Abstract
BackgroundPositive mindset (PM) is an important domain of health-related quality of life in Singapore, a multi-ethnic urban city state in Southeast Asia. We therefore developed and calibrated a novel item bank to measure and improve PM.MethodsWe developed an initial candidate pool of 48 items from focus groups, in-depth interviews and existing instruments locally developed and validated for use in Singapore. We administered all items in English to a multi-stage sample stratified for age and gender, of subjects with and without medical conditions recruited from the community and a hospital, and calibrated their responses using Samejima’s Graded Response Model. We evaluated a final 36-item bank with respect to Item Response Theory (IRT) model assumptions, model fit, differential item functioning (DIF), concurrent and known-groups validity.ResultsAmong 493 participants (49.3% male, 41.6% above 50 years old, 33% Chinese, Malay and Indian), bifactor model analyses supported unidimensionality: explained common variance of the general factor was 0.86 and omega hierarchical was 0.97. Local independence was deemed acceptable: the average absolute residual correlations were <0.06 and 3.3% of the total item-pair residuals were flagged for local dependence. The overall model fit was adequate and provided good coverage of the PM construct (theta range: -3.6 to +2.4). Five items exhibited DIF with respect to ethnicity and gender, but were retained without modification of scores because they measured important aspects of PM. Scores correlated in the hypothesized direction with a self-reported measure of global health (Spearman’s rho = -0.28, p<0.001) and discriminated between groups of participants with and without a self-reported diagnosis of a mood disorder (p = 0.007) adjusting for age, gender, ethnicity, education and marital status.ConclusionThe 36-item PM item bank demonstrated satisfactory psychometric properties for the English-speaking Singaporean population. IRT model assumptions were sufficiently met and scores showed concurrent and known-groups validity. Future studies to evaluate the validity of PM scores when items are administered adaptively are needed.
Highlights
The World Health Organization (WHO) states that health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.[1]
The development of a Positive mindset (PM) item bank is a foundation for measuring PM and will enable development of short static instruments or computer adaptive testing (CAT) to measure PM as a latent construct
See Table 3. ¥ Minimum omega Hierachical (OmegaH) attained among three exploratory bifactor models
Summary
The World Health Organization (WHO) states that health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.[1] PM is defined as thinking positively in life.[2] static instruments have been developed, we were not able to identify an item bank measuring this latent construct. In contrast PM refers to the amount of optimism one has.[3] Being able to measure the magnitude of how an individual thinks positively in life will allow interventions to be created and reduce the negative impact of poor PM.[8] with the high prevalence of mental health conditions, the ability to maintain a PM may reduce the number of patients with mental health conditions.[9] The development of a PM item bank is a foundation for measuring PM and will enable development of short static instruments or computer adaptive testing (CAT) to measure PM as a latent construct. We developed and calibrated a novel item bank to measure and improve PM
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