PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “construct validity”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 811 records · Page 45Linked to original sources

Computer-assisted medication review for asthmatic patients as a basis for intervention. Constructing and validating an algorithmic computer instrument in pharmacy practice.

OBJECTIVE: To construct and validate a computer instrument that identifies asthma patients receiving--theoretically--suboptimal drug therapy in community pharmacies, by the use of patient medication records. This selection enables the pharmacist to assist these patients in using medicines appropriately. METHODS: According to Dutch asthma guidelines which describe a stepwise approach and in order to define correct profiles for the use at each level of these guidelines, the optimum use of drugs in the different levels in asthma treatment was expressed in defined daily doses (DDDs) per pharmacological drug-group during a period of one year. An algorithmic computer instrument was developed to select patients with medication use deviant from these profiles. By using nine different selection profiles, the computer instrument stratified patients according to the medication records filed in the pharmacy computer. Patient medication records in four community pharmacies were investigated to validate the selection profiles as indicators for theoretically suboptimal drug use by asthma patients. The validation was performed by comparing the professional judgement of participating pharmacists with the selections made by the computer. MAIN OUTCOME MEASURE: Positive predictive value and negative predictive value of the selection made by algorithmic computer instrument. Rate of false-positive results. RESULTS: The computer instrument identified asthma patients using theoretically suboptimal drug therapy with approximately 95% predictive value compared with the professional judgement of the pharmacists. The rate of false-positive results was 5%. CONCLUSION: The results of the algorithmic computer instrument and the professional judgement of the pharmacists are in close agreement. The instrument will be utilised in further research in the IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigating the role of Dutch community pharmacists in counselling patients who are at risk of suboptimal drug use in the treatment of their asthma.

Adolescent↗

[Predicting the risk of extra-uterine pregnancy. Construction and validation of a French risk scale].

This paper reports the construction and validation of a composite measurement scale to predict the risk of ectopic pregnancy in France. The data from three case-control studies of ectopic pregnancy conducted in France were used. Fourteen potential factors were found to be associated to ectopic pregnancy, which were grouped by multiple correspondence analysis in four dimensions: infection, pelvic surgery, smoking and induced conception. Logistic regression was further used to model the relationship between candidate risk factors (single or grouped as suggested by multiple correspondence analysis) and ectopic pregnancy. The regression coefficients of the final model were scaled and rounded to integers so as to make the scoring system simpler to use. The resulting composite measurement scale was finally validated on two independent samples. It allows simple determination (with a nomogram) of the absolute risk of developing ectopic pregnancy, for a given level of risk factors. This indicator for the risk of ectopic pregnancy could be used by clinicians to predict occurrence and provide an indication as to which type of early pregnancy follow-up and information should be given to women planning a pregnancy. It could also be used to provide earlier diagnostic screening in case of mild symptoms.

Case-Control Studies↗

Validation of a questionnaire measuring patient satisfaction with general practitioner services.

BACKGROUND: In order that patient satisfaction may be assessed in a meaningful way, measures that are valid and reliable are required. This study was undertaken to assess the construct validity and internal reliability of the previously developed Patient Satisfaction Questionnaire (PSQ). METHOD: A total of 1390 patients from five practices in the North of England, the Midlands, and Scotland completed the questionnaire. Responses were checked for construct validity (including confirmatory factor analysis to check the factor structure of the scale) and internal reliability. RESULTS: Confirmatory factor analysis showed that items loaded on the appropriate factors in a five factor model (doctors, nurses, access, appointments, and facilities). Scores on the specific subscales showed highly significant positive correlations with general satisfaction subscale scores suggesting construct validity. Also, the prediction (derived from past research) that older people would be more satisfied with the service was borne out by the results (F (4, 1312) = 57.10; p < 0.0001), providing further construct validation. The five specific subscales (doctors, nurses, access, appointments, and facilities), the general satisfaction subscale, and the questionnaire as a whole were found to have high internal reliability (Cronbach's alpha = 0.74-0.95). CONCLUSION: The results suggest that the PSQ is a valid and internally reliable tool for assessing patient satisfaction with general practitioner services.

Factor Analysis, Statistical↗

Measurement of perceived school climate for active travel in children.

OBJECTIVES: To describe the development of an original scale that measures perceived school climate for active travel in fourth- and fifth-grade girls and boys. METHODS: The data were analyzed using confirmatory factor analysis (CFA) to provide evidence of factorial validity, factorial invariance, and construct validity. RESULTS: The CFA supported the fit of a 3-factor (encouragement, praise, and importance) correlated model for the school climate for active travel measure. This hierarchical model was invariant between sex and across a 7-month time period, and initial evidence for construct validity was provided. CONCLUSIONS: School climate for active travel is a measurable construct, and preliminary evidence suggests relationships with more support for active travel from friends and family.

Attitude↗

[Construction and validation of a gastroesophageal reflux symptom scale. Preliminary report].

BACKGROUND: Gastroesophageal reflux symptoms are frequent in the general population, but there is a lack of information about its prevalence and valid and reliable scales to determine it. AIM: To design a valid and reliable scale to determine gastroesophageal reflux disease. SUBJECTS AND METHODS: A Cross-sectional study with patients and controls was conducted. The diagnosis of gastroesophageal reflux was based of clinical plus radiological, endoscopic or pathologic criteria. A structured questionnaire was built, containing items covering different clinical manifestations of gastroesophageal reflux disease. All subjects were subjected to 24 h esophageal pH monitoring. Internal consistency of items, interobserver reliability, criterion and construct validity, sensitivity, specificity and predicted values were obtained. RESULTS: One hundred thirteen subjects (74 female and 39 male with a mean age of 46 years old) were studied. Seventy three had gastroesophageal reflux and 40 were controls. Internal consistency of the score was 0.82. Inter observer reliability was greater than 0.80 and a significant association was observed between the score and 24 h esophageal pH monitoring (p < 0.001). Instrument sensitivity was 97% and specificity 83%. CONCLUSIONS: The designed scale proved to be a valid and reliable instrument to measure gastroesophageal reflux symptoms, that can be used for future prevalence studies.

Adult↗

Reliability and validity of an instrument to measure maternal health beliefs.

Noncompliance with recommended preventive pediatric care continues to be a major problem, especially in inner-city pediatric clinics. There has been little evaluation of the maternal beliefs that are associated with such noncompliance, perhaps because there are no instruments which have been assessed for reliability and validity. To evaluate the internal consistency and construct validity of a maternal health belief instrument, we interviewed 500 mothers of healthy full-term newborns postpartum. Forty-eight items measured the maternal health beliefs, according to Health Belief Model constructs (perceived susceptibility, perceived severity, perceived benefits of medical care, perceived barriers, and health motivation). Construct validity was assessed by principal components factor analysis. Eight internally consistent indices emerged, including illnesses having high and low perceived susceptibility, and low and moderate perceived benefit. Logistical access barriers and economic access barriers were also distinct. Perceived severity and health motivation formed single indices. This maternal health belief instrument was internally consistent in the study sample and showed evidence of construct validity. These indices may make important independent contributions to understanding variation in preventive well-child care utilization.

Adult↗

Examination of movement in patients with long-lasting musculoskeletal pain: reliability and validity.

BACKGROUND AND PURPOSE: An examination method based on psychosomatic physiotherapy, with 24 standardized tests related to general aspects of mobility, flexibility and the ability to relax, is used in some pain and rehabilitation clinics in Scandinavia in order to document where--and to what degree--patients have aberrations within the domain 'movement'. The measurement properties of the movement tests have, however, not been investigated in patients with long-lasting musculoskeletal pain. The aims of the present study were, therefore, to investigate inter-tester reliability and validity (construct, discriminative and concurrent validity) related to movement. METHOD: The study design was cross-sectional. Reliability was examined by three physiotherapists examining 19 people. Construct validity was studied by means of structural equation modelling (SEM). Discriminative validity was examined by comparing movement data from 247 patients with long-lasting musculoskeletal pain, and 104 healthy subjects. The patient sample was categorized according to localized or widespread pain, and movement scores compared between the groups. Most patients filled in a psychological screening questionnaire (MMPI-2), plus information about pain intensity and function, and concurrent validity of the movement measures were examined by correlation. RESULTS: SEM results indicated a modified movement scale, consisting of 16 items in four subscales. Both the original and modified versions showed good reliability, and scores differed significantly between healthy subjects and patients, and between patients with localized versus widespread pain. A relationship was found between the movement tests and psychological characteristics, but mainly in patients with widespread pain. Significant relationships were found between the ability to relax and pain, and between all aspects of movement and function. CONCLUSIONS: Movement may be reliably and validly assessed with composite scores from 4 x 4 items. The method may be useful as a global screening instrument in order to examine where, and to what extent, patients with long-lasting pain problems have movement aberrations; findings to be addressed in treatment.

Adult↗

Reliability of the Thai-modified Function Living Index Cancer questionnaire version 2 (T-FLIC 2) for the evaluation of quality of life in non-small cell lung cancer patients.

Quality of life is an important measurement of medical outcome. The objective of the present study was to determine the reliability and validity of the Thai-Modified Function Living Index Cancer questionnaire version 2 (T-FLIC 2) in Non-Small Cell Lung Cancer (NSCLC) patients. The FLIC was developed into Thai version 2 and applied to a sample of 36 in-patients with NSCLC. Reliability was assessed by internal consistency using the Cronbach's alpha statistic, and validity was checked by construct validity using the factor analysis statistic. Cronbach's alpha coefficient, equal to 0.8710, showed good reliability. A factor analysis was conducted to examine construct validity. It revealed a 5-factor solution accounting for 58.075 percent of the variance. In conclusion, the T-FLIC 2 is a reliable and valid measurement of the quality of life in NSCLC patients and can be used in clinical trials, studies of outcome and research in oncology.

Adult↗

Spanish version of the Health Assessment Questionnaire: reliability, validity and transcultural equivalency. Grupo para la Adaptación del HAQ a la Población Española.

OBJECTIVE: To study the feasibility, reliability, and validity, of a Spanish European version of the Health Assessment Questionnaire (SHAQ). METHODS: A total of 170 patients with rheumatoid arthritis (RA) from 11 public general hospitals in Spain were included. We studied (a) the feasibility of the SHAQ by finding the proportion of patients able to self-administer it and the time they take to do so; (b) the test-retest reliability of the SHAQ when completed twice, with an interval of one week, calculating the Pearson correlation coefficient (r) between the first and second SHAQ scores; (c) the criterion validity of the SHAQ by comparing the clinician's assessment of the patient's activities (observed disability) with the scores noted by the patient in the questionnaire (referred disability); (d) cross sectional construct validity comparing the scores of the SHAQ with the other tests used in the assessment of RA; and (e) the longitudinal construct validity of the SHAQ comparing the difference between the initial and final SHAQ scores with the patient rating of improvement or worsening after a 3-month followup. RESULTS: The SHAQ was self-administered by 63% of patients, the rest needed the presence of an interviewer. The time taken to complete the questionnaire was 6.4 min. Test-retest reliability (r = 0.89), criterion validity (r = 0.87), cross sectional construct validity, and longitudinal construct validity were satisfactory and similar to other HAQ versions used in different countries. CONCLUSION: The SHAQ is a reliable, valid tool, but for use in Spain an interviewer may be necessary.

Activities of Daily Living↗

Development and psychometric evaluation of the Benzodiazepine Craving Questionnaire.

AIM: To assess the scalability, reliability and validity of a newly constructed self-report questionnaire on craving for benzodiazepines (BZs), the Benzodiazepine Craving Questionnaire (BCQ). SETTING AND PARTICIPANTS: The BCQ was administered once to a sample of 113 long-term and 80 former long-term general practice BZ users participating in a large BZ reduction trial in general practice. MEASUREMENTS: (1) Unidimensionality of the BCQ was tested by means of the Rasch model. (2) The Rasch-homogeneous BCQ items were assessed for subject and item discriminability. (3) Discriminative and construct validity were assessed. FINDINGS: The BCQ met the requirements for Rasch homogeneity, i.e. BZ craving as assessed by the scale can be regarded as a unidimensional construct. Subject and item discriminability were good. Construct validity was modest. Highest significant associations were found with POMS depression (Kendall's tau-c = 0.15) and Dutch Shortened MMPI negativism (Kendall's tau-c = 0.14). Discriminative validity was satisfactory. Highest discriminative power was found for a subset of eight items (Mann-Whitney U Z = - 3.6, P = 0.000). The first signs of craving are represented by the acknowledgement of expectations of positive outcome, whereas high craving is characterized by direct intention to use. CONCLUSIONS: The BCQ proved to be a reliable and psychometrically sound self-report instrument to assess BZ craving in a general practice sample of long-term BZ users.

Aged↗

The multidimensional inventory of dissociation (MID): A comprehensive measure of pathological dissociation.

This article describes the development and validation of the Multidimensional Inventory of Dissociation (MID). The MID is a 218-item, self-administered, multiscale instrument that comprehensively assesses the phenomenological domain of pathological dissociation and diagnoses the dissociative disorders. The MID measures 14 major facets of pathological dissociation; it has 23 dissociation diagnostic scales that simultaneously operationalize (1) the subjective/ phenomenological domain of pathological dissociation and (2) the hypothesized dissociative symptoms of dissociative identity disorder (Dell, 2001a). The MID was designed for clinical research and for diagnostic assessment of patients who present with a mixture of dissociative, posttraumatic, and borderline symptoms. The MID demonstrated internal reliability, temporal stability, convergent validity, discriminant validity, and construct validity. The MID also exhibited incremental validity over the Dissociative Experiences Scale (DES) by predicting an additional 18% of the variance in weighted abuse scores on the Traumatic Experiences Questionnaire (TEQ). Confirmatory factor analysis (CFA) did not support a one-factor model of the MID's clinical scales (i.e., the 14 facets and the 23 diagnostic symptoms). In contrast, however, CFA of the MID's factor scales (Dell & Lawson, 2005) has strongly supported a one-factor model. It was concluded that both the MID's 168 dissociation items and the construct of pathological dissociation have a second-order, unifactorial structure.

Adult↗

The Delirium Observation Screening Scale: a screening instrument for delirium.

The Delirium Observation Screening (DOS) scale, a 25-item scale, was developed to facilitate early recognition of delirium, according to the Diagnostic and Statistical Manual-IV criteria, based on nurses' observations during regular care. The scale was tested for content validity by a group of seven experts in the field of delirium. Internal consistency, predictive validity, and concurrent and construct validity were tested in two prospective studies with high risk groups of patients: geriatric medicine patients and elderly hip fracture patients. Among the patients admitted to a geriatric department (N = 82), 4 became delirious; among the elderly hip fracture patients (N = 92), 18 became delirious. The DOS scale was determined to be content valid and showed high internal consistency, alpha = 0.93 and alpha = 0.96. Predictive validity against the Diagnostic and Statistical Manual-IV diagnosis of delirium made by a geriatrician was good in both studies. Correlations of the DOS scale with the Mini Mental State Examination (MMSE) were Rs -0.79 (p < or = 0.001) in the hip fracture patients and Rs -0.66 (p < or = 0.001) in the geriatric medicine patients. Concurrent validity, as tested by comparison of the research nurse's ratings of the DOS scale and the Confusion Assessment Method (CAM), for the group of hip fracture patients was 0.63 (p < or = 0.001). Construct validity of the DOS was tested against the Informant Questionnaire of Cognitive Decline in Elderly (IQCODE), a preexisting psychiatric diagnosis and the Barthel Index. Correlation with the IQCODE was 0.74 (p < or = 0.001) in the study with the hip fracture patients and 0.33 (p < or = 0.05) in the study with the geriatric medicine patients. Correlation with the Barthel Index was -0.26 (p < or = 0.05) in the geriatric medicine patients and -0.55 (p < or = 0.001) in the hip fracture patients. The overall conclusion of these studies is that the DOS scale shows satisfactory validity and reliability, to guide early recognition of delirium by nurses' observation.

Activities of Daily Living↗

The reliability and validity of the Chinese version of the caregiver burden inventory.

BACKGROUND: The assessment of burden has become a challenging task for most researchers because cultural, ethical, religious, and other personal values may influence perceptions of the meaning and consequences of burden. The lack of examination of the psychometric properties of the burden measures across studies limits the scientific rigor for generating additional research into "burden." OBJECTIVE: To examine the psychometric properties of the Chinese version of the Caregiver Burden Inventory for its utility in clinical and research practice. METHOD: The first investigation evaluated the consistency between the Chinese and English versions of the Caregiver Burden Inventory. The second investigation established the internal consistent reliability, test-retest reliability, content validity, concurrent validity, and construct validity. RESULTS: A paired -test and intra-class correlation indicated that the Chinese version of the Caregiver Burden Inventory was a very good reflection of the English version and demonstrated item equivalence. It also showed adequate internal consistency reliability, appropriate content validity, and concurrent validity. Factor analysis revealed moderate intercorrelations between subscales and high factor loadings also helped to clarify the psychometric meaning. DISCUSSION: The reliability and validity information presented in this paper support using the Chinese version of the Caregiver Burden Inventory as a research instrument in measuring the caregiver burden in the Chinese population. Further study is needed to discriminate the developmental, emotional, and social burden constructs.

Activities of Daily Living↗

Validation of a checklist to assess ward round performance in internal medicine.

BACKGROUND: Ward rounds are an essential responsibility for doctors in hospital settings. Tools for guiding and assessing trainees' performance of ward rounds are needed. A checklist was developed for that purpose for use with trainees in internal medicine. OBJECTIVE: To assess the content and construct validity of the task-specific checklist. METHODS: To determine content validity, a questionnaire was mailed to 295 internists. They were requested to give their opinion on the relevance of each item included on the checklist and to indicate the comprehensiveness of the checklist. To determine construct validity, an observer assessed 4 groups of doctors during performance of a complete ward round (n = 32). The nurse who accompanied the doctor on rounds made a global assessment of the performance. RESULTS: The response rate to the questionnaire was 80.7%. The respondents found that all 10 items on the checklist were relevant to ward round performance and that the item collection was comprehensive. Checklist mean-item scores differed between levels of expertise: junior house officers 1.4 (1.0-1.9); senior house officers 2.0 (1.5-2.9); specialist trainees 2.5 (1.8-2.8), and specialists 2.7 (2.3-3.5); median (range) (P < 0.001). A significant correlation was found between global observer scores and nurse scores (r = 0.56, P < 0.001). CONCLUSION: The checklist, developed for assessing trainees' performance of ward rounds in internal medicine, showed high content validity. Construct validity was supported by the higher scores of experienced doctors compared to those with less experience and the significant correlation between the observer's and nurses' global scores. The developed checklist should be valuable in guiding and assessing trainees on ward round performance.

Clinical Competence↗

Reliability and validity of the objective structured clinical examination in assessing surgical residents.

The purpose of this research was to assess reliability and construct validity of the objective structured clinical examination (OSCE) for evaluating the clinical skills of surgical residents. Reliability refers to precision of the examination and construct validity to the degree to which the examination can discriminate between different levels of training. Twenty-seven second postgraduate year surgical residents took a 38-station OSCE representing seven surgical specialties and that tested history-taking, physical examination, problem-solving, technical skills, and attitudes. A couplet methodology was used wherein a patient encounter was followed by written questions aimed at testing problem-solving and patient management capabilities. Thirty-six standardized patients were trained and 36 surgeons served as examiners marking from structured checklists. Overall reliability, Cronbach's alpha, was 0.89. Construct validity was examined by comparing the scores of the residents with those of a group of graduates of foreign medical schools applying for a "pre-internship" program. For 17 of 19 stations that both groups took, the residents performed significantly better (p less than 0.01). Individual station validity was significant for 32 of 38 stations (r = 0.36 to 0.82, p less than 0.05). The examinations took 3.83 hours at a cost of $5,293 (Canadian dollars). The OSCE has been shown to be a reliable method of assessing clinical skills of surgical residents, construct validity has been established, and inter-item validity confirmed. Reliabilities achieved exceed those traditionally required for both acceptance and promotion decisions.

Analysis of Variance↗

Adaptation and validation of the Turkish version of the Rheumatoid Arthritis Quality of Life Scale.

OBJECTIVE: The aim of this study was to adapt the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Turkey and to test its reliability and validity. METHODS: The translation process included the recent guidelines for cross-cultural adaptation. Reliability of the Turkish RAQoL was assessed by internal consistency and test-retest reliability, internal construct validity by Rasch analysis, and external construct validity by associations with impairments, disability, and general health status. Cross-cultural validity was tested through analysis of differential item functioning (DIF) by comparison with data from the UK version of the RAQoL. RESULTS: Reliability of the adapted version was good, with high internal consistency (Cronbach's alpha 0.95 and 0.96 at times 1 and 2, respectively) and test-retest reliability (Spearman's rho 0.874). Internal construct validity was confirmed by excellent fit to the Rasch model (mean item fit 0.236, SD 1.113) and external construct validity by expected associations. The DIF for culture was found in four items. CONCLUSIONS: Adaptation of the RAQoL for use in Turkey was successful. The instrument can be used in both national and international studies for cross-cultural comparison with the UK, as long as adjustments are made for the few items displaying DIF for culture.

Aged↗

Patient-assessed health outcome measures for diabetes: a structured review.

AIMS: To identify available disease-specific measures of health-related quality of life (HRQL) for diabetes and to review evidence for the reliability, validity and responsiveness of instruments. METHODS: Systematic searches were used to identify instruments. Instruments were assessed against predefined inclusion and exclusion criteria. Letters were sent to authors requesting details of further instrument evaluation. Information relating to instrument content, patients, reliability, validity and responsiveness to change was extracted from published papers. RESULTS: The search produced 252 references. Nine instruments met the inclusion criteria: Appraisal of Diabetes Scale (ADS), Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP-1, DHP-18), Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Measure (DQOL), Diabetes-Specific Quality of Life Scale (DSQOLS), Questionnaire on Stress in Diabetic Patients-Revised (QSD-R), Diabetes-39 (D-39) and Well-being Enquiry for Diabetics (WED). The shortest instrument (ADS) has seven items and the longest (WED) has 50 items. The ADS and ADDQoL are single-index measures. The seven multidimensional instruments have dimensions covering psychological well-being and social functioning but vary in the remainder of their content. The DHP-1 and DSQOLS are specific to Type 1 diabetes patients. The DHP-18 is specific to Type 2 diabetes patients. The DIMS and DQOL have weaker evidence for reliability and internal construct validity. Patients contributed to the content of the ADDQoL, DHP-1/18, DQOL, DSQOLS, D-39, QSD-R and WED. The authors of the ADDQoL, DHP-1/18, DQOL, DSQOLS gave explicit consideration to content validity. The construct validity of instruments was assessed through comparisons with instruments measuring related constructs and clinical and sociodemographic variables. None of the instruments has been formally assessed for responsiveness to changes in health. CONCLUSIONS: Five of the diabetes-specific instruments have good evidence for reliability and internal and external construct validity: the ADDQoL, DHP-1/18, DSQOLS, D-39 and QSD-R. Instrument content should be assessed for relevance before application. The instruments should be evaluated concurrently for validity and responsiveness to important changes in health.

Diabetes Mellitus↗

The measurement of aggression and violence in hospitalized psychiatric patients.

Aggression and violence are significant clinical problems in psychiatric inpatient units. However, research exploring violent behavior is limited by the lack of an adequate research scale. This paper reports on the development and testing of the Violence Scale (VS), a behavioral rating scale which measures aggressive and violent behavior towards self, others and property. The VS has been tested in two studies of psychiatric inpatients (N = 162) and (N = 42). Tests of reliability included internal consistency, item analysis and stability. Tests of validity included content and construct validity. The psychometric results were evaluated through the application of standard statistical criteria [Carmines, E. G. and Zeller, R. A. (1979). Reliability and Validity Assessment. Sage University Press, Beverly Hills, CA; Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16, 197-333; Nunnally J. (1978). Psychometric Theory, McGraw-Hill, New York]. Coefficient alpha was 0.91 (study 1) and 0.68 (study 2) and stability was r = 0.79 (study 1). The items met most of the established criteria for item analysis and internal consistency. In factor analysis, the items met the criteria for loading onto the three predicted factors (others, self and property). Results of predictive model testing indicated that three of the four predicted relationships were supported. Initial testing indicates the scale is moderately stable, is internally consistent, and has evidence of initial limited construct validity.

Adult↗