Two-factor Model Research Articles

Psychometric properties of the ultra-brief self-report Patient Health Questionnaire-4 (PHQ-4) to assess anxiety and depression in Arabic-speaking adults

BackgroundAnxiety and depression are psychiatric disorders that often coexist and share some features. Developing a simple and cost-effective tool to assess anxiety and depression in the Arabic-speaking population, predominantly residing in low- and middle-income nations where research can be arduous, would be immensely beneficial. The study aimed to translate the four-item composite Patient Health Questionnaire – 4 (PHQ-4) into Arabic and evaluate its psychometric properties, including internal reliability, sex invariance, composite reliability, and correlation with measures of psychological distress.Methods587 Arabic-speaking adults were recruited between February and March 2023. An anonymous self-administered Google Forms link was distributed via social media networks. We utilized the FACTOR software to explore the factor structure of the Arabic PHQ-4.ResultsConfirmatory factor analysis (CFA) indicated that fit of the two-factor model of the PHQ-4 scores was modest (χ2/df = .13/1 = .13, RMSEA = .001, SRMR = .002, CFI = 1.005, TLI = 1.000). Internal reliability was excellent (McDonald’s omega = .86; Cronbach’s alpha = .86). Indices suggested that configural, metric, and scalar invariance were supported across sex. No significant difference was found between males and females in terms of the PHQ-4 total scores, PHQ-4 anxiety scores, and PHQ-4 depression scores. The total score of the PHQ-4 and its depression and anxiety scores were significantly and moderately-to-strongly associated with lower wellbeing and higher Depression Anxiety and Stress Scale (DASS) total and subscales scores.ConclusionThe PHQ-4 proves to be a reliable, valid, and cost-effective tool for assessing symptoms related to depression and anxiety. To evaluate the practical effectiveness of the Arabic PHQ-4 and to further enhance the data on its construct validity, future studies should assess the measure in diverse contexts and among specific populations.

Variance dynamics and term structure of the natural gas market

In this paper, we develop a stochastic model to investigate the variance dynamics and term structure of the US natural gas market. The model features two variance factors, the Samuelson effect, seasonality and linearly analytical pricing formula. With variance swap rates synthesized from options prices spanning more than 20 years, we show that the two-factor variance model has better performance and is preferred to describe the variance term structure. Moreover, we find that the two variance factors are particularly needed to capture humps in variance term curves implied from the market. Finally, we apply the two-factor model to hedging natural gas straddles and obtain improved performance. These results highlight the importance of introducing multiple variance factors to the natural gas market, and may be applied to other similar sectors.

A Short Progressive Supranuclear Palsy Quality of Life Scale.

The Progressive Supranuclear Palsy quality of life scale (PSP-QoL) has been shown to be a useful tool for capturing health-related quality of life of patients in "everyday life" and in progressive supranuclear palsy (PSP) research. However, at 45 items in length, the questionnaire can take a long time, exhausting PSP patients, in particular if cognitive impaired, which can have a negative impact on the assessment. The aim of this study was to establish a condensed version of the PSP-QoL for research and routine clinical care. In this retrospective study, data originating from a German cohort of PSP patients was analyzed. Data from 245 PSP patients were included in this study. The short PSP-QoL questionnaire was created using a two-factor solution and item-total and inter-item correlations for mental and physical aspects of daily living of the PSP-QoL followed by confirmatory factor analysis. The final scale included 12 items representing mental (five items) and physical symptoms (seven items). The specified two-factor model displayed an excellent fit in the confirmatory factor analysis. The short Progressive Supranuclear Palsy Quality of Life scale (PSP-ShoQoL) correlated moderately with the PSP Rating Scale (r [243] = 0.514, P < 0.001) and Geriatric depression scale (r [231] = 0.548, P < 0.001). Sensitivity to change confirmed a significant decrease in QoL after 12 months. In this study, we created a 12-item PSP-ShoQoL designed to "facilitate" daily clinical work that correlated strongly with the PSP-QoL and was sensitive to change. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Gender differences in job satisfaction among gig workers in Bangladesh

The gig economy (temporary, contract, and freelance online jobs rather than permanent positions) is a component of the fourth industrial revolution and preview of future work. The rise of digital platforms has increased career opportunities and income potential, particularly for women. Yet, the sex-disaggregated evidence regarding platform usage, employment characteristics, and working motivations and satisfaction remains untapped. Using data from a quantitative survey of Bangladeshi gig workers (242 men and 201 women) conducted in 2022, this paper addresses these gaps between male and female workers. The gig economy appears to be gender-segregated across digital platform usages and working categories. Women tend to prioritize digital work options for managing multiple responsibilities, while men are often driven by the potential for higher income. This study conceptually utilized the two-factor theory and empirically ordered a probit model to identify gender differences in job satisfaction. Job satisfaction was significantly increased by work-life balance, monthly income, and social-media connection, while an increase in working hours, complexity in payment systems, and unstable networks all led to a decrease in job satisfaction. The findings have implications for the future growth of the gig economy, provide new insights into gender differences in job satisfaction, and underscore the need for gender-sensitive policies in the online labor market.

Collective teacher efficacy and its relationship to attitudes to inclusion of students with special educational needs in Sweden

ABSTRACT This study aimed to investigate the perceived collective teacher efficacy, teacher attitudes to inclusion of students with special educational needs, and the relationship between the constructs in a sample of Swedish teachers. The participants were 930 teachers involved in the Inclusive Behavioural Support in Schools implementation programme. The teachers answered the two questionnaires: The Teacher Attitudes to Inclusion Scale Swedish version (TAIS-Sw) and the Collective Teacher Efficacy Scale (CTES). The questionnaires were analysed and adapted to fit the sample adequately. This exploration identified a three-factor model for TAIS-Sw that is suitable for the data. The three latent variables related to classroom management, perception of the positive effects of inclusion for all students, and objections towards segregated special education. For CTES, a two-factor model showed a good fit for the data. The latent variables were related to aspects of teachers’ competence, including belief in competency and skills to teach all students. The questionnaires identified positive expressions of collective teacher efficacy but more hesitant attitudes to inclusion. Structural equation modelling was used to investigate the relationship between the constructs of collective teacher efficacy and attitudes to inclusion, revealing a small positive relationship. Further investigations could help identify factors supporting successful inclusive practices.

Evaluation of working conditions in the production system

The paper analyzes methods for assessing professional risk, emphasizing that the primary method is job certification. Job certification establishes the compliance of the workplace with regulatory characteristics for specific risk factors in the production environment. The analysis reveals that the existing methodology for job certification does not provide insights into changes in the parameters of hazardous and harmful factors in the production environment, and consequently, changes in working conditions between planned certifications. The study advocates for a comprehensive assessment of the collective impact of all factors in the production environment and work processes on the human body. This is achieved through hygienic risk factor assessment. The paper highlights the appropriateness of quantitatively assessing working conditions in points, considering the simultaneous influence of multiple hazardous factors. A procedure for point-based assessment of working conditions is proposed, and the applicability of Haber's Law to determine the cumulative dose of a harmful factor in the body is demonstrated.

Longitudinal measurement invariance and psychometric properties of the Patient Health Questionnaire-Four in China

BackgroundDepression and anxiety symptoms among medical students are often a concern. The Patient Health Questionnaire-Four (PHQ-4), an important tool for depression and anxiety screening, is commonly used and easy to administer. This study aimed to assess and update the longitudinal measurement invariance and psychometric properties of the simplified Chinese version.MethodsA three-wave longitudinal survey was conducted among healthcare students using the PHQ-4. Structural validity was based on one-factor, two-factor, and second-order factor models, construct validity was based on the Self-Rated Health Questionnaire (SRHQ), Sleep Quality Questionnaire (SQQ), and Rosenberg Self-Esteem Scale (RSES), and longitudinal measurement invariance (LMI), internal consistency, and test–retest reliability were based on structural consistency across three time points.ResultsThe results of the confirmatory factor analysis indicated that two-factor model was the best fit, and LMI was supported at three time points. Inter-factor, factor-total, and construct validity correlations of the PHQ-4 were acceptable. Additionally, Cronbach’s alpha, McDonald’s omega, and the intraclass correlation coefficient demonstrated acceptable/moderate to excellent reliability of the PHQ-4.ConclusionsThis study adds new longitudinal evidence that the Chinese version of the PHQ-4 has promising LMI and psychometric properties. Such data lends confidence to the routine and the expanded use of the PHQ-4 for routine screening of depression and anxiety in Chinese healthcare students.

Characteristics of life-cycle carbon dioxide emissions of arterial highway maintenance and the influencing factors

With the focus of highway development transitioning from construction to maintenance, a comprehensive understanding of the characteristics and influencing factors of carbon dioxide (CO2) emissions from highway maintenance activities is crucial for formulating effective strategies to promote the low-carbon development of road infrastructure. However, the quantitative relationships between CO2 emissions from highway maintenance schemes and factors such as pavement deterioration, traffic volume, and road grade remain unclear owing to a lack of comprehensive, multi-category, and real data. Using real maintenance data from 340 arterial highway segments in China, this study conducts the life cycle assessment (LCA) to estimate CO2 emissions from maintenance activities and examines the primary emission sources among various structural layers and materials. Furthermore, multiple linear regression (MLR) analysis is conducted to investigate the impact of traffic volume, road grade, and pavement deterioration on CO2 emissions from maintenance projects, and factors influencing the early-stage degradation of pavement performance. The results demonstrate that average CO2 emissions from heavy rehabilitation projects are 6.97 times higher than those from medium rehabilitation projects. Emissions from heavy rehabilitation projects exhibit a significantly negative linear relationship with the riding quality index (RQI) before maintenance (p < 0.05), and emissions from medium rehabilitation projects show a significant negative linear relationship with the pavement condition index (PCI) before maintenance (p < 0.05). Emissions from heavy and medium rehabilitation projects are significantly positively correlated with heavy vehicle traffic volume before maintenance (p < 0.05). Moreover, the early-stage degradation of PCI after heavy rehabilitation and RQI after medium rehabilitation exhibit significantly negative linear relationships with their respective indicators before maintenance (p < 0.05). The early-stage degradation of RQI after heavy rehabilitation is significantly positively correlated with CO2 emissions from the base course and cushion layers (p < 0.05). The findings emphasize that timely maintenance and reduction of CO2 emissions from asphalt mixing equipment are essential for mitigating emissions from road maintenance. This study offers valuable insights for advancing the low-carbon development of highways in temperate regions.

Validation of an Arabic tool for assessing vaccination literacy: A factor and Rasch analysis

ABSTRACT Vaccine literacy is a significant part of health literacy. Although several tools have been developed to assess vaccine literacy, such tools are lacking in Arabic. Validating an Arabic version of a tool that evaluates vaccine literacy is critically important, as it would aid in understanding the decision-making process regarding vaccinations among individuals in Arabic-speaking countries. Therefore, the current study aimed to validate an Arabic tool for assessing vaccine literacy in adult vaccination. An online questionnaire was distributed to people throughout Jordan by sharing the questionnaire link via various social media platforms. The reliability and validity of the Arabic version of the vaccination literacy assessment tool (HLVa-Ar) were evaluated using factor analysis and Rasch analyses. The two-factor model generated fit indices were in the acceptable range (χ2/df = 2.48, RMSEA = 0.06, SRMR = 0.05, GFI = 0.94, CFI = 0.97, and TLI = 0.96). Cronbach’s alpha for functional Vaccination literacy (VL) and interactive/critical VL were 0.91 and 0.88 respectively. The Rasch analysis indicated acceptable infit/outfit values and high item and person separation reliabilities for the two factors (0.852, 0.868, and 0.771, 0.818 respectively). Overall, the 420 participants displayed a good understanding of the general benefits and importance of vaccination. The HLVa-Ar was shown to be a valid and reliable tool that portrayed a wide range of vaccination literacy levels in the studied sample and provided valuable insights into participants’ vaccination knowledge. The findings emphasize the need for developing targeted strategies to improve vaccination literacy and increase vaccination rates.

Caregiving Appraisals and Emotional Valence: Moderating Effects of Activity Participation.

The present study examines the extent to which a two-factor model of affect explains how caregiving appraisals experienced by caregivers influence their own well-being. We used data from three waves of Nation Study of Caregiving (NSOC) to conduct latent growth curve models with the time-varying predictors to investigate the effect of between-person (BP) and within-person (WP) caregiving appraisals on positive and negative affect. Furthermore, we simultaneously modeled WP differences in activity participation and affective experience with multilevel modeling. Then, we tested the moderating effect of activity participation in the association between WP caregiving appraisals and emotional valence. We found that BP and WP caregiving negative appraisal also contribute to caregiver positive affect similar to that of negative affect. Time-varying effects of negative appraisals and emotional valence are consistent with the two-factor model. Future longitudinal investigations could target WP and BP activity participation to alleviate caregiving cognitive appraisal among caregivers.

Assessment of Non-Phytate Phosphorus Requirements of Chinese Jing Tint 6 Layer Chicks from Hatch to Day 42.

We aimed to estimate the non-phytate phosphorus (NPP) requirements of Chinese Jing Tint 6 layer chicks. We randomly allocated 720 birds to five treatments with six cages of 24 birds each, feeding them a corn-soybean diet containing 0.36%, 0.41%, 0.46%, 0.51%, and 0.56% NNP. The results showed that the body weight gain (BWG), tibial length, and apparent total tract digestibility coefficients (ATTDC) of P were affected (p < 0.05) by dietary NPP level. A quadratic broken-line analysis (p < 0.05) of BWG indicated that the optimal NPP for birds aged 1-14 d was 0.411%. Similarly, 0.409% of NPP met tibial growth needs. However, 0.394% of NPP was optimal for P utilization according to the ATTDC criterion. For 15-42 d birds, 0.466% NPP, as estimated by the BWG criterion, was sufficient for optimal growth without decreasing P utilization. Using the factorial method, NPP requirements were calculated as 0.367% and 0.439%, based on the maintenance factors and BWG for 1-14 and 15-42 d birds, respectively, to maintain normal growth. Combining the non-linear model with the factorial method, this study recommends dietary NPP levels of 0.367% and 0.439% for 1-14 and 15-42 d birds, respectively, to optimize P utilization without affecting performance.

Translation and validation to the Arabic language version of the climate change anxiety scale (CCAS)

BackgroundThe Arab world is one of the global regions the most directly concerned by, and suffering from climate change’s adverse consequences. As such, there appears to be a strong need for an understanding of how Arab people may emotionally respond to climate change. Providing valid and reliable measures of climate change anxiety (CCA) can help gain a clear overview of the situation in Arab countries, and allow to intervene timely and effectively to mitigate any adverse effects on Arab people’s mental health. To this end, the present study sought to validate the Arabic language version of the Climate Change Anxiety Scale (CCAS) in a sample of native Arabic-speaking adults from the general population of Lebanon.MethodsThis study adopted a cross-sectional approach and enrolled 763 adults between July and September 2023.ResultsA confirmatory analysis of the one-factor model showed poor fit indices as follows: CFI = 0.90, GFI = 0.83, SRMR = 0.048 and RMSEA 0.131 [90% CI 0.123, 0.138). The two-factor model showed a satisfactory fit with a high CFI of and a GFI of 0.91 and a SRMR of 0.04 and RMSEA of 0.05 [90% CI 0.04, 0.06]. Both McDonald’s omega and Cronbach alpha values were high for the overall CCAS score (α = 0.96 and ω = 0.96) in the whole sample. Configural, metric and scalar invariance across gender was demonstrated. No significant difference was found between males and females in terms of total CCAS scores (24.53 ± 10.59 vs. 26.03 ± 11.17, t(761) = -1.82, p = .069). Higher CCA, functional impairment and cognitive impairment scores were significantly associated with higher depression, anxiety and stress.ConclusionThe reliability and validity of the CCAS in its Arabic version were proven. The availability of this self-report measure could offer a chance to assess CCA among Adults speaking Arabic, and to spread its future use for screening and research purposes.

Опросник «Шкала воспринимаемого стресса для детей» (ШВС-Д): Адаптация и психометрические показатели

&lt;p&gt;The article presents the results of adapting and testing of the &amp;ldquo;Perceived Stress Scale for Children&amp;rdquo; (PSS-C) on a Russian-speaking sample of adolescents aged 11 to 16 (n = 612). The study sample consisted of students from grades 5 to 8 in secondary schools in various regions of the Russian Federation (Trans-Baikal Territory, Altai Territory, Moscow Region, Leningrad Region). The results of psychometric testing indicate that the questionnaire has good internal consistency with correlations between the final score and stand alone questions being rs = [0.4; 0.64], p &amp;lt; 0.01; the half-form reliability rt = 0.78; the Cronbach's &amp;alpha; = 0.741. A direct relationship between the perceived stress level and situational anxiety was shown (rs = 0.67, p &amp;lt; 0.01), which persisted when taking into account the age, gender, and region of residence of the respondents. These findings suggest that PSS-C has convergent validity. Factor analysis of the questionnaire revealed the presence of two factors in the perceived stress structure: 1) &amp;ldquo;Tension&amp;rdquo; and 2) &amp;ldquo;Resources&amp;rdquo;. The two-factor model of perceived stress was confirmed using confirmatory factor analysis (RMSEA = 0.058, 90% CI [0.045, 0.072], CFI = 0.952, GFI = 0.977). The discriminativeness of the questionnaire was &amp;delta; = 0.97. Gender differences in the level of perceived stress are shown; age differences are due to an increase in study load. The &amp;ldquo;Perceived Stress Scale for Children&amp;rdquo; questionnaire is a valid and reliable technique for diagnosing stress in adolescents aged 11 to 16. It can be used both in individual assessments and group diagnostics for monitoring of stress levels in adolescence.&lt;/p&gt;

Self-employed people with chronic health conditions: Business maintenance and well-being.

Chronic health conditions (CHCs) involve physical, psychological, and social challenges and can have a significant negative impact on work ability, which can then affect performance and job satisfaction. However, the various effects of CHCs on business operations and maintenance among self-employed workers are understudied. This study examined four common CHCs that are characterised by persistent symptoms and can prompt major life changes: respiratory disease, heart conditions, inflammatory bowel disease, and cancer survivorship. Groups were compared regarding the CHC's impact on business maintenance (declining in income and activity, and slowing business growth), and well-being. A sample of 294 self-employed workers with these CHCs completed questionnaires about how their conditions affect their businesses, physical symptoms, and well-being. The four CHCs had substantial negative effects on business maintenance. Differences were found in reported changes in income, activity, and growth between individuals with inflammatory bowel disease and cancer. No differences in well-being occurred among self-employed people with different CHCs. In the overall sample, work absences and slowing business growth were negatively associated with well-being. Although the groups differed in the severity of symptoms, threat to life, and treatment regimen, the CHCs had similar effects on most business maintenance factors and well-being. Moreover, the results indicate that the inability to maintain a business can negatively affect well-being.

SEM Analysis of Contractor Performance in Accelerating Electrical Construction Project: Insights from Herzberg's Dual Factor Theory

In the rapidly developing electrical construction industry, the success of organizations is directly linked to the performance of their business partners. This study focuses on Indonesia's state-owned electrical enterprises, where a notable decline in Key Performance Indicators (KPIs) has raised concerns, hypothesizing that deficiencies in contractor performance are a major barrier to the timely completion of electrical construction projects. At the core of this issue is the role of human resources, identified as a pivotal factor in contractor performance that directly impacts project completion. The aim of the research is to elucidate the complex dynamics between motivator and hygiene factors, which are fundamental to Herzberg's dual factor theory, and their impact on the performance of the contractor's employees. Using Structural Equation Modeling (SEM), the study analyzes data from questionnaires distributed to 250 industry professionals. The analysis provides key insights into how these factors significantly influence job satisfaction and, ultimately, employee performance. These insights play a critical role in strategically planning contractor management practices. By emphasizing the need to understand the key factors driving employee satisfaction and performance, the study lays a solid foundation for designing effective employment contracts and management strategies. The practical implications of this research are significant, offering a pathway for contractors to enhance employee satisfaction and performance. This ultimately leads to the delivery of high-quality electrical infrastructure projects efficiently and promptly, underlining the study's relevance and importance in the contemporary industrial landscape.

Behavioral and physiological pain structures of PIPP-R and parental stress: structural equation modeling approach.

Although most non-acute pain assessment tools are multi-dimensional (behavioral and physiological measures) in their approach, the outputs of such tools are considered unidimensional. This study aimed to explore and determine the behavioral and physiological pain structures of Premature Infant Pain Profile-Revised (PIPP-R) for neonates and its association with parental stress. This cross-sectional study was conducted in 2022-2023 in Isfahan, Iran. We recruited 400 pre-term infants, i.e. with gestational age (GA) of less than 37weeks who were admitted to the NICU of educational hospitals. PIPP-R and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) were used for data gathering. The latent structures of pain and its association with parental stress were explored using latent variable modeling approach. A two-factor model, i.e. behavioral and physiological pain factors, was extracted, explaining 65% of the total variance. The results of confirmatory factor analysis showed that the identified structures in the exploratory factor analysis could be nearly replicated (CFI = 0.99، TLI = 0.98, RMSEA = 0.001). Behavioral pain structure, independent from gestational age had a significant direct association with parental stress score (β = 0.005, SE = 0.002, p = 0.026). The PIPP-R assesses both behavioral and physiological pain factors. We also found that behavioral pain factor was associated with parental stress. These results may provide a potential clue for physicians, nurses, and parents to manage the pain in preterm infant. The PIPP-R scores in preterm infants consist of "Behavioral and Physiological" pain factors. Single dependence on behavioral indicators (such as facial expression) has some limitations. Multidimensional tools may be the optimal method in detecting pain in preterm infants. Parental stress can affect behavioral pain structure in preterm infants. Intensive care nurses play an effective role in reducing the parental stress and pain severity of these preterm infants by including the help of mothers in procedures and providing them with psychological support.

Viral hepatitis in China during 2002–2021: epidemiology and influence factors through a country-level modeling study

BackgroundViral hepatitis imposes a heavy disease burden worldwide and is also one of the most serious public health problems in China. We aimed to describe the epidemiological characteristics of hepatitis in China and to investigate the influencing factors.MethodsWe first used the JoinPoint model to analyze the percentage change (APC) and average annual percentage change (AAPC) of hepatitis in Chinese provinces from 2002 to 2021. We then explored the influencing factors by using the time-series global principal component analysis (GPCA) and the panel fixed-effects model.ResultsThe disease burden varied across different provinces from 2002 to 2021. The AAPC of the total HAV incidence decreased by 10.39% (95% CI: [-12.70%, -8.02%]) from 2002 to 2021. Yet the AAPC of HBV, HCV, and HEV increased by 1.50% (95% CI: [0.23%, 2.79%]), 13.99% (95% CI: [11.28%, 16.77%]), and 7.10% (95% CI: [0.90%, 13.69%]), respectively. The hotspots of HAV, HBV, HCV, and HEV moved from the west to the center, from the northwest to the southeast, from the northeast to the whole country, and from the northeast to the southeast, respectively. Different types of viral hepatitis infections were associated with hygiene, pollutant, and meteorological factors. Their roles in spatial-temporal incidence were expressed by panel regression functions.ConclusionsViral hepatitis infection in China showed spatiotemporal heterogeneity. Interventions should be tailored to its epidemiological characteristics and determinants of viral hepatitis.

Factor Structures in the Depressive Symptoms Domains in the 9Q for Northern Thai Adults and Their Association with Chronic Diseases.

Most of the common models to examine depression are one-factor models; however, previous studies provided several-factor structure models on each depressive symptom using the Patient Health Questionnaire-9 (PHQ-9). The Nine-Questions Depression-Rating Scale (9Q) is an alternative assessment tool that was developed for assessing the severity of depressive symptoms in Thai adults. This study aimed to examine the factor structure of this tool based on the factor structure models for the PHQ-9 provided in previous studies using confirmatory factor analysis (CFA). We also examined the association of chronic diseases and depressive symptoms using the Multiple Indicators Multiple Causes model among 1346 participants aged 19 years old or more without psychiatric disorders. The results show that the two-factor CFA model with six items in the cognitive-affective domain and three items in the somatic domain provided the best fit for depressive symptoms in the study population (RMSEA = 0.077, CFI = 0.953, TLI = 0.936). Dyslipidemia was positively associated with both cognitive-affective symptoms (β = 0.120) and somatic depressive symptoms (β = 0.080). Allergies were associated with a higher level of cognitive-affective depressive symptoms (β = 0.087), while migraine (β = 0.114) and peptic ulcer disease (β = 0.062) were associated with a higher level of somatic symptoms. Increased age was associated with a lower level of somatic symptoms (β = -0.088). Our findings suggested that considering depressive symptoms as two dimensions yields a better fit for depressive symptoms. The co-occurrence of chronic diseases associated with depressive symptoms should be monitored.

Measuring electronic health literacy in the context of diabetes care: psychometric evaluation of a Persian version of the condition-specific eHealth literacy scale for diabetes

BackgroundThe rise of the internet and social media has led to increased interest among diabetes patients in using technology for information gathering and disease management. However, adequate eHealth literacy is crucial for protecting patients from unreliable diabetes-related information online.ObjectiveTo examine the psychometric characteristics and explore the preliminary validity of the Persian version of the Condition-specific eHealth Literacy Scale for Diabetes (Persian CeHLS-D) to assess eHealth literacy in the context of diabetes care.MethodsAfter adapting, translating, examining content validity, and pilot testing the questionnaire, it was administered to 300 patients with type 2 diabetes mellitus (T2DM). Construct validity was assessed through confirmatory factor analysis, convergent and known-groups validity. The internal consistency (Cronbach’s alpha), composite reliability and maximum reliability, and test-retest correlation were assessed.ResultsFactor analysis supported the hypothesized two-factor model with 10 items, and the standardized factor loadings ranged from 0.44 to 0.86 (P-values < 0.001). Cronbach’s alpha and test-retest correlation were good for each factor. Convergent validity was confirmed by significant correlations of Persian CeHLS-D with diabetes health literacy, perceived usefulness and importance of using the internet for health information, internet anxiety, and perceived physical and mental health. Know-groups validity determined using groups with different internet-use frequencies, and different attitudes towards providing online healthcare services, were satisfied.ConclusionThis study demonstrated the Persian CeHLS-D as a reliable and valid measure of eHealth literacy among patients with T2DM in Iran. Its satisfactory psychometric properties support its use in research and clinical settings to assess eHealth literacy and inform interventions.

Exploring Leadership and Other Influential Dimensions When Assessing Online Learning Modules Within Higher Education Institutions: Insights From Flow Theory and Two-Factor Principles

This study explores the concept of flow status as a crucial factor affecting student engagement in online learning, using Herzberg’s motivation-hygiene theory as an analytical framework. Herzberg proposed two main principles influencing learner satisfaction: motivating factors associated with increased satisfaction and hygiene factors associated with dissatisfaction avoidance. While both motivation and hygiene factors influence learner satisfaction, this study applies the concept of flow status and incorporates elements of leadership to the concept to examine the implementation of effective learning systems in higher education institutions. A qualitative approach was applied to data collected from 24 interviews with stakeholders in the field of learning, including students, tutors, curriculum designers/programme leaders and policy makers in education. Interviews were recorded, transcribed, and subjected to text mining analysis. Most students interviewed identified various hygiene factors as motivating factors, such as their grades and supportive guidance from their tutors, thereby underscoring the importance of leadership visualisation in learning design. These hygiene factors were particularly appreciated in the disruptive environment experienced during the COVID-19 period. Students expressed scepticism about pre-set online group work, suggesting a preference for the ability to choose to participate in various types of group work. Tutors emphasised the importance of motivating factors in student engagement, recognising the significance of students’ technological readiness and effective teamwork in relation to how well they concentrated on their learning. This study develops practical insights for higher education educators, considering contemporary technological impacts and the immersive effects of online module design. The results propose a conceptual model that fosters students’ ability to concentrate in disruptive environments, highlighting the necessity of clear leadership from both system designers and implementers to enhance student engagement in online learning. This study’s findings are expected to serve as a valuable analytical tool for stakeholders in the field of education.