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[Model development in nursing science; the construction of a theoretical model].

The aim of the paper is to describe the development of nursing theory. As an example, a theoretical model of the compliance of young diabetics and related factors is built. The content of the theoretical model is not described but the process of developing the model is presented. In the first phase, a hypothetical model of young diabetics' compliance was developed inductively. The data were collected by interviewing 51 young diabetics aged 13-17 years, by observing the behaviour of 18 of these young people during an adaptation course and by analysing their drawings (N = 17). The data were analysed by using continuous comparative analyses and content analyses. In the second phase, an instrument for testing the model was developed. For this purpose, data were collected with a questionnaire from young diabetics aged 12-17 years (N = 91). The content validity, construct validity and reliability of the instrument turned out to be quite good. In the third phase, the hypothetical model was tested and developed further by using LISREL (linear structural relations) analyses. The data were collected with a questionnaire from young diabetics aged 13-17 years (N = 346). In the fourth phase, the model was expanded using the qualitative data (N = 51). The categories which had been discovered by continuous comparative analyses were quantified. The data were analysed by cross-tabulation, the chi square test and discriminant analyses. A summary of the results has been presented by building a theoretical model of young diabetics' compliance and related factors.

Adaptation, Psychological↗

Validity and reliability of a behavior-based food coding system for measuring fruit, 100% fruit juice, vegetable, and sweetened beverage consumption: results from the Girls Health Enrichment Multisite Studies.

BACKGROUND: This paper presents the rationale, reliability, and validity of a behavior-based food coding system for measuring fruit (F), juice (J), vegetable (V), sweetened beverage, and water consumption in children. METHODS: Coding algorithms for FJV, sweetened beverages, and water were developed for use with the Nutrition Data System for Research (NDS-R). Two hundred and ten 8- to 10-year-old African American girls at four field centers completed two 24-h dietary recalls at baseline and at 12 weeks follow-up after a weight gain prevention intervention. Differences in mean baseline consumption of selected food variables and other selected nutrients across the four field centers were analyzed. Intraclass correlation coefficients (ICCs) for reliability across 2 days of food recalls and 12-week test-retest reliability correlations were calculated. For the purposes of this paper, nutrient intake estimates were considered construct validators of food intake, and validity was assessed by correlating the coded food variable servings with nutrient intake. RESULTS: ICCs varied from zero (0.001 for beta carotene equivalents) to moderate (0.44 for sucrose), indicating substantial instability in consumption or reporting. Twelve-week test-retest correlations were slight to moderate (0.09 for lycopene to 0.49 for folate). FJV consumption was negatively related to percent energy from fat (r = -0.28; P = 0.001) and positively related to other nutrients. Sweetened beverage consumption was positively related to energy, sucrose, fructose, and vitamin C consumption. CONCLUSIONS: This behavior-based food coding system demonstrated construct validity among 8- to 10-year-old African American girls and can measure the desired food groups.

Black or African American↗

Quality of life at the initiation of maintenance dialysis treatment--a comparison between the SF-36 and the KDQ questionnaires.

OBJECTIVE: To evaluate the construct validity of the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) and to assess the quality of life of patients with end-stage renal disease (ESRD) at the initiation of maintenance dialysis treatment. METHODS: Cross-sectional study. SETTING: Eight ambulatory dialysis units in São Paulo city, Brazil. STUDY PARTICIPANTS: Eighty ESRD patients at the initiation of chronic dialysis program and consecutively accepted for treatment in selected units in 1998. MAIN OUTCOME MEASURES: Quality of life as measured by the dimensions of the SF-36 questionnaire. The 'Kidney Disease Questionnaire' was used in a subgroup of patients to evaluate the validity of the SF-36. RESULTS: Median (range) scores of the SF-36 dimensions (ranging from 0 to 100, higher scores representing better quality of life) were: Physical Function 70 (0-100), Role Limitations due to Physical Problems 25 (0-100), Bodily Pain 62 (0-100), General Health 57 (5-100), Vitality 55 (10-100), Social Function 63 (0-100), Role Limitations due to Emotional Problems 34 (0-100) and Mental Health 68 (0-100). SF-36 dimensions correlated significantly with those of the 'Kidney Disease Questionnaire' (correlation coefficients ranging from 0.23 to 0.68). CONCLUSIONS: The SF-36 was shown to have construct validity when used in patients with ESRD in Brazil. The quality of life of ESRD patients is impaired at the initiation of dialysis treatment and this was clearly evidenced in the Role Limitations due to Physical Function and Emotional Function items. Greater attention should be given to interventions that could improve the quality of life parameters at the initiation of dialysis treatment.

Adult↗

Development and validation of an instrument to measure asthma symptom control in children.

BACKGROUND: Few instruments exist to measure control of asthma symptoms in children. A brief instrument administered at healthcare visits could provide a more consistent approach to symptom recognition for patients and providers. OBJECTIVE: To develop a Pediatric Asthma Control Tool to measure asthma symptom control at pediatric healthcare visits and evaluate the instrument compared to expert assessment and an asthma-related quality-of-life (QOL) measure. DESIGN/METHOD: A preliminary 14-item instrument was generated through a process of literature review, meetings of institutional experts, and focus groups of parents and providers. The preliminary survey measured asthma control over the past 3 months in 2 domains: frequency of asthma flares and presence of symptoms when the child was at their best. Persistent symptoms were categorized according to published national asthma guidelines (NAEPP). The instrument and an asthma-related QOL measure were administered in the waiting room before a specialist visit for asthma. After the visit the specialist independently assessed asthma control in both domains on a 7-point Likert scale. Internal consistency and assessments of criterion and construct validity were calculated using standard statistics. RESULTS: A total of 200 subjects ranging from 1 to 18 years of age and their caregivers were enrolled; 60% were male. During the prior 3 months, 19% had an emergency visit and 24% described persistent asthma symptoms. After item review the instrument was shortened to five items each for frequency of flares and symptoms at best. Internal consistency was high for each of these domains (Cronbach's alpha = 0.81/0.83, respectively). Correlation of each domain was good when compared to expert assessment (r = 0.54/0.59) and QOL (r = 0.61/0.77). CONCLUSIONS: Responses to a 10-item instrument to measure control of asthma symptoms in children at a healthcare visit demonstrated internal consistency and criterion and construct validity.

Adolescent↗

Testing technical skill via an innovative "bench station" examination.

BACKGROUND: A new approach to testing operative technical skills, the Objective Structured Assessment of Technical Skill (OSATS), formally assesses discrete segments of surgical tasks using bench model simulations. This study examines the interstation reliability and construct validity of a large-scale administration of the OSATS. METHODS: A 2-hour, eight-station OSATS was administered to 48 general surgery residents. Residents were assessed at each station by one of 48 surgeons who evaluated the resident using two methods of scoring: task-specific checklists and global rating scales. RESULTS: Interstation reliability was 0.78 for the checklist score, and 0.85 for the global score. Analysis of variance revealed a significant effect of training for both the checklist score, F(3,44) = 20.08, P <0.001, and the global score, F(3,44) = 24.63, P <0.001. CONCLUSIONS: The OSATS demonstrates high reliability and construct validity, suggesting that we can effectively measure residents' technical ability outside the operating room using bench model simulations.

Clinical Competence↗

Stressful life events and Rorschach content.

This study investigated the construct validity of Elizur's (1949) Rorschach Content Test anxiety score. The study compared the Rorschach protocols of subjects experiencing high and low life-stress conditions. The Rorschach test was administered to 56 college students, half men and half women, who were selected from a larger group on the basis of their extreme scores on a measure of stressful life events, the College Schedule of Recent Experience (Anderson, 1972). Subjects in the high stress condition responded to the Rorschach with significantly (p less than .05) more anxious content than did subjects in the low stress condition. The findings of the study add support to the construct validity of Elizur's anxiety score. Implications for future research are discussed.

Adolescent↗

Assessment of smoking urge and its concomitants under an environmental smoking cue manipulation.

The construct validity of smoking urge was examined through investigation of the effects of an environmental smoking cue manipulation on subjective smoking urge ratings and on the physiological, behavioral and cognitive responses hypothesized to relate to smoking urges. Forty-eight moderate cigarette smokers served as participants. All participants underwent an exposure to smoking cues condition and a nonexposure condition. Order of conditions was counterbalanced across participants. Results indicated that measures of physiological response, cognitions, and behavior vary with urge to smoke. Higher physiological indices and closer association between specific cognitive measures and smoking urges occurred under the cue exposure manipulation. Results were interpreted as preliminary data supporting the construct validity of smoking urge.

Blood Pressure↗

Attention, autonomic arousal, and personality in behaviorally disordered children.

This study assessed the construct validity of the Revised Behavior Problem Checklist (RBPC) by measuring attention, autonomic arousal, and personality in 40 behaviorally disordered children aged 7 to 15 years. Conduct Disorder and Socialized Aggression subscales were characterized by high Psychoticism, Impulsivity, and Lie personality scores, by lower heart rate levels, and by more errors on a continuous performance reaction-time task. Conversely, Attention Problems, Anxiety Withdrawal, and Motor Excess were characterized by greater variability in reaction times. Conduct Disorder alone was related to an external locus of control, while only Attention Problems was characterized by low scores on the WISC Freedom from Distraction factor. These differential relationships suggest (a) support for the construct validity of the RBPC, (b) that antisocial behavior and hyperactivity/attention deficits are dissociated disorders, and (c) that hyperactivity/attention deficits may be characterized by fluctuations in the allocation of attentional resources rather than a core structural deficit in attention.

Adolescent↗

Psychometric evaluation of the Readiness for Discharge Questionnaire.

OBJECTIVE: The Readiness for Discharge Questionnaire (RDQ) was developed as an easy to use tool for assessing readiness for discharge, independent of socio-economic factors, for inpatients with schizophrenia. The psychometric properties of the RDQ are described. METHODS: The RDQ consists of 6 items assessing suicidality/homicidality, control of aggression/impulsivity, activities of daily living, medication-taking, delusions/hallucinations interfering with functioning and global status. A final yes/no question assesses readiness for discharge. Data derived from 3 studies (500 patients in 3 countries) were used in analyzing inter-rater and test-retest reliability, content and construct validity, and sensitivity to change. RESULTS: The inter-rater reliability was high for all items of the RDQ (reliability coefficients >0.9) and moderate to high for the readiness for discharge status (Session I: 84% agreement, kappa 0.39, polychoric correlation r=0.81; Session II: 89% agreement, kappa 0.63, polychoric correlation r=0.81. Test-retest reliability was also high for all items of the RDQ (reliability coefficients >0.9) and the readiness for discharge status (kappa=0.743; tetrachoric correlation r=0.819). Overall, 84% of the raters agreed (mean score=5.0 of possible 6.0) that the RDQ was useful in assessing a patient's readiness for discharge from the hospital. Evidence of good construct validity included significant correlations with PANSS total and factor scores, and a significant relationship with actual discharge. Significantly more patients with symptom improvement were judged ready for discharge (compared to those without symptom improvement), indicating that the RDQ was sensitive to change over time. CONCLUSIONS: The RDQ has favorable reliability and validity properties, and is an easy to use instrument in research studies for assessing readiness for discharge of inpatients with schizophrenia. Additional work in naturalistic settings is required to further validate the instrument for routine clinical use.

Activities of Daily Living↗

Clinical scales for the assessment of spasticity, associated phenomena, and function: a systematic review of the literature.

PURPOSE: To characterise clinical assessment methods for spasticity and/or its functional consequences in clinical patient populations at risk to suffer from spasticity. METHOD: Systematic literature search and manual-based two-step review process of psychometric properties of clinical assessment scales for spasticity and associated phenomena, as well as of functional scales with an association with spasticity. Reviewed psychometric properties included internal consistency, interrater, intrarater as well as retest reliability, construct validity, ecological validity, and responsiveness. RESULTS: Until May 2003 electronic database searches established a reference pool of 4151 references of which 90 references contributed to the review objectives. An additional 20 references were identified by an informal reference search. Twenty-four clinical scales that assess spasticity and/or related phenomena as well as 10 scales for 'active function' and three scales for 'passive function' with an association with spasticity could be identified. Some evidence signals that a high interrater reliability of the Ashworth and modified Ashworth scales can be achieved, however not in all circumstances. For many scales, reliability data is, however, missing. This is especially true for test retest reliability. Information about construct validity can promote our understanding of what individual scales are likely to assess. Many scales have been able to document changes after therapeutic intervention. CONCLUSIONS: The collated evidence can guide our clinical decision about when to use which scale and can promote evidence-based assessment of spasticity and related clinical phenomena.

Adult↗

The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading.

A method for assessing disease severity of atopic dermatitis (AD) in children has been developed for population-based research. Based on an index first described by Rajka and Langeland in 1989, disease severity is determined by evaluating the three elements of clinical course, disease intensity and extent of examined AD. This paper describes development of the index for use in epidemiological studies based on a community-based study of 290 pre-school children (aged 1-5 years). Construct validity of the index was evaluated with respect to clinical severity assessment according to a dermatologist, parental severity assessment, use of topical corticosteroids and impairment of quality of life. The severity distribution of AD in this community-based sample of children was: mild 82% (n = 237), moderate 12% (n = 36) and severe 6% (n = 17) according to this new index. In this sample 24% of children had suffered from AD of more than 9 months duration in the preceding 12 months, 4.5% had experienced significant sleep loss (6 or more nights of average sleep loss per week over 12 months) and 11% had experienced widespread extent of involvement (more than 10 body sites involved). Construct validity of the index was demonstrated for clinical and patient-derived severity assessment. This included a comparison between the new index and a global severity assessment by a dermatologist in which exact agreement was achieved in 88% of the cases. A small subgroup of children suffering from persistent localized forms of AD (discoid pattern, hand/ foot dermatitis, perioral dermatitis), who reported considerable morbidity, was identified using quality of life measures of severity; they would otherwise have been misclassified by the dermatologist or new index. Preliminary use of the Nottingham Eczema Severity Score would support further development as a research tool for a simple assessment of disease severity that could be used in epidemiological studies. Further validation is required with respect to use in older children, administration by researchers/health professionals and development as a wholly questionnaire-based assessment.

Administration, Topical↗

Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients.

This report summarizes findings related to the psychometric properties (internal consistency and construct validity) of the Pittsburgh Sleep Quality Index (PSQI) and discusses issues related to its use based on data from two clinical studies with diverse samples of cancer patients. Subjects completed a questionnaire that included the PSQI, the Schwartz Cancer Fatigue Scale, and specific demographic, disease, and treatment variables. There were complete data on 170 (of 214) cases in Study 1 and 249 (of 259) cases in Study 2. The Cronbach's alpha for the Global Sleep Quality scale was 0.81 in Study 1 and 0.77 in Study 2 A comparison of Global Sleep Quality in two contrasting groups with low and high fatigue yielded statistically significant differences in both samples. Psychometric evaluation supports its internal consistency reliability and construct validity. However, the scoring is rather cumbersome and raises questions regarding level of measurement and appropriate analysis techniques.

Benchmarking↗

Assessment of strategies in families tested by Finnish families.

The aim of this paper was to describe testing a Finnish version of the assessment of strategies in families (ASF) instrument and its construct validity and reliability in Finnish families. The ASF instrument is based on Friedemann's framework of systemic organization and the version used in this study consists of 25 items, each containing three statements. The instrument was developed to estimate family functioning in reaching the four targets of the framework of systemic organization. It provides sub-scores for the targets, family stability (system maintenance and coherence), family growth (system change and individuation), control (system maintenance and system change) and spirituality (individuation and coherence). Data were collected from patients attending the outpatient clinics of pulmonary and rheumatic diseases (N=196). Questionnaires were given to patients capable of understanding the questions and they returned questionnaires by mail directly to researchers. Construct validity was tested with exploratory factor analysis. Factor analysis was done with 22 items. The four factor solution was best suited. Two items were eliminated because of low factor loadings and crossloading. The total of 20 items were left in the instrument. Crohnbach's alpha was used to measure internal consistency. It was computed for each target separately and the total tool. There were discrepancies in the assignment of process dimensions which were expected because of cultural perceptions. The total instrument had a reliability of 0.85. The result of the analyses was a pretested tool with subscales for stability, growth, control and spirituality that have acceptable reliability and concept validity. Less satisfactory was the small number of items representing individuation. Another weakness is the lack of statistical distinction between system maintenance and coherence. The instrument is also usable in these subscales, but it needs further development and retesting. Items need to be added to express individuation, possibly some others. The new items will be formulated freely, paying attention to culture. However, the tool appears good enough to be used as measurement in various research studies.

Adaptation, Psychological↗

Comparison of algometry and palpation in the recognition of temporomandibular disorder pain complaints.

AIMS: To determine the construct validity of algometry and to compare it with that of palpation, and to compare tenderness of masticatory muscle sites and the temporomandibular joint (TMJ) on palpation and on algometry. METHODS: Two hundred fifty subjects, 148 with temporomandibular disorder (TMD) pain complaints, underwent a standardized blinded physical examination that included pain-intensity measures on palpation and pressure pain threshold measures on algometry of masseter muscle sites, temporalis muscle sites, and the TMJ. RESULTS: Logistic regression analysis indicated that the recognition of TMD pain complaints based on pressure algometry was comparable to that of palpation (R2 = 0.22 and R2 = 0.21, respectively). The masseter muscles were most tender to palpation and algometry, followed by the TMJs and the temporalis muscles. CONCLUSION: Construct validity of algometry in the recognition of TMD pain complaints is comparable to that of palpation, and differences in tenderness on palpation and on algometry are found between masticatory muscle sites and the TMJ.

Adult↗

Translation, adaptation and validation of the Roland-Morris questionnaire--Brazil Roland-Morris.

The purpose of the present study was to translate the Roland-Morris (RM) questionnaire into Brazilian-Portuguese and adapt and validate it. First 3 English teachers independently translated the original questionnaire into Brazilian-Portuguese and a consensus version was generated. Later, 3 other translators, blind to the original questionnaire, performed a back translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of 3 rheumatologists and the final Brazilian version was established (Brazil-RM). This version was then pretested on 30 chronic low back pain patients consecutively selected from the spine disorders outpatient clinic. In addition to the traditional clinical outcome measures, the Brazil-RM, a 6-point pain scale (from no pain to unbearable pain), and its numerical pain rating scale (PS) (0 to 5) and a visual analog scale (VAS) (0 to 10) were administered twice by one interviewer (1 week apart) and once by one independent interviewer. Spearman's correlation coefficient (SCC) and intraclass correlation coefficient (ICC) were computed to assess test-retest and interobserver reliability. Cross-sectional construct validity was evaluated using the SCC. In the pretesting session, all questions were well understood by the patients. The mean time of questionnaire administration was 4 min and 53 s. The SCC and ICC were 0.88 (P<0.01) and 0.94, respectively, for the test-retest reliability and 0.86 (P<0.01) and 0.95, respectively, for interobserver reliability. The correlation coefficient was 0.80 (P<0.01) between the PS and Brazil-RM score and 0.79 (P<0.01) between the VAS and Brazil-RM score. We conclude that the Brazil-RM was successfully translated and adapted for application to Brazilian patients, with satisfactory reliability and cross-sectional construct validity.

Brazil↗

[A study on standardization of the Five-Factor Personality Inventory for Children (FFPC)].

The purpose of this study is to construct and standardize the Five Factor Personality Inventory for Children (FFPC). Fifty items were chosen through two preliminary surveys. Then the 50-item questionnaire was administered to 3,386 primary school children. Based on the results of principal component analysis, 40 items were selected for the FFPC final version. The mean scores, standard deviations, and score distributions of the five-factor scales were computed. One sample of 215 children was tested twice, the interval being 9 weeks. The test-retest correlations ranged between .778 and .854. Scale scores correlated with teacher nominations of the various kinds of personality. The FFPC five-factor scales were shown to have high internal consistency and test-retest reliability. The factorial validity, construct validity, and concurrent validity were also confirmed.

Child↗

Use of the SF-12 instrument for measuring the health of homeless persons.

OBJECTIVE: To evaluate the construct validity of the Short Form 12-item Survey (SF-12) among users of a homeless day shelter. Adding brief health assessments has potential to provide information regarding the effect that programs have upon the health status and functioning of homeless persons. STUDY SETTING: A convenience sample of 145 homeless persons at a day shelter in an urban setting. STUDY DESIGN: Participants were verbally administered the SF-12 that provides information on mental and physical health status and the Dartmouth Improve Your Medical Care Survey (IYMC) that provides information on functional health, clinical symptoms, medical conditions, and health risk. The IYMC survey system has been widely used in clinical settings to assess health status and the outcomes of care. DATA COLLECTION/EXTRACTION METHODS: Construct validity was assessed by the following approaches: (a) the method of extreme groups was used where multivariate analysis of variance determined if SF-12 summary scores varied for individuals who differed in self-reported clinical symptoms and medical conditions, and (b) convergent validity was assessed by correlating SF-12 summary scores with the subscales. PRINCIPAL FINDINGS: Four to 10 point differences in physical health (PCS12) and 5-11 point differences in mental health (MCS12) were found between those who reported acute symptoms and medical conditions and those who did not. A 13-point difference in PCS12 scores and a 7-16-point difference in MCS12 scores were found for those who reported none or few to several symptoms or conditions. The summary scores and subscales yielded satisfactory convergent validity coefficients that ranged from 0.62 to 0.88 with one exception. CONCLUSIONS: The SF-12 shows promise as a valid outcome indicator for assessing and monitoring health status among the homeless. Its strengths include brevity and availability of norms for specific medical conditions.

Adult↗

Competency standards for critical care nurses: do they measure up?

OBJECTIVE: To determine the construct validity of the Australian College of Critical Care Nurses (ACCCN) competency standards as a tool for assessing the clinical practice of specialist level critical care nurses in Australia. DESIGN: A comparative descriptive design was used to examine the relationship between the domains, competencies and elements of the ACCCN competency standards. Participants were sent a questionnaire and asked to describe on a 7-point Likert scale how closely each competency statement and related elements reflected their level of critical care nursing practice. SUBJECTS: A systematic sampling method was used to randomly select 1000 critical care nurses from a prelisting of members of ACCCN. A total of 532 completed questionnaires were returned. MAIN OUTCOME MEASURE: The purpose of this study was to determine the construct validity of the ACCCN competency standards by examining two structural models. The first examined how well the descriptive elements fit with their respective competency standard. The second model examined how well the competency standards group together under specific domains. RESULTS: Statistically there was no support for the current structure for the ACCCN competencies because the elements did not fit uniquely to a single competency, but were multidimensional and loaded across several competencies. Competency statements also loaded across several domains. Modification of the current model resulted in the identification of a four-factor competency model, which demonstrated reasonable model fit. CONCLUSION: Several issues are highlighted, resulting in concerns regarding the validity of the ACCCN Competency Elements and Standards as a tool with which to assess the practice of critical care nurses.

Clinical Competence↗