Item Infit Research Articles

Myths about suicide - validating the Hungarian version of the Literacy of Suicide Scale (H-LOSS) on a community sample

BackgroundSuicide was exceptionally high in Hungary in the last century. According to Eurostat, Hungary ranks second in the EU in death by suicide and was among the few countries where the suicidal tendencies increased in 2020. Primary tasks of suicide prevention programs are to develop suicide literacy and dispel myths and misconceptions about suicide. Therefore, the goal of our research was the Hungarian validation of the 26-item Literacy of Suicide Scale (LOSS). Methods: 749 people (382 female (51.0%), 364 male (48.6%), 3 identify as non-binary or other (0.4%); 4 identifying as transgender (0.5%)) participated in our online cross-sectional survey with a mean age of 32.4 years (SD = 14.5 years). The H-LOSS questionnaire was adapted using the 2PL (two-parameter logistic) model with WLSE (weighted least squares) estimation in item response theory method, similarly to the original English version.ResultsScale unidimensionality was confirmed. Model fit indices and internal reliability indicators were acceptable. Item infit and outfit values were adequate, item discrimination values were within range, but one item had extremely high and three items had extremely low item difficulty parameters. Few items had differential item functioning by age, gender and own suidice attempt.ConclusionsThe H-LOSS scale deemed to be appropriate for assessing suicide literacy in Hungarian speaking samples.

A multi-center international study on the spinal cord independence measure, version IV: Rasch psychometric validation

Context The Spinal Cord Independence Measure is a comprehensive functional rating scale for individuals with spinal cord lesion (SCL). Objective To validate the scores of the three subscales of SCIM IV, the fourth version of SCIM, using advanced statistical methods. Study Design Multi-center cohort study. Setting Nineteen SCL units in 11 countries. Methods SCIM developers created SCIM IV following comments by experts, included more accurate definitions of scoring criteria in the SCIM IV form, and adjusted it to assess specific conditions or situations that the third version, SCIM III, does not address. Professional staff members assessed 648 SCL inpatients, using SCIM IV and SCIM III, at admission to rehabilitation, and at discharge. The authors examined the validity and reliability of SCIM IV subscale scores using Rasch analysis. Results The study included inpatients aged 16–87 years old. SCIM IV subscale scores fit the Rasch model. All item infit and most item outfit mean-square indices were below 1.4; statistically distinct strata of abilities were 2.6–6; most categories were properly ordered; item hierarchy was stable across most clinical subgroups and countries. In a few items, however, we found misfit or category threshold disordering. We found SCIM III and SCIM IV Rasch properties to be comparable. Conclusions Rasch analysis suggests that the scores of each SCIM IV subscale are reliable and valid. This reinforces the justification for using SCIM IV in clinical practice and research.

Psychometric Properties of the German Version of the Quality of Life after Brain Injury Scale for Kids and Adolescents (QOLIBRI-KID/ADO) Using Item Response Theory Framework: Results from the Pilot Study.

Health-related quality of life (HRQOL) is an important indicator for recovery after pediatric TBI. To date, there are a few questionnaires available for assessing generic HRQOL in children and adolescents, but there are not yet any TBI-specific measures of HRQOL that are applicable to pediatric populations. The aim of the present study was to examine psychometric characteristics of the newly developed Quality of Life After Brain Injury Scale for Kids and Adolescents (QOLIBRI-KID/ADO) questionnaire capturing TBI-specific HRQOL in children and adolescents using an item response theory (IRT) framework. Children (8-12 years; n = 152) and adolescents (13-17 years; n = 148) participated in the study. The final version of the QOLIBRI-KID/ADO, comprising 35 items forming 6 scales, was investigated using the partial credit model (PCM). A scale-wise examination for unidimensionality, monotonicity, item infit and outfit, person homogeneity, and local independency was conducted. The questionnaire widely fulfilled the predefined assumptions, with a few restrictions. The newly developed QOLIBRI-KID/ADO instrument shows at least satisfactory psychometric properties according to the results of both classical test theoretical and IRT analyses. Further evidence of its applicability should be explored in the ongoing validation study by performing multidimensional IRT analyses.

Investigating eye examination-related anxiety in autistic adults

ABSTRACT Clinical relevance It is important to investigate whether anxiety is a barrier to accessing eye examinations for autistic adults, because existing research suggests this population are more likely to develop ophthalmic abnormalities. Background Anxiety influences healthcare accessibility for autistic people without learning disabilities. Previous qualitative studies by the research team, with a small sample of autistic adults, have indicated several aspects of eyecare services which cause anxiety. Considering the limited existing research suggesting autistic individuals are more likely to develop ophthalmic abnormalities, this study explored whether this population more widely experiences anxiety when accessing eye examinations. Methods A total of 322 UK-based autistic adults completed the Optometric Patient Anxiety Scale (OPAS) online, between July and December 2020. Rasch analysis was used to validate this questionnaire for an autistic adult population, and compare optometric anxiety levels to the general population. Results Item infit (0.77 to 1.39) and outfit (0.78 to 1.33) values, the person separation index (2.64), and item (0.99) and person (0.97) reliability coefficients suggested that all 10 items in the OPAS are useful to assess optometric anxiety in an autistic adult population. Item probability curves confirmed the response scale to be appropriate. A comparison of optometric anxiety between the autistic population in the current study and a general population in previous work found no statistically significant difference. Conclusion The OPAS is a statistically valid tool for use in the autistic adult population. It appears to suggest no significant difference in optometric anxiety between the autistic adult and general population. However, it is possible that it underestimates the true optometric anxiety of autistic adults since the items do not include some of the anxiety provoking factors for this population which have been indicated in previous studies by the research team.

Improving and validating a rating scale to assess student pharmacists’ perception of professional identity

BackgroundThere are limited data on the psychometric properties of instruments evaluating professional identity (PI) among student pharmacists. ObjectivesThis study analyzed the psychometric properties of an instrument to assess student pharmacists’ perception of their PI. MethodsData from a cross-sectional survey were used to establish validity and reliability evidence of student pharmacists’ perception of PI using Rasch analysis. Linear regression was conducted to evaluate the association of students’ characteristics with their perceived PI. Analyses were conducted in WINSTEPS (SWREG, Minnetonka, MN) and SAS (SAS, Cary, NC). ResultsThe analysis included 118 student pharmacists. Primary analysis suggested inadequate scale functionality; thus, some response categories were merged. With modified item anchors and the removal of the most misfitting item, the data fit the model as measured by student and item infit and outfit mean-squared values. The item-person map showed appropriate distribution of item difficulty, identifying medicine adviser and entrepreneur being the easiest and hardest items to agree with, respectively. Students’ abilities initially mismatched with item difficulty and exhibited a ceiling effect, requiring addition of items reflecting students’ higher perceptions of PIs. Although students’ reliability coefficient (RC) and separation index were 0.98 and 1.73, respectively, RC of the items was 0.94. Students who reported receiving formal PI training were 0.3 times more likely to have high perception of PI than those who did not report training. ConclusionThe instrument exhibited fair validity and reliability evidence for assessing the perception of PI among student pharmacists. Additional items to fill identified item gaps are needed to improve the instrument’s content validity.

Validation of the Arabic version of the quality of life impact of refractive correction questionnaire.

PURPOSE:To validate the Arabic version of the quality of life impact of refractive correction (QIRC) questionnaire.METHODS:This was a cross-sectional study included participants with refractive errors (myopia, hypermetropia, or astigmatism) aged between 19 and 40 years who were pre or postrefractive surgeries. Uncorrected distance visual acuity, refraction, and corneal topography were collected. The 20-item QIRC questionnaire was translated to the Arabic language and then back translated to the English language. Participants were asked to answer all items of the Arabic QIRC. The validity and reliability of the translated questionnaire were tested using Rasch analysis.RESULTS:A total of 145 participants with refractive errors participated in this study. The mean age ± standard deviation of participants was 26.29 ± 5.1 years. Person separation (2.01) and reliability (0.80) indicates good precision and stability of the Arabic QIRC questionnaire. Item infit was ranged between 0.82 and 1.23; and item outfit was range between 0.76 and 1.32. The items were well targeted to the persons with a mean difference of 0.30. Skew and kurtosis values were within the normal limits (−2.00 to + 2.00). Cronbach's α for the scale was 0.79, which indicates good reliability of the Arabic 20-item QIRC.CONCLUSION:The Arabic 20-item QIRC questionnaire is a valid tool to assess the impact of refractive correction on Arabian participants’ quality of life.

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.

Validity and Reliability of the Student Refractive Error and Eyeglasses Questionnaire-Revised Version in Myopic Children.

Multiple vision-related quality of life (VRQol) instruments exist, but questionnaires designed specifically for myopic children that are appropriate for assessing the impact of refractive error are rare. This study aimed to assess the validity and reliability of the Student Refractive Error and Eyeglasses Questionnaire - Revised (SREEQ-R) in school-aged children with myopia in the United Kingdom. Community optometrists in the United Kingdom invited children up to the age of 18 years presenting for an eye examination with current or previous reported use of eyeglasses for myopia to complete the SREEQ-R, which consists of 20 specific items divided into two sections each with three response categories. The "without glasses" section relates to perceptions of uncorrected vision/not wearing glasses, and the "with glasses" relates to corrected vision/wearing glasses. Rasch analysis was used to explore the psychometric performance (content, construct validity, and reliability) of the questionnaire items and scale using Winsteps software (Winsteps.com. Portland, OR). A total of 125 eligible children with a mean ± standard deviation age of 12.7 ± 2.9 years completed the SREEQ-R. All items fit the Rasch model and were retained, and the scale was found to be unidimensional. All children and item infit and outfit mean square statistics fell within the recommended fit criteria. As per the Rasch analysis, the person reliability coefficients were 0.84 and 0.91, whereas item reliabilities were 0.99 and 0.80 for the without glasses and with glasses sections, respectively. The internal consistency for the SREEQ-R was good; Cronbach α values were 0.84 for without glasses and 0.91 for with glasses. The SREEQ-R had satisfactory validity and reliability evidence. Construct validity of the scale was supported to measure the impact of uncorrected and corrected refractive error on vision-related quality of life in myopic school-aged children in the United Kingdom. The SREEQ-R could be used in future studies to evaluate vision-related quality of life in children with myopia.

Construct Validity of the 29‐Item Sense of Coherence Scale: Exploratory Analysis of a Compatible Three‐Factor Model Using a Rasch Measurement Model1

AbstractSense of coherence means perceiving one's experiences as coherent; it has been shown to be important for mental health and well‐being. This study examined the item fit and construct validity of the 29‐item Sense of Coherence (SOC) Scale using the Rasch measurement model and confirmatory analysis. Based on the values of item Infit and Outfit mean square, the total number of items in the scale was reduced from 29 to 20. Verifying the three‐factor structure using the fitted items revealed an acceptable goodness‐of‐fit (CFI = .915, SRMR = .058, RMSEA = .064). All results, including the values of item difficulty for each response category, suggest that omitting some items and revising the number of response categories is effective. Examinations improving the structural validity and measurement accuracy of the SOC Scale in this study may contribute to psychological assessment in epidemiological and clinical studies.

Validation of the Dutch-Flemish translated ABCD questionnaire to measure cardiovascular diseases knowledge and risk perception among adults

Valid and reliable measurement of an individual’s knowledge and risk perception is pivotal to monitor and evaluate the effectiveness of interventions aimed at preventing cardiovascular diseases (CVDs). The recently developed Attitudes and Beliefs about Cardiovascular Disease (ABCD) knowledge and risk questionnaire is shown to be valid in England. In this study, we evaluated the psychometric properties of the modified and Dutch (Flemish)-translated ABCD questionnaire using both the classical test and item response theory (IRT) analysis. We conducted a community-based survey among 525 adults in Antwerp city, Belgium. We assessed the item- and scale-level psychometric properties and validity indices of the questionnaire. Parameters of IRT, item scalability, monotonicity, item difficulty and discrimination, and item fit statistics were evaluated. Furthermore, exploratory and confirmatory factorial validity, and internal consistency measures were explored. Descriptive statistics showed that both the knowledge and risk scale items have sufficient variation to differentiate individuals’ level of knowledge and risk perception. The overall homogeneity of the knowledge and risk subscales was within the acceptable range (> 0.3). The exploratory and confirmatory factor analyses of the risk scale supported a three-factor solution corresponding to risk perception (F1), perceived benefits and intention to change physical activity (F2), and perceived benefit and intention to change healthy dietary habit (F3). The two parametric logistic (2—PL) and rating scale models showed that the item infit and outfit values for knowledge and risk subscales were within the acceptable range (0.6 to 1.4) for most of the items. In conclusion, this study investigated the Dutch (Flemish) version of the ABCD questionnaire has good psychometric properties to assess CVD related knowledge and risk perception in the adult population. Based on the factor loadings and other psychometric properties, we suggested a shorter version, which has comparable psychometric properties.

Towards a science inquiry test in primary education: development of items and scales

BackgroundInquiry-based learning is widely applied in science education; however, so far, the outcomes of learning process have been systematically assessed mainly at the secondary school level. For primary school students, there is no valid instrument for assessing the outcomes of their science inquiry. The aim of the current study was to develop a test for assessing science learning outcomes (analytical skills, planning skills, interpretation skills, and science knowledge) related to the five phases of inquiry-based learning (Orientation, Conceptualization, Investigation, Conclusion, and Discussion) at primary education level (ISCED 1).ResultsA set of contextualized science tasks was created to assess each of the learning outcomes at three levels. The Science Inquiry Test for Primary Education (SIT-PE test) was developed through several phases, including pilot studies with large groups of fourth-grade students (10 to 11 years of age). The 1 PL Item Response Theory model was used to analyze the quality of the test and items based on the test’s reliability score, item difficulty measure, infit and outfit indices, estimation of item discrimination, item-scale correlation, and the quality of the scoring key. The final test, consisting of 24 items, was used with a sample of 1868 students. The analysis showed the SIT-PE test to be of good quality on test level and item level and to also have good predictive validity. Confirmatory factor analysis revealed that the correlated factors model and second-order factor model of the science learning outcomes both had a good fit to data collected with the SIT-PE test. Confirmatory factor analysis confirmed the multidimensionality of science learning outcomes and validated four dimensions of the model: analytical skills, planning skills, interpretation skills, and science knowledge.ConclusionsIn conclusion, the SIT-PE test could be further used for assessing students’ inquiry competence in primary education. However, it could be even further improved in several ways and this study provides guidelines on how to do that. In addition, the SIT-PE provides test developers with information on how to design derivations of the SIT-PE test for assessing particular science inquiry outcomes or the same outcomes in older age groups as well.

A motivational factors assessment instrument for medication management center employees providing medication therapy management services: A Rasch analysis

BackgroundTelephonic medication management centers (MMCs) provide medication therapy management services to help alleviate medication-related issues and improve health outcomes. Motivation factors driving the performance of MMC personnel are key components in achieving these goals. Yet, published literature is limited on how motivation affects MMC personnel performance. ObjectiveTo assess validity and reliability of the employee motivation questionnaire (EMQ), a 19-item measure of barriers and facilitators to motivation associated with MMC employees’ work performance. MethodsPharmacist, nurse, pharmacy technician, and intern employees (N = 534) from 5 telephonic-based U.S. MMCs were invited to complete the electronic EMQ. Rasch analysis was conducted in Winsteps software using a rating scale model. Construct and content validity and reliability were analyzed with employee and item separation index (SI) and reliability coefficient (RC). Linear regression was conducted to test the association of employee characteristics with individual work performance motivation. ResultsA total of 319 employees completed the EMQ, 59.7% response rate. Principal components analysis suggested a unidimensional construct. Employee and item infit and outfit mean squared values met recommended fit criteria (0.5–1.5), suggesting that the data fit the model. An item-person map identified items that were easiest (joy of helping patients) and most difficult (motivated to work harder if incentives were tied to goal achievements) to agree with. Mismatch of employee motivation and item difficulty level on the measurement continuum (−1 to 0.92 logits) indicated a need for additional items that employees perceive as more difficult to agree with. The employee RC was 0.81 and the SI was 2.04; whereas, the item RC was 0.97 and the SI was 5.94. None of the variables tested illustrated statistically significant associations with the person motivation measure. ConclusionsThe EMQ illustrated reasonable content validity, good construct validity, and reliability evidence when used to measure motivation factors among MMC employees. Consideration of employee motivation factors may help to better meet MMC program goals and improve patient outcomes.

Validity and Reliability Study for the Turkish Version of Number Sense Screener for 60-71 Months Old Children

In this study, it was aimed to carry out the validity and reliability study of Number Sense Screener (NSS)’s Turkish version for 60-71 year-old children. The universe of the study in which general survey model was used consists of children at 60-71 years of age, who were continuing their education during the spring term of academic year 2017-2018 in public and private kindergartens under the Ministry of National Education within the central district of Aydin/Turkey. As for the sample of the study, 658 children contunuing their education in 12 different preschools pre-determined according to socioeconomic status (low-middle-high) were included through systematic sampling method. Validity and reliability studies were carried out using data from the NSS application. Drawing from the analyses, it was determined that item difficulty values of the assessment tool ranged between 0.08 and 0.96, item discrimination indices ranged between 0.17 and 0.53 and item infit and outfit values ranged between 0.50-1.50. Having used Guttman's lambda-2, Alpha coefficient, Feldt-Gilmer coefficient, Feldt-Brennan coefficient and Raju's beta coefficient, it was determined that reliability coefficient calculated for the entire assessment tool varied between .826 and .837. Following DIF analysis, it was concluded that assessment tool items were not biased towards gender. According to the results of the study, it was concluded that the Turkish version of NSS is a valid and reliable assessment tool for assessing the number sense of children at 60-71 months of age.

Rasch analysis in the development of the NutriQoL\xae questionnaire, a specific health-related quality of life instrument for home enteral nutrition

BackgroundHome enteral nutrition (HEN) is a therapeutic method used in patients who are unable to ingest the required amounts of nutrients but retain a functional gastrointestinal tract. The objective of this study was to compose a specific questionnaire for measuring health-related quality of life (HRQoL) in HEN patients irrespective of their underlying condition and HEN route of administration.MethodsLiterature review, focus groups and semi-structured interviews were used to propose an initial version of the questionnaire which was answered by 165 participants. The responses were analyzed using the Rasch methodology. Firstly, the appropriateness of response options was assessed. Then, the differential item functioning (DIF) was evaluated. Finally, the item fit statistics, infit and outfit, were determined.ResultsRasch analysis was performed on the responses given to the 43 items included in the initial questionnaire. Four items were excluded because more than 50% of respondents answered that the situation proposed did not apply to them. Seven items that showed overlapping and disordered categories were also removed. Pairwise DIF analysis were performed in subgroups defined by underlying disease and administration route. Eleven items presented DIF and were eliminated from the questionnaire. Finally, four items were deleted after analyzing the fit statistics, three of which did not fit the Rasch model and one did not belong to either of the dimensions. The final version of NutriQoL® includes 17 items.ConclusionsNutriQoL® is a useful instrument to assess the HRQoL of HEN patients with any disease and any administration route.

Rasch analysis of three dry eye questionnaires and correlates with objective clinical tests

PurposeTo assess the psychometric properties of Chinese versions of the Ocular Comfort Index (OCI), Ocular Surface Disease Index (OSDI) and McMonnies questionnaires. Further, to assess the correlation between questionnaire scores and objective dry eye disease (DED) clinical tests. MethodsTranslated versions of the OCI, OSDI and McMonnies questionnaires were completed in a random order by 238 participants with DED. Objective clinical tests included visual acuity (VA), fluorescein tear film break-up time (TBUT), corneal fluorescein staining, Schirmer I testing and meibomian gland grading. Rasch analysis was used to assess questionnaire psychometrics and spearman rank for correlations. ResultsFor the OCI, the person separation was 2.31, item infit and outfit statistics ranged from 0.74–1.14 and 0.75–1.32, respectively, and targeting 1.54 logits. For the OSDI, person separation was 0.94. None of the three subscales provided valid measurements based on Rasch analysis. For the McMonnies questionnaire, person separation was 1.17, item infit and outfit statistics ranged from 0.7 to 1.21 and 0.51–3.49, respectively. There were weak correlations between questionnaire scores and clinical tests. There were weak correlations between OSDI scores and VA, fluorescein TBUT, Schirmer I testing and corneal fluorescein staining. There were weak correlations between McMonnies scores and VA, fluorescein TBUT, Schirmer I testing, and corneal fluorescein staining and meibomian gland grading. ConclusionsThe OCI questionnaire was the only questionnaire that provided valid measurement on the basis of Rasch analysis, although slight multidimensionality was found. There were weak correlations between OCI scores and fluorescein TBUT, Schirmer I testing, and corneal fluorescein staining. Due to this paradoxical disconnect between symptoms and signs and the repeatability of tests, the use of both subjective and objective markers in the clinical management of patients or as endpoints in clinical trials would appear prudent.

Validity and reliability of Child Perception Questionnaire (CPQ11–14) by Rasch Analysis in Turkish children

Assessment for the reproducibility of the answers to the Child Perception Questionnaire (CPQ11–14) in different languages with test-retest exercises have importance to be acceptable in other populations. The present study is to evaluate the validity and reliability of Child Perception Questionnaire for ages 11–14 (CPQ11–14) with 37 items by means of Rasch Analysis in a group of Turkish population. 133 children aged 11–14 years old were included to the study. CPQ11–14 was administered at their first visit, as well as Facial Image Scale questions. After two weeks, CPQ11–14 was re-applied to a subgroup (n = 25) of the children. The construct validity of the CPQ11–14 data was assessed by using Rasch Analysis. Intraclass Correlation Coefficient was calculated with the CPQ11–14 scores of first and second visits. Cronbach's α coefficient was obtained for evaluating internal consistency. According to Rasch Analysis, mean item infit ± sd was 0.98 ± 0.25; mean item outfit ± sd was 1.08 ± 0.91. Item and person separation indices and reliabilities were calculated as 3.34 and 2.42; 0.92 and 0.85, respectively. The Pearson's correlation coefficient between the total scores of CPQ11–14 and the Facial Image Scale was found as 0.74 (p < 0.001). Cronbach's alpha coefficient was 0.93 and ICC was 0.90 for the total scale. The findings of the present study showed that the Turkish version of CPQ11–14 with 37 items is valid and has excellent reliability.

Experiential Household Food Insecurity in an Urban Underserved Slum of North India

One-third of India’s urban population resides in extreme poverty, in slums and squatters. Food insecurity remains a visible reality among this segment. Yet, it is scarcely documented.This paper describes levels and determinants of experiential household food insecurity (HFI) in an underserved urban slum of Delhi (India) and reports the internal validity and reliability of the measure used to assess experiential HFI. A four item scale was adapted from the U.S. six-item short form food security scale and was administered in Hindi through household interviews with 410 female adults. Association of HFI with household economic and sociodemographic characteristics were examined using multiple logistic regression. Cronbach’s alpha and Rasch model-based item fit statistics were used to assess reliability and internal validity. Fifty-one percent of households were food insecure. Significant HFI predictors were unemployed to employed family members’ ratio of >3:1 (Odds Ratio 2.1, Confidence Interval 1.2-3.4) and low household standard of living (OR 4.9, C.I. 2.7-8.9).Cronbach’s alpha was 0.8. Item severities as estimated under Rasch model assumptions spanned 9.7 logits. Item infit statistics (0.77-1.07) indicated that the Rasch model fit the data well. Item outfit statistics suggested that one item was inconsistently understood by a small proportion of respondents. Extent of household food insecurity Two-thirds (65.8%) of households reported that they sometimes or often could not afford to eat balanced meals in the 12 months preceding the survey. Similarly, 51.7% households sometimes or often faced the problem of ‘food not lasting for the purchased period and having no money at hand to buy more food’. ‘Cutting size of meals or skipping meals’ was sometimes or often faced by 23.9% households. Few (14.7%) households ever faced a condition wherein ‘one or more family members were hungry but family could not afford to buy food’. A total of 135 households (32.9%) never faced any of the above 4 conditions. Overall, 51% households were ‘food-insecure’ (27.1% food-insecure without hunger and 23.9% and food-insecure with hunger). The remaining (49%) households were ‘food-secure’. Factors that emerged as determinants of household insecurity included i) illiteracy level of head of household, ii) family size of 7 or more, iii) high unemployment of family members, iv) low food spending - families whose MPCE on food was reported less than INR 580 were more likely to be food insecure.For improving HFI among the urban poor, in addition to improving behaviors/entitlement access, programs should consider linkage of urban poor to existing employment schemes, upgrading of their skills and linkage to potential employers. The adapted scale was reliable and easy to administer. However, being a subjective assessment, its sensitivity to social expectation and its association with nutrition security require examination.

Psychometric Evaluation of the Ford Insomnia Response to Stress Test (FIRST) in Early Pregnancy.

To evaluate the construct validity and factor structure of the Spanish-language version of the Ford Insomnia Response to Stress Test questionnaire (FIRST-S) when used in early pregnancy. A cohort of 647 women were interviewed at ≤ 16 weeks of gestation to collect information regarding lifestyle, demographic, and sleep characteristics. The factorial structure of the FIRST-S was tested through exploratory and confirmatory factor analyses (EFA and CFA). Internal consistency and construct validity were also assessed by evaluating the association between the FIRST-S with symptoms of depression, anxiety, and sleep quality. Item response theory (IRT) analyses were conducted to complement classical test theory (CTT) analytic approaches. The mean score of the FIRST-S was 13.8 (range: 9-33). The results of the EFA showed that the FIRST-S contained a one-factor solution that accounted for 69.8% of the variance. The FIRST-S items showed good internal consistency (Cronbach α = 0.81). CFA results corroborated the one-factor structure finding from the EFA; and yielded measures indicating goodness of fit (comparative fit index of 0.902) and accuracy (root mean square error of approximation of 0.057). The FIRST-S had good construct validity as demonstrated by statistically significant associations of FIRST-S scores with sleep quality, antepartum depression and anxiety symptoms. Finally, results from IRT analyses suggested excellent item infit and outfit measures. The FIRST-S was found to have good construct validity and internal consistency for assessing vulnerability to insomnia during early pregnancy.

Rasch Analysis of the Adult Strabismus Quality of Life Questionnaire (AS-20) among Chinese Adult Patients with Strabismus.

BackgroundThe impact of strabismus on visual function, self-image, self-esteem, and social interactions decrease health-related quality of life (HRQoL).The purpose of this study was to evaluate and refine the adult strabismus quality of life questionnaire (AS-20) by using Rasch analysis among Chinese adult patients with strabismus.MethodsWe evaluated the fitness of the AS-20 with Rasch model in Chinese population by assessing unidimensionality, infit and outfit, person and item separation index and reliability, response ordering, targeting and differential item functioning (DIF).ResultsThe overall AS-20 did not demonstrate unidimensional; however, it was achieved separately in the two Rasch-revised subscales: the psychosocial subscale (11 items) and the function subscale (9 items). The features of good targeting, optimal item infit and outfit, and no notable local dependence were found for each of the subscales. The rating scale was appropriate for the psychosocial subscale but a reduction to four response categories was required for the function subscale. No significant DIF were revealed for any demographic and clinical factors (e.g., age, gender, and strabismus types).ConclusionThe AS-20 was demonstrated by Rasch analysis to be a rigorous instrument for measuring health-related quality of life in Chinese strabismus patents if some revisions were made regarding the subscale construct and response options.

Validity and Reliability Evidence for a New Measure: The Evidence-Based Practice Knowledge Assessment in Nursing.

Studies of evidence-based practice (EBP) among nurses often focus on attitudes and beliefs about EBP and self-reported EBP knowledge. Because knowledge self-assessments can be highly inaccurate, the authors developed and tested a new objective measure of EBP knowledge--the Evidence-Based Practice Knowledge Assessment in Nursing (EKAN). Seven subject matter experts reviewed candidate items, resulting in a scale content validity index of 0.94. Rasch modeling was used to evaluate item-person performance on the proposed unidimensional trait of EBP knowledge. The candidate item pool was then tested among 200 undergraduate nursing students. Strong evidence of unidimensionality was confirmed by narrow item infit statistics centering on 1.0. The item separation index was 7.05, and the person separation index was 1.66. Item reliability was 0.98, and person reliability was 0.66. The 20-item EKAN showed strong psychometric properties for an instrument developed under the Rasch model and is available for use in research and educational contexts.