Confirmatory Factor Analysis Fit Research Articles

The Patient Perceptions of Deprescribing (PPoD) Survey: Short-Form Development.

Deprescribing, the intentional reduction of medication, is recognized as an important component of clinical care; however, standardized identification of patient attitudes and beliefs that contribute to deprescribing may be limited due to the length of current surveys. We sought to develop a short-form (≤ 15 items) of the patient perceptions of deprescribing (PPoD) questionnaire, a validated 30-item instrument that assesses dimensions relevant to deprescribing, to be used in clinical and research settings. We conducted a secondary analysis of data from 803 US veteran respondents to the original PPoD survey, randomly divided into derivation and validation samples. In the derivation sample, we used ordinary least squares linear regression with R2 model selection to identify candidate items reflective of overall readiness for deprescribing. We then used iterative multitrait analysis, followed by confirmatory factor analysis (CFA) in the validation sample to assess the psychometric properties of the proposed short form. The resulting short-form PPoD consisted of 11 items representing two overarching domains reflective of overall readiness for deprescribing: 'Motivation for Deprescribing' and 'Primary Care Provider Relationship'. CFA fit statistics supported the proposed structure and the two new scales demonstrated high internal consistency reliability (Cronbach alphas: 0.82 and 0.91, respectively) and good discriminant validity (interscale correlation - 0.30). The proposed short-form PPoD captures two important sources of variance in patient readiness for deprescribing: motivation and patients' relationships with their primary care providers. This brief, 11-item survey may help foster the inclusion of patient perceptions into clinical decision making for deprescribing to yield safer, more appropriate medication use.

The general self-efficacy scale (GSES): Reevaluation of its reliability and validity evidence in Chile

Self-efficacy is a psychological variable closely related to healthy behaviors. One of the most widely used instruments to measure this variable is the general self-efficacy scale (GSES). In Chile, the only psychometric study of this scale has important analytical limitations. To assess reliability and validity of GSES in a large Chilean sample. The GSES and a self-esteem scale were applied to 2995 participants aged 11 to 76 years (60% women). The scale showed optimal levels of homogeneity and internal consistency. The exploratory factor analysis and the parallel analysis suggested a one-dimensional internal structure. However, this model showed a mediocre fit in the confirmatory factor analysis due to the residual correlation between a pair of items with high semantic similarity. A one-dimensional model specifying this residual correlation attained an acceptable fit in a new confirmatory factor analysis. The new model reached strict invariance according to sex, and partial strict invariance according to age. The latent factor of the GSES showed a positive association with the latent factor of a self-esteem scale. The GSES is an adequate scale to measure general self-efficacy in the Chilean population and allows unbiased comparisons based on sex or age.

Development and Implementation of Societal Influences Survey Questionnaire (SISQ) for Peoples during COVID-19 Pandemic: A Validity and Reliability Analysis.

The emergence of Coronavirus disease 2019 (COVID-19) had rapidly spread since FEB/MAR 2020. Policy to prevent transmission of COVDI-19 resulted in multi-dimensional impact on social interaction. We aimed to develop a beneficial survey tool with favorable quality and availability, the Societal Influences Survey Questionnaire (SISQ), to evaluate social influences on people during this pandemic. The SISQ was developed with 15 items and 4-point Likert scales consisting of five factors. These include social distance, social anxiety, social desirability, social information, and social adaptation. Construct validity and reliability were performed to verify the SISQ. A total of 1912 Taiwanese were recruited. The results demonstrated that the SISQ has acceptable reliability, with Cronbach’s alphas ranging between 0.57 and 0.76. The SISQ accounted for 58.86% and satisfied the requirement of Kaiser–Mayer–Olkinvalues (0.78) and significant Bartlett’s Test of sphericity. Moreover, the confirmatory factor analysis fit indices also indicated the adequacy of the model. As for multiple comparison, females scored higher than males in factor of social distance. Unemployed participants and those without partners scored higher in several domains of factors. The survey method and survey instrument prove reliable and valuable, also providing different categories of assessment results regarding social influences and their impacts. Further studies are warranted to extend the applicability of SISQ.

Psychometric Validation of the Chinese Version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema in Patients With Breast Cancer-Related Lymphedema.

Breast cancer-related lymphedema (BCRL) has a notable impact on patients' quality of life. However, no instrument is available to assess the problems in functioning due to BCRL in China. The aims of this study were to translate and validate a Chinese version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL). A process of translation and cultural adaptation was conducted based on international standards. The study included 155 patients with BCRL and 90 patients without lymphedema. Psychometric properties that were tested consisted of internal consistency, test-rest reliability, content, construct and discriminant validity. The Cronbach's α was .92, and intraclass correlation coefficient was 0.83. Content validity was confirmed by a sufficient content validity index in item level and scale level. Exploratory factor analysis identified 5 factors accounting for 62.44% of the total variance, and confirmatory factor analysis fit indices were acceptable. Convergent validity was supported by a moderate correlation with the 36-item Short-Form Health Survey Questionnaire and relatively weak correlations with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. There was good divergent validity with all hypotheses evaluating divergent validity were confirmed. Significant differences were found between the lymphedema and nonlymphedema groups. The Chinese version of the Lymph-ICF-UL is a valid and reliable instrument that can be used in both clinical and scientific settings in China. The Chinese version of the Lymph-ICF-UL could be applicable in assessing the impairments in function, activity limitations, and participation restrictions of Chinese patients with BCRL.

Validation and confirmatory factor analysis of the pediatric Adherence Barriers to Continuous Positive Airway Pressure Questionnaire

ObjectiveTo evaluate and refine a newly proposed factor structure for the Adherence Barriers to Continuous Positive Airway Pressure Questionnaire (ABCQ) and to present psychometric data from a large, geographically diverse sample of children and young adults with sleep disordered breathing (SDB) treated with positive airway pressure (PAP). MethodsA sample of 181 patients prescribed PAP for treatment of SDB, ages 8–21 years, and caregivers (n = 234) of patients ages 2–21 years, completed the ABCQ during routine sleep medicine clinic visits. Adherence data from participants' PAP machines were obtained via electronic download, providing objective data on PAP adherence immediately preceding the clinic visit during which the ABCQ was completed. ResultsA three-factor structure (1. Behavior, Beliefs, Environment, 2. Emotional Barriers, & 3. Physical Barriers) exhibited good model fit in confirmatory factor analysis. Results indicate that the ABCQ has strong psychometric properties, including good internal consistency among subscales and strong convergent validity with objectively measured PAP adherence. Analysis of the Receiver Operator Characteristic Curve (ROC) yielded an ABCQ total cut-off score of 46.5 for patient report and 53.5 for caregiver report. Scores above the cutpoint predicted nonadherence to PAP, defined as failure to use PAP for ≥4 h on 70% of nights. ConclusionsThe three-factor ABCQ appears to be a useful patient- and caregiver-report instrument to measure barriers to PAP treatment in children and young adults with sleep disordered breathing.

Chi‐square for model fit in confirmatory factor analysis

Chi‐square for model fit in confirmatory factor analysis

MACHINE LEARNING-STRUCTURAL EQUATION MODELING ALGORITHM ON ONLINE SHOPPING CUSTOMER SATISFACTION MEASUREMENT

Purpose-The purpose/aim of this empirical research was to know the impact of ease of use, service, convenience, reliability and security on online customer satisfaction. Further, to investigate the role of reliability and security on online customer satisfaction. There are three categories of variables mainly influencing on online customer satisfaction. They are 1.Control variables: gender, age, education, service and income. 2. Main variables: ease of use, service and convenience. 3. Interaction variables: reliability and security. Design/Methodology/Approach: Using a structured closed ended questionnaire to collect the data from 400 respondents. The questionnaire validated with pilot study followed by standardized loaded factors validated through confirmatory factor analysis and model fit was validated through GFI, AGFI, CFI and TLI >0.90. Researcher applied hierarchical regression analysis to see the impact of moderator on customer satisfaction. Findings- The outcome of the research proved that, ease of use, service, convenience, reliability and security have shown significant positive impact on online customer satisfaction followed by the moderating variables: security and reliability strengthened in such manner which leads to high customer satisfaction. The factor analysis also proved through standardized loadings with good model fit. Research implications- The outcome of the research can be generalized under any circumstances, situations and conditions. The proposed model was useful to understand online customer satisfaction level. In fact, the research was strengthened through literature review. Social implications- present study can be useful to judge the pulse of the online customer. Originality/value- This study provides new insight to the readers, which has not been designed earlier to understand the online customer satisfaction level. Paper type- by nature it is a research paper.

Assessing Mental Health for China's Police: Psychometric Features of the Self-Rating Depression Scale and Symptom Checklist 90-Revised.

Police mental health is important because police officers usually encounter stressors that cause high levels of stress. In order to better understand mental health for Chinese police, the Zung Self-Rating Depression Scale (SDS) and Symptom Checklist 90-Revised (SCL-90-R) are commonly used in mainland China. Unfortunately, both the SDS and SCL-90-R lack detailed information on their psychometric properties. More specifically, factor structures of the SDS and SCL-90-R have yet to be confirmed among the police population in mainland China. Therefore, the present study compared several factor structures of the SDS and SCL-90-R proposed by prior research and to determine an appropriate structure for the police population. Utilizing cluster sampling, 1151 traffic police officers (1047 males; mean age = 36.6 years [SD = 6.10]) from 49 traffic police units in Jiangxi Province (China) participated in this study. Confirmatory factor analysis (CFA) with Akaike information criterion (AIC) was used to decide the best fit structure. In the SDS, the three-factor model (first posited by Kitamura et al.) had the smallest AIC and outperformed other models. In the SCL-90-R, the eight-factor model had the smallest AIC and outperformed the one-factor and nine-factor models. CFA fit indices also showed that both the three-factor model in the SDS and the eight-factor model in the SCL-90-R had satisfactory fit. The present study’s results support the use of both SDS and SCL-90-R for police officers in mainland China.

Eating behavior tendencies among Finnish adults in relation to previous weight loss attempts

BackgroundThe number of weight loss attempts may be associated with higher weight status and unfavorable health behaviors as well as dysfunctional eating behaviors. We aimed to study eating behavior tendencies, i.e., cognitive restraint, uncontrolled eating and emotional eating among a sample of Finnish adults who had engaged in a different number of attempts to lose weight during their lifetime. MethodsData were collected through a web-based survey. Participants completed a background questionnaire (including questions on weight, height, number of attempts to lose weight) and the Three-Factor Eating Questionnaire (TFEQ-R18). Out of 1985 individuals, 1679 with complete data were included in the study. The TFEQ-R18 was tested for its reliability and fit to our study population using Cronbach's alpha and Confirmatory Factor Analysis (CFA). ResultsSubscales of the TFEQ-R18 had acceptable reliability except for that of ‘cognitive restraint’, which reached acceptable reliability when three items were deleted (items 15, 16, 18). The revised version of the questionnaire was designated as the TFEQ-R15, which showed good fit based on CFA fit indices. Participants who had attempted to lose weight during their lifetime (n = 1229), especially those with ≥3 weight loss attempts (n = 499), had greater cognitive restraint, uncontrolled eating, emotional eating, and higher body mass index (BMI) than those with no previous weight loss attempts (n = 132). ConclusionsOur findings suggest that eating behavior tendencies, i.e., decreasing tendencies of uncontrolled and emotional eating should receive more emphasis to support successful weight management.

Development and Psychometric Evaluation of the Life Interference Questionnaire for Growth Hormone Deficiency (LIQ-GHD) to Assess Growth Hormone Injection Burden in Children and Adults.

BackgroundCurrent recombinant human growth hormone (r-hGH) replacement therapy involves long-term daily subcutaneous injections to treat growth hormone deficiency (GHD) in children and adults. Daily r-hGH injections can be burdensome, often resulting in poor treatment compliance. Clinical outcome assessments (COAs) can capture the burden of these injections from the patient (and caregiver) perspective and may demonstrate the benefit of a less-frequent r-hGH injection regimen, which may ultimately improve treatment compliance and long-term outcomes.ObjectiveTo address this knowledge gap, qualitative research was conducted to inform the development of a new Life Interference Questionnaire for Growth Hormone Deficiency (LIQ-GHD), designed to measure the experiences of patients taking r-hGH GHD injections. A second objective was to evaluate the hypothesized factor structure and preliminary performance of the LIQ-GHD in a cross-sectional observational study.MethodsAn empirical literature review and expert advice meetings were conducted to inform development of the draft LIQ-GHD (pediatric and adult versions). In-person concept elicitation and cognitive debriefing interviews were conducted with GHD patients (and patient dyads including caregivers) to explore and confirm concept coverage and evaluate respondents’ ability to understand the questionnaire. The draft LIQ-GHD was then tested in a cross-sectional field study involving pediatric and adult patients receiving daily r-hGH injections for GHD. The factor structure, reliability, and validity were analyzed for the overall sample and for pediatric, adolescent, and adult subgroups.ResultsResults from the literature review and input from six experts were used to develop and refine the LIQ-GHD, with content covering pen ease of use; regimen convenience; life interference due to regimen; benefit/satisfaction/willingness to continue treatment; regimen choice/preference; intent to comply with regimen; injection-related signs/symptoms; and reasons for missed injections. Twenty-one patient interviews confirmed comprehensive concept coverage and patient/caregiver comprehension of the LIQ-GHD. A total of 224 patients (n = 70 children/caregiver dyads, n = 79 adolescents/caregiver dyads, n = 75 adults) participated in the field study. While most items showed floor effects, confirmatory factor analysis fit statistics were good for the overall sample (root mean square error of approximation = 0.07, comparative fit index = 0.98) and for the full pediatric sample after dropping co-dependent questions from the model. Cronbach’s alpha (α) ranged from 0.746 to 0.905 and intra-class correlation coefficients ranged from 0.761 to 0.918 for the overall sample on LIQ-GHD domains. Scores correlated as predicted with an existing criterion measure in the overall sample and LIQ-GHD domain scores distinguished known groups as expected.ConclusionsThe LIQ-GHD is a new COA for the measurement of r-hGH injection treatment burden. This research provides evidence supporting its content validity, hypothesized factor structure, score reliability, and construct validity in pediatric and adult populations.

Skin Picking Impact Scale: Reliability and Validity Study of Turkish Version

Abstract Background: In this study, we aimed to perform the validity and reliability study for Turkish version of Skin Picking Impact Scale (SPIS). Methods: This study included 80 patients diagnosed with SPD according to DSM-5 diagnostic criteria. Patients were given Sociodemographic Data Form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Short Form-36 Quality of Life Scale (SF-36), Yale-Brown Obsessive Compulsive Scale Modified for Neurotic Excoriation (NE-YBOCS) and Turkish version of SPIS. Cronbach’s alpha coefficient and item-total correlation were examined for the reliability of the scale. Confirmatory factor analysis (CFA) was used to examine the factor structure of the scale and ROC (Receiver Operating Characteristics) was performed to the discriminatory validity analysis. Results: Cronbach’s alpha internal consistency coefficient was determined to be 0.942. Item-total correlation coefficients of all questions ranged between 0.665 and 0.849. The one-factor structure showed a good model fit in CFA. Good correlations were observed between SPIS and number of sites of picking (r=0.265, p=0.037), duration of skin picking per day (r=0.453, p

COVİD-19 PANDEMİSİNE İLİŞKİN ALGI VE TUTUM ÖLÇEKLERİNİN GELİŞTİRİLMESİ

Aim: The aim of this study is to develop scales that can enable to evaluate perceptions and attitudes associated with the outbreak during the COVID-19 pandemic. Materials and Methods: The research sample was composed of 352 healthcare workers and 507 non-healthcare workers. In the study, perceptions and attitudes regarding COVID-19 were evaluated on five scales: Perception of COVID-19 (P-COVID-19), Perception of Causes of COVID-19 (PCa-COVID-19), Perception of Control of COVID-19 (PCo-COVID-19), Avoidance Attitudes from COVID-19 (AA-COVID-19) and Attitudes Towards the COVID-19 Vaccine (ATV-COVID-19). In the study, scales were evaluated with appearance validity, content validity, structural validity (explanatory and confirmatory factor analysis) and Cronbach alpha internal reliability coefficients. Results: After the explanatory factor analysis, the scales were found to be suitable for factor analysis and had sub-dimensions. The P-COVID-19 scale had "Dangerousness" and "Contagiousness", the PCo-COVID-19 scale had "Macro Control", "Personal Control" and "Controllability", the PCa-COVID-19 scale had "Conspiracy", "Environment" and "Faith", the AA-COVID-19 scale had "Cognitive avoidance " and "Behavioral avoidance", and the ATV-COVID-19 scale had "Positive Attitude" and "Negative Attitude" subscales. The determined sub-dimensions were evaluated by confirmatory factor analysis and good fit indexes were observed. Cronbach alpha coefficients were 0.74 for the P-COVID-19 scale, 0.79 for the PCo-COVID-19 scale, 0.88 for the PCa-COVID-19 scale, 0.88 for the AA-COVID-19 scale, and 0.80 for the ATV-COVID-19 scale. Conclusion: When the validity and reliability analyze of the scales are evaluated together, it can be said that the scales have a valid and reliable structure that measures the perceptions and attitudes regarding COVID-19 both in healthcare workers and non-healthcare workers.

Validity and reliability evaluation of the multidimensional Japanese athletic identity measurement scale

Purpose: The purpose of this study was to evaluate the psychometric properties of the 7-item multidimensional Japanese Athletic Identity Measurement Scale (AIMS). Participants: In total, 1514 male Japanese students participated in this study. Measures: Athletic identity was measured using the Japanese AIMS (Hagiwara & Isogai, 2013). Analysis: Scale reliability and validity was confirmed by Cronbach’s alpha and confirmatory factor analysis (CFA). The CFA fit estimation utilized the goodness-of-fit index (GFI), adjusted goodness-of-fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). The results indicated an adequate fit for the Japanese athletes relative to Brewer and Cornelius’s (2001) three first-order factors (i.e., social identity, exclusivity, negative affectivity) subordinate to one higher-order athletic identity factor: GFI=.98, AGFI=.94, CFI=.99, RMSEA=.05. The internal consistency (Cronbach’s alpha) of the items comprising the multidimensional Japanese AIMS was acceptable. This study thus developed a multidimensional Japanese AIMS, which can be used to measure three aspects of a Japanese athlete’s identity, thereby potentially providing further insight into his or her identification with the athletic role.

A scale for measuring member commitment and integration in fitness services

This study assesses the reliability and validity of an instrument adapted from the domain of student attrition in higher-education research, for implementation in the field of fitness services management. The study was conducted at a commercial fitness facility based in Dubai, UAE, and comprised 184 subjects. A questionnaire was created by adapting a model with extensive research support in the field of student attrition studies; modifications were based on Delphi technique and subject interviews. Items were measured on a 5-point Likert scale, and the data set was subjected to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Four factors emerged: goal commitment; institutional commitment; social integration; institutional integration. CFA fit indices indicated good model fit, and all factors had strong Cronbach alpha coefficients. The instrument displayed robust psychometric properties/factor-loading invariance, and can be used to measure commitment and integration constructs in commercial fitness-club settings.

Validity and reliability of the Persian version of the Adverse Childhood Experiences Abuse Short Form.

BACKGROUND AND AIM:Measuring child abuse and adverse experiences is a critical task with regard to its long-term impact on the health of individuals and communities. The purpose of this study was to validate the Persian version of the International Adverse Childhood Experiences Abuse Short Form (ACE-ASF) in Iranian society.MATERIALS AND METHODS:This cross-sectional study was conducted in Kerman, southeast of Iran, in 2019, on 494 students from Kerman University of Medical Sciences, selected by convenience sampling method. Psychometric properties of the questionnaire were examined after the forward and backward translation processes. The factor structure of the questionnaire was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The concurrent validity of the questionnaire was assessed using the childhood trauma questionnaire (CTQ). Cronbach's alpha and corrected item-total correlation were used to measure reliability.RESULTS:The mean age of participants was 24.3 ± 5.3 years. Based on EFA, two physical–emotional abuse and sexual abuse factors were obtained. The CFA fit indices well supported two extracted factors. The CFA showed acceptable factor loadings. The internal consistency coefficient of Cronbach's alpha was 0.75 for the physical–emotional abuse factor and 0.77 for the sexual abuse factor. The correlation coefficient of ACE-ASF and CTQ was r = 0.56. The reliability index of intraclass correlation coefficient was 0.73 (95% confidence interval: 0.60–0.84).CONCLUSION:The Persian version of the ACE-ASF questionnaire has acceptable psychometric properties.

A scale for measuring member commitment and integration in fitness services

This study assesses the reliability and validity of an instrument adapted from the domain of student attrition in higher-education research, for implementation in the field of fitness services management. The study was conducted at a commercial fitness facility based in Dubai, UAE, and comprised 184 subjects. A questionnaire was created by adapting a model with extensive research support in the field of student attrition studies; modifications were based on Delphi technique and subject interviews. Items were measured on a 5-point Likert scale, and the data set was subjected to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Four factors emerged: goal commitment; institutional commitment; social integration; institutional integration. CFA fit indices indicated good model fit, and all factors had strong Cronbach alpha coefficients. The instrument displayed robust psychometric properties/factor-loading invariance, and can be used to measure commitment and integration constructs in commercial fitness-club settings.

The Self-Care of Heart Failure Index: A psychometric study.

The Self-Care of Heart Failure Index is an empirically tested instrument to measure self-care of heart failure patients across different populations and cultures. To develop and evaluate the psychometric properties of the Nepali Self-Care of Heart Failure Index. This psychometric study used a cross-sectional, observational, study design to collect data. The study was guided and reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline. To develop and culturally validate Nepali Self-Care of Heart Failure Index, a combination of the recommended methods for cross-cultural validation studies were applied such as translation, back translation, expert committee review of the translated version and validity/reliability testing. Face and content validity were ensured using expert review. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis. Composite reliability scores were calculated for each sub-scale of the Nepali Self-Care of Heart Failure Index. A total of 221 heart failure patients in Nepal were enrolled in the study. Adequate face and content validity were ensured through expert review. Exploratory factor analysis and confirmatory factor analysis supported the original three-factor model. Although the three factors explained only 41% of the variance, confirmatory factor analysis fit indexes and error measures were found reasonable. The composite reliability coefficients for self-care maintenance, management and confidence scale were 0.6, 0.7 and 0.8, respectively. The Nepali Self-Care of Heart Failure Index is a theoretically based, culturally acceptable and appropriate instrument for use among Nepali heart failure patients. However, further studies are needed to refine its psychometric properties. Access to reliable, valid and culturally appropriate instruments is crucial in describing the state of the problem as well as for developing and evaluating tailored and targeted self-care practice interventions for Nepali patients living with heart failure.

Psychometric Properties Of The Persian Version Of The Uncivil Behavior In Clinical Nursing Education Among Nursing Students.

BackgroundSome clinical staff nurses show unprofessional behavior toward nursing students in clinical nursing education that can negatively affect their self-esteem and professionally. Examination of uncivil behavior toward nursing students requires a valid and reliable instrument. Therefore, the goal of the present study was to examine the psychometric properties of the Persian version of the Uncivil Behavior in Clinical Nursing Education (UBCNE) among nursing students.MethodsIn this methodological study, a total of 558 nursing students participated who were selected using a convenience sampling method, and were asked to complete the Persian version of the UBCNE. The UBCNE was translated based on the WHO guidelines. The face, content, and construct (using explanatory and confirmatory factor analysis) validities were assessed. In addition, internal consistency was assessed using the McDonald’s omega and the Cronbach’s alpha coefficient, and stability was assessed using the test-retest method.ResultsExplanatory factor analysis led to two factors, including Dismissive Behavior and Exclusionary Behavior that together explained 62.1% of the total variance of uncivil behavior. In the confirmatory factor analysis, the comparative and parsimonious fit indices were very good, but the absolute fit indices were poor (RMSEA=0.116, GFI=0.98, NFI=0.97, AFGI=0.83, PNFI=0.78). Reliability of the UBCNE was found to be 0.93 and 0.97, using the Cronbach’s alpha coefficient and the test-retest method, respectively.ConclusionThe two-factor structure of the UBCNE has good validity and reliability among nursing students. Therefore, it can be used to assess civil behavior in clinical nursing education.

The health literacy questionnaire among the aged in Changsha, China: confirmatory factor analysis

BackgroundHealth literacy is defined as the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health. A Health Literacy Questionnaire (HLQ) is a toolkit with good reliability and validity. Accordingly, this study administered HLQ among older adults in China to examine its factor structure, reliability, homogeneity, and discriminant validity for use in understanding better the health literacy of older adults and determining corresponding measures.MethodsPsychometric properties were examined based on the data collected via face-to-face interviews (N = 343). Tests included the difficulty level, composite scale reliability, confirmatory factor analysis (CFA), and Bayesian structural equation modeling (BSEM).ResultsThe easiest scale to obtain a high score was “Social support for health” and the hardest, “Navigating the health care system” and “Appraisal of health information.” Two one-factor models fitted well with no correlated residuals allowed. After model modification, the CFA fit statistics of the other seven scales were good. All HLQ scales were found to be homogenous, with a composite reliability ranging from 0.74 to 0.85. The nine-factor Bayesian structural equation model fitted the data well (Posterior-Predictive-P value = 0.670; 95% Confidence Interval for the difference between the observed and replicated Chi-square values = − 163.320, 102.750).ConclusionsThe Chinese version of the HLQ has strong construct and content validity and high composite reliability when applied to older adults in Changsha City, China. Therefore, the nine-scale HLQ can now be administered to Chinese older adults, thereby providing a powerful approach to understanding the multidimensional area of health literacy.

Validation of the nurse leadership and organizational culture (N-LOC) questionnaire

BackgroundLeadership style and organizational culture have often been studied independently in nursing research despite abundant evidence that the two factors both influence employee outcomes. Moreover, diverse theoretical typology and measuring instruments challenges generalizability of findings. Employees from different cultural, geographical, occupational settings were also reported to have varying interpretation on organizational culture and leadership style underlying constructs. This study aims to validate the Nursing Leadership and Organizational Culture (N-LOC) questionnaire, based on the two commonly used theoretical frameworks: Multifactor Leadership Theory and Competing Values Framework, on its applicability in an Asian hospital setting.MethodsAll full-time nurses from two distinctive Asian hospitals (H1: n = 295 and H2: n = 1146) were invited to participate in this questionnaire study. Exploratory factor analysis (EFA) was carried out when confirmatory factor analysis (CFA) fit indices were not satisfactory after model refinement to explore the actual underlying construct in sampled population. Part-time and outsourced nurses were excluded. 93 nurses from H1 were randomly selected for test-retest reliability 4 weeks post initial survey. Scale internal consistency, convergent and discriminant validity were also assessed.ResultsCFA results indicated that the proposed CVF organizational culture 4-factor structure was applicable to our sample but not the MLQ leadership 3-factor/9-factor structure. EFA revealed a 2-factor leadership style construct for our sample, named Confucius transformational and Laissez-Faire passive leadership. Transformational leadership traits already embedded in Confucius cultural values (self-sacrifice, stresses collective mission, instills pride) did not apply, the new Confucius transformational construct which resembles LMX theory paternalistic leadership style is deemed more suitable in an Asian context. A final 14-item 2-factor leadership and 13-item 4-factor organizational culture construct was yielded with satisfactory fit indices (CFI, TLI > 0.95, RMSEA < 0.08), internal consistency (Cronbach’s alpha > 0.7), test-retest reliability (ICC > 0.4) and convergent and discriminant validity.ConclusionA reliable N-LOC organizational culture and leadership questionnaire (N-LOC) has been validated in an Asian nurse context. Study results demonstrated the importance of scale validation in cross-cultural adaptation, as underlying scale constructs may change with specific cultural and contextual factors. Future studies are encouraged to test the adaptation of this scale in other cultural and occupational settings.