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PubMed2004

Development of a scale to measure adolescents' beliefs and attitudes about postponing sexual initiation.

PURPOSE: To develop a scale to measure adolescent beliefs and attitudes about postponing sexual initiation (PSI). METHODS: A theory-based, 12-item scale measuring beliefs about PSI was developed and administered via a mailed questionnaire to those participants in an ongoing longitudinal cohort study of adolescents who had not yet initiated sexual intercourse. Internal consistency reliability, content validity, factorial validity, and construct validity were assessed using cross-sectional data. RESULTS: Mean age for boys was 14.4 (+/- 1.6) years and for girls 14.3 (+/-1.6) years (range 11 to 19 years), and 93% of respondents were white. The beliefs about PSI rated as most important by both girls and boys were concern about pregnancy and sexually transmitted infection. Cronbach alpha for the scale was 0.83 for girls and 0.88 for boys. Exploratory factor analysis demonstrated that the items loaded on four factors consistent with the theoretical basis of the model and confirmatory factor analysis demonstrated good fit of the overall model. The PSI scale score was associated with hypothesized sociodemographic, psychological, and behavioral variables, supporting construct validity of the scale. A higher score was associated with female gender; age < or = 14 years; higher global and social self-esteem; more frequent attendance at religious services; less peer pressure to have sexual intercourse; nonuse of alcohol, illicit drugs, and cigarettes; and no intention to initiate sexual intercourse in the next year. CONCLUSIONS: The PSI scale demonstrated satisfactory psychometric properties. Future research is needed to evaluate the utility of this scale in predicting sexual initiation and in interventions aimed at postponing sexual initiation.

Adolescent↗

PubMedDate not supplied

Assessing dysfunctional behaviors in long-term care.

OBJECTIVE: The Geriatric Level of Dysfunction Scale (GLDS) was developed to assess the intensity, frequency, and duration of 19 behavioral disturbance categories that can potentially interfere with long-term care. DESIGN: Secondary analysis of data collected from residents in long-term care facilities. PARTICIPANTS: Participants were 399 adults aged 60 and older residing in one of 16 long-term care facilities. RESULTS: The GLDS items were analyzed for reliability, content validity, and convergent and discriminant validity. The GLDS items were significantly correlated with items from the Geriatric Multidimensional Pain and Illness Inventory, Geriatric Depression Scale, Neurobehavioral Cognitive Status Examination, and the Psychosocial Resistance to Activities of Daily Living Index. CONCLUSIONS: The GLDS is evidenced to be a reliable and valid assessment tool for assessing dysfunctional behaviors of residents in long-term care facilities. Its brevity and clearly defined assessment criteria are assets to the administering clinician. Research on the utility of the GLDS as a treatment outcome instrument in long-term care is warranted. The potential for psychologists, physicians, social workers, and registered nurses to administer the GLDS in long-term care settings is discussed.

Activities of Daily Living↗

PubMed2006

Newborn screening for CF in a regional paediatric centre: the psychosocial effects of false-positive IRT results on parents.

Neonatal screening for cystic fibrosis (CF) has been established in Leeds since 1975. The current method is measuring IRT and genotyping. Newborn screening for CF results in a small but significant number of false positives. This study explored the psychosocial reactions to such results in a group of parents (N=21) using semi-structured interviews. Responses were analysed using descriptive statistics and well-validated content analysis. Mothers described a range of emotions during the screening process including anxiety, distress and upset. Waiting for the repeat IRT test results was identified as the most emotionally difficult stage. Discussion focuses on good practice and implications for CF services.

Adult↗

PubMed2005

A study compared nine patient-specific indices for musculoskeletal disorders.

BACKGROUND AND OBJECTIVE: Patient-specific quality of life indices show great potential, but certain conceptual and methodological concerns have yet to be fully addressed. The present study reviewed nine patient-specific instruments used in musculoskeletal disorders: the Canadian Occupational Performance Measure (COPM), Juvenile Arthritis Quality of life Questionnaire (JAQQ), McMaster-Toronto Arthritis questionnaire (MACTAR), Measure Yourself Medical Outcome Profile (MYMOP), Patient-Specific Index (PASI) for total hip arthroplasty, Problem Elicitation Technique (PET), Patient Generated Index (PGI) of quality of life, Patient-Specific Functional Scale (PSFS), and Schedule for the Evaluation of Individual Quality of Life (SEIQoL). STUDY DESIGN AND SETTING: Each tool was evaluated for purpose, content validity, face validity, feasibility, psychometric properties, and responsiveness. RESULTS: This critical appraisal revealed important differences in terms of the concept underlying these indices, the domains covered, the item-generation techniques and the scoring (response scale, methods) in each scale. The nine indices would generate different responses and likely scores for the same patient, despite the fact that they all include patient-generated items. CONCLUSION: Although the value of these indices in treatment planning and monitoring at an individual level is strong, more studies are needed to improve our understanding of how to interpret the numeric scores of patient-specific indices at both an individual and a group level.

Health Status Indicators↗

PubMed2005

Systematically reviewing qualitative studies complements survey design: an exploratory study of barriers to paediatric immunisations.

BACKGROUND AND OBJECTIVES: Designing survey questions requires content expertise, awareness of previous qualitative literature, and piloting. We examined surveys addressing parental barriers to vaccinating children to determine if they comprehensively included themes identified in published qualitative studies. METHODS: We performed a systematic literature search of 12 electronic databases and compared questions asked in eligible surveys identified to issues raised in qualitative studies. Issues included nine themes related to harm, six related to distrust, eight to issues of access, and three other issues. RESULTS: The 29 eligible surveys failed to adequately address several important themes identified in qualitative studies. The number that failed to address the following themes were as follows: beliefs that vaccines cause diseases (n = 26); painful (n = 25); distrust of medical community (n = 28); communication problems with staff (n = 25); memories of their own or others adverse experiences (n = 28); fear of long-term effects (n = 26); belief the medical community does not understand adverse events associated with vaccines (n = 28); and parent's own lack of knowledge about diseases (n = 29). CONCLUSIONS: Many surveys of parental barriers to immunization failed to address a number of important themes identified in qualitative studies. To the extent this is true in other areas, ensuring that investigators have conducted an adequate number and variety of qualitative studies, and systematically reviewing those studies, will improve surveys' content validity.

Attitude↗

PubMed2006

Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients.

BACKGROUND AND OBJECTIVES: To test the hypothesis that self-reported physical functioning is more influenced by pain than performance-based physical functioning. METHODS: 163 knee-osteoarthritis patients completed the performance-based DynaPort KneeTest (DPKT), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and SF-36 (self-report measures of pain and physical functioning) before, 3, 6, and 12 months after knee replacement. RESULTS: Correlations between (two) self-reported measures of functioning and (two) pain measures were higher (0.57-0.74) than correlations between the performance-based measure of functioning and the two pain measures (0.20 and 0.26). In factor analysis, WOMAC and SF-36 pain and physical functioning subscores loaded on the first factor (eigenvalue 3.2), while DPKT KneeScore2 loaded on the second factor (eigenvalue 0.92). Before surgery, correlations between performance-based and self-reported physical functioning were higher in patients with less pain (0.43) compared to patients with more pain (0.17), for the WOMAC (as expected), but not for the SF-36. After surgery, when the pain had diminished, the correlations between performance-based and self-reported physical functioning were higher, especially for the WOMAC. CONCLUSIONS: Our hypothesis was convincingly supported by the results of the WOMAC, and somewhat less by the results of the SF-36. We consider this as evidence for a lack of content validity of the WOMAC.

Activities of Daily Living↗

PubMed2006

Quality criteria were proposed for measurement properties of health status questionnaires.

OBJECTIVES: Recently, an increasing number of systematic reviews have been published in which the measurement properties of health status questionnaires are compared. For a meaningful comparison, quality criteria for measurement properties are needed. Our aim was to develop quality criteria for design, methods, and outcomes of studies on the development and evaluation of health status questionnaires. STUDY DESIGN AND SETTING: Quality criteria for content validity, internal consistency, criterion validity, construct validity, reproducibility, longitudinal validity, responsiveness, floor and ceiling effects, and interpretability were derived from existing guidelines and consensus within our research group. RESULTS: For each measurement property a criterion was defined for a positive, negative, or indeterminate rating, depending on the design, methods, and outcomes of the validation study. CONCLUSION: Our criteria make a substantial contribution toward defining explicit quality criteria for measurement properties of health status questionnaires. Our criteria can be used in systematic reviews of health status questionnaires, to detect shortcomings and gaps in knowledge of measurement properties, and to design validation studies. The future challenge will be to refine and complete the criteria and to reach broad consensus, especially on quality criteria for good measurement properties.

Evaluation Studies as Topic↗

PubMedDate not supplied

Complex syntax used by school-age children with specific language impairment (SLI) in child-adult conversation.

UNLABELLED: The present study is an investigation of complex sentence structures produced by school-age children in ordinary 100-utterance language samples. A total of 15 children with specific language impairment (SLI) and 15 of their classmates with typical language (TL) were the participants. Each child's conversational sample was coded for several types of complex sentence structures. While a 100-utterance language sample was adequate to yield exemplars of several types of spoken syntactic complexity, findings raise concerns about the content validity of conversational language sampling in the assessment of spoken syntactic complexity. Results also indicated that, although the children with SLI produced fewer complex sentences as well as combined complex sentences than their classmates with TL, they produced some examples of most spoken complex sentence structures in their conversations. Implications for using conversational language sampling to assess complex syntax are discussed. LEARNING OUTCOMES: The reader will (a) explain the strengths and weaknesses of language sampling in assessment of spoken syntactic complexity in school-age children, and (b) describe differences in children with SLI and children with TL for spoken syntactic complexity in child-adult conversation, as well as how to account for those differences.

Adult↗

PubMed2006

Treatment barriers identified by substance abusers assessed at a centralized intake unit.

The 59-item Barriers to Treatment Inventory (BTI) was administered to 312 substance abusers at a centralized intake unit following assessment but before treatment entry to assess their views on barriers to treatment. Factor analysis identified 25 items in 7 well-defined latent constructs: Absence of Problem, Negative Social Support, Fear of Treatment, Privacy Concerns, Time Conflict, Poor Treatment Availability, and Admission Difficulty. The factorial structure of the barriers is consistent with the findings of other studies that asked substance abusers about barriers to treatment and is conceptually compatible with Andersen's model of health care utilization. Factors were moderately to highly correlated, suggesting that they interact with one another. Selected characteristics were generally not predictive of barrier factors. Overall, results indicate that the BTI has good content validity and is a reliable instrument for assessing barriers to drug treatment. The potential utility of the BTI in assessment settings is discussed.

Adolescent↗

PubMed2003

Development of the National Eye Institute refractive error correction quality of life questionnaire: focus groups.

OBJECTIVE: To identify the content area for a questionnaire designed to measure the vision-targeted, health-related quality of life for persons with well-corrected refractive error. DESIGN: Cross-sectional study. PARTICIPANTS: Fifty-two focus groups were conducted with 414 patients from 5 geographically diverse ophthalmic and optometric sites to identify the content area of a questionnaire for use among persons with myopia and hyperopia. METHODS: A standard protocol was used to structure each focus group discussion, and groups were led by centrally trained moderators at each participating site. Results were summarized and analyzed using a standard set of codes. Qualitative and quantitative analyses were conducted. MAIN OUTCOME MEASURE: Self-reported observations or comments about vision, vision correction, and other aspects of quality of life. RESULTS: Among the 414 participants, 9262 mentions of comments were recorded. The most frequent comments reported by participants were about types of vision correction, followed by comments with their own vision and vision-related symptoms. The distribution of comments by topic domain was generally similar across types of correction and type of refractive error. The most frequent specific comments about glasses concerned problems with reading, adjustment between near and far vision, and appearance. The most frequent comments about contact lenses included those on symptoms such as dry eyes, itching and tired eyes, and headaches, and negative comments about ease of use. The most frequent comments among patients with surgical correction concerned fewer driving problems; fewer symptoms; and improvement in vision, recreation, and comfort. Participants provided equal numbers of positive and negative comments about glasses. Twice as many positive as negative comments were given by contact lens wearers, and 4 times as many positive comments were provided by patients who had undergone surgical correction. CONCLUSIONS: Using focus groups, we were able to identify content areas and aspects of visual functioning in persons with refractive error that are not measured by standard visual acuity testing in the clinic or by other vision-targeted, health-related quality of life instruments such as the 25- or 51-item National Eye Institute-Visual Functioning Questionnaire. The similarity of problems mentioned across refractive error type and correction method suggests it will be possible to develop a single questionnaire with adequate content validity to compare the impact of different modes of correction in vision-targeted, health-related quality of life.

Adult↗

PubMed2005

Objective Assessment of Skills in Intraocular Surgery (OASIS).

OBJECTIVE: To establish an objective ophthalmic surgical evaluation protocol to assess residents' surgical competency and improve residents' surgical outcomes. PARTICIPANTS: Eight experts in resident education from comprehensive ophthalmology, cornea, glaucoma, and retina services; 2 chief residents (postgraduate year 5 [PGY5]); and resident representatives from PGYs 2, 3, and 4 participated in the development of an objective assessment tool of skills in resident cataract surgery. METHODS: Analysis of all resident cataract surgeries performed at our service from July 2001 to July 2003 led to the development of a 1-page objective evaluation form to assess residents' skills in cataract surgery. A panel of surgeons at the Massachusetts Eye and Ear Infirmary reviewed the database and the evaluation form and provided constructive feedback. RESULTS: Development of a unique database of all resident cataract cases and constructive feedback by experts in resident teaching assisted in creating a 1-page evaluation form entitled Objective Assessment of Skills in Intraocular Surgery (OASIS). CONCLUSIONS: OASIS has face and content validity and can be used to assess, objectively, surgical events and surgical skill. We believe the OASIS evaluation form and database will be a valuable tool for assessing ophthalmology residents' surgical skills at other residency programs as well.

Cataract Extraction↗

PubMed2004

The influence of diabetic retinopathy on quality of life: interviews to guide the design of a condition-specific, individualised questionnaire: the RetDQoL.

An individualised measure of the impact of diabetic retinopathy on quality of life (QoL) was developed, using a four-phase iterative approach, incorporating qualitative and quantitative methods. In semi-structured interviews, eleven people with diabetic retinopathy in each of two UK and two German hospitals described how QoL would be different without diabetic retinopathy. They completed and commented on the latest Retinopathy Dependent QoL (RetDQoL) draft. Interviews were content analysed before questionnaire revision and translation for the next centre. Twenty-six men and 18 women were interviewed: median age 60.5 (28-82) years; severity ranged from untreated background diabetic retinopathy to proliferative diabetic retinopathy requiring photocoagulation in both eyes, and vitrectomy. The resulting 26-domain RetDQoL asks about the impact of 'diabetic eye problems'. Iterative methodology ensured good understanding, face and content validity. It can be self- or interviewer-completed. Visual impairment, worries and movement restrictions impaired many aspects of QoL, with impacts before vision loss. Practice implications relate to using the RetDQoL and improving practitioner-patient communication.

Activities of Daily Living↗

PubMed2004

Assessing ambiguity at the family-nurse boundary interface in pediatric health crisis.

This article discusses the conceptualization and measurement of family-nurse relationships in pediatric intensive care unit (PICU) from the perspective of family systems and boundaries. The 14 items for the Family-Nurse Boundary Ambiguity Scale for PICU (FNBAS-PICU) were developed from a qualitative study. Nurse panels established face and content validity. Parents (156) from four PICUs participated in reliability estimates (Cronbach's alpha = .81) and validity testing with measures of illness uncertainty and role alteration stress. Principal components analysis confirmed the conceptual intent of the FNBAS-PICU.

Child↗

PubMed2005

Gradations of clinical severity and sensitivity to change assessed with the Beck Depression Inventory-II in Japanese patients with depression.

Knowledge of what constitutes a minimal clinically important difference and change on a psychiatric rating scale is essential in interpreting its scores. The present study examines the Beck Depression Inventory-II (BDI-II), a recently revised successor to the world's most popular self-rating instrument for depression. BDI-II was administered to 85 patients with major depression, diagnosed with DSM-IV along with its severity specifiers. It was again administered to 40 first-visit patients from the original sample when they returned 14 or more days later. The Clinical Global Impression-Change Scale was rated at the same time. All the ratings were done independent of each other. The BDI-II was able to distinguish between all grades of depression severity. An approximate 10-point difference existed between each severity specifier. The BDI-II was also sensitive to change in depression: a 5-point difference corresponded to a minimally important clinical difference, 10-19 points to a moderate difference, and 20 or more points to a large difference. Given the already established high reliability, content validity, construct validity and factorial validity, and the high sensitivity to between-subject differences and within-subject changes demonstrated in the present study, the BDI-II promises to continue to be a leading self-rating instrument to assess depression severity worldwide.

Cohort Studies↗

PubMed2006

Patients' perceptions of the side-effects of prostate cancer treatment--a qualitative interview study.

Primary prostate cancer treatment often results in suboptimal urinary, bowel and/or sexual function. These effects are not inevitable. After treatment patients typically report high health related quality of life (QoL) scores. This discrepancy between disease-specific and generic results raises the question which meaning side effects actually have to patients. In a qualitative study we explored two mechanisms which could possibly explain the discrepancy: insensitivity of generic QoL measures to these specific symptoms and adaptation to changed health (response shift). In semi-structured interviews with 33 prostate cancer patients in the Netherlands we collected data on their opinions regarding health and QoL, we observed how respondents behaved when completing health status and QoL questionnaires, and solicited comments on a QoL questionnaire, its items, and its content validity. We observed that patients trivialized sexual (dys) function referring to old age. We found that while they might consider sexual, urinary, and bowel dysfunctions as problems, they did not take such dysfunctions into account when completing QoL measures because they did not view these dysfunctions as aspects of health. This finding reveals a so far unidentified cause of the insensitivity of generic measures of health status. Furthermore, response shift appeared to be present: many patients accepted the side effects as inevitable consequences of having been treated for prostate cancer, a condition they perceived as life threatening. We conclude that generic QoL measures cannot reveal the impact of sexual, urinary and bowel dysfunctions on patients because such dysfunctions are not perceived as health problems. By presenting these findings we want to draw attention to issues that complicate QoL assessments in general and in prostate cancer patients in particular.

Aged↗

PubMed2004

Measuring stigma in children with epilepsy and their parents: instrument development and testing.

PURPOSE: The goal of this work is to describe psychometric properties of two scales measuring perceived stigma in children with epilepsy and their parents. METHODS: Data were collected for the parent scale in two samples: parents of 173 children with epilepsy and of 224 children with new-onset seizures. The child scale was tested in the chronic sample. Content validity, internal consistency reliability, and construct validity were tested. RESULTS: Both scales had strong internal consistency reliability and construct validity. Higher scores were associated with greater seizure severity scores. In the parent scale, lower scores were associated with more positive mood, less worry, and more family leisure activities. In the child scale, higher scores were correlated with more negative attitude, greater worry, poorer self-concept, and more depression symptoms. CONCLUSIONS: Both scales were found to have strong psychometric properties. They are short, and items are easy to understand. These scales have potential for use in research and in the clinical setting to measure stigma.

Adolescent↗

PubMed1999

Development of the Perioperative Nursing Data Set.

Nursing practice is a major component of health care. Yet, it remains undervalued and essentially invisible because little data exist to substantiate the influence of nurses on patient outcomes. The research-based Perioperative Nursing Data Set (PNDS), with an easily automated nomenclature capable of describing the specialty practice of perioperative nursing, was designed to fill this gap. Four domains (i.e., safety, physiologic response to surgery, patient and family behavioral response to surgery, health system) form the foundation of the PNDS. Each domain, with accompanying desired outcomes, nursing interventions, and nursing diagnoses, has reliability, content validity, and evidence of construct validity. The purpose of this article is to introduce the conceptual framework, taxonomy, and potential clinical applications of the PNDS.

Databases as Topic↗

PubMed1998

A criterion-referenced measure of latex allergy knowledge.

The exponential use of latex products has increased patients' and health care workers' sensitization to natural rubber latex. The purpose of this research study was to develop and test a set of items designed to measure professional nurses' knowledge about natural rubber latex reactions and interventions appropriate for latex precautions. The items were developed from research reports in the literature and changed to reflect the suggestions offered by experienced perioperative nurses (pilot = 8) and three nationally known experts in latex allergy responses. The revised form was mailed to the home or distributed at the workplace of perioperative nurses (n = 158). Criteria for item retention were < .90 difficulty index and clinical relevance. Certified nurses (i.e., CNORs) scored significantly higher than other nurses who took the test at the same time (t-test = 2.00, P = .05). A pretest and posttest evaluation of the revised 20 items was conducted before and after a latex allergy continuing education program during the spring of 1998. The current knowledge test (i.e., version 1.1) has reliability (alpha = .80); content validity (CVI = .92); and accumulated evidence of construct validity (preinstruction mean = 14.16, postinstruction mean = 17.15, t-paired = 10.54, df = 70, P = < .001). An empirically developed professional nurse latex allergy competency test suitable for clinical use was the outcome of this research study.

Clinical Competence↗