Comprehension Items Research Articles

Abstract P330: Heart Failure Patient Insights Reflected in the Kansas City Cardiomyopathy Questionnaire

Background: Heart failure (HF) reduces patient quality of life more than other chronic illnesses. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a patient-reported outcome (PRO) instrument that is completed directly by the patient and is commonly used to address the patient's perspective on HF in clinical trials. The FDA Guidance on using PROs in clinical programs emphasizes the need to use qualitative patient interviews to ensure that a PRO instrument addresses all relevant concepts in a clinical area and that it is easily understood by patients. Objectives: The goal of this project was to assess patient insights regarding HF symptoms, physical limitations, and other impacts and to compare these to the content of the KCCQ, and to see how well patients understand the KCCQ items. Methods: Participants were 28 stable Class II - IV NYHA heart failure patients ages 42 to 90. Fifteen patients were interviewed to elicit patient insights and 13 patients were interviewed to assess patient comprehension of the KCCQ items. Results: The most commonly endorsed HF symptoms and impacts are listed in the table . These concepts are assessed in the KCCQ. The majority of the KCCQ items were rated as highly or somewhat relevant by 66% or more of the patients interviewed; items assessing ability to dress and shower/bathe, need to sleep sitting up, and limitations in visiting friends or family were rated as relevant by less than 50% of patients. Patients generally understood the instructions, items, and response options of the KCCQ with no problems or complications. Conclusions: Qualitative data from this study support the significance of the concepts measured by the KCCQ, such as HF symptoms and physical limitations. Thus, the KCCQ and other measures of these concepts may be useful as endpoints in development programs of novel drugs that may potentially have an impact on the burden of illness of HF in terms of symptoms and physical limitations. Category Examples/patient descriptions Percent of patients endorsing symptom or impact Symptoms Breathing problems Shortness of breath, wheezing 93% Tiredness Drowsy, exhausted 93% Swelling Legs when up and going all day 67% Impacts Physical mobility Get light headed when I bend down 93% Physical limitations Steer away from anything strenuous 93% Emotional effects Anxiety about shortness of breath 87%

Anna Dziemianko. User-friendliness of Verb Syntax in Pedagogical Dictionaries of English

To be user-friendly, monolingual and bilingual dictionaries for foreign users must be both easy to use and easy to read. They are designed to help prospective users both encode and decode, and to facilitate the comprehension of some vocabulary items or particular grammatical constructions. However, it often happens in practice that dictionaries are not used fully because some users are not aware of the richness of their contents. In carrying out the redesign of their dictionaries, lexicographers have been helped greatly by the views, needs, and preferences of a wide range of language users, many of them, of course, from schools and universities as well as general language learners. Further adaptations always follow, based on the experience of using a new dictionary and for this purpose feedback is always of great importance. In the process of establishing a user-friendly dictionary, the changes, though extensive, remain modest but in the much longer term, more complex changes take place to incorporate revisions and give them new clarity and coherence across the many and expanding contexts in which they are used. Whether this redesign actually helps users is the subject of much research. Both traditional and electronic dictionaries have now included a large number of tools in the definition, such as IPA pronunciation, examples and syntactic information, often presented in the shape of codes which will enable users not only to understand a particular structure, but to be able to reuse it.

Developing a Measure of Behavior Change in a Program to Help Low-Income Parents Prevent Unhealthful Weight Gain in Children

Objective To develop and test a brief measure of changes in eating, active play, and parenting practices after an intervention to help parents shape children’s choices and home environments. Design Sequential phases of development and testing: expert panel review, cognitive testing interviews, field testing, test-retest study, and assessment of convergence with detailed previously validated instruments. Setting and Participants Expanded Food and Nutrition Education Program (EFNEP), New York State. Low-income parents of 3- to 11-year-old children; Cooperative Extension nutrition and parenting educators. Main Outcome Measures Questionnaire reliability, validity, respondent comprehension, and feasibility of use in program contexts. Analysis Qualitative analysis of item comprehension. Correlational analysis of test-retest reliability and convergent validity. Results A behavior checklist was developed to assess change in parent-reported family eating, physical activity, and parenting practices addressed by an intervention. The checklist was feasible for use in EFNEP and questions were understood as intended. Test-retest reliability was good ( r = 0.83) and scores correlated significantly (range, 0.25 to –0.60; P < .05) with detailed measures of dietary habits, parental modeling, physical activity, and home environment. Conclusions and Implications Development and testing in a program context produced a tool community nutritionists can use to evaluate educational interventions aimed at helping parents promote healthful eating and activity.

Development, Reliability, and Validity of a New Preference and Satisfaction Questionnaire

Objectives Existing questionnaires that assess preference and/or satisfaction with postmenopausal bone loss treatments were reviewed and determined to be inadequate for the assessment of an oral pill versus a subcutaneous injection. The Preference and Satisfaction Questionnaire (PSQ) was developed to assess preference, satisfaction, and bother with a weekly oral tablet versus a once every 6 months subcutaneous injection for treatment of postmenopausal bone loss. Methods Questions were developed based on literature review and expert input. Content validity of the PSQ in this patient population was assessed among current or previous bisphosphonate users in group interviews, and item comprehension and readability were also evaluated. Reliability, validity, and structure of the questionnaire were assessed in two phase 3 randomized clinical trials. Results Twenty-four women participated in cognitive interviews and found the PSQ understandable and acceptable. Subsequently, 1583 trial participants took the PSQ. Interitem correlations, ranging from 0.50 to 0.97 for preference items, 0.85 to 0.94 for pill-satisfaction items, and 0.84 to 0.92 for injection-satisfaction items, and a well-fitting confirmatory factor analysis (root mean square error of approximation 0.04, nonnormed fit index 0.99, and root mean square residual 0.08) supported the structure of the instrument. Cronbach's alpha reliability values for pill satisfaction, injection satisfaction, pill bother, and injection bother were 0.93, 0.89, 0.82, and 0.61, respectively. Discriminative validity was indicated with better satisfaction and bother scores being related to adherence and the absence of adverse events. Conclusions The PSQ is a valid and reliable measure and may be a valuable tool to assess patient preference and satisfaction with a weekly oral tablet and 6-month subcutaneous injection for postmenopausal bone loss.

Effect of the response tree format on the utility and psychometric properties of scales measuring symptoms in adults undergoing inpatient rehabilitation

Imbedding a response tree into self-report scales is a strategy recommended to improve item comprehension and reduce burden in older adults. However, researchers have posed potential utility, validity, and reliability limitations to this strategy that have not been examined in the clinical setting. We evaluated the effect of the response tree format (RTF) on the psychometric properties and utility of three scales measuring symptoms in 86 rehabilitation inpatients. The RTF had little effect on the scales' psychometric properties or utility. Time to complete the scales differed for one scale only. The two formats manifested comparable levels of utility, reliability, and validity in the study sample, and may be used with older adults who experience difficulty responding to the original scales.

Preliminary study of Internet addiction and cognitive function in adolescents based on IQ tests

The potential relationship between Internet addiction and certain cognitive function problems has been suggested by several studies. However, few or no studies have examined the differences in cognitive functioning between persons addicted to the Internet and persons not addicted using a standard neuropsychological test. This study screened 253 middle school students and 389 high school students for Internet addiction and compared 59 Internet-addicted students with 43 non-addicted students using an IQ test. The Internet-addicted group had comprehension sub-item scores that were significantly lower than those of the non-addicted group. As the comprehension item reflects ethical judgement and reality testing, there may be a relationship between Internet addiction and weak social intelligence. Earlier onset of Internet addiction and longer addiction duration were associated with lower participant performance in areas related to attention. As this study is a cross-sectional study, it is not clear whether the persons who display weak cognitive functioning are susceptible to Internet addiction or if Internet addiction causes cognitive problems. However, as brain development remains active during adolescence, the possibility that Internet addiction adversely affects the cognitive functioning of adolescents cannot be ruled out.

Cognitive Testing of the Spinal Appearance Questionnaire With Typically Developing Youth and Youth With Idiopathic Scoliosis

The Spinal Appearance Questionnaire (SAQ) underwent initial psychometric studies, which suggested good reliability and discriminative ability. Although the SAQ is used as a self report of appearance, our center was concerned about its use with youth owing to complex words and vague questions. We conducted this cross-sectional study to evaluate the readability, comprehension, and interpretation of items on the SAQ. Cognitive interview methodology of 76 youths (8 to 16 y; average age 13) included 31 with scoliosis and 45 typically developing. Subjects were required to read each SAQ item and think aloud to capture cognitive processes about the items and responses. Interviews were audiotaped and transcribed verbatim. Problems were categorized and frequencies for each category were calculated. There were reading and comprehension problems and problems understanding the illustration with every written and pictorial SAQ item, respectively. The percent of subjects who encountered at least one problem ranged from 16% to 96%. Subjects had difficulty with understanding the intent of every SAQ item and with understanding the meaning of specific words such as "prominence" and "flank." The pictorial illustrations for items 2 and 3 were problematic for 58% and 49% of subjects, respectively. The illustrations of the lungs (item 4) and hips (items 4 and 5) were problematic for 42% and 27% of subjects, respectively. These results were consistent regardless of age or diagnoses. This study does not support the use of the SAQ as currently used with youth owing to use of complex medical words, vague questions, difficult illustrations, and various interpretations of the intent of many of the items. Not applicable (not an intervention study).

Abstract B8: Bringing science to underserved communities: Using community-based participatory research to evaluate biobanking educational materials

Abstract Introduction: Biospecimen donation and banking from diverse populations are critical for translational cancer research. Yet, little is known about community members’ perceptions about biospecimen donation and banking. The objectives of this study are to develop instruments to examine perceptions of biospecimen donation and banking and evaluate the efficacy of biobanking educational materials. Methods: Guided by a community-based participatory research (CBPR) approach, the study consists of two phases. In phase I, an instrument named Biobanking Attitudes and Knowledge Survey (BANKS) was developed in collaboration with the Tampa Bay Community Cancer Network (TBCCN) Biobanking Community Advisory Board to assess participants’ knowledge about and attitudes towards biospecimen collection, intention to donate biospecimens to a biobank, as well as self-efficacy regarding biospecimen donation. BANKS development and validation consists of iterative processes, including content analysis of 12 focus groups (n=95) for item generation; cognitive interviews (n=12 community members) to assess item comprehension and language appropriateness; content validity analyses with biobanking experts (n=5) to evaluate item relevancy to the constructs of interest (Knowledge, Attitudes and Self-efficacy); pilot-testing with community members; and instrument translation into Spanish. In Phase II, a small randomized control trial will be conducted with 60 community members to assess the efficacy of biobanking educational materials in increasing knowledge, positive attitudes, self-efficacy, and intentions to donate biospecimens to a biobank. The study will compare a multimedia biobanking educational intervention developed by TBCCN, with the National Cancer Institute brochure titled Providing Your Tissue for Research: What You Need to Know (NCI brochure). BANKS data will be collected following study enrollment (baseline), and then participants will be randomly assigned to one of two intervention groups (TBCCN multimedia intervention or NCI brochure). Follow-up interviews using the BANKS will be conducted between 7 and 14 days after enrollment. Participants’ medical records will be reviewed to assess group differences in biospecimen donation consent rates. Results: Using a CBPR approach, the project has successfully developed and validated a culturally and linguistically appropriate instrument to assess community members’ knowledge, attitudes, intention, and self-efficacy related to biospecimen donation. The BANKS is comprised of 21 attitudes items, 17 knowledge items, 11 self-efficacy items, and 2 intention items. Phase II of the study is expected to provide preliminary data on the efficacy of a multimedia biobanking educational intervention in improving perceptions of biospecimen donation and biobanking. Conclusion: Using a CBPR approach, data collected during this study have yielded a culturally appropriate instrument to assess community members’ perceptions about biobanking, the BANKS. The next step in the study is to use the BANKS to evaluate a multimedia biobanking intervention in increasing knowledge, positive attitudes, self-efficacy, and intention to donate biospecimens to a biobank among racial/ethnically and linguistically diverse populations in Tampa Bay, Florida. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B8.

Coping resources in individuals with aphasia

Background: Individuals with aphasia (IWA) may be under considerable stress due to the nature of language impairments and other stroke sequelae. IWA have reported a greater perception of stress compared to neurologically intact individuals, including fewer perceived coping resources to assuage the effects of this stress. Aims: This study sought to identify which areas of coping resources are perceived to be available or unavailable to IWA in comparison with those with right brain damage (RBD) and neurologically intact individuals. Methods & Procedures: A total of 31 IWA, 12 individuals with RBD, and 14 neurologically intact individuals completed the Coping Resources Inventory for Stress with a caregiver, spouse, or friend to facilitate comprehension of test items. Subtest scores were compared for group differences. Outcomes & Results: All three groups perceived similar coping resources in the areas of social support and financial freedom. IWA perceived fewer resources than those with RBD and neurologically intact individuals in the areas of stress monitoring and tension control. Both IWA and those with RBD perceived fewer resources in the area of acceptance. Conclusions: IWA have retained coping resources in some areas, specifically confidence, social support and financial freedom. Helping IWA use these resources may be an effective way to reduce stress in this population. IWA may also benefit from counselling in coping resources, specifically in the areas of stress monitoring and tension control. Counselling programmes should educate IWA on the chronic nature of aphasia and how acceptance may be a useful coping resource in later stages of recovery.

Premorbid expertise produces category-specific impairment in a domain-general semantic disorder

For decades, category-specific semantic impairment – i.e., better comprehension of items from one semantic category than another – has been the driving force behind many claims about the organisation of conceptual knowledge in the brain. Double dissociations between patients with category-specific disorders are widely interpreted as showing that different conceptual domains are necessarily supported by functionally independent systems. We show that, to the contrary, even strong or classical dissociations can also arise from individual differences in premorbid expertise. We examined two patients with global and progressive semantic degradation who, unusually, had known areas of premorbid expertise. Patient 1, a former automotive worker, showed selective preservation of car knowledge, whereas Patient 2, a former botanist, showed selective preservation of information about plants. In non-expert domains, these patients showed the typical pattern: i.e., an inability to differentiate between highly similar concepts (e.g., rose and daisy), but retention of broader distinctions (e.g., between rose and cat). Parallel distributed processing (PDP) models of semantic cognition show that expertise in a particular domain increases the differentiation of specific-level concepts, such that the semantic distance between these items resembles non-expert basic-level distinctions. We propose that these structural changes interact with global semantic degradation, particularly when expert knowledge is acquired early and when exposure to expert concepts continues during disease progression. Therefore, category-specific semantic impairment can arise from at least two distinct mechanisms: damage to representations that are critical for a particular category (e.g., knowledge of hand shape and action for the category ‘tools’) and differences in premorbid experience.

Test Taking Strategies: Implications for Test Validation

To collect pieces of evidence for the construct validity of the reading section of a high-stakes test, test taking strategies of 40 test takers were analyzed via a checklist of strategies. The checklist consisted of 28 strategies tapping test takers’ behaviors while taking some reading comprehension items. The goal was to see whether there was concordance between the type of strategies and the item types in the reading comprehension passages. For example, if the strategy of guessing is used on inference items, this jeopardizes the validity of the item because there is a mismatch between the intentions of the test makers and those of test takers (Cohen, 1984). Hopefully, it was found mostly the right strategies were used on the right item types. This speaks to the construct validity of the reading section of University of Tehran English Proficiency Test (the UTEPT) which was exposed to investigation.

On the Factor Structure of a Reading Comprehension Test

To investigate the construct validly of a section of a high stakes test, an exploratory factor analysis using principal components analysis was employed. The rotation used was varimax with the suppression level of .30. Eleven factors were extracted out of 35 reading comprehension items. The fact that these factors emerged speak to the construct validity of the test. However the problem of over-factoring was obvious. This may be attributable to different paradigms of testing on which the items were based. In other words, the test constructer opted for passages from TOEFL, FCE and IELTS books with much alteration.

PMH53 ASSESSING THE IMPACT OF MAJOR DEPRESSIVE DISORDER (MDD) ON FAMILY FUNCTIONING: DEVELOPMENT OF THE DEPRESSION AND FAMILY FUNCTIONING SCALE

To assess family functioning from patients' and partners' perspectives to better understand the impact of depression on family functioning; To develop and test patient and partner versions of a new self-reported measure, the Depression and Family Functioning Scale (DFFS), for use in clinical trials. First, 32 in-depth interviews were conducted separately with adults with moderate-to-severe MDD and their respective partners to 1) gather qualitative data describing the impact of depression on family functioning, and 2) identify constructs relevant to measuring this impact. Next, based on the interview results and a targeted literature review conducted to supplement these results, 26 items were drafted to address each aspect of family functioning likely to be affected by depression. Questionnaire items were then tested and refined through two iterative sets of cognitive interviews with a total of 15 MDD patients and 15 partners of MDD patients to allow for enhanced comprehension of questionnaire items, as well as optimization of the recall period and response scales used in the final DFFS. Depression negatively affects family functioning, most notably through poorer communication, increased conflicts, decreased family interaction, and decreased intimacy. Family functioning constructs most commonly referenced in the literature review included communication, satisfaction, and cohesion. Draft DFFS items generally tested well and only minor modifications were made to the items after the second set of interviews to further facilitate comprehension and accurate responses. Both patients and partners found the final 15 DFFS items important and relevant. Depression negatively affects family functioning in multiple ways. The DFFS is a brief scale designed to evaluate depression's impact on family functioning in patients with MDD and their partners. The DFFS has the potential to provide unique and important information facilitating more comprehensive evaluation of new treatments in clinical trial settings.

Defining and Comparing the Reading Comprehension Construct: A Cognitive-Psychometric Modeling Approach

As a construct definition, the current study develops a cognitive model describing the knowledge, skills, and abilities measured by critical reading test items on a high-stakes assessment used for selection decisions in the United States. Additionally, in order to establish generalizability of the construct meaning to other similarly structured tests designed for international populations and distinct uses, the skills invoked during a reading comprehension test for English learners from a previous study are contrasted to those in the present study. The results obtained using rule-space methodology suggest that the most difficult skills on reading comprehension items pertain to complex cognitive processes (e.g., understanding implicit ideas), while skills tapping into basic cognitive processes (e.g., word meaning) are mastered with ease by both populations. However, variations across tests in the impact of various cognitive skills on test scores suggest that the differences in construct meaning be considered when interpreting and comparing test scores. Cognitive-psychometric modeling approaches such as those applied in this study prove to be useful in substantively examining score interpretation and construct generalizability.

The Development of a Spanish Language Instrument to Measure Genetic Knowledge of Diabetes Mellitus Type 2

The purpose of this study was to develop a Spanish-language measure of genetic knowledge relevant to type 2 diabetes for use with members of the ethnically heterogeneous U.S. Latino community. Review of the literature and expert content analysis guided initial instrument development. The instrument was pretested in three cognitive interview waves with 36 Latinos representative of Mexican, Central and South American, and Cuban heritage. Interview analysis indicated potential sources of response error and guided an iterative process of instrument refinement. Difficulties associated with item interpretation, grammatical structure, and comprehension were identified. Analysis indicated that revisions improved item quality and enhanced cultural and linguistic appropriateness of the instrument. Field testing suggested initial validity of a Spanish-language instrument to measure genetic knowledge relative to type 2 diabetes. A Spanish-language measure of genetic knowledge can guide nursing interventions that support culturally appropriate integration of genetics into health care.

Analysis of the construct of dignity and content validity of the patient dignity inventory

BackgroundMaintaining dignity, the quality of being worthy of esteem or respect, is considered as a goal of palliative care. The aim of this study was to analyse the construct of personal dignity and to assess the content validity of the Patient Dignity Inventory (PDI) in people with an advance directive in the Netherlands.MethodsData were collected within the framework of an advance directives cohort study. This cohort study is aiming to get a better insight into how decisions are made at the end of life with regard to advance directives in the Netherlands. One half of the cohort (n = 2404) received an open-ended question concerning factors relevant to dignity. Content labels were assigned to issues mentioned in the responses to the open-ended question. The other half of the cohort (n = 2537) received a written questionnaire including the PDI. The relevance and comprehensiveness of the PDI items were assessed with the COSMIN checklist ('COnsensus-based Standards for the selection of health status Measurement INstruments').ResultsThe majority of the PDI items were found to be relevant for the construct to be measured, the study population, and the purpose of the study but the items were not completely comprehensive. The responses to the open-ended question indicated that communication and care-related aspects were also important for dignity.ConclusionsThis study demonstrated that the PDI items were relevant for people with an advance directive in the Netherlands. The comprehensiveness of the items can be improved by including items concerning communication and care.

Development and validation of a brief self-report measure of trauma exposure: The Trauma History Screen.

Although information about individuals' exposure to highly stressful events such as traumatic stressors is often very useful for clinicians and researchers, available measures are too long and complex for use in many settings. The Trauma History Screen (THS) was developed to provide a very brief and easy-to-complete self-report measure of exposure to high magnitude stressor (HMS) events and of events associated with significant and persisting posttraumatic distress (PPD). The measure assesses the frequency of HMS and PPD events, and it provides detailed information about PPD events. Test-retest reliability was studied in four samples, and temporal stability was good to excellent for items and trauma types and excellent for overall HMS and PPD scores. Comprehensibility of items was supported by expert ratings of how well items appeared to be understood by participants with relatively low reading levels. In five samples, construct validity was supported by findings of strong convergent validity with a longer measure of trauma exposure and by correlations of HMS and PPD scores with posttraumatic stress disorder (PTSD) symptoms. The psychometric properties of the THS appear to be comparable or better than longer and more complex measures of trauma exposure.

Influencing Factors on Functional Health Literacy among the Rural Elderly

Purpose:Thepurposeof this study was to describe the statusof thefunctional health literacyof theelderly living in a rural community and to identify the influencing factors on the functional health literacy. Methods: Subjects (n=238) aged over 60years wereselectedfor datacollection.Functional healthliteracy wasmeasuredbyKorean Health Literacy, which consisted of 15 items including eight numeracy and seven comprehension items. Descriptive statistics, t test, ANOVA with Scheffe test, and stepwise multiple regression were used to analyze - the data. Results: The mean score of total functional health literacy was 6.66±3.31, numeracy was 3.52±1.76, and comprehension was 3.41±2.10. Of the subjects, 39.1% showed a low score below the median split. In the results of stepwise multiple regression, the factors affecting functional health literacy were basic literacy, age, number of chronic diseases, self reported health status, and gender. These factors accounted for 33.0% of - functional health literacy. Conclusion: These results suggest that interventions for improving functional health literacy are necessary to enhance elders' ability of self care management. In addition, it is needed to take into - account the individual characteristics of the subjects depending on their gender, age, and health status.

Metacognitive instruction for helping less-skilled listeners

This article reports on a small-scale study of the effect of metacognitive instruction on listeners’ comprehension. Twenty adult, Japanese, advanced level EFL learners participated in a task sequence, or ‘pedagogical cycle’, of predicting, monitoring, problem identification, and evaluating in each of five listening lessons aimed at promoting their comprehension of television news items. A comparison of pre-test and post-test scores illustrated that three of four less-skilled listeners made notable gains across the five lessons, whereas only one of four more-skilled listeners improved. Findings add support to the view that metacognitive instruction utilizing a pedagogical cycle may help less-skilled listeners to develop their listening ability, though there seems to be a threshold for higher skill levels beyond which effects are minimal.

An Introspective Study of Arabic and Mandarin-Speakers’ Reading Comprehension Strategies

Little L2 reading strategy research has explored the effect of linguistic and cross-cultural differences on strategic reading habits. This study attempted to fill this void by examining the reading strategies that Arabic and Mandarin speaking immigrants employed when reading and answering Canadian Language Benchmarks Assessment reading comprehension items. A chi-square analysis of their bottom-up and top-down strategy use revealed that the Mandarin-speakers used bottom-up strategies significantly more than expected, whereas the Arabicspeakers used top-down strategies more than expected. The findings of the study are discussed in the light of earlier research, and some preliminary implications for reading strategy instruction, strategy training studies, and test development practices are suggested.