Deriving a preference-based measure for cancer using the EORTC QLQ-C30 : a confirmatory versus exploratory approach

Background: To derive preference-based measures from various condition-specific descriptive health-related quality of life (HRQOL) measures. A general 2-stage method is evolved: 1) an item from each domain of the HRQOL measure is selected to form a health state classification system (HSCS); 2) a sample of health states is valued and an algorithm derived for estimating the utility of all possible health states. The aim of this analysis was to determine whether confirmatory or exploratory factor analysis (CFA, EFA) should be used to derive a cancer-specific utility measure from the EORTC QLQ-C30. Methods: Data were collected with the QLQ-C30v3 from 356 patients receiving palliative radiotherapy for recurrent or metastatic cancer (various primary sites). The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter based on a conceptual model (the established domain structure of the QLQ-C30: physical, role, emotional, social and cognitive functioning, plus several symptoms) and clinical considerations (views of both patients and clinicians about issues relevant to HRQOL in cancer). The dimensions determined by each method were then subjected to item response theory, including Rasch analysis. Results: CFA results generally supported the proposed conceptual model, with residual correlations requiring only minor adjustments (namely, introduction of two cross-loadings) to improve model fit (increment χ2(2) = 77.78, p < .001). Although EFA revealed a structure similar to the CFA, some items had loadings that were difficult to interpret. Further assessment of dimensionality with Rasch analysis aligned the EFA dimensions more closely with the CFA dimensions. Three items exhibited floor effects (>75% observation at lowest score), 6 exhibited misfit to the Rasch model (fit residual > 2.5), none exhibited disordered item response thresholds, 4 exhibited DIF by gender or cancer site. Upon inspection of the remaining items, three were considered relatively less clinically important than the remaining nine. Conclusions: CFA appears more appropriate than EFA, given the well-established structure of the QLQ-C30 and its clinical relevance. Further, the confirmatory approach produced more interpretable results than the exploratory approach. Other aspects of the general method remain largely the same. The revised method will be applied to a large number of data sets as part of the international and interdisciplinary project to develop a multi-attribute utility instrument for cancer (MAUCa).

Travel context : development of a model to measure destination brand performance across different travel situations

Purpose: There is a lack of theory relating to destination brand performance measurement in the destination branding literature, which emerged in the late 1990s (see for example Dosen, Vransevic, & Prebezac, 1998). Additionally, there is a lack of research about the importance of travel context in consumers’ destination decision making (Hu & Ritchie, 1993). This study develops a structural model to measure destination brand performance across different travel situations. The theory of planned behaviour (TpB) was utilised as a framework to underpin the consumer-based brand equity (CBBE) hierarchy to develop a model of destination brand performance. Research approach: A proposed model of destination brand performance was developed through a review of the literature. The first study was used to identify destination image attributes (the core construct) using an analysis of the literature, a document analysis, and personal interviews using the Repertory Test qualitative technique. Underpinned by Personal Construct Theory (PCT), the Repertory Test enables the elicitation of attributes consumers use to evaluate destinations when considering travel. Data was examined in the first study to i) identify any attribute differences in travel contexts and ii) create a scale for use in a questionnaire. A second study was conducted to test the proposed model using a questionnaire with eight groups of participants to assess four destinations across two travel contexts. The model was tested utilising structural equation modelling. Findings: The first study resulted in a list of 29 destination image attributes for use in a scale index. Attributes were assessed across travel contexts and few differences were identified. The second study assessed the congruence of destination brand identity (the destination marketing organisation’s desired image) and destination brand image (the actual perceptions held by consumers) using importance-performance analyses. Finally, the proposed model of destination brand performance was tested. Overall the data supported the model of destination brand performance across travel contexts and destinations. Additionally, this was compared to consumers’ decision sets, further supporting the model. Value: This research provides a contribution to the destination marketing literature through the development of a measurement of destination brand performance underpinned by TpB. Practically; it will provide destination marketing organisations with a tool to track destination brand performance, relative to key competing places, over time. This is important given the development of a destination brand is a long term endeavour.

Current measure of food insecurity used in the National Health Survey may be underestimating its prevalence

Objective: Food insecurity may be associated with a number of adverse health and social outcomes however our knowledge of its public health significance in Australia has been limited by use of a single-item measure in the Australian National Health Surveys (NHS) and, more recently, the exclusion of food security items from these surveys. The current study compares prevalence estimates of food insecurity in disadvantaged urban areas of Brisbane using the one-item NHS measure with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA-FSSM). Design: Data were collected by postal survey (n= 505, 53% response). Food security status was ascertained by the measure used in the NHS, and the 6-, 10- and 18-item versions of the USDA-FSSM. Demographic characteristics of the sample, prevalence estimates of food insecurity and different levels of food insecurity estimated by each tool were determined. Setting: Disadvantaged suburbs of Brisbane city, Australia, 2009. Subjects: Individuals aged ≥ 18 years. Results: Food insecurity was prevalent in socioeconomically-disadvantaged urban areas, estimated as 19.5% using the single-item NHS measure. This was significantly less than the 24.6% (P <0.01), 22.0% (P = 0.01) and 21.3% (P = 0.03) identified using the 18-item, 10-item and 6-item versions of the USDA-FSSM, respectively. The proportion of the sample reporting more severe levels of food insecurity were 10.7%, 10% and 8.6% for the 18-, 10- and 6-item USDA measures respectively, however this degree of food insecurity could not be ascertained using the NHS measure. Conclusions: The measure of food insecurity employed in the NHS may underestimate its prevalence and public health significance. Future monitoring and surveillance efforts should seek to employ a more accurate measure.

Development of a survey instrument to measure TEFL academics' perceptions about, individual and workplace characteristics for conducting research

The Chinese Ministry of Education (MOE) initiatives to improve the English competence of college students, as well as increased proficiency level of entering college students (Cheng, 2002) have contributed to greater demands on Teaching English as a Foreign Language (TEFL) academics (MOE, 2004), as “the upgrading of national English proficiency, then, is predicated largely on the professional competence of the teaching force” (Hu, 2005, p. 655). For TEFL academics, one component of this competence is the capacity to conduct research (Shu, 2002), which also reflects other changes in Chinese higher education. The aspirations of higher education institutions at all levels have led to more rigorous recruitment policies and promotion requirements (Che, 2004; Wang, 2007), stressing research as an important indicator of academics’ performance (Shi, 2002; Pan, 2006). These changes highlight the role of research in higher education institutions’ efforts to raise their national status and world ranking (Zhang, Wang, & He, 2006), and have exerted influences on faculty’s academic role. Academics are obliged to engage in research activities, and this has posed challenges to teaching-oriented institutions and disciplines.

How activation, entanglement, and searching a semantic network contribute to event memory

Free association norms indicate that words are organized into semantic/associative neighborhoods within a larger network of words and links that bind the net together. We present evidence indicating that memory for a recent word event can depend on implicitly and simultaneously activating related words in its neighborhood. Processing a word during encoding primes its network representation as a function of the density of the links in its neighborhood. Such priming increases recall and recognition and can have long lasting effects when the word is processed in working memory. Evidence for this phenomenon is reviewed in extralist cuing, primed free association, intralist cuing, and single-item recognition tasks. The findings also show that when a related word is presented to cue the recall of a studied word, the cue activates it in an array of related words that distract and reduce the probability of its selection. The activation of the semantic network produces priming benefits during encoding and search costs during retrieval. In extralist cuing recall is a negative function of cue-to-distracter strength and a positive function of neighborhood density, cue-to-target strength, and target-to cue strength. We show how four measures derived from the network can be combined and used to predict memory performance. These measures play different roles in different tasks indicating that the contribution of the semantic network varies with the context provided by the task. We evaluate spreading activation and quantum-like entanglement explanations for the priming effect produced by neighborhood density.

The development of a model to measure destination brand performance across travel contexts

The field of destination image has been widely discussed in the destination literature since the early 1970s (see Mayo, 1973). However the extent to which travel context impacts on an individual’s destination image evaluation, and therefore destination choice, has received scant attention (Hu & Ritchie, 1993). This study, utilising expectancy-value theory, sought to elicit salient destination attributes from consumers across two travel contexts: short-break holidays and longer getaways. Using the Repertory Test technique, attributes elicited as being salient for short-break holidays were consistent with those elicited for longer getaways. While this study was limited to Brisbane’s near-home destinations, the results will be of interest to destination marketers and researchers interested in the challenge of positioning a destination in diverse markets.

Modelling word activation in semantic networks : three scaled entanglement models compared

Modelling how a word is activated in human memory is an important requirement for determining the probability of recall of a word in an extra-list cueing experiment. Previous research assumed a quantum-like model in which the semantic network was modelled as entangled qubits, however the level of activation was clearly being over-estimated. This paper explores three variations of this model, each of which are distinguished by a scaling factor designed to compensate the overestimation.

An objective measure of reactive behaviour in horses

Several tests have been devised in an attempt to detect behaviour modification due to training, supplements or diet in horses. These tests rely on subjective observations in combination with physiological measures, such as heart rate (HR) and plasma cortisol concentrations, but these measures do not definitively identify behavioural changes. The aim of the present studies was to develop an objective and relevant measure of horse reactivity. In Study 1, HR responses to auditory stimuli, delivered over 6 days, designed to safely startle six geldings confined to individual stalls was studied to determine if peak HR, unconfounded by physical exertion, was a reliable measure of reactivity. Both mean (±SEM) resting HR (39.5 ± 1.9 bpm) and peak HR (82 ± 5.5 bpm) in response to being startled in all horses were found to be consistent over the 6 days. In Study 2, HR, plasma cortisol concentrations and speed of departure from an enclosure (reaction speed (RS)) in response to a single stimulus of six mares were measured when presented daily over 6 days. Peak HR response (133 ± 4 bpm) was consistent over days for all horses, but RS increased (3.02 ± 0.72 m/s on Day 1 increasing to 4.45 ± 0.53 m/s on Day 6; P = 0.005). There was no effect on plasma cortisol, so this variable was not studied further. In Study 3, using the six geldings from Study 1, the RS test was refined and a different startle stimulus was used each day. Again, there was no change in peak HR (97.2 ± 5.8 bpm) or RS (2.9 ± 0.2 m/s on Day 1 versus 3.0 ± 0.7 m/s on Day 6) over time. In the final study, mild sedation using acepromazine maleate (0.04 mg/kg BW i.v.) decreased peak HR in response to a startle stimulus when the horses (n = 8) were confined to a stall (P = 0.006), but not in an outdoor environment when the RS test was performed. However, RS was reduced by the mild sedation (P = 0.02). In conclusion, RS may be used as a practical and objective test to measure both reactivity and changes in reactivity in horses.

An Arabic instrument to measure medication adherence in Saudi hypertensive patients

Aim: To show the validity and reliability of the translated Hill-Bone scale on 110 hypertensive participants from an Arabic speaking country. Background: With the wide spread availability of treatment, individuals with hypertension have reported various levels of adherence to their medications. Flexible and practical methods of measuring adherence are the use of surveys, scales and interviews. There is a scarcity in Arabic tools and scales that measure levels of adherence to antihypertensive treatments in the Arabic speaking context. Design and Methods: A cross-sectional study was conducted among 110 individuals diagnosed with hypertension and from an Arabic speaking country. The Hill-Bone scale includes three subscales that measure salt intake, medication adherence and appointment keeping. Given the focus on the pharmacological management of hypertensive patients, only items related to medication adherence and appointment keeping subscales were used. The scale was translated by following a comprehensive and accepted method of translation. Results: Instrument reliability was tested by identifying the Cronbach’s alpha coefficient. The subscale for medication adherence in the Hill-Bone scale reported an acceptable level of reliability (Cronbach’s alpha =0.76). Compared with other translated versions of the Hill-Bone scale, the scale also reported good reliability and validity. Conclusion: Results indicate that the Arabic translated version of the Hill-Bone scale has an acceptable level of reliability and validity and therefore can be used in Arabic speaking populations.

Development and validation of an instrument to measure organizational cultures' support of business process management

The purpose of Business Process Management (BPM) is to increase the efficiency and effectiveness of organizational processes through improvement and innovation. Despite a common understanding that culture is an important element in these efforts, there is a dearth of theoretical and empirical research on culture as a facilitator of successful BPM. We develop the BPM culture construct and propose a validated instrument with which to measure organizational cultures’ support of BPM. The operationalization of the BPM culture concept provides a theoretical foundation for future research and a tool to assist organizations in developing a cultural environment that supports successful BPM.