Interaction Anxiousness Scale Research Articles

The Impact of Social Exclusion on Social Anxiety: The Chain Mediating Role of Self-focused Attention and Self Esteem

Objective: To explore and study the mediating role of self-concern and self-esteem in social exclusion and social anxiety among college students. Methods: A survey of 400 college students was conducted using the Social Exclusion Questionnaire for Undergraduate, the Self-Focused Attention Scale, the Self-Esteem Scale, and the Interaction Anxiousness Scale. Results: 1) Social exclusion was significantly positively correlated with self-focused attention and social anxiety, and negatively correlated with self-esteem; self-focused attention was significantly negatively correlated with self-esteem, and positively correlated with social anxiety; self-esteem was significantly negatively correlated with social anxiety. 2) Social exclusion can have a direct effect on social anxiety, or it can act on social anxiety through three mediating pathways: the mediating role of self-focused attention, the mediating role of self-esteem, and the chain mediating role of self-focused attention and self-esteem. Conclusion: College students' social exclusion not only directly predicts social anxiety, but also indirectly predicts social anxiety through the mediating roles of self-focused attention and self-esteem, as well as the chain mediating role of self-focused attention and self-esteem.

Left-behind experience and mobile phone addiction among college students: A moderated mediation of social anxiety and sex

BackgroundWith the popularity of smartphone among Chinese college students, mobile phone addiction (MPA) is emerging a remarkable behavior problem in this population. Thus, the present study was aimed at investigating a moderated mediation model of left-behind experience (LBE) affecting MPA via social anxiety moderated by sex difference. MethodsA total of 1268 college students (Mage = 20.74, SD = 2.21) were recruited to complete self-administered questionnaires of mobile phone addiction index (MPAI) and interaction anxiousness scale (IAS). The participants also reported their sex, grade, and childhood and juvenile LBE. ResultsThe results indicated that LBE increased the level of MPA among college students via mediation by social anxiety. Furthermore, sex moderated the influence of social anxiety on MPA in the mediating model. Specifically, social anxiety affects male college students more strongly than female ones in terms of MPA. ConclusionOur findings support that LBE, social anxiety, and sex difference should be critically included into consideration when performing interventions to buffer MPA among college students.

The Effect of Negative Physical Self on Social Anxiety in College Students: The Bidirectional Chain Mediation Roles of Fear of Negative Evaluation and Regulatory Emotional Self-Efficacy.

The detrimental effects of social anxiety on college students require urgent mitigation. To explore the influencing factors and underlying mechanisms of social anxiety among college students, this study aims to examine the relationship between negative physical self and social anxiety, and the mediating effects of fear of negative evaluation and regulatory emotional self-efficacy. The Negative Physical Self Scale, Brief Fear of Negative Evaluation Scale, Regulatory Emotional Self-Efficacy Scale, and Interaction Anxiousness Scale were administered to 924 Chinese college students. SPSS 26.0 was used for analysis, and the Bootstrap method was used to test the significance level of the mediating effect. Negative physical self was significantly and positively related to social anxiety in college students. Fear of negative evaluation and regulatory negative emotional self-efficacy played independent mediating roles between negative physical self and social anxiety. Fear of negative evaluation and regulatory negative emotional self-efficacy showed a bidirectional chain mediating effect between negative physical self and social anxiety. This study elucidates the mechanistic pathways between negative physical self and social anxiety. The relationship between negative physical self and social anxiety is influenced by the mediating effects of fear of negative evaluation, regulatory negative emotional self-efficacy, and the bidirectional chain mediating effect of fear of negative evaluation and regulatory negative emotional self-efficacy. This finding provides a reference for policy makers and educators to develop interventions for social anxiety in college students.

The mediating role of resilience and interaction anxiousness in the effects of physical activity on mobile phone addiction among Chinese college students.

Recent studies have shown that regular physical activity (PA) can positively influence mobile phone addiction (MPA) behaviors in college students. However, it remains unknown whether this effect is mediated by other factors. Evidence suggests that resilience and interaction anxiousness may be candidate mediators that partly explain the positive effect of PA on MPA. This study aims to explore the impact of PA on MPA through a mediation model, and the role of resilience and interaction anxiousness in this relationship. The participants were 590 college students (272 males; mean age = 19.67) who completed a psychosocial battery, including the international physical activity questionnaire-short form (IPAQ-SF), the connor - davidson resilience scale (CD-RISC), the interaction anxiousness scale (IAS), and the mobile phone addiction index (MPAI). Correlations of variables were computed using Pearson's test. Mediation models were tested using SPSSS PROCESS macro with the regression bootstrapping method. PA were negatively associated with MPA behavior (r=-.21, p < 0.01). Resilience and interaction anxiousness moderated the relationship between PA and MPA. More importantly, PA could also influence MPA through the chain-mediating effects of resilience and interaction anxiousness. It is essential to improve resilience and reduce interaction anxiousness to reduce MPA problems through regular engagement in PA among college students.

Cross-lagged analysis of rumination and social anxiety among Chinese college students

BackgroundSocial anxiety, which is widely prevalent among Chinese college students, poses a significant barrier to their holistic psychological and physiological development. Although numerous cross-sectional studies have examined the relationship between rumination and social anxiety, there is still a gap in understanding their interplay over time. This longitudinal study aimed to explore and analyze the intricate interrelations between these two factors, with the ultimate goal of informing the development of effective mental health education interventions for university students.MethodsUsing the Ruminative Responses Scale (RRS) and the Interaction Anxiousness Scale (IAS), a two-stage longitudinal follow-up study of 392 college students from three universities in Henan Province was conducted over a six-month period (October 2022 to March 2023) using a cross-lagged model to explore the correlation between rumination and social anxiety. The results of the correlation analysis showed that rumination was positively associated with social anxiety at both time points (r = 0.18,0.12, p < 0.01).ResultsCross-lagged regression analyses revealed that the predictive effect of the first measure (T1) rumination on the second measure (T2) rumination was statistically significant (β = 0.32, p < 0.001). The predictive effect of T1 social anxiety on T2 social anxiety was statistically significant (β = 0.65, p < 0.001), the predictive effect of T1 rumination on T2 social anxiety was statistically significant (β = 0.33, p < 0.001), and the prediction of T1 social anxiety on T2 rumination was statistically significant (β = 0.28, p < 0.001).ConclusionCollege students’ rumination and social anxiety are mutually predictive of each other, and interventions by educators in either of these areas have the potential to interrupt the vicious cycle between ruminant thinking and social anxiety.

Exploring the Interplay of Social Anxiety Symptoms and Family Perception among Chinese Adolescents: A Psychosocial Investigation

Anxiety among children and adolescents has received significant attention. Nonetheless, the inquiry into social anxiety and its relationship with family dynamics, particularly within the Chinese culture, remains less explored. This study undertakes the task of bridging this scholarly void through the employment of a comprehensive questionnaire survey. Data from 308 participants aged 13 to 17 were collected through a questionnaire facilitated by the Sojump platform. The survey employed the Interaction Anxiousness Scale (IAS) and the Adolescent Student Family Satisfaction Scale (ASFSS). Results reveal high internal reliability (=0.963) for IAS and ideal reliability (=0.973) for ASFSS. A strong negative correlation (r = -0.548) emerged between family satisfaction and social anxiety symptoms. This study addresses the underexplored relationship between these factors, contributing to the understanding of adolescent mental health dynamics within the familial context. Future research is recommended to incorporate longitudinal designs to enhance the breadth and depth of findings. Additionally, investigating mediating factors and developing family-centered interventions could yield valuable insights for shaping mental health interventions for adolescents.

How relative deprivation affects the sleep quality of Chinese college students: testing an integrated model of social anxiety and trait mindfulness.

Although previous studies have confirmed the association between relative deprivation and individual health, the relationship between and underlying mechanisms of relative deprivation and sleep quality have rarely been explored. Therefore, the present study investigated how relative deprivation affected sleep quality by testing an integrated model and examining the roles of social anxiety and trait mindfulness. We surveyed 568 college students using the Relative Deprivation Scale, Interaction Anxiousness Scale, Mindful Attention Awareness Scale, and Pittsburg Sleep Quality Index. Data were analyzed using SPSS 24.0 and PROCESS macro for SPSS. We found that a high relative deprivation score predicted poor sleep quality, and social anxiety partially mediated this relationship. Our model also indicated that the relationship between relative deprivation and sleep quality via social anxiety was moderated by mindfulness. Specifically, increasing trait mindfulness may decrease the indirect effect of relative deprivation on sleep quality through social anxiety. The current study expands our understanding of the underlying mechanisms, paths, and conditions of the effects of relative deprivation on sleep quality. Furthermore, we provide additional evidence that trait mindfulness can mitigate the adverse effects of negative events. College students should consciously use trait mindfulness techniques to consider problems, reduce anxiety, and improve their sleep quality.

Development of social anxiety cognition scale for college students: Basing on Hofmann's model of social anxiety disorder.

To develop the Chinese version of the Social Anxiety Cognition Scale for College Students (SACS-CS) based on Hofmann's model of social anxiety disorder and examine its reliability and validity. Based on literature analysis and structured interviews, a theoretical model was constructed and behavioral examples were collected. According to the results of participants' and experts' evaluations, the initial SACS-CS was developed. The study data were collected from a total of 500 valid participants, randomly divided into two samples. Sample 1 (n = 200) and sample 2 (n = 300) were considered for exploratory factor analysis and confirmatory factor analysis (CFA), respectively. Internal reliability and validity were examined using all 500 participants, and temporal reliability was established using sample 3 (n = 70), who completed the scale again after 4 weeks. The SACS-CS consists of 21 items, grouped under four factors: self-perception, social skills, emotional control, and cost estimation. The four-factor model fits well. The internal consistency coefficient of the scale and the four factors ranged from 0.87 to 0.96, and the test-retest reliability ranged from 0.76 to 0.84. The scores of the scale and the four factors were significantly correlated with the score of the Interaction Anxiousness Scale (r = 0.54-0.64). The SACS-CS possesses good reliability and validity and can be applied in the cognitive assessment of college students' social anxiety. The scale could help people with different social anxiety disorder conditions receive more personalized interventions.

The association between academic achievement, psychological distress, and smartphone addiction: A cross-sectional study among medical students

ABSTRACT This study investigates the relationship between academic achievement, psychological distress, and smartphone addiction in medical students. In total, 513 medical students voluntarily completed a survey that included the Personal Information Questionnaire, the Smartphone Addiction Scale-Short Version (SAS-SV), the Depression, Anxiety and Stress Scale (DASS-21), and the Interaction Anxiousness Scale (IAS). Results showed that 321 participants were screened positive for smartphone addiction and the prevalence of smartphone addiction was 62.6%. We found that the prevalence of smartphone addiction was higher among male rather than female students (67.1% vs 58.2%; p = 0.039). There were significant differences between the smartphone addiction group and the smartphone non-addiction group as per the DASS-21 scores and the IAS scores. In addition, multiple regression indicated that psychological distress including anxiety, stress, depression, and social anxiety might be the predictors of smartphone addiction. However, smartphone addiction was found to have no significant correlation with academic performance in 274 undergraduate medical students. In conclusion, the study revealed the high prevalence of smartphone addiction in medical students. Smartphone addiction was associated with states of depression, anxiety, stress, and social anxiety, and there was no significant relationship between academic performance and smartphone addiction in undergraduate medical students. Further longitudinal research is needed to clarify the causal relationship between smartphone addiction and psychological distress.

The Relationship between Perfectionism and Social Anxiety: A Moderated Mediation Model.

Social anxiety is one of the mental health problems associated with perfectionism. The present study investigated the possible mediation of perceived stress in the relationship between perfectionism and social anxiety, and whether this mediation depends on the level of trait mindfulness. A total of 425 college students (female: 82.9%; mean age: M = 19.90 ± 1.06 years old) completed the Multidimensional Perfectionism Scale (MPS), the Chinese Perceived Stress Scale (CPSS), the Interaction Anxiousness Scale (IAS), and the Five-Facet Mindfulness Questionnaire (FFMQ). After controlling for age and gender, the moderated mediation analysis suggested that perfectionism significantly and positively predicted social anxiety and that perceived stress mediated the link between perfectionism and social anxiety. In addition, the indirect effect of perfectionism on social anxiety was moderated by trait mindfulness. Specifically, the indirect effect was weaker among the individuals with a high level of mindfulness compared to those with a low level of mindfulness. The findings of this study suggest that trait mindfulness significantly moderates the indirect effect of perfectionism on social anxiety via perceived stress.

Influence of family function on social anxiety among Chinese nursing students: The mediating role of alexithymia.

This study aims to explore the relationship between family function, alexithymia and social anxiety among Chinese nursing students, especially to determine whether alexithymia acts as a mediator between family function and social anxiety among this social group. A cross-sectional study. From January to March 2021, a cross-sectional study was conducted among 204 Chinese nursing students at a nursing school of a medical university in the Northeastern Region of China. The interaction anxiousness scale, APGAR family function scale and Tronto alexithymia scale were used for measurement of social anxiety, perceived family function and alexithymia respectively. The data were subjected to correlation analysis, multiple linear regression and structural equation modelling (SEM). Results indicated that social anxiety score was negatively correlated with perceived family function (r=-.232), but positively with alexithymia (r=.307). After controlling for demographic variables, family function and alexithymia could explain 14.5% of the total variance in social anxiety. The SEM results suggested that the effect of family function on social anxiety was partially mediated by alexithymia with a 36.9% mediating effect. This study reveals that alexithymia might partially mediate the impact of family function and social anxiety in Chinese nursing students. In this sense, improvement of alexithymia is expected to be an effective strategy to ameliorate the severity social anxiety in Chinese nursing students, especially for those with a dysfunctional family context.

Relationship between Self-Esteem, Interpersonal Trust, and Social Anxiety of College Students.

This study attempts to disclose the relationship between self-esteem, interpersonal trust, and social anxiety of college students and provide an empirical reference for enhancing their self-esteem, cultivating their interpersonal trust, and reducing their social anxiety. Specifically, 673 college students were randomly sampled and measured against the self-esteem scale (SES), interpersonal trust scale (TS), and interaction anxiousness scale (IAS). The results show that self-esteem does not vary significantly with genders and origins; social anxiety does not vary significantly with origins but differs significantly between genders; the social anxiety of males is much lower than that of females; interpersonal trust differs significantly between genders and between origins. Self-esteem is significantly correlated with interpersonal trust (r = 0.22, p < 0.01). Social anxiety has a significant negative correlation with self-esteem (r = −0.17, p < 0.01) and with social anxiety (r = −0.26, p < 0.01). Interpersonal trust partly mediates the relationship between self-esteem and social anxiety. These findings provide a theoretical basis for enhancing and improving mental health education of college students.

Relationship between view of context, psychosocial malaise and problematic internet use: mediation analysis using partial least squares structural equation modelling.

According to more recent approaches on problematic internet use (PIU), using the internet can be seen as a way of compensating for psychosocial malaise. Taking semiotic cultural psychology theory as its theoretical framework, this study examines the role of affect-laden assumptions concerning the world, known as latent dimensions of sense (LDSs), in promoting (or not) adaptive responses, including internet use as a maladaptive strategy against problems and difficulties. To test a theoretical model in which PIU is predicted by LDSs through the mediation of high levels of psychosocial malaise. We measured PIU (using the Generalized Problematic Internet Use Scale 2), LDSs (View of Context questionnaire), negative affect (Positive and Negative Affect Schedule), social anxiety (Interaction Anxiousness Scale) and loneliness (Italian Loneliness Scale) in 764 Italian adolescents (mean age 15.05 years, s.d. = 1.152 years). LDSs were detected using a multiple correspondence analysis; after confirmatory composite analysis, partial least squares structural equation modelling with higher-order components was performed to test the mediation model. The results show a relationship between LDSs corresponding to an extreme negative evaluation of the sociocultural context, experienced as absolutely unreliable, and PIU through the mediation of psychosocial malaise (95% CI 0.101- 0.171; P = 0.000). Overall, the findings suggest that PIU might be a way of compensating for unpleasant states in a context perceived in an extremely negative and homogenising way, i.e. as totally lacking resources and trustworthy people.

The Relationship Between Self-Esteem and Approval Dependence in University Students: The Serial Mediation of Interaction Anxiety and Insight

This research examined the serial mediating effect of interaction anxiety and insight into the relationship between self-esteem and approval dependence in university students. The research group comprised 511 volunteer university students, of whom 78,7% were females and 21,3% were males. Research data was collected via “The Two-Dimensional Self-Esteem Scale”, “The Scale of Interpersonal Relationship Dimensions”, “Interaction Anxiousness Scale”, and “Insight Scale”. In analysing the data, descriptive statistics were examined and the relationship between variables was calculated using the Pearson correlation coefficient. The bootstrap method was used to test the mediation model.The mediation analysis results revealed that interaction anxiety and insight functioned as mediation variables in the relationship between self-esteem and approval dependence. According to the findings, an increase in self-esteem causes a decline in interaction anxiousness, which causes an increase in insight, which in turn leads to a decline in approval dependence. Findings related to the model that was tested were discussed following the literature. Suggestions for researchers and field practitioners were listed.

The Role of Workplace Spirituality in Reducing Organizational Hypocrisy in Schools

In this research, the serial mediating effect of interaction anxiety and insight in the relationship between self-esteem and approval dependence in university students was examined. The study group of the research consists of 511 university students. Research data was collected via “Two-Dimensional Self-Esteem Scale”, “the Scale of Interpersonal Relationship Dimensions”, “Interaction Anxiousness Scale” and “Insight Scale”. Descriptive statistics were used in the analysis of the data, while Pearson Correlation Coefficient was used in determining the relationship between the variables, and Bootstrap method was used to test the mediation model. According to the mediation analysis results, it was revealed that interaction anxiousness and insight functioned as mediation variables in the relationship between self-esteem and approval dependence. According to the findings, increase in self-esteem causes a decline in interaction anxiousness, which causes an increase in insight, which in turn leads to a decline in approval dependence. Findings related to the model that was tested were discussed in accordance with the literature. Suggestions for researchers and field practitioners were listed. here to enter text.

Psychometric evaluation of the Chinese version of social anxiety scale for social media users and cross-sectional investigation into this disorder among college students

BackgroundRecent years have seen an increased incidence of social anxiety due to increasing intensive use of social media, especially among young adults. ObjectiveThe present study aimed to translate the original English version of Social Anxiety Scale for Social Media Users (SAS-SMU) into Chinese, examine its applicability among Chinese College students via reliability and validity indexes, and investigate the influencing factors contributing to SAS-SMU. MethodsA cross-sectional study was conducted among a cohort of 1307 Chinese college students, 486 males and 821 females, aged 20.75 ± 3.13 years old. The original version of SAS-SMU was translated into Chinese using the backward and forward translation procedure. An exploratory factor analysis (EFA) and a confirmatory factor (CFA) analysis were used for construction of underlying factor structure. Criterion-related validity was assessed using Interaction anxiousness scale (IAS) and the “extraversion” domain of Eysenck Personality Short Scale (EPQ-R-S). Cronbach's alpha coefficient was computed for evaluation of internal consistency. A multivariate stepwise linear regression analysis was conducted for determining the potential correlates of SMU-related social anxiety. ResultsThe final Chinese version of SAS-SMU had 21 items. Item analysis, exploratory factor, EFA, and CFA jointly supported a three-factor structure of the translated version, defined as social recognition anxiety, interaction anxiety, and privacy concern anxiety, respectively. The three-factor structure of this scale showed configural, metric, scalar measurement invariance across gender. Cronbach's alpha coefficient of the scale and its three subscales were 0.96, 0.93, 0.94, and 0.91, respectively. The mean SAS-SMU overall score for each college student was 51.63 ± 16.32, with 21.64 ± 7.24 (recognition anxiety), 17.10 ± 6.30 (interaction anxiety), 12.90 ± 4.61 (privacy concern anxiety) for each subscale, respectively. IAS score, mobile phone addiction index (MPAI) score, EPQ-E score, time spent on social media per week, relationship with parents, childhood life status, whether being an only child, and cyber bullying experience can explain 51.1% of the variance of SMU related social anxiety. ConclusionBased on the data, the Chinese version of SAS-SMU has shown to be satisfactory in psychometric properties. Subjects prone to interaction anxiousness, addictive smartphone use, extraversion personality trait, bad relationship with parents, unfortunate childhood life, only-child status, and having cyberbullying experience tend to have a higher level of SMU related social anxiety.

The influence of alexithymia on problematic mobile phone use among Chinese adolescent students: Multiple mediating roles of social interaction anxiousness and core self-evaluations

BackgroundAlexithymia can lead to problematic mobile phone use (PMPU). However, the underlying mechanisms remain unclear. MethodsDrawing on the Interaction of Person-Affect-Cognition-Execution model, the present study tests the mediating effects (parallel and serial) of social interaction anxiety (SIA) and core self-evaluations (CSE) on the relationship between alexithymia and PMPU. We obtained 1267 valid responses from adolescent students (mean age, 20.36, standard deviation, 0.97) from southeast China who completed the Mobile Phone Addiction Index, Toronto Alexithymia-20 Scale, Social Interaction Anxiousness Scale, and Core Self-Evaluation Inventory. ResultsAfter controlling for demographic variables (i.e., gender) as covariates, the results revealed that: (1) alexithymia had a positive predictive effect on PMPU in adolescent students; (2) SIA and CSE mediated the association between alexithymia and PMPU; and (3) a series of indirect pathways (i.e., from alexithymia to PMPU via SIA and CSE) were detected. Thus, alexithymia can directly affect (parallel mediation) PMPU by increasing SIA and lowering CSE simultaneously. However, alexithymia can also indirectly affect (serial mediation) PMPU by increasing the level of SIA by decreasing CSE. LimitationsData were collected by participant self-report. This method may lead to recall bias. Further, we adopted a cross-sectional rather than an experimental design, thus precluding causal conclusions. Lastly, it would be useful to validate our findings with other age groups outside southeast China. ConclusionsThe current study findings are conducive to understanding the relationship between alexithymia and PMPU and inspire the prevention and intervention of PMPU.

The Relationship between Learning Vocabulary via Mobile (Mobile-Assisted Language Learning) and Iranian EFL Learners’ Social Anxiety and Loneliness

The present study has investigated the relationship between learning English vocabulary via mobile phone and the learners’ social anxiety and loneliness. The participants of the study were thirty-two intermediate English as foreign language (EFL) learners studying English at the University of Zanjan, Zanjan, Iran. Sixty American English idioms were chosen and became available in a Telegram channel, during a six-week period of treatment to provide the participants with Mobile-Assisted Language Learning (MALL). A researcher-designed achievement test was administered to assess the learners’ vocabulary learning via mobile phone. Interaction Anxiousness Scale (IAS) (Leary 1983) and UCLA Loneliness Scale version 3 (ULS) (Russell 1996) were used to estimate the learners’ social anxiety and loneliness, respectively. The results showed no significant correlation between the variables; thus, it can be concluded that MALL not only frees the learners from the restrictions of time and place, but also minimizes the possible intervention of some socially and emotionally affective variables, such as social anxiety and loneliness in the process of language learning. Keywords: Learning Vocabulary, Mobile-assisted Language Learning, Social Anxiety, Loneliness

A confirmatory composite analysis for the Italian validation of the interactions anxiousness scale: a higher-order version

This study examined the factor structure and model specifications of the Interaction Anxiousness Scale (IAS) with confirmatory composite analysis (CCA) using partial least squares-structural equation modeling (PLS-SEM) with a sample of Italian adolescents (n = 764). The CCA and PLS-SEM results identified the reflective nature of the IAS sub-scale scores, supporting an alternative measurement model of the IAS scores as a second-order reflective–reflective model.

Psychological assessment of atopic dermatitis in Asia: a systematic review

ABSTRACT Atopic dermatitis (AD) is a frequently occurring skin disorder in Asia that substantially impacts the social, financial, and psychological lives of individuals. However, there is uncertainty regarding the psychological instruments for this domain. Hence, this review systematically assessed the existing measurement instruments used, developed, and/or validated for the measurement of psychological outcomes in Asian adult patients with AD as well as the scope of those assessment tools (e.g. validity and reliability). Electronic searches were performed using six databases (inception to February 2020) to identify studies. Thematic analysis of 44 included studies revealed that the commonly employed tools to assess the quality of life were the Dermatology Life Quality Index followed by the Skindex-16 questionnaire, the European Quality of Life-5 Dimensions, and the Quality of Life Hand Eczema Questionnaire. Similarly, the Patient Health Questionnaire, Self-rating depression scale (SDS), and Hospital Anxiety and Depression Scale were frequently employed to assess depressive symptoms. Additionally, symptoms of anxiety were frequently assessed through Interaction Anxiousness Scale and the Spielberger State-Trait Anxiety Inventory. Although a variety of psychological assessment measures have been used in research, data on their reliability and validity is limited. Also, information on the cultural applicability of these instruments is scantier. More research is needed to ascertain the suitability of tools for use in clinical practice.