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PubMed1997

Development and testing of the Primary Health Care Questionnaire (PHCQ): results with students and faculty in diploma and degree nursing programs.

Primary health care (PHC) has been proposed as a key strategy for improving the health of the world community, and nurses are acknowledged as key health-care professionals in meeting this goal. Efforts to have nurses implement PHC policies presuppose that they are knowledgeable about this approach to health care and have positive attitudes. The underlying aim of this study was to develop a measure of knowledge, attitudes, and practices in PHC and to assess the reliability and validity of the measure with a sample of student nurses and faculty in degree and diploma programs. The Primary Health Care Questionnaire (PHCQ) is a three-part self-report measure that provides quantitative data on knowledge and attitudes and qualitative data on practices of PHC. The instrument was developed from a rigorous review of the literature and systematic feedback from two panels (local and national) expert in PHC. Data were collected from 457 students and faculty in one four-year degree program (three sites), one post-diploma degree program, and three diploma programs, in a western Canadian province. Internal consistency reliability estimates using Cronbach's alpha were .76 (knowledge) and .85 (attitudes). Test-retest reliability at two weeks was r = .67 (knowledge) and .76 (attitudes). Content validity was enhanced through a systematic review of the instrument by a two-phase local and a national expert panel. Findings indicated greater knowledge and more positive attitudes among senior compared to junior students, degree compared to diploma students, and faculty compared to students. These findings lend support to the validity of the measure. The qualitative data revealed that learning opportunities related to PHC were built into both the diploma and the degree program through classroom teaching, clinical practice, and written assignments.

Canada↗

PubMed1995

Reliability and validity of the Smoking and Women Questionnaire among three ethnic groups.

Cigarette smoking among women continues to be a major health risk to the smoker and to those around her. Programs aimed at stopping and maintaining smoking cessation have had very limited success due in part to the failure to individualize smoking cessation programs based on specific characteristics of the smoker. This study presents reliability and validity of a 14-item questionnaire developed to determine the readiness of women from three ethnic groups (non-Hispanic white, black American, and Hispanic American) to stop smoking. The Smoking and Women Questionnaire (SWQ) consists of items representative of core elements conceptualized in the Smoking/Ex-smoking Model for Women. The core factors are: beliefs/attitudes toward smoking, sociability, stress, coping, self-efficacy, motivation, nicotine dependence, and support. The SWQ was completed by both smoking and nonsmoking non-Hispanic white (N = 233), smoking and nonsmoking black American (N = 70), and smoking and nonsmoking Hispanic American (N = 73) women. The test-retest correlation coefficient over a one- to three-week period (N = 53) was .84. Cronbach alphas for whites, blacks, Hispanics, and combined groups were .81, .85, .84 and .83, respectively. Content validity was shown by experts who agreed that the core elements were represented in the SWQ. Construct validity was shown for ethnic groups separately and combined in that smokers had significantly lower SWQ scores than nonsmokers. Items representative of the core elements were rated by smokers in a similar manner irrespective of ethnicity, suggesting similar attitudes and behaviors toward smoking. Further research is needed to determine if the SWQ can predict readiness of women to stop smoking and serve as a basis for developing individualized smoking cessation programs. Implications for smoking cessation programs are reviewed.

Adolescent↗

PubMed1999

Underlying structure of the National Institutes of Health Stroke Scale: results of a factor analysis. NINDS tPA Stroke Trial Investigators.

BACKGROUND AND PURPOSE: No stroke scale has been validated as an outcome measure using data from a clinical trial demonstrating a positive therapeutic effect. Therefore, we proposed to use data from the National Institute of Neurological Disorders and Stroke (NINDS) tPA Stroke Trial to determine whether the National Institutes of Health Stroke Scale (NIHSS) was valid in patients treated with tissue plasminogen activator (tPA) and to explore the underlying clinimetric structure of the NIHSS. METHODS: We performed an exploratory factor analysis of NIHSS data from Part 1 (n=291) of the NINDS tPA Stroke Trial to derive a hypothesized underlying factor structure. We then performed a confirmatory factor analysis of this structure using NIHSS data from Part 2 of the same trial (n=333). We then tested whether this final factor structure could be found in tPA- and placebo-treated patients serially over time after stroke treatment. Using 3-month outcome data, we tested for an association between the NIHSS and other measures of stroke outcome. RESULTS: The exploratory analysis suggested that there were 2 factors underlying the NIHSS, representing left and right brain function, confirming the content validity of the scale. An alternative structure composed of 4 factors could be derived, with a better goodness of fit: the first 2 factors could represent left brain cortical and motor function, respectively, and the second 2 factors could represent right brain cortical and motor function, respectively. The same factor structures were then found in tPA and placebo patient groups studied serially over time, confirming the exploratory analysis. All 3-month clinical outcomes were associated with each other at subsequent time points, confirming predictive validity. CONCLUSIONS: This is the first study of the validity of a stroke scale in patients treated with effective stroke therapy. The NIHSS appeared to be valid in patients with acute stroke and for finding treatment-related differences. The scale was valid when used serially over time after stroke, up to 3 months, and showed good agreement with other measures of outcome.

Brain↗

PubMed2006

Made in the USA: the import of American Consumer Assessment of Health Plan Surveys (CAHPS) into the Dutch social insurance system.

BACKGROUND: In the Netherlands, managed competition between health plans has been introduced. For Dutch health plans this implies that they need to collect data about their own performance and that of the care providers they contract. To that end, Consumer Assessment of Health Plan Surveys (CAHPS) instruments have recently been adopted by a large Dutch health plan. OBJECTIVES: This paper presents the results of a validation study of the Dutch version of the CAHPS Adult Commercial questionnaire. The questions addressed are as follows: Can this questionnaire be adapted for use in the context of the Dutch insurance system? and Can it generate valid information about the quality of health care and the performance of Dutch health plans? METHODS: The translated questionnaire has been mailed to a sample of 977 enrollees. The psychometric properties of the translated instrument have been studied, and the results have been compared with those of other Dutch and American studies. RESULTS: The net response rate was 51% (n = 500). In general, the questionnaires were filled out completely and consistently. Principal component analyses revealed a factor that can be labelled as patient-centredness in the primary process. It contains the domains that in the CAHPS literature are described as 'courteous/helpful staff' and 'doctors communicating well'. CONCLUSIONS: The translated version of the CAHPS Adult Commercial questionnaire is a promising tool for Dutch health plans. More research is needed on the external and the content validity of these questionnaires in the Dutch context.

Adult↗

PubMedDate not supplied

Computerized content analysis of conversational interactions.

The emotional impact of illness sustained by patients, their families, and friends is increasingly recognized as an important dimension of clinical evaluation and intervention. This study first attempted to extend a computerized technique of measuring the magnitude of mental events from a content analysis of speech initially designed for use on single verbal samples or verbal texts to the analysis of conversational interactions. The study then applied this method of extended measurement to conversations concerning seriously ill surgical patients. The authors' objective was to develop a graphic method that illustrates the neuropsychological interchanges occurring in these conversations. Speech samples were recorded during discussions among nurses, surgeons, intensivists, and family members involved in the care and treatment of seriously ill patients hospitalized in the surgical intensive care unit at Barnes-Jewish Hospitals associated with Washington University School of Medicine, St. Louis, Missouri. These samples then were transcribed into computer-readable text files and divided into utterances: uninterrupted speech by a single individual. The utterances were assigned numeric scores by a computer program on each of 14 validated content analysis scales measuring various neuropsychological dimensions. The scores are presented graphically in chronological sequence to illustrate the emotional interactions in these conversations. The graphic representations depicting sequences of computerized content analysis-derived scores for the mental reactions of the speakers in such conversations provide insights into the psychodynamics occurring in such stressful situations.

Adaptation, Psychological↗

PubMed1996

Monitoring outcomes in routine practice: defining appropriate measurement criteria.

With the development of an internal market for health care, 'purchasing for outcomes' has become an important if somewhat rhetorical catchphrase. While there is emerging understanding about how it can be pursued, doubts are being expressed over an outcomes rather that a process emphasis. This debate has been confused by a failure to differentiate the role and importance of monitoring outcomes at an individual patient care level from those at an aggregate population/purchaser level. The clinical need to collect outcomes data on individual patient care within routine care settings places additional requirements on measurement development and selection. Traditional measurement criteria, stressing reliability, validity and responsiveness to change, must be supplemented by criteria of feasibility of use, clinical utility and acceptability. One option is to select domains or items of interest from longer instruments initially designed for research, carefully selected in relation to the purposes of measurement. Further measurement criteria must be addressed which stress the relevance of the proposed instrument to the condition and to the participants in the clinical interaction: in particular, patient-centredness and sensitivity to the setting. Monitoring the outcomes of individual patient care within routine clinical practice poses considerable challenges to researchers who are developing instruments and to clinicians who collect and use the data. A shift in emphasis is required towards more context-specific tests, addressing relevance to lay perceptions, to clinical use and to the condition and setting under review. The content validity, the responsiveness to patient-relevant and clinically relevant change and, of course, reliability must have greater primacy. In this way, outcome data which measure the quality of clinical practice and which provide appropriate criteria for research into effectiveness can be generated.

Clinical Medicine↗

PubMed2004

Motor capacities of upper limbs in tetraplegics: a new scale for the assessment of the results of functional surgery on upper limbs.

STUDY DESIGN: Metrological investigation. OBJECTIVES: To study the validity and the reliability of a Motor Capacities Scale (MCS) specifically designed for tetraplegics who undergo a functional surgery of upper limbs. SETTING: Bouffard-Vercelli Centre, Cerbere, France. METHODS: From diverse sources (observation of patients, review of literature, discussions with occupational therapists and physicians), we compiled a list of 300 activities relating to daily living tasks. From this list, 80 items of motor capacities were retained. They correspond to the abilities of a patient to perform basic and functional tasks regardless of contextual factors (environmental and personal factors). In a preliminary study, items were reviewed by occupational therapists and by 40 tetraplegics for criticism. An open study and an intermediate study were conducted to assess, respectively, the feasibility and the reliability of the MCS. A prefinal study was focused on construct validity. Convergent and divergent hypotheses were formulated and tested against other measures. Four criteria were identified for the elimination of some of the 36 remaining items: a variance of the item equal to 0, a low reproducibility, a high level of redundancy studied by item-to-item correlation and a low level of comprehension. RESULTS: In all, 52 tetraplegics were included in the prefinal study. Global inter-rater reproducibility was excellent (intraclass correlation coefficient of 0.99). In accordance with the criteria of elimination, the number of items was reduced to 31. Correlations with the Sollerman test and the Asia Motor Score were, respectively, 0.959 and 0.7444 (P<0.0001). Correlation with the interval since the onset of the tetraplegia and the educational level were, respectively, 0.20 and 0.195 (P=0.163). CONCLUSION: MCS displays a good apparent and content validity, and excellent reproducibility and construct validity. Metrological properties were good enough to allow the evaluation of sensitivity to change in the final study.

Adolescent↗

PubMed1996

Evaluating health-related quality of life in patients with facial acne: development of a self-administered questionnaire for clinical trials.

Although psychosocial aspects of skin diseases are well known, disease-specific questionnaires validated for use in clinical trials are not available to assess the impact of facial acne on health-related quality of life or to evaluate therapeutic change. Development of such an instrument was undertaken and included item generation, reduction and pilot-testing phases. By interviewing acne subjects and dermatologists and literature review, 168 possible items were identified. Next, 165 acne subjects identified which items affected them and rated importance on a 5-point scale. Reduction to a brief questionnaire was performed by evaluating patient-perceived importance and factor analysis; four domains were identified (self-perception, role-emotional, role-social, acne symptoms). After pilot-testing for comprehension in acne subjects, further revisions were made to improve clarity and applicability. The resulting instrument takes 10 minutes to complete, and consists of 24 questions assessing how acne affected certain aspects of patients' lives during the past week on a 7-point scale. Thus, an instrument with excellent content validity was developed to assess health-related quality of life in patients with facial acne, and is comprised of statistically meaningful items of importance to patients. Other measurement characteristics are being assessed in a recently initiated study to evaluate test-retest reliability and responsiveness to therapy.

Acne Vulgaris↗

PubMed1999

Self-perceived health in urban diabetic patients in Tanzania.

OBJECTIVES: To compare self-perceived health in a group of urban Tanzanian diabetic patients and the general population and to investigate validity of the Swahili version of the health questionnaire used. DESIGN: A health questionnaire and a symptom check list were filled in by diabetic patients after informed consent. The results were compared with data from the general population. SETTING: The study was carried out at the diabetes out-patient clinic at Muhimbili Medical Centre in Dar es Salaam, Tanzania. SUBJECTS: Adult diabetic patients (n = 518) with a mean diabetes duration of 5.5 years were consecutively included. Thirty one per cent of the patients were on insulin treatment. OUTCOME MEASURES: The Swahili version of a health questionnaire measuring eight health-domains and a check-list including 29 symptoms were used. RESULTS: Diabetic patients reported significantly poorer health when compared to the general population. Patients on insulin treatment reported poorer health than those on diet/oral treatment and those with less than ten years duration of diabetes had poorer self-perceived health than patients with shorter duration. Satisfactory concurrent and content validity of the Swahili version of the health questionnaire was found. All but the general health domain showed Cronbach's alpha levels exceeding .70. CONCLUSIONS: It is important to include validated health measures when assessing diabetes treatment and care. The health questionnaire used here was found to differentiate between diabetic patients and the general population. Underlying cultural factors might explain the unsatisfactory reliability of the general health domain.

Adult↗

PubMed2006

Is the childhood asthma questionnaire a good measure of health-related quality of life of asthmatic children in Asia?: validation among paediatric patients with asthma in Singapore.

BACKGROUND: Health-related quality of life (HR-QOL) is an important outcome in the treatment of chronic childhood diseases such as asthma. However, this measure is rarely used in young children in Asia because of the difficulty of obtaining valid, reliable instruments that are developmentally and culturally suitable. OBJECTIVES: To select, culturally adapt and validate a disease-specific HR-QOL questionnaire (Childhood Asthma Questionnaire [CAQ]-B) for asthmatic children aged 7-11 years in Singapore, and to understand the relationship between patient-reported HR-QOL domains and physician- or caregiver-rated severity. METHODS: A literature review was conducted to shortlist questionnaires based on pre-specified criteria. A pre-test was conducted to assess suitability and relevance of the questionnaires in Singapore. The selected questionnaire (CAQ-B) was then adapted to more closely reflect the local culture, climate, school system and terminology. Cross-sectional validation was conducted. All asthmatic patients aged 7-11 years attending the respiratory clinic in a paediatric hospital, and without co-morbidities that could significantly affect their HR-QOL, were invited to participate. Patients and their parents or caregivers were asked to complete the relevant sections of the questionnaire before their medical consultation. The child's severity of asthma was rated by the attending physician according to guidelines from the Singapore Ministry of Health. Correlations between the child-reported CAQ-B outcomes and clinical ratings of severity by both parents and physicians were investigated. Internal reliability was tested with Cronbach's alpha, and the overall questionnaire structure was explored using principal axis analysis with oblimin rotation and extraction for factors with Eigen values >1.0. RESULTS: The adapted CAQ-B was validated in 96 patients (40 girls and 56 boys) with a mean age of 8.7 +/- 1.1 years (range 7-11). Most children had no difficulty understanding and completing the questionnaire. The median time taken to complete a questionnaire was 10 minutes. Internal consistency of the various scales ranged from 0.29 to 0.76 (Cronbach's alpha) when items were analysed according to the UK or Australian scale structure. This increased to 0.57-0.76 after item reduction. Physician-rated severity only correlated significantly with the Active Quality of Living (AQOL) domain (r = -0.29, p = 0.02). However, parent/caregiver-rated severity correlated with three of four patient-reported domains: AQOL (r = -0.359, p = 0.001), Passive Quality Of Living (PQOL) [r = -0.271, p < 0.01] and severity (r = 0.367, p < 0.001). The AQOL domain was significantly correlated with the PQOL domain (r = 0.513, p = 0.005). CONCLUSIONS: The children and parents/caregivers in this study found CAQ-B to be a simple and acceptable questionnaire with some evidence of content validity. While two of the domains did not meet internal consistency standards expected of HR-QOL instruments for adults (Cronbach's alpha = 0.70), they were acceptable for children of this age. The patterns of correlation also suggest that parent/caregivers' perception of the severity of a young child's asthma may be a better indicator of a child's HR-QOL than clinical diagnosis of severity. However, further investigation is recommended to improve and validate the internal structure of the scale.

Adolescent↗

PubMed2004

Adapting the Lung Cancer Symptom Scale (LCSS) to mesothelioma: using the LCSS-Meso conceptual model for validation.

BACKGROUND: The underpinning conceptual model for the Lung Cancer Symptom Scale (LCSS), an instrument used to assess health-related quality of life in patients with lung cancer, has been described elsewhere. The patient-rated scale of the LCSS was modified slightly for patients with mesothelioma (LCSS-Meso), because no other mesothelioma-specific instrument was available. METHODS: In the current methodologic study, the authors tested the conceptual model for the LCSS-Meso. Chemotherapy-naive patients with unresectable malignant pleural mesothelioma who were participating in two clinical trials of pemetrexed (ALIMTA; Eli Lilly, Indianapolis, IN) completed the scale twice before the start of therapy and once weekly during the trials. Three time points were analyzed: baseline, Day 40, and Day 82. Poisson regression was used to determine the contribution of predictive factors (i.e., symptoms) to the summary items (symptom distress, activity level, and global quality of life). RESULTS: The model was tested in 495 patients who had malignant pleural mesothelioma. More than 85% of patients reported pain, dyspnea, fatigue, and appetite loss. Pain, dyspnea, and fatigue were significant and stable predictors for all summary items; however, pain had a significant effect on global quality of life only through Day 40. Appetite loss was a significant and stable predictor of activity level and global quality of life. The explained variance for the model was 39-55%. CONCLUSIONS: Further support for the content validity of the LCSS-Meso was obtained, as nearly all patients validated that the symptoms described in the scale captured their disease experience. The only exception was the hemoptysis item, which was removed based on the current large normative data set. Support for the construct validity of the LCSS-Meso also was obtained. For both mesothelioma and lung cancer, the majority of factors within the LCSS model are relevant and have the expected amount of variability. These findings support the use of the LCSS as a sensitive instrument for serial measurement during clinical trials involving patients with lung malignancies.

Adult↗

PubMed2003

Evidence for the Factorial and Construct Validity of a Self-Report Concussion Symptoms Scale.

OBJECTIVE: To evaluate the factorial and construct validity of the Head Injury Scale (HIS) among a sample of male and female collegiate athletes. DESIGN AND SETTING: Using a cross-sectional design, we established the factorial validity of the HIS scale with confirmatory factor analysis and the construct validity of the HIS with Pearson product moment correlation analyses. Using an experimental design, we compared scores on the HIS between concussed and nonconcussed groups with a 2 (groups) x 5 (time) mixed-model analysis of variance. SUBJECTS: Participants (N = 279) in the cross-sectional analyses were predominately male (n = 223) collegiate athletes with a mean age of 19.49 +/- 1.63 years. Participants (N = 33) in the experimental analyses were concussed (n = 17) and nonconcussed control (n = 16) collegiate athletes with a mean age of 19.76 +/- 1.49 years. MEASUREMENTS: All participants completed baseline measures for the 16-item HIS, neuropsychological testing battery, and posturography. Concussed individuals and paired controls were evaluated on days 1, 2, 3, and 10 postinjury on the same testing battery. RESULTS: Confirmatory factor analysis indicated that a theoretically derived, 3-factor model provided a good but not excellent fit to the 16-item HIS. Hence, the 16-item HIS was modified on the basis of substantive arguments about item-content validity. The subsequent analysis indicated that the 3-factor model provided an excellent fit to the modified 9-item HIS. The 3 factors were best described by a single second-order factor: concussion symptoms. Scores from the 16-item HIS and 9-item HIS were strongly correlated, but there were few significant correlations between HIS scores and scores from the neuropsychological and balance measures. A significant group-by-day interaction was noted on both the 9-item HIS and 16-item HIS, with significant differences seen between groups on days 1 and 2 postconcussion. CONCLUSIONS: We provide evidence for the factorial and construct validity of the HIS among collegiate athletes. This scale might aid in return-to-play decisions by physicians and athletic trainers.

Journal Article↗

PubMed2006

Initial linguistic and psychometric validation of the Arabic version of Nepean Dyspepsia Index.

OBJECTIVE: To report the initial evaluation of the linguistic and psychometric validation of the Nepean Dyspepsia Index (NDI), as part of the ongoing research of quality of life among dyspeptic patients. METHODS: The Arabic version of the NDI was administered to 158 subjects (54 with non-ulcer dyspeptic [NUD]), 50 with gastro-esophageal reflux disease (GERD) and 54 with no history of gastroenteritis disease), with a mean age of 46.6 and SD 10.7. All subjects answered the Arabic versions of the General Health Questionnaire (GHQ), the Self-Report Questionnaire (SRQ), and the Short Form-12 Quality of Life (QOL) scale. We administered the final translation of the NDI by consensus. The study was conducted in King Fahad Hospital of the University, Al-Khobar, Saudi Arabia, between December 2002 and January 2004. RESULTS: The NDI has shown adequate internal consistency. Cronbach Alpha coefficient ranged between 0.88 to 0.93, and Split-half correlation reliability ranged between 0.82 and 0.94. Correlations between NDI subscales and total scores were high and significant. Adequate Face and content validity was demonstrated by consultation with gastroenterologists and clinical psychologists. Convergent validity was shown in the moderate and significant correlation of the NDI subscales and global index with the indices of the SF-12. Divergent validity was shown in that subscales of the NDI revealed low correlation with scales which measure other dimensions; thus, both QOL subscales and symptom checklist have discriminated patients from non-patients groups (p > 0.01). The factorial structure of the NDI was also examined, and it revealed 4 factors, which is similarly the same with other studies. CONCLUSION: The initial validation of the Arabic version of the NDI has shown that this scale has adequate psychometric and linguistic property and can represent a good addition to health outcome measures in dyspepsia research. Further validation studies are recommended.

Dyspepsia↗

PubMed1993

[Reliability and validity of the Japanese version of the coping inventory for stressful situations (CISS): a contribution to the cross-cultural studies of coping].

OBJECTIVE: There has recently been a dramatic increase in the number of studies on coping behavior as an intervening variable between stress and health. Most of the available measures of coping are, however, psychometrically inadequate. We therefore decided to develop the Japanese version of the Coping Inventory for Stressful Situations (CISS) with special regards to its cross-cultural equivalence, reliability and validity. The CISS is a self-report measure of an individual's typical pattern of coping along three orthogonal dimensions of Task-, Emotion-, and Avoidance-oriented coping; its reliability and validity have been well studied in North America, where it was originally developed. METHOD: We obtained the Japanese version of the CISS (J-CISS) by means of back-translation. In Study 1, we administered the J-CISS and the 12-item General Health Questionnaire (GHQ) to 33 Japanese university students twice with an interval of four weeks. In Study 2,550 Japanese high school students completed the J-CISS and the Maudsley Personality Inventory. RESULTS: The equivalence of the Japanese version with the original was ascertained by means of back-translation involving multiple, independent mental health professionals and by factor congruence between the two versions. A principal component factor analysis (Varimax rotation) of the Study 2 data allowed us to extract three factors, which were virtually identical to the original ones. The high corrected item-remainder correlations, internal consistency reliabilities and test-retest reliabilities all attested to the reliability of the J-CISS. In order to examine its content validity, we compared the J-CISS with two coping questionnaires that have been in use in Japan, and found that the J-CISS covered most of the coping styles in these two questionnaires. However, such coping styles as "giving up," "to lose is to win (a Japanese proverb)," "it is best to do nothing" were not included in the original CISS and hence in the J-CISS. The criterion validity of the J-CISS was examined both in terms of predictive validity and concurrent validity. In Study 1, those who scored below the cut-off of the GHQ at Time 1 but above the cut-off at Time 2 had significantly higher Emotion-oriented coping scores at Time 1 than those who remained below the cut-off of the GHQ at Times 1 and 2 (predictive validity). In Study 2, the J-CISS scales and the MPI scales showed theoretically predicted correlations (concurrent validity). The results of the factor analysis and the corrected item-remainder correlations were suggestive of high construct validity of the J-CISS. Moreover, the mean inter-item correlation was between .20 and .40 for each scale, indicating its homogeneity. Factor analysis of each scale revealed that each scale indeed contained only one factor. Correlations among the three scales of the J-CISS established that the three scales formed multi-dimensional measures of coping. CONCLUSION: The results of our study indicate 1) that the obtained Japanese version of the CISS is to be regarded as final, 2) that coping styles can be measured in a consistent and reliable manner both in Japan and North America, and 3) that this cross-cultural equivalence as well as the other validity studies have further augmented the validity of the CISS itself.

Adaptation, Psychological↗

PubMed2005

Development of a psychometrically valid and reliable sports nutrition knowledge questionnaire.

The present range of sports nutrition knowledge questionnaires have inadequate psychometric validation, and few are up to date in a rapidly changing discipline. The purpose of this study was to design a sports nutrition questionnaire that satisfied acceptable psychometric criteria of validity (content and construct) and reliability (test-retest). The questionnaire was designed by an expert panel of six sports dietitians and distributed to five groups, selected for their expected variation in sports nutrition knowledge. Dietitians, university business staff and nutrition students received questionnaires via e-mail. The response rates obtained were 21.3% (n = 49), 34.4% (n = 33), and 72.0% (n = 18), respectively. University business and fitness students completed questionnaires during class time. Response rates were 52.3% (n = 23) and 75.4% (n = 49), respectively. The questionnaire was administered a second time to the business staff and the dietitians to assess test-retest reliability. Two methods were used: 1, Pearson's product-moment correlation; and 2, a percentage calculation of questions answered in an identical manner on both test occasions. Reliability was acceptable with Method 1 yielding acceptable values (r = 0.74-0.93), aside from the fluid sub-category (r = 0.52). Method 2 showed good test-retest concordance with 81.2% duplication of responses of all questions. Construct validity was high, as indicated by significant mean knowledge score differences between the groups (p = 0.0001). Dietitians and nutrition students achieved significantly greater mean scores than the remaining groups. The findings of this study indicate that the questionnaire is suitably valid and reliable to be used in research and practice to determine sports nutrition knowledge.

Dietetics↗

PubMedDate not supplied

Developing and testing instruments to measure client outcomes at the Comox Valley Nursing Center.

A Nursing Centre in Canada was initiated to demonstrate nursing practice in a primary health care context, unencumbered by conventional health care agency parameters. As one part of a multimethod evaluation, a 5 instrument client questionnaire was designed. The main instrument was developed by the researchers to measure the impact of the Centre and nurses' work from the perspective of clients. No established instrument could be found that was appropriate for the Centre's diverse client population and nature and variation in outcomes. To guide the development of the new instrument, minimally structured client interviews were conducted with 15 clients. To assess the validity and reliability of other selected instruments for the population, clients were asked to comment on the appropriateness of items. Based on findings, the Nurses' Work and Client Outcomes Questionnaire (NWCOQ) was developed, the Client Satisfaction Questionnaire and demographic questions modified, and a Cantril Self-Anchoring ladder to assess health status was supported for use. An open section was added to invite further description of clients' experiences, in particular, the unexpected, contrary or outstanding. Further pilot work was done and the refined five instrument questionnaire then was used to survey all clients who used the Centre during a seven month period. Findings from the NWCOQ revealed the nature of the nurses' work and the degree change occurred for clients on multiple health dimensions: physical, emotional, managing their situation, and group and community involvement. Clients were highly satisfied with the Centre and experienced many positive outcomes. The quantitative instruments and results were examined in relation to results from other data collection approaches and data sources. The NWCOQ has evidence of content validity and internal consistency reliability. The use of qualitative methods to develop and refine quantitative instruments for assessment of health outcomes for diverse client populations is highly recommended. This strategy is feasible even when outcome measurement timeframes are short.

British Columbia↗

PubMed2003

The development and preliminary validation of a Preference-Based Stroke Index (PBSI).

BACKGROUND: Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortunately, HRQL is often difficult to quantify in a comprehensive measure that can be used in cost analyses. Preference-based HRQL measures meet this challenge. To date, there are no existing preference-based HRQL measure for stroke that could be used as an outcome in clinical and economic studies of stroke. The aim of this study was to develop the first stroke-specific health index, the Preference-based Stroke Index (PBSI). METHODS: The PBSI includes 10 items; walking, climbing stairs, physical activities/sports, recreational activities, work, driving, speech, memory, coping and self-esteem. Each item has a 3-point response scale. Items known to be impacted by a stroke were selected. Scaling properties and preference-weights obtained from individuals with stroke and their caregivers were used to develop a cumulative score. RESULTS: Compared to the EQ-5D, the PBSI showed no ceiling effect in a high-functioning stroke population. Moderately high correlations were found between the physical function (r = 0.78), vitality (r = 0.67), social functioning (r = 0.64) scales of the SF-36 and the PBSI. The lowest correlation was with the role emotional scale of the SF-36 (r = 0.32). Our results indicated that the PBSI can differentiate patients by severity of stroke (p < 0.05) and level of functional independence (p < 0.0001). CONCLUSIONS: Content validity and preliminary evidence of construct validity has been demonstrated. Further work is needed to develop a multiattribute utility function to gather information on psychometric properties of the PBSI.

Aged↗

PubMed2001

Local perceptions of the mental health effects of the Rwandan genocide.

The objectives of this study were to investigate how Rwandans perceive the mental health effects of the 1994 genocide, to investigate the local validity of western mental illness concepts, and (if these concepts were found to be valid) to provide data to adapt existing mental health assessment instruments for local use. We used three ethnographic methods to interview people in two rural areas in Rwanda: first, free listing provided a list of local terms for mental symptoms and disorders; second, key informant interviews then provided more detailed information about these disorders; and finally, pile sorts confirmed the relationships among symptoms and disorders that emerged from the other methods. We found that interviewees described the diagnostic symptoms of depression and posttraumatic stress disorder as results of the genocide and also described associated "local" symptoms not included in the established diagnostic criteria. They divided symptoms into a "mental trauma" syndrome that included the posttraumatic stress disorder symptoms and some depression and local symptoms, and a grief syndrome that included other depression and local symptoms. In the pile sorts, we focused on investigating mood disorders and confirmed that four of the locally described symptoms formed part of a local depression-like illness. The results suggest that depression occurs among this population and support the local content validity of depression assessment instruments, such as the Depression section of the Hopkins Symptom Checklist. Similar independent evidence of validity is missing from most cross-cultural surveys. Our work supports the need and feasibility for collecting this supporting evidence prior to conducting cross-cultural surveys using existing instruments.

Anthropology, Cultural↗