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PubMed2004

Measuring activity limitations in climbing stairs: development of a hierarchical scale for patients with lower-extremity disorders living at home.

OBJECTIVE: To develop a hierarchical scale that measures activity limitations in climbing stairs in patients with lower-extremity disorders living at home. DESIGN: Cross-sectional study with Mokken scale analysis of 15 dichotomous items. SETTING: Outpatient clinics of secondary and tertiary care centers. PARTICIPANTS: Patients (N=759; mean age +/- standard deviation, 59.8+/-15.0y; 48% men) living at home, with different lower-extremity disorders: stroke, poliomyelitis, osteoarthritis, amputation, complex regional pain syndrome type I, and diabetic foot problems. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) Fit of the monotone homogeneity model, indicating whether items can be used for measuring patients; (2) fit of the double monotonicity model, indicating invariant (hierarchical) item ordering; (3) intratest reliability, indicating repeatability of the sum score; and (4) differential item functioning, addressing the validity of comparisons between subgroups of patients. RESULTS: There was (1) good fit of the monotone homogeneity model (coefficient H=.50) for all items for all patients, and for subgroups defined by age, gender, and diagnosis; (2) good fit of the double monotonicity model (coefficient H(T)=.58); (3) good intratest reliability (coefficient rho=.90); and (4) no differential item functioning with respect to age and gender, but differential item functioning for 4 items in amputees compared with nonamputees. CONCLUSIONS: A hierarchical scale, with excellent scaling characteristics, has been developed for measuring activity limitations in climbing stairs in patients with lower-extremity disorders who live at home. However, measurements should be interpreted with caution when comparisons are made between patients with and without amputation.

Activities of Daily Living↗

PubMedDate not supplied

Development of a scale to measure barriers to health promotion activities among persons with disabilities.

Subjectively-defined barriers to engaging in health promoting activities are one of the most important, yet least well operationalized, components in our models of health promotion. This article describes the development of a tool to measure barriers to health promotion among persons with disabilities. The Barriers to Health Activities among Disabled Persons scale (BHADP) is comprised of 16 items reflecting barriers to taking care of one's health identified from previous barriers literature and interviews with disabled persons. In a study of 135 disabled adults living in two southwestern cities, the BHADP yielded a Cronbach Alpha of .82 as a measure of internal consistency reliability. In addition, t-test analyses demonstrated a significant difference in scores between the disabled sample and a comparison group of 144 nondisabled adults, suggesting the BHADP discriminate between these groups. The BHADP may be useful in sensitizing health care providers to the wide range of barriers experienced by persons with disabilities, thereby enabling them to work more effectively with this special population.

Adult↗

PubMed1985

Development of a scale for measuring techniques in the psychotherapy of borderline patients.

Studies of psychodynamic psychotherapy require an instrument to measure the application of the prescribed therapeutic techniques during ongoing treatment. The authors describe the development of such an instrument, the Therapist Verbal Intervention Inventory (TVII), designed specifically for use in the study of the treatment of patients with borderline personality disorders. The TVII was designed, in addition, to test the hypothesis that psychodynamic techniques defined at a middle level of inference could be reliably rated by trained clinicians. The authors present data on the inter-rater reliabilities and inter-rater agreements obtainable with the TVII in the hands of highly experienced clinicians and in the hands of an independent group of junior clinicians trained in its use. The TVII appears to be a potentially useful tool for monitoring psychotherapy techniques in ongoing studies of the treatment of patients with severe personality disorders. Psychiatrists at the advanced resident level or immediate postresidency level have been trained to use the TVII to rate videotaped therapy sessions reliably.

Borderline Personality Disorder↗

PubMed1996

Development and validation of the State Hope Scale.

Defining hope as a cognitive set comprising agency (belief in one's capacity to initiate and sustain actions) and pathways (belief in one's capacity to generate routes) to reach goals, the Hope Scale was developed and validated previously as a dispositional self-report measure of hope (Snyder et al., 1991). The present 4 studies were designed to develop and validate a measure of state hope. The 6-item State Hope Scale is internally consistent and reflects the theorized agency and pathways components. The relationships of the State Hope Scale to other measures demonstrate concurrent and discriminant validity; moreover, the scale is responsive to events in the lives of people as evidenced by data gathered through both correlational and causal designs. The State Hope Scale offers a brief, internally consistent, and valid self-report measure of ongoing goal-directed thinking that may be useful to researchers and applied professionals.

Adult↗

PubMed1998

Development of a scale to measure adherence to self-monitoring of blood glucose with latent variable measurement.

OBJECTIVE: Adherence to self-monitoring of blood glucose (SMBG) is problematic for many people with diabetes. Self-reports of adherence have been found to be unreliable, and existing paper-and-pencil measures have limitations. This study developed a brief measure of SMBG adherence with good psychometric properties and a useful factor structure that can be used in research and in practice. RESEARCH DESIGN AND METHODS: A total of 216 adults with diabetes responded to 30 items rated on a 9-point Likert scale that asked about blood monitoring habits. In part I of the study, items were evaluated and retained based on their psychometric properties. The sample was divided into exploratory and confirmatory halves. Using the exploratory half, items with acceptable psychometric properties were subjected to a principal components analysis. In part II of the study, structural equation modeling was used to confirm the component solution with the entire sample. Structural modeling was also used to test the relationship between these components. It was hypothesized that the scale would produce four correlated factors. RESULTS: Principal components analysis suggested a two-component solution, and confirmatory factor analysis confirmed this solution. The first factor measures the degree to which patients rely on others to help them test and thus was named "social influence." The second component measures the degree to which patients use physical symptoms of blood glucose levels to help them test and thus was named "physical influence." Results of the structural model show that the components are correlated and make up the higher-order latent variable adherence. CONCLUSIONS: The resulting 15-item scale provides a short, reliable way to assess patient adherence to SMBG. Despite the existence of several aspects of adherence, this study indicates that the construct consists of only two components. This scale is an improvement on previous measures of adherence because of its good psychometric properties, its interpretable factor structure, and its rigorous empirical development.

Adult↗

PubMed2002

Development of a measure that integrates positive and negative affect and personality: the Comprehensive Personality and Affect Scales.

The development, reliability and validity of a new measure of personality and affect, the Comprehensive Personality and Affect Scales (COPAS) was investigated in three studies of college students. In study 1, the factor structure of personality, negative affect, and positive affect was assessed, with five-factors found in each of the three analyses. Fifteen scales (Personality: Emotionality, Extroversion, Openness, Conscientiousness, and Agreeableness; Negative Affect: Depression, Hostility, Agitation, Anxiety, and Social Anxiety; Positive Affect: Contentment, Joy, Love, Vigor, and Excitement) were constructed based on results of the factor analysis. Confirmatory factor analyses confirmed the measurement model. In study 2, the reliability and construct validity of each of the 15 factor-derived scales was assessed in both referred and non-referred college students. Study 3 investigated the utility of the COPAS scales in differentiating referred and non-referred college students. Results indicated that reliability of the scales was good to excellent, while convergent and divergent validity was good for most scales. The COPAS scales were also shown to differentiate between referred and non-referred samples of college students. Overall, the COPAS was shown to be suitable for research with college student populations.

Adult↗

PubMed1988

Measurement of life satisfaction. Developing a life satisfaction scale.

The purpose of this study was to develop a life satisfaction scale (LSS) suited for elderly Finnish people. The subjects were non-institutionalized elderly living in rural and urban areas in south-western Finland. They were interviewed for a prospective follow-up study (TURVA project) concerned with the psychosocial development of elderly people during retirement. Following the interview, the first version of the LSS was submitted to 339 respondents. It was completed and returned by 330 (97%). This version of the scale was then reduced to a 26-item version (LSS-A), which had a high reliability coefficient (Cronbach alpha 0.89). In factor analysis, LSS-A consisted of three main components: psychic balance, assessment of past life, and present happiness. An abbreviated 12-item scale (LSS-B) was also drawn up. When the number of items was reduced, the roles of psychic balance and present happiness were emphasized. The LSS, proved to be easy to use, its reliability was good, and the correlations between the sum score of LSS and the questions concerning life satisfaction in the interviews suggested fairly good validity. To further evaluate the validity and applicability of the scale, we need further studies in different types of elderly populations.

Adaptation, Psychological↗

PubMedDate not supplied

Development of a new pain scale: Colorado Behavioral Numerical Pain Scale for sedated adult patients undergoing gastrointestinal procedures.

A limited number of studies have addressed pain assessment among sedated patients undergoing a gastrointestinal examination. The Colorado Behavioral Numerical Pain Scale is a quick, simple tool that can provide an estimation of the patient's comfort level while sedated. Multiple studies completed in intensive care unit and postanesthesia care unit settings provide ample evidence of the accuracy of behavioral pain scales ratings. In developing the Colorado Behavioral Numerical Pain Scale, experienced endoscopy nurses provided suggestions and modifications of descriptive words for behavioral assessment of pain selected from the relevant literature. Three nurses simultaneously rated pain using the scale for 30 procedures. Interrater reliability was high with 82% of observations in total agreement and 17% having one of the three persons disagreeing on the rating. Nurses from four hospitals and one ambulatory facility also evaluated the Colorado Behavioral Numerical Pain Scale tool. In this evaluation, 98% of the 52 respondents agreed that the words described what they observed during a gastrointestinal examination and 94% felt it was a better descriptor of pain than a patient self-report numerical scale. Assessment of pain for the sedated patient undergoing gastrointestinal procedures is often difficult due to the patient's inability to report pain levels. The sedated patient undergoing painful procedures depends on the nurse to interpret physical signs to quantify his or her distress. The Acute Pain Management Guidelines (AHCPR, 1992) promotes the use of both physiological and behavioral responses to pain for assessment when self-report is absent. While an individual's self-report of pain intensity and distress is the most accurate assessment measurement, the validity of a sedated patient's elicited response about pain is questionable. It is the nurse, through observation, who attempts to assess the sedated individual's pain levels.

Adult↗

PubMed2003

Meso-scale testing and development of test procedures to maintain mass balance.

The Conrad Blucher Institute for Surveying and Science (Texas A&M University--Corpus Christi) has conducted numerous petroleum experiments at the Shoreline Environmental Research Facility (Corpus Christi, Texas, USA). The meso-scale facility has multiple wave tanks, permitting some control in experimental design of the investigations, but allowing for real-world conditions. This paper outlines the evolution of a materials balance approach in conducting petroleum experiments at the facility. The first attempt at a materials balance was during a 1998 study on the fate/effects of dispersant use on crude oil. Both water column and beach sediment samples were collected. For the materials balance, the defined environmental compartments for oil accumulation were sediments, water column, and the water surface, while the discharge from the tanks was presumed to be the primary sink. The "lessons learned" included a need to quantify oil adhesion to the tank surfaces. This was resolved by adhering strips of the polymer tank lining to the tank sides that could be later removed and extracted for oil. Also, a protocol was needed to quantify any floating oil on the water surface. A water surface (oil slick) quantification protocol was developed, involving the use of solid-phase extraction disks. This protocol was first tested during a shoreline cleaner experiment, and later refined in subsequent dispersant effectiveness studies. The effectiveness tests were designed to simulate shallow embayments which created the need for additional adjustments in the tanks. Since dispersant efficacy is largely affected by hydrodynamics, it was necessary to scale the hydrodynamic conditions of the tanks to those expected in our prototype system (Corpus Christi Bay, Texas). The use of a scaled model permits the experiment to be reproduced and/or evaluated under different conditions. To minimize wave reflection in the tank, a parabolic wave dissipater was built. In terms of materials balance, this design reduced available surface area as a sink for oil adsorption.

Accidents↗

PubMed1993

Development of the Child Attitude Toward Illness Scale.

Described the development of the Child Attitude Toward Illness Scale (CATIS), a short self-report instrument designed to provide a systematic assessment of how favorably or unfavorably children feel about having a chronic physical condition. Subjects were children (N = 269), ages 8-12 years, who had either epilepsy (n = 136) or asthma (n = 133). Results of confirmatory factor analysis and predicted relationships with scores on the Child Behavior Checklist and the Piers-Harris Children's Self-Concept Scale provided support for construct validity of the scale. Good internal consistency and test-retest reliability were also found.

Adaptation, Psychological↗

PubMed2006

Worries and concerns of patients with multiple sclerosis: development of an assessment scale.

This study examined the nature of worry in adult patients with multiple sclerosis (MS) in the UK. A measure of worry in MS was developed and the relationship between worry and standard scale measures of anxiety and depression was examined. Thirty-nine patients with MS and 40 controls completed the new worry scale (WQMS) that was psychometrically evaluated, together with the Penn State Worry Questionnaire (PSWQ), the Hospital Anxiety and Depression Scale (HAD) and a previously developed scale to assess self-efficacy in MS (SESMS). The scores for both anxiety (t = 2.34; P < 0.05) and depression (t = 5.52; P <0.01) were higher in MS patients than controls, as was the new scale for worry--the WQMS. A factor analysis (explaining 65.73% of the variance) suggests that the worries of patients may be dichotomized into those concerned with the physical effects of the disease and those relating to the impact on social interaction, family relationships and daily activity in the home and/or work. Worry in patients with MS was associated with a decreased sense of being able to produce positive activities or effect positive outcomes (low self-efficacy). The questionnaire provides a framework for investigation in clinic of specific concerns and level of worry they engender.

Adult↗

PubMed1994

Role of epidermal-dermal tissue interactions in regulating tenascin expression during development of the chick scutate scale.

During normal chicken development tenascin begins to accumulate in the dermis of anterior metatarsal skin at the time of scutate scale ridge formation, and is localized in a distinct pattern along the outer scale surface. Anterior metatarsal skin from scaleless (sc/sc) embryos, which do not form scutate scales, begins to accumulate tenascin 4 days later than normal skin. This study shows that normal and scaleless anterior metatarsal dermis accumulate the same tenascin isoforms and undergo the same isoform changes in the post-hatch period, but there is less tenascin accumulated in scaleless dermis and there is no pattern to its distribution. In both normal and scaleless anterior metatarsal skin, tenascin mRNA is localized in the dermis and is distributed in the same way as the protein. Thus, scaleless skin is defective in the ability to accumulate appropriate amounts of tenascin and to maintain the tenascin in the patterned manner of normal. Recombinant skin cultures show that epidermal-dermal interactions are required for tenascin accumulation. The dermis specifies the way that tenascin is organized, but interaction with epidermis is required to maintain this organization. The epidermal role appears to be permissive because in heterotypic recombinants, neither scaleless anterior metatarsal epidermis nor normal footpad epidermis changes the way that tenascin appears in the normal anterior metatarsal dermis; and in reciprocal recombinants, normal anterior metatarsal epidermis does not change the way tenascin is accumulated in either scaleless anterior metatarsal dermis or normal footpad dermis.

Animals↗

PubMed2006

Comparison of a qualitative and a quantitative approach to developing a household food insecurity scale for Bangladesh.

This paper compares a qualitative and a quantitative (Rasch) method of item assessment for developing the content of a food insecurity scale for Bangladesh. Data are derived from the Bangladesh Food Insecurity Measurement and Validation Study, in which researchers collected 2 rounds of ethnographic information and 3 rounds of conventional household survey data between 2001 and 2003. The qualitative method of scale development relied on content experts and respondents themselves to evaluate household food insecurity items generated through ethnographic research. The quantitative method applied the Rasch model to assess the fit of the same items using representative survey data. The Rasch model was then used to test for differential item functioning (DIF) across diverse demographic and geographic subgroups. The qualitative assessment flagged and discarded 10 items, leaving 13. The Rasch assessment of infit and outfit flagged 3 items, and the Rasch DIF test discarded another 10 items, leaving a total of 10 items in the Rasch-derived scale. The 2 scales contained 8 of the same items. The qualitatively and quantitatively derived scales were highly correlated (r = 0.96, P < 0.01), and the 2 methods located 90% of households in the same food insecurity tercile. This convergence lends added confidence to the use of either scale for identifying food-insecure households in different regions of Bangladesh. Multiple methods should continue to be applied in a systematic and transparent way to lend additional credence to the results when they converge and to pinpoint directions for further clarification where they do not.

Adult↗

PubMed1996

Initial development of a scale to measure dental indifference.

Lack of concern about dental health contributes significantly to the reluctance of people to attend for dental check-ups and to implement preventive dental measures. The aim of this study was to develop and assess a questionnaire method of detecting this attitude which was described as dental indifference. The questionnaire was tested on 910 dentate adults in Scotland. A 62% response rate was obtained. Five hundred of the respondents were then sent a second copy of the questionnaire to assess its reliability, a 67% response rate was obtained. The Pearson correlation coefficient between the first and second completion of the dental indifference questionnaire was 0.79. The internal consistency measured by Chronbach's alpha was 0.71. High scores on the dental indifference questionnaire were significantly associated with being young, male and a manual worker. High scores had fewer teeth, on average, than the rest of the sample and more than half of them had no record of attending for dental care within 4 years. Those who did attend a dentist were more likely to have teeth filled or extracted. The dental indifference questionnaire may be useful for targeting groups who require oral health promotion activity and may prove to be a reliable means of identifying individuals who display behaviours which could be expected to be associated with a lack of interest in dental health, such as lack compliance with oral care instructions and failing to complete course of treatment.

Adult↗

PubMed2006

Development of a child safety seat Hassles Scale in a largely low-income Latino population.

OBJECTIVE: High rates of use of child safety seats have been achieved. A remaining challenge in child passenger safety is to reach the Healthy People 2010 objective of child safety seat use to 100%. Several factors have been reported to influence child safety seat use. A child safety seat Hassles Scale was developed to explore hassles that are associated with child safety seat nonuse. METHODS: Focus groups with violators of the California Child Passenger Safety Law provided data to construct the 29-item Hassles Scale. The scale was used in an interview that was conducted with 132 parents who were cited for violation of the law and whose children were 12 to 47 months of age and weighed 20 to 40 pounds. Interviews were conducted 3 months after parents paid the fine for the citation. Each hassle was rated 0 to 3 on frequency and intensity. Parent report of child safety seat use was obtained. Factor analysis was used to construct subscales. Relationship of subscale frequency and intensity scores to reported child safety seat use was assessed with linear regression. RESULTS: The sample was 86% Latino, 45% Spanish-speaking, and 55% with income < dollar 30000. Thirty-one percent of the parents reported that the child did not now always use a child safety seat. Four subscales were identified: child, crowding/inconvenience, busy, and vehicle. Only the frequency of the child subscale items (eg, resists, gets out of seat) and the frequency and the intensity of the crowding/inconvenience subscale items (eg, child safety seat takes up too much room, too many passengers) were related to child safety seat nonuse. Sixty-nine percent agreement with parent report of child safety seat use was achieved using only the frequency scores for the 9 items in the 2 subscales child and crowding/inconvenience, compared with 65% for the 29-item scale. CONCLUSIONS: In this low-income largely Latino population of violators, self-report of "always using a child safety seat" when transporting their child was low (59%). Child safety seat nonuse was related to hassles that are associated with child behaviors and vehicle crowding/inconvenience. The child safety seat Hassles Scale documented barriers and difficulties with the use of a child safety seat in a high-risk population for nonuse. These concepts can be explored by clinicians and others who work to increase consistent child safety seat use. Additional evaluation and development of the instrument requires validation for its use as a screening or educational tool.

Child, Preschool↗

PubMed2003

Computing measures of simplicity of fit for loadings in factor-analytically derived scales.

A very simple structure is sought when factor analysis is used to develop measurement scales. The SIMLOAD program computes measures of factorial simplicity for rows and columns of loading matrices (usually the factor pattern) as well as some overall measures. These include Kaiser's (1974) index of factorial simplicity for variables (rows), the author's scale fit index for factors (columns), Bentler's (1977) scale-free matrix measure, and hyperplane counts. Routine use of these measures is recommended for multifactor scale development. The measures may also be useful in more general factor applications and in confirmatory as well as exploratory analyses. SIMLOAD also computes factor scale intercorrelations, scale alpha coefficients (including alpha when an item is removed), and sorted loadings for ease of interpretation.

Data Interpretation, Statistical↗

PubMed1996

Quality of center child care and infant cognitive and language development.

The relations between quality of center-based child care and infant cognitive and language development were examined in a sample of 79 African-American 12-month-old infants. Both structural and process measures of quality of child care were collected through interviews with the center director and observation of the infant classroom. Results indicated that quality of infant care positively correlated with scores on standardized assessments of cognitive development (Bayley Scales of Infant Development), language development (Sequenced Inventory of Communication Development), and communication skills (Communication and Symbolic Behavior Scales). In addition, quality of care in child care centers and at home was positively related. Analyses that adjusted for this association between quality of care at home and in child care suggested that the process measure of quality of child care independently related to the infant's cognitive development, and one structural measure, the infant-adult ratio, independently related to the infant's overall communication skills. Neither child nor family factors was found to moderate the association between child care quality and infant development. These findings, in conjunction with the growing child care literature, suggest that researchers and policymakers should focus on how quality of child care can be improved to enhance, not impair, infant development.

Black or African American↗

PubMed2003

Measuring therapeutic attitudes in the prison environment: development of the Prison Attitude to Drugs scale.

AIMS: To develop and test the validity of a scale measuring therapeutic attitudes among prison staff working with drug misusers. DESIGN: A cross-sectional postal questionnaire study using 27 statements with a five-point Likert scale. SETTING: Four prisons in the south-west of England PARTICIPANTS: A total of 252 prison staff (response rate 70%), including 67 for test-retest (response rate 57%). FINDINGS: The study resulted in a three-dimensional, nine-item scale: the Prison Attitude to Drugs scale (PAD). The three subscales measure confidence in skills (four items), personal rewards (three items) and job satisfaction (two items). Test-retest correlations for the questions were above 0.7, with each factor having an internal coherence (coefficient alpha) of greater than 0.7. CONCLUSIONS: The PAD is a reliable tool that can be used in the prison environment.

Adult↗