Confirmatory Factor Analysis Solutions Research Articles

New insights into validity, reliability, and measurement invariance of the Kansas City Cardiomyopathy Questionnaire 23

Background: People affected by heart failure (HF) often exhibit a poor health status, which places a great deal of burden on the healthcare systems. The Kansas City Cardiomyopathy Questionnaire (KCCQ) 23 is the most used tool to measure the health status in this population; however, its psychometric properties have not been thoroughly established.Objective: To evaluate the psychometric properties of the KCCQ-23 in a European cohort of HF patients.Methods: 510 patients (median age 74 years, IQR=18, 58% males) completed the KCCQ-23 along with clinical and psychosocial measures. Factorial validity was established with confirmatory factor analysis (CFA); omega and model-based internal consistency indexes were computed to examine the internal consistency of the scale. Convergent validity was established by correlating the KCCQ-23 scores with clinical and psychosocial measures. Measurement invariance tests across those with preserved vs reduced ejection fraction were conducted within a multigroup framework.Results: Two CFA solutions were tested, which confirmed the theoretical and empirical models postulated by the original author. The internal consistency coefficients for the latent dimensions were adequate (Omega range =0.77-0.93; internal consistency coefficient =0.89-96). KCCQ-23 scores were found to be correlated with ejection fraction, NYHA levels, quality of life, self-care confidence, anxiety and depression, and symptom burden, supporting its convergent validity. Finally, the KCCQ-23 was invariant across ejection fraction levels, both in the theoretical and empirical factor solution.Conclusion: Overall, this study provides evidence of satisfactory psychometric properties of the KCCQ-23, promoting its use in clinical settings and research fields.

Psychometric analysis of the kansas city cardiomiopathy questionnaire-23 in a european population

Abstract Background People affected by heart failure (HF) often exhibit poor quality of life, which places a great deal of burden on the healthcare systems. The Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 is one of the most widespread instruments to measure quality of life in this population. So far, its psychometric properties have been investigated by a broad array of research, but the overall findings reveal inconsistency of the factorial structure and lack of rigorous psychometric testing. Objective The aim of this study was to evaluate the psychometric properties of the KCCQ-23 in a European cohort of HF patients. Methods The data used for this study were collected for the MOTIVATE-HF study, which was a three-arm, multicenter, randomized controlled trial to evaluate the effect of motivational interviewing for improving self-care in HF. A group of 510 patients (median age 74 years, IQR=18, 58% males) completed the KCCQ-23 along with clinical and psychosocial measures. Factorial validity was established with confirmatory factor analysis (CFA); omega and model-based internal consistency indexes were computed to examine the internal consistency of the scale. Convergent validity was established by correlating the KCCQ-23 scores with several clinical and psychosocial measures. Measurement invariance testing was conducted within a multigroup framework across patients with preserved vs those with reduced ejection fraction. Results Two CFA solutions were tested, which confirmed the theoretical and empirical models postulated by the original author. The internal consistency coefficients for the latent dimensions were adequate (Omega range =0.77-0.93; internal consistency coefficient =0.89-96)- KCCQ-23 scores were found to be correlated with ejection fraction, NYHA levels, quality of life, self-care confidence, anxiety and depression, and symptom burden, supporting its convergent validity. Finally, the KCCQ-23 was invariant across ejection fraction levels, both in the theoretical and empirical factor solution. Conclusion Overall, this study provides for the first time evidence that the KCCQ-23 has satisfactory psychometric properties, promoting its use in clinical settings and research to investigate the quality of life in patients with HF.

Is exploratory factor analysis always to be preferred? A systematic comparison of factor analytic techniques throughout the confirmatory-exploratory continuum.

The number of available factor analytic techniques has been increasing in the last decades. However, the lack of clear guidelines and exhaustive comparison studies between the techniques might hinder that these valuable methodological advances make their way to applied research. The present paper evaluates the performance of confirmatory factor analysis (CFA), CFA with sequential model modification using modification indices and the Saris procedure, exploratory factor analysis (EFA) with different rotation procedures (Geomin, target, and objectively refined target matrix), Bayesian structural equation modeling (BSEM), and a new set of procedures that, after fitting an unrestrictive model (i.e., EFA, BSEM), identify and retain only the relevant loadings to provide a parsimonious CFA solution (ECFA, BCFA). By means of an exhaustive Monte Carlo simulation study and a real data illustration, it is shown that CFA and BSEM are overly stiff and, consequently, do not appropriately recover the structure of slightly misspecified models. EFA usually provides the most accurate parameter estimates, although the rotation procedure choice is of major importance, especially depending on whether the latent factors are correlated or not. Finally, ECFA might be a sound option whenever an a priori structure cannot be hypothesized and the latent factors are correlated. Moreover, it is shown that the pattern of the results of a factor analytic technique can be somehow predicted based on its positioning in the confirmatory-exploratory continuum. Applied recommendations are given for the selection of the most appropriate technique under different representative scenarios by means of a detailed flowchart. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Scale of concern about COVID-19 infection in Peruvian Health Care Workers

IntroductionThe global SARS-CoV-2 pandemic has generated concern about contagion, especially among healthcare workers who are on the front line. ObjectiveTo design and analyse the evidence of content validity, internal structure and reliability of a measure of concern about the spread of COVID-19 among Peruvian healthcare workers. Material and methodsQuantitative study and instrumental design. The scale was administered to 321 health science professionals (78 males and 243 females), whose ages ranged from 22 to 64 years (38.12 ± 9.61). ResultsAiken’s V-coefficient values were statistically significant. An exploratory factor analysis was performed which indicated the existence of a single factor, and confirmatory factor analysis (CFA) confirmed a satisfactory six-factor model. The CFA solution obtained adequate fit indices (RMSEA = 0.079; P = .05; TLI = 0.967; IFC = 0.980; GFI = 0.971, and AGFI = 0.931), and showed good internal consistency based on Cronbach's alpha coefficient (α = 0.865; CI 95%, 0.83−0.89). ConclusionsThe scale of concern for COVID-19 infection is a valid and reliable brief measure that can be used for research and professional purposes.

Analysis of factors influencing pharmaceutical sales workforce engagement in pharmaceutical marketing in Nigeria: a structural equation modeling approach

In the pharmaceutical sales and marketing industry, human capital in terms of the sales workforce is essential to organizational success. However, there is a need to ensure that the task-environment is adequately resourced. The application of structural equation modeling (SEM) techniques such as factor analysis is necessary to further understand the underlying relevance of these factors. The objective of the study was to explore the factors influencing pharmaceutical sales personnel's work engagement in pharmaceutical companies using factor analysis. A cross-sectional, qualitative research study used an 11-item literature-guided questionnaire administered online to 406 medical sales professionals in the pharmaceutical supply network in Nigeria using random sampling. The factors evaluated include regularity and impact of training, marketing support, job security as perceived by the employee, incentives, reward for performance, and the prospect of promotion. Others include; minimal work stress, improved career prospects, and an enabling work environment provided for employees involved in pharmaceutical sales operations. The questions were rated on a 3-point Likert scale of 1=fair, 3=poor, and 5=good, to evaluate respondents’ estimation of factors. Exploratory factor analysis (EFA) was executed on the dataset and thereafter, confirmatory factor analysis (CFA) was conducted on the dataset using SPSS AMOS. Statistical significance was set at p-value < 0.05. The majority of respondents were male (72.2%, 293) and female (27.8%, 113). Respondents from Indigenous firms were predominant (249, 61.3%) compared to Multinational firms (157, 38.7%). There were 289 (71.2%) non-pharmacists and 117 (28.8%) pharmacists. EFA measures of adequacy were satisfactory (Kaiser-Meyer-Olkin=0.878, Goodness-of-fit=0.023, Cronbach alpha=0.859, Total variance explained= 51.6%) and produced a 2-factor solution consisting of 9-items (work factors=6, implied factors=3). CFA solution from EFA output produced satisfactory fit estimates (RMSEA=0.044, CMIN/DF=1.787, GF1=0.977, AGFI=0.957, RMR=0.029, and TLI=0.981). The final model had acceptable convergent and discriminant validity values. Job security was considered as the most influential factor (regression coefficient=0.859) and the least was work-life balance (regression coefficient=0.559). The study provided a validated tool to evaluate the pharmaceutical sales workforce’s estimation of the key factors influencing job performance. This serves as an operational template for strategic managers in pharmaceutical companies to improve employee’s perception of management support.

Escala de preocupación por el contagio de la COVID-19 en personal de la salud peruano

IntroductionThe global SARS-CoV-2 pandemic has generated concern about contagion, especially among healthcare workers who are on the front line. ObjectiveTo design and analyse the evidence of content validity, internal structure and reliability of a measure of concern about the spread of COVID-19 among Peruvian healthcare workers. Material and methodsQuantitative study and instrumental design. The scale was administered to 321 health science professionals (78 males and 243 females), whose ages ranged from 22 to 64 years (38.12±9.61). ResultsAiken's V-coefficient values were statistically significant. An exploratory factor analysis was performed which indicated the existence of a single factor, and confirmatory factor analysis (CFA) confirmed a satisfactory six-factor model. The CFA solution obtained adequate fit indices (RMSEA=0.079; p=0.05; TLI=0.967; IFC=0.980; GFI=0.971, and AGFI=0.931), and showed good internal consistency based on Cronbach's alpha coefficient (α=0.865; CI 95%, 0.83-0.89). ConclusionsThe scale of concern for COVID-19 infection is a valid and reliable brief measure that can be used for research and professional purposes.

Computational Identification of Confirmatory Factor Analysis Model with Simplimax Procedures

Confirmatory factor analysis (CFA) refers to the FA procedure with some loadings constrained to be zeros. A difficulty in CFA is that the constraint must be specified by users in a subjective manner. For dealing with this difficulty, we propose a computational method, in which the best CFA solution is obtained optimally without relying on users’ judgements. The method consists of the procedures at lower (L) and higher (H) levels: at the L level, for a fixed number of zero loadings, it is determined both which loadings are to be zeros and what values are to be given to the remaining nonzero parameters; at the H level, the procedure at the L level is performed over the different numbers of zero loadings, to provide the best solution. In the L level procedure, Kiers’ (1994) simplimax rotation fulfills a key role: the CFA solution under the constraint computationally specified by that rotation is used for initializing the parameters of a new FA procedure called simplimax FA. The task at the H level can be easily performed using information criteria. The usefulness of the proposed method is demonstrated numerically.

Psychometric Properties of the Adult Self-Report: Data from over 11,000 American Adults

The first purpose of this study was to examine the factor structure of the Adult Self-Report (ASR) via traditional confirmatory factor analysis (CFA) and contemporary exploratory structural equation modeling (ESEM). The second purpose was to examine the measurement invariance of the ASR subscales across age groups. We used baseline data from the Adolescent Brain Cognitive Development study. ASR data from 11,773 participants were used to conduct the CFA and ESEM analyses and data from 11,678 participants were used to conduct measurement invariance testing. Fit indices supported both the CFA and ESEM solutions, with the ESEM solution yielding better fit indices. However, several items in the ESEM solution did not sufficiently load on their intended factors and/or cross-loaded on unintended factors. Results from the measurement invariance analysis suggested that the ASR subscales are robust and fully invariant across subgroups of adults formed on the basis of age (18–35 years vs. 36–59 years). Future research should seek to both CFA and ESEM to provide a more comprehensive assessment of the ASR.

Psychometric Properties of the General Anxiety Disorder 7-Item (GAD-7) Scale in a Heterogeneous Psychiatric Sample.

The GAD-7 is commonly used as a measure of general anxiety symptoms across various settings and populations. However, there has been disagreement regarding the factor structure of the GAD-7, and there is a need for larger studies investigating the psychometric properties of the measure. Patients undergoing treatment (N = 1201), both inpatient and outpatient patients, completed the GAD-7 at pre- and post-treatment. Measures of depression, well-being, and other anxiety measures were also completed, making it possible to investigate convergent and divergent validity. Internal consistency and convergent validity were excellent for the total sample, and there was acceptable variation related to treatment groups. We conducted an exploratory factor analysis (EFA) on a random sample (50%) of the patients at intake and then conducted a confirmatory factor analysis (CFA) to confirm the factor structure in the other part of the sample at intake. The EFA indicated a clear one-factor solution, but the one-factor solution with CFA provided a poor fit to the data. Correlating the residuals among items assessing somatic symptoms led to a good fit in a respecified CFA solution. The GAD-7 has excellent internal consistency, and the one-factor structure in a heterogeneous clinical population was supported.

Psychometric Properties of the Generalized Anxiety Disorder Scale-7 (GAD-7) in Outpatients with Anxiety and Mood Disorders.

This study examined the psychometric properties of the Generalized Anxiety Disorder Scale-7 (GAD-7) in a sample of 536 outpatients presenting at a specialty clinic for anxiety and mood disorders. A confirmatory factor analysis (CFA) was used to test the unidimensionality of the GAD-7. This model did not fit the data well. The CFA solution was respecified correlating residuals among items assessing somatic symptoms. This respecified model fit the data well. A series of multiple-groups CFAs determined that the measurement properties of the GAD-7 were invariant between sexes. Scale reliability estimates of the GAD-7 were favorable for the full sample, and for males and females. Sensitivity and specificity could not be balanced at any cut-point. Findings attest to the value of this instrument as a dimensional indicator of GAD severity rather than a screening tool for the presence or absence of the disorder in outpatients with anxiety and mood disorders.

The Coaching Behavior Scale for Sport: Factor Structure Examination for Singaporean Youth Athletes

The Coaching Behavior Scale for Sport (CBS-S) is designed to evaluate coaches' involvement in developing athletes, taking into considerations the complex training and competition environment. Although the CBS-S has been used in a number of empirical studies, the factor structure of the instrument has not been examined rigorously. The present study was, therefore, conducted to assess the factor structure of the CBS-S for Singaporean youth athletes. A total of 519 participants completed the CBS-S, and their responses were examined with confirmatory factor analysis (CFA) and recent exploratory structural equation modeling (ESEM). Both seven-factor CFA and ESEM models fit to the sample data adequately. In addition, the sizes of factor loadings on target factors were substantial and found comparable between the CFA and ESEM solutions. The findings from this study supported the factorial validity of the CBS-S for the present sample.

Psychiatric disorders in preschoolers: the structure of DSM-IV symptoms and profiles of comorbidity

Psychiatric disorders have been increasingly recognized in preschool children; at present, however, we know comparatively less about how well current diagnostic manuals capture the symptoms described in this age group and how comorbidity is patterned. Therefore, this study aimed to investigate whether the symptoms defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) load on their respective disorders, examine whether individual symptoms exist that load particularly high or low on the disorder they allegedly define, and analyze how comorbidity clusters in individual children. Parents of a community sample of Norwegian 4-year-olds (N = 995) were interviewed using the Preschool Age Psychiatric Assessment. A confirmatory factor analysis (CFA) and a latent profile analysis (LPA) were performed on the symptoms of seven DSM disorders: attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, major depressive disorder (MDD), generalized anxiety disorder (GAD), social phobia, and separation anxiety disorder. The results showed that the CFA solution that closely resembled the disorders delineated in the DSM-IV fitted the data best. However, vegetative symptoms did not define preschool depression. The LPA identified nine symptom profiles among preschoolers, of which four showed evidence of psychopathology: comorbid MDD/GAD ? ADHD combined type, comorbid MDD/GAD ? ADHD hyperactive/impulsive type, separation anxiety only, and social phobia only. In conclusion, the symptoms observed in preschoolers fit the DSM-IV well, and comorbidity followed specific patterns.

Measure for measure: Calibrating ten commonly used calibration scores

This study examined the dimensionality of 10 different calibration measures using confirmatory factor analysis (CFA). The 10 measures were representative of five interpretative families of measures used to assess monitoring accuracy based on a 2 (performance) × 2 (monitoring judgment) contingency table. We computed scores for each of the measures using a common data set and compared one-, two-, and five-factor CFA solutions. We predicted that the two-factor solution corresponding to measures of specificity and sensitivity used to assess diagnostic efficiency would provide the best solution. This hypothesis was confirmed, yielding two orthogonal factors that explained close to 100% of sample variance. The remaining eight measures were intercorrelated significantly with the sensitivity and specificity factors, which explained between 91 and 99 percent of variance in each measure. The two-factor solution was consistent with two different explanations, including the possibility that metacognitive monitoring may utilize two different types of processes that rely on separate judgments of correct and incorrect performance, or may be sufficiently complex that a single measurement statistic fails to capture all of the variance in the monitoring process. Our findings indicated that no single measure explains all the variance in monitoring judgments. Implications for future research are discussed.

Psychometric Characteristics of the Parenting Scale in a Head Start Population

Examined the reliability, construct, and concurrent validity of the Parenting Scale (PS), a brief instrument designed to measure dysfunctional parenting practices for parents of young children. In Study 1, 183 primarily African American mothers and their Head Start children completed the PS. The PS, which consists of 3 subscales-Laxness, Overreactivity, and Verbosity-was subjected to confirmatory factor analysis (CFA). Neither the original 3-factor structure, nor a 2-factor structure consisting of the original Laxness and Overreactivity factors, fit the data. A subsequent exploratory factor analysis yielded a 2-factor solution that was generally consistent with the Overreactivity and Laxness subscales identified by Arnold, O'Leary, Wolff, and Acker (1993). The 2-factor CFA solution was replicated with a sample of 216 similar mothers, and the 5-item Overreactivity and Laxness subscales retained internal consistencies above .70. Analysis of the convergent validity of the modified PS and its 2 subscales revealed moderate associations with measures of permissiveness, authoritarianism, involvement, and limit setting. Scores on the PS were not correlated significantly with measures of social desirability, maternal education level, or parent report of internalizing behavior problems. Concurrent validity evidence was obtained by correlating the PS with measures of parenting satisfaction and support, parenting stress, maternal depression, and measures of externalizing child behavior problems.

Factor structure and construct validity of the Scale for the Assessment of Negative Symptoms.

Confirmatory factor analysis (CFA) was used to examine the underlying structure of the of schizophrenia as measured by the Scale for the Assessment of Negative Symptoms (SANS). Schizophrenia patients (AT = 457) were assessed with the SANS on at least I of 2 occasions: (a) 2-4 weeks after an index hospitalization, and (b) after a clinical stabilization period that lasted 3-6 months. Results of an exploratory factor analysis conducted for the first assessment (n = 401) were largely supported by the CFAs conducted on the data at the second assessment (« = 345). The CFA solution included 3 factors: Diminished Expression, Inattention-Alogia, and Social Amotivation. Analysis of patients' clinical characteristics, treatment outcome, chronicity of the illness, premorbid history, and social adjustment supported the validity of the 3 factors. The negative symptoms of schizophrenia, such as blunted affect or asociality, have become the focus of increased inquiry in the last one and a half decades. Several theoretical and methodological developments have spurred this research, most nota