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Evaluating paramedic comfort with field pronouncement: development and validation of an outcome measure.

OBJECTIVES: Interventions designed to improve cardiac resuscitation and the quality of field pronouncement need to consider outcomes on paramedic providers. The authors developed and evaluated the reliability and validity of a survey instrument measuring paramedic comfort with field pronouncement. METHODS: A mail survey of 120 paramedics (EMT-Ps) was performed using the Modified Dillman survey methodology. Questions were sorted for analysis into subgroups assessing psychological comfort and technical skills. Sixty-five respondents were retested within two weeks. RESULTS: The overall response rate was 96% (115). Respondents had an average age of 36 years (SD +/- 5), with 5.2 years (SD +/- 3.8) of out-of-hospital experience as an EMT-P, and were involved in a median of ten field pronouncements annually (range = 2-60). The face and content validity of the survey instrument was consistent with a content matrix derived by a focus group. The Cronbach's alpha for the survey instrument was 0.91. The retest response rate was 76% (46). The test-retest reliability coefficient was 0.84. CONCLUSIONS: This survey is a valid and reliable instrument for measuring the paramedic psychological comfort with field pronouncement. The high response rate and intrareliability support its generalizability. This outcome measure may be helpful in evaluating the psychological impact of changes to emergency medical services (EMS) policy with respect to termination of resuscitation promoted by the National Association of EMS Physicians.

Adult↗

Measurement of the quality of life in cancer survivors.

A QOL instrument was developed to measure the specific concerns of long term cancer survivors. The QOL-CS is based on previous versions of the QOL instrument developed by researchers at the City of Hope National Medical Centre (Grant, Padilla, and Ferrell). This instrument was revised over a one year pilot by Hassey-Dow and Ferrell. The revised instrument included 41 items representing the four domains of quality of life incorporating physical, psychological, social, and spiritual well being. The present study was conducted as a mail survey to the membership (n = 1,200) of the National Coalition for Cancer Survivorship with 686 subjects responding to the survey. This survey included a Demographic tool, QOL-CS and the FACT-G tool developed by Cella. Psychometric analysis, performed on 686 respondents, included measures of reliability and validity. Two measures of reliability included test-retest and internal consistency. The overall QOL-CS tool test-retest reliability was 0.89 with subscales of Physical r = 0.88, Psychological r = 0.88, Social r = 0.81, and Spiritual, r = 0.90. The second measure of reliability was computation of internal consistency using Cronbach's alpha coefficient as a measure of agreement between items and subscales. Analysis revealed an overall r = 0.93. Subscale alphas average ranged from r = 0.71 for spiritual well being, r = 0.77 for physical, r = 0.81 for social, and r = 0.89 for psychological. Several measures of validity were used to determine the extent to which the instrument measured the concept of QOL in cancer survivors. The first method of content validity was based on a panel of QOL researchers and nurses with expertise in oncology. The second measure used stepwise multiple regression to determine factors most predictive of overall QOL in cancer survivors. Seventeen variables were found to be statistically significant accounting for 91% of the variance in overall QOL. The fourth measure of validity used Pearson's correlations to estimate the relationships between the subscales of QOL-CS and the subscales of the established FACT-G tool. There was moderate to strong correlation between associated subscales including QOL-CS physical to FACT physical (r = 0.74), QOL-CS Psych to FACT Emotional (r = 0.65), QOL Social to FACT Social (r = 0.44). The overall QOL-CS correlation with the FACT-G was 0.78. Additional measures of validity included correlations of individual items of the QOL-CS tool, factor analysis, and construct validity discriminating known groups of cancer survivors. Findings demonstrated that the QOL-CS and its subscales adequately measured QOL in this growing population of cancer survivors.

Adult↗

Subjective assessment of nutritional status-validity and reliability of a modified Detsky index in a Swedish setting.

In the search for a clinically useful nutritional index for use in a European context, we have translated an American nutritional assessment index - Subjective Global Assessment (SGA), and tested the modified translated version for validity and reliability in a Swedish setting. Judgements by an expert panel resulted in a mean agreement of 71% for clarity, 80% for content validity and 65% for internal consistency. Construct validity was demonstrated by the use of contrasting patient-groups (n = 20) and by 90% agreement with a medical expert as 'gold standard' for unknown patients (n = 20). Inter-rater reliability showed 75% agreement by 3 Registered Nurses (RNs) (n = 20). The individual Kappas for the raters varied from 0.68 to 0.89. The study showed difficulties experienced by raters in relating certain aspects in the SGA-index to normality. However, we concluded that a modified SGA-index translated from one language to another, with all the problems of cultural and idiomatic differences, can be of value for assessing and documenting pre-operative nutritional status of patients undergoing gastrointestinal surgery in a Swedish setting.

Journal Article↗

Chinese translation and validation of the Nowicki-Strickland Locus of Control Scale for Children.

The objective of this study is to evaluate the psychometric properties of the Chinese version of the Nowicki-Strickland Locus of Control Scale for Children for its utility in clinical research and nursing practice. The scale was translated from the original English language into the Chinese language and the reliability and validity of the translated scale were tested. Results showed that there was high test re-test reliability, acceptable internal consistency reliability, appropriate content validity, concurrent validity and construct validity. It is concluded that the psychometric properties of the Chinese version of the Nowicki-Strickland Locus of Control Scale for Children presented in this paper supports its feasibility as a research instrument to measure children's locus of control objectively and appropriately in the Chinese population.

Adaptation, Psychological↗

Development of the Korean version of the Geriatric Depression Scale and its short form among elderly psychiatric patients.

OBJECTIVE: The aim of this study was to evaluate the diagnostic validity of the Korean version of the Geriatric Depression Scale (GDS-K) and its short form among elderly psychiatric patients. METHOD: After three preliminary trials, the authors translated the GDS, including the Geriatric Depression Scale-Short Form (SGDS) into Korean. The GDS-K, the Korean version of the SGDS (SGDS-K), Hamilton Rating Scale for Depression (HRS-D), and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered to 154 elderly psychiatric patients. In addition, the Diagnostic Interview Schedule (DIS-III-R) was administered independently to diagnose DSM-III-R major depression. Reliability and validity test, optimal cutoff point estimation, and receiver operating characteristics (ROC) curve analysis were performed to investigate the diagnostic validity of the GDS-K and SGDS-K. RESULTS: Internal consistency-reliability and concurrent validity of the GDS-K and SGDS-K associated with other depression scales (HRS-D, CES-D) were excellent. Content validity and discriminant validity, which differentiate DSM-III-R major depression from nonmajor depression was also good. We suggest a score of 16 as the optimal cutoff point of GDS-K for screening DSM-III-R major depression among clinical populations and a score of 8 as optimal cutoff score of SGDS-K. ROC curve analysis indicated high diagnostic validity for both GDS-K and SGDS-K in assessing DSM-III-R major depression. Moreover, we found that the GDS-K and SGDS-K were highly correlated (r=.9522). This finding suggests that the SGDS-K can be used as an adequate substitute for the GDS-K. CONCLUSION: The GDS-K and SGDS-K proved valid and reliable case-finding tools for screening DSM-III-R major depression among the elderly psychiatric patients in Korea. The relatively high cutoff points of both the GDS-K and SGDS-K require further evaluation from the viewpoint of culturally determined response style in elderly Koreans.

Aged↗

Development and validation of a Breast Cancer Genetic Counseling Knowledge Questionnaire.

Women who undergo genetic counseling concerning their increased risk of developing breast cancer confront large quantities of complex information in a short period of time. Clinical reports have suggested that many women may not retain what they learned during counseling. A validated questionnaire to measure their knowledge, however, is lacking. In this study, we describe the development and validation of a questionnaire to assess knowledge of information typically included in genetic counseling for breast cancer. Items were empirically derived from detailed content analyses of actual genetic counseling sessions. The instrument's content validity was high, as evidenced by high levels of independent interrater agreement (0.93) on items. Subsequent data reduction and confirmatory factor analytic techniques yielded a highly reliable (alpha = 0.92) 27-item Breast Cancer Genetic Counseling Knowledge Questionnaire (BGKQ). Direct comparison of this questionnaire to a scale previously developed in the literature (BCHK; [Breast Cancer Res. Treat. 53 (1999) 69]) supported the utility of the new questionnaire for evaluation of knowledge after counseling. Compared to non-counseled groups (n = 45), women who had undergone genetic counseling (n = 28) scored significantly higher (P < 0.0001) on the BGKQ, but not on the other questionnaire, establishing the BGKQ's criterion validity. The BGKQ may, thus, provide a useful clinical and research tool for assessing knowledge of information provided during genetic counseling and exploring the potential impact of distress on knowledge, as well as the impact of knowledge on screening behaviors.

Adult↗

Criteria for assessing pain and nonarticular soft-tissue rheumatic disorders of the neck and upper limb.

OBJECTIVE: To critically review the criteria used to diagnose nonarticular soft-tissue rheumatic disorders of the neck and upper limb. METHODS: An extensive search of the literature, including a search of Medline and EMBASE, authoritative recent reviews, and relevant textbooks, was completed. The diagnostic criteria used in epidemiologic studies were compared and the reliability and validity of these criteria were assessed. RESULTS: Altogether, the search identified 117 relevant research articles, among which 69 included a physical examination component, but few specified diagnostic criteria. Evidence supported respectable levels of between-observer repeatability regarding: symptom questionnaires (kappa, 0.52 to 0.79); measurement of shoulder range of motion with a goniometer (intraclass coefficients > 0.70); tests for carpal tunnel syndrome (Tinel's and Phalen's kappa, 0.53 to 0.80); and demonstration of neck tenderness (kappa = 0.43). The Katz hand diagram, and combinations of physical signs of carpal tunnel syndrome, show reasonable sensitivity and specificity for that diagnosis but only among patients referred to specialists with that putative diagnosis; no such validity has been shown among the general population. Only 1 diagnostic examination schedule has published data on both the reliability and the validity of its criteria and diagnoses. For the remaining soft-tissue upper-limb disorders, diagnostic criteria rely apparently on face and content validity and reliability data have not been published. CONCLUSION: Classification of specific disorders of the neck and upper limb requires a back to basics approach. At present, the diagnosis of most of these conditions relies heavily on the clinical opinions of investigators and there are insufficient data to indicate that these criteria are repeatable, sensitive, or specific. Recent European initiatives offer scope to follow a more disciplined approach, but more work is urgently required.

Humans↗

An instrument for measuring cancer patients' preferences for support groups.

The purpose of this study was to develop a valid and reliable instrument to assess cancer patients' preferences for all types of social support and organizational features of cancer support groups. The content of the instrument was the result of a detailed analysis of four resources: (1) literature relating to cancer support group interventions, (2) program materials from existing groups, (3) interviews with individuals who developed or directed groups, and (4) interviews with patients who have participated in cancer support groups. A jury of six experts was used to establish content validity of the instrument. The reliability of the instrument was examined by measuring a sample of 258 cancer patients. The reliability coefficients of the instrument were all above .80, except for two types of social support (instrumental and informational-educational), which were .72 and .78, respectively. It was concluded that the instrument produces valid and reliable measurements of cancer patients' preferences for cancer support groups.

Neoplasms↗

The Cardiff Anomalous Perceptions Scale (CAPS): a new validated measure of anomalous perceptual experience.

The study describes the Cardiff Anomalous Perceptions Scale (CAPS), a new validated measure of perceptual anomalies. The 32-item CAPS measure is a reliable, self-report scale, which uses neutral language, demonstrates high content validity, and includes subscales that measure distress, intrusiveness, and frequency of anomalous experience. The CAPS was completed by a general population sample of 336 participants and 20 psychotic inpatients. Approximately 11% of the general population sample scored above the mean of the psychotic patient sample, although, as a group, psychotic inpatients scored significantly more than the general population on all CAPS subscales. A principal components analysis of the general population data revealed 3 components: "clinical psychosis" (largely Schneiderian first-rank symptoms), "temporal lobe disturbance" (largely related to temporal lobe epilepsy and related seizure-like disturbances) and "chemosensation" (largely olfactory and gustatory experiences), suggesting that there are multiple contributory factors underlying anomalous perceptual experience and the "psychosis continuum."

Adolescent↗

Quality of care from the perspective of the cataract patient: the reliability and validity of the QUOTE-cataract.

BACKGROUND/AIMS: To assess reliability and validity of the QUOTE-cataract, a questionnaire that measures the quality of care from the perspective of cataract patients. METHODS: The QUOTE-cataract was tested in a multicentre study among 540 cataract patients in three different hospitals. Reliability was represented by internal consistency (Cronbach's alpha), and repeatability (intraclass correlation coefficient (ICC)). Validity was evaluated qualitatively and by factor analyses. RESULTS: A strong internal consistency coefficient (0.89), and high repeatability (ICC = 0.76) demonstrated good reliability. Content validity was assured by involvement of patients in the development of the questionnaire. Factor analysis confirmed an underlying taxonomy of generic and disease specific items. CONCLUSION: The QUOTE-cataract has good reliability and provides a valid assessment of quality of care in cataract surgery.

Aged↗

The left ventricular dysfunction questionnaire (LVD-36): reliability, validity, and responsiveness.

OBJECTIVE: To examine the reliability, validity, and responsiveness of a new health status measure (LVD-36) for patients with left ventricular dysfunction which was designed with emphasis on content validity, clarity, brevity, and ease of use. DESIGN: At baseline, patients completed the LVD-36 and a range of measures reflecting general health and disease severity. The LVD-36 was repeated after one week. After six months, it was repeated again, along with a transition question to measure global changes in health. SETTING: Patients were recruited from the cardiology and general medical clinics at a south west London hospital. PATIENTS: 60 patients with chronic left ventricular dysfunction. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Short form 36 questionnaire (SF-36), Minnesota living with heart failure questionnaire (LIhFE), New York Heart Association criteria, and exercise performance and echocardiographic tests. RESULTS: The LVD-36 showed good internal consistency (kappa = 0.95) and repeatability (r(i) = 0.95). Its scores were significantly associated with SF-36 mental and physical component scores (r = -0. 48 and -0.75; p < 0.0001), with exercise capacity (r = -0.52; p < 0. 0001), and with systolic shortening fraction (r = -0.27; p < 0.05). Change in the LVD-36 over six months was associated with change in overall health (F = 5.7; p < 0.001). In tests of validity and responsiveness, the LVD-36 performed similarly to or marginally better than the LIhFE. CONCLUSIONS: The LVD-36 showed a high level of reliability and validity, and appears to measure changes in health. It provides a short, simple, valid, and reliable measure of health status in patients with left ventricular dysfunction.

Aged↗

Cognitive-behavioral techniques to reduce pain: a validation study.

The purpose of this study was to identify and validate specific activities considered important in the implementation of three non-pharmacologic pain management interventions--relaxation, distraction and guided imagery. Using a two-round Delphi survey, nurses selected for their expertise in pain management were asked to validate definitions and activities considered important in the implementation of each of these strategies. Data were analyzed using a modification of Fehring's diagnostic content validity method. From this process, a list of activities for each intervention evolved that has implications for nursing research, practice and education.

Analgesia↗

The development of the Australian Basic Intensive Care Knowledge Test.

The Basic knowledge Assessment Tool (BKAT), a test developed in the United States, has been presented as a valid and reliable test of basic knowledge for critical care nursing. However, it was necessary to determine the BKAT's validity and reliability in the Australian intensive care (IC) context. The Delphi technique, utilising a panel of eleven experts, was used to determine the content validity of the BKAT. The Delphi process resulted in the development of a test with 105 questions. These questions consist of 49 original BKAT questions, 25 original BKAT questions slightly modified, 3 original BKAT questions with major modifications and 28 new questions. A criterion group design was used to establish the modified test's reliability and decision validity. Item analysis was undertaken using item difficulty and item discrimination indexes. The modified test was completed by 14 registered nurses with no IC experience, 18 registered nurses with intermediate IC experience and 25 registered nurses qualified as intensive care specialists. The mean score (and standard deviation) for the test for each of the respective groups was 41(9), 69(9) and 86(7). These results were significantly different (p < 0001). The reliability was established with a Cronbach Alpha coefficient of .96. The modified test is a reliable and valid measure of IC basic knowledge and can be used as a valuable adjunct in the assessment of IC orientation programs.

Australia↗

The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure.

BACKGROUND: Empathy is a key aspect of the clinical encounter but there is a lack of patient-assessed measures suitable for general clinical settings. OBJECTIVES: Our aim was to develop a consultation process measure based on a broad definition of empathy, which is meaningful to patients irrespective of their socio-economic background. METHODS: Qualitative and quantitative approaches were used to develop and validate the new measure, which we have called the consultation and relational empathy (CARE) measure. Concurrent validity was assessed by correlational analysis against other validated measures in a series of three pilot studies in general practice (in areas of high or low socio-economic deprivation). Face and content validity was investigated by 43 interviews with patients from both types of areas, and by feedback from GPs and expert researchers in the field. RESULTS: The initial version of the new measure (pilot 1; high deprivation practice) correlated strongly (r = 0.85) with the Reynolds empathy measure (RES) and the Barrett-Lennard empathy subscale (BLESS) (r = 0.63), but had a highly skewed distribution (skew -1.879, kurtosis 3.563). Statistical analysis, and feedback from the 20 patients interviewed, the GPs and the expert researchers, led to a number of modifications. The revised, second version of the CARE measure, tested in an area of low deprivation (pilot 2) also correlated strongly with the established empathy measures (r = 0.84 versus RES and r = 0.77 versus BLESS) but had a less skewed distribution (skew -0.634, kurtosis -0.067). Internal reliability of the revised version was high (Cronbach's alpha 0.92). Patient feedback at interview (n = 13) led to only minor modification. The final version of the CARE measure, tested in pilot 3 (high deprivation practice) confirmed the validation with the other empathy measures (r = 0.85 versus RES and r = 0.84 versus BLESS) and the face validity (feedback from 10 patients). CONCLUSIONS: These preliminary results support the validity and reliability of the CARE measure as a tool for measuring patients' perceptions of relational empathy in the consultation.

Adult↗

Reliability and validity of the Food Pyramid Self Efficacy Scale: use in coronary artery bypass patients.

Inappropriate dietary intake is associated with 5 of the 10 leading causes of U.S. death; coronary artery disease (CAD) ranks highest regardless of gender in people over the age of 65. Of the modifiable risk factors for CAD, two of four pertain to food choices. Although lifestyle habits can enhance or impair health, people's beliefs that they can motivate and regulate their own behavior (self efficacy) plays a crucial role in whether they even consider changing detrimental health habits. The Food Pyramid Self Efficacy Scale (FPSES) is an instrument to measure an elder's confidence in his/her ability to choose healthy food items in a variety of situations. The purpose of this study was to determine the reliability and validity of the FPSES. Thirty postoperative CABG patients participated (mean age 70.4). FPSES test-retest (r = 0.78, p = 0.008); coefficient alpha = 0.92. Six content experts judged the FPSES (content validity index [CVI] = 0.85). Construct validity of the instrument was achieved through hypothesis testing, supporting the statement that the higher the nutritional risk, the greater the functional decline (r = 0.37, p = 0.05). As many of the health problems associated with the elderly are preventable or controllable through health promotion, it is vital that measures exist to determine a person's confidence that one believes in the capability to change to healthy eating behaviors.

Activities of Daily Living↗

Risk assessment scales for pressure ulcers: a theoretical, methodological, and clinical perspective.

Several instruments have been devised to measure risk of developing pressure ulcers. In this article, the value of risk assessment scales is explored and discussed from a theoretical, methodological, and clinical perspective. The first part of the article focuses on the validity of such scales from the first two perspectives. It is argued that currently it is not possible to devise an instrument with perfect content validity because too many factors are involved in the development of pressure ulcers. When establishing predictive validity of a risk assessment instrument, one needs an external criterion to test sensitivity and specificity. This article argues that the external criterion normally used--pressure ulcers that actually develop--is not a good indicator of the risk of developing pressure ulcers, because this criterion is influenced by the use of preventive methods. Therefore, the author suggests using not only the pressure ulcers that actually develop, but also incorporating preventive methods into the external criterion. Despite their limitations, risk assessment scales are recommended. However, to be effective, they should be used within a broader preventive program. Furthermore, using the chance a patient has of developing pressure ulcers, instead of one or two cutoff points, is recommended.

Humans↗

[Assessment of the health-promoting lifestyle profile on reliability and validity].

The purpose of this study is to test the reliability and validity of a translated lifestyle scale, Health-Promoting Lifestyle Profile (HPLP), for college students. Methods such as Cronbach's Alpha, test-retest, content validity, item analysis and factor analysis were utilized. Two hundred and fifty-two college students in Kaohsiung City were sampled as subjects and data were collected by interviews. On the basis of statistical data, 6 items were deleted from the original scale. The revised scale revealed good internal consistency (alpha = .93) and test-retest reliability (r = .84). Six factors, which were identified by means of factor analysis, well corresponded with the concept of original scale. These factors included self-actualization, health responsibility, stress management, interpersonal support, nutrition and exercise, which accounted for 52.8% of variance of the scores. In conclusion, this study has proved that the revised HPLP is an adequate scale to be utilized on future research for Taiwanese young adults.

Adult↗

Validation of the functional assessment of multiple sclerosis quality of life instrument.

Based on scientific literature and interviews with clinicians and patients, we developed a quality of life instrument for use with people with MS called the Functional Assessment of Multiple Sclerosis (FAMS). The initial item pool consisted of 88 questions: 28 from the general version of the Functional Assessment of Cancer Therapy quality of life instrument, plus 60 generated by patients, providers, and literature review. The validation samples comprised a mail survey cohort (N = 377) and a clinical cohort (N = 56). Both cohorts provides evidence for internal consistency of the derived subscales, test-retest reliability, content validity, concurrent validity, and construct validity. Principal components and Rasch measurement model analyses were applied sequentially to survey sample data, reducing test length to 44 questions, divided into six subscales: mobility, symptoms, emotional well-being (depression), general contentment, thinking/fatigue, and family/social well-being. Fifteen initially rejected questions were added back as miscellaneous (unscored) questions for their potential clinical and empirical value. The mobility subscale was strongly predictive of the Kurtzke Extended Disability Status Scale and the Scripps Neurologic Rating Scales. The other five subscales were not, indicating they measure aspects of patient quality of life not captured by the neurologic exam. The final 59-item English language instrument (FAMS version 2) is available for inclusion in clinical trials and clinical practice.

Adult↗