. Studies were eligible if they used a measure of end of life care intensity, defined as all quantifiable measures describing the type and intensity of medical care administered during the last year of life. RESULTS A total of 58 of 1590 potentially eligible studies met our inclusion criteria and were included. The most commonly reported measures were hospitalizations (n = 44), intensive care unit admissions (n = 39) and chemotherapy use (n = 27). Studies measured intensity of care in different timeframes ranging from 48 hours to 12 months. The majority of studies were conducted in cancer patients (n = 31). Only 4 studies included information on validation of the measures used. None evaluated construct validity, while 3 studies considered criterion and 1 study reported both content and criterion validity. CONCLUSIONS This review provides a synthesis to aid in choosing intensity of end of life care measures based on their previous use but simultaneously highlights the crucial need for more validation studies and consensus in the field.

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking. Keywords: national final examination, licensing examination, summative assessment, OSCE, action research

Entwicklung und Validierung einer Skala der Bereitschaft zu verzeihen (SBV)

Verzeihen dient der Bewältigung von Kränkungen und zwischenmenschlichen Konflikten. Es werden Definitionen und Operationalisierungen aus dem englischen Sprachraum vorgestellt. Die Entwicklung eines deutschsprachigen szenarienbasierten Instruments zur Erhebung der Bereitschaft zu verzeihen wird beschrieben. Es wird eine Differenzierung des Konstruktes in zwei Komponenten vorgeschlagen: (a) die Bereitschaft, anderen Menschen zu verzeihen, wenn diese ihre Tat bedauern, (b) die Bereitschaft, anderen Menschen zu verzeihen, wenn diese ihre Tat nicht bedauern. Die Messeigenschaften der neu entwickelten Skala wurden in fünf Studien an insgesamt 1824 Probanden untersucht. Die Ergebnisse zeigen, dass das Instrument gute psychometrische Eigenschaften besitzt. Die theoretische Differenzierung des Konstrukts wird empirisch bestätigt. Hinweise auf die Konstruktvalidität der Skala ergeben sich aus Zusammenhängen mit theoretisch einschlägigen Referenzkonstrukten: der habituellen Ärgerneigung, der Wahrnehmung und Klarheit über eigene und fremde Gefühle, positiver und negativer Affektivität, den fünf Persönlichkeitsfaktoren und sozialer Erwünschtheit. Für die Konstruktvalidität der Skala sprechen ferner konvergente Korrelationen mit anderen Maßen der Bereitschaft zu verzeihen.

Translation and cultural adaptation of the Stigma-Devaluation scale for use among family caregivers of mentally ill relatives in Jordan

Background/significance. Mental illness stigma is a matter of great concern to family caregivers. Few research studies have been conducted in the Arab World on family caregivers' perception of stigma associated with caring for a mentally ill relative. Review of the literature on measurement of the concept of stigma related to caring for a mentally ill relative yielded no instrument appropriate for use in a Jordanian sample. Reliable and valid instruments to measure stigma perception among family caregivers are needed for research and practice, particularly in Arabic speaking populations. ^ Purpose. The purposes of this study were: (1) translate the Stigma-Devaluation scale (SDS) into Arabic, modifying it to accurately reflect the cultural parameters specific to Jordan, and (2) test the reliability, the content and construct validity of the Arabic version of the SDS for use among a sample of family members of mentally ill relatives in Jordan. ^ Design. Methodologic, cross-sectional. ^ Methods. The SDS was translated into Arabic language, modified and culturally adapted to the Jordanian culture by a translation model which incorporates a cultural adaptation process. The Arabic SDS was evaluated in a sample of 164 family caregivers in the outpatient mental health clinic in Irbid-Jordan. Cronbach's alpha estimation of internal consistency was used to assess the reliability of the SDS. Construct validity was determined by confirmatory factor analysis (CFA). Measurements of content validity and reading level of the Arabic SDS were included. ^ Findings. Content Validity Index was determined to be 1.0. Reading level of the Arabic SDS was considered at a 6th grade or lower Cronbach's alpha coefficient of the modified Arabic SDS total scale was .87. Initial results of CFA did not fully support the proposed factor structures of the SDS or its subscales. After modifications, the indices indicated that the modified model of each subscale had satisfactory fit. ^ Conclusion. This study provided psychometric evidence that the modified Arabic SDS translated and culturally adapted instrument, is valid and conceptually consistent with the content of the original English SDS in measuring stigma perception among families of mentally ill relatives in Jordan. ^

An epidemiologic evaluation of a worksite based intervention

The healthcare industry spends billions on worker injury and employee turnover. Hospitals and healthcare settings have one of the highest rates of lost days due to injuries. The occupational hazards for healthcare workers can be classified into biological, chemical, ergonomic, physical, organizational, and psychosocial. Therefore, interventions addressing a range of occupational health risks are needed to prevent injuries and reduce turnover and reduce costs. ^ The Sacred Vocation Program (SVP) seeks to change the content of work, i.e., the meaningfulness of work, to improve work environments. The SVP intervenes at both the individual and organizational level. First the SVP attempts to connect healthcare workers with meaning from their work through a series of 5 self-discovery group sessions. In a sixth session the graduates take an oath recommitting them to do their work as a vocation. Once motivated to connect with meaning in their work, a representative employee group meets in a second set of five meetings. This representative group suggests organizational changes to create a culture that supports employees in their calling. The employees present their plan in the twelfth session to management beginning a new phase in the existing dialogue between employees and management. ^ The SVP was implemented in a large Dallas hospital (almost 1000 licensed beds). The Baylor University Medical Center (BUMC) Pastoral Care department invited front-line caregivers (primarily Patient Care Assistants, PCAs, or Patient Care Technicians, PCTs) to participate in the SVP. Participants completed SVP questionnaires at the beginning and following SVP implementation. Following implementation, employer records were collected on injury, absence and turnover to further evaluate the program's effectiveness on metrics that are meaningful to managers in assessing organizational performance. This provided an opportunity to perform an epidemiological evaluation of the intervention using the two sources of information: employee self-reports and employer administrative data. ^ The ability to evaluate the effectiveness of the SVP on program outcomes could be limited by the strength of the measures used. An ordinal CFA performed on baseline SVP questionnaire measurements examined the construct validity and reliability of the SVP scales. Scales whose item-factor structure was confirmed in ordinal CFA were evaluated for their psychometric properties (i.e., reliability, mean, ceiling and floor effects). CFA supported the construct validity of six of the proposed scales: blocks to spirituality, meaning at work, work satisfaction, affective commitment, collaborative communication, and MHI-5. Five of the six scales confirmed had acceptable measures of reliability (all but MHI-5 had α>0.7). All six scales had a high percentage (>30%) of the scores at the ceiling. These findings supported the use of these items in the evaluation of change although strong ceiling effects may hinder discerning change. ^ Next, the confirmed SVP scales were used to evaluate whether the intervention improved program constructs. To evaluate the SVP a one group pretest-posttest design compared participants’ self-reports before and after the intervention. It was hypothesized that measurements of reduced blocks to spirituality (α = 0.76), meaning at work (α = 0.86), collaborative communication (α = 0.67) and SVP job tasks (α = 0.97) would improve following SVP implementation. The SVP job tasks scale was included even though it was not included in the ordinal CFA analysis due to a limited sample and high inter-item correlation. Changes in scaled measurements were assessed using multilevel linear regression methods. All post-intervention measurements increased (increases <0.28 points) but only reduced blocks to spirituality was statistically significant (0.22 points on a scale from 1 to 7, p < 0.05) after adjustment for covariates. Intensity of the intervention (stratifying on high participation units) strengthened effects; but were not statistically significant. The findings provide preliminary support for the hypothesis that meaning in work can be improved and, importantly, lend greater credence to any observed improvements in the outcomes. (Abstract shortened by UMI.)^

A methodologic study of pain assessment in Anglo and Hispanic children with cancer

There is growing clinical evidence that even young children experience pain and accompanying anxiety. Few instruments have been validated to assess pain characteristics in children. The study of related demographic, illness, psychologic and parental factors in children has also been limited. This study examines the reliability and validity of pain assessment tools in an outpatient pediatric cancer population. A total of 78 children from three to fifteen years of age were observed and interviewed about the pain of invasive procedures. The effect of cultural factors and the stress of acculturation were examined by comparing data from two cultural groups, Anglo and Hispanic.^ Spielberger State-Trait Anxiety Scales were administered to children and parents prior to an invasive procedure. The Procedure Behavioral Checklist (PBCL) was used for observation of the child's response during the procedure. The Children's Procedural Interview (CPI) which contains items on the PBCL and visual analogues (scales of faces indicating varying degrees of pain and anxiety) was administered following the procedure.^ Reliability coefficients for Anglos were.78 on the PBCL,.79 on the CPI and.85 on the visual analogue scales. For Hispanics, the reliability for the PBCL was.54, while the CPI had a reliability of.72 and the visual analogue scales,.87. Construct validity was demonstrated by high correlations between the PBCL and CPI scores for both ethnic groups (.66 for Anglos and.64 for Hispanics) and by the significant correlation of State anxiety scores with both PBCL and CPI scores. Age was inversely correlated with PBCL and CPI scores for both ethnic groups. Hispanic parents' anxiety scores were higher than Anglo parents, but were not highly correlated with their child's PBCL, CPI or State-Trait anxiety scores. Caregivers' ratings were correlated with the PBCL scores for Anglos but not for Hispanics.^ The findings of this study indicate that pain responses may be reliably assessed using both observational and self-report methods in children, though differences in Anglo and Hispanic cultures exist. Differences in pain symptomatology and assessment in the two cultural groups warrant further study. ^

Self -management behavior in patients with cystic fibrosis

Self-management is being promoted in cystic fibrosis (CF). However, it has not been well studied. Principal aims of this research were (1) to evaluate psychometric properties of a CF disease status measure, the NIH Clinical Score; (2) to develop and validate a measure of self-management behavior, the SMQ-CF scale, and (3) to examine the relation between self-management and disease status in CF patients over two years.^ In study 1, NIH Clinical Scores for 200 patients were used. The scale was examined for internal consistency, interrater reliability, and content validity using factor analysis. The Cronbach's alpha (.81) and interrater reliability (.90) for the total scale were high. General scale items were less reliable. Factor analysis indicated that most of the variance in disease status is accounted for by Factor 1 which consists of pulmonary disease items.^ The SMQ-CF measures the performance of CF self-management. Pilot testing was done with 98 CF primary caregivers. Internal consistency reliability, social desirability bias, and content validity using factor analysis were examined. Internal consistency was good (alpha =.95). Social desirability correlation was low (r =.095). Twelve factors identified were consistent with conceptual groupings of behaviors. Around two hundred caregivers from two CF centers were surveyed and multivariate analysis of variance was used to assess construct validity. Results confirmed expected relations between self-management, patient age, and disease status. Patient age accounted for 50% and disease status 18% of the variance in the SMQ-CF scale.^ It was hypothesized that self-management would positively affect future disease status. Data from 199 CF patients (control and education intervention groups) were examined. Models of hypothesized relations were tested using LISREL structural equation modeling. Results indicated that the relations between baseline self-management and Time 1 disease status were not significant. Significant relations were observed in self-management behaviors from time 1 to time 2 and patterns of significant relations differed between the two groups.^ This research has contributed to refinements in the ability to measure self-management behavior and disease status outcomes in cystic fibrosis. In addition, it provides the first steps in exploratory behavioral analysis with regard to self-management in this disease. ^

Metas de vida de adolescentes argentinos

El objetivo principal de esta Tesis es construir un instrumento de evaluación psicológica válido para examinar las metas de vida de las adolescencias argentinas. Para arribar a su construcción se realizan distintos estudios: un primer Estudio Exploratorio, del que surge evidencia empírica acerca de diferencias en las posibles elecciones de metas según las distintas variables: género, región geográfica y contexto sociocultural de pertenencia. Del mismo estudio provienen las categorías de análisis que se emplean para la selección de ítems a incluir en la versión preliminar del instrumento. A lo largo de la investigación se realizan tres versiones del Inventario Metas Vitales [MV], luego de la aplicación de la prueba correspondiente a cada versión, se hacen los ajustes y se somete a valoración de jueces expertos [validez del constructo]. Finalmente se establece la ESCALA MV defintiva sometida a análisis estadístico confirmatorio. Dado el caudal de datos obtenidos en la muestra definitiva, se decide incluir un análisis complementario de los mismos en función de las variables diferenciales seleccionadas. Para llevar a cabo el objetivo enunciado, se trata de articular una investigación acerca de la población adolescente de nuestro país tomando como referentes a sujetos de entre 17 y 19 años, de ambos sexos, escolarizados en contextos educativos públicos y privados, de distintas provincias del norte, centro y sur de Argentina. Se parte de considerar dos dimensiones conceptuales: la primera refiere a una concepción de Adolescencia no tradicional y desde allí se pone énfasis en la segunda dimensión que comprende una tarea integradora para conocer y comprender las Metas que orientan las vidas de las adolescencias hoy