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Parent- and patient-validated content for pediatric epilepsy quality-of-life assessment.

PURPOSE: The purpose of this study was to assess the parent-and patient-validated content of quality-of-life measurement for use in children with epilepsy. METHODS: We asked the parents of 80 consecutive children and adolescents with epilepsy to list in order of importance their concerns about living with or caring for their children with epilepsy. Patients were 3 months to 18 years of age (mean, 10 years) and identified at the outpatient clinic or during hospital stay. To minimize investigator bias, parents and children listed their concerns in a private setting without staff involvement. RESULTS: Twenty-six distinct domains were generated by the parents and children. Concerns listed by more than 20 of parents included medication adverse effects (58), cognitive effects of epilepsy (46), prospects for the future (41), safety (35), independence (31), and brain damage caused by seizures (30). Concerns ranked by parents as most important included safety (18), brain damage from seizures (12), enigma of epilepsy (12), cognitive effects of epilepsy (11), and prospects for the future (10). Concerns listed by more than 20 of children included social problems (35), cognitive effects of epilepsy (29), driving (29), sports (27), medication adverse effects (25), and schooling (21). Concerns ranked by children as most important included issues related to medication adverse effects (13), cognitive effects of epilepsy (10), hatred of epilepsy (8), social embarrassment (6), fear of seizures (6), injury (6), and dislike of hospital visits (6). CONCLUSION: The effect of epilepsy on health-related quality of life in pediatric patients is defined by a limited number of domains. A 20-item inventory was chosen from the 26 domains generated by the parents and children. Our study provides insight into parents' and children's perception of seizures and the impact of epilepsy on everyday life.

Adolescent↗

Content validity of the Psychiatric Symptom Index, CES-depression Scale, and State-Trait Anxiety Inventory from the perspective of DSM-IV.

We compared the item content of three commonly used scales of psychiatric symptoms [the broad-band Psychiatric Symptom Index (Ilfeld) and two narrow-band scales, the Center for Epidemiologic Studies-Depression Scale (Radloff) and the State-Trait Anxiety Inventory (Spielberger)], with diagnostic criteria and criterion-based symptoms for Major Depressive Episode and Generalized Anxiety Disorder as they appeared in DSM-IV. The Psychiatric Symptom Index and the Center for Epidemiologic Studies-Depression Scale each measured 7 of 9 criterion-based symptoms of Major Depressive Episode. The Psychiatric Symptom Index and State-Trait Anxiety Inventory each measured 5 of 8 domains for Generalized Anxiety Disorder. The Psychiatric Symptom Index had comparable content validity to the narrow-band measures. All met a majority of DSM-IV criteria for depression and anxiety, supporting their applicability for current research.

Adult↗

Maintaining Content Validity in Computerized Adaptive Testing.

A major advantage of using computerized adaptive testing (CAT) is improved measurement efficiency; better score reliability or mastery decisions can result from targeting item selections to the abilities of examinees. However, this type of engineering solution can result in differential content for different examinees at various levels of ability. This paper empirically demonstrates some of the trade-offs which can occur when content balancing is imposed in CAT forms or conversely, when it is ignored. That is, the content validity of a CAT form can actually change across a score scale when content balancing is ignored. On the other hand, efficiency and score precision can be severely reduced by over specifying content restrictions in a CAT form. The results from two simulation studies are presented as a means of highlighting some of the trade-offs that could occur between content and statistical considerations in CAT form assembly.

Journal Article↗

The caring dimensions inventory (CDI): content validity, reliability and scaling.

Caring is an elusive phenomenon but this should not prevent the development and validation of reliable quantitative tools for studying this concept in large samples of nurses. The present paper reports on the content analysis of a questionnaire called the Caring Dimensions Inventory (CDI). The CDI was content validated in terms of existing conceptualizations of caring and research in this area and also in terms of a nursing taxonomy and its representation in popular United Kingdom nursing publications. The CDI was administered to a large sample of nurses working in Scotland and data were obtained from 1430 qualified and student nurses. The internal consistency of the CDI items related to perceptions of caring was established and the scalability of a sub-set of CDI items was demonstrated. The CDI scale was related to the constructs of age and sex of respondents. Possibilities for further analysis and development of the CDI are discussed.

Age Factors↗

Content validation of key features on a national examination of clinical decision-making skills.

Key features (KFs) represent the critical, or essential, steps in the identification and management of a clinical problem. KFs for 59 clinical problems were defined by members of a test committee for the Medical Council of Canada as part of their efforts to create a more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. In order to evaluate the content validity of KFs that the test committee had defined for the examination, 99 physicians from outside the committee, who came from clerkship programs at all 16 of Canada's medical schools, participated in three studies conducted in 1991. The first study was retrospective and was designed to find the degree of agreement or disagreement that the outside physicians had with the KFs already defined for each problem by the committee members. The second study was prospective and was to compare the KFs generated de novo by the participants with those already defined by the committee members. The third study was to gather the outside physicians' opinions of the frequencies with which graduating students in Canada are exposed to the 59 problems used in the retrospective and prospective studies. Almost all the KFs defined by the test committee were corroborated by the outside physicians, 92% in the retrospective study and 94% in the prospective one.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Content validity, face validity and comprehensiveness of generic quality-of-life measures in adults and children with rare genetic conditions and their carers: a think aloud qualitative study.

PURPOSE: This study aims to assess the content validity, face validity and comprehensiveness of the: (a) EQ-5D-5L, EQ-HWB, and ASCOT SCT4, for adults with rare genetic conditions; (b) the EQ-5D-5L, EQ-HWB, and ASCOT-carer for carers of adults or children with rare genetic conditions; and (c) the EQ-5D-Y-5L carer proxy-complete for children with rare genetic conditions. METHODS: In total, 60 qualitative think-aloud interviews were conducted in Australia and England to understand individuals' thought process during the completion of the QoL measures. Participants were subsequently led through a semi-structured discussion. Transcripts were analysed for whether participants demonstrated understanding of the measures and thematic analysis was conducted on responses to the semi-structured discussion. RESULTS: The majority of participants showed good understanding and supported the validity of the measures for people experiencing rare conditions. For carers, however, a broader evaluative space than health-related QoL was preferred. Several non-health domains were identified as important to both patients and carers, including treatment availability, impact on employment and finance, information and uncertainty, medication and carer burden, impact of passing on a condition, relationships and social connection, and experience with the healthcare system. CONCLUSION: This study provides some support for the face validity and comprehensiveness of the measures for people experiencing rare conditions. However, several participants felt that the narrow health domains were inadequate to capture the breadth of their lived experience. Future research should explore the extent to which the measures capture differences and changes in the QoL domains identified as important to patients and carers.

Humans↗

Cultural and ethnic differences in content validation responses.

Eight instruments to evaluate grant interventions aimed at increasing recruitment and retention of Hispanic/Latino and American Indian nurses were developed for a Nursing Workforce Diversity Grant. This article compares expert reviewer responses during content validation of these instruments with (a) current literature and (b) seven filmed intervals of Hispanic/Latino and American Indian nurses speaking about their educational experiences. White reviewers responded differently to certain items than did Hispanic/Latino and American Indian reviewers (or reviewers closely affiliated with such persons). Responses of Hispanic/Latino and American Indian experts were aligned with one another but not aligned with the responses of White experts, who also agreed with one another, prompting literature and film comparisons with their responses. Faculty development may be needed to help teachers uncover their assumptions about students of color, acquire knowledge about cultural perspectives, recognize institutional racism, and attain the skills necessary to develop and implement a curriculum of inclusion.

Attitude of Health Personnel↗

The high-level mobility assessment tool (HiMAT) for traumatic brain injury. Part 2: content validity and discriminability.

PRIMARY OBJECTIVES: (i) To assess the measurement properties of the high-level mobility assessment tool (HiMAT) for people with traumatic brain injury (TBI), (ii) to measure the extent to which the HiMAT is a uni-dimensional, discriminative hierarchical outcome scale. RESEARCH DESIGN: The content validity was assessed using a three-stage process of investigating internal consistency, factor analysis and Rasch analysis. The uni-dimensionality of the HiMAT items was also tested. Discriminability was investigated by correlating raw and logit scores obtained from Rasch analysis. The study was conducted at a major rehabilitation facility using a convenience sample of 103 adults with TBI. MAIN OUTCOMES AND RESULTS: The internal consistency for the high-level items was very high (Cronbach's alpha = 0.99). Principal axis factoring identified several balance items as belonging to a second factor not related to high-level mobility, hence these items were excluded. Rasch analysis identified several misfitting items, such as walking around a figure of eight and stopping from a run, which were also excluded. Logit scores were used to exclude clustered and, therefore, redundant items. Raw scores correlated very highly (r = 0.98) with logit scores, indicating that raw scores provided good discriminability and were suitable for use by clinicians. CONCLUSION: The HiMAT, which assesses higher-level mobility requirements of people with TBI for return to pre-accident social, leisure and sporting activities, is a uni-dimensional and discriminative scale for quantifying therapy outcomes.

Adult↗

Content validation of standards of nursing care for the child with asthma.

Standards of nursing care for the child with asthma were developed utilizing outcome criteria to evaluate the patient's status. These standards were submitted to three experts in the field of pulmonary nursing to enable calculation of a content validity index (CVI). The experts also provided qualitative comments to improve clarity of the standards. The CVI for the standards was 0.85. The standards were revised to reflect the CVI and the qualitative comments by the three experts.

Asthma↗

Indicators of the appropriateness of long-term prescribing in general practice in the United Kingdom: consensus development, face and content validity, feasibility, and reliability.

OBJECTIVES: To develop valid, reliable indicators of the appropriateness of long-term prescribing in general practice medical records in the United Kingdom. DESIGN: A nominal group was used to identify potential indicators of appropriateness of prescribing. Their face and content validity were subsequently assessed in a two round Delphi exercise. Feasibility and reliability between raters were evaluated for the indicators for which consensus was reached and were suitable for application. PARTICIPANTS: The nominal group comprised a disciplinary mix of nine opinion leaders and prominent academics in the field of prescribing. The Delphi panel was composed of 100 general practitioners and 100 community pharmacists. RESULTS: The nominal group resulted in 20 items which were refined to produce 34 statements for the Delphi exercise. Consensus was reached on 30, from which 13 indicators suitable for application were produced. These were applied by two independent raters to the records of 49 purposively sampled patients in one general practice. Nine indicators showed acceptable reliability between raters. CONCLUSIONS: 9 indicators of prescribing appropriateness were produced suitable for application to the medical record of any patient on long term medication in United Kingdom general practice. Although the use of the medical record has limitations, this is currently the only available method to assess a patient's drug regimen in its entirety.

Data Collection↗

Content validity for dementia of three generic preference based health related quality of life instruments.

A semi-structured interview was conducted with dementia patients and their caregivers in order to explore which aspects of quality of life were perceived as relevant and important. These aspects of quality of life were compared with the content of three generic utility-based quality of life instruments: European Quality of Life Instrument, Health Utilities Index, and Quality of Well-Being (QWB) Scale. Twenty patients with mild dementia and 20 caregiver volunteers provided narrative data derived from interviews that were analyzed using a modified Grounded Theory method of analysis. Essential attributes of dementia quality of life identified by the respondents were missing in the three utility-based quality of life instruments selected for the study. Patients provided a wider range of attributes than the instruments including some attributes not described by caregivers. Of the three utility-based measures, the QWB scale included the largest number of quality of life attributes but still missed many. Compared to the respondent generated attributes all three utility-based quality of life instruments have important shortcomings in content validity.

Adult↗

Content validation on the Work Performance Rating Scale for sheltered workshop workers.

The purpose of this study was to revise the content of the Work Performance Rating Scale (WPRS) as a valid assessment tool for sheltered workshop workers. A focus group of 11 sheltered workshop workers was recruited to collect their opinions about the relevance of the WPRS from the service users' perspectives. A panel of 23 frontline practitioners who had experience in using various work assessment instruments provided at their work setting was recruited to review the content of the WPRS. A 14-item amended version of the WPRS with five new items added was proposed based on the opinions of service users, frontline practitioners, and the concept of the Minnesota Theory of Work Adjustment (MTWA). An expert panel of 12 professionals at the senior level from various vocational rehabilitation settings was recruited to comment on the content validity of the 14-item amended version of the WPRS. The expert panel agreed that the amended version of the WPRS was related to the concept of job satisfactoriness which could be used to assess the work performance of sheltered workshop workers. Thus, the use of the MTWA for improving the content validity of the WPRS to assess the employability of sheltered workshop workers was supported by the findings of the study.

Adult↗

Rating dysthymia: an assessment of the construct and content validity of the Cornell Dysthymia Rating Scale.

BACKGROUND: Mason et al. developed the Cornell Dysthymia Rating Scale (CDRS), a 20-item clinician-rated inventory, and hypothesized that it may be superior to the commonly-used Hamilton Depression Rating Scale (HDRS) in assessing the symptoms of dysthymia, a form of chronic depression. The purpose of this study was to compare these instruments in an outpatient sample of dysthymic patients. METHOD: The CDRS and the HDRS and other inventories (including the Hopkins Symptom Check List (SCL)) were administered to 110 patients meeting DSM-IIIR diagnosis of dysthymia. RESULTS: There was a significant correlation between the CDRS and the HDRS at baseline and termination, indicating concurrent validity. Distributional statistics were compared for baseline and termination severity scores, showing that the CDRS has greater severity range scores than the HDRS. Furthermore, results of the DSM-IV Mood Disorders Field Trial suggest that the CDRS has better content validity than the HDRS when it comes to the dysthymic population. LIMITATIONS: The results are limited by the use of a homogeneous sample, the absence of observer ratings of divergent symptoms, and less than excellent validity of self-report divergent symptoms. CONCLUSIONS: Our results support the value of the CDRS in assessing symptoms of dysthymia.

Adolescent↗

Reliability and content validity of a new instrument for assessment of communicative skills and language abilities in young Swedish children.

The Swedish Early Communicative Development Inventories (SECDI)--w&g (words and gestures; 8-16 months) and w&s (words and sentences; 16-28 months)--is a new instrument to assess communicative and language abilities in Swedish speaking children. Test-retest reliability and content validity of SECDI were examined. The results show that the SECDI covers common words in Swedish children's vocabulary and that its grammar scale (w&s) incorporates items that develop early among many children. Test-retest was analysed over 2 or 3 months, first for 57 and then for 60 children. Test-retest reliability scores are as follows: SECDI--w&g = between 0.70 and 0.90 in most age ranges; and SECDI--w&s = close to or above 0.90 on most measures.

Child Development↗

Modification of the EORTC QLQ-C30 (version 2.0) based on content validity and reliability testing in large samples of patients with cancer. The Study Group on Quality of Life of the EORTC and the Symptom Control and Quality of Life Committees of the NCI of Canada Clinical Trials Group.

A revision of the Quality of Life Questionnaire (QLQ-C30) of the European Organization for Research and Treatment of Cancer (EORTC) was undertaken to improve low internal consistency estimates (Cronbach's alpha) and content validity for the role functioning scale and a conceptual difficulty (undue emphasis on physical functioning) in the global quality of life (QOL) scale. The role functioning items were reworded and a four-category response format was substituted for the previous dichotomous format. A new item asking about 'overall health' was substituted for the 'overall physical condition' item in the global QOL domain. The original and new versions were tested at three time points in a total of 1,181 patients with cancer in Canada (n = 696) and the Netherlands (n = 485). In both samples there was a marked improvement in internal consistency for the role functioning scale (Cronbach's alpha s ranging from 0.78-0.88) in the new version. In the global QOL scale, the substitution of the new item for the previous one did not alter internal consistency (Cronbach's alpha's ranging from 0.81-0.92). The revised versions of the role functioning and global QOL domains have been incorporated into the QLQ-C30 (version 2.0).

Adult↗

[The internal consistency and content validity of the Spanish version of the Asthma Autonomy Questionnaire].

The Asthma Autonomy Questionnaire (AAQ) was designed to evaluate asthmatics' desire to learn about their disease and to make decisions. The AAQ consists of 26 items distributed in two scales: Preferences in the Search for Information (PSI, 8 items) and Preferences in Decision Making (PDM, 6 general items and 12 related to 3 scenarios depicting asthma in stable phase, during mild exacerbation and during severe exacerbation). The aim of this study was to analyze the internal consistency (Cronbach's-coefficient) and content validity (factorial analysis of principal components) of the AAQ. After translation and back translation, the Spanish version of the AAQ was administered to 115 adult asthmatics of both sexes and differing levels of severity. The alpha coefficients for the two scales and 3 scenarios ranged from 0.42 (PSI) to 0.73 (stable phase scenario); only for the stable-phase scenario were values high or statistically acceptable. Factorial analysis reproduced the content of the scales only approximately, with some items proving to relate to factors that were different from the scale they originally belonged to. These results indicate that, in its current formulation, the AAQ presents important measurement problems and revision is advisable.

Adult↗

Assessment of general practice consultations: content validity of a rating scale.

A rating scale for assessing clinical performance of trainee general practitioners was constructed based on a contemporary definition of knowledge, skills and attitudes necessary for competent general practice in Australia. The purpose of the rating scale is the provision of feedback to the trainee by both self-evaluation and evaluation by training supervisors. As part of a wider study into the use of videotaped genuine general practice consultations for teaching purposes, the content validity of the scale was examined by comparing the scale data with an open-ended rating form. The comparison resulted in six suggestions which might improve the precision of the instrument, and produce a compact practical scale suitable for the evaluation of general practice consultation.

Clinical Competence↗

Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients.

In this study, the psychometric properties of a quality of life scale, the WHOQOL-Bref, were examined in a population of 533 Dutch adult psychiatric outpatients. Participants underwent two semistructured interviews in order to obtain Axis-I and II diagnoses, according to DSM-IV. Besides the WHOQOL-Bref they also completed questionnaires for measuring psychopathological symptoms (SCL-90) and perceived social support (PSSS). Scores on 25 of the 26 questions of the WHOQOL-Bref had a good distribution. Similar to previous findings, exploratory factor analysis revealed a four-factor structure. A priori expected associations were found between the domains of the WHOQOL-Bref, on the one hand, and dimensions of the SCL-90 and the PSSS-score, on the other hand, indicating good construct validity. The internal consistency of the four domains of the WHOQOL-Bref ranged from 0.66 to 0.80. Domain scores of the WHOQOL-Bref correlated around 0.92 with the WHOQOL-100 domain scores. Relatively low correlations were found between demographic characteristics (age and sex) and WHOQOL-Bref domain scores. It is concluded that the content validity, construct validity, and the reliability of the WHOQOL-Bref in a population of adult Dutch psychiatric outpatients are good. The WHOQOL-Bref, therefore, is an adequate measure for assessing quality of life at the domain level in a population of adult psychiatric outpatients.

Adult↗