Interpretation Of Items Research Articles

306EMF Defining the Learning Curve for First Trimester Ultrasound Image Interpretation Skills for Emergency Physicians

First trimester pregnancy ultrasound is an oft-used, high-stakes skill for emergency physicians (EPs). Performing bedside ultrasound for symptomatic first trimester pregnant patients requires the skill of image acquisition, image interpretation and integration of interpretation in clinical decision-making. Learning curves for EPs' skills in ultrasound applications have been shown to vary considerably. Some have advocated for a “mastery-based” competency evaluation in which trainees practice until they reach a pre-defined level of performance. However, clinical practice alone may not be sufficient in achieving this standard since opportunities for immediate feedback at the bedside may be limited by the number of patient encounters and the frequency of pathology. Little is known about the development of the skill of image interpretation over time among EPs engaged in deliberate practice of image review. The objective of this study is develop an educational innovation to teach first trimester pregnancy ultrasound image assessment using an online learning platform and assess learners’ skill acquisition for this critical emergency medicine skill. This is a multicenter prospective cohort study. First trimester ultrasound examinations from two academic medical centers’ ultrasound image archival systems were reviewed to identify 400 high-quality studies with complete imaging and a specified case mix. An online experience was developed for each case and integrated into an online learning platform. Images, case-specific information and education for each case were developed and reviewed by emergency ultrasound specialists. EPs will be recruited to complete an education experience using the online learning platform which presents cases and images to physicians whose interpretations are then evaluated. 400 cases of early first trimester ultrasound examinations have been reviewed and cataloged, including 200 transvaginal and 200 transabdominal ultrasound examinations. Of these, 195 include an intrauterine pregnancy (IUP), 205 do not include an IUP, 132 are viable, and 43 are confirmed ectopic pregnancies. Classification of findings of each case has been reviewed by one expert reviewer. Development of an online learning intervention is underway. Data acquisition of 135 EPs’ performance with this intervention, rate of skill acquisition and learning curves is forthcoming. We will determine changes in accuracy, sensitivity and specificity, and the effect size of the learning intervention. We will determine the item reliability and interpretation difficulty for each case. We will determine the time it took to complete the course and evaluate the participant experience. We will examine the rate of learning for first trimester TVUS and TAUS measured by deriving learning curves and determining the median number of cases required to reach the following performance benchmarks: 80%, 85%, 90%, and 95% accuracy. EPs frequently evaluate symptomatic first trimester pregnant patients. Patients experience high morbidity and mortality if an ectopic pregnancy is missed and ultrasound is the imaging modality of choice to evaluate for the presence or absence of an IUP. We have developed an online learning platform with an image bank of 400 cases and plan to evaluate 135 physician’ learning with the platform.

Quality of Life in Epilepsy: Same questions, but different meaning to different people.

Patient-reported outcome measures (PROMs) are used widely to elicit patient's self-appraisal of their health status and quality of life. One fundamental assumption when measuring PROMs is that all individuals interpret questions about their health status in a consistent manner. However, subgroups of patients with a similar health condition may respond differently to PROM questions (ie, differential item functioning [DIF]), leading to biased estimates of group differences on PROM scores. Understanding these differences can help inform the clinical interpretation of PROMs. This study examined whether DIF affects 10-item Quality of Life in Epilepsy (QOLIE10)scores reported by patients with epilepsy in outpatient clinics. Data were from the Calgary Comprehensive Epilepsy Program, a prospective registry of patients with epilepsy in Calgary, Alberta. Latent variable mixture models (LVMMs) based on standard two-parameter graded response models with increasing numbers of latent classes were applied to QOLIE10 item data. Model fit was assessed using the Bayesian Information Criterion (BIC) and latent class model entropy. Ordinal logistic regression was used to identify QOLIE10 items that exhibited DIF. In this cohort of 1143 patients, 567 (49.6%) were female and the median age was 37.0 (interquartile range [IQR] 27.0) years. A two-class LVMM, which provided the best fit to the data, identified two subgroups of patients with different response patterns to QOLIE10 items, with class proportions of 0.62 and 0.38. The two subgroups differed with respect to antiseizure polytherapy, reported medication side effects, frequency of seizures, and psychiatric comorbidities. QOLIE10 items on the physical and psychological side effects of medication exhibited large DIF effects. Our study revealed two different response patterns to quality-of-life instruments, suggesting heterogeneity in how patients interpret some of the questions. Researchers and users of PROMs in epilepsy need to consider the differential interpretation of items for various instruments to ensure valid understanding and comparisons of PROM scores.

Translation and validation in Brazilian Portuguese of the reactions to homosexuality scale

ABSTRACT Internalized homonegativity results from the acceptance of negative attitudes about one’s same-sex orientation, which has negative consequences for the health of gay, bisexual and other men who have sex with men (GBM). We translated the 7-item Reactions to Homosexuality Scale (RHS) to Brazilian Portuguese and assessed its factor structure, validity and reliability. The first step included the translation, back-translation, evaluation, peer review, and pre-testing of the scale. Then, we piloted the scale in two convenience samples of adult Brazilians recruited online during October 2019 and February to March 2020 through advertisements on Grindr and Hornet, respectively. The largest sample was randomly split into two groups for exploratory factor analysis (EFA) then confirmatory factor analysis (CFA). Criterion and construct validity were assessed via correlations between scale scores and study variables. A total of 5573 GBM (sample 1: 218; sample 2: 5355) completed the RHS. EFA (N = 2652) yielded two eigenvalues greater than one (Factor 1: 3.5 and Factor 2: 1.1). A one-factor solution provided the most interpretable model based on examination of scree plot and item factor loadings (χ2(14) = 1373.1, p < 0.001; CFI = 0.89; TLI = 0.84; RMSEA = 0.19; SRMS = 0.09). Though one-factor CFA showed moderate fit, freeing errors terms to covary, based on item content and interpretation, significantly improved model fit (χ2(12) = 309.1, p < .001; CFI = 0.97; TLI = 0.96; RMSEA = 0.09; SRMR = 0.02). As hypothesized, men who did not self-identify as gay (mean score 17.9 compared to those self-identifying as gay: 11.8) and men who reported no sex with men in the past 6 months (mean score 12.6 compared to those who reported sex with men: 10.6) scored higher reflecting higher internalized homonegativity. The RHS was effectively translated and validated in Brazilian Portuguese and can be used to evaluate the role of internalized homonegativity on GBM’s health, as well as its impact on the uptake of HIV prevention technologies.

Defining Vaso-Occlusive Crises in Sickle Cell Disease from the Perspective of the Patient: Development of a New Toolbox to Measure Treatment Outcomes

Defining Vaso-Occlusive Crises in Sickle Cell Disease from the Perspective of the Patient: Development of a New Toolbox to Measure Treatment Outcomes

Investigation of Radiation-Induced Toxicity in Head and Neck Cancer Patients through Radiomics and Machine Learning: A Systematic Review.

Background. Radiation-induced toxicity represents a crucial concern in oncological treatments of patients affected by head and neck neoplasms, due to its impact on survivors' quality of life. Published reports suggested the potential of radiomics combined with machine learning methods in the prediction and assessment of radiation-induced toxicities, supporting a tailored radiation treatment management. In this paper, we present an update of the current knowledge concerning these modern approaches. Materials and Methods. A systematic review according to PICO-PRISMA methodology was conducted in MEDLINE/PubMed and EMBASE databases until June 2019. Studies assessing the use of radiomics combined with machine learning in predicting radiation-induced toxicity in head and neck cancer patients were specifically included. Four authors (two independently and two in concordance) assessed the methodological quality of the included studies using the Radiomic Quality Score (RQS). The overall score for each analyzed study was obtained by the sum of the single RQS items; the average and standard deviation values of the authors' RQS were calculated and reported. Results. Eight included papers, presenting data on parotid glands, cochlea, masticatory muscles, and white brain matter, were specifically analyzed in this review. Only one study had an average RQS was ≤ 30% (50%), while 3 studies obtained a RQS almost ≤ 25%. Potential variability in the interpretations of specific RQS items could have influenced the inter-rater agreement in specific cases. Conclusions. Published radiomic studies provide encouraging but still limited and preliminary data that require further validation to improve the decision-making processes in preventing and managing radiation-induced toxicities.

Quality appraisal of systematic reviews of interventions for children with cerebral palsy reveals critically low confidence.

To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions. A comprehensive search of 22 databases identified eligible systematic reviews with and without meta-analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) to appraise methodological quality. Eighty-three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR-2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR-2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time. Most of these systematic reviews are considered unreliable according to AMSTAR-2. Current recommendations for treating children with CP based on these flawed systematic reviews need re-evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high-level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper adds Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP). Quality issues in the sample were not limited to systematic reviews of non-randomized trials, or to those about certain populations of CP or interventions. The inclusion of meta-analysis did not improve the level of confidence in these systematic reviews. Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve.

Negative interpretations of ambiguous ‘psychosis‐like’ and ‘anxiety‐like’ experiences in recovery from psychosis or anxiety

Fear of relapse (FOR) after experiencing psychosis has been found to predict actual relapse; however, potential mechanisms underlying this relationship have not been investigated. Negative appraisals of 'prodromal symptoms' are believed to play an important role in both psychosis and mental health anxiety (MHA). This study aimed to explore whether people in recovery from psychosis or anxiety disorders show an enduring tendency to negatively interpret ambiguous experiences both related and less related to their previous mental health difficulty relative to controls. Cross-sectional between-groups questionnaire design. Participants self-reported as in recovery from psychosis (n=33) or anxiety (n=77) or without previous experience of mental health problems (n=61) were recruited online or via NHS services. Interpretations of psychosis-like, anxiety-like, and external-control experiences were measured using the newly developed Experiences Interpretation Questionnaire (EIQ). MHA and FOR were measured using self-report questionnaires. People in recovery from psychosis interpreted psychosis-like experiences significantly more negatively than the other groups. Negative interpretations of anxiety-like experiences were greater than controls but comparable between mental health groups. Contrary to predictions, FOR was not significantly different between the mental health groups. MHA and FOR did not significantly predict negative interpretations of psychosis-like items in the psychosis group, however, MHA predicted negative interpretations of anxiety-like items in the anxiety group. The EIQ subscales demonstrated good test-retest reliability. People in self-defined recovery from psychosis or anxiety are more likely to negatively interpret ambiguous experiences relating to their previous mental health difficulties. Clinical and future research implications are outlined. People in recovery from psychosis or anxiety appraise possible symptoms of their previous difficulties negatively/catastrophically (as indicating relapse) relative to those without prior MH problems. Clinicians should consider attending to how people in recovery appraise possible symptoms when encouraging early signs monitoring as part of relapse prevention. This may be important to ensure that self-monitoring leads to helpful responses rather than being counterproductive, with catastrophic interpretations leading to anxiety and thus increasing the risk of relapse. Interventions drawing on CBT principles to address catastrophic interpretations of possible symptoms may potentially be a useful addition to relapse prevention work; in psychosis this may also include symptoms of anxiety.

Cross-cultural adaptation of an anxiety measure in a disadvantaged South African community context: Methodological processes and findings.

An important challenge to enhancing community access to mental health interventions in marginalised, transcultural settings is the development of culturally relevant screening measures. Cross-cultural adaptation (CCA) and translation methods offer guidelines for the adaption of existing screening measures for use across cultures with the aim of preserving semantic and construct equivalence as well as validity. Yet, the application of CCA methods has been inconsistent and validation strategies have focused predominantly on expert review and quantitative validity testing. Additionally, potentially important context-specific interpretations of measure items have been lost in translation-heavy approaches. The missing link in the CCA of existing measures may be the addition of culturally sensitive, community-based evaluative methods. This paper presents a report of the application of a seven-step CCA method developed by the first author to address the issue of cultural relevance in the translation and cross-cultural adaptation of the Spence Child Anxiety Scale (SCAS) an anxiety measure for use in a specific South African community context. The findings emphasise the surprising context-specific interpretations of items in measures applied transculturally, which support the case for qualitative, community-based validation of translated, CCA screening measures used to explore the effectiveness of mental health interventions across cultural contexts.

Using change scores on the vestibular ocular motor screening (VOMS) tool to identify concussion in adolescents

Objective To develop clinical cutoffs using change scores for the VOMS individual items and an overall VOMS change score that identified concussion in adolescent athletes. Methods Change score clinical cutoffs were calculated from a sample of adolescents (13–18 years) with SRC (n = 147) and a sample of uninjured adolescents CONTROL (n = 147). Receiver operating characteristic (ROC) curves, with area under the curve (AUC), based on Youden’s J statistic were used to identify optimal cutoffs for identifying SRC from CONTROLS using VOMS individual item change scores, an overall VOMS change scores, and NPC distance (cm). Results AUC values for VOMS item change scores ranged from .55 to .71. Optimal change score cutoffs were ≥1 for VOMS items and ≥3 for overall VOMS change score. The optimal cutoff for NPC distance was ≥3 cm. A ROC analysis revealed a three-factor model (AUC = .76) for identifying SRC that included vertical vesibular ocular reflex (VVOR), visual motion sensitivity (VMS), and NPC distance items. The AUC (.73) for the overall VOMS change score was higher than any individual VOMS AUC values. Conclusions This study supports an alternate scoring approach and clinical interpretation of VOMS items involving change scores that account for pretest symptoms.

Object understanding: Investigating the path from percept to meaning

Researchers tend to follow two paths when investigating categorization: 1) artificial classification learning tasks and 2) studies of natural conceptual organization involving reasoning from prior category knowledge. Largely separate, another body of research addresses the process of object recognition, i.e., how people identify what they are looking at strictly in terms of visual as opposed to semantic properties. The present work brings together elements from each of these approaches in order to address object understanding: the ubiquitous natural process of accessing meaning based on a realistic image of an everyday object. According to a widely held features-first framework, a stimulus is initially encoded as a set of features that is compared to stored category representations to find the best match. This approach has been successful for explaining artificial classification learning, but it bypasses how items are encoded and fails to include a role for top-down processing in constructing item representations. We used a speeded verification task to evaluate the features-first account using realistic stimuli. Participants saw photographic images of everyday objects and judged as quickly as possible whether a provided verbal description matched the picture. Category descriptions (basic-level labels) were verified significantly faster than descriptions of physical or functional properties. This suggests that people access the category of the stimulus prior to accessing its parsed features. We outline a construal account whereby the category is accessed first to construct a featural item interpretation rather than features being the basis for determining the category.

Validation of the portuguese version of the mentalization questionnaire in a sample of college students: Preliminary results

IntroductionMentalization (MZ) is the capacity by which people make sense of their own’s and others’ mental states; when compromised, it is associated with several mental disorders (Bateman &amp; Fonagy, 2010). A valid instrument to assess MZ is missing and required for the Portuguese population.ObjectivesTo develop and validate a Portuguese version (Questionário de Mentalização – QMZ) of the Mentalization Questionnaire (MZQ) (Hausberg et al., 2012).MethodsA sample of 184 Portuguese medical students (mean age = 21.6 ± 2.47 years, 59.8% female) was used to explore the psychometric properties of the scale, using reliability and factor analysis (varimax rotation method).ResultsThe QMZ exhibited a Cronbach’s alpha score of .80. All items contributed to its reliability. Based on the scree plot of Cattell and interpretability of items, a 2-factor and a 5-factor structures were further explored. The former explained 38.8% of the total variance (VE) and included a regulation of affect (VE= 27.3%, α=.79) and a self-reflection and emotional awareness (VE= 11.5%, α=.62) factors. The latter explained 60.6% of the total variance and incorporated the following dimensions: self-control (VE= 27.3%, α=.74), daily relationships (VE= 11.5%, α=.67), self-comprehension (VE= 8.1%, α=.54), close relationships (VE= 7.0%, α=.41) and self-monitoring (VE= 6.7%, α=.52). The 5-factor structure was closer to the dimensional concept of mentalization.ConclusionsThe QMZ has proved to be a promising instrument, with adequate psychometric properties, confirmed by its acceptable construct, criterion and factorial validity and reliability to assess mentalization in Portuguese language.

Self- and proxy-rating of the ICECAP-O for people with dementia: A cross-sectional linguistic validation study in Germany and Portugal

BackgroundThe capability concept became a recognized approach to the measurement of quality of life. The ICECAP-O for older people aims to measure capabilities and has recently been used in people with dementia (self-rating) and informal carers (substituted judgement). However, linguistic validation studies have so far been lacking. MethodsA cross-sectional cognitive interview study with 15 people with dementia (PwD) and 23 informal carers (ICs) was conducted in Germany and Portugal. Respondents were asked to reveal their understanding of the ICECAP-O and the capability approach as well as the response process. A summarising content analysis was performed. ResultsDespite the small sample, our linguistic validation of the German and Portuguese translations detected considerable difficulties or deviations in item comprehension when compared with the intended meaning. In some cases, the item interpretations did not reflect the entire scope of the associated capability dimension, though they were basically correct. Moreover, participants were not able to differentiate some items appropriately from one another, and some misinterpretations occurred. ICs relied mainly on observable behaviour, emotions, or verbal expressions of the PwD. Therefore, ICs found items that ask about the achievement of individual expectations or thoughts about the future difficult to assess. Only very few PwD clearly indicated that they understood the capability approach. ICs in Germany had more difficulties in understanding the capability concept than in ICs Portugal. DiscussionThis linguistic validation study in Germany and Portugal indicates a need for some rephrasing and refinements of the ICECAP-O translated items in both countries to fully encompass some dimensions and avoid misinterpretations. Further studies with larger samples are necessary. Based on our findings, the current German version for ICs’ substituted judgement cannot be recommended for this kind of respondents without further advancements.

Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis.

The population of patients with kidney failure in the United States using home dialysis modalities is growing rapidly. Unlike for in-center hemodialysis, there is no patient-reported experience measure for assessment of patient experience of care for peritoneal dialysis or home hemodialysis. We sought to develop and establish content validity of a patient-reported experience measure for patients undergoing home dialysis using a mixed methods multiple stakeholder approach. We conducted a structured literature review, followed by concept elicitation focus groups and interviews among 65 participants, including 21 patients on home dialysis, 33 home dialysis nurses, three patient care partners, and eight nephrologists. We generated a list of candidate items for possible measure inclusion and conducted a national prioritization exercise among 91 patients on home dialysis and 39 providers using a web-based platform. We drafted the Home Dialysis Care Experience instrument and conducted cognitive debriefing interviews to evaluate item interpretability, order, and structure. We iteratively refined the measure on the basis of interview findings. The literature review and concept elicitation phases supported 15 domains of home dialysis care experience in six areas: communication and education of patients, concern and helpfulness of the care team, proficiency of the care team, patient-centered care, care coordination, and amenities and environment. Focus groups results showed that domains of highest importance for measure inclusion were patient education and communication, care coordination, and personalization of care. Prioritization exercise results confirmed focus group findings. Cognitive debriefing indicated that the final measure was easily understood and supported content validity. The Home Dialysis Care Experience instrument is a 26-item patient-reported experience measure for use in peritoneal dialysis and home hemodialysis. The Home Dialysis Care Experience instrument represents the first rigorously developed and content-valid English-language instrument for assessment of patient-reported experience of care in home dialysis.

Past performance contaminates the ADAPTS measurement

Theory suggests that adaptive selling behaviors improve sales performance. While this causation appears to be supported using the ADAPTS measurement scale, an alternative explanation is that perception of past performance predicts response to the ADAPTS scale. The ADAPTS items often contain abstract concepts such as “sales approach” and “not working” which may be difficult for respondents to interpret. Consistent with a halo error, salespeople may draw upon their overall attitude toward their selling ability to help them answer abstract ADAPTS items. Because past performance contributes to overall attitude toward selling ability, past performance could be biasing ADAPTS ratings through a halo error. This research consists of three studies. The first study uses a qualitative methodology to investigate ADAPTS item interpretation. The second study uses a time-lagged experimental methodology to demonstrate that past performance influences ADAPTS ratings above and beyond actual adaptive behaviors. The final study uses a survey methodology to show that sales self-efficacy mediates the relationship between self-rate performance and ADAPTS, even while controlling for an acquiescence bias. The results of the three studies demonstrate that ADAPTS contains significant bias. Alternative methods for operationalizing adaptive selling behaviors are suggested.

Consequences, norms, and inaction: Response to Gawronski et al. (2020)

AbstractIn response to arguments made by Gawronski et al. (2020), responding to Baron and Goodwin (2020), we concentrate on four issues. First, the CNI design requires substantial numbers of “perverse” responses to congruent items — those in which both consequences and norms both favor action, or both favor inaction — and these responses depend on the ambiguity of the items concerning which norms apply or which consequences are worse. Effects of outside variables, such as psychopathy, may result from the effect of such variables on the interpretation of ambiguous items, rather than from their effect on sensitivity to norms or consequences. Second, the CNI design may not be so useful at measuring general action/inaction biases. Third, the order of the two processes in the model could in fact affect the conclusions drawn (even though it does not do so in most studies done so far). Fourth, the conclusions drawn do in fact depend on the items’ susceptibility to reinterpretation (owing to their ambiguity): the tests proposed for item validity are too weak, since they require only that a majority of subjects agree with the experimenters’ classification, even though a minority could affect the conclusions drawn. We illustrate some of our points with an analysis of the psychopathy study of Luke and Gawronski (2020).

Development and initial evaluation of a multidimensional digital stress scale.

Digital stress is believed to play a role in the association between social media use and psychosocial outcomes. However, the literature is limited by a lack of measures that conform to published theoretical models of the construct. The present investigation details the development of a new multidimensional measure of digital stress. Based on an earlier conceptualization of Digital Stress (Steele et al., 2020), Study 1 identified items from extant measures of digital stress, conducted a qualitative review of the literature to compose new items, and conducted focus groups with young adults and adolescents (N = 23) to improve item wording and interpretation. Study 2 conducted an exploratory factor analysis (EFA) of items with a young adult sample (N = 247) collected online, yielding support for four hypothesized factors (i.e., availability stress, approval anxiety, fear of missing out [FoMO], and connection overload) plus one unanticipated factor (i.e., online vigilance). In Study 3, college students (N = 174) completed paper-and-pencil surveys, and EFA results showed a similar structure as detected in Study 2. In Study 4, confirmatory factor analysis examining the five-factor model was conducted on data from adolescents (N = 163) and college students (N = 152). These procedures yielded 24 items measuring 5 components of digital stress: availability stress, approval anxiety, FoMO, connection overload, and online vigilance. Associations between digital stress and psychosocial distress and functioning are reported to demonstrate convergent and divergent validity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Translation and cultural adaptation of a romanian version of the communication assessment tool (CAT_Ro)

BackgroundThe communication between health providers and patients influences the quality of medical care. The Communication Skills Assessment (CAT) is a reliable, validated tool, which was developed to assess interpersonal communication skills between physicians and patients. The purpose of this study was to obtain a Romanian version of the CAT (CAT_Ro), using a controlled and systematic process to translate and cross-culturally adapt the original questionnaire, since there are no validated instruments to assess healthcare professionals’ communication capability in Romania.MethodsThe study was conducted in two Departments of Internal Medicine and Rheumatology from Bucharest, Romania, using a rigorous scientific methodology for the translation process, according to literature recommendations, implicating conceptual evaluation, semantics, and cultural adaptation, which involved several steps. The updated version was pre-tested in a pilot study, which included 89 outpatients.ResultsThe results showed a narrow range of variability in item interpretation, without differences in patients’ responses according to variables such as age, gender, education, disease type, number of previous visits with the same doctor.ConclusionCAT-Ro is the result of a comprehensive process study. It represents the first translation and cultural adaptation in Romanian of an instrument able to assess the health providers’ communication skills, which was validated in a pilot study and is to be used in more extensive studies with patients from several specialties.

Qualitative evaluation of the Autism Behavior Inventory: use of cognitive interviewing to establish validity of a caregiver report scale for autism spectrum disorder

PurposeThe Autism Behavior Inventory (ABI) is an observer-reported outcome scale measuring core and associated features of autism spectrum disorder (ASD). Extensive scale development (reported elsewhere) took place, in alignment with the Food and Drug Administration’s patient-reported outcome guidance, to address the need for instruments to measure change and severity of ASD symptoms.MethodsCognitive interviewing was used to confirm understanding and content validity of the scale prior to its use in clinical trials. Respondents were caregivers of individuals with ASD (N = 50). Interviews used a hybrid of the “think-aloud” and verbal probing approach to assess ABI’s content validity and participant understanding of the instrument, including: item clarity and relevance; item interpretation; appropriateness of response scales; and clarity of instructions. Audio-recordings of the interviews were transcribed for qualitative data analysis. The scale was revised based on participant feedback and tested in a second round of interviews (round 1 N = 38, round 2 N = 12).ResultsIn total, 67/70 items reached ≥ 90% understandability across participants. Caregivers were able to select an appropriate response from the options available and reported finding the examples helpful. Based on participant feedback, instructions were simplified, 8 items were removed, and 10 items were reworded. The final revised 62-item scale was presented in round 2, where caregivers reported readily understanding the instructions, response options, and 61/62 items reached ≥ 90% understandability.ConclusionsCognitive interviews with caregivers of a diverse sample of individuals with ASD confirm the content validity and relevance of the ABI to assess core and associated symptoms of ASD.

Applicability of a Salient Belief Elicitation to Measure Abortion Beliefs.

Objectives: Salient belief elicitations (SBEs), informed by the Reasoned Action Approach (RAA), are used to identify 3 sets of beliefs - behavioral, control, and normative - that influence attitudes toward a health behavior. SBEs ask participants about their own beliefs through open-ended questions. We adapted a SBE by focusing on abortion, which is infrequently examined through SBEs; we also included a survey version that asked participants their views on what a hypothetical woman would do if contemplating an abortion. Given these deviations from traditional SBEs, the purpose of this study was to assess if the adapted SBE was understood by participants in English and Spanish through cognitive interviewing. Methods: We examined participants' interpretations of SBE items about abortion to determine if they aligned with the corresponding RAA construct. We administered SBE surveys and conducted cognitive interviews with US adults in both English and Spanish. Results: Participants comprehended the SBE questions as intended. Participants' interpretations of most questions were also in line with the respective RAA construct. Conclusions: SBE survey questions were comprehended well by participants. We discuss areas in which SBE questions can be modified to improve alignment with the underlying RAA construct to assess abortion beliefs.

À procura de Moçambique no Museu Nacional de Etnologia, Portugal

Em 1965, o Museu de Etnologia do Ultramar – hoje Museu Nacional de Etnologia – foi inaugurado em Lisboa. A sua criação resultou em muito da atividade do antropólogo Jorge Dias e da sua equipa de colaboradores, mais concretamente de uma campanha a Moçambique, desenvolvida no seio da Missão de Estudos das Minorias Étnicas do Ultramar (1958-1961). Este artigo procura entender a relação entre a presença e a invisibilidade de Moçambique no Museu Nacional de Etnologia, através do espólio atual do museu, das exposições temporárias relacionadas com Moçambique que foram realizadas ao longo do tempo, e da exposição permanente atual. Contextualiza-se o aparecimento do Museu de Etnologia do Ultramar e os moldes em que foi criado; analisa-se a sua evolução, através de uma análise panorâmica do conjunto de exposições que incluíram objetos de Moçambique e que foram sendo organizadas nos mais de 50 anos da sua existência; e estuda-se a exposição permanente “O Museu, muitas coisas”, em exibição desde 2013. Conclui-se que Moçambique ocupa um lugar de destaque no Museu Nacional de Etnologia, quer pelas suas coleções e materiais documentais, quer pelas diversas exposições organizadas pelo museu ao longo da sua história. No entanto, está praticamente ausente da sua exposição permanente, sendo que a interpretação dos poucos objetos de Moçambique em exposição, necessita de uma revisão, pois está ancorada na estética dos seus objetos e não estimula qualquer tipo de pensamento crítico.