Development and Validation of an Instrument to Measure Residents’ Social Perception of Road Cycling Events

To the Editor: With the increase in life expectancy, the number of adults aged 60 and older will increase to 2 billion by 2050, 80% of whom will be living in developing countries.1 Falling is one of the main health problems of older adults, with approximately one-third of individuals aged 65 and older experiencing falls.2 Falls and fear of falls are related to one another, with each being a risk factor for the other.3 Fear of falls may result in avoidance of daily activities and reduction in the older adult's quality of life.4, 5 The Falls Efficacy Scale—International (FES-I) is an instrument that Prevention of Falls Network Europe (ProFaNE) designed to investigate fear of falls in older adults.6 The present study was conducted to assess the reliability and validity of a Persian version of the FES-I in Iranian older adults. Individuals aged 60 and older from a retirement center in Tabriz (Iran) who were able to speak, comprehend, read, and write Persian and were living independently in the community participated (n = 200). The study was performed between October 2012 and March 2013 after approval of the ethics committee of Tabriz University of Medical Sciences. The FES-I is a self-report questionnaire with 16 items assessed on a four-item Likert scale (not at all concerned to very concerned).6 Cronbach alpha (internal consistency) and Spearman-Brown correlation coefficients (test–retest) were used to investigate reliability; values greater than 0.7 indicated good reliability, and values less than 0.5 indicated unacceptable reliability.7 To determine the validity of the construct, exploratory and confirmatory factor analysis were considered. Correlation matrix, principal axis factoring, varimax rotation, and the Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) were used for exploratory factor analysis.1 To evaluate the structure of the factors of exploratory factor analysis, goodness of fit of confirmatory factor analysis was conducted based on chi-square degrees of freedom (χ2/df) less than 5, goodness-of fit index (GFI), adjusted goodness-of-fit index (AGFI) greater than 0.9, root mean square residual (RMSR) less than 0.1, root mean square error of approximation (RMSEA) less than 0.08, comparative fit index (CFI) greater than 0.9, normed fit index (NFI) greater than 0.9, non-normed fit index (NNFI) greater than 0.9, incremental fit index (IFI) greater than 0.9, relative fit index (RFI).7 Data analysis was performed using SPSS version 11.5 (SPSS Inc., Chicago, IL). In all analyses, P < .05 was considered statistically significant. Cronbach alpha was 0.90 to 0.95 and Spearman-Brown correlation coefficients were 0.82 to 0.84 for the factors and total instrument. The adequacy of the factor analysis model was confirmed (KMO = 0.936 and for Bartlett test, χ2 of Bartlett test was 2,505.781, df 120, P < .05). In exploratory factor analysis with varimax rotation, two factors were extracted. Items 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, and 16 from the questionnaire were loaded in the first factor, and items 11, 13, 14, and 15 were loaded in the second factor. Two extracted factors determined 67.55% of total variance changes.1 In confirmatory factor analysis, based on the comparison of the data of goodness of fit for two- and one-factor analysis and theoretical basic (χ2/df < 5, RMSR < 0.1, NFI > 0.9, NNFI > 0.9, CFI > 0.9, IFI > 0.91) and the closeness of GFI and AGFI to 0.9, there was no considerable difference in these values for three models. All relationships between the items and factors were significant (P < .05). Thus, based on this model, the structure of exploratory factor analysis for this questionnaire was confirmed in two factors (Table 1). Test–retest and internal consistency reliability in accordance with previous literature were confirmed.6, 8-10 In the investigation of factor analysis in the present study and other studies, two factors were extracted, but loaded items on each factor in the studies were different.6, 10 Based on the results of this study, the Persian version of the FES-I has good validity and reliability in community-dwelling older people. This instrument can be used as an easy, low-cost method of measuring fear of falling in Iranian older adults. This article is the result of a thesis approved by the ethics committee of Tabriz University of medical sciences no. 9161. Our gratitude goes to all the older adults participating in this study, ProFANE, and the collaboration of Persian and English translators who helped us in translating the instrument. Finally, we are grateful to the staff of the Tabriz retirement center in allowing us to conduct the research there. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors contributed to this paper. Sponsor's Role: None.

PurposeThe quantitative assessment of mindful eating has been challenging, even with the latest additions to the field of multifactorial mindful eating psychometric tools. This manuscript presents the development, validity and reliability assessment of a trait and state Mindful Eating Behaviour Scale across four studies driven by recent theory (Mantzios in Nutr Health 27: 1–5, 2021).MethodsStudy 1 assessed the content validity of the scale through ratings of clinical and research experts in the field. Study 2 inspected the scale through exploratory and confirmatory factor, parallel, correlation, and reliability analyses. Study 3 assessed the temporal stability through a test–retest in a 2-week interval. Study 4 assessed the scale in a randomized control experimental design, where a mindful eating (vs. control group) received the trait scale before consuming chocolate, and an equivalent state scale was modified to assess state changes during the 10-min eating session.ResultsStudy 1 yielded items to be reflective and concise of the definition of mindful eating behaviour. Study 2 indicated 2 potential factors through exploratory factor analyses, which were further verified through a parallel analysis, while subscales correlation indicated one-dimensionality, which was further verified through confirmatory factor analysis. In addition, the internal consistency of the scale and subscales was good. Study 3 certified the reliability of the scale over time, while Study 4 indicated that both the trait and state scales were significant indicators of eating mindfully.ConclusionsTogether, all studies signal the utility of theoretically sound and empirically validated measurements for the replicable assessment of mindful eating behaviour.Level of evidence: No level of evidence: basic science.

Background: Many lifestyle modification interventions have been introduced for young elderly population (aged from 60 to 74 years) in Sri Lanka to improve their health and well-being. However, little is known about the outcome of those interventions as there is no valid tool available to measure the level of a healthy lifestyle. This study was conducted to develop and validate a new tool to assess the level of healthy lifestyle among young elderly in Sri Lanka. Materials and Methods: An operationalized definition of the healthy lifestyle was formulated. Items for the tool were identified following a literature review, key informant interviews, and focus group discussions. The content validity of the tool was ensured by the panel of experts. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore factor structure and construct validity, respectively. The internal consistency, test–retest, and interobserver reliabilities of the tool were also assessed. Results: Sixty-two items were identified initially, and they were reduced to 31 based on experts’ opinion. Out of those, 28 items were loaded into 8 factors during the EFA. The results of the CFA showed a satisfactory model fit. Internal consistency (Cronbach’s alpha &gt;0.7), test–retest, and interobserver reliabilities (Interclass correlation coefficients &gt;0.7) were also found to be satisfactory. Conclusions: The tool was named the Healthy Lifestyle Profile Scale for Elderly (HLPSE). The HLPSE is a valid and reliable tool to assess the level of healthy lifestyle among Sri Lankan young elderly.

ObjectiveThe main aim was to perform a systematic literature review of studies investigating the factor structure of the Eating Disorder Examination‐Questionnaire (EDE‐Q), a widely used measure of eating pathology. Secondary aims were to summarize the quality of reporting of latent variable (factor) analyses in these studies and review support for different factor solutions.MethodLiterature was identified through Scopus, Medline, PsycInfo, and ProQuest databases published up to February 23, 2022 and outreach via an international listserv. All studies published in English reporting factor analysis of the EDE‐Q were included with few restrictions. Sixty studies including 63,389 participants met inclusion criteria.ResultsThe originally proposed four‐factor solution received little empirical support, although few alternative models have been robustly evaluated. Items assessing shape and weight concerns frequently coalesce in factor solutions, suggesting that these constructs are closely related. Investigations of brief versions of the EDE‐Q have produced more consistent findings, suggesting that these measures, particularly a seven‐item version, might be useful alternatives to the full version. Quality of studies was reasonable, with important methodological elements of factor analysis often reported.DiscussionThe findings are of relevance to practitioners and researchers, suggesting that the “original” factor structure of the EDE‐Q should be reconsidered and that use of a seven‐item version is to be encouraged.Public SignificanceSelf‐report questionnaires are widely used in the assessment of disordered eating. The current study found that there is little consensus about the structure of a common measure of eating psychopathology. There is more consistent support for a brief, seven‐item, version assessing dietary restraint, body dissatisfaction, and overvaluation of weight and shape.

Exploratory factor analysis (EFA) is a frequently used multivariate analysis technique in statistics. Jennrich and Sampson (1966) solved a significant EFA factor loading matrix rotation problem by deriving the direct Quartimin rotation. Jennrich was also the first to develop standard errors for rotated solutions, although these have still not made their way into most statistical software programs. This is perhaps because Jennrich's achievements were partly overshadowed by the subsequent development of confirmatory factor analysis (CFA) by Jöreskog (1969). The strict requirement of zero cross-loadings in CFA, however, often does not fit the data well and has led to a tendency to rely on extensive model modification to find a well-fitting model. In such cases, searching for a well-fitting measurement model may be better carried out by EFA (Browne, 2001). Furthermore, misspecification of zero loadings usually leads to distorted factors with over-estimated factor correlations and subsequent distorted structural relations. This article describes an EFA-SEM (ESEM) approach, where in addition to or instead of a CFA measurement model, an EFA measurement model with rotations can be used in a structural equation model. The ESEM approach has recently been implemented in the Mplus program. ESEM gives access to all the usual SEM parameters and the loading rotation gives a transformation of structural coefficients as well. Standard errors and overall tests of model fit are obtained. Geomin and Target rotations are discussed. Examples of ESEM models include multiple-group EFA with measurement and structural invariance testing, test–retest (longitudinal) EFA, EFA with covariates and direct effects, and EFA with correlated residuals. Testing strategies with sequences of EFA and CFA models are discussed. Simulated and real data are used to illustrate the points.

Preterm infants often continue to have feeding difficulties after hospital discharge. Parental use of assessment tools and collaboration with health professionals are important for the early diagnosis of postdischarge feeding difficulties. This methodological study examined the validity and reliability of the Turkish version of the Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding in postdischarge preterm infants in Türkiye. A Turkish version of the NeoEAT-Bottle-feeding was developed and applied to 321 mothers of preterm infants younger than 7 months of corrected age between August 2021 and December 2022. Cronbach's alpha, exploratory factor, confirmatory factor, item-total correlation, test-retest, and known-groups validity analyses were performed. The Turkish NeoEAT-Bottle-feeding has 60 items in five factors explaining 55.785% of the total variance. Exploratory factor analysis indicated that the item factor loading ranged from 0.320 to 0.792. The known-group validity analysis confirmed that preterm infants with diagnosed feeding problems had higher total and subscale scores than those without (p = 0.001). The Cronbach's alpha (α) of the entire scale was 0.96. The item-total correlation coefficients were between 0.31 and 0.77 (p = 0.001). There was excellent agreement between test values and retest values obtained after a 2-week interval (intraclass correlation coefficient: 0.930-1.000). The Turkish NeoEAT-Bottle-feeding was shown to be a reliable and valid parent-reported assessment tool for oral feeding skills and difficulties after neonatal intensive care unit discharge in bottle-fed preterm infants younger than 7 months of corrected age. Healthcare professionals can use this assessment tool during the initial evaluation of risk factors contributing to problematic feeding and to determine the effectiveness of planned interventions in preterm infants.

ObjectiveThe aim of the present study was to use exploratory and confirmatory factor analysis (CFA) to investigate the factorial structure of the 9-item Utrecht work engagement scale (UWES-9) in a multi-occupational female sample.MethodsA total of 702 women, originally recruited as a general population of 7–15-year-old girls in 1995 for a longitudinal study, completed the UWES-9. Exploratory factor analysis (EFA) was performed on half the sample, and CFA on the other half.ResultsExploratory factor analysis showed that a one-factor structure best fit the data. CFA with three different models (one-factor, two-factor, and three-factor) was then conducted. Goodness-of-fit statistics showed poor fit for all three models, with RMSEA never going lower than 0.166.ConclusionDespite indication from exploratory factor analysis (EFA) that a one-factor structure seemed to fit the data, we were unable to find good model fit for a one-, two-, or three-factor model using CFA. As previous studies have also failed to reach conclusive results on the optimal factor structure for the UWES-9, further research is needed in order to disentangle the possible effects of gender, nationality and occupation on work engagement.

Identifying the factor structure of the Mother-to-Infant Bonding Scale for post-partum women and examining its consistency during pregnancy.

The Knee Injury and Osteoarthritis Outcome Score (KOOS) is well known and commonly used to assess young, active patients with ACL injuries. However, this application of the outcome measure has been called into question. There is currently no evidence supporting the structural validity of the KOOS for this patient population. Structural validity refers to whether a questionnaire meant to provide scores on different subscales behaves as intended in the populations of interest. Structural validity should be assessed for all questionnaire measures with multiple items or subscales. Does the KOOS demonstrate adequate structural validity in young, active patients with ACL tears, when evaluated using (1) exploratory and (2) confirmatory factor analyses? Between January 2014 and March 2017, 1033 patients were screened for eligibility in the Stability 1 randomized controlled trial from nine centers in Canada and Europe. Patients were eligible if they had an ACL deficient knee, were between 14 and 25 years old, and were thought to be at higher risk of reinjury based on the presence of two or more of the following factors: participation in pivoting sports, presence of a Grade 2 pivot shift or greater, generalized ligamentous laxity (Beighton score of 4 or greater), or genu recurvatum greater than 10°. Based on this criteria, 367 patients were ineligible and another 48 declined to participate. In total, 618 patients were randomized into the trial. Of the trial participants, 98% (605 of 618) of patients had complete baseline KOOS questionnaire data available for this analysis. Based on study inclusion criteria, the baseline KOOS data from the Stability 1 trial represents an appropriate sample to investigate the structural validity of the KOOS, specifically for the young, active ACL deficient population.A cross sectional retrospective secondary data analysis of the Stability 1 baseline KOOS data was completed to assess the structural validity of the KOOS using exploratory and confirmatory factor analyses. Exploratory factor analysis investigates how all questionnaire items group together based on their conceptual similarity in a specific sample. Confirmatory factor analysis is similar but used often in a second stage to test and confirm a proposed structure of the subscales. These methods were used to assess the established five-factor structure of the KOOS (symptoms [seven items], pain [nine items], activities of daily living [17 items], sport and recreation [five items], and quality of life [four items]) in young active patients with ACL tears. Incremental posthoc modifications, such as correlating questionnaire items or moving items to different subscales, were made to the model structure until adequate fit was achieved. Model fit was assessed using chi-square, root mean square error of approximation (RMSEA) and an associated 90% confidence interval, comparative fit index (CFI), Tucker-Lewis index (TLI), as well as standardized root mean square residual (SRMR). Adequate fit was defined as a CFI and TLI > 0.9, and RMSEA and SRMR < 0.08. Structural validity of the KOOS was not confirmed when evaluated using (1) exploratory or (2) confirmatory factor analyses. The exploratory factor analysis, where the 42 KOOS items were allowed to group naturally, did not reflect adequate fit for a five-factor model (TLI = 0.828). Similarly, the confirmatory factor analysis used to investigate the KOOS structure as it was originally developed, revealed inadequate fit in our sample (RMSEA = 0.088 [90% CI 0.086 to 0.091]). Our analysis suggested a modified four-factor structure may be more appropriate in young, active ACL deficient patients; however, the final version presented here is not appropriate for clinical use because of the number and nature of post-hoc modifications required to reach adequate fit indices. The established five-factor structure of the KOOS did not hold true in our sample of young, active patients undergoing ACL reconstruction, indicating poor structural validity. We question the utility and interpretability of KOOS subscale scores for young, active patients with ACL tears with the current form of the KOOS. A modified version of the KOOS, adjusted for this patient population, is needed to better reflect and interpret the outcomes and recovery trajectory in this high-functioning group. A separate analysis with a defined a priori development plan would be needed to create a valid alternative.

Core Competence in Fundamental Nursing Practicum Scale: A validity and reliability analysis

ObjectivesThe aim of this study was to assess the reliability and validity of the Turkish version of the Individual-Level Abortion Stigma Scale.SettingThree hospitals affiliated to Public Hospitals Union General Secretariat...

Background Alcohol use is a gendered behavior and motherhood is a life stage which may influence drinking motives. However, there are no drinking motive scales uniquely tailored to maternal populations. This work developed a new maternal drinking motives scale (M-DMS) and determined associations between the M-DMS and alcohol-related behavior. Methods An online observational survey (n = 534) and online test–retest survey (n = 164) were conducted with adult, UK mothers. From the observational study, data on drinking motives was extracted to determine M-DMS items and factor loading. This was split into two data sets for exploratory and confirmatory factor analyses. Alcohol Use Disorders Identification Test (AUDIT) and Timeline Follow back data, taken from both surveys, were combined to determine the M-DMS’s predictive validity. Results Following a parallel analysis and exploratory factor analysis, a two-factor model (positive reinforcement motives, negative reinforcement motives) was deemed the best fit. Probability functional analysis identified items with problematic responses. These were removed before confirmatory factor analysis (on the second dataset) demonstrated a good fit for the two-factor model. All factor loadings were significant and positive (βs > 0.56). Reliability of the two subscales was excellent: negative reinforcement (ωT = 0.95), positive reinforcement (ωT = 0.89). Test–retest reliability was good for both negative (ICC = 0.84, 95%CI = 0.80–0.88) and positive (ICC = 0.77, 95% CI = 0.71–0.82) subscales. Both subscales predicted AUDIT and quantity of alcohol consumption (ps < 0.001). Conclusion The first tailored Maternal Drinking Motives Scale (M-DMS) provides a more valid research tool for assessing psychological mechanisms of alcohol use in mothers.

The Dietary Sodium Restriction Questionnaire (DSRQ) was designed to assess attitudes and behaviors of patients with heart failure (HF) related to following a low-sodium diet. Recently, it has been translated and culturally adapted for use in Brazil. However, further validation of the instrument is required before it can be used in the management of patients with HF in Brazil. To test the reliability and validity of the Brazilian version of the DSRQ. Face and content validity were assessed by a panel of experts. Construct validity was tested using exploratory and confirmatory factor analysis. Reliability was tested using Cronbach's alpha to assess the internal consistency of the instrument. A total of 206 systolic HF outpatients were assessed (mean age, 60.4 ± 11.9 years). Face and content validity analysis showed equivalence between the Brazilian version and the original instrument. In the exploratory factor analysis, the principal component analysis (PCA) yielded four factors with eigenvalues greater than 1. Three models were tested in the confirmatory factor analysis, and the three-factor model resulting from the PCA showed the best fit, accounting for 49% of the variance. Alpha values obtained for the attitude/subjective norm, perceived behavioral control, and dependent behavior subscales were 0.71, 0.67, and 0.79, respectively. Our results suggest that the final validated Brazilian version of the DSRQ is a valid and reliable tool for measuring attitudes and behaviors related to following a low-sodium diet in Brazilian patients with HF.

Background: There is broad consensus that assessing and improving the competence of nurses is a crucial element of nursing education and practice. Numerous national and international nursing research studies have used the 35-item Nurse Professional Competence Scale (NPC-SV) to measure the self-reported competence of nursing students and registered nurses. To increase its usage in Arabic-speaking nations, however, a culturally adapted Arabic version of the scale with the same level of quality was necessary. Objectives: The study aimed to develop a culturally adapted Arabic version of the NPC-SV and evaluate its reliability and validity (construct, convergent, and discriminant types). Methods: Methodological descriptive cross-sectional design was utilized. A convenience sampling technique was employed to recruit 518 undergraduate nursing students from three Saudi Arabian institutions. The translated items were appraised by a panel of experts, who considered the content validity indexes. The structure of the translated scale was examined using exploratory and confirmatory factor analysis, structural equation modelling, and the Analysis of Moment Structure method. Results: When utilized with nursing students in Saudi Arabia, the Arabic short version of the Nurse Professional Competence Scale (NPC-SV-A) was shown to be reliable and valid in terms of its content, construct, convergent, and discriminant validity. Cronbach’s alpha for the entire NPC-SV-A scale was 0.89 and varied from 0.83 to 0.89 for each of the six subscales. Exploratory factor analysis (EFA) revealed six significant factors with 33 items that accounted for 67.52 percent of the variance. The scale was congruent with the suggested six-dimensional model, as confirmed by confirmatory factor analysis (CFA). Conclusion: The Arabic version of the NPC-SV, which was reduced to 33 items, showed good psychometric properties, with a six-factor structure accounting for 67.52% of the total variance. When used alone, this 33-item scale can allow for more in-depth evaluations of self-reported competence among nursing students and licensed nurses.

Is there a Gulf War syndrome?