Breastfeeding provides significant benefits for infant health and well-being. However, many mothers develop avoidance behaviors due to the physical, psychological, and sociocultural challenges they encounter during the breastfeeding process. The purpose of this study was to create and assess the Breastfeeding Avoidance Scale's psychometric features in Turkish postpartum mothers. A cross-sectional, methodological, and descriptive design was used to assess 227 postpartum mothers. The Breastfeeding Avoidance Items were developed based on an extensive review of the literature, and include 18 items across two subscales. Reliability was assessed using Cronbach's alpha and test-retest techniques, while validity was assessed using expert feedback and exploratory factor analysis. A two-factor structure that accounted for 63.06% of the variation was found using exploratory and confirmatory factor analysis. A satisfactory model fit was shown by confirmatory factor analysis (χ2/df = 2.90, RMSEA = 0.08, CFI = 0.91). Breastfeeding Avoidance Items showed great test-retest reliability (r = 0.82, ICC = 0.861) and excellent internal consistency (Cronbach's alpha = 0.965). Concurrent validity was supported by the finding of a substantial negative correlation (r = -0.743, p < 0.01) between the Breastfeeding Avoidance Items and the Breastfeeding Self-Efficacy Scale. The Breastfeeding Avoidance Items is a valid and reliable tool for evaluating Turkish mothers' avoidance of breastfeeding. It offers potential for use in clinical and research settings to identify and address challenges in breastfeeding practices.

BackgroundSocio-economic changes and evolving family structures have created unique caregiving challenges in China, highlighting the need for tools to systematically measure child care deficits. This study aims to develop and preliminarily validate the Inadequate Child Care Scale (ICCS), a culturally relevant instrument designed to measure deficits in child care specific to the Chinese context.MethodsThe development and validation of the Inadequate Child Care Scale (ICCS) were conducted through a three-phase process. Phase One involved the generation of an initial item pool informed by a prior grounded theory study. Phase Two included nationwide data collection via a structured survey administered to participants across diverse regions in China. Phase Three focused on evaluating the psychometric properties of the ICCS using Exploratory Factor Analysis (EFA; n = 468) and Confirmatory Factor Analysis (CFA; n = 702), with an emphasis on assessing convergent validity, discriminant validity, and composite reliability.ResultsThe initial item pool comprised 32 items, 30 of which were retained following expert evaluation for content validity. EFA revealed a four-factor structure underlying the scale: Inadequate Daily Life Care, Inadequate Psychological and Emotional Care, Inadequate Safety Care, and Inadequate Educational Care, encompassing 30 items in total. CFA supported the factorial validity of the ICCS, yielding favorable model fit indices (GFI = 0.929, CFI = 0.977, TLI = 0.975, RMSEA = 0.038, χ²/df = 2.025). The scale demonstrated strong internal consistency (Cronbach’s alpha > 0.80) and acceptable test-retest reliability.ConclusionThe ICCS is a psychometrically sound tool for assessing child care deficits in China. Its development fills a critical gap in child care research and provides a foundation for targeted interventions and policy reforms. Future studies should refine the scale further and explore its applications in broader caregiving contexts.

Purpose This study validates a multidimensional framework of visitor experience quality in urban parks and examines how satisfaction mediates the relationships between experiential dimensions, perceived crowding and behavioural outcomes, including loyalty and pro-environmental behaviour. Design/methodology/approach Data were collected from 460 local residents visiting urban parks in Indonesia through on-site surveys. Using exploratory factor analysis and partial least squares structural equation modelling (PLS-SEM), three experience dimensions – social-educational, sensory-aesthetic and service-facility – were identified and tested in terms of their direct and mediated effects. Findings All experience dimensions significantly enhanced satisfaction, which in turn predicted both loyalty and pro-environmental behaviour. Satisfaction also mediated the effects of experience quality and perceived crowding. Social-educational experience emerged as the strongest driver, while moderate crowding contributed positively when perceived as vibrant and socially engaging. Practical implications Park managers should prioritise interpretive, sensory and community-based programmes that integrate learning and emotional engagement, while managing rather than eliminating crowding through zoning and participatory design. Originality/value This study positions satisfaction as the central psychological mechanism linking multidimensional park experiences to loyalty and sustainability-oriented behaviour while reframing perceived crowding as a potential source of social vitality in urban green spaces.

Development and validation of the gestational diabetes mellitus holistic healthcare needs scale.

Dementia is more prevalent in Puerto Rico than in the U.S. mainland, increasing demands for caregiving. However, research on the mental health impact of dementia caregiving among island Puerto Ricans is sparse. We examined caregiver burden and depressive symptoms among Puerto Rican dementia caregivers while also considering behavioral and psychological symptoms of dementia (BPSD). Using data from the Puerto Rican Elder: Health Conditions (PREHCO) study (Wave 3), 132 caregivers of PREHCO participants requiring care completed an ancillary data collection, of whom 101 cared for PREHCO participants with dementia. Measures included the 15-item Geriatric Depression Scale (depressive symptoms), Neuropsychiatric Inventory Questionnaire (NPI-Q; BPSD), and Zarit Burden Interview (ZBI-6; caregiver burden). Caregivers were 63 ± 10 years of age on average, and 77% were women. Exploratory factor analysis yielded two BPSD factors: Emotional Dysfunction/Behavioral Instability and Perceptual Disturbances/Apathy. In linear regression models adjusted for age, sex, education, marital status, self-rated health, hours of caregiving per week, and perceived social support, caregiver burden was positively associated with depressive symptoms (β = 0.68, p < .001), as were BPSD factors Emotional Dysfunction/Behavioral Instability (β = 0.50, p < .001) and Perceptual Disturbances/Apathy (β = 0.50, p < .001). Only Perceptual Disturbances/Apathy significantly moderated this association (β = 0.24, p = .032), with the burden-depression link strengthening as BPSD increased. Appetite/Eating Symptoms (β = 0.42, p = .007) emerged as the main BPSD item driving this moderation effect. In this Puerto Rico-based sample, perceptual disturbances/apathy, and appetite/eating symptoms specifically, were most likely to magnify the caregiver burden-depressive symptoms link.

ABSTRACT The current research focused on how competing narratives (i.e., dominant and resistance narratives) are endorsed among low‐status group members, through the case of the US military base issue in Okinawa, Japan. Specifically, we explored patterns of Okinawans’ narrative endorsement (i.e., dominant and resistance narratives surrounding the presence of US military in Okinawa), as well as their behavioural responses (e.g., resistance and compliance) using survey responses of Okinawan participants ( N = 172). Following the identification of factors in narrative endorsement and behavioural responses through exploratory factor analyses, we identified narrative profiles of participants through a latent profile analysis. Then, we mapped narrative profiles, behavioural responses and social positions (i.e., gender, age and educational background) in understanding the relationship among these constructs. The results revealed that participants’ narrative endorsement was often ambivalent, as many of them endorsed both dominant and resistance narratives to some degree. The results also showed that participants’ narrative profile was significantly related to their behavioural responses. Implications regarding the conceptualization of narrative endorsement and its behavioural consequences are further discussed.

Background: Fatigue is a multidimensional and subjective experience, and it is one of the most common symptoms of multiple sclerosis (MS), affecting up to 80% of patients and acting as a major driver of work disability. Despite its clinical significance, existing assessment tools often lack conceptual clarity or remain too lengthy for routine clinical use. Objective: To develop and evaluate a new patient-reported outcome instrument designed to assess multidimensional fatigue domains in patients with multiple sclerosis (MS) for use in clinical practice. Methods: This study was carried out in three research stages. Stage 1 (Concept Elicitation) involved qualitative interviews (n = 19) to identify core fatigue domains based on patient experience. Stage 2 (Cognitive Interviews) consisted of interviews with 50 patients to ensure the relevance and clarity of the items. Stage 3 (Exploratory Factor Analysis) and internal consistency testing (Cronbach’s alpha) were performed on the same sample of 50 patients to examine the preliminary factor structure and reliability. Results: Concept elicitation identified lack of energy and persistent exhaustion as core symptoms. The resulting 14-item instrument covers three subdomains: Psychosocial, Physical, and Cognitive. Exploratory factor analysis supported a three-factor solution explaining 75% of the total variance (Factor 1: 28%; Factor 2: 27%; Factor 3: 20%). Internal consistency was high across all factors: Psychosocial (α = 0.923), Physical (α = 0.895), and Cognitive (α = 0.844). Conclusions: This new instrument is a conceptually robust tool that captures the interconnected nature of fatigue in multiple sclerosis (MS). These initial findings support its internal structure and conceptual foundation, providing a practical tool for symptom monitoring in neurological consultations.

This research explores the ways in which green procurement and carbon management practices contribute to sustainable supply chain performance in emerging markets, while also investigating how stakeholder pressure moderates these relationships. Anchored in Institutional Theory and the Natural Resource-Based View, the study treats sustainable supply chain performance as a multifaceted outcome influenced by deliberate sourcing choices, structured carbon reduction efforts, and external pressures for legitimacy. Using a quantitative cross-sectional approach, the authors gathered responses from 385 supply chain practitioners, sustainability officers, and sector specialists through an online 5-point Likert-scale survey. Data analysis, performed in SPSS, included checks for reliability, exploratory factor analysis, multiple regression models, and moderation testing via Hayes’ PROCESS macro. The results demonstrate that green procurement (β = 0.666) and carbon management practices (β = 0.688) each exert a robust, highly significant positive influence on sustainable supply chain performance. In addition, stakeholder pressure markedly enhances the effect of carbon management on performance outcomes (β = 0.565), illustrating how institutional demands can substantially reinforce internal environmental initiatives. Collectively, the evidence suggests that strong sustainability performance in emerging-market supply chains emerges not from standalone green efforts, but from the thoughtful alignment of procurement strategies, carbon-focused governance, and proactive stakeholder collaboration. By synthesizing institutional and resource-based lenses, this work enriches theoretical insights and delivers practical guidance for managers and policymakers navigating sustainability challenges in institutionally complex environments.

Research suggests that the quality of mother–infant bonding (MIB) is a critical factor for long-term infant development. This study aimed to culturally adapt and psychometrically validate the Mother–to-Infant Bonding Scale (MIBS) for use among Greek mothers. Methods: A total of 750 mothers (Mage = 33.6 ± 4.6) with infants aged 0–12 months completed the MIBS and the Edinburgh Postnatal Depression Scale. The sample was randomly split to conduct exploratory and confirmatory factor analyses (EFA/CFA). Results: Analyses supported a unidimensional structure after removal of the ‘protective’ item. The MIBS demonstrated good reliability and convergent validity against the Edinburgh Postnatal Depression Scale (EPDS). Discussion: MIBS is a reliable and valid tool to assess bonding in a general population of Greek mothers up to one year postpartum. Future studies should examine the structure of MIBS in different timepoints during the postpartum period. The MIBS appears to be a reliable screening instrument for early identification of bonding difficulties.

In recent years, there has been a growing interest in research on language teacher emotions while relatively fewer studies have focused on language teachers’ professional pride. This study aims to develop and validate a scale for language teacher pride (LTP), and it seeks to understand how this critically important emotion may be linked to other central, conceptually related constructs including wellbeing, work engagement, and burnout. Data were collected employing an online questionnaire in which 423 language teachers from 52 countries took part in the study. The results of exploratory factor analysis, confirmatory factor analysis, and exploratory structural equation modeling revealed that the newly constructed Language Teacher Pride Scale (LTPS) reflects the multifaceted nature of LTP as a positive emotional experience. We further found that language teachers with a heightened sense of pride in their teaching were more engaged in their work, had higher wellbeing, and were less prone to burnout. We hope that the results of this study will aid future research by informing policy and practice as well as theory building about the role of pride as a potential core construct in positive psychology, which can help us to understand and support teacher flourishing.

The Hierarchical Taxonomy of Psychopathology (HiTOP) provides a dimensional alternative to categorical nosology. Using a nationally representative sample (N = 16,238), we first replicated the hierarchical structure via bass-ackward exploratory factor analysis. Moderated nonlinear factor analysis (MNLFA) was used to test differential item functioning, mean impact, and factor score differences for HiTOP dimensions across categorical (i.e., sex assigned at birth and race/ethnicity) and continuous (i.e., age and income) sociodemographic covariates and their two-way interactions. Results for MNLFA revealed sources of measurement noninvariance that were not previously detected using multigroup confirmatory factor analysis. Both significant diagnostic differential item functioning and latent factor mean-level differences emerged at the spectrum and subfactor levels across sociodemographic moderators. In contrast to previous studies supporting robust measurement invariance of the HiTOP structure, the results of the present study demonstrate that the HiTOP latent dimensions are generalizable only once measurement noninvariance, especially for categorical diagnostic data, is identified and adjusted for. These results also highlight the unique information provided by the MNLFA approach in assessing the generalizability of HiTOP. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Green procurement (GP) is increasingly recognized as a strategic mechanism for embedding sustainability within the construction industry (CI), yet its adoption in developing economies remains inconsistent and uneven. This study investigates the key drivers shaping GP adoption in Malaysia’s CI and uncovers the underlying factors that explain variations in stakeholder behaviour. Drawing on Institutional Theory (IT) and the Resource-Based View (RBV), twenty-one GP drivers were identified through a comprehensive literature review and evaluated using a structured questionnaire administered to developers, consultants, and contractors. Quantitative analyses—including descriptive statistics, Kruskal–Wallis tests, and exploratory factor analysis (EFA)—revealed four interrelated dimensions: Institutional and Strategic Support, Market and Business Competitiveness, Availability of Green Resources and Infrastructure, and Stakeholder Engagement and Social Responsibility. These dimensions form the basis of the Integrated Institutional–Capability Framework for Green Procurement (IICF-GP), which explains how external institutional pressures interact with internal organizational capabilities to influence both strategic intent and operational implementation of GP. The framework contributes theoretically by integrating IT and RBV within a single empirically grounded explanatory model, and practically by identifying targeted policy, capability-building, and supply-chain levers. Findings underscore that regulatory clarity, supplier readiness, technological capability, and stakeholder collaboration are critical to advancing GP in developing-country construction contexts.

This study aimed to develop the Comprehensive School Readiness Assessment Scale (COSRAS), a multidimensional instrument designed to evaluate school readiness in children aged 57–72 months. Scale development followed DeVellis’s framework. An initial item pool of 216 items was generated based on developmental, learning-related, and functional school readiness constructs and subsequently refined through expert review to 182 items. The finalized scale was completed by teachers of 1813 children, and test–retest reliability data were obtained from 386 teachers. Content validity indices were high, ranging from 0.892 to 1.000. Exploratory and confirmatory factor analyses supported the proposed eight-factor structure, demonstrating excellent model fit (CFI = 0.999; RMSEA = 0.000–0.009). Convergent validity with the Primary School Readiness Scale was strong (r = 0.665–0.695). The internal consistency of the scale was excellent across all domains (α = 0.916–0.969), and test–retest reliability was high (ICC > 0.990). COSRAS demonstrates strong psychometric properties and provides a comprehensive assessment of school readiness by integrating developmental competencies, learning-related skills, and functional performance. The scale enables early identification of children who may be at risk for neurodevelopmental or learning-related challenges before school entry. COSRAS may assist educators and allied professionals in early childhood and school-based settings by offering domain-specific profiles that inform instructional planning, individualized supports, and early intervention strategies.

Digital media are central to adolescents’ daily lives, raising concerns about problematic usage such as excessive gaming, social media use, and video streaming. Parents are key in managing these behaviors, yet their confidence in guiding children’s technology use—digital parenting self-efficacy—remains understudied in human–computer interaction. This study validates the six-item Digital Parenting Self-Efficacy Scale (DPSES), assessing parents’ perceived competence in managing their child’s digital engagement. Using data from three panel waves (2019–2024; N ≈ 1200 dyads each), exploratory and confirmatory factor analyses confirmed a bifactor-(S-1) structure with good internal consistency (ωT = 0.84). Validity was supported through correlations with restrictive mediation, family climate, and communication. Higher self-efficacy predicted lower problematic media use across platforms, outperforming general parenting efficacy. The DPSES offers a brief, reliable measure for family-technology research and informs the design of adaptive parental mediation tools, digital well-being apps, and interventions promoting healthier adolescent media use.

Type of the article: Research ArticleAbstractIn the context of Vietnam’s rapidly expanding digital ecosystem, understanding how psychological differences shape brand cognition among Generation Z has become increasingly important. This study aims to examine the influence of the Big Five personality traits on brand awareness across major digital touchpoints, addressing the limited empirical evidence from emerging markets. A quantitative survey was conducted in January 2025 with 898 Gen Z consumers residing in Hanoi and Ho Chi Minh City. Using Cronbach’s Alpha, Exploratory Factor Analysis, and multiple regression, the study assessed the reliability of measurement scales and the effects of personality traits on brand awareness indicators derived from Aaker’s (1991) framework. The findings show that four personality traits – openness, conscientiousness, extraversion, and neuroticism – positively and significantly predict brand awareness on digital platforms (β = 0.171–0.250; p &amp;amp;lt; 0.001). Conscientiousness exhibits the strongest impact (β = 0.250), followed by neuroticism (β = 0.240), extraversion (β = 0.224), and openness (β = 0.171). Agreeableness does not demonstrate adequate construct validity and is excluded from the final model. Additional analyses using ANOVA reveal significant differences in brand awareness across regions but not across genders. These results illustrate that personality-driven tendencies, such as exploratory behavior, systematic information processing, social interaction, and risk-avoidance, play a substantial role in determining how frequently and effectively young consumers encode brand cues in digital environments. The study concludes that integrating personality insights into digital brand communication strategies can enhance relevance, memorability, and consumer-brand alignment, especially within dynamic Gen Z segments.Acknowledgment(s)The researchers express sincere gratitude to all the participants who generously participated in this study.

Physician assistant/associate (PA) programs assess student clinical competence using both standardized exams and preceptor evaluations from supervised clinical practice experiences. However, it remains unclear to what extent the clinical environment influences preceptor evaluations and what specific constructs these evaluations capture. This study explores the relationship between the latent factors underlying standardized exams and preceptor evaluations. A retrospective, cross-sectional analysis of student-level data from 3 PA programs across diverse regions of the country (2020-2024; n = 782) was performed. Measures included PA National Certification Exam (PANCE) task scores; end of rotation (EOR) exam task scores for internal medicine (IM), family medicine (FM), and emergency medicine (EM); and preceptor evaluations for the corresponding clinical rotations. Exploratory factor analysis (EFA) (least-squares estimation, Promax rotation; eigenvalue >1 criterion) identified latent factors. A 4-factor solution explained 54.3% of variance. Standardized assessments (PANCE and EOR task scores) loaded together on a single factor, whereas preceptor evaluations formed 3 distinct factors corresponding to FM, EM, and IM. Each factor contributed comparably equal to the variance, with minimal cross-loading between standardized exams and preceptor ratings. Findings indicate that standardized exams assess a common knowledge or clinical reasoning construct, while preceptor evaluations capture rotation-specific dimensions. This may be due to context-dependent performance and interpersonal/professional behaviors, distinct from test-based knowledge. These findings have implications for programs and stakeholders. Future work should examine environmental and evaluator influences and incorporate additional noncognitive domains.

Background: The Temporomandibular Joint Ankylosis Quality of Life Questionnaire (TMJAQoL) is a disease-specific instrument designed to assess quality of life in patients with temporomandibular joint (TMJ) ankylosis. No validated Turkish version of this scale existed prior to this study. The aim of this study was to translate, culturally adapt, and evaluate the Turkish version of the TMJAQoL (TMJAQoL-TR) in patients with severe temporomandibular disorders, including a predefined ankylosis subgroup. Materials and Methods: A total of 120 patients with temporomandibular complaints were included. Test–retest reliability was evaluated in a clinically stable subsample of 72 participants with a one-week interval. Following forward–backward translation and cultural adaptation procedures, the TMJAQoL-TR was administered together with the Oral Health Impact Profile Short Form-14 (OHIP-14), the Short Form-36 (SF-36), and Visual Analog Scale (VAS) pain scores. Reliability was assessed using Cronbach’s α, item-level Weighted Cohen’s Kappa, and test–retest Intraclass Correlation Coefficients (ICC), supported by measurement error indices (Standard Error of Measurement [SEM] and Minimal Detectable Change at 95% confidence [MDC95]). Construct validity was examined using Spearman correlation coefficients. Structural validity was investigated through exploratory factor analysis, followed by a confirmatory structural model in AMOS to evaluate preliminary model consistency. Floor and ceiling effects were analyzed using the 15% criterion. Results: The TMJAQoL-TR demonstrated excellent internal consistency (Cronbach’s α = 0.879) and very high test–retest reliability (ICC = 0.995; 95% CI: 0.992–0.997). Strong correlations were observed with OHIP-14 (r = 0.772, p &lt; 0.01), and moderate correlations with VAS pain scores (r = 0.312, p &lt; 0.01). No significant floor or ceiling effects were detected. A weak but significant negative correlation with the SF-36 physical role subscale suggests that TMJ-related quality of life impairment is associated with role limitations in daily activities, although the magnitude of this association was modest. Exploratory factor analysis supported a clinically coherent two-factor structure, and the AMOS structural model demonstrated acceptable consistency with this framework. Conclusions: The TMJAQoL-TR appears to be a valid and reliable instrument for assessing quality of life in patients with severe TMJ-related functional limitations. Findings from the ankylosis subgroup support potential applicability within the instrument’s original target population; however, further validation in larger ankylosis-specific samples is warranted.

To investigate symptom clusters and their longitudinal trajectories in patients undergoing maintenance hemodialysis (MHD). A convenience sample of 510 MHD patients was enrolled between June 2022 and June 2023. Symptom assessments were conducted at four time points: baseline (T1), 4months (T2), 8months (T3), and 12months (T4), using a general information questionnaire and the dialysis symptom index (DSI). Exploratory factor analysis was applied to identify symptom clusters, and latent class growth modeling was used to examine the longitudinal trajectories of these symptom clusters over the one-year follow-up period. Exploratory factor analysis revealed seven symptom clusters: emotional symptoms, water-electrolyte imbalances, gastrointestinal symptoms, uremia-related symptoms, sleep disturbances, sexual symptoms, and sexual-emotional symptoms. The first five clusters-emotional, water-electrolyte imbalances, gastrointestinal, uremia-related, and sleep disturbances-exhibited common patterns over time. Latent class growth models identified 3 distinct trajectories within each symptom cluster, reflecting heterogeneous patterns of symptom progression. This one-year longitudinal study revealed heterogeneous developmental trajectories across symptom clusters in MHD patients. These findings underscore the importance of continuous symptom assessment and monitoring, particularly in patients with persistently high symptom severity. Tailored intervention strategies should be developed to address the specific needs of different patient subgroups, thereby alleviating symptom burden and enhancing the effectiveness of nursing care. Symptom management efforts may be prioritized based on the severity and trajectory of symptom clusters.

Adolescent eating autonomy survey development and exploratory factor analysis.

The Body Acceptance by Others Scale-2: An examination of its psychometric properties in a French-Canadian adult sample.