Content Validity Research Articles

Development and Validation of the Comprehensive Acute Pancreatitis Pain Core Outcome Set (CAPPOS): Study Protocol.

Acute pancreatitis (AP) is a leading cause of gastrointestinal hospitalizations worldwide, with rising incidence, significant morbidity, and high healthcare costs. Pain, a hallmark symptom of AP, remains inadequately assessed, often relying on unidimensional scales such as visual analogue score, which fail to capture its multidimensional nature. Poorly managed acute pain negatively impacts clinical outcomes, prolongs recovery, and increases the risk of chronic pain syndromes. Comprehensive pain assessment tools specific to AP are lacking, highlighting the need for improved evaluation methods. The proposed study aims to develop and validate the Comprehensive Acute Pancreatitis Pain Outcome Set (CAPPOS) to address this evidence gap. The CAPPOS initiative follows COMET and COSMIN guidelines. Three systematic reviews will identify pain domains and assessment methods in AP, acute abdominal pain, and post-pancrectomy pain. A consensus process, using a modified Delphi approach, will involve multidisciplinary experts and patients to confirm and define key domains. Measurement tools will be selected for each domain and refined through iterative feedback. Pilot testing with 50 patients will evaluate the feasibility, clarity, and responsiveness to change of the preliminary tool. Validation studies with 200 AP patients will assess structural, content, and criterion validity, reliability, and sensitivity to change, ensuring content validity and clinical utility. CAPPOS will provide a validated, multidimensional core outcome set to optimize pain assessment in AP. It will also facilitate standardized reporting in clinical trials, advancing research and care for AP-related pain.

The Support Needs Approach for Patients (SNAP): content validity and response processes from the perspective of patients and nurses in Swedish specialised palliative home care

BackgroundThe Support Needs Approach for Patients (SNAP) enables patients to reflect on, identify and prioritise their own support needs from a holistic perspective and enable tailored support. Therefore, the aim of this study was to examine the content validity and response processes for the Swedish version of the SNAP Tool among patients with life-threatening illness and palliative care needs, and registered nurses (RN) in specialized palliative home care services.MethodsThis was a two-stage validation study: (I) translation of the original English version of the SNAP Tool into Swedish, and (II) examination of content validity for patients and RNs in specialized palliative home care, and response processes among the patients. Cognitive interviews were conducted with patients (n=11) and focus groups with RNs (n=10). Data were, in stage II, analysed for relevance, clarity, and sensitivity.ResultsThe translation process identified a few differences in wordings that were thoroughly debated to retain the meaning of the questions. Both patients and RNs considered the Swedish version of the SNAP Tool relevant to the palliative care context and its questions clear and easy to understand. Patients believed that their responses on the tool could be helpful in providing a clear structure for conversations and present a picture of their individual support needs. There were just a few considerations about sensitivity of questions from the patients’ perspectives and the RNs felt that some of the questions may need to be handled with care.ConclusionsThis study demonstrates that the Swedish version of the SNAP Tool has good coverage of Swedish patients’ support needs, and that the questions are perceived as intended. This indicates that the SNAP Tool effectively captures a wide range of support needs and aligns with its intended purpose. The tool is appropriate for specialized palliative home care and allows the SNAP intervention to be made available to this group of patients.

Cross-Cultural Adaptation and Cross-Validation of the Italian Version of the EPICC Spiritual Care Competency Self-Assessment Tool for Clinical Nurses.

To cross-culturally adapt and psychometrically test the Italian version of the EPICC Spiritual Care Competency Self-Assessment Tool for clinical nurses (EPICC Tool-It). Multicentre, cross-sectional validation study. The 28-item EPICC Tool was translated into Italian and culturally adapted following a rigorous methodology. A nationwide survey was conducted. Psychometric evaluation included content validity, structural validity (exploratory and confirmatory factor analyses), construct validity (known group analysis) and reliability using Cronbach's alpha, McDonald's omega and factor score determinacy. The sample included 725 clinical nurses (76% female, 80% hospital-based), on average 38.7 years old (SD 11.33), with 14.6 years (SD 11.03) of experience. Confirmatory factor analysis supported a four-factor model (Knowledge of spirituality, Attitudes towards spirituality and spiritual care, Knowledge of spiritual care and Skills in spiritual care), with a second-order factor for the EPICC Tool-It. Construct validity was supported through known group analysis, showing score variation based on nurses' experience, education and religiosity. Internal consistency was excellent across all factors and the overall scale. A valid, multidimensional instrument is provided to assess spiritual care competencies in Italian-speaking nurses. The EPICC Tool-It is suitable for research and practice, facilitating evaluation of self-perceived competencies and educational effectiveness. The use of the EPICC Tool-It by nursing managers, educators and clinicians is recommended in both clinical and research settings to support education on spiritual care competencies. The EPICC Tool-It sets reliable measurement standards for spiritual care competencies, enhancing holistic care and comprehensive understanding of competencies globally. This study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Patients, service users, caregivers, or the public were not involved in the study. However, nurses as target users of the tool participated in the cultural adaptation and validation process.

Listening-Related fatigue in adults: cross-cultural adaptation and validation of the Italian version of the Vanderbilt Fatigue Scale

Introduction: Individuals with hearing loss frequently encounter augmented listening-related fatigue due to the elevated effort required for auditory processing, which can be evaluated using the Vanderbilt Fatigue Scale for Adults (VFS-A-40). The objective of this study was to cross-culturally adapt the VFS-A-40 into Italian and validate the Italian version of the scale (VFS-A-40-Ita). Methods: The study employed an observational design, with rigorous cross-cultural adaptation and back-translation procedures. The data were collected from a large sample of native Italian speakers aged 18 years or older without neuropsychological and/or cognitive disorders. The sample was recruited through convenience sampling and included 125 adults with hearing loss (AHL) and 203 adults with normal hearing (ANH). The validation of the VFS-A-40-Ita entailed the assessment of its construct validity (structural validity, known-groups validity, and convergent validity), internal consistency, test-retest reliability, and content validity. Additionally, face validity was assessed by a panel of 10 audiological experts, including individuals with hearing loss. Results: The results indicated a statistically significant difference in perceived hearing fatigue across different domains for AHL participants. Indeed, AHL tended to rate the cognitive domain as more impaired than the other domains. As for structural validity, the results of the confirmatory factor analysis provided support for a first-order one-dimensional solution comprising four correlated factors, thereby justifying the use of a total fatigue score. The known-groups validity demonstrated statistically significant differences between the AHL and ANH groups for all variables under analysis. The convergent validity was confirmed with a moderate correlation between the total scores on the VFS-A-40-Ita and scores related to the physical and mental symptoms of persistent generic fatigue (r > .39; p < .01). Internal consistency analysis revealed Cronbach's alpha values greater than .96 for the VFS-A-40-Ita total score, indicating high reliability. Test-retest reliability showed robust correlations between baseline and retest scores (p < .01). Content validity was deemed adequate, with almost all items meeting the item-level content validity index cut-off score of .78, as rated relevant or highly relevant by at least 8 out of 10 experts. Conclusion: the findings of this study provide substantial evidence for the validity of the VFS-A-40-Ita, confirming its relevance, validity, and reliability for the assessment of listening-related fatigue in Italian-speaking adults. The instrument is open access and suitable for use in clinical settings and for future research, providing a valuable subjective outcome measure for initial assessment, follow-up and post-intervention evaluation within bio-psychosocial and evidence-based clinical practice.

Effect of the Blended Workshop Learning and Web-Based Learning Order and Sequence on the Interest Level: (Spiritual Effectiveness) Factor Analysis

The well-known blended electronic learning system has been seen so far from the point of view of comparison with other e-learning, but not much research has been done about educational planning, in terms of students' interest in how to organize the combined face-to-face and non-face-to-face implementation of this type of educational method. The present study is an assessment with the aim of comparing the effect of the combined implementation sequence of two methods of blended web-based and workshop learning on the level of interest of students who are members of the research committee of Arak University of Medical Sciences to participate in the Vital Statistics course. This is a quasi-experimental study with an alternative treatment design. The statistical population, who were selected through census sampling due to limited numbers, included 38 students of the Faculty of Medicine and 15 students of the Faculty of Health. The data collection tool included two questionnaires of demographic characteristics and an interesting questionnaire. The validity of the interest questionnaire was assessed through content validity and factor analysis, and its reliability was by calculating Cronbach's alpha coefficient. The data were analyzed in SPSS-16 through independent t-tests, Keyser's index, Bartlett's test, and Cronbach's alpha coefficient. The results showed a statistical difference between interest in the first group (A: Workshop/Web-based) and the second group (B: Web-based/Workshop) in blended learning: In the medical faculty (P=0.043), in the health faculty (P=0.051) and the total of two faculties (P=0.004). Given the statistical difference observed in conditions (Comparison of groups in each faculty independently and comparison of groups in total of two faculties), we suggest holding Workshop (in-person) courses at first and online courses then.

A Scale for Assessing Pain in Older Adults: The Influence on Activities of Daily Living

Physical functional impairment generates pain, fear and anguish, impacting the activities of daily living (ADLs) of older adults (OAs); The background was to design an instrument that can measure pain in OA living with pain. Methods: mixed analytical and cross-sectional study in two non-probabilistic samples: 15 experts in the care of OAs and 185 OAs from day homes in three municipalities of the State of Mexico. The instruments used included an integrated scale of 30 items, elaborated with the Delphi technique over three rounds, and the Scale for Measuring Pain in Older Adults (SMPOA), with 30 items divided into four factors. An analysis was conducted using content validity ratios and the Lawshe´s method adapted by Tristán for qualitative studies, with a minimum of 0.87 and a maximum of 1.0. An exploratory factor analysis (EFA) was conducted to structure the underlying factors into a data matrix, addressing the relationships between a set of variables, and a confirmatory factor analysis (CFA) was conducted to validate the scale using the main axis method and rotation via Quartimax with Kaiser normalisation. Results: proposal of a scale to measure pain in MA (EMEDAM). Conclusion, the adapted scale assesses sensory and affective intensity and the influence on the ADLs and can be used in OAs living with acute or chronic pain.

Fatigue among psoriatic arthritis patients: validity of the Arabic version of the FACIT-F questionnaire

BackgroundFatigue is a prominent complaint in psoriatic arthritis (PsA). The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Scale is considered a self-reported measure commonly employed for evaluating fatigue in individuals with PsA.AimThe study aims to focus on the effects of fatigue on the daily functioning of PsA patients and assess the content validity and reliability of the Arabic version of the FACIT-Fatigue Scale among PsA patients.MethodsUsing the FACIT-F Scale, PsA patients who consistently visited the outpatient clinic underwent two evaluations at a 2-week interval. Patients got comprehensive clinical assessments. Cronbach’s α was employed to evaluate the internal consistency of different items, the interclass correlation coefficient (ICC) was utilized for evaluation of test–retest reliability, also for detection of the association between the FACIT-F scores and other disease activity measures and disease manifestations was studied to establish validity.ResultsAmong the total studied 54 PsA patients, 35.2% exhibited fibromyalgia. Patients with fibromyalgia reported decreased FACIT-F scores compared to those without fibromyalgia (19.4 ± 2 versus 25.5 ± 2.9, respectively) (P = 0.01). An assessment was carried out to evaluate the test–retest repeatability of the Arabic version of the FACIT-F. The results showed an acceptable ICC value of 0.70, indicating good reliability and a strong internal consistency of 0.93. The FACIT-F questionnaire revealed strong positive correlations with the SF-36 questionnaire and inverse correlations with the PsA-QoL questionnaire, demonstrating its convergent validity. FACIT-F Scale showed a moderate negative significant correlation with tender and swollen joint total count. Also, there was a strong negative correlation between BASDAI and DASPSA scores. ROC curve for distinguishing PsA patients with and without fibromyalgia was conducted and revealed that the FACIT-F score had good discriminating power, with an AUC of 0.86, sensitivity (of 69.7%, and specificity of 94%.ConclusionThe reproducible Arabic version of the FACIT-Fatigue Scale was well-correlated with activity parameters and other fatigue scales among PsA patients. Thus, the FACIT-Fatigue Scale is a reliable and valid tool for assessing fatigue among PsA patients.

Electronic Payment System and Customer Patronage of shopping Malls in South -South Nigeria

This study was established to determine the extent to which electronic payment system has improved customers’ patronage of shopping malls in South-South zone of Nigeria. A descriptive survey research method of co-relational research design was employed in this study. The population of the study consisting of 77 registered shopping malls in the South-South Zone of Nigeria from which target population 6890 managers and sale persons were drawn. The Taro Yamane’s formula was used to determine a sample size of 378 managers and sales personnel for the study. A purposive sampling technique was adopted using considerable percentage of representation approach to ensure effective selection of the sample elements of the population. A structured instrument for data collection containing fifteen (15) items questions was used for the study. The face and content validation of the instrument was obtained through the judgment of experts. A test-retest method was used to determine the reliability of the instrument and a reliability index of .83 was obtained. The data collected were presented and analyzed using simple percentage and frequency analysis, mean and standard deviation, while the formulated hypotheses were tested using Pearson Product Moment Correlation of SPSS software program version 23.0 at .05 level of significance. The findings indicated that card payment system, electronic funds transfer and e-wallet payment system has a significant relationship with improvement in customer patronage of shopping malls in the zone. Based on these findings, it was concluded that electronic payment system has significantly improves customer patronage, of shopping malls in the South-South zone of Nigeria. Thus, it was recommended that shopping mall operators in the South-South zone who are yet to introduce sustainable electronic payment system should do so immediately to promote customers patronage and improve increase in repeat purchase.

Development of Training Program to Improve Specific Fitness and Wushu Taolu Skills for Youth Athletes

Background and Aims: Nowadays, whether it is an amateur training team or a professional training team, they only use special training methods and some conventional training methods to strengthen athletes' Specific fitness and quality, focusing more on muscle strength exercises. Such training methods are not systematic or comprehensive. Traditional Specific fitness training may have adverse effects on athletes' performance in some cases. Overemphasis on specific fitness training and neglect of comprehensive training can lead to imbalances and increase the risk of injury. The purpose of this study was to develop of training program to improve specific fitness and Wushu Taolu skills for youth athletes. Methodology: This study was a mixed method; it combines quantitative and qualitative research. The sample of this study consisted of 8 experts and 30 male youth Wushu athletes aged between 9-12 years old. They were divided into 2 groups by systematic method. Training program design begins with an analysis of factors affecting specific fitness and Wushu Taolu skills. After that, the information was synthesized and consulted with experts through a focus group method. The content validity value (IOC) was 0.87. The experiment duration was 8 weeks. Wushu Taolu's skills and specific fitness were tested by pre-test and post-test and compared using the independent t-test. As for Wushu Taolu skills were tested by pre-test, mid-test, and post-test using the comparison analysis one-way ANOVA repeated measures, then pairwise with Bonferroni post hoc (*p<.05 Results found that:1) Before the experimental the specific fitness result between groups of standing long jump test results was a significant difference (*p<.05). Post experimental the specific fitness result between groups of shuttles run test results was not a significant difference. The test result between the experimental group and control group of Wushu Taolu skills, before the experiment found that all Wushu Taolu skills pairwise were not significantly different. Post experimental found that all Wushu Taolu skills pairwise were significantly different (*p<, 05). The comparison of the Wushu Taolu skills test within the experimental group found that all Wushu Taolu skills in the experimental group had a significant difference (*p <.05). Conclusion: The training program can improve specific fitness and Wushu Taolu skills for youth athletes.

Psychometric properties of the Persian version of the ambivalent ageism scale (benevolent and hostile) in the adult population in Iran

BackgroundWith the growing population of older adults and the prevalence of negative attitudes towards them, the issue of ageism and its health and economic impacts in both benevolent and hostile contexts warrants special attention. It is crucial to examine the attitudes of other age groups towards older adults across different societies. Particularly, the benevolent dimension of ageism, which has been less explored in research, requires more focus. Therefore, this study aims to conduct a psychometric evaluation of The Ambivalent Ageism Scale among the adult population in Iran.MethodsThis methodological study was conducted in comprehensive health centers in Gorgan city in 2023. A total of 381 eligible adults participated. The Ambivalent Ageism Scale (AAS) was utilized, and the psychometric assessment included translation, face validity, and content validity. Additionally, exploratory factor analysis and confirmatory factor analysis were performed. The reliability of the scale was evaluated using the internal consistency method. The research findings were analyzed using SPSS and AMOS software version 24.ResultsQualitative face and content validity assessments led to textual and editorial modifications of the items. The Content Validity Ratio (CVR), Item-Content Validity Index (I-CVI), and Kappa (K*) scores were acceptable for all items. In the exploratory factor analysis (EFA), similar to the original questionnaire, three factors were extracted, accounting for approximately 54% of the total variance. The fit indices in the confirmatory factor analysis (CFA) indicated an acceptable model fit. During CFA, four items were eliminated. The reliability of the entire questionnaire was deemed acceptable with a Cronbach’s alpha coefficient of 0.763. Consequently, the Persian version of the Ambivalent Ageism Scale was confirmed with nine items.ConclusionThe Persian version of The Ambivalent Ageism Scale demonstrates sufficient validity and reliability for measuring attitudes towards aging within Iranian society. Given the cultural adaptation of this tool, the questionnaire can be utilized to assess adults’ views and attitudes towards older adults in both hostile and benevolent dimensions. Furthermore, it can aid in formulating family-oriented policies for older adult care and facilitate improvements in the quality of care for this population group.

Translation, Cross-Cultural Adaptation, and Psychometric Properties of the Persian Version of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (P-MARS-HA)

Objectives: This study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of the Persian version of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA) in elderly Iranian adults. Methods and Materials: This cross-sectional study was conducted in Tehran, 2021. Following translation and cross-cultural adaptation, the face validity, content validity, and reliability of the questionnaire were assessed. The Satisfaction with Amplification in Daily Life (SADL) questionnaire was used to assess concurrent validity. Study participants included 300 hearing-aid users aged 60 years and older who completed the research instruments. Data were analyzed using Confirmatory Factor Analysis (CFA), Cronbach’s alpha coefficient, Pearson correlation coefficient, independent t-tests, and analysis of variance (ANOVA) in SPSS and AMOS version 24. The significance level was set at p ≤ 0.05 for all tests. Results: The mean (SD) age of the participants was 71.38 (8.05) years. The face and content validity of the questionnaire were confirmed by ten experts (CVI > 0.91). The CFA supported the four-factor structure of the questionnaire, and the goodness-of-fit indices indicated that the final model had a good fit. The Cronbach’s alpha for the total questionnaire was 0.93, and for the subscales, it ranged between 0.83 and 0.93. The Pearson’s correlation analysis results showed a positive and significant correlation between MARS-HA and SADL scores (r = 0.61, p < 0.05), supporting criterion validity. Conclusions: The P-MARS-HA questionnaire demonstrates good validity and reliability and can be used as an appropriate tool for assessing self-efficacy in hearing-aid use among elderly Iranian adults.

Validity and psychometric characteristics of the Duruöz Hand Index (DHI) with systemic sclerosis

Objective: The Duruöz Hand Index (DHI) is a self-report questionnaire originally developed to assess hand function in rheumatoid arthritis patients and validated for various rheumatic conditions. The aim of the study is to evaluate the validity and psychometric features of the DHI in patients with systemic sclerosis (SSc). Methods: SSc patients diagnosed using EULAR/ACR 2013 criteria were included in study. Hand functionality was assessed using the DHI, Hand Functional Index (HFI) and visual analog scales (VAS) for disability and handicap. Overall disability and quality of life were measured using the Health Assessment Questionnaire (HAQ) and Short Form-36 (SF-36). Reliability (Cronbach’s alpha and ICC) and validity (face, content, convergent and divergent) were also analyzed and correlations with other measures assessed for construct validity of the DHI were examined. Results: Seventy-three patients were included in the study, 78.1% were female. The baseline mean DHI score was 31.2 (SD: 20.2). Completion and calculation of the questionnaire were easy and took 5 min and 30 s, respectively. The Cronbach’s alpha coefficient for internal consistency was 0.973 and the ICC for test-retest reliability was 0.993 (95%CI 0.981–0.997), suggesting that the DHI has high internal consistency and a high degree of reliability. Cognitive debriefing showed that the DHI is clear, understandable, relevant, and covers many domains of daily life, indicating good face and content validity. The DHI demonstrated good to moderate correlations with functional measures indicating convergent validity and moderate to non-significant correlations with non-functional parameters that supported divergent validity. Cronbach’s alpha was 0.973, indicating excellent internal consistency. Conclusion: In SSc patients, specific tools for assessing hand function are lacking. The DHI is a practical, reliable and valid measurement tool for both clinical assessment and research in this disease affecting skin, tendons, subcutaneous tissue and arthritis.

The Impact of Resource Management on Water Supply Project Performance

Resource management has become a critical focus globally as nations strive for sustainability and efficiency in utilizing their natural assets. Despite significant efforts to improve water accessibility in Rwanda, water supply projects continue to face high failure rates, particularly due to inadequate resource management. The general objective of the study was to examine the effect of project resource management on performance of water supply projects in Rwanda, specifically, Financial Resource Management, Human Resource Management, and Material Resource Management. The study used Resource-Based View (RBV) Theory and Goal setting theory. The target population was 273 people who were members of the Water for All Rwanda Project. To find the right amount of data to collect, the researcher used Slovin's formula to get a sample size of 162 respondents. The sampling technique that was used in the research was stratified sampling to put respondents into their appropriate groups. Then the researcher proportionately selected respondents using simple random sampling. The study made use of a questionnaire, interviews, and documentation research to collect data. The study adopted descriptive and correlational research design. The researcher did a pilot study with 10% of the total sample size equal to 16 respondents. Content Validity Index was 0.8 and the overall reliability coefficient was 0.814 for all items. Data analysis involved descriptive and inferential statistics of correlation and regression analyzed by Statistical Package for the Social Sciences (SPSS) version 25. The findings for three hypotheses were at ?=.05 that: There is no significant effect of financial resource management, human resource management and material resource management on performance of water supply projects in Rwanda were rejected since P=0.000<0.05, confirming that they have a significant positive influence on performance of water supply projects. The study revealed that there is significant effect of financial resource, human resource, and material resource management on performance of water supply projects in the Water for All Rwanda Project. It is recommended that the Water for All Rwanda Project focus on enhancing financial resource management by improving funding timeliness and strengthening financial monitoring mechanisms to ensure efficient resource allocation. Future research needs to examine the effects of community involvement on project implementation of water supply projects.

Development and Psychometric Evaluation of the Wright Normalization of Deviance (NOD) Scale.

Normalization of deviance (NOD) occurs when individuals and teams depart from acceptable performance standards until the adopted way of practice becomes the new norm. There is little research on the incidence of NOD in health care, and there is no validated instrument to measure it. Identification and quantification of NOD is critical for the evaluation of the effectiveness of interventions designed to reduce its adverse consequences. The objective was to develop and psychometrically evaluate the Wright Normalization of Deviance Scale. Items for the scale were drawn from existing qualitative interview data and a review of relevant literature. Expert judges independently reviewed the initial item pool and rated each item for relevance and clarity. A sample of 222 respondents who work in a variety of high-risk environments was recruited via email, social media, and ResearchMatch. Cronbach alpha and item analysis were used to identify problematic items for elimination. The latent structure of the scale was explored using principal component analysis. The approach to item development and expert judging supported content validity of the NOD. The latent structure identified using principal component analysis was consistent with the dimensions the scale was intended to measure. The final set of 27 items had four dimensions and each had good internal consistency (Cronbach alphas ranged from 0.72-0.94). The Wright NOD Scale demonstrated content and construct validity along with good internal consistency. It can be used by any high-risk organization, including health care, to facilitate identification of NOD, so that mitigating strategies can be applied.

The SCIEPR checklist: A tool for standardizing chest X-ray interpretation in resource-constrained settings - A pilot study.

The SCIEPR checklist: A tool for standardizing chest X-ray interpretation in resource-constrained settings - A pilot study.

Development and psychometric properties of the nursing ethical decision-making ability scale

BackgroundNursing ethical decision-making ability is a core competency of nurses. However, no tool has been developed to measure the ethical decision-making ability of nurses in China. Therefore, we aimed to develop a nursing ethical decision-making ability scale (EDMAS) and assess its validity and reliability.MethodsA literature review, qualitative study, and the Delphi method were employed to identify the most common ethical dilemmas and original scale items. A cross-sectional study was conducted to evaluate the items. The reliability and validity of the scale were evaluated. Exploratory factor analysis (EFA) was employed to investigate the factor structure based on data from group 1 (N = 404). Confirmatory factor analysis (CFA) was employed to assess the construct validity based on the data from group 2 (N = 503). Convergent validity was evaluated using composite reliability (CR) and average variance extracted (AVE). Discriminant validity was assessed by analyzing the maximum shared variance (MSV). We invited 15 experts to evaluate the content validity of the EDMAS. This study was conducted between December 2021 and January 2023.ResultsWe defined 4 nursing ethical dilemmas and 71 original items. We deleted 4 items during the screening process. Additionally, 3 items were deleted from the EFA. The EFA revealed that the EDMAS with 64 items had a four-factor structure (ethical sensitivity, motivation, judgment, and action), accounting for 56.05% of the total variance. The CFA revealed that χ2/df = 1.291, RMSEA = 0.024, CFI = 0.976, TLI = 0.974, NFI = 0.902, and IFI = 0.976. The CR values were between 0.945 and 0.964. The AVE values were between 0.583 and 0.588. The MSV values were between 0.533 and 0.572. The value of I-CVI varied from 0.867 to 1.000, and the S-CVI/Ave was 0.965. The Cronbach’s of the scale was 0.982. The test–retest reliability of the EDMAS was 0.982.ConclusionEDMAS is a reliable and valid tool for evaluating nurses’ ethical decision-making ability and enhancing its ability through ethics training programs.

Development and validation of a school satisfaction scale for medical students

ObjectiveThere is currently no widely accepted multidimensional School Satisfaction Scale (SSS) for Chinese medical students. To develop and validate the first SSS specifically for medical students in China. Our research sample is from China. This study was conducted in two parts: the first focused on scale development, validity and reliability verification, while the second focused on the analysis of factors influencing school satisfaction.MethodsThe study was conducted in four stages: (a) item generation (a literature review; a pilot test, n = 35; two rounds of the Delphi method, n = 12); (b) exploratory factor analysis (EFA) and reliability measure, n = 237; (c) confirmatory factor analysis (CFA), n = 446; (d) test–retest reliability, n = 100; predictive validity, n = 290; measurement invariance, n = 444. The content validity was evaluated with Pearson correlation coefficients. Medical students (n = 897) completed a cross-sectional survey.ResultsFifteen questions and four SSS dimensions, including learning satisfaction, interpersonal relationship satisfaction, teaching satisfaction, and service satisfaction. The entire SSS has good reliability (Cronbach’s α = 0.916) and validity (0.673–0.783). Logistic regression predictive effects of learning, interpersonal, teaching and service on school satisfaction. And the model has invariance at different majors (p > 0.05).ConclusionThis study demonstrated that the SSS has good validity and reliability and is a reliable tool for assessing medical students’ school satisfaction in China.

Psychometric evaluation of the birth participation scale for fathers (BPS-F): a methodological study

BackgroundThe participation of fathers in childbirth contributes primarily to the improvement of maternal and infant health and, consequently, to public health. To increase the participation of expectant fathers in childbirth, an appropriate screening tool is needed. This study was conducted to evaluate the psychometric properties of the “Birth Participation Scale” developed for expectant fathers.MethodsThe research involved a total of 250 expectant fathers who submitted applications to the Gynecology and Obstetrics Polyclinic of a university hospital. After translating the scale into a methodological and cross-sectional investigation, psychometric properties were evaluated. The validity of the scale was assessed by evaluating the content, construct, and face validity. Cronbach’s alpha, McDonald’s Omega, Spearman-Brown split-half and test-retest reliability coefficients were calculated to determine the item’s reliability.ResultsThe average content validity index (CVI) values for relevance, clarity, and simplicity were found to be 0.99 for each. The impact score of the items was 1.5 and above. A factor structure with 17 items, and 3 sub-dimensions was obtained through Exploratory Factor Analysis. The factor loadings of the items ranged between 0.55 and 0.85. The validity of this structure was assessed by Confirmatory Factor Analysis and the model fit indices were “acceptable” or “good fit”. The reliability coefficients for Cronbach’s alpha, McDonald’s Omega, and Spearman-Brown split half were 0.89, 0.92, and 0.81, respectively. Moreover, the test-retest correlation was 0.96.ConclusionsThe Birth Participation Scale for Fathers has a suitable validity and reliability for assessing fathers’ participation in birth. It is a simple reporting tool that healthcare professionals in Turkey can easily implement.

Validation of the Chinese version of the perceived medical school stress (PMSS) scale and analysis of the associated factors

BackgroundIn recent decades, mental health and stress among medical students have become a global concern. Currently, China lacks a scale specifically designed to assess stress levels in medical school settings. This study aims to cross-culturally translate and adapt the Perceived Medical School Stress (PMSS) Scale into Chinese, evaluate its psychometric properties in medical schools, and analyze the associated factors of medical students’ stress levels.MethodsData collection for the Chinese version of the PMSS was conducted from October to November 2023, among medical students from selected medical schools in North and East China. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the underlying factor structure. Content validity was assessed using the Content Validity Index (CVI). Criterion validity was evaluated with the Chinese version of the Perceived Stress Scale (PSS). Internal consistency was assessed by calculating Cronbach’s alpha coefficient, McDonald’s Omega coefficient, and test-retest reliability. Additionally, relationships between medical school stress and general demographic characteristics, insomnia severity, and self-efficacy were examined.ResultsThe final Chinese version of the PMSS supports a two-factor structure with 13 items, defined as “psychological stress and environment” and “resilience and expectations.” The scale’s Content Validity Index (CVI) was 0.980, with a criterion validity of 0.767. The Cronbach’s alpha coefficient was 0.911, McDonald’s Omega coefficient was 0.914, and the test-retest reliability was 0.794. Medical school stress levels showed significant differences based on gender and educational background (P < 0.05). Stress levels were positively correlated with insomnia severity and negatively correlated with self-efficacy.ConclusionsThe Chinese version of the PMSS is a reliable and valid tool for assessing stress levels among medical students in Chinese medical schools. Female students and those pursuing graduate degrees report higher levels of medical stress. Insomnia severity and self-efficacy significantly influence stress levels among medical students.

The cross-cultural adaptation and psychometric properties of the menstrual health instrument (MHI) among Iranian adolescent females

BackgroundMenstrual health encompasses a holistic state of physical, mental, and social well-being rather than simply the absence of illness associated with the menstrual cycle. It touches all aspects of human life. However, few tools are available to comprehensively examine the various areas of menstrual health. This study aimed to assess the psychometric properties of the menstrual health instrument (MHI).MethodThis study employed a cognitive method to psychometrically evaluate the English version of the Menstrual Health Questionnaire. This questionnaire consists of 29 items and 5 domains, including Affective symptoms, Somatic symptoms, school life, Daily habits for menstrual health, Menstrual cycle characteristics, Attitudes and perceptions on menstruation. It was conducted on 412 adolescent girls aged 13 to 18 from high schools in Babol City in 2023. Confirmatory and exploratory factor analyses were conducted in this study.ResultsA total of 412 adolescent girls from girls’ high schools in Babol City participated in this study. The mean age and mean age of menarche in participants were 14.20 ± 0.80 and 12.14 ± 0.99, respectively. The highest correlation among the 5 scales of the Menstrual Health Questionnaire was observed between emotional symptoms and physical symptoms and daily activities (r = 0.736, p < 0.001). In the content validity quantitative phase, all items of the original 29-question questionnaire had appropriate CVR and CVI and were retained in the study. The results of confirmatory factor analysis of the original questionnaire indicated that the hypothesized model has a reasonably good fit (Chi-square statistic = 846.09, CFI = 0.93, RMSEA = 0.057). The overall Cronbach’s alpha was 0.87. Finally, in the exploratory factor analysis within the same population for the initial 29 questions, 17 questions remained with 3 factors at the end of the structural validity phase, which explained 64.52% of the variance.ConclusionThe Persian version of the menstrual health questionnaire, with three extracted factors, demonstrates appropriate validity and reliability for use in studies related to menstrual health among Iranian girls.