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PubMed2003

Measuring the impact of diagnostic decision support on the quality of clinical decision making: development of a reliable and valid composite score.

OBJECTIVE: Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful. DESIGN: Sets of differential diagnoses and clinical management plans generated by 71 clinicians for six simulated cases, before and after decision support from a Web-based pediatric differential diagnostic tool (ISABEL), were used. MEASUREMENTS: A composite quality score was calculated separately for each diagnostic and management plan by considering the appropriateness value of each component diagnostic or management suggestion, a weighted sum of individual suggestion ratings, relevance of the entire plan, and its comprehensiveness. The reliability and validity (face, concurrent, construct, and content) of these two final scores were examined. RESULTS: Two hundred fifty-two diagnostic and 350 management suggestions were included in the interrater reliability analysis. There was good agreement between raters (intraclass correlation coefficient, 0.79 for diagnoses, and 0.72 for management). No counterintuitive scores were demonstrated on visual inspection of the sets. Content validity was verified by a consultation process with pediatricians. Both scores discriminated adequately between the plans of consultants and medical students and correlated well with clinicians' subjective opinions of overall plan quality (Spearman rho 0.65, p < 0.01). The diagnostic and management scores for each episode showed moderate correlation (r = 0.51). CONCLUSION: The scores described can be used as key outcome measures in a larger study to fully assess the value of diagnostic decision aids, such as the ISABEL system.

Artificial Intelligence↗

PubMed2004

Development of the Korean version of Short-Form 36-Item Health Survey: health related QOL of healthy elderly people and elderly patients in Korea.

The health-related QOL (HRQOL) has been used extensively in clinical and epidemiological research and health service studies. Especially, the Medical Outcome Study Short-form 36-Item Health Survey (SF-36) is a widely used health status measure. However, a Korean version has not been developed and tested yet. The purpose of this study was to develop a Korean version of the Short-form Health Survey (SF-36) for use in health related quality of life measurements for Korean elderly people. SF-36 data from 90 healthy elderly people using Social Education Service and 120 elderly patients using a day care service in Seoul, Korea, were examined. We translated SF-36 version 2.0 into Korean and assessed its reliability and validity. In the results, the content validity and discriminant validity were found to be satisfactory. Cronbach's alpha coefficients ranged from 0.9298 to 0.9383. The test-retest reliability coefficients ranged from 0.710 to 0.895. In addition, the utility was examined by testing the correlation between the health-related QOL and related factors (sex, age, motor function, ability of daily life) among the elderly people. The present findings suggested that the Korean version of SF-36 would be useful as a measure of the health related QOL in Korean elderly people.

Age Factors↗

PubMed1984

Examining the reliability and validity of the Play History.

Few occupational therapy tools exist that evaluate play totally and systematically. The purpose of this study was to examine the Play History Interview and establish its value as a scientific clinical tool. The parents of 15 disabled and 15 nondisabled children between the ages of 1 and 7 1/2 years were interviewed about their children's play behaviors using the Play History Interview. Children were rated on an ordinal scale according to the criteria outlined on the Play History Chart and Taxonomy for Diagnosis. Interrater and test-retest reliabilities were determined by two independent raters. The scores from the Play History and Minnesota Child Development Inventory were correlated to examine concurrent validity of the Play History. Content validity was studied via a literature review. Significant results suggest that the Play History is a reliable and valid interview in occupational therapy for assessing children's play behavior.

Child↗

PubMed2004

[Validation of the Diagnostic Interview for Genetic Studies (DIGS) in Colombia].

An interview tool, Diagnostic Interview for Genetic Studies (DIGS 3.0), was translated into Spanish for application in studies of psychiatric disorders in Colombia. Two Spanish translations of the original English version of DIGS were prepared and back-translated into English. A review committee verified the linguistic and cultural equivalence of the translations. The evaluator and test-retest reliability were assessed calculating Cohen's kappa for samples of 65 and 91 patients respectively. DIGS proved valid in both appearance and content. The confidence interval (C.I.) was excellent for schizophrenia (kappa = 0.81, C.I. 95% = 0.68-0.93), bipolar disorder (kappa = 0.87, C.I. 95% = 0.75-0.99), major depressive disorder (kappa = 0.86, C.I. 95% = 0.70-1.00), and for a normal diagnosis (kappa = 0.65, C.I. 95% = 0.41-0.89); it was good for other psychiatric diagnosis (kappa = 0.65, C.I. 95% = 0.41-0.89) and poor for schizoaffective disorder (kappa = 0.37, C.I. 95% = -0.02-0.76). Test-retest reliability was excellent for all diagnoses (kappa > 0.8), except for "other psychiatric diagnoses" (kappa = 0.64, C.I. 95% = 0.31-0.96). The Spanish translation of the DIGS was comprehensible, with face and content validity, and good test-retest and evaluator reliability. This translation will be a useful tool for genetic studies of psychiatric disorders in Latin America, particularly where schizophrenia and affective disorders are involved.

Colombia↗

PubMed2006

Competencies for the beginning dental practitioner in Canada: a validity survey.

As part of the recommended review of the national competencies for beginning general dentists in Canada, a validation survey was distributed to 731 dentists. The survey asked participants to supply demographic information and rate each of the forty-six competencies on a 5-point Likert scale. The response rate was 43.1 percent (315 total usable responses). Self-reported demographic data was used to create respondent subgroups. The participants rated all of the competencies quite high with thirty-six of the forty-six receiving rankings averaging 4.0 or higher on the 5-point scale. No competency received a ranking averaging lower than 3.0. Competencies rated as most important by the entire sample were also rated as most important by all respondent subgroups. The results of this validation survey provide evidence of content validity and reinforce the value of a national competency document that can serve as a reference for curriculum management, program accreditation, and development of certification examinations.

Accreditation↗

PubMedDate not supplied

Validity and reliability of medical and surgical oncology patient acuity tools.

PURPOSE/OBJECTIVES: To develop valid and reliable medical and surgical acuity tools as part of an overall classification system for patients with cancer. SETTING: An acute care, tertiary, research, academic oncology hospital in the southeastern United States. SAMPLE: Clinical nursing experts in medical and surgical oncology; 125 patient observations for the surgical oncology acuity tool, and 75 patient observations for the medical oncology acuity tool. METHOD: The nursing division developed a medical oncology acuity tool and a surgical oncology acuity tool using the Johns Hopkins Oncology Patient Classification System as a model. They then studied the validity of developed tools using content validity indexes (CVIs). Two independent raters studied the interrater reliability of each tool. FINDINGS: CVIs for items on the surgical tool ranged from 0.57-1.0; the overall CVI for this tool was 0.86. CVIs for items on the medical tool ranged from 0.25-1.0. The overall CVI for this tool was 0.88. Pearson correlation coefficients were r = 0.95 (p < 0.001) for the surgical oncology acuity tool and r = 0.92 (p < 0.001) for the medical tool. Interrater reliability, tested continually for four years, was greater than 95%. CONCLUSIONS: The tools are reliable and valid. IMPLICATIONS FOR NURSING PRACTICE: Medical and surgical oncology acuity tools that are nursing diagnosis based, interface with nursing standards of care, are easy to use, and require no calculation provide reliable quantification of nursing work loads based on the care needs of patients with cancer. Supervisors use data from these tools to determine variable nursing hours per patient per day, establish productivity for units, make staffing and scheduling decisions, assign patients, work on budgets, and, ultimately, establish charges for nursing services. As the needs of medical and surgical oncology patients evolve, continued refinement of indicators and acuity levels will be needed. As other medical and surgical oncology tools are developed, further comparison will be warranted. Additional study would determine if the tools could be modified for these nursing uses in other cancer centers as well as in designated medical and surgical oncology units of other types of hospitals. Oncology acuity systems also could be established in the future as the basis for third-party reimbursement.

Cancer Care Facilities↗

PubMed2000

Measurement of community beliefs about colorectal cancer.

Few educational campaigns have focused on bowel cancer, though studies have indicated that members of the community need and want current information about relevant issues. In order to facilitate research in this area, reliable and valid measures of community attitudes are needed. Content validity of a survey instrument was obtained through use of a Delphi process with Directors of Education from the Australia Cancer Council and focus group discussions with informed members of the public. The subsequent survey of community perceptions about colorectal cancer included a broad range of content areas related to the risk of bowel cancer, preventing and coping with bowel cancer and beliefs about susceptibility and severity. The construct validity of these content areas was investigated by use of a factor analysis and confirmation of an association with related predictor variables. Two measures related to personal influence and anticipated coping responses showed favourable psychometric properties, including moderate to high levels of internal consistency and test-retest reliability. A test of the concurrent validity of these measures requires further development of instruments related to colorectal cancer or adaptation of measures from other areas of health research.

Adult↗

PubMed2006

Development of a questionnaire to evaluate patient satisfaction with medical encounters.

Given that a medical practice exists for patients, it is worth determining the degree of patient satisfaction with regard to the medical practice's quality of care. Considering the importance of noticing patient satisfaction and its influence on clinical care, intense evaluation of a questionnaire's validity and reliability is essential. The purpose of this study was to establish a valid and reliable self-administered scale to measure patient satisfaction with fewer questions than previous scales applicable in medical settings in Japan. A qualitative method was used to develop and revise content-valid question items of the questionnaire. Factor analysis revealed five subscales among 12 items: "overall satisfaction", "complete examination", "patient centeredness", "examination time", and "whole person care". A test of internal consistency was also assessed. The concurrent validity was assessed to evaluate the association between the score of the current questionnaire and that of the visual analogue scale or other questionnaire. Agreement between two sets of score, scores just after consultation and 30-50 min after that, was assessed to evaluate the test-retest reliability of each question item. The results revealed satisfactory validity, including the content and concurrent validity, internal consistency (Cronback alpha = 0.77-0.85), and the test-retest reliability of our questionnaire (Kappa score = 0.61-0.71). In conclusion, we have developed a short-form self-administered patient satisfaction questionnaire applicable in Japan, with acceptable validity and reliability. This questionnaire may contribute to conducting further studies related to patient subjective responses to encounters in Japanese medical settings, and evaluating and improving the clinical interview skills of medical students or trainees in medical education.

Delivery of Health Care↗

PubMedDate not supplied

Content and criterion validity evaluation of National Public Health Performance Standards measurement instruments.

OBJECTIVE: The Centers for Disease Control and Prevention's National Public Health Performance Standards Program (NPHPSP) has developed instruments to measure the performance of local and state public health departments on the 10 "Essential Services of Public Health," which have been tested in several states. This article is a report of the evaluation of the content and criterion validity of the local public health performance assessment instrument, and the content validity of the state public health performance assessment instrument. METHODS: Health department performance is measured using a set of indicators developed for the 10 Essential Services of Public Health and a model standard for each indicator. Content validity of each model standard in the local instrument was addressed by community partners along the following dimensions: the importance of each standard as a measure of the associated Essential Service, its completeness as a measure, and its reasonableness for achievement. All standards for each Essential Service were then judged in terms of their completeness in measuring performance in that service. Content validity of the state instrument was evaluated in a group interview of health department staff members from three states. Criterion validity of the local instrument was assessed for a sample of eight public health departments in Florida and six in New York by examining documentary evidence for selected responses. Criterion validity was also evaluated for a sample of Florida local public health departments and one Hawaii public health department by comparing state health department staffs' judgments of performance against the instrument score. RESULTS: Criterion validity was upheld for a summary performance score on the local instrument, but was not upheld for performance judgments on individual Essential Services. The NPHPSP standards based on the Essential Services have validity for measuring local public health system performance, according to community partners. The model standards are valid measures of state performance, according to state public health departments in three states. CONCLUSIONS: Within the scope of the validity evaluations completed, the NPHPSP state and local performance assessment instruments were found to be valid measures of public health performance.

Attitude of Health Personnel↗

PubMed1996

Community health assessment index content and face validation studies.

The objective of the study was to evaluate content and face validity of Community Health Assessment Index (CHAI). Two independent groups of experts convened in Dar-es-salaam and Eldoret after having had a chance to study CHAI for two or more weeks in order for them to make written evaluations on the index. Twelve and 11 experts representing a broad range of interest in community health in the African context convened in Dar-es-salaam and Eldoret respectively. Most of these were nominated by their respective institutions, namely, ministries of health, academic and research institutions and non-governmental and multilateral organisations. The findings of the two groups of experts were very similar. The consensus was that CHAI has face and content validity. However, both groups suggested that (i) total adult mortality instead of male adult mortality be used; and (ii) that a 5 km rather than 10 km radius be used to define accessibility to health care. Regarding to questionnaire the consensus was that (a) the questions were both clear and culturally appropriate; (b) apart from the part which concerns a description of health services policy and community participation, the questionnaire could be administered by literate primary health care workers after appropriate training and translation; and (c) in addition to generating CHAI scores, the data gathered with this instrument could be used for planning and evaluation at the local community level. Overall the questionnaire was judged as "good" by 19 while the remaining 4 judged it as being "very good". Several suggestions in wording were made. Also a few additional questions were suggested. This evaluation provides justifications for further studies to assess the remaining measurement properties of this index.

Adult↗

PubMed1992

Validity and reliability of the Pressure Sore Status Tool.

There is not yet a universal system for describing the status of pressure sores. The purpose of this study was to assess the validity and reliability of an instrument developed by the researchers for evaluation of pressure sores, the Pressure Sore Status Tool (PSST). This study was part of a larger study, which included development of a theoretical model for creation of items for the PSST. A nine-member expert judge panel established content validity of items on the instrument. Data were analyzed using a content of validity index (average index for tool = .91) and judges' comments were used to modify two items on the PSST. Two Enterostomal Therapy (ET) nurses independently used the revised tool to rate 20 pressure sores on ten adult medical-surgical patients, at two observation times. Interrater reliability was established at r = .91 for first observation and r = .92 for the second observation (p < .001). Intrarater reliability was r = .99 for rater one and r = .96 for rater two (p < .001). Future research will focus on refinement and further reliability testing of the instrument.

Adult↗

PubMed2007

QUALIDEM: development and evaluation of a dementia specific quality of life instrument--validation.

OBJECTIVE: To validate the QUALIDEM, a quality of life measure for people with dementia within residential settings rated by professional caregivers. METHOD: In a sample of 202 residents of nursing homes Spearman rank correlations were calculated between the QUALIDEM subscales aand indices of convergent validity and discriminant validity, with dementia severity and need of care, with global QOL scores by the head nurse and family, and with self-report on COOP/WONCA Charts. RESULTS: The one-method multi-trait matrix showed 90.5% of the correlations to be in support for convergent and discriminant validity. Low to moderate correlations were observed with dementia severity and need of care, confirming that QOL is not merely disease severity. Support for concurrent validity was found in correlations with QOL ratings by the head nurse. The QUALIDEM did not correlate with most of the family ratings or with the COOP/WONCA Charts. CONCLUSION: The results of this validation study together with the obtained content validity through the method of construction provide sufficient support for validity of the QUALIDEM to be used for care evaluation and research in residential settings.

Activities of Daily Living↗

PubMed2000

Validity of residents' self-reported cardiovascular disease prevention activities: the Preventive Medicine Attitudes and Activities Questionnaire.

BACKGROUND: This article describes the development, reliability, and validity of three cardiovascular disease (CVD) prevention subscales-CVD prevention behaviors, perceived importance, and perceived effectiveness-of the Preventive Medicine Attitudes and Activities Questionnaire (PMAAQ). METHODS: The PMAAQ was administered three times to University of Minnesota family practice residents (178) over 2 years (91% response rate). Stability measures were calculated, and validity was demonstrated in four ways: content validity through an expert panel; calculation of internal consistency reliabilities; demonstration of divergent validity; and external validation via a separate chart review. RESULTS: High internal consistency reliabilities among the subscales were seen (Cronbach's alpha = 0.77 to 0.92). Divergent validity was verified by low intercorrelations among the subscales (r = -0.23 to 0.27). Two-month test-retest scores ranged from Cronbach's alpha = 0.47 to 0.64. Significant correlations were seen between the chart review scale and both the CVD behaviors subscale and the PMAAQ smoking scale (r = 0.25 and 0.36, respectively). CONCLUSIONS: Results indicate that the PMAAQ can validly and reliably measure residents' CVD prevention behaviors and provide insight into their preventive health care attitudes. Further, the independence among the subscales suggests that importance and effectiveness by themselves do not affect behavior and that other factors are likely to be important in influencing physician behavior change.

Adult↗

PubMed2006

A validated tool for gaining insight into clinicians' preventive medicine behaviors and beliefs: the preventive medicine attitudes and activities questionnaire (PMAAQ).

OBJECTIVE: This article describes the development, reliability, and validity of the Preventive Medicine Attitudes and Activities Questionnaire (PMAAQ). METHOD: From 1995 to 2003, the PMAAQ was administered to 353 residents at six primary care residency programs in the United States. Validity was demonstrated in four ways: content validity through an expert panel, calculation of internal consistency reliabilities, demonstration of divergent validity, and external validation using a pre-existent chart review dataset. Stability measures were also calculated. RESULTS: High internal consistency reliabilities among the eight scales were seen (Cronbach's alpha = 0.74 to 0.98). Divergent validity was demonstrated by low to moderate intercorrelations among scales (r = -0.23 to 0.54). Significant correlations were seen between several PMAAQ scales and scales created from chart review data. Two-month test-retest correlations ranged from r = 0.56 to 0.87. Results suggest that clinicians' attitudes alone are not directly responsible for behaviors. CONCLUSION: The PMAAQ can validly and reliably measure residents' prevention behaviors and provide insight into their preventive healthcare attitudes. This survey could be useful in targeting areas for interventions to improve delivery of clinical preventive services, as a means of evaluating the effectiveness of such interventions, or as a quality assurance tool to monitor physician prevention activities.

Female↗

PubMed1984

Development of an empathic interaction skills schedule in a nursing context.

This study was an attempt to develop a means of teaching and assessing empathic interaction skills in the classroom and in the clinical situation. A descriptive-analytic system of interaction observation was formulated from a theoretical standpoint, with videotape recordings of nurse-patient interactions used as an additional data base. The schedule was applied to both student and qualified nurses in a variety of clinical settings and in the classroom. The videotape recordings were used as a means of assessing the validity and reliability of the schedule. The validity was ascertained in terms of content validity and criterion-related validity. These two aspects of validity were appraised by reference to the professional judgement of experienced qualified nurses. Positive validity coefficients were obtained. The reliability was determined by estimation of inter-rater reliability and intra-rater reliability. Positive reliability coefficients were obtained. Observer objectivity was also calculated.

Education, Nursing↗

PubMed1982

Patient management problems. Issues of validity.

Patient management problems (PMP) are being used in medical examinations with increasing frequency despite evidence which throws doubt on their validity as measures of clinical competence. This study investigated the construct validity of a PMP constructed in both written and interview formats. Each test was administered to groups of students of different seniorities and to two groups of doctors, interns and post-interns. The pattern of scores for the different groups was not that expected of a valid test of competence. The most competent groups (the post-interns) generally scored less well on the calculated indices than the senior students and interns. These findings were similar for both formats of the test so cueing was not thought to be the major factor. It appears that the scoring system is at fault. A comparison of performance on the written and interview (uncued) formats showed that many more options were chosen by all groups tested on the written PMP. It was concluded that written PMPs cannot yet be regarded as a valid simulation of clinical performance. Although content validity is high this does not appear to be so for construct validity or concurrent validity.

Australia↗

PubMed2001

Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease.

OBJECTIVES: Brief, reliable, and valid self-administered questionnaires could facilitate the diagnosis of gastroesophageal reflux disease in primary care. We report the development and validation of such an instrument. METHODS: Content validity was informed by literature review, expert opinion, and cognitive interviewing of 50 patients resulting in a 22-item survey. For psychometric analyses, primary care patients completed the new questionnaire at enrollment and at intervals ranging from 3 days to 3 wk. Multitrait scaling, test-retest reliability, and responsiveness were assessed. Predictive validity analyses of all scales and items used specialty physician diagnosis as the "gold standard." RESULTS: Iterative factor analyses yielded three scales of four items each including heartburn, acid regurgitation, and dyspepsia. Multitrait scaling criteria including internal consistency, item interval consistency, and item discrimination were 100% satisfied. Test-retest reliability was high in those reporting stable symptoms. Scale scores significantly changed in those reporting a global change. Regressing specialty physician diagnosis on the three scales revealed significant effects for two scales (heartburn and regurgitation). Combining the two significant scales enhanced the strength of the model. Symptom response to self-directed treatment with nonprescription antisecretory medications was highly predictive of the diagnosis also, although the item demonstrated poor validity and reliability. CONCLUSIONS: A brief, simple 12-item questionnaire demonstrated validity and reliability and seemed to be responsive to change for reflux and dyspeptic symptoms.

Adult↗

PubMed2006

Quality of life in patients with benign thyroid disorders. A review.

The importance of patient-reported outcomes such as health-related quality of life (HRQL) in clinical research is increasingly acknowledged. In order to yield valid results, the measurement properties of HRQL questionnaires must be thoroughly investigated. One aspect of such a validation process is the demonstration of content validity, i.e. that the questionnaire covers all relevant aspects. We review studies reporting on consequences of thyroid disorders and present the frequency of identified aspects, both overall HRQL issues and classical thyroid symptoms, in order to evaluate which issues are relevant for patients with thyroid diseases. Furthermore, existing questionnaires for thyroid patients are reviewed. A systematic search was performed in the Medline, Cinahl and Psycinfo databases and the reference lists of the relevant articles were hand-searched. Seventy-five relevant studies were identified. According to these studies, patients with untreated thyroid disease suffer from a wide range of symptoms and have major impairment in most areas of HRQL. Furthermore, the studies indicate that impairments in HRQL are also frequent in the long term. Six HRQL questionnaires for thyroid patients were identified. Generally, data supporting the validity of these questionnaires were sparse. According to the available literature, the quality of life of thyroid patients is substantially impaired over a wide range of aspects of HRQL in the untreated phase and continues to be so in many patients also in the long term. Studies systematically exploring the relative importance of these various aspects to thyroid patients are lacking, as is a comprehensive, validated thyroid-specific HRQL questionnaire.

Graves Ophthalmopathy↗