Infit Statistics Research Articles

A Descriptive Study Using Rasch Analysis and Hypothesis Testing to Evaluate the Psychometric Properties of the UMOVE Mobility Screen Tested With Hospitalized Older Adults.

The purpose of this study was to test the reliability and validity of the UMOVE Mobility Screen in older adults living with dementia using a Rasch analysis and hypothesis testing. The UMOVE Mobility Screen (UMOVE) focuses on nine activities: following commands, muscle strength, and basic functional mobility tasks. Trained evaluators completed assessments on 244 patients, the majority of whom were female (62%), and White (71%). Based on Rasch Analysis, there was evidence of good item and person reliability (indexes > 0.80), good INFIT statistics, and only one item fitting the model based on OUTFIT statistics. Validity was supported based on hypothesis testing. There was no evidence of Differential Item Functioning between races and genders. Item mapping raised concerns about the spread of the items across the full spectrum of mobility assessed in the UMOVE Mobility Screen. Future testing should consider adding some easier and some more difficult items.

Psychometric Properties of the Resilience Scale in Older Adults Post-Hip Fracture.

Objectives: The purpose of this study was to evaluate the psychometric properties of the modified 25-item Resilience Scale (RS-25) in older adults post-hip fracture using Rasch analysis. Methods: This was a descriptive study using baseline data from the Seventh Baltimore Hip Studies (BHS-7). There were 339 hip fracture patients included in this analysis. Results: Findings suggest there was support for reliability of the measure based on person and item separation index. The INFIT and OUTFIT statistics for testing validity were all in the acceptable range indicating that each item on the modified RS-25 fits the appropriate concept. There was no evidence of Differential Item Functioning (DIF) between genders. Conclusions: This study demonstrated evidence that the modified RS-25 is a reliable and valid measure to evaluate resilience among older adults post-hip fracture and therefore can be used in this population in clinical practice and research.

Validity of Food insecurity experience scale (FIES) for use in rural Bangladesh and prevalence and determinants of household food insecurity: An analysis of data from Bangladesh integrated household survey (BIHS) 2018-2019

“Access” dimension of Food insecurity (FI) is directly measured by the Food Insecurity Experience Scale (FIES). The current study assessed the appropriateness of the FIES for measuring FI in rural Bangladesh, followed by an assessment of FI prevalence and its correlates utilizing Bangladesh Integrated Household Survey (BIHS) data. The internal validity of the FIES and the prevalence of FI were investigated using the Rasch modeling approach. We utilized equating procedure to calibrate the study’s result to the global FIES reference scale and determined FI prevalence rates that were comparable across countries. The external validity of the FIES was evaluated by examining its association with other FI measures using Spearman’s rho correlation analysis. With an overall Rasch reliability of 0.84, the FIES met the Rasch model assumptions of conditional independence and equal discrimination, and as well as the fit statistics standards for all eight items. Infit statistics were within the allowed limit for all FIES items indicating good internal validity. However, we noted a high outfit (>2) for the “unable to eat healthy and nutritious food” item indicating the presence of some unusual response patterns. Our analysis found no significant (>0.4) correlation between FIES items. We also found a significant correlation between FIES and other FI proxies, e.g., the Household hunger scale (HHS), Food consumption score (FCS), and Household dietary diversity score (HDDS). Overall, the prevalence of moderate or severe FI was 18.92% in rural Bangladesh. Geographic areas, access to electricity, household ownership, access to sanitation, livestock ownership, family size, education level, and monthly per capita food expenditure significantly explained the variation in FI. Our analyses suggest that the FIES is internally and externally valid for FI measurement in rural Bangladesh. However, FIES questions may need to be reordered to more accurately evaluate lower levels of FI, and the item “unable to eat healthy and nutritious food” may need cognitive testing.

Test results with and without blueprinting: Psychometric analysis using the Rasch model

IntroductionThe test blueprint bridges the teaching, learning, and assessment processes. It describes what to measure in which learning domain and at what competency level. We used Rasch analysis to compare the test results and item response patterns of two uro-reproductive tests. The Fall-2020 (Test one) exam was developed without a test blueprint, while the Fall-2021 (Test two) exam used a test blueprint. MethodsThe study analyzed data from 143 Sultan Qaboos University medical students who passed the course in fall 2020 and fall 2021. 25 MCQs were chosen at random. Psychometric analysis was performed using the Rasch model. Means, measurement errors, and reliability indices were calculated. Rasch's dichotomous model computed PCAR for unidimensionality, local item independence, person separation estimate, and fit statistics for item conformity. ResultsBoth tests exhibited non-significant variations in test scores, person separation indices (PSI), and item reliability. On test two, item separation measures showed three difficulty levels. Unidimensionality assumptions were validated in both tests. Test one items 16 and 18 were 0.53 intercorrelated, indicating response dependence. Both tests produced acceptable infit statistics, with 8 items in test one and 6 in test two unfitting for the outfit range (0.7--1.3). Test two ICC had a wider range of item difficulty. The item-person map showed that students' abilities are greater than item difficulties in both tests, with a wider range of abilities in test two. ConclusionsPsychometrically sound tests require test blueprints. The Rasch model analyzes test psychometrics effectively. Test score accuracy, item differentiation, and item independence improved with blueprinting. Creating a test with a high correlation between item difficulty and student ability reduced score measuring errors. General research should examine blueprinting methods and educational milestones.

Detecting Rater Centrality Effects in Performance Assessments: A Model-Based Comparison of Centrality Indices

ABSTRACT Recent research on rater effects in performance assessments has increasingly focused on rater centrality, the tendency to assign scores clustering around the rating scale’s middle categories. In the present paper, we adopted Jin and Wang’s (2018) extended facets modeling approach and constructed a centrality continuum, ranging from raters exhibiting strong central tendencies to raters exhibiting strong tendencies in the opposite direction (extremity). In two simulation studies, we examined three model-based centrality detection indices (rater infit statistics, residual–expected correlations, and rater threshold SDs) as well as the raw-score SD in terms of their efficiency of reconstructing the true rater centrality rank ordering. Findings confirmed the superiority of the residual–expected correlation, rater threshold SD, and raw-score SD statistics, particularly when the examinee sample size was large and the number of scoring criteria was high. By contrast, the infit statistic results were much less consistent and, under conditions of large differences between criterion difficulties, suggested erroneous conclusions about raters’ central tendencies. Analyzing real rating data from a large-scale speaking performance assessment confirmed that infit statistics are unsuitable for identifying raters’ central tendencies. The discussion focuses on detecting centrality effects under different facets models and the indices’ implications for rater monitoring and fair performance assessment.

Content validity of the disability of the arm, shoulder, and hand questionnaire in a college-age patient population.

ObjectiveThe Disability of the Arm, Shoulder, and Hand questionnaire (DASH) is a region-specific Patient Reported Outcome Measure and has been found to be valid and reliable. However, it has not been evaluated in a young patient population. Our objective was to understand how often the uninjured ‘collegiate’ population completes the specific tasks on the DASH.DesignA questionnaire-based survey.MethodsA total of 256 participants (age: 19.44 ± 1.83) completed the study. Participants were asked to track how often they completed 21 tasks taken from the DASH over a 14-day period. Data were analyzed using descriptive statistics and A Rasch partial-credit model.ResultsThe 3 most commonly completed tasks are Recreational Activities in which you take some force or impact through your arm, shoulder, or hand (e.g., golf, hammering, tennis, etc.), Wash or blow-dry your hair, and Put on a pullover sweater while the least most commonly completed tasks were garden or do yard work, change a light bulb overhead, and sexual activities. Infit statistics ranged from .94 to 1.12, and Outfit ranged from .27 to 1.33. Person and item separation indices were 0.40 and 5.24, respectively. Person and item reliability indices were 0.14 and 0.96, respectively.ConclusionsFindings from this study suggest that clinicians should be cautious when using the DASH with the ‘college aged’ patient population.

The Validity of the SQoL-18 in Patients with Bipolar and Depressive Disorders: A Psychometric Study from the PREMIUM Project.

The S-QoL 18 is a self-administered questionnaire that assesses quality of life (QoL) among individuals with schizophrenia. This study aims to validate the S-QoL 18 in bipolar and depressive disorders for a more widespread use in psychiatric settings. This study was conducted in a non-selected sample of individuals with bipolar and depressive disorders in the day hospital of a regional psychiatric academic hospital. Two-hundred and seventy-two stable outpatients with bipolar (n = 73) and recurrent and persistent depressive (n = 199) disorders were recruited over a 12 month-period. The S-QoL 18 was tested for construct validity, reliability, and external validity. The eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA = 0.075 (0.064–0.086), CFI = 0.972, TLI = 0.961). Internal consistency and reliability were satisfactory. External validity was confirmed via correlations between S-QoL 18 dimension scores, symptomatology, and functioning. The percentage of missing data for the eight dimensions did not exceed 5%. INFIT statistics were ranged from 0.7 to 1.2, ensuring that all items of the scale measured the same QoL concept. In conclusion, the S-QoL 18 appears to be a valid and reliable instrument for measuring QoL in patients with bipolar and depressive disorders. The S-QoL 18 may be used by healthcare professionals in clinical settings to accurately assess QoL in individuals with bipolar and depressive disorders, as well as in schizophrenia.

Convergent and Construct Validity of a Conversation Difficulties Outcome Measure in Primary Progressive Aphasia

Cognition and language changes, and their impacts on functional communication, are central to many dementias. Thus, functional communication, including conversation difficulties, is an important endpoint for clinical trials. To develop robust outcomes in primary progressive aphasia (PPA), a dementia characterized by communication impairments, we examined the convergent and construct validity of the Perception of Conversation Difficulties-Dementia Alzheimer’s Type (PCI-DAT; Orange et al., 2009). The PCI-DAT is a care partner reported measure of conversation difficulties. Eighty-two care partners with a mean age of 64.8 years (SD=10.61; 85% spouses, 5% adult children, 10% friends/siblings) whose mean relationship duration to the person with PPA was 39.1 (SD=15.1) years completed the study. Pearson’s correlation indicated a significant, modest correlation (r=-0.54, p<0.0001) between the PCI-DAT Perception of Conversation Difficulties subscale and the Communication Effectiveness Index (Lomas et al., 1989) suggesting strong convergent validity. A Rasch analysis conducted on the same PCI-DAT subscale showed high person (0.92) and item (0.95) reliability indicating a robust overall scale structure that adequately evaluates various levels of conversation difficulty severity in PPA. Six items (27%) had minor ‘fit’ issues (defined by Wright and Linacre, 1994 as having infit statistics < 0.6 or > 1.4) relative to the underlying construct. Results suggest strong convergent and construct validity of the PCI-DAT in PPA and indicate items that will benefit from further development. Overall, our results suggest that the PCI-DAT holds promise for use as a functional communication endpoint in PPA clinical trials. Data for all five PCI-DAT subscales will be presented.

Detection of Outliers in Anchor Items Using Modified Rasch Fit Statistics

ABSTRACT The existence of outliers in the anchor items can be detrimental to the estimation of examinee ability and undermine the validity of score interpretation across forms. However, in practice, anchor item performance can become distorted due to various reasons. This study compares the performance of modified INFIT and OUTFIT Rasch statistics with the Logit Difference approach with 0.3 and 0.5 as the predetermined cutoff values, and the Robust z statistic with 1.645 and 2.7 as the cutoff values through a simulation study by varying the sample size, proportion of outliers, item difficulty drift direction, and group difference magnitude. The results suggest that both modified INFIT and OUTFIT statistics perform very similarly and outperform the other methods in all aspects, including sensitivity of flagging outliers, specificity of flagging non-outliers, recovery of translation constant, and recovery of examinee ability in all simulated conditions.

Development of a Short Form Assessment of Upper Extremity Motor Ability for Individuals Post Stroke

Research Objectives To develop a short form assessment that combines items from the Fugl Meyer Assessment-Upper Extremity (FMA) and the Wolf Motor Function Test (WMFT) to provide a more comprehensive and precise measure of UE motor ability post stroke. Design We used a convenience sample of pre-intervention data from two upper extremity rehabilitation trials conducted with stroke survivors. Factor analysis and the Rasch rating scale model were applied to examine the properties of the full item bank prior to the development of the short form. Setting Outpatient, academic research center. Participants Data were pooled since the parent studies had similar eligibility criteria. Participants were included in the studies if they experienced a stroke ≥ 3 months prior and had UE hemiparesis. Participants were excluded if they had severe hemiparesis, severe spasticity (Modified Ashworth Scale >3 in elbow, wrist, or fingers), or reported UE pain. 167 individuals with stroke who completed both the WMFT and FMA were included. Interventions N/A. Main Outcome Measures Data from the 30-item FMA and the 15-item WMFT (rating scale score) were analyzed using factor analysis to ensure unidimensionality. Item response theory methodologies were used to develop the short form. The Rasch rating scale model was applied to examine the measurement properties. Results A 15-item short form was developed. Item infit statistics (Mnsq) ranged from 0.63-1.35 and point measure correlations ranged from 0.39-0.90. Person reliability was 0.93 and the person separation index was 3.7 indicating the measure can separate between 5 statistically different strata. Conclusions Items from the FMA and WMFT can be combined to provide a precise measure of UE motor ability. The short form demonstrated acceptable psychometric properties. Author(s) Disclosures The authors have no conflicts of interest to disclose. To develop a short form assessment that combines items from the Fugl Meyer Assessment-Upper Extremity (FMA) and the Wolf Motor Function Test (WMFT) to provide a more comprehensive and precise measure of UE motor ability post stroke. We used a convenience sample of pre-intervention data from two upper extremity rehabilitation trials conducted with stroke survivors. Factor analysis and the Rasch rating scale model were applied to examine the properties of the full item bank prior to the development of the short form. Outpatient, academic research center. Data were pooled since the parent studies had similar eligibility criteria. Participants were included in the studies if they experienced a stroke ≥ 3 months prior and had UE hemiparesis. Participants were excluded if they had severe hemiparesis, severe spasticity (Modified Ashworth Scale >3 in elbow, wrist, or fingers), or reported UE pain. 167 individuals with stroke who completed both the WMFT and FMA were included. N/A. Data from the 30-item FMA and the 15-item WMFT (rating scale score) were analyzed using factor analysis to ensure unidimensionality. Item response theory methodologies were used to develop the short form. The Rasch rating scale model was applied to examine the measurement properties. A 15-item short form was developed. Item infit statistics (Mnsq) ranged from 0.63-1.35 and point measure correlations ranged from 0.39-0.90. Person reliability was 0.93 and the person separation index was 3.7 indicating the measure can separate between 5 statistically different strata. Items from the FMA and WMFT can be combined to provide a precise measure of UE motor ability. The short form demonstrated acceptable psychometric properties.

A Competency-Based Approach to Pass/Fail Decisions: An Observational Study

Any high-stakes assessment that leads to an important decision requires careful consideration in determining whether a student passes or fails. Despite the implementation of many standard-setting methods in clinical examinations, concerns remain about the reliability of pass/fail decisions in high stakes assessment, especially clinical assessment. This observational study proposes a defensible pass/fail decision based on the number of failed competencies. In the study conducted in Erbil, Iraq, in June 2018, results were obtained for 150 medical students on their final objective structured clinical examination. Cutoff scores and pass/fail decisions were calculated using the modified Angoff, borderline, borderline-regression, and holistic methods. The results were compared with each other and with a new competency method using Cohen’s kappa. Rasch analysis was used to compare the consistency of competency data with Rasch model estimates. The competency method resulted in 40 (26.7%) students failing, compared with 76 (50.6%), 37 (24.6%), 35 (23.3%), and 13 (8%) for the modified Angoff, borderline, borderline regression, and holistic methods, respectively. The competency method demonstrated a sufficient degree of fit to the Rasch model (mean outfit and infit statistics of 0.961 and 0.960, respectively). In conclusion, the competency method was more stringent in determining pass/fail, compared with other standard-setting methods, except for the modified Angoff method. The fit of competency data to the Rasch model provides evidence for the validity and reliability of pass/fail decisions.

Calibration of the Activity Inventory Item Bank: A Patient-Reported Outcome Measurement Instrument for Low Vision Rehabilitation.

PurposeTo provide calibrated item measures and rating category thresholds for the Activity Inventory (AI), an adaptive visual function questionnaire, from difficulty ratings obtained from a large sample of new low vision patients at pre-rehabilitation baseline.MethodsBaseline AI (510 items) rating scale data from five previous low vision rehabilitation outcome studies (n = 3623) were combined, and the method of successive dichotomizations was used to estimate calibrated item measures and rating category thresholds. Infit statistics were analyzed to evaluate the fit of the data to the model. Factor analysis was applied to person measures estimated from different subsets of items (e.g., functional domains such as reading, mobility) to evaluate differential person functioning.ResultsEstimated item measures were well targeted to the low vision patient population. The distribution of infit statistics confirmed the validity of the estimated measures and the two-factor structure previously observed for the AI.ConclusionsOur calibrated item measures and rating category thresholds enable researchers to estimate changes in visual ability from low vision rehabilitation on the same scale, facilitating comparisons between studies.Translational RelevanceThe work described in this paper provides calibrated item measures and rating category thresholds for a visual function questionnaire to measure patient-centered outcomes in low vision clinical research. The calibrated AI also can be used as a patient outcome measure and quality assurance tool in clinical practice.

Validity of the Food Insecurity Experience Scale (FIES) for Use in League of Arab States (LAS) and Characteristics of Food Insecure Individuals by the Human Development Index (HDI).

ABSTRACTBackgroundThe Food Insecurity Experience Scale (FIES) is a UN FAO Voices of the Hungry (FAO-VoH) experiential metric of food insecurity (FI). It was pilot tested in some countries but not in Arab speaking ones and validated using global data. Yet, its psychometric properties may vary in the League of Arab States (LAS) due to cultural and linguistic differences.Objectives 1) assess the validity of FIES for use in the LAS region, 2) determine the prevalence of FI, by gender, age group, and the human development index (HDI), and 3) examine sociodemographic characteristics of severe FI individuals.MethodsTo assess the psychometric properties of FIES, Rasch modeling was applied to the 2014–2015 Gallop World Poll (GWP) in the LAS. Prevalence and characteristics of severely FI individuals were assessed using the 2014–2017 GWP data of 62,261 respondents.ResultsOverall, FIES met the Rasch model assumptions of equal discrimination and conditional independence. Infit statistics for FIES items, in most LAS countries, were <1.3, indicating good internal validity. In Syria and Sudan, the item “worried about not having enough food to eat” had infits >1.3. Outfit statistics >2.0, indicating erratic responses, were noted in 26% of the LAS countries. Significant correlations were found (≥0.4) between items in Algeria, Tunisia, and Lebanon. The overall prevalence of severe FI was 15.7%. At highest risk were those aged ≥50 y compared with younger adults (16.5% versus 15.5%, respectively, P <0.02), women compared with men (17.6% versus 14.1%, respectively, P <0.0001), and those in countries with low HDI compared with high HDI (24.9% versus 8.3%, respectively, P <0.0001).ConclusionsOverall, FIES is valid for measuring FI in the LAS. Cognitive testing of items with high outfit statistics and omission of correlated ones may improve the scale. Populations vulnerable to severe FI include older adults and women. These populations should be examined further.

Item Difficulty of Fugl-Meyer Assessment for Upper Extremity in Persons With Chronic Stroke With Moderate-to-Severe Upper Limb Impairment.

Background and Purpose: Limited research has been conducted with the aim of understanding which upper extremity movements are difficult for persons with severe chronic stroke. The purpose of this study was to test the structure of the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) using Rasch analysis in persons with chronic stroke with moderate to severe deficits and to determine the item difficulty hierarchy.Methods: This was a secondary analysis of data from previous randomized, controlled trials, or clinical trials. The participants were 101 persons with chronic stroke with moderate to severe hemiparesis (time after onset of stroke, 1375.3 ± 1157.9 days; the 33-item FMA-UE, 31.1 ± 12.8). Principal component analysis and infit statistics were used to evaluate dimensionality. Rasch analysis using a rating scale model was performed, and item difficulty was determined.Results: Six misfit items were removed. The results showed that the 27-item FMA-UE was unidimensional. Rasch analysis showed that the movements performed within synergies were among the easiest items. Shoulder and elbow movements were among the easiest items, whereas forearm and wrist movements were among the moderately to most difficult items. Hand items spanned various difficulty levels.Discussion and Conclusions: The FMA-UE is a valid assessment tool of upper extremity motor function in persons with chronic stroke with moderate to severe deficits. The results showed that item difficulty was consistent with the stepwise recovery course proposed by Fugl-Meyer. The movements that are difficult for patients with moderate to severe chronic paresis were determined, which would enable comparison of each movement using a measure of motion difficulty in future studies.

Reliability and Validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD Test.

The purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis. This study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial. A total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions. Future use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.

Item fit statistics for Rasch analysis: can we trust them?

AimTo compare fit statistics for the Rasch model based on estimates of unconditional or conditional response probabilities.BackgroundUsing person estimates to calculate fit statistics can lead to problems because the person estimates are biased. Conditional response probabilities given the total person score could be used instead.MethodsData sets are simulated which fit the Rasch model. Type I error rates are calculated and the distributions of the fit statistics are compared with the assumed normal or chi-square distribution. Parametric bootstrap is used to further study the distributions of the fit statistics.ResultsType I error rates for unconditional chi-square statistics are larger than expected even for moderate sample sizes. The conditional chi-square statistics maintain the significance level. Unconditional outfit and infit statistics have asymmetric distributions with means slighly below 1. Conditional outfit and infit statistics have reduced Type I error rates.ConclusionsConditional residuals should be used. If only unconditional residuals are available parametric bootstrapping is recommended to calculate valid p-values. Bootstrapping is also necessary for conditional outfit statistics. For conditional infit statistics the adjusted rule-of-thumb critical values look useful.

Is the Patient Activation Measure a valid measure of osteoarthritis self-management attitudes and capabilities? Results of a Rasch analysis

BackgroundThe Patient Activation Measure (PAM-13) was developed using Rasch analysis to assess knowledge, skills and confidence in the management of one’s health. Previous studies report positive relationships between PAM-13 scores, self-management behaviours and longitudinal health outcomes in adults with chronic disease. There is little extant measurement property evidence for the use of PAM-13 in specific osteoarthritis (OA) populations. This study tested measurement properties of the PAM-13 in people living with hip and knee OA.MethodsItem response frequency analysis was conducted. Rasch analysis evaluated the fit of the PAM-13 data to the Rasch model. Model-data fit was evaluated using infit and outfit statistics; person/item reliability and person separation indices were computed. Unidimensionality was evaluated using Principal Components Analysis of Rasch residuals and the data were assessed for item redundancy. Differential Item Functioning (DIF) examined bias in respondent subgroups and correlations tested relationships between PAM-13 and other patient-reported outcomes.ResultsTwo-hundred-and-seventeen PAM-13 surveys were completed; there were no missing responses, floor or ceiling effects. Person and item reliability were acceptable (0.98 and 0.87 respectively) with good separation (person separation index 2.58). Unidimensionality was evaluated, with 49.4% of the variance explained by the first eigenvector. There was evidence of potential local response-dependence. The Rasch fit statistics were acceptable (except for item-2). There were some issues identified with targeting of the PAM-13 items to people with higher ability and the item difficulty order was different to that proposed in original cohorts. Significant DIF was identified for sex and educational level for a small number of items. PAM-13 scores were moderately correlated with depressive symptoms on the Depression Anxiety Stress Scale and Assessment of Quality of Life-6D. There were small correlations between PAM-13 and Knee injury and Osteoarthritis Outcome Score pain and activities of daily living scores.ConclusionsThis study provides some evidence of adequate person and item reliability, unidimensionality, and construct validity to support the use of PAM-13 to measure patient activation in people living with hip and knee OA. Possible limitations regarding targeting, different item difficulty order, DIF and local response dependence should be investigated in future research.

Reliability and Validity Testing of the Assessment of the Environment for Person-Centered Management of BPSD and Assessment of Policies for Person-Centered Management of BPSD Measures

The purpose of this study was to test the reliability and validity of the Assessment of the Environment for Person-Centered Management of BPSD and the Assessment of Policies for Person-Centered Management of BPSD. The sample included 35 long term care facilities. There was evidence of reliability based on internal consistency and test-retest reliability of both measures. There was some evidence of validity based on Rasch model testing and INFIT and OUTFIT statistics. Across both measures, there were six items that were endorsed as present by all facilities. The INFIT and OUTFIT statistics were all within the expected range of .5 to 1.5 with the exception of four high OUTFIT statistics for the Assessment of the Environment for Person-Centered Management of BPSD. For the Assessment of Policies for Person-Centered Management of BPSD, there were two items that had high INFIT statistics and six with low OUTFIT statistics and one with high OUTFIT statistics. Measure revisions are suggested including removal of some poor fitting items, items with no variance, and adding items to differentiate those very high in evidence of environments and policies that manage BPSD.

Child-Reported Food Insecurity Is Negatively Associated with Household Food Security, Socioeconomic Status, Diet Diversity, and School Performance among Children Attending UN Relief and Works Agency for Palestine Refugees Schools in Lebanon

Recent studies have shown that children are able to accurately describe their own experiences of food insecurity; however, few studies have quantified this experience. We aimed to develop and validate a child food security scale to be used in Arabic-speaking countries. As part of the Healthy Kitchens Healthy Children study on food security and nutrition in schools, 14 questions were administered to 5-15-y-old children (n=1433) attending 4 UN Relief and Works Agency for Palestine refugees schools. We used statistical methods based on Item Response Theory to assess the internal validity of a proposed food security scale using these items. Further validation of the scale was conducted by examining associations with sociodemographic, economic, household food security, and diet diversity variables through logistic regression models adjusted for age, sex, and school of the children. A total of 1287 children (89.8%) provided complete responses to the questionnaire. Four items were dropped from the scale because of high infit statistics (>1.3) and high residual correlation with other items. The resulting 10-item scale had acceptable reliability (Cronbach α coefficient=0.89). Children who reported food insecurity were more likely to be from food-insecure households (OR: 2.3; P<0.001). Food-insecure children came from households with lower expenditures per capita (OR: 0.80; P=0.007) and higher household crowding (OR: 1.70; P=0.001), and had less educated mothers (OR: 0.89; P=0.009), lower household diet diversity (OR: 0.85; P<0.001), and lower household consumption of meat (OR: 0.89; P<0.001) and fruit (OR: 0.95; P=0.001). Child food insecurity was also associated with higher school absenteeism (OR: 1.64; P=0.01) and lower academic grades in languages and science (P<0.05). Child food security was accurately measured through a 10-item scale. This tool is appropriate to assess child food insecurity experience directly with children, and can be used in school-based interventions, where obtaining data from parents may be cumbersome.

The Latin American version of the internalized stigma of mental illness scale (LA-ISMI): a multicentric validation study from three Latin American countries

BackgroundTo date, no data have been available concerning the psychometric characteristics of the Internalized Stigma of Mental Illness scale (ISMI-29) in Latin American countries. The aim of this study was to validate a Latin American version of the ISMI in people with schizophrenia.MethodsThe study included 253 stabilized outpatients with schizophrenia from 3 Mental Health Services in three Latin American countries: Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). We analyzed the psychometric properties using item response and classical test theories. An item reduction was then performed to improve the psychometric properties of the ISMI-29. The final version of the ISMI was tested for construct validity, reliability, external validity and differential item functioning (DIF).ResultsThe five-factor structure of the ISMI-29 was not confirmed using confirmatory factor analysis (RMSEA = 0.12, CFI = 0.77, and WRMR = 2.20). Seventeen items were discarded to obtain a satisfactory psychometric version. The ISMI-12 evaluates 3 dimensions: social stigma (4 items), stigma experience (4), and self-stigma (3). The factor structure accounted for 68% of the total variance. Internal consistency was satisfactory. The scalability was satisfactory, with INFIT statistics within an acceptable range. In addition, the results confirmed the absence of DIF and supported the invariance of the item calibrations between countries.ConclusionThe ISMI-29 is not valid in our sample and should not be used in Latin American countries. The ISMI-12 is the first internalized stigma questionnaire with satisfactory psychometric properties available in Latin American countries. Its brevity could facilitate its dissemination and use in clinical settings.