Development and Validation of the Transtheoretical Model-based Questionnaire to Assess Dietary Iron Intake in Adolescent Girls

BACKGROUND: The Transtheoretical model (TTM) is one of the most commonly used theories in assessing behavioral change and designing more effective interventions. The study aimed to develop and validate a questionnaire based on the TTM to assess the behavioral change of adolescent girls related to dietary micronutrient intake. MATERIALS AND METHODS: A TTM-based questionnaire (Items 36) was validated through 150 adolescent girls aged 13–18 years. The questionnaire is made on four constructs: stages of change, processes of change, self-efficacy, and decision balance. The content validity and face validity were assessed by expert panels and participants, respectively. The confirmatory factor analyses (CFA) were used to test construct validity. The Cronbach’s alpha coefficient and Intraclass Correlation Coefficient (ICC) were used to analyze the internal consistency and stability of the questionnaires. RESULTS: Results showed that all content validity Index values of items in questionnaires were within the range (0.8-1). Based on face validity results, most of the items were clear, easy, and understood by participants. The CFA results included a comparative factor index of 0.99 for all constructs; a goodness of fit index ranging from 0.88 to 0.951, and a root mean square error of approximation ranging from 0.039-0.069, suggesting good model fit indices. The reliability analysis with Cronbach’s alpha of 0.737-0.953 and ICCs of 0.737-0.845 was acceptable. CONCLUSION: These psychometric analysis results provided evidence for the appropriateness, reliability, and validity of the developed questionnaire. Hence, this questionnaire may help to develop customized nutrition intervention programs based on behavioral changes in the context of micronutrient intake.

Patients from different social environments and cultural backgrounds have different nursing needs. If nurses ignore the cultural differences of patients, it is easy to lead to the strained nurse-patient relationship, affect the nursing effect and cause harm to patients. Critical cultural competence (CCC) can help nurses to meet the nursing needs of patients from different cultural backgrounds, which is beneficial to building a harmonious nurse-patient relationship and improving the quality of nursing. Almutairi, et al designed the Critical Cultural Competence Scale (CCCS) which can be used to evaluate accurately nurses' CCC. No studies have reported the development of a critical cultural competence measurement tool for nurses or the introduction of foreign scales in China. This study aims to conduct Chinese and cross-cultural debugging and test the reliability of the English version of the CCCS in order to form CCCS suitable for Chinese cultural background and provide an effective evaluation tool for investigating the current situation of clinical nurses' CCC. This study used Brislin's back-translation model to translate and back-translation the English version of CCCS. The Chinese version of CCCS was then created through cross-cultural debugging by expert consultation and a pre-survey with a sample size of 30 clinical nurses. From August to October 2019, 580 clinical nurses were surveyed using a whole group sampling method. The participants were randomly divided into 2 groups with a 7꞉3 ratio. One group (n=406) was used for exploratory factor analysis and reliability analysis, while the other group (n=174) was used for confirmatory factor analysis. Six experts used the scale-level content validity index (S-CVI) and the item-level content validity index (I-CVI) to assess content validity. In the exploratory factor analysis, items were screened using the critical ratio method, and were tested using the KMO (Kalser-Meyer-Olkin) index, Bartlett's sphericity test, and principal component analysis. In the confirmatory factor analysis, average variance extracted (AVE), goodness of fit index (GFI), adjusted goodness of fit index (AGFI), and root mean square error of approximation (RMSEA) were used to assess the degree of fit of the constructed model. For the total scale and the 4 subscales, the Cronbach's α coefficient, split-half reliability, and retest reliability were used to assess the scale's reliability. The S-CVI was 0.930, while the I-CVI ranged from 0.833 to 0.944. For all items, the critical ratio exceeded 3, and the difference between the high and low subgroups was statistically significant (P<0.05). Exploratory factor analysis revealed critical knowledge subscale had a KMO value of 0.676, with the total scale and other 3 subscales all having a KMO value >0.8 and a chi-square value of 814.32 to 12 442.45 for the Bartlett's spherical test, with degree of freedom ranging from 21 to 136 (P<0.001), indicating that all items were suitable for factor analysis. The principal component analysis showed that 17, 12, 7, and 7 items were extracted from the 4 subscales, with 4, 3, 2, and 2 components whose eigenvalues were more than 1, and the cumulative variance contribution was 66.0%, 54.3%, 56.6%, and 70.2%, respectively. The confirmatory factor analysis showed that the AVE of the 4 subscales were 0.637, 0.499, 0.560, and 0.565, GFI was 0.904, AGFI was 0.863, and RMSEA was 0.076. The Cronbach's α coefficient for the total scale and subscales ranged from 0.811 to 0.878, the split-half reliability ranged from 0.707 to 0.842, and the retest reliability was 0.827. The Chinese version of the CCCS has good reliability and validity, and it can be used as a valid assessment tool for clinical nurses' critical cultural competence in China.

BackgroundThe transtheoretical model (TTM) is a common framework for studies of smoking cessation. Using the TTM, several instruments were developed to measure to what extent interventions could make changes in people’s behavior. The current study aimed to test the validity and reliability of the Persian version of a TTM based questionnaire for smoking cessation in Iran.MethodsThis was a cross-sectional validation study among adult male smokers using the TTM Questionnaire. Backward-forward procedure was applied to translate the questionnaire from English into Persian (the Iranian language). The confirmatory factor analyses were performed to test validity. The internal consistency and stability of the questionnaire was examined using Cronbach’s alpha coefficient and Intraclass Correlation Coefficient (ICC).ResultsIn all 150 male smokers were entered into the study. The mean age of participants was 36.51 ± 7.94 years. The results obtained from confirmatory factor analysis revealed that the data was fit to the model: the goodness of fit index (GFI) = 0.92; the comparative fit index (CFI) = 0.91; the root mean square error of approximation (RMSEA) = 0.065 (95% CI = 0.063-0.067), and the relative chi-square (x2/df) = 1.87, p < 0.001. The Cronbach’s alpha ranged from 0.60 to 0.84 indicating an acceptable result. Also Intraclass Correlation of Coefficient (ICC) ranged from 0.61 to 0.83 corresponding to a satisfactory finding.ConclusionThe current study provided psychometric evidence for an appropriate, reliable, and valid tool to determine smoking behaviors among Iranian adult smokers. Indeed the findings from this study could be applied in designing smoking cessation interventions in Iran.

Food literacy is the ability to understand the nature of food and its level of importance, to obtain, process, analyze, and use information about food. This study aims to translate and cross-culturally adapt the Food Literacy Questionnaire for school children (FLQ-sc) into Turkish and to study its psychometric properties of reliability and validity. The study was conducted with 303 students aged 12-14 in Kayseri, Turkey. A pilot study was conducted with 36 students, and a test-retest was conducted with 219 students, 2weeks after the first study was performed. Data were collected with the sociodemographic data form and FLQ-sc. Linguistic, content, face, and construct validity were evaluated for validity. Cronbach's alpha and intraclass correlation coefficients (ICCs) were calculated for the reliability evaluation. Model validity was tested with confirmatory factor analysis. Root mean square error of approximation (RMSEA), χ2/SD, and goodness-of-fit index (GFI) statistics were in good agreement. Comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square error of approximation (SRMR) statistics were at acceptable levels (RMSEA = 0.033, χ2/SD = 1.324, GFI = 0.958, CFI = 0.944, TLI = 0.939, SRMR = 0.063). The Cronbach's alpha coefficient for the total scale score was quite good (0.795). The ICC for test-retest reliability was good (0.874) for the total scale score. Conclusion: The Turkish version of the Food Literacy Questionnaire for school children (FLQ-sc) is a valid and reliable measurement tool and can be used to evaluate food literacy levels in Turkish children aged 12-14. What is Known: • It is important to acquire knowledge and skills in food literacy from childhood because the behaviors learned during childhood and adolescence regarding food intake and preparation continue into adulthood. • In addition to the limited scales evaluating the food literacy levels of children, there is no scale evaluating the food literacy levels of Turkish children between the ages of 12 and 14. What is New: • The Turkish version of FLQ-sc is a valid and reliable scale for evaluating the food literacy levels of Turkish school children. • Scale is a suitable tool to ensure the comparison of food literacy levels in different student groups and measure abstract concepts such as education.

Background: Adolescence is the time period of greatest breast development. Diet during this time has been hypothesized to be associated with later breast cancer risk through its effect on insulin resistance. C-peptide is a good indicator of insulin production and higher levels in adulthood have been associated with insulin resistance. Information on dietary predictors of C-peptide levels in adolescence, however, is limited. Objectives: To examine associations between dietary intake of selected nutrients [fat, animal and vegetable protein, carbohydrate, lactose, fructose, glucose, galactose, sucrose, starch, fiber, calcium, zinc, iron, and sodium] and serum C-peptide in adolescent girls. Methods: The current study includes 155 postmenarcheal adolescent girls 14.6-to-18.9 yrs (mean: 16.6 ± 0.9 yrs) who attended the last visit of the DISC. Intervention and control group data are combined. Dietary intake was assessed via 3 averaged, nonconsecutive 24–hour dietary recalls with nutrient intakes estimated using Nutrition Data System v20. Serum C-peptide levels were determined by electrochemiluminescence immunoassay. Nutrients were selected based on those associated in the literature with insulin or C-peptide and availability in our data set. Associations between nutrients and C-peptide were estimated using unadjusted and adjusted Pearson's correlation analyses. Adjusted geometric means of C-peptide were also calculated within quartiles of each nutrient with linear trends calculated across quartiles. Adjusted analyses included age, time since menarche and energy intake. Associations were also examined using forward-selection multivariable linear regression (p&amp;lt;0.05) including age, time since menarche, body mass index (BMI)-for-age-percentile, total fat, energy intake, starch, and either fiber or vegetable protein intake in analyses. To mitigate skewness, nutrients and C-peptide were log transformed; thus, β coefficients represent percentage changes in C-peptide for 1% increases in nutrient intakes. Results: In correlation analyses the following dietary variables were significant predictors of C-peptide (p&amp;lt;0.05): total fat, vegetable protein, starch and fiber. Adjusted Pearson's correlation coefficients were 0.17, -0.19, -0.17 and -0.20, respectively. In adjusted analyses, trends in geometric means of C-peptide across quartiles of nutrients were significant for vegetable protein (p=0.048) and fiber (p=0.027). For the lowest to the highest quartiles of dietary fiber intake, geometric means of C-peptide were 643 pmol/L (95% CI: 547, 755), 593 pmol/L (95% CI: 501, 702), 592 pmol/L (95% CI: 504, 695), and 490 pmol/L (95% CI: 417, 577). In multivariable linear regression analyses, vegetable protein and fiber intake were examined in separate models due to collinearity (r=0.749, p&amp;lt;0.0001). In forward selection multivariable analyses, only BMI-for-age percentile (β=0.004, p=0.004) and fiber intake (β=-0.305, p=0.009) remained as significant predictors of C-peptide. In a similar model, vegetable protein was not a significant predictor. Conclusion: This study suggests dietary fiber intake in adolescent girls is inversely associated with serum C-peptide, a marker of insulin resistance, after adjustment for BMI-for-age-percentiles. To our knowledge, no previous studies have examined this association in adolescence. Citation Format: Zhenzhen Zhang, Jean M. Kerver, Joseph C. Gardiner, Joanne F. Dorgan, Ellen M. Velie. Dietary intake and C-peptide levels in adolescent girls: Results from the Dietary Intervention Study in Children (DISC). [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A26.

BackgroundTranstheoretical model (TTM) has been recognized as a common theoretical model in researches in terms of addictive behaviors. The aim of this study was to examine the psychometric properties of the Persian brief version of the TTM for hookah tobacco smoking cessation in a sample of Iranian rural adults who were in the preparation stage for hookah cessation.MethodsThis was a validation study on Iranian rural adult hookah smokers by the TTM instrument. First, to translate the questionnaire items from English to Persian, backward-forward procedure was used. Face and content validity of the instrument items were assessed. Confirmatory factor analysis (CFA) was performed to determine the construct validity of the instrument. For this aim, 300 participants completed the instrument. Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were calculated to examine the internal consistency and reliability of the subscales of the instrument.FindingsThe content validity index (CVI) and content validity ratio (CVR) of the items were ≥ 0.80 and ≥ 0.60, respectively. Based on CFA, the data fitted the TTM model. root mean square error of approximation (RMSEA), the goodness of fit index (GFI), adjusted GFI, and comparative fit index (CFI) were 0.037, 0.960, 0.910, and 0.950, respectively. At this stage, 6 items were deleted. The ICC and Cronbach's alpha of the subscales ranged between 0.60-0.74 and 0.71-0.86, respectively. The final instrument with 29 items was confirmed.ConclusionThe findings suggest that translating Persian brief version of the TTM instrument was a reliable and valid tool to identify the determinants of hookah smoking cessation among Iranian rural adults.

BackgroundThe theory of planned behavior (TPB) is one of the most commonly used theories to explain oral health behaviors. To gain a deeper understanding of the determinants of oral health behaviors, we aimed to design and evaluate the psychometrics of a theory of planned behavior model-based instrument for assessing the determinants of oral health behaviors in mothers of children younger than six years in Iraq.MethodsQuestionnaires and guidelines related to the topic were searched in 2023, and the appropriate items based on the domains of the TPB model were extracted. The items were revised and completed to develop the initial version of the instruments. Face validity and content validity of the instrument were assessed. The content validity index (CVI) and content validity ratio (CVR) were calculated subsequently. The construct validity was examined by confirmatory factor analysis (CFA). Cronbach’s alpha, intra-class correlation coefficient (ICC), and percentage of agreement were employed to check the tool’s internal consistency and reproducibility reliability. The data were analyzed using SPSS version 25 and Amos software.ResultsThe questionnaire had adequate content validity (CVR ≥ 0.75, CVI ≥ 0.75). The percentage of agreement, Kappa, and ICC coefficients were 57.1–95.3%, 0.52–0.89, and 0.43–0.90, respectively. The p-value for ICC was significant in all cases (p < 0.001).For the internal stability of the tool to keep Cronbach’s alpha values > 0.7 for all domains, we had to omit three questions from attitude, one from subjective norms, and one from perceived behavioral control. In terms of construct validity, the results were as follows: the Goodness of Fit Index (GFI) was 0.942, the Comparative Fit Index (CFI) was 0.900, the Adjusted Goodness of Fit Index (AGFI) was 0.921, and the Root Mean Square Error of Approximation (RMSEA) was 0.046. These values indicate that the instrument demonstrates appropriate construct validity based on the TPB.ConclusionThe psychometric evaluation of the designed instrument showed that it was a valid and reliable tool in Arabic-speaking countries for determining child-related oral health behaviors in mothers of children under six years old.

BackgroundThis study is to evaluate swallowing problems (dysphasia) in multiple sclerosis (MS) patients; the importance of using tools that are durable and appropriate is well understood. One of the most trusted tools is the dysphagia in multiple sclerosis (DYMUS) test. The aim of this study was to prepare a Persian version and to evaluate the validity and reliability of the test.Materials and MethodsThis methodological study was conducted on 236 MS patients in Southeast of Iran from August 2015 to February 2016. After translation and cultural adaptation of the test in Persian, the validity of this test was determined using expert opinions accordance with the International Quality of Life Assessment Project. In addition, exploratory factor analysis (EFA) was performed with varimax rotation. The confirmatory factor analysis (CFA) was conducted and the goodness of fit indices was calculated. Moreover, to test the reliability, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used.Results:In total, 236 MS patients were included in the study (81 males and 155 females). All the questions in the test's Persian version obtained an acceptable face and content validity (content validity ratio = 1, Scale content validity index/Ave = 1). EFA revealed that the scale has two factors (solid–liquid) with 67.5% cumulative variance. CFA indicated a good fit to the intended two-factor structure, and the ratio of Chi-square to the degree of freedom was 1.79, and the root mean square error of approximation was 0.058. The internal consistency of total test indicated the appropriate level (Cronbach's alpha coefficient = 0.775), and test–retest reliability total questionnaire was found to be ICC = 0.985, indicating its high reliability.Conclusion:The results of this study indicated that the Persian version of the DYMUS questionnaire had good reliability and validity for patients with MS.

Development and psychometric evaluation of the self-care of informal caregivers inventory

Introduction: Gender dysphoria is one of the significant challenges in healthcare systems, and primary healthcare providers play a key role in caring for and referring these individuals. However, their insufficient knowledge and attitudes may lead to inadequate care. Given the lack of a standard Persian tool for measuring these variables, this study aimed to psychometrically evaluate a questionnaire assessing the knowledge and attitudes of primary healthcare providers regarding gender dysphoria. Methods: This descriptive cross-sectional study was conducted in 2024 in Tabriz, involving three phases: translation, back-translation, validity, and reliability. The study sample for content validity included 15 experts, 30 healthcare providers for reliability, and 205 primary healthcare providers for construct validity. The research tool consisted of questionnaires assessing attitudes and knowledge about transgender individuals, which were translated into Persian and culturally adapted. Content validity was evaluated using content validity ratio (CVR) and content validity index (CVI), and construct validity was assessed through confirmatory factor analysis (CFA). The reliability was calculated using Cronbach’s alpha coefficient and the intra-class correlation coefficient (ICC). Results: The results of this study indicated that the overall CVI was 0.81 and the CVR was 0.93. For the knowledge section, CVI was 0.76 and CVR was 0.94, while for the attitude section, CVI was 0.85 and CVR was 0.91. In confirmatory factor analysis, the factor loadings for the attitude section were above 0.30, but some questions in the knowledge section had factor loadings lower than 0.30. The comparative fit index (CFI), goodness of fit index (GFI), normed fit index (NFI), and root mean square error of approximation (RMSEA) were 0.96, 0.90, 0.85, and 0.057, respectively, all indicating a good model fit. Additionally, the Cronbach’s alpha coefficient for the entire questionnaire was 0.86, and for the knowledge and attitude sections, it was 0.65 and 0.88, respectively. The ICC obtained from the test-retest method was 0.76, confirming the reliability of the questionnaire. Conclusion: The results of this study showed that the tool for measuring the knowledge and attitude of primary healthcare providers regarding gender dysphoria has good validity and reliability. The confirmatory factor analysis results indicated that the two-factor structure (knowledge and attitude) fits well, although some items in the knowledge section had lower factor loadings. This questionnaire can be helpful in designing educational and research programs in this area. Practical Implications: The questionnaire could be used as a screening tool in educational programs related to gender dysphoria, assessing the impact of educational interventions, and evaluating educational needs in healthcare policy-making.

BACKGROUND:Structural empowerment (SE) is an effective method of advancing work environments and has previously been widely discussed in Western countries. Due to the lack of culturally and academically accepted scales in Iran for measuring SE, localization of a foreign scale in this field is necessary.OBJECTIVES:This study aimed at investigating the validity and reliability of the Persian Version of the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II-PV) among Iranian nurses.METHODS:The present cross-sectional methodological research was conducted during 2017–2018. Participants were 230 nurses working in four teaching hospitals affiliated to Kashan University of Medical Sciences in Kashan, Iran, who were selected using quota sampling. A standard forward–backward translation procedure according to Wild et al. (2005) was used to translate the English Version of the CWEQ-II to Persian. The psychometric evaluation processes were achieved by face, content, and construct validity (confirmatory factor analysis [CFA]). Reliability was examined using test–retest and Cronbach's alpha for internal consistency reliability.RESULTS:The CWEQ-II-PV showed good content validity (the mean content validity scores for relevancy, clarity, and simplicity were 94%, 96%, and 94%, respectively). In the CFA, the original six-factor version with 19 items was confirmed. The original model was presented and incorporated in the CFA, indicating an acceptable fit for the model (root mean square error of approximation = 0.06, comparative fit index = 0.92, goodness of fit index (GFI) = 0.94, and adjusted GFI = 0.91). Cronbach's alpha coefficient for the total scale was 0.84 and for each component ranged from 0.71 to 0.87, indicating good internal consistency, and the test–retest Spearman and intraclass correlation coefficients were 0.93 and 0.87, respectively, showing good test–retest reliability.CONCLUSIONS:Evidence was found to support the reliability and validity of the CWEQ-II-PV scale that measures the quality of the work environment for nurses from a SE perspective.

Children and adolescents with childhood-onset physical disabilities, including cerebral palsy (CP), face a significantly higher risk of developing mental health disorders due to factors such as reduced physical activity, participation limitations, sleep disturbances, pain, social isolation, rejection, bullying and victimization. Therefore, identifying mental health problems in this population is crucial for promoting their mental health and psychosocial well-being. This study aimed to investigate the reliability and construct validity of the self-report Strengths and Difficulties Questionnaire (SDQ) in children and adolescents with CP. The study included 120 children and adolescents with CP (mean age = 14.13 ± 2.2 years), representing the full spectrum of CP subtypes. Internal consistency was assessed using McDonald's omega (ω). Test-retest reliability was assessed using intraclass correlation coefficients (ICC) to estimate the level of consistency in scores for 50 children and adolescents who completed the SDQ again after 14 days. Three types of construct validity were assessed: factorial, convergent and known-group validity. Factorial validity was assessed based on the model fit of structural equation model-based confirmatory factor analysis (CFA). For CFA, the following fit indices were considered acceptable: a Root Mean Square Error of Approximation (RMSEA) < 0.08, a Goodness of Fit Index (GFI) ≥ 0.95 and a Standardized Root Mean Square Residual (SRMR) ≤ 0.08. Convergent validity was assessed by estimating correlations between the SDQ and Cerebral Palsy Quality of Life (CP QOL) scores using Pearson correlation coefficient (r). Internal consistency and test-retest reliability of both SDQ Total Difficulties Scale and SDQ Prosocial subscale were found to be acceptable (ω: 0.73-0.85; ICCs: 0.77-0.96). The SDQ's factor structure showed good fit (Total Difficulties Scale: RMSEA = 0.03, GFI = 0.95 and SRMR = 0.037; SDQ Prosocial: RMSEA = 0.025, GFI = 0.97 and SRMR = 0.066). Acceptable correlations between SDQ and CP-QOL scores (r = 0.53-0.93) supported convergent validity. Known-groups validity was confirmed, with children with CP showing significantly different SDQ scores compared to their TD peers (p < 0.05). Our findings provide evidence of adequate internal consistency reliability, test-retest reliability and construct validity for scores on the SDQ for children and adolescents with CP. ClinicalTrials.gov identifier: NCT06527508. This is the first study investigating the measurement properties of the self-report SDQ in children and adolescents with CP This study yielded satisfactory evidence for the factorial validity, convergent validity and known-group validity of the self-report SDQ, supporting its suitability as a tool for assessing the mental health status of children and adolescents CP aged 11-17 years. All items in the self-report SDQ were found to effectively measure the intended construct-mental health-demonstrating item homogeneity and supporting internal consistency The satisfactory agreement between SDQ scores obtained over a two-week interval demonstrated the instrument's temporal stability, indicating strong test-retest reliability.

Using Health-related quality of life (HRQL) in chronic patients with severe respiratory insufficiency (SRI) requires a valid instrument. Hence, this study aimed to translate and validate the Persian version of the Severe Respiratory Insufficiency Questionnaire in chronic patients with severe respiratory insufficiency. In this methodological study, the original version of the HRQL questionnaire in chronic patients with SRI was translated based on the approach presented by Wild et al. Face validity, content validity such as content validity index (CVI) and content validity ratio (CVR), convergent, and discriminant validity were evaluated. Moreover, construct validity evaluation was conducted by exploratory and confirmatory factor analyses (EFA & CFA).Reliability was also evaluated by calculating Cronbach's alpha and test-retest intraclass correlation coefficient (ICC). SPSS-16 and AMOS-24 software were used for data analysis. The target group approved the face validity of the questionnaire and the content validity index was 0.94. In total, 500 chronic patients with severe respiratory insufficiency participated in the construct validity. Seven factors were extracted in exploratory factor analysis as respiratory complaints, physical functioning, social relationship, anxiety, attendant symptoms and sleep, social functioning, and psychological well-being. These factors explained 73.91% of the total variance of the concept of HRQL in chronic patients with SRI. All factors confirmed in confirmatory factor analysis based on model fit indices [Comparative Fit Index (CFI)=0.94, Goodness of fit index (GFI)=0.94, Minimum Discrepancy Function by Degrees of Freedom divided (CMIN/DF) =2.99, and Root Mean Square Error of Approximation (RMSEA)=0.01]. Convergent and discriminant validity were also confirmed. Moreover, Cronbach's alpha coefficients of 0.84 and intraclass correlation coefficient of 0.82-0.96 with 15-day intervals confirmed the internal consistency of the instrument. According to the findings of the present study, the Persian version of the SRI questionnaire, with 7 subscales and 40 items, is a valid and reliable instrument to assess the HRQL in chronic patients with SRI.

Martin and Petrie developed the Vaccine Attitudes Examination (VAX) scale with an aim to document general vaccination attitudes. Vaccine acceptance plays an important role in curbing COVID-19 infections. Thus, it was important to assess vaccination attitudes of Pakistani people towards novel COVID-19 vaccines. The VAX scale was not available in Urdu language for Pakistani population. The study aimed to carry out cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitude Examination (VAX) scale in a selected population sample from Pakistan. A cross sectional study was conducted in September 2021 in an outpatient department of a healthcare facility in Karachi, Pakistan. Adult visitors, eligible for COVID-19 vaccine and spoke Urdu as first language were invited. Convenient sampling was used, and sample size was based on an item response ratio of 1:20. An Urdu version of the VAX scale was developed. The reliability was assessed using Cronbach's alpha (α) and intraclass correlation coefficient (ICC). The model fitness was evaluated using confirmatory factor analysis (CFA) and fit indices namely goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). A structural equation model (SEM) was also developed. IBM SPSS and AMOS were used to analyse the data. The study had ethical clearance. A total of 211 responses were analysed. The reliability (Cronbach's α) was 0.821. The ICC was 0.831 (95% CI: 0.795-0.863). CFA using a 4-factor model revealed the following values for fit indices; GFI = 0.944, AGFI = 0.909, TLI = 0.953, CFI = 0.966, and RMSEA = 0.051. All values reported were in the acceptable range. The VAX Urdu version is a reliable and valid instrument for use in an Urdu speaking population and will enable clinicians to assess the public's attitude towards general vaccination including COVID-19 vaccination. Clinicians can use the VAX-U to document a person's vaccine hesitancy and tailor their counselling to address the issues in vaccine uptake.

Background: Pediculosis is a common ectoparasitic infestation that involves especially the skin of children worldwide. Studying the children’s perception of the disease’s risk factors, the effectiveness of personal preventive measures, and its implications for their health could be a major leap forward in health promotion activities. Objectives: This study aimed to develop and evaluate the psychometric properties of the Children’s Perception Scale of Head Lice Infestation (CPS-HLI) and its initial feasibility assessment for use on Iranian and possibly other elementary school children. Methods: The scale’s items were retained based on an extensive literature search and classified into the underlying constructs of the extended health belief model (EHBM). An expert panel endorsed the qualitative content and face validity of the preliminary draft, and 47 items remained for quantitative validity testing on a sample of 362 elementary school students in the city of Paveh, West of Iran. Explanatory and confirmatory factor analyses (EFA and CFA) were employed to test the content and structural validity of the constructed instrument. Cronbach's alpha and intra-class correlation coefficients were calculated to assess the internal consistency and reliability of the scale. Results: The values of Lawshe's content validity index (0.90) and content validity ratio (0.77), the subscales’ Cronbach's alpha (0.59), and intra-class correlation (0.72) coefficients confirmed plausible internal consistency of the scale. The values of root mean square error of approximation (RMSEA) (&lt; 0.08 with χ2 &lt; 0.05), Tucker-Lewis index (TLI), and comparative fit index (CFI) &gt; 0.9 approved the applied statistical model’s goodness of fit. The ranges of Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy for the underlying subscales (0.49 - 0.74) and the statistically significant result of Bartlett’s test of sphericity (P &lt; 0.001) confirmed the patterned relationship among the constructed scale’s items. The principal component analysis that was performed using STATA favored the 11-factor solution. Conclusions: The study findings support the construct validity of CPS-HLI for use in studies on children’s perception of head lice infestation risk factors, the effectiveness of personal preventive measures, and the disease implications for their health and well-being. Further cross-cultural and cross-national validation studies are recommended for using the instrument in a wider range of populations and settings.