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PubMed1994

Development of the long-term medication behaviour self-efficacy scale: qualitative study for item development.

There are no published instruments of patient self-efficacy related to medication behaviour, yet understanding and promoting medication compliance are central to nursing practice. The purpose of this quanlitative study was to explore patient perceptions, experiences and practices associated with long-term medication behaviour in order to establish an instrument measuring self-efficacy in medication behaviour. In-depth interviews were conducted with 14 patients with lifelong dependency on medicine. Using a phenomenological method of analysis the following themes emerged, all of which could be integrated within Bandura's conceptualization of dimensions of self-efficacy. The dimension of personal attributes comprised the themes of emotional distress, confidence in the physician, perceived health status, and normalcy. Environmental factors included the themes of routine, distraction, social support and cost of medication. The third dimension of self-efficacy, task-related and behavioural factors was composed of themes of side-effects, drug delivery system, medication aids, medication schedule, and knowledge. Based on these themes, items for the Long-Term Medication Behaviour Self-Efficacy Scale, were developed and integrated into a version that is currently being submitted to further psychometric work.

Adult↗

PubMed1998

The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder.

Intentional self-harm behavior is an important clinical phenomenon that appears highly related to borderline personality disorder (BPD). Self-harm behavior in the context of borderline personality probably exists along a continuum from graphic, self-harm behavior to milder forms of self-sabotaging behavior that might be viewed as self-defeating Relatively little attention has been paid to developing a self-report measure of intentional self-harm, particularly as a screening device for detecting BPD. In Study 1, an initial list of self-harm behaviors encountered in clinical practice was narrowed to those behaviors related to BPD in a sample comprised of adults from both a mental health and non-mental health setting. All participants (N = 221) underwent a semistructured diagnostic interview for BPD. Using a cut-off score of 5 on the resulting 22-item Self-Harm Inventory (SHI), 83.7% of research participants were correctly classified as having BPD or not. In Study 2, women (N = 285) sampled from an outpatient medical setting completed the SHI and a widely used self-report measure of BPD. The SHI cut-off score resulted in correct classification of 87.9% of the individuals. In Study 3, using a sample of adults involuntarily hospitalized for psychiatric reasons (N = 32), the SHI performed at least as well as another self-report measure of BPD in diagnosing participants (the final diagnosis was based on a semistructured interview). The results are discussed with regard to potential advantages and utility of the SHI and need for further validation.

Adolescent↗

PubMed2002

Appropriate starter culture technologies for small-scale fermentation in developing countries.

Modern food biotechnology has moved a long way since ancient times of empirical food fermentations. Preservation and safeguarding of food are, however, still major objectives of fermentation. In addition, other aspects, such as wholesomeness, acceptability and overall quality, have become increasingly important and valued features to consumers even in developing countries where old traditions and cultural particularities in food fermentations are generally well maintained. Due to limitations in infrastructure and existing low technologies, rural areas in most developing countries have not been able to keep abreast of global developments toward industrialisation. At the same time, fermented foods play a major role in the diet of numerous regions in Africa and Asia. In many traditional approaches, the advantages of some form of inoculation of a new batch, e.g. by back-slopping or the repeated use of the same container (e.g. a calabash) is appreciated and generally practised. Still, the benefits of small-scale starter culture application as a means of improved hygiene, safety and quality control, in support of HACCP approaches, are not yet realised in small-scale fermentation operations. Approaches and considerations for the selection of pure cultures for small-scale, low-tech applications may differ in some respects from the large-scale industrial approaches practised since 100 years. Selection criteria should take account of the substrate, technical properties of the strain, food safety requirements and quality expectations. Lack of experience in the application of starter cultures in small-scale operations and under rural conditions presents a major obstacle but also an exciting challenge to food microbiologist and technologist. Culture preservation, maintenance and distribution demand special logistic and economic considerations. Quality, safety and acceptability of traditional fermented foods may be significantly improved through the use of starter cultures selected on the basis of multifunctional considerations, also taking into account the probiotic concept and possibilities offered for improved health benefits.

Bacteria↗

PubMed1997

Early stroke recognition: developing an out-of-hospital NIH Stroke Scale.

OBJECTIVE: To develop an abbreviated and practical neurologic scale that could assist emergency medical services or triage personnel in identifying patients with stroke. METHODS: A prospective, observational, cohort study was performed at university-based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non-stroke patients evaluated during 4 random 12-hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using chi 2 were performed to rank items. Recursive partitioning was then performed to develop the decision rule for predicting the presence of stroke. RESULTS: Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NIH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out-of-hospital NIH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%. CONCLUSION: Using the derivation data set, a proposed Out-of-hospital NIH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out-of-hospital arena are needed.

Adult↗

PubMed2005

Development and validation of a scale to measure work-related fatigue and recovery: the Occupational Fatigue Exhaustion/Recovery Scale (OFER).

OBJECTIVE: Various empirical studies link persistent failure to recover from acute fatigue to the evolution of chronic fatigue. However, existing fatigue measurement scales do not tend to distinguish between acute and chronic fatigue elements well, and none include a measure of effective recovery from fatigue. METHODS: The 15 item Occupational Fatigue Exhaustion Recovery (OFER) scale has been developed and validated in three study populations specifically to measure work-related fatigue. RESULTS: The OFER scale possesses robust, gender-bias free psychometric characteristics. Its three subscales identify and distinguish between chronic work-related fatigue traits, acute end-of-shift states and effective fatigue recovery between shifts. CONCLUSION: These studies confirm the mediating role of intershift-shift recovery in the evolution of adaptive end-of-shift fatigue states to maladaptive persistent fatigue traits. The OFER scale is suggested as a potentially valuable new tool for use in work-related fatigue research.

Adult↗

PubMed2000

The development and validation of the Sense of Support Scale.

Two studies were conducted to develop and validate the Sense of Support Scale (SSS). Study 1, which consisted of scale development and an evaluation with a sample of corporate and university employees, supported the scale's internal consistency and construct validity. Study 2, which was conducted with a sample of undergraduate students, was designed to evaluate the revised and shortened version of the SSS. The scale was found to be internally consistent and had a high test-retest reliability. Concurrent validity was supported by significant correlations to the Social Provisions Scale and the Interpersonal Support Evaluation List. Construct validity was supported by significant positive correlations to hardiness and approach-coping and significant negative correlations to avoidance-coping, stress, and symptoms of illness. The relationship between the SSS and symptoms of illness supported a main effect rather than a stress-buffering model. Implications for using the SSS to investigate the influences of social support on health are discussed.

Adaptation, Psychological↗

PubMed1993

Quantitating qualitative issues in residency training: development and testing of a scaled program evaluation questionnaire.

OBJECTIVES: To develop and test a scaled program evaluation questionnaire focusing on resident satisfaction with workload, learning environment, and stress. DESIGN/PARTICIPANTS: Phase 1: A cross-section of 92 residents from five programs completed questionnaires for factor analysis and descriptive statistics. Phase 2: A three-year prospective study of questionnaire responses in a single program. QUESTIONNAIRE DEVELOPMENT: After extensive literature review, 33 Likert-scaled statements were written, dealing with situational, personal, and professional issues. After pilot testing, the 92 questionnaires obtained in Phase 1 were factor analyzed, resulting in three distinct scales: workload, faculty/learning environment, and stress. INTERVENTIONS: Program changes in Phase 2 included the introduction of a night float between 1989 and 1990, and an increase in senior resident call between 1990 and 1991. RESULTS: Phase 1: The first-year residents reported significantly less stress and generally greater satisfaction with workload and learning environment than did the second- or third-year residents. Marked differences between programs were also present in the mean scores on all three scales. Phase 2: The introduction of a night float did not significantly affect response to the questionnaire, but the increase in nights on call significantly increased stress and dissatisfaction with the faculty/learning environment. CONCLUSIONS: This study demonstrates the techniques needed to develop and use scaled program evaluation questionnaires. It is hoped that widespread use and validation of such instruments may result in greater responsiveness to the needs of trainees and more facilitative environments in which to acquire medical knowledge.

Cross-Sectional Studies↗

PubMed1984

The development and initial validation of a scale to measure social fear.

Developed a true-false scale to measure Social Fear, which Meehl argues is a sign of schizotypy, using procedures to maximize reliability and minimize response set bias (N = 910). Interviews with selected Ss (N = 44) confirm that the scale measures social fear, and the scale was found to correlate with previously developed schizotypy scales (N = 252).

Adult↗

PubMed1997

The relationship between role conception and ethical behaviour of student nurses in Hong Kong.

This paper was designed to explore the relationships of three role conception types (the professional, bureaucratic and service role conceptions) to the ethical behaviour of student nurses from the apprenticeship and degree nursing programmes in Hong Kong. The effect of role discrepancy on ethical behaviour will also be explored. A nonprobability convenience sampling of 140 certificate students from a hospital-based training course and 81 degrees nursing students from a tertiary programme were selected. Role conception and role discrepancy were measured by the modified Nursing Role Conception scale originally developed by Corwin. For ethical behaviour, the Judgement About Nursing Decisions scale developed by Ketefian was used. Multiple regression analyses showed that the ideal professional role conception was a significant predictor, accounting for 17% of the variance in the ideal ethical score of the degree students. Actual service role conception was a better predictor of the actual ethical score, explaining 10% and 14% of its variance for the certificate and degree students respectively. Professional and bureaucratic role discrepancies together were found to have a negative effect on the actual ethical behaviour of the degree students. These results suggest that professional values that have been developed through socialization in nurse education programmes could benefit patients only when degree students, in particular, could adapt successfully to the demands of bureaucratic organization.

Education, Nursing, Baccalaureate↗

PubMed2005

Development of a foot impact scale for rheumatoid arthritis.

OBJECTIVE: To develop a new foot impact scale to assess foot status in rheumatoid arthritis (RA) using established qualitative methodology and the latest item response techniques (Rasch analysis). METHODS: Foot problems in RA were explored by conducting qualitative interviews that were then used to generate items for a new foot impact scale. Further validation was undertaken following postal surveys and Rasch analysis. RESULTS: Analysis of the first postal survey (n = 192 responses) produced a 63-item binary response, 4-subscale instrument. The 4 subscales covered the domains impairment, activities, participation, and footwear. Following test-retest postal surveys and additional analysis, the instrument was reduced to a 2 subscale, 51-item questionnaire covering the domains of impairments/shoes and activities/participation. Initial results of these subscales indicate good psychometric properties, external validity, and test-retest reliability. CONCLUSION: A foot impact scale to assess the impact of RA and to measure the effect of interventions has been developed. The 2 scales comprising the instrument demonstrate good psychometric properties.

Adult↗

PubMed2006

Development and validation of a scale to assess attitudes of health care administrators toward the use of e-mail communication between patients and physicians.

BACKGROUND: The medical profession has been slow in embracing the e-mail as a means of improving patient communications. Today, most physicians work in group practices where administrators seek to develop standard procedures for care delivery. To understand the slow adoption of e-mail technology among physicians when communicating with their patients, it is important to understand these administrators' attitudes. OBJECTIVE: The purpose of this study was to develop and purify a scale to measure health care administrators' attitudes toward the use of e-mail communication and identify associations between e-mail communication attitudes and administrators' demographic and practice-related characteristics. METHODS: A preliminary list of features for e-mail communication was generated by reviewing the literature and Rogers' diffusion theory. The features were grouped initially into 5 hypothesized dimensions: relative advantage, norms (established rules of the social system), complexity, compatibility, and infrastructure. Following pilot testing, the main survey instrument was mailed to a total of 1500 health care administrators. Attitudes toward features of e-mail communication scale were analyzed using exploratory factor analysis with promax rotation. Internal consistency of the scale and its subscales was determined using Cronbach's alpha and item-total correlations. RESULTS: The overall response rate was 8.7%. Scale purification procedures reduced the preliminary scale of 22 items to a final scale of 20 items. The reliability of the scale measured by Cronbach's alpha was 0.81. Norms was considered the major barrier to e-mail communication, whereas infrastructure was considered a facilitator, and other features like relative advantage, complexity, and compatibility issues were perceived more as a barrier than a facilitator. The item related to and usage of e-mail by staff was statistically significant with the overall scale score (P=0.0095), complexity subscale score (P=0.0168), and infrastructure subscale score (P=0.0480). The relationship between number of years of experience of the administrator and infrastructure subscale score was statistically significant (P=0.0480). CONCLUSION: A scale developed to determine the attitudes of health care administrators regarding e-mail communication between patients and physicians demonstrated adequate content validity and reliability.

Adolescent↗

PubMed1990

Grading white matter lesions on CT and MRI: a simple scale.

We developed and tested a simple three-point scale for grading white matter lesions in anterior and posterior regions of the brain. Twenty four CT scans and 24 MRI scans were separately judged by 11 and five observers, respectively, on the presence and severity of white matter lesions. The observers were radiologists and neurologists. For CT scans, these periventricular changes were graded according to their extent as absent, or partly involving the white matter, or extending up to the subcortical region. The MRI lesions were graded as no lesion or only a single one, multiple focal lesions, and multiple confluent lesions. The pairwise agreements of all possible combinations of observers for each scan were corrected for chance (kappa statistics; maximal agreement 1.0). The weighted kappa value, for anterior and posterior regions combined, was 0.63 for CT scans, and 0.78 for MRI scans. This three-point scale for two separate regions seems suitable as a basis for cross-sectional or longitudinal studies of large series of patients.

Brain↗

PubMed1989

Stability of Bayley Motor Scale scores in the first year of life.

The purpose of this study was to determine whether Bayley Motor Scale scores were stable in infants during the first year of life, that is, whether each individual infant's score was essentially the same at each of the five test ages. Subjects were 15 low-risk and 8 high-risk infants with Bayley Scales of Infant Development Motor Scale scores at 2, 3, 4, 8, and 12 months. All high-risk and most low-risk infants also had outcome scores at either 24 or 36 months. For the group as a whole, and for all infants with "normal" outcomes, subjects did not change ranks over the six test ages (ie, high-scoring infants' ranks remained high and low-scoring infants' ranks remained low), but scores varied significantly from test to test. Scores of infants with "non-normal" outcomes did not vary significantly from test to test. The highest and lowest scores of 75% of the infants with normal outcomes and 57% of the infants with non-normal outcomes differed significantly. Four patterns of variations of Bayley Motor Scale scores over the five test ages of the first year after birth were identified. The first pattern included three infants with the most stable scores. The three remaining patterns were different from each other, but a consistent feature of each was a peak at 4 months. Finally, scores at 3 and 8 months were best able to correctly identify outcome. A single Bayley Motor Scale score may not reflect an infant's true abilities; some factor may be inflating scores at age 4 months.

Child Development↗

PubMedDate not supplied

Assessing quality of a diagnostic test evaluation.

OBJECTIVE: To develop a standardized scale for assessing the quality of a diagnostic test evaluation. DESIGN: Fourteen participants with formal and practical experience in evaluating diagnostic tests formed a consensus panel. Panel members identified and weighted questions that should be addressed when assessing the quality of a diagnostic test evaluation. SETTING: General internal medicine division at an academic medical center. RESULTS: A 19-item weighted scale was developed. It prioritizes and addresses issues such as description of the proposed purpose of the test; appropriate selection and description of the study population; appropriate performance and description of the diagnostic test; appropriate selection and performance of the reference standard; and adequate presentation of test characteristics. CONCLUSIONS: The scale is proposed as a useful instrument for readers, investigators, reviewers, and editors, because it represents an updated synthesis of important criteria to consider when evaluating diagnostic tests. It can also be used to rate quantitatively the quality of diagnostic test evaluations.

Decision Making↗

PubMed1995

Development of a new scale for measuring acculturation: the Taiwan Aboriginal Acculturation Scale (TAAS).

As part of the Taiwan Aboriginal Study Project (TASP), a new acculturation scale (the Taiwan Aboriginal Acculturation Scale, or TAAS) has been developed among the aboriginal minorities of Austronesian origin in Taiwan. The design of the original 54 items was based on Milton Gordon's concept of assimilation in association with a careful consideration of cross-cultural validity. These items were administered to 144 subjects stratified by age and sex who were randomly sampled from four major Taiwanese aboriginal groups. Item analysis and factor analysis were applied to select an 18-item scale which has three subscales (factors): cultural assimilation, social assimilation, and social attitude. Results of validity and reliability studies of the TAAS were found to be acceptable. The development of TAAS demonstrates the applicability of the concept of acculturation as a process that involves changes both in attitude, and in behaviour, to non-western societies.

Acculturation↗

PubMedDate not supplied

Enhancing early literacy skills for preschool children: bringing a professional development model to scale.

A quasi-experimental, statewide intervention targeting preschool teachers' enhancement of children's language and early literacy was evaluated. Across 2 years and 20 Head Start sites, 750 teachers participated (500 target, 250 control), with 370 classrooms randomly selected to conduct pre- and posttest assessments (10 randomly selected children per class). The inability to randomize children to classrooms was addressed by examining children's performance for teachers who were control teachers in Year 1 and target teachers in Year 2. We also compared teachers with 2 years of training with teachers with 1 year of training and with control teachers. Greater gains were found for children in target classrooms than for those in control classrooms for all skills, but particularly for language skills, in Year 2, and this varied by program site. The presence of a research-based early literacy curriculum, higher levels of teacher education, and full-day versus half-day programs were significant moderators of intervention effectiveness. The challenges of implementing a statewide initiative across programs that varied in their readiness to implement a cognitively rich experience for preschool children are discussed.

Age Factors↗

PubMed1986

The development of a functional rating scale to measure the treatment outcome of chronic spinal patients.

A Functional Rating Scale (FRS) was developed to quantify behavioral changes in chronic pain patients relative to six subcategories. The aim was to demonstrate its validity, test the instrument's reliability, and determine its value in measuring treatment outcome. Five sample populations were examined: a test group of 58 pain clinic patients; a medical control group comprising 29 outpatients with arthritis; and a three-part, healthy control group of 98 subjects. The validation and reliability of the scale were affirmed by clearly differentiating healthy from infirm subjects and through a test-retest check of the four control groups. The difference between means of the test group, before and after treatment, was of high statistical significance, which indicates the practical value of the FRS in measuring relative changes.

Activities of Daily Living↗

PubMed2000

Measuring clients' satisfaction with self-help agencies.

OBJECTIVE: Clients' satisfaction with their involvement in treatment decisions has been largely overlooked in the formulation of satisfaction measures. The authors describe the development of a scale that assesses clients' satisfaction with services and with their involvement in treatment decisions. METHODS: Long-term users of four client-operated mental health self-help agencies were interviewed at baseline (N=310) and six months (N=248) using the 11-item Self-Help Agency Satisfaction Scale (SHASS). The scale was developed on the basis of consumers' input about their satisfaction with services and their involvement in treatment decisions. To explore the relationship between satisfaction as measured by the SHASS and outcomes, the six-month interview included four outcome measures-independent and assisted social functioning, symptom severity, and a sense of personal empowerment. Internal consistency, stability, and discriminant validity were evaluated. RESULTS: Factor analyses confirmed that the SHASS has two subscales, one assessing service satisfaction and the other assessing satisfaction with involvement in treatment decisions. The scale and its subscales showed high internal consistency, moderate stability, and discriminant validity. The SHASS subscales showed modest associations with two of four outcome measures-assisted and independent social functioning. CONCLUSIONS: The SHASS is a brief instrument that can be used to measure clients' satisfaction with their involvement in treatment in mental health self-help agencies.

Adult↗