The Validity and Reliability of the Turkish Version of the Parental Needs Scale for Rare Diseases (PNS-RD).

This study aimed to translate the "Children with Cochlear Implant: Parental Perspectives (CCIPP)" scale into Turkish and evaluate its validity and reliability. Parents of 378 children between the ages of 2 and 18, who had used cochlear implants for at least one year, filled out the Turkish version of the scale. The original scale was translated from English to Turkish. Explanatory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the scale construct validity. For the evaluation of the scale reliability, internal consistency and test-retest reliability measures were evaluated with Cronbach's alpha (α) and correlation, respectively. The reliability coefficients of the dimensions are between 0.237 and 0.678. The test-retest correlation coefficient of 0.875 was obtained. As a result of factor analysis, ten sub-dimensions were determined, corresponding to the original ten domains defined in the CCIPP scale. The Kaiser-Meyer-Olkin (KMO) sample adequacy coefficient calculated in the sub-factor analysis was determined to be 0.850. The dimensions obtained according to the result of the Bartlett test in which the significance of the factor structures was tested (test value: 9596.996, degrees of freedom (df): 2628, p < 0.001) are structurally significant. CFA confirmed the accuracy of the ten-dimensional structures (Comparative Fit Index (CFI) = 0.901; Incremental Fit Index (IFI) = 0.902; Root Mean Square Error of Approximation (RMSEA) = 0.054). The Turkish version of the scale has good validity and reliability and can be used to examine parents' perspectives on cochlear implants.

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.

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.

Vaccine hesitancy amongst healthcare workers (HCWs) has been a major challenge throughout the COVID-19 pandemic. While many studies have identified HCW characteristics and specific attitudes associated with COVID-19 vaccine hesitancy, researchers are still working towards developing a holistic understanding of the psychological constructs that influence COVID-19 vaccine decision-making in this population. Between 15 March and 29 March 2021, we distributed an online survey assessing individual characteristics and vaccine-related perceptions to employees of a not-for-profit healthcare system in Southwest Virginia (N = 2459). We then performed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to describe patterns of vaccine-related thought amongst HCWs and identify latent psychometric constructs involved in vaccine decision-making. The goodness of model fit was assessed using the Tucker-Lewis Index (TLI), the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RMSEA). Internal consistency and reliability of each factor were assessed using Cronbach's alpha. EFA identified four latent psychometric constructs: Lack of trust in the COVID-19 vaccine; Anti-science sentiment; Adverse side-effects; and Situational risk assessment. The goodness of EFA model fit was adequate (TLI > 0.90, RMSEA ≤ 0.08) with acceptable internal consistency and reliability for three of four factors (Cronbach's alpha > 0.70). The CFA model also had adequate goodness of fit (CFI > 0.90, RMSEA ≤ 0.08). We believe the psychometric constructs identified in this study can provide a useful framework for interventions to improve vaccine uptake amongst this critical population.

Background:Improving health literacy has become one of the most important public health-related goals at the global level; however, there is no clear consensus on measurement of health literacy. Despite numerous health literacy scales available in Turkish, none of the existing scales was originally developed and validated at a national level.Objective:This study aimed to develop and validate a culturally appropriate original health literacy scale (HLS) to be used as a reference for the Turkish-speaking literate adult population in Turkey and abroad.Methods:Two multidisciplinary workshops with more than 20 experts were conducted and a large item pool was developed. The first and second draft of the scale were pre-tested with 20 and 150 adults, respectively, from different age groups and socioeconomic levels in Ankara. The validity and reliability study of the revised scale (110 items plus 20 self-efficacy statements) was carried out with a household survey of 2,411 adults in 12 randomly selected provinces from 12 Nomenclature of Territorial Units for Statistics Regions in Turkey. Explanatory and confirmatory factor analysis were performed. The fit indices were obtained. The item analysis was applied, and Cronbach's alpha statistics were obtained.Key Results:The scale was found to be both a valid and a reliable measurement tool to assess health literacy. Cronbach's alpha for two sub-dimensions (“disease prevention and health promotion” and “treatment and access to health services”) were 0.79 and 0.91, respectively. Construction validity indices were Root Mean Square Error of Approximation (RMSEA) = 0.043, Goodness of Fit Index (GFI) = 0.96, Normed Fit Index (NFI) = 0.95, and Adjusted Goodness of Fit Index (AGFI) = 0.95. The scale includes “self-efficacy” as an additional dimension (Cronbach's alpha = 0.83, RMSEA = 0.68, GFI = 0.94, NFI = 0.94, and AGFI) = 0.91).Conclusion:HLS is a valid and reliable measurement tool to assess health literacy of Turkish-speaking literate adults with a mixed (objective and subjective) assessment approach. [HLRP: Health Literacy Research and Practice. 2022;6(1):e2–e11.]Plain Language Summary:This study aimed to develop and validate a culturally sensitive original health literacy scale to be used as a reference scale for the Turkish-speaking literate adult population in Turkey and abroad. Study findings showed that HLS is both a valid and a reliable measurement tool to assess health literacy of Turkish-speaking literate adults.

The Double-Edged Sword Effects of Career Calling on Occupational Embeddedness: Mediating Roles of Work–Family Conflict and Career Adaptability

The development and validation of the specific health literacy assessment tool for older adults is the basis for conducting the research on health literacy among older adults. The existing health literacy assessment scale for older adults in Chinese mainland has some limitations, such as too many items and poor compliance during the survey. It is necessary to develop or introduce simplified assessment tools to support large-scale surveys in the future. This study aims to modify the brief health literacy assessment scale compiled by Taiwan scholars, and to conduct the test for the reliability, validity and the measurement equivalence across gender in the older population in mainland China. From March to April 2021, 508 older adults from Jinan, Shandong Province, China were selected by cluster sampling method to conduct a questionnaire survey using the brief health literacy assessment scale and health-promoting lifestyle profile. After 4 weeks, 83 of them were selected for retesting. SPSS 25.0 statistical software was used for descriptive analysis, item analysis, exploratory factor analysis, correlation analysis, and reliability test, and Mplus 8.0 was used for confirmatory factor analysis and gender measurement equivalence test. Each item of the scale had good discrimination, and there were significant differences in the scores of each item between high score and low score groups (P<0.05), and the coefficient of correlation between the scores of each item and the total score was between 0.721 and 0.891. Exploratory factor analysis extracted a factor with a characteristic root greater than 1, and the cumulative variance interpretation amount was 67.94%. The confirmatory factor analysis showed that the single factor structure fit was good [χ2/df was 2.260, the Tucker-Lewis index was 0.973, the comparison fit index (CFI) was 0.982, and the root mean square error of approximation (RMSEA) was 0.071]. The multi-group confirmatory factor analysis results showed that the brief health literacy assessment scale's configural equivalence, weak equivalence, and strong equivalence models were all accepted. The comparison results of measurement equivalence models showed that the changes of RMSEA were less than 0.015, and the changes of CFI were less than 0.01, indicating that the brief health literacy assessment scale had measurement equivalence between different gender groups. Cronbach's α coefficient was 0.945, and the test-retest reliability was 0.946. The correlation coefficient between health literacy and health-promotion lifestyles was 0.557 (P<0.05). The brief health literacy assessment scale has good reliability, validity, and measurement equivalence across gender, and can be used as an effective measurement tool for the health literacy of the older people in Chinese mainland.

Chronic kidney disease (CKD) represents a significant global public health challenge, characterized by its high prevalence and the complexity of its treatment, which collectively impose substantial burdens on patients' quality of life and healthcare systems. Hemodialysis remains a critical life-sustaining treatment for CKD patients, with arteriovenous fistulas (AVFs) being the most commonly used vascular access. The long-term functionality of AVFs relies heavily on patients' self-care abilities, encompassing their knowledge of maintenance practices, appropriate attitudes toward care, and the implementation of effective self-care behaviors. Consequently, accurately assessing the self-care capabilities of patients with AVFs is essential for optimizing treatment outcomes and enhancing their overall quality of life. This study aims to translate the scales of knowledge, attitude, and practice of self-care for patients with arteriovenous fistula (SKAPS-AVF) into Chinese and evaluate its psychometric properties among Chinese patients to ensure its validity and reliability in clinical and research settings. The study employed the Brislin translation model to translate and back-translate the original scale, followed by cultural adaptation to ensure its relevance to the Chinese context. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to assess the structural validity of the scale. Reliability was evaluated by calculating Cronbach's alpha, split-half reliability, and McDonald's Omega (Ω) to determine the internal consistency and stability of the scale. Exploratory factor analysis (EFA) revealed that the translated scale has a three-factor structure, with eigenvalues greater than 1 for all factors and a total variance explanation rate of 63.099%. Confirmatory factor analysis (CFA) demonstrated good model fit, with fit indices such as the chi-square value, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA) meeting acceptable standards. Reliability analysis indicated that Cronbach's alpha, split-half reliability, and McDonald's Omega values all exceeded 0.7, suggesting good internal consistency and stability of the scale. The C-SKAPS-AVF demonstrated good psychometric properties, with high structural validity and reliability, making it a robust tool for assessing self-care capabilities in patients with arteriovenous fistulas. This scale provides a reliable measurement tool for related clinical interventions and research. However, future studies should consider expanding the sample size and evaluating the scale's longitudinal stability and applicability across different cultural contexts.

Introduction Many burn injuries result in a prolonged recovery involving extensive therapy and surgical reconstruction. Burn patients experience a broad range of symptoms and acute symptoms can develop into chronic conditions that can significantly impact function and overall quality of life. Hypertrophic scars, a complication from burn injury, can lead to contractures, tightness, pain, pruritis, altered appearance, and impaired psychosocial well-being. The Brisbane Burn Scar Impact Profile (BBSIP) is a patient-reported health-related quality of life survey designed to assess the impact of burn scars in children and adults. In this study, we aimed to assess the reliability and factor structure of the BBSIP in adult patients with hypertrophic burn scars undergoing reconstruction and/or laser treatment. Methods A prospective cohort study enrolled 113 adult patients with hypertrophic burn scars undergoing reconstruction, including skin grafts, and/or laser treatment at a North American major tertiary care center. Patient demographics, percent total body surface area (TBSA) burned, and burn etiologies were obtained. A total of 238 surveys were collected after a reconstructive or laser treatment. An exploratory and confirmatory factor analysis was carried out on the seven sub-domains of the BBSIP to determine the reliability of each. For each sub-domain, we determined the acceptable model fit with a comparative fit index (CFI) &amp;gt;0.9 and a root mean square error of approximation (RMSEA) &amp;lt; 0.1. We considered a sub-domain to have acceptable reliability if the omega reliability or coefficient omega hierarchical was greater than 0.8. Results Of the 113 patients (59 female, 54 male), 61 (54%) completed the survey only once, 20 (17.7%) completed 2 surveys, and 16 (14.2%) completed 3 surveys. For the burn patients, most sub-domains in the BBSIP (sensory symptoms, work/daily activities, relationships/social interactions, appearance, emotional reactions, and physical symptoms) presented with a unidimensional scale (CFI&amp;gt;0.9 and RMSEA &amp;lt; 0.1) and had an acceptable reliability (omega reliability or coefficient omega hierarchical ranged from 0.8 to 0.94) after eliminating select items from the profile that were redundant. The “overall impact” sub-domain presented as a multidimensional scale and was also found to have acceptable reliability. Conclusions This study demonstrates acceptable reliability of the BBSIP in adult patients with hypertrophic burn scars undergoing reconstruction and/or laser treatment. To strengthen BBSIP reliability, within each sub-domain (except “overall impact”), we recommend deleting misfit items and pairing others. This modification would decrease the redundancy of questions and ensure the survey more reliably assesses the impact of burn scars. Applicability of Research to Practice This study provides recommended changes to the BBSIQ that will improve its reliability in the clinical setting.

The primary goal of exploratory factor analysis (EFA) is to determine the number of factors and their structure. Thus, the decision on the number of factors to retain is crucial. Nevertheless, researchers frequently overlook the precision of factor retention techniques and opt for unreliable methodologies instead. The objective of this study is to compare the efficiency of utilizing root mean square error of approximation (RMSEA) and parallel analysis (PA) methods for retaining factors in exploratory factor analysis (EFA). Two methods for comparing RMSEA, namely root deterioration per restriction (RDR) and RMSEA difference test, are employed for nested models. Although researchers use RMSEA to compare two different models, no studies have compared RMSEA and RDR methods. Thus, this study examined three different methods for factor retention. Monte-Carlo simulations were utilized to evaluate the accuracy of RDR compared to RMSEA difference testing and PA. The simulations show that RDR performs better than RMSEA difference testing and PA when the number of variables per factor is low. However, as the number of variables per factor increases, PA becomes more effective. This study provides guidance to researchers using EFA to select factor retention methods that suit different conditions.

In differentiated learning, the teacher needs to be aware of the learning styles of students in the classroom to accommodate specific learning preferences, e.g., the Felder–Silverman learning style model. The corresponding instrument, i.e., the Felder–Silverman Index of Learning Style (ILS), was designed to assess learning styles, specifically for engineering students. The ILS has been tested at the middle school level to identify the learning styles; however, validity/reliability had not been established in earlier studies with large samples. The focus of this study was to identify the validity and reliability of an ILS instrument for middle school students (N=450) by investigating the factor structure through factor analysis. This includes internal consistency reliability and constructing validity report of the ILS. An exploratory and confirmatory factor analysis was undertaken to investigate the factor structure to establish validity. As a result of the study, the reliability of the instrument was established. Five-factors emerged through exploratory factor analysis (EFA), which were subjected to confirmatory factor analysis (CFA). The outcome provided five-factors (i.e., Comparative Fit Index (CFI), Tucker–Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Residual (SRMR), and Goodness of Fit (GFI)), out of which four factors were related to the four dimensions of the Felder–Silverman model, and the fifth factor was related to the association of sensing/intuitive and sequential/global dimensions of the model, which is in agreement with the theoretical construct of ILS. As a result of CFA, ILS entailing 24 items indicates a good fit with five-factor structure. CFI=0.922;TLI=0.927; RMSEA=0.026; SRMR=0.585;GFI=0.911;X2=277;df=42;p=0.60. This study suggests that the ILS for the secondary-grade students needs to be revised with fewer items to improve the reliability, as supported by empirical evidence through the EFA and CFA.

The Family Caregiver Medication Administration Hassles Scale (FCMAHS) was developed to evaluate the hassles and concerns experienced by family caregivers in medication administration. This study aimed to evaluate the reliability and validity of the Turkish version of the Family Caregiver Medication Administration Hassles Scale (FCMAHS-TR). The FCMAHS-TR was developed after translation, cultural adaptation, and a pilot study. The cross-sectional study was conducted among family caregivers (≥18 years) in community pharmacies. Test-retest reliability analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were performed. Hypothesis testing was used for the assessment of construct validity. The majority (68.7%) of the family caregivers were female (n = 470). In the test-retest reliability analysis (n = 30), the ICC value was 0.917 (P < 0.001). In EFA analysis (n = 251), the Kaiser‒Meyer‒Olkin (KMO) measure was 0.799, 62.6% of the total variance was explained by five factors including eighteen items, and Cronbach's alpha was 0.836. According to CFA (n = 219), the root mean square error of approximation (RMSEA) was 0.0654, and the comparative fit index (CFI) was 0.918. In construct validity, family caregivers with low reading ability of health-related materials and with high care burden had significantly higher median scores for all the factors of the FCMAHS-TR (P < 0.05 for all). The FCMAHS-TR can be used to evaluate the hassle and concerns experienced by family caregivers in medication administration. This scale can be used by healthcare professionals to identify family caregivers who need individualized interventions for medication administration hassles.

It is very important to determine the consumption of sugar-sweetened beverages that cause diseases, such as obesity, diabetes, hypertension, and cardiovascular disease in late adolescence. This study aimed to evaluate the validity and reliability of the Turkish version of the Sugar-Sweetened Beverages Media Literacy Scale aimed at university students. This methodological-descriptive-correlational study was conducted with 884 university students between September 2018 and December 2018. The data were collected using a socio-demographic data collection form and the Sugar-Sweetened Beverages Media Literacy Scale. Factor analysis, Cronbach’s alpha, and item-total correlation were used to evaluate the data. It was determined that the scale consists of 19 items and three sub-dimensions; the three sub-dimensions explained 49.9% of the total variance. In both the explanatory and confirmatory factor analyses, all the factor loads were found to be >0.30. In confirmatory factor analysis, it was found that all of the fit indices were > 0.85 and the root mean square error of approximation (RMSEA) was <0.080. Cronbach’s alpha was found to be 0.86 for the entire scale; the Cronbach’s alpha values for all three sub-dimensions were found to range between 0.65 and 0.84. In this study, the Turkish version of the Sugar-Sweetened Beverages Media Literacy Scale aimed at university students was found to be a valid and reliable measurement tool for the Turkish sample.

Strategic Self‐Regulation for Speaking English as a Foreign Language: Scale Development and Validation

Multiple imputation (MI) is one of the recommended modern techniques for handling missing data in structural equation modeling (SEM) and evaluating model fit is a crucial aspect of analyzing SEM models. Methods for pooling model fit indices across imputed datasets are still under development, however, especially in the context of non-normal data. In this study, we considered methods for estimating a robust measure of the Root Mean Square Error of Approximation (RMSEA) fit index and introduced strategies for pooling the robust RMSEA across imputed datasets. We evaluated the performance of the proposed strategies under various conditions by manipulating sample size, level of non-normality, non-normal data generation algorithm, missing data mechanism, and percentage of missing data. Results showed that the MI-based RMSEA approach, extended from the Lai method with complete data, tended to outperform other methods, yielding smaller biases in point estimates. Furthermore, confidence intervals (CIs) for the population RMSEA can be computed with better coverage rates by using a normal approximation. Drawing on our findings, we discuss the practical implications of our study and suggest directions for future research.