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The Index of Readiness: development and psychometric analysis.

This article describes the development and initial psychometric evaluation of a measure of individual appraisal of readiness to initiate health behavior change. Items were developed from inductively generated data to index dimensions of individual appraisal of readiness. Quantification of Index of Readiness content validity was established through the ratings of 10 experts, following criteria established by Imle and Atwood (1988). The instrument was tested in successive steps with 146 individuals who were participating in an outpatient cardiac rehabilitation program, for reliability and validity, including internal consistency reliability, and three forms of validity assessment (content validity, criterion-related validity, and construct validity). The three subscales of Reevaluation of Lifestyle, Identification of Barriers, and Goal Commitment demonstrated internal consistency. Criterion-related and construct validity were substantiated. With refinement, this measure will provide a basis for nursing interventions designed to enhance individual motivation in relation to specific health behaviors.

Adult↗

The index of self-regulation: development and psychometric analysis.

This paper describes the development and initial psychometric evaluation of a measure of individual self-regulation in the maintenance of health behavior change. Items were developed from inductively generated data to index dimensions of self-regulation in behavioral change (Fleury, 1991). Quantification of Index of Self-Regulation (ISR) content validity was supported through the ratings of 10 experts, following criteria established by Imle and Atwood (1988). The instrument was tested in successive steps with 146 individuals who were participating in an outpatient cardiac rehabilitation program for reliability and validity, including internal consistency reliability and three forms of validity assessment (content validity, criterion-related validity, and construct validity). The three subscales of Stimulus Control, Reconditioning, and Behavioral Monitoring demonstrated internal consistency ranging from .73-.76. Total scale alpha was .87. Initial estimates of criterion-related and construct validity were documented with correlations between ISR subscales and theoretically related criterion measures (.20-.47). With refinement the ISR will provide a basis for tailoring and evaluating clinical interventions designed to enhance motivation in the maintenance of health behavior change.

Adult↗

[Evaluation and validation of a test of psychological distress in a general population in french Quebec].

Psychological distress scales used in epidemiologic surveys usually show high construct validity. The content validation however is less convincing since these scales rest on lists of psychiatric symptoms which are hypothesized as the very content of a psychological distress. This study presents the results of the construct and criterion validation of a new Psychological Distress Manifestations Measure Scale (PDMMS) founded on an initial list of manifestations derived from an original content validation in a general population. Twenty-three items are grouped in four oblique factors with Cronbach's alpha ranging between 0.81 and 0.89. High scores on the scale are correlated with psychoactive drugs consumption, visits to health professionals and self-evaluations of psychological health.

Adolescent↗

Evaluating peer reviews. Pilot testing of a grading instrument.

OBJECTIVE: To measure the reliability and preliminary validity of a grading instrument for editors to evaluate the quality of peer reviews. DESIGN: The consecutive sample design included 53 reviews of 23 manuscripts. Reviews were systematically assigned to interrater reliability (n = 41; power greater than 0.90 to detect a difference of greater than one point) and preliminary criterion-related validity (n = 12) subsamples. Content validity was closely examined. SETTING: Nonclinical. PARTICIPANTS: Three graders evaluated reliability. One individual examined content validity and two editors tested preliminary criterion-related validity. INTERVENTION (INSTRUMENT)--Attributes reflecting two basic dimensions, review content and format, were identified and scored (values are possible points/percent contribution): timeliness, 3/21%; grade sheet, 1/7%; etiquette, 1/7%; sectional narratives, 3/21%; citations, 2/14%; narrative summary, 2/14%; and insights, 2/14%. A scoring guide was provided. MAIN OUTCOME MEASURES: Statistical analyses used to test the interrater reliability of the total score included the intraclass correlation coefficient and analysis of variance with the expectation to uphold the null hypothesis. Kendall's coefficient of concordance was used to test preliminary criterion-related validity. RESULTS: The intraclass correlation coefficient was .84 (P < .001) and a lack of difference between mean scores was demonstrated by analysis of variance (P = .46). Content validity was confirmed and preliminary criterion-related validity was indicated (Kendall's coefficient of concordance = .94, P = .038). CONCLUSIONS: The instrument is reliable. Content validation has been completed, and further criterion-related validation is warranted.

Evaluation Studies as Topic↗

Clinical application of the satisfaction with amplification in daily life scale in private practice I: statistical, content, and factorial validity.

Statistical, content, and factorial validity of the Satisfaction with Amplification in Daily Life (SADL) scale was assessed. SADL subscales closely correspond to four satisfaction domains. Subjective benefit is a key component of satisfaction, but other nonauditory factors contribute to wearer satisfaction, notably telephone use and appearance. Results confirm the SADLs psychometric properties and verify its use to validate hearing aid fitting satisfaction in private practice settings for a general patient population at 1-year postfitting. Interim SADL norms may be refined as more SADL data are obtained for different patient populations, hearing aid types, and fitting environments.

Aged↗

Importance of expert judgment in content-related validity evidence.

The unified conceptualization of validity with regard to content-related evidence has been expressed succinctly by the authors of the Standards for Educational and Psychological Testing (AERA et al., 1985): Content-related evidence of validity is a central concern during [instrument] development, whether such development occurs in a research setting, in a publishing house, or in the context of professional practice. Expert professional judgment should play an integral part in developing the definition of what is to be measured, such as describing the universe of content, generating or selecting the content sample, and specifying the item format and scoring system. Thus, inferences about content are linked to [instrument] construction as well as to establishing evidence of validity after [an instrument] has been developed and chosen for use. (p. 11) This article has demonstrated the process of collecting content-related validity evidence in terms of the specific requirements of the Standards. Five standards were identified and interpreted according to the initial stages of instrument construction: domain specification, item development, and item, subscale, and scale content validation. The role of expert judgment during these stages and the variety of evidence that can be gathered were described. For most instruments, the review process would necessitate two meetings of 1 to 2 hours each to review the domain specifications and another two meetings to determine the match between the items and the specifications. The importance of these 8 hours or whatever additional time is needed to obtain the validity evidence was emphasized. Finally, an application of the Standards was provided to illustrate step-by-step how the judgmental review process can be planned and executed.

Acquired Immunodeficiency Syndrome↗

The validity and reliability of the World Health Organization Mental Disorders Checklist for use in a telehealth clinic in Hong Kong.

This research aimed to test the validity and reliability of the 'World Health Organization Mental Disorders Checklist' for use in a telehealth clinic in Hong Kong. The Checklist adopted four subscales: (i) depression; (ii) anxiety; (iii) alcohol use disorders; and (vi) functioning and disablement, and was translated from English into Chinese. It was validated by a panel of five experts to confirm its content validity (content validity index = 0.98) and cultural appropriateness in Hong Kong. The reliability of the checklist was supported by the findings of a test-retest procedure (Pearson correlation = 0.66-0.88, P < 0.01), internal consistency reliability (Cronbach's alpha = 0.54-0.83), and interrater reliability (Kendall's coefficient of concordance = 0.58-1.00, P < 0.01) involving a sample of 197 subjects from one telehealth clinic in Hong Kong.

Activities of Daily Living↗

Testing the Health Practices in Pregnancy Questionnaire-II.

OBJECTIVE: To revise and test a 34-item self-administered questionnaire that measures health practices important to pregnancy outcome. DESIGN: Three studies were conducted: a content validity study with nurse experts, a content validity study with pregnant women, and a cross-sectional study using mailed surveys to test the reliability and construct validity of the Health Practices in Pregnancy Questionnaire-II (HPQ-II). SETTINGS: Nurse-midwifery and obstetric physician practices. PARTICIPANTS: Clinical experts (n = 8) and pregnant women (n = 10 for Study 2; n = 312 for Study 3). MAIN OUTCOME MEASURE: The HPQ-II, a self-report instrument that measures pregnancy health practices. RESULTS: Content validity was established with two reviews of the HPQ-II conducted by clinical experts and pregnant women and by a satisfactory Content Validity Index. Construct validity was supported by statistically significant correlations with a measure of prepregnancy health practices, scores on individual prepregnancy health practice items, and a theoretically related measure of women's attitudes toward their pregnancies and babies. Reliability (internal consistency) was satisfactory. CONCLUSIONS: This instrument promises to be useful in research and practice involving health practices during pregnancy.

Adolescent↗

Standards for validating health measures: definition and content.

Adherence to standards for judging the content validity of health measures and for labeling them is needed for the field of health assessment to proceed in an orderly fashion. This paper discusses the dimensionality of health and the range of health states that can be measured within each dimension. These two attributes of published definitions of health are used to derive minimum standards for judging the validity of health measures in terms of their content. Five generic health concepts are defined: physical health, mental health, social functioning, role functioning, and general health perceptions. Items from widely used health measures are presented to clarify distinctions among these concepts and the different health states they encompass. It is recommended that labels be assigned to health measures in a manner consistent with their content and other evidence of validity.

Health Status Indicators↗

Robinson Bashall Functional Assessment for arthritis patients: reliability and validity.

The Robinson Bashall Functional Assessment (RBFA) for arthritis patients has four scales: self-care, ambulation, transportation, and activity tolerance. Criticism has been directed at the Assessment because it is relatively time consuming and requires a trained professional to conduct it. Tests of reliability revealed that the internal consistency of the total Assessment was moderate, interrater reliability was high, and test-retest reliability ranged from moderate to high. Analysis of scale validity (content, clinical, concurrent, and discriminant validity) showed content validity to be low to moderate. Therapists found the scales more useful in identifying patient problems than in assessing improvement in function over time. There were low positive correlations between dressing, undressing, and ambulation scores and ROM scores on admission. Correlations between the American Rheumatism Association Functional Classification and scales of the RBFA were significant, while the Assessment as a whole and all four scales discriminated significantly between the functional abilities of patients on admission and discharge.

Activities of Daily Living↗

Quality-of-life assessment in respiratory disease: an examination of the content and validity of four questionnaires.

Four recent questionnaires for measuring the quality of life of patients with respiratory disease (Chronic Respiratory Disease Questionnaire, St George's Respiratory Questionnaire, Living with Asthma Questionnaire, and Asthma Quality of Life Questionnaire) differ in the content and style of the items used. Differences in content arise over the use or emphasis on symptom items, functional limitation (activity) items, and emotion items. These differences stem in part from the different methods used for item selection and refinement, which include selecting the most 'important' items, qualitative analysis for clarity, ratings of distress, and psychometric analysis. Despite these differences, there is considerable evidence for content validity of all four questionnaires. Because quality of life is so poorly developed as a theoretical construct, the demonstrable statement that all 4 questionnaires have construct validity provides little information about the questionnaires.

Humans↗

Developing and testing of the Foot Care Confidence Scale.

This study developed and tested the Foot Care Confidence Scale (FCCS), an instrument designed to measure the confidence (self-efficacy) diabetics have in performing foot self care. Content validity was assessed using Lynn's (1986) Content Validity Index (CVI) with a total of 100% content validity (Sloan, 1993). The FCCS was administered to four persons with diabetes (Sloan, 1994) and pilot tested with 41 healthy older adults (Wills & Sloan, 1995). Based on the feedback from the pilot testing and CVI panel of judges, as well as additional literature review, the instrument was revised. A study involving 122 community-dwelling older adults with a diagnosis of diabetes for five or more years was conducted. The FCCS had a Cronbach's alpha of 0.92. Factor analysis revealed that all 12 items loaded on one factor and all 12 items are needed to measure confidence to care for one's feet. The FCCS is a practical instrument for use in many settings, especially where time constraints exist. It may assist the nurse in evaluating and improving outcomes of self care of the feet of persons with diabetes mellitus.

Adult↗

Reliability and validity of the Pressure Management Inventory in a Malaysian population.

There is a general lack of valid tools to measure work stress of Malaysian. This study examines the validity and reliability of the Pressure Management Inventory (PMI). Reliability was evaluated using test retest method, and its correlation coefficient was calculated using Pearson's r. Internal consistencies were examined using Cronbach's Alpha. For precision, the Intraclass coefficients (ICC) were calculated for all the scales. Face Validity and Content Validity were assessed using an open-ended questionnaire on 6 content experts (psychiatrists in HKL). The results show good internal consistencies (alpha < or = 0.7) for most subscales, with the best results in the 'Pressure Scale'. The weak scales are 'Individual-Differences' scale and 'Social Support' scale. The test-retest correlation coefficients were significant at the level of p<0.001 for all, except one scale. The ICC coefficients were high (>0.7) for most scales, particularly for Pressure, Health and Coping Scales. The PMI is a suitable, reliable and valid tool to measure stress of Malaysians. More in-depth study with a wider sampling needs to be carried out to add confidence of its usage on Malaysians.

Adolescent↗

Validation of performance indicators for rehabilitation of workers with mental health problems.

OBJECTIVE: The objective of this study was to evaluate content validity and predictive validity of 11 performance indicators for the rehabilitation of workers with mental health problems. RESEARCH DESIGN AND SUBJECTS: Content validity was assessed by experts who evaluated the validity of the performance indicators in 2 Delphi rounds. Predictive validity was evaluated by relating the performance indicators and their sum score to the outcome of a cohort of 191 employees absent from work as a result of mental health problems. Scores for the performance indicators were obtained by processing registration forms of consultations filled out by occupational physicians. MAIN OUTCOME MEASURES: Three outcome measures were used: time to return to work, change in level of fatigue, and patient satisfaction. RESULTS: Ten of the 11 performance indicators showed adequate content validity according to the expert panel. The evaluation of predictive validity yielded mixed results. One performance indicator did not show sufficient variability and was excluded from further analysis. The sum score of 9 performance indicators and performance on the evaluation of work disabilities were significantly related to a shorter time to return to work (hazard ratio [HR], respectively, 0.7; confidence interval [CI], 0.7-0.9 and 0.5; CI, 0.2-0.9). Adequate care regarding interventions aimed at providers of care in the curative sector was related to a longer time to return to work (HR, 1.8; CI, 1.1-3.0). The linear regression revealed that the sum score was not significantly related to a change in level of fatigue. However, lower quality of overall care was significantly related to moderately higher patient satisfaction (beta=0.18; P<0.05). CONCLUSIONS: The evaluated performance indicators showed sufficient content validity and overall predictive validity, but no clear relation could be established between individual performance indicators and outcome.

Adult↗

Assessing advance care planning readiness in individuals with kidney failure.

The purpose of this study was to initiate development of an instrument to assess readiness of patients to discuss advance care plans. The first step of the development of the instrument involved the generation of a 49-item pool representative of the grounded theory of personal preservation (Calvin, 2004). The second step was to assess the content validity of the items using both a professional panel of four experts in end-of-life care and a patient panel of five persons currently being treated with hemodialysis in an inpatient setting. The third step was to pilot test the resultant 30-item instrument with another sample of 10 patients on hemodialysis. The instrument showed preliminary evidence of content validity (overall content validity index = 0.90) and internal consistency reliability of the scale (Cronbach's alpha = 0.73).

Adult↗

Diagnosis in adolescent inpatients: diagnostic confidence and comparison of diagnoses using ICD-9 and DSM-III.

In a prospective Multi-Centre research study involving four British Adolescent Psychiatry Inpatient Units, all 276 adolescent admissions were diagnosed using both ICD-9 and DSM-III. Ratings of diagnostic confidence for each diagnostic group varied considerably. Clinicians recorded high levels of confidence in the diagnosis of both Schizophrenia and Anorexia nervosa, while considerably lower scores were noted for Adjustment Disorders (ICD-9 3-digit code 309.), and for Emotional Disorders (ICD-9 3-digit code 313.). Exact concordance in diagnoses made for each case using both ICD-9 and DSM-III occurred in 72% of the entire cohort. The dissimilar concordance rates comparing ICD-9 and DSM-III diagnoses for the same patient admissions suggest differences in validity measures, such as face validity and content validity, in the reliability of diagnostic criteria between similarly named disorders across the two systems, and in the clinician's training and attitude to diagnosis. With the recent introduction of DSM-IV following upon ICD-10, further comparative studies are needed to examine both reliability and validity issues into diagnosis and classification in child and adolescent psychiatry.

Adolescent↗

An index of scientific quality for health reports in the lay press.

Although the quality of health reporting has been criticized for being unscientific, evaluations of health care reporting have been limited by the lack of a reliable and credible measure of scientific quality. We developed an index of scientific quality (ISQ) for health-related news reports and tested its reliability and sensibility. Items were generated from a survey of the literature and experts in research methodology. Items that were unclear, confusing or discriminated poorly between articles of high and low scientific quality were revised or deleted in an iterative process wherein potential criteria were independently applied to samples of 5 to 15 articles by 6 raters. To test the reliability of the final criteria 60 articles were drawn from three sampling frames: newspapers, magazines, and professional journals. Articles were intentionally selected to obtain a wide range of quality and topics. Two categories of raters were used: research assistants and physicians with research training. All 6 raters assessed all 60 articles. The sensibility of the index was tested by a questionnaire with 13 items related to face validity and content validity as well as other aspects of sensibility. The questionnaire was completed by 20 researchers and 13 health and science writers. The final ISQ includes 7 items that address the extent to which a report allows readers to draw conclusions about the applicability, validity and practical importance of the information that is reported. Chance corrected agreement (kappa) among all 6 raters for overall scientific quality was 0.62 (SE 0.02). The index was found to be sensible with only one major problem, the need for judgment in making ratings. While some degree of subjectivity appears to be inevitable in rating the scientific quality of health reports, the ISQ is acceptable reliable and credible and should be useful for evaluating and improving the scientific quality of health reporting.

Evaluation Studies as Topic↗

Cross-cultural adaptation of the Diabetes Management Self-Efficacy Scale for patients with type 2 diabetes mellitus: scale development.

BACKGROUND: As a profession, nurses are particularly concerned with cross-cultural influences that affect the health practices of populations. Although the international literature describes questionnaires and specific scales in health and disease behaviours, adequate Turkish-language instruments are scarce. Therefore, suitable Turkish-language instruments need to be developed or adapted for the Turkish population. OBJECTIVES: Study aim was to adapt a Dutch/English version of the diabetes management self-efficacy (SE) scale for use with a Turkish population and evaluate its psychometric properties. DESIGN: Methodological research design. SETTINGS: Attendants of an outpatient clinic of a university hospital in Turkey. PARTICIPANTS: A convenience sample of 110 patients with type 2 diabetes mellitus (DM). METHODS: Translation and back-translation of the original English instrument and content validation through a expert panel were the first two steps of the study. Third step was the psychometric testing of the adapted instrument by establishing internal consistency (Cronbach's alpha), stability (test-retest reliability), and construct validity (factor analysis). RESULTS: Content validity procedure resulted in a final scale that consisted of 20 items. Internal consistency of the total scale was coefficient alpha=0.88, and test-retest reliability with a 4-week time interval was r=0.91 (p<0.001). Factor analysis yielded three factors related to diet, exercise and medical treatment. Two relevant items of the scale, weight control and blood sugar control, however, had low reliability and validity scores. CONCLUSIONS: Although acceptable levels of reliability and validity of the Turkish version of the diabetes management SE scale for people with type 2 DM were reached, cultural factors appeared to play a role in the applicability of some items of the scale.

Analysis of Variance↗