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The Adolescent Menstrual Attitude Questionnaire, Part I: Scale construction.

A valid, reliable, and age-appropriate instrument to measure adolescent responses to menarche was constructed. The Adolescent Menstrual Attitude Questionnaire is a 5-point Likert scale (with six sub-scales) with versions for pre- and postmenarcheal girls. Scale development included (a) content validation, (b) testing (with 860 premenarcheal and 1,013 postmenarcheal girls), (c) discriminant analysis (to identify items unique to the pre- and postmenarcheal experience, (d) construct validity using principal component factor analysis, and (e) reliability analysis. Development of the scale revealed that on some dimensions, the attitudes of premenarcheal girls were qualitatively different from those of postmenarcheal girls. Thus, the final versions of the Adolescent Menstrual Attitude Questionnaire consist of 58 items each, with 43 common items, 4 common items that load on different subscales, and 11 unique items. Reliabilities (r) are .91 and .90 for the pre- and postmenarcheal versions, respectively.

Adolescent↗

The Hamilton Depression Rating Scale: has the gold standard become a lead weight?

OBJECTIVE: The Hamilton Depression Rating Scale has been the gold standard for the assessment of depression for more than 40 years. Criticism of the instrument has been increasing. The authors review studies published since the last major review of this instrument in 1979 that explicitly examine the psychometric properties of the Hamilton depression scale. The authors' goal is to determine whether continued use of the Hamilton depression scale as a measure of treatment outcome is justified. METHOD: MEDLINE was searched for studies published since 1979 that examine psychometric properties of the Hamilton depression scale. Seventy studies were identified and selected, and then grouped into three categories on the basis of the major psychometric properties examined-reliability, item-response characteristics, and validity. RESULTS: The Hamilton depression scale's internal reliability is adequate, but many scale items are poor contributors to the measurement of depression severity; others have poor interrater and retest reliability. For many items, the format for response options is not optimal. Content validity is poor; convergent validity and discriminant validity are adequate. The factor structure of the Hamilton depression scale is multidimensional but with poor replication across samples. CONCLUSIONS: Evidence suggests that the Hamilton depression scale is psychometrically and conceptually flawed. The breadth and severity of the problems militate against efforts to revise the current instrument. After more than 40 years, it is time to embrace a new gold standard for assessment of depression.

Depressive Disorder↗

Cross-cultural validation of the St. Louis Inventory of Community Living Skills for Chinese patients with schizophrenia in Hong Kong.

AIM: The study validated a culturally sensitive community living skills rating scale for Chinese patients by adapting the St. Louis Inventory of Community Living Skills (SLICLS). METHOD: The Chinese version (SLICLS-C) was produced by forward and backward translation. An expert panel evaluated its content validity. Its internal consistency, inter-rater reliability, construct and concurrent validity were tested on 80 DSM-IV schizophrenia inpatients in a long-term facility. For predictive validity, the above sample was extended to ensure at least 20 subjects discharged to each of three levels of community care were included in the study sample. RESULTS AND CONCLUSION: The SLICLS-C was psychometrically sound and could be used for predicting level of community care, program evaluation and measuring outcome.

Activities of Daily Living↗

[Relevance and validity of a new French composite index to measure poverty on a geographical level].

BACKGROUND: A number of disease conditions are influenced by deprivation. Geographical measurement of deprivation can provide an independent contribution to individual measures by accounting for the social context. Such a geographical approach, based on deprivation indices, is classical in Great Britain but scarcely used in France. The objective of this work was to build and validate an index readily usable in French municipalities and cantons. METHODS: Socioeconomic data (unemployment, occupations, housing specifications, income, etc.) were derived from the 1990 census of municipalities and cantons in the Doubs departement. A new index was built by principal components analysis on the municipality data. The validity of the new index was checked and tested for correlations with British deprivation indices. RESULTS: Principal components analysis on municipality data identified four components (explaining 76% of the variance). Only the first component (CP1 explaining 42% of the variance) was retained. Content validity (wide choice of potential deprivation items, correlation between items and CP1: 0.52 to 0.96) and construct validity (CP1 socially relevant; Cronbach's alpha=0.91; correlation between CP1 and three out of four British indices ranging from 0.73 to 0.88) were sufficient. Analysis on canton data supported that on municipality data. CONCLUSION: The validation of the new index being satisfactory, the user will have to make a choice. The new index, CP1, is closer to the local background and was derived from data from a French departement. It is therefore better adapted to more descriptive approaches such as health care planning. To examine the relationship between deprivation and health with a more etiological approach, the British indices (anteriority, international comparisons) would be more appropriate, but CP1, once validated in various health problem situations, should be most useful for French studies.

Analysis of Variance↗

Nurse codependency: instrument development and validation.

This study developed and evaluated the Nurse Codependency Questionnaire (NCQ) and generated initial estimates of the stability and internal consistency of responses for the questionnaire. An initial pool of 95 items, reflective of four domains of codependency, was generated from the codependency literature using a domain-referenced approach. Seven expert judges from the nursing and codependency fields calculated the content validity index (CVI) as > .80. Items were critiqued for relevance, clarity, and predicted direction of each item's correlation with the total codependency score. A convenience sample of 547 male and female nurses from Texas was recruited from a variety of professional settings to test the NCQ. Evidence of reliability and validity was sought through the use of principal factor analysis (PFA) techniques and correlation analysis. The specific domains of "codependent caretaking" and "lack of voice" represented two of the four hypothesized domains that were supported by factor analysis. Data screening and item analysis resulted in a final sample of 24 items. Test-retest reliability was .90 and internal consistency reliability was .80 for the entire scale. Reliability estimates for the "codependent caretaking" and "lack of voice" scales were .65 and .59, respectively for test-retest; and .81 and .64, respectively for internal consistency. Known groups validity was supported by each of the factors' ability to discriminate between binge and nonbinge eaters. The NCQ may be useful for identifying codependency within the nursing profession. Research is needed to determine the external factors that influence the overt expression of nurse codependency. Screening for nurse codependency may contribute to the health of the profession by providing a means for anticipatory guidance and early intervention.

Adult↗

Development of an instrument to measure pain in rheumatoid arthritis: Rheumatoid Arthritis Pain Scale (RAPS).

OBJECTIVE: To develop a valid and reliable clinical instrument for measuring pain in adult patients with rheumatoid arthritis. The resulting Rheumatoid Arthritis Pain Scale (RAPS) is a quantitative, single-score, self-report 24-item instrument. METHODS: Psychometric evaluation of RAPS was conducted following estimation of content validity and a pilot study. The actual study used a convenience sample of 120 adults, 18 years of age or older, with pain of at least 3 months duration. The setting was a large rheumatology private practice in a metropolitan southwestern city. The gate control and affective motivational theories of pain served as a framework guiding the development of RAPS, which includes items suggestive of the multidimensional pain experience in rheumatoid arthritis. Four subscales, physiological, affective, sensory-discriminative, and cognitive, evaluated numerous pain factors. RESULTS: Findings indicate a high estimate for internal consistency for the total scale and a moderate to high estimate of internal consistency for projected subscales. Data were analyzed using Cronbach's coefficient alpha, Pearson product-moment correlation coefficients, and exploratory factor analysis. Using Cronbach's coefficient alpha, RAPS showed an internal consistency reliability coefficient of 0.92, a strong indicator of reliability. Reliability assessments for the 4 subscales also indicate reliability, with Cronbach's coefficients ranging from 0.65 to 0.86. Exploratory factor analysis yielded 3 factors with criteria for factor loadings > or = 0.4. CONCLUSION: The study's findings provided support for RAPS as a reliable and valid measurement of rheumatoid arthritis pain. Assessment of rheumatoid arthritis pain and its relationship to treatment outcomes could significantly impact the treatment interventions.

Adult↗

Reliability and validity of the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS).

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.

Adult↗

Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index.

Little is known about the prevalence, severity, or impact of symptoms in hemodialysis patients because of the lack of a validated symptom assessment instrument. We systematically developed an index to assess physical and emotional symptom burden in this patient population. We employed four steps in the generation of this index: a review of dialysis quality-of-life instruments, three focus groups, experts' content validity assessment, and test-retest reliability measurement. Seventy-five symptoms were identified. Of these, 46 appeared in > or = 4 of the instruments/focus groups and were considered for inclusion. Twelve were grouped into other symptom constructs and experts judged four of the remaining items not to be pertinent, leaving 30 items in the new index. Overall kappa statistic was 0.48+/-0.22. These steps allowed the systematic development of a 30-item symptom assessment index for hemodialysis patients. Additional reliability and validity testing is needed prior to its widespread use.

Health Status Indicators↗

Development of an instrument to measure strategic and clinical quality indicators in postoperative pain management.

AIM OF THE STUDY: To develop and evaluate psychometric properties, that is reliability and validity, of an instrument to measure strategic and clinical quality indicators in postoperative pain management. BACKGROUND: Strategic and clinical quality indicators in postoperative pain management were previously developed from a tentative model of important aspects of surgical nursing care and assessed to have content validity, that is to be essential for the quality of care, realistic to carry out and possible for nurses to use to influence management. METHODS: The quality indicators were converted to items suitable for a patient questionnaire and were scored on a 5-point scale, with higher scores indicating higher quality of care. Inpatients from five surgical wards took part in this study on their second postoperative day. The response rate was 96% and the average ages of the female (n=120) and the male (n=78) respondents were 62 and 63 years, respectively. RESULTS: Items in the total scale had an average inter-item correlation >0.20 and an item-total correlation >0.30. Cronbach's coefficient alpha was 0.84 for the total scale. Four factors entitled 'communication', 'action', 'trust' and 'environment' emerged from an orthogonal factor analysis, with a cumulative variance of 61.4%. Patients who received epidural analgesia had higher scores on the total scale compared with those who did not receive epidural analgesia. Patients who reported more pain than expected had lower scores on the total scale compared with those who did not report more pain than expected. Correlation between the total scale and an overall pain relief satisfaction question was 0.53. CONCLUSION: The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated.

Adult↗

Development of an observational instrument to measure mother-infant separation post birth.

The importance of the timing, quality, and quantity of early maternal-infant contact has gained prominence over the years. However, no researcher has adequately documented the nature of maternal-infant contact and separation. This study assessed the psychometric properties of the Index of Mother-Infant Separation (IMIS), pronounced "I miss," which is a 37-item observational measure of the process of mother-infant contact or separation post birth. Assessment of reliability and validity of the IMIS was conducted using data collected in a randomized clinical trial with 224 healthy newborn infants assigned at 1 hour post birth to self-regulatory or routine nursery care (control) groups. Time-sampled observations occurred every 15 minutes. Content validity indices of the IMIS, determined by nine nationally known perinatal experts, were 77% to 100% for instrument items. Construct validity was supported through known-groups hypothesis testing (p < .0001). Interrater reliability was from 86% to 90%. The IMIS is a valid observational measure of maternal contact when raters are trained to score it reliably.

Adult↗

[A revised Iowa collateral head injury interview: a new instrument for the assessment of traumatic psychosocial frontal symptoms].

OBJECTIVE: To validate a semi-structured Revised Iowa Collateral Head Injury Interview (RICHII) to assess post-traumatic, psychosocial frontal symptoms. METHOD: 1. To revise the RICHII in the light of recent research findings and previous pilot studies. 2. External experts assure face and content validity. 3. Standard reliability and validity study in a sample of consecutive patients fulfilling inclusion and exclusion criteria of severe head trauma. 4. Principal component analysis and distribution of results of RICHII administration to the full sample (N= 55). RESULTS: Several original items were modified and two new items (inappropriate euphoria and affective unstableness) were incorporated, as well as a new, graded scoring system. Feasibility, internal consistency (Cronbach's alfa= 0.94), inter-rater reliability (n= 40, kappa= 0.60) and test-retest reliability (n= 25, kappa= 0.70) were quite acceptable. Four factors emerged in the factor analysis, explaining a high percentage of the variance; they tend to reflect modern knowledge in the field and are judged to support the construct validity of the RICHII. More than two thirds of patients (70.9%) scored high in at least one of the items. CONCLUSION: This is the first report about the reliability and validity of a collateral interview to assess post-traumatic, psychosocial frontal symptoms.

Adult↗

The Rheumatoid Arthritis Quality of Life (RAQoL) for Sweden: adaptation and validation.

OBJECTIVE: To produce and evaluate the official Swedish language version of the Rheumatoid Arthritis Quality of Life instrument (RAQoL). METHODS: The UK RAQoL was translated into Swedish by a bilingual translation panel. A separate lay panel was conducted to consider the appropriateness and comprehensibility of the items in Swedish. Interviews were conducted with 15 Swedish RA patients to assess face and content validity. Responses to a postal survey were used to calculate reproducibility and construct validity. RESULTS: Few difficulties arose in the translation process and the new language version was well received by the lay panel and field-test participants. One hundred and sixty-five RA patients participated in the postal survey (69% female; mean age 62.7 years, SD 11.3, RA duration range 1-62 years). Cronbach's alpha for the Swedish RAQoL was 0.91 and test-retest reliability was 0.95, indicating that the instrument has adequate inter-relatedness of items and very low inherent random measurement error. A high correlation with the Health Assessment Questionnaire (HAQ) was observed; this was expected because RA has significant physical manifestations that are in turn a significant determinant of QoL. The Swedish RAQoL was able to distinguish between patients who differed according to their self-perceived RA severity, general health, and rating of their RA today, in addition to whether or not the patient was experiencing a flare of RA. CONCLUSIONS: The official Swedish RAQoL was well received by RA patients. The psychometric quality of the adapted questionnaire means that it is suitable for inclusion in clinical trials involving patients with RA.

Adult↗

Development and preliminary validation of Brace Questionnaire (BrQ): a new instrument for measuring quality of life of brace treated scoliotics.

BACKGROUND: The quality of life among children with idiopathic scoliosis during their adolescence has been reported to be affected by the brace itself. However, a controversy exists whether brace treated scoliotics experience a poor quality of life, thus there is a need for the development of a brace-oriented instrument, as the now-existing questionnaires that are commonly used, such as the SRS -22, take into consideration the effects of both the conservative and the surgical treatment on quality of life of scoliotic children. The aim of the present study is to assess the validity and reliability of Brace Questionnaire (BrQ), a new instrument for measuring quality of life of scoliotic adolescents who are treated conservatively with a brace. MATERIAL-METHOD: Methodology of development involved literature review, patient and health care professionals' in-depth interviews and content validity analysis on patients. A validation study was performed on 28 brace treated scoliotic children aged between 9 and 18 years old. BrQ was assessed for the following psychometric properties: item convergent validity, floor and ceiling effects, internal consistency reliability, clinical validity and responsiveness to change. RESULTS: BrQ is self administrated and developmentally appropriate for ages 9 to 18 years old and is consisted of 34 Likert-scale items associated with eight domains: general health perception, physical functioning, emotional functioning, self esteem and aesthetics, vitality, school activity, bodily pain and social functioning of scoliotic children treated conservatively with a brace. The subscales of these eight dimensions can be combined to produce a total score. Higher scores mean a better quality of life. An item convergent validity >/= 0.40 was satisfied by all items in the present study. A satisfactory internal consistency reliability for the BrQ was recorded (Cronbach's alpha coefficient was 0.82). There were no floor or ceiling effects. The correlation between BrQ overall scores and mild and moderate scoliosis was statistically significant (p < 0.001), revealing high clinical validity. An increase in effect sizes for the patient with improved scoliotic curves indicates that the BrQ is responsive to change in health status. CONCLUSION: BrQ is reliable, valid and responsive to change in adolescents with IS who are treated conservatively with a brace.

Journal Article↗

Assessment of the validity and reliability of the University of Wisconsin Children's Hospital Pain scale for Preverbal and Nonverbal Children.

PURPOSE: This study tested the reliability and validity of a pain scale that was developed at University of Wisconsin Children's Hospital for the preverbal child (less than 3 years old) and the nonverbal child (children who cognitively were not able to communicate a pain rating on traditional pain scales). METHOD: Content validity was established by expert review. Construct validity was demonstrated by having the nurse rate the child's pain before and after analgesic and during a procedure. Inter-rater reliability was achieved by two nurses simultaneously and independently rating the child's pain. Criterion validity was determined by comparing ratings with those obtained on the Wong-Baker Faces scale. Internal consistency was calculated using Cronbach's alpha. FINDINGS: Seventy-four patients provided data for 124 observation times. At 58 of the observation times, two nurses independently used the newly developed University of Wisconsin Children's Hospital (UWCH) scale, resulting in 182 pain ratings. Internal consistency of the scale (Cronbach's alpha) was 0.93. Mean pain scores were significantly higher prior to pain medication administration and during procedures than following analgesic administration. Inter-rater reliability was 0.92. Correlation of the new scale with the Wong-Baker Faces Scale was r = .62. CONCLUSIONS: Initial testing of the construct validity, internal reliability, and internal consistency of the UWCH Pain Scale for Preverbal and Nonverbal Children were acceptable. Parents provided ratings for most of the faces scale, which could account for the low correlation in the construct validity testing.

Child Behavior↗

Professional perceptions about home safety: cross-national validation of the Home Falls and Accidents Screening Tool (HOME FAST).

The Home Falls and Accidents Screening Tool (HOME FAST) was developed to measure the risk of older people falling within their home environment. If this tool is to be effective, the underlying dimensions perceived by potential raters when using the HOME FAST need to be consistent with the purpose of the tool. The content validation process undertaken to evaluate the HOME FAST and a method to develop a home safety score are described. Experts in home safety assessment were recruited from the British Association of Occupational Therapy, the Chartered Society of Physiotherapists, and the Royal College of Nursing in the United Kingdom. Participants rated each HOME FAST item using a Thurstone technique format. Each item was weighted according to the level of perceived falls risk each expert attributed to the home safety item. Principal components factor analysis identified a two-factor structure interpreted as environment and function underlying the HOME FAST. Results indicated that no item should be deleted from the checklist. Weights were calculated for each item to generate an overall hazard score. Some differences in responses to the degree of risk associated with home safety items were noted between the professional groups. The HOME FAST has captured highly relevant home safety items considered by an expert panel and measures a domain applicable to home safety and falls risk.

Accidental Falls↗

Faking the MMPI-2: utility of the Subtle-Obvious scales.

We explored the effect of different subject response sets on the profile configuration of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the utility of traditional validity, Back F, and Subtle-Obvious scales in detecting response set. College students were administered the MMPI-2 under one of three response sets; faking good, faking bad, or standard report. Results revealed significant differences across the three response set groups on all clinical, content, validity, obvious, and two of the five subtle scales in the expected direction. Additionally, respondents in the faking conditions produced consistent T-score patterns and significant O-S differences on the Subtle-Obvious scales. Examination of these subtle-obvious patterns may offer clinicians valuable information regarding profile validity beyond that offered by the traditional validity and Back F scales.

Adolescent↗

Development and validation of a professional behavior assessment.

Allied health students must quickly socialize into a professional role as they transition from classroom to clinic. In addition to skill development, students must exhibit a host of professional behaviors that facilitate successful interaction with patients, families, and colleagues. There is a need for a valid, reliable assessment of professional behaviors that contribute to clinical competence. This study reports on the development and validation of a professional behavior assessment for occupational therapy students on a part-time clinical rotation (Level I). The Philadelphia Region Fieldwork Consortium (PRFC) Level I Student Evaluation was developed from an initial survey (n = 75) to generate an item pool, followed by a content review by a panel of experts (n = 5) to establish relevancy, clarity and content validity. This 12-item instrument was administered to 317 occupational therapy and occupational therapy assistant students. A principal component factor analysis and item analysis was conducted. Internal consistency reliability (Cronbach's alpha) was 0.89, with intra-rater reliability for the 12 items ranging from 0.68 for "written communication" to 0.89 for "observation skills." The PRFC Level I Evaluation demonstrates discriminant validity, with students on their first clinical rotation scoring significantly (p < 0.001) lower than students on their third or fourth rotations, indicating a developmental process of professional socialization.

Adult↗

Illness awareness in cancer patients: a conceptual framework and a preliminary classification hypothesis.

The study describes the initial phases of research aimed at developing a methodology for assessing awareness in cancer patients. A first sample of cancer patients (n = 36) was interviewed about their knowledge of the diagnosis and their perception of treatment goals and outcomes. Thirteen domains which refer both to cognitive and emotional areas were identified, and considered as content valid by a panel of six experts. A second sample of patients (n = 54) participated in a semi-structured interview developed to explore awareness by means of the domains identified. Seven patterns of awareness were identified, ranging from 'completely aware patient' to 'completely unaware patient'. Twenty of the 54 patients (37.0%) were completely aware, 19 (35.2%) were partially aware with defence mechanisms and 15 (27.8%) were not aware of their diagnosis. Patients from the National Cancer Institute were more frequently aware (54.3%) compared with the patients interviewed in the community hospitals (5.3%) (p < 0.001). A computerized content analysis allowed the identification of two main groups of patients on the basis of the content of the recorded interviews. This independent classification agreed with the classification of the patients performed by the psychologists, suggesting the validity of the procedure of awareness evaluation proposed in this study.

Adaptation, Psychological↗