Final Confirmatory Factor Analysis Research Articles

Biobehavior Life Regulation (BLR) scale for living well in chronic pain: Preliminary scale development and validation.

Currently available pain assessment scales focus on pain-related symptoms and limitations imposed by pain. Validated assessment tools that measure how pain is regulated by those who live well with pain are missing. This study seeks to fill this gap by describing the development and preliminary validation of the Biobehavior Life Regulation (BLR) scale. The BLR scale assesses engagement, social relatedness, and self-growth in the presence of chronic pain and the unpredictability of chronic pain. Sources for items included survivor strategies, patient experiences, existing scales, and unpredictable pain research. Review for suitability yielded 52 items. Validation measures were identified for engagement, social relatedness, self-growth, and unpredictability of pain. The study sample (n = 202) represented patients treated in the Phoenix VA Health Care System (n = 112) and two community clinics (n = 90). Demographic characteristics included average age of 52.5, heterogeneous in ethnicity and race at the VA, mainly Non-Hispanic White at the community clinics, 14 years of education, and pain duration of 18 years for the VA and 15.4 years for community clinics. Exploratory factor analysis using Oblimin rotation in the VA sample (n = 112) yielded a two-factor solution that accounted for 48.23% of the total variance. Confirmatory factor analysis (CFA) in the same sample showed high correlations among items in Factor 1, indicating redundancy and the need to further reduce items. The final CFA indicated a 2-factor solution with adequate fit to the data. The 2-factor CFA was replicated in Sample 2 from the community clinics (n = 90) with similarly adequate fit to the data. Factor 1, Pain Regulation, covered 8 items of engagement, social relatedness, and self-growth while Factor 2, Pain Unpredictability, covered 6 items related to the experience of unpredictable pain. Construct validity showed moderate to higher Pearson correlations between BLR subscales and relevant well-established constructs that were consistent across VA and community samples. The BLR scale assesses adaptive regulation strategies in unpredictable pain as a potential tool for evaluating regulation resources and pain unpredictability.

Measuring users' psychological self-withdrawal on mobile social media: the development of a context dependent instrument.

MSM users have many concerns when disclosing information, such as role conflicts and privacy risks, which can result in nondisclosure. We call these negative feelings associated with MSM use "psychological self-withdrawal" (PSW). Using a mixed-methods design, this study develops and validates an instrument for measuring PSW in the WeChat context, based on focus-group interviews (seven participants), one-on-one interviews (eight participants), and a survey of 1200 WeChat users. The result shows that PSW measure is a four-item instrument designed to measure PSW in the WeChat context. The results of two exploratory factor analysis pilot tests (n = 91 and n = 81) and a final confirmatory factor analysis test (n = 1200) indicate that the PSW measure has good internal consistency (α = 0.839), factorial validity, and a single-factor structure. The study defines PSW as "users' series of negative feelings when using WeChat" and develops and validates an PSW measurement, using focus groups, interviews, and a survey. A four-item PSW with acceptable reliability and validity was finally developed.

Adaptation and Validation of the Readiness for Practice Instrument for Senior Undergraduate Nursing Students in China

Background. The high turnover rate of new nurses is significantly impacted by the transition issue. Practice readiness has been identified as a key factor in ensuring a smooth transition, but there is currently a lack of specific instruments available in China to measure it. Aims. To translate and adapt the Casey-Fink Readiness for Practice Survey and validate its psychometric properties in senior nursing students in the Chinese cultural context. Methods. The descriptive cross-sectional study design was used. The English version of the Casey-Fink Readiness for Practice Survey was translated into Chinese according to Brislin’s translation guidelines. A total of 590 senior nursing students from three nursing schools in China were surveyed with the Chinese version of the Readiness for Practice Instrument. Data analyses were performed to assess the reliability and validity of the instrument. The STROBE guidelines were used as the reporting method. Results. The validated Chinese version of the Casey-Fink Readiness for Practice Survey contained 18 items in the same four dimensions as the original English version. The internal consistency was satisfactory, with Cronbach’s α and composite reliability values for all four dimensions above 0.70. The final confirmatory factor analysis model also demonstrated good fit indices, with the average variance extracted values for all dimensions above 0.50. Conclusion. The validated Chinese version of the Casey-Fink Readiness for Practice Survey is a reliable and effective instrument for measuring the readiness for practice among senior nursing students in China. Implications for Nursing Management. This study presents a valuable contribution to adapting an effective and reliable tool to assess readiness for practice among Chinese senior undergraduate nursing students. This will enable the development of specific strategies based on cultural context to optimize the readiness for practice for senior nursing students and smooth the transition of new nurses in China.

Can severity of a humanitarian crisis be quantified? Assessment of the INFORM severity index

BackgroundThose responding to humanitarian crises have an ethical imperative to respond most where the need is greatest. Metrics are used to estimate the severity of a given crisis. The INFORM Severity Index, one such metric, has become widely used to guide policy makers in humanitarian response decision making. The index, however, has not undergone critical statistical review. If imprecise or incorrect, the quality of decision making for humanitarian response will be affected. This analysis asks, how precise and how well does this index reflect the severity of conditions for people affected by disaster or war?ResultsThe INFORM Severity Index is calculated from 35 publicly available indicators, which conceptually reflect the severity of each crisis. We used 172 unique global crises from the INFORM Severity Index database that occurred January 1 to November 30, 2019 or were ongoing by this date. We applied exploratory factor analysis (EFA) to determine common factors within the dataset. We then applied a second-order confirmatory factor analysis (CFA) to predict crisis severity as a latent construct. Model fit was assessed via chi-square goodness-of-fit statistic, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA). The EFA models suggested a 3- or 4- factor solution, with 46 and 53% variance explained in each model, respectively. The final CFA was parsimonious, containing three factors comprised of 11 indicators, with reasonable model fit (Chi-squared = 107, with 40 degrees of freedom, CFI = 0.94, TLI = 0.92, RMSEA = 0.10). In the second-order CFA, the magnitude of standardized factor-loading on the ‘societal governance’ latent construct had the strongest association with the latent construct of ‘crisis severity’ (0.73), followed by the ‘humanitarian access/safety’ construct (0.56).ConclusionsA metric of crisis-severity is a critical step towards improving humanitarian response, but only when it reflects real life conditions. Our work is a first step in refining an existing framework to better quantify crisis severity.

Engineering process safety research instrument: Assessing students’ moral reasoning in process safety contexts

Process safety decision making is a key component of undergraduate chemical engineering education. Despite this, there are no existing survey instruments designed to measure students’ moral reasoning in the context of process safety decision making. The Engineering Process Safety Research Instrument (EPSRI) was developed to address this deficit in process safety assessment. The EPSRI was modeled after existing moral reasoning instruments including the DIT2, EERI, and ESIT. The process safety scenarios included were drawn from personal experience and reports from the Chemical Safety Board. Each scenario in the instrument was followed by a decision prompt and 12–15 considerations. The EPSRI went through content validation with chemical engineering industry practitioners and chemical engineering faculty members. Subsequently, three rounds of exploratory factor analysis were conducted to finalize the instrument design before a final confirmatory factor analysis was completed to ensure validity and reliability of the instrument. Completion of the exploratory factor analysis resulted in five dilemmas with 9–12 considerations each that loaded onto pre-conventional, conventional, and post-conventional reasoning constructs according to Kohlberg’s moral development theory. Confirmatory factor analysis reaffirmed the validity and reliability of the instrument and its ability to measure chemical engineering students’ moral reasoning within process safety contexts.

Development and validation of the Italian version of the Orofacial Esthetic Scale (OES-I).

To develop an Italian version of the Orofacial Esthetic Scale (OES-I), validated in a prosthodontic and non-prosthodontic patients' cohort, for clinicians and researchers to use in their practice. The OES-I was obtained with a process of translation and back translation from the English version of the questionnaire (OES-E). The psychometric properties of the obtained version were then observed in a group of 70 prosthodontic and 70 non-prosthodontic patients. Validity (discriminative and convergent) and reliability (internal and external) were measured. Also, CFA (confirmatory factor analysis) was run, and several models were obtained. The OES-I scores were much higher for patients who were not scheduled for an esthetic prosthodontic treatment (p < 0.05); similarly, the same analysis conducted by a clinicians provided similar results (Pearson's coefficient = 0.93, p < 0.05). Reliability results show that the different items of the questionnaire are consistent within the test (Cronbach alpha = 0.93) and that the obtained results are stable within a reasonable time period (test-retest reliability = 0.98). The Final CFA model showed that OES score can properly characterize orofacial esthetic. The OES-I is a reliable means both for clinicians and researchers to assess patients' self-perceived esthetic. The OES-I can be used effectively for measuring the self-perceived esthetic appearance in all areas of dental practice and research.

Validation of the Behavioral Anger Response Questionnaire for Children (BARQ-C) in a large community sample of Vietnamese middle adolescents in Hanoi

BackgroundDepression and other forms of psychological distress are common among Vietnamese adolescents and increase the risk of mental health problems in adulthood. As anger coping is a robust predictor of adolescent mental health difficulties, and there appear to be cultural variations in anger coping, a measure of adolescent anger coping styles that has been validated using a non-Western adolescent sample is required to inform and support early intervention to prevent or treat mental health difficulties in Vietnamese adolescents. This study examined the construct validity (structural and external) of the Behavioral Anger Response Questionnaire for Children in Vietnam (BARQC-V).MethodsBaseline data sourced from a recent randomised control trial conducted with Grade 10 Vietnamese adolescents aged 14 to 16 (N = 1084) were used to examine multiple aspects of construct validity: factorial structure (evaluated using factor analysis); internal consistency (tested using Cronbach’s alpha coefficient); and external aspect (assessed using Pearson’s correlation coefficients between the BARQC-V and Vietnamese translations of the Coping Self-Efficacy Scale, Centre for Epidemiologic Studies Depression Scale Revised, Mental Health Continuum Short Form, and the Depression Anxiety and Stress Scale).ResultsEvaluating factorial structure using confirmatory factor analysis failed to converge on a solution. Exploratory factor analysis yielded a 5-factor structure model that explained 49.32% of the BARQC-V’s total variance and was deemed to be a good fit by the final confirmatory factor analysis. Cronbach’s alpha coefficients of the 5 factors demonstrated acceptable internal reliability for the BARQC-V’s sub-scales. Concerning concurrent validity, three sub-scales predicted well-being and mental health difficulties: the maladaptive anger coping styles Rumination and Direct Anger-out were positively associated with depression and distress, and negatively associated with coping self-efficacy and mental well-being; and the adaptive anger coping style Assertion was positively associated with coping self-efficacy and mental well-being, and negatively associated with depression.ConclusionsThe BARQC-V provides a validated measure of three anger coping strategies used by adolescents in Vietnam (Rumination, Direct Anger-out, and Assertion) that can be used to improve detection and treatment of mental health difficulties in this population, and as a starting point by future research to develop a much-needed gold standard measure of anger coping for adults, adolescents and children world-wide.

HIV Treatment Adherence Self-efficacy Scale for Pakistani HIV/AIDS patients: Translation and psychometric evaluation

AimThis study translated HIV-Adherence Self-efficacy scale (HIV-ASES) and evaluated its psychometric properties in Pakistani HIV/AIDS patients. BackgroundHigh level of adherence to highly active antiretroviral therapy (HAART) is required in management of HIV/AIDS; and it is significantly associated with self-efficacy for adherence to treatment. Understanding and enhancing adherence self-efficacy is a huge challenge for care management staff including nurses, counselors and doctors due to paucity of research and availability of valid and reliable instruments in Urdu language to assess HIV treatment adherence self-efficacy. MethodsBrislin's translation method was used to translate HIV-ASES in Urdu. A cross-sectional survey consisting of a demographic questionnaire and Urdu HIV-ASES was administered on 300 HIV/AIDS patients seeking treatment in a government hospital. SPSS-20 and Mplus 8.1 were used for statistical analysis. ResultsSemantic, content, conceptual and technical equivalence between source and target versions were established. The final Confirmatory Factor Analysis model had 0.95 CFI and 0.06 RMSEA (CI = 0.04–0.08). Cronbach's alpha was 0.89 for full scale, 0.81 for integration, and 0.88 for perseverance subscales. ConclusionUrdu HIV-ASES is a valid and a reliable instrument for assessing HIV treatment adherence self-efficacy for further research, intervention and management of HIV/AIDS.

Developing the Vulnerability Factor Structure Affecting Injuries and Health Problems Among Migrant Seafood Processing Industry Workers

BackgroundThe vulnerability of international migrant workers is on the rise, affecting the frequency of occupational accidents at workplaces worldwide. If migrant workers are managed in the same way as native workers, the consequences on safety assurance and risk management will be significant. This study aimed to develop the vulnerability factor model for migrant workers in seafood processing industries because of significant risk-laden labor of Thailand, which could be a solution to control the risk effectively. MethodsA total of 569 migrant workers were surveyed (432 Burmese and 137 Cambodian), beginning with 40 initial vulnerability factors identified in the questionnaire established from experts. The data were analyzed through descriptive analysis; exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to ascertain the model. ResultsThe result of content validity >0.67 and the Cronbach’s alpha of 0.957 specified the high reliability of 40 factors. The EFA indicated a total variance of 65.49%. The final CFA validated the model and had an empirical fitting; chi-square = 85.34, Adjust Goodness-of-Fit Index = 0.96, and root mean square error of approximation = 0.016. The structure concluded with three dimensions and 18 factors. Dimension 1 of the structure, “multicultural safety operation,” contained 12 factors; Dimension 2, “well-being,” contained four factors; and Dimension 3, “communication technology,” contained two factors. ConclusionThe vulnerability factor structure developed in this study included three dimensions and 18 factors that were significantly empirical. The knowledge enhanced safety management in the context of vulnerability factor structure for migrant workers at the workplace.

Development of a scale to measure expected concussion reporting behavior

BackgroundMost concussion education aims to increase athlete self-report of concussive symptoms. Although the population burden of concussion is high, frequency with which this injury occurs on a given sports team in a given season is relatively low. This means that powering concussion education evaluation studies to measure change in post-injury symptom reporting behavior requires what is often a prohibitively large sample size. Thus, evaluation studies are typically powered to measure proximal cognitions. Expected reporting behavior, a cognition that reflects planned and reactive decision-making, is a theoretically indicated construct for inclusion in evaluation studies. However, previously no scales were available to measure this construct with demonstrated reliability and validity among youth athletes. The objective of this study was to develop and assess the validity of a brief single-factor scale to measure expected youth athlete concussion reporting behavior (CR-E) in a sample of youth athletes.MethodsA mixed methods approach was used, including cognitive interviews with youth athletes, and quantitative item reduction and validation. Participants were youth athletes (aged 9–16) from the Seattle metropolitan and rural south-Georgia regions. After refining an initial pool of items using cognitive interviews with a diverse group of youth athletes (n = 20), a survey containing these items was administered to youth soccer and football players (n = 291). Item reduction statistics and sequential confirmatory factor analyses were used to reduce the initial scale using a randomly selected half of the sample. Then, a final confirmatory factor analysis and validation tests were applied to the other half of the sample of youth athletes. Predictive validation was conducted longitudinally in a separate sample of youth athletes (n = 155).ResultsInternal consistency was high (alpha = 0.89), model fit was excellent, validation tests were in the hypothesized directions, and the scale was feasible to use. Using the finalized 4-item scale, we observed that less than one-third of youth soccer and football athletes expect to “always” tell their coach about symptoms of a suspected concussion.ConclusionsThe CR-E measure should be included in future studies evaluating concussion education programming in youth athlete populations.

Development and Validation of the Youth Career Development Competency Scale: A Study Based on Hong Kong Youth.

The challenging labor market conditions concomitant with economic globalization and advanced technology have made youth career development competency (YCDC)—young people’s ability to navigate transitions through education into productive and meaningful employment—especially important. The present study aims to develop a holistic instrument to measure YCDC in Hong Kong, which has rarely been investigated in past studies. The sample consisted of 682 youths aged 15–29 years (387 male, mean age = 19.5 years) in Hong Kong. Exploratory factor analysis of the 17-item YCDC scale resulted in four competence factors—engagement, self-understanding, career and pathway exploration, and planning and career management—which accounted for 78.95% of the total variance. The final confirmatory factor analysis results indicated good model fit (CFI = 0.96, TLI = 0.95, RMSEA = 0.06, 90% CI (0.05, 0.07), SRMR = 0.03) and good factor loadings (0.78–0.91). Moreover, the results demonstrated a satisfactory internal consistency of subscales (0.89–0.93). Subgroup consistency across subsamples categorized by gender, age, and years of residence in Hong Kong was also demonstrated. In addition, correlations between the YCDC scale and subscales with other career-related and psychosocial outcomes (i.e., career outcome expectancy, career adaptability, civic engagement, social contribution, and social integration) showed good concurrent validity. The results indicated that the YCDC scale is a valid and reliable tool for measuring career development competence among youth in the Hong Kong context. Its development sheds light on how career professionals can holistically assess young people’s navigation competence during their school-to-work transitions.

Adapting and Validating the Sexual Experiences Questionnaire to Study Sexual Harassment Among University Women in Jordan.

Despite the adverse effects of sexual harassment, measurement gaps persist. Using a sequential, mixed-methods approach, we adapted and validated the Sexual Experiences Questionnaire (SEQ) to measure sexual harassment victimization among college-going women in Jordan. From a 213-item pool and qualitative data from students at the study site, we removed 50 items and collapsed or rephrased 163 items into selected 27 items for examination. After expert reviewers and study-site staff assessed content validity, we replaced three items. Items were tested using cognitive interviews (n = 7) and then administered in a survey to 567 women students. We sequentially performed exploratory factor analysis (EFA) with a random split-half sample (N1 = 283), confirmatory factor analysis (CFA) with the second sample (N2 = 284), and confirmatory bifactor analysis. Five items with cross-factor loadings were dropped. Model fit for the final four-factor EFA and CFA was adequate (EFA: RMSEA: 0.013, CFI: 0.996, TLI: 0.994; CFA: RMSEA 0.020, CFI: 0.988, TLI: 0.986). Three factors were similar to those identified in the SEQ-gender harassment, sexual coercion, and unwanted sexual attention-but we also identified a fourth factor-physical-contact sexual harassment. The bifactor analysis suggested that the scale was unidimensional (general factor ECV=.701 and PUC =.727). The unidimensional scale was positively associated with depressive symptoms. Using an adapted SEQ, sexual harassment is a measurable construct in the Jordanian university context. Further validation of this tool and efforts to capture each dimension of sexual harassment in the Arab region is needed.

Creation and validation of the Postpartum Specific Anxiety Scale Research Short-Form (PSAS-RSF)

The Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure of postpartum anxiety (PPA). However, it contains 51 items, so is limited by its length. This study aimed to reduce the number of items in the PSAS, produce a small number of high-performing short-form tools, and confirm the factor structure of the most statistically and theoretically meaningful model. A pooled sample of English-speaking mothers (N = 2033) with infants up to 12 months were randomly split into three samples. (1) A principal component analysis (PCA) was conducted to initially reduce the items (n = 672). (2) Four short-form versions of varying length (informed by statistical, theoretical, lay-person, and expert-guided feedback) were developed and their factor structure examined (n = 673). (3) A final confirmatory factor analysis (CFA) was performed to confirm the factor structure of the PSAS Research Short-Form (PSAS-RSF) (n = 688). PCA and theoretical review reduced the items from 51 to 34 (version 1). Statistical review retained 22 items (version 2). Quantitative expert panel data retained 17 items (version 3). Qualitative expert panel data retained 16 items (version 4). The 16-item version was deemed the most theoretically and psychometrically robust. The resulting 16-item PSAS-RSF demonstrated good psychometric properties and reliability. The PSAS-RSF is the first brief research tool which has been validated to measure PPA. Our findings demonstrate it is theoretically meaningful, statistically robust, reliable, and valid. This study extends the use of the measure up to 12 months postpartum, offering broader opportunity for measurement while further enhancing accessibility through brevity.

Questionário de eficácia clínica e prática baseada em evidências

Introduction: Health care, as it is currently conceived, is based on the view that clinical decisions must be based on the best scientific evidence available, while recognizing the patient's preference, health care context and clinical judgment. Objetives: To evaluate the validity of the Clinical Effectiveness and Evidence-Based Practice Questionnaire (QECPBE). Methods: Methodological study in order to determine internal consistency using Cronbach's alpha and confirmatory factor analysis Results: 738 nurses were included, with an average age of 37.57 years, 76.0% of whom were women. After the questionnaire was refined, the final confirmatory factor analysis showed a good quality of adjustment of the factor structure composed of 3 factors with 19 items (x2/gl = 2.030; CFI = 0.967; GFI = 0.926; RMSEA = 0.053; RMR = 0.064) . The overall internal consistency was  = 0.930, demonstrating a very high reliability, explaining 63.660% of the total variance. Conclusions: The results showed that the scale is reliable and valid in the evaluation of the structural components of EBP. EBP appears as an enhancer of safe clinical decision, quality of care and autonomy in nursing.

Validation of the Brief Coping Orientation to Problem Experienced (Brief COPE) inventory in people living with HIV/AIDS in Vietnam.

The Brief Coping Orientation to Problem Experienced (Brief COPE) inventory is one of the most widely used instruments in coping research; however, no study has evaluated the psychometric properties of the Brief COPE in the Vietnamese population. This study aimed to validate a culturally appropriate Vietnamese version of the Brief COPE for the evaluation of coping strategies in people living with HIV/AIDS in Vietnam. We translated the Brief COPE into Vietnamese, and it was self-administered among 1,164 HIV-infected patients receiving antiretroviral therapy at a large HIV outpatient clinic in Hanoi between January 2019 and March 2020. Data on demographics and HIV-related information, depression and social support were also collected. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to assess construct validity. Content validity, internal consistency, and convergent validity were also assessed. The CFA of a 14-factor structure of the original Brief COPE revealed acceptable model fitness, but poor internal consistency for some subscales. In the subsequent EFA, we found a revised 26-item version which had a six-factor structure consisting of problem-solving, avoidance, humor, social support, religion, and substance use. The final CFA found that the model fitness of the revised scale with fewer factor structures was comparable to that of the original Brief COPE; the internal consistency of the revised scale was even better than that of the original scale. Furthermore, six factors of the revised scale showed anticipated associations with depression and social support.

Development and validation of the chronic illness self-management (CISM) scale: Data from a young patient sample in Hong Kong

The increasing prevalence of early-onset chronic illnesses is a major global health challenge. Effective chronic illness self-management (CISM) is crucial in improving the quality of life of patients. This study aims to develop a holistic instrument to measure CISM among the young patient population in Hong Kong, which has rarely been investigated in past studies. A total of 497 individuals aged 12–45 years with chronic illness completed the questionnaire. A confirmatory factor analysis (CFA) resulted in a four-factor model. The four factors include treatment adherence, health maintenance efficacy, self-stigma, and coping with stigma. The final CFA results indicated good model fit (RMSEA = 0.069, CFI = 0.907, TLI = 0.894, and SRMR = 0.059) and good factor loadings (0.636–0.843). Subgroup consistency across the gender, age, illness category, and illness severity subsamples was demonstrated. Correlation between the CISM factors and emotional and behavioral functioning variables showed good concurrent validity. The results reflected unique CISM characteristics in Hong Kong under the influence of Chinese culture and the city’s healthcare system. The development of this scale sheds light on how healthcare professionals can assess the CISM of young patients in a holistic manner.

Factorial validity, measurement and structure invariance of the Malay language decisional balance scale in exercise across gender.

BackgroundThis study examined the psychometric properties of the Malay version of the decisional balance (DB-M) for exercise (i.e. perceived benefits and perceived barriers) using a cross-sectional design. Also, this study assessed the measurement and structural invariance of the DB-M across gender.MethodsThe study sample consisted of 750 students (female: 51.7%, male: 48.3%), with a mean age of 20.2 years (SD = 1.2). Decision balance (DB) scale was assessed with the 10-item DB-M. Standard forward-backward translation was performed to translate the English version of the DB into Malay version (DB-M).ResultsThe confirmatory factor analysis (CFA) results based on the hypothesised measurement model of two factors and ten items demonstrated adequate factor structure after the addition of some correlated item residuals (comparative fit index (CFI) = .979, Tucker and Lewis index (TLI) = .969, standardised root mean square residual (SRMR) = .037, root mean square error of approximation (RMSEA) = .047). The construct reliability and average variance extracted values were .850 and .839, and .542 and .538, for perceived benefits and perceived barriers, respectively. Meanwhile, the Cronbach’s alpha was .857 and .859, and the intraclass correlation coefficient for test-retest reliability was .979 and .960 for perceived benefits and perceived barriers respectively. The findings provided evidence for measurement invariance of DB-M for the male and female samples. The final CFA model fit the data well for both male sample (CFI = .975, TLI = .964, SRMR = .040, RMSEA = .052) and female sample (CFI = .965, TLI = .949, SRMR = .044, RMSEA = .058).ConclusionsThe translated version of the DB-M was valid and reliable for assessing the level of perceived benefits and perceived barriers in exercise among university students in Malaysia.

Measuring Patients' Perceptions of Health Care Encounters: Examining the Factor Structure of the Revised Patient Perception of Patient-Centeredness (PPPC-R) Questionnaire.

Given the ongoing desire to make health care more patient-centered and growing evidence supporting the provision of patient-centered care, it is important to have valid tools for measuring patient-centered care. The patient-centered clinical method (PCCM) is a conceptual framework for providing patient-centered care. A revision to the PCCM framework led to a corresponding need to enhance the Patient Perception of Patient-Centeredness (PPPC) questionnaire. The original PPPC was aligned with the components of the PCCM conceptual framework and developed to measure patient-centeredness from the patient's perspective. The purpose of this study was to examine the factor structure of a revised version of the PPPC (ie, PPPC-R). Eleven new items were added to the original 14 items. The modified questionnaire was administered to patients in primary health care teams in Ontario, Canada. The confirmatory factor analysis was conducted on a subset of 381 patients who had seen a family physician. The initial proposed 4-factor model first tested with a confirmatory factor analysis (CFA) did not fit adequately. Exploratory factor analysis was therefore used as a second step to modify the model and to identify weak items. A 3-factor exploratory model with 18 of the original 25 items was converted into a final hypothetical CFA model that had a good fit (χ2 (132)=176.795, P<0.01; CFI=0.991; RMSEA=0.030). The third factor contained only 2 items and so is interpreted with caution. The validity of the PPPC-R is supported by some congruence between the conceptual framework (the PCCM) and the statistical analysis (CFA), but there is not a 1:1 correspondence. The components of the PCCM represent conceptually what is important when teaching, researching, and providing patient-centered care, whereas the PPPC-R represents patient-centered care as it is experienced by the patient.

Evaluation of a questionnaire to assess nutritional knowledge, attitudes and practices in a Thai population

BackgroundThe rapid increase in non-communicable chronic diseases in people of working age has had a major effect on health care utilization, productivity and economy. Lifestyle and diet are recognized as being major risk determinants involved. Disease prevention strategies need to be based on people’s understanding of nutritional knowledge, attitudes and practice. This study evaluates the validity of a new nutritional knowledge and practice questionnaire specifically developed for assessing individuals of working age in a Thai population.MethodsThe questionnaire was constructed and based on previous relevant literature and its content validity was scrutinized by an expert panel. An exploratory factor analysis (EFA) was performed to reduce the number of questions included. Subsequently, data from a cross-sectional study of 1,032 participants were used to evaluate the reliability and validity of this questionnaire. The validity of the questionnaire constructed for assessing knowledge and attitude was evaluated using Confirmatory Factor Analysis (CFA). For the practice component, set criteria were applied to determine the final variables used.ResultsCFA of the nutritional knowledge component suggested that all the variables in the model fitted with the data (χ2 = 80.17, df = 66, p > 0.05, CFI = 0.99, RMSEA = 0.01, SRMR = 0.02). The CFA final model for the nutritional knowledge included three factors (food recommendation, nutrients related to diseases, and healthy diet) with a total of 14 questions. For nutrition attitude, CFA also revealed a good fit (χ2 = 178.14, df = 93, p < 0.001, CFI = 0.99, RMSEA = 0.03, SRMR = 0.03). The final CFA model for nutritional attitude included three factors (food choice, healthy diet and food recommendation) with a total of 16 questions. For practice items, the number of questions was reduced from 76 to 60.ConclusionsQuestionnaire development should use a logical, systematic and structured approach. Results from our evaluation process demonstrates the construction validity of the nutritional knowledge and practice questionnaire developed. This questionnaire can be further modified for use in other countries within the region.

Refining the medical student safety attitudes and professionalism survey (MSSAPS): adaptation and assessment of patient safety perception of French medical residents

BackgroundImplementing a patient safety curriculum for medical students requires to identify their needs and current awareness of the topic. Several tools have been developed to measure patient safety culture, but none of them have been developed in the French context.Our objective was to adapt and refine the psychometric properties of the MSSAPS, developed by Liao et al, to use it among general practice (GP) residents.Methods1-We conducted a translation and transcultural adaptation of the MSSAPS questionnaire (28 items, 5 dimensions: safety culture, teamwork culture, experiences with professionalism, error disclosure culture and comfort expressing professional concerns) in accordance with the international recommendations.2-We studied the new questionnaire’ psychometric properties on a sample of GP residency students in 2016. This validation comprised 2 steps: a confirmatory factor analysis (CFA) for each dimension of the MSAPPS to explore the adequacy of the structure of the questionnaire; an exploratory factor analysis to refine the instrument, using a principal component analysis and Cronbach’s α-coefficients calculation. A final CFA examined the structure validity of the refined questionnaire.3-We described the items and the safety cultural scores in our sample of residents.ResultsAmong 391 eligible students, 213 responded (54%).The initial structure was not confirmed by CFAs, showing a poor fit for 3 of the 5 dimensions: safety culture, teamwork culture and professionalism. Exploratory PCA led to 3 dimensions: Safety culture (PVE: 18.5% and 7 of 8 initial items), Experiences with professionalism (PVE: 17.8% and 5 of 7 initial items) and Error disclosure culture (PVE: 13.6% and 3 of 4 original items). Cronbach’s α-coefficients were 0.74, 0.78 and 0.76 respectively. The final CFA confirmed the existence of the 3 latent dimensions with a good fit to the and highly significant structural coefficients (P < 0.001). Mean scores were equal to 65.4 [63.6; 67.6] for the safety culture, 66.9 [63.8; 70.1] for the experience with professionalism, and 54.4 [51.6; 57.2] for the error disclosure culture.ConclusionThis study reports satisfactory psychometrics properties of the French version of the MSAPPS and provides evidence of important training needs for GP residents in the field of patient safety culture.