Item Difficulty Research Articles

Development of a Brief, Positively Framed Care Team Experience Measure.

Measures that quantify clinician fulfillment and engagement with work (clinician experience measures) have the potential to improve the quality, effectiveness, and enjoyment of patient care. Many existing measures of clinician fulfillment and engagement with work are relatively long and potentially burdensome, negatively framed, or address personal well-being. A measure with a small number of items that address positive attributes to which a team aspires may be a more useful measure to guide organizational improvement efforts. In a series of cross-sectional studies we asked: (1) Can we develop a brief, positively framed, and team-oriented care team experience measure (CTEM)? (2) How does the CTEM perform relative to the Team Climate Inventory (TCI)? In a first step, the clinical leadership group of a nascent multispecialty group practice curated 21 items, some from existing engagement and burnout measures and others based on suggestions from clinical leaders. After pilot testing and interviews with specific clinicians, these items were then administered to all clinicians in the practice, and 44% (120 of 274) participated. Factor analysis identified three groups of items (factors). In a second step, 43% (493 of 1135) of patient-facing employees (75% [368] of whom were women and 45% [222] of whom were ages 42 to 61 years) of a statewide musculoskeletal specialty practice rated 12 items (two from each of the factors identified in the first stage and six new items recommended by administrative leaders) and completed the TCI. Participants were then randomly allocated to a learning cohort (70% [343 participants]), in which we performed factor analysis and item response theory to develop a new CTEM and validation cohort (30% [150 participants]) to test the consistency of the findings. The best-performing items in terms of factor loadings (the degree to which an individual item represents an identified factor or "theme"; we chose a minimum of 0.4 as items above this threshold are generally regarded as stable), item discrimination (ability to measure different experiences among participants), item difficulty (the ability of an item to contribute to variation in scores), and model fit (the degree to which the estimates of the statistical model align with the observed data) were selected to form a new three-item CTEM. The CTEM was subsequently evaluated for internal consistency (Cronbach alpha, which measures the extent to which different subsets of the included items would provide the same measurement), floor and ceiling effects (the percentage of the lowest and highest possible scores, with high percentages indicating that information is lost because of the inability of a tool to measure the extremes of variation), and correlation with the TCI. Factor analysis identified two groups of items representing "effectiveness" (nine items, including "I am proud of the work we do") and "collaboration" (three items, including "Our team encourages everyone's input before making changes"). The best-performing items of "effectiveness" (two items) and "collaboration" (one item) were selected to form the three-item CTEM, which had good internal consistency (Cronbach α = 0.77; > 0.7 generally considered acceptable); a notable ceiling (37%; higher than desired, common with experience measures, and-in our opinion-acceptable for routine use given the trade-off of limited participant burden) and limited floor effect (1.3%); strong correlation with the TCI (Spearman ρ 0.77 [95% confidence interval 0.70 to 0.85]), which supports convergent validity (part of construct validity, meaning correlation with measures of related concepts); and similar correlations with participant characteristics compared with the TCI, supporting construct and criterion validity (association with real-world outcomes). A small number of positively framed, team-oriented questions (the CTEM) can quantify clinician and care team experience and provide a practical and feasible method for health organizations to monitor and improve the experience of their clinicians. Routine measurement of organizational climate at regular intervals using a brief, user-friendly, team-oriented measure might help organizations improve their culture and help their clinicians feel appreciated and engaged.

Measuring Spatial Ability: Analysis of Spatial Ability Test for Gulf State Students Using Item Response Theory

This study evaluates the psychometric properties of the spatial ability test using the three-parameter logistic model within item response theory. The final version of the scale comprised 29 dichotomous items, administered to a sample of 2,694 male and female students from grades 5 and 6 across schools in the Arab Gulf region. The test adhered to the three-parameter model, satisfying the assumptions of unidimensionality and local independence. The item difficulty parameters ranged from -1.541 to 1.735, discrimination parameters spanned from 0.419 to 5.252, and guessing parameters varied between 0.00 and 0.346. With a marginal reliability coefficient of 0.86, the scale demonstrated strong stability. These findings indicate that the test items align with established measurement principles, supporting the spatial ability test as a valid and reliable assessment tool for measuring spatial abilities in the Gulf region. The results have important implications for educational assessment in the Arab Gulf and could guide the development of similar assessments in other educational contexts. Further research is recommended to improve the test’s precision and explore its application in diverse educational settings.

Can the Short-Form UCLA Loneliness Scale Be Used to Measure Loneliness Among Chinese Older Adults? From Classical Test Theory to Rasch Analysis.

Loneliness among older adults, is a subjective experience and a public health issue in aging societies. Psychometrically sound and culturally sensitive measures are needed for developing precisely targeted interventions in culturally distinct groups. This study tested the Short-Form UCLA Loneliness Scale (ULS-8) among Chinese older adults. Confirmatory factor analysis, internal consistency, and the correlation with the single question of loneliness were conducted with a sample of Chinese older adults. Rasch analyses assessed the unidimensionality, response category functioning, item difficulty, and targeting of the ULS-8 for older Chinese adults. Data from 347 Chinese older adults (mean age 71.36±9.51years) were analyzed; 74.64% of the participants were female. The ULS-8 showed acceptable internal consistency and criterion validity in Classical Test Theory. Confirmatory factor analysis and Rasch analysis indicated that the ULS-8 did not demonstrate a unidimensional structure. Additionally, Rasch analysis revealed (1) a misfit in item 3, indicating a problem with construct validity; (2) the need to combine response categories; and (3) that Chinese older adults are less likely to endorse a high level of loneliness when using the ULS-8. To ascertain the adequacy of the loneliness measure, it is crucial to customize a new short version of the loneliness scale for Chinese older adults through Rasch analysis.

Treating Noneffortful Responses as Missing.

This study investigates the treatment of rapid-guess (RG) responses as missing data within the context of the effort-moderated model. Through a series of illustrations, this study demonstrates that the effort-moderated model assumes missing at random (MAR) rather than missing completely at random (MCAR), explaining the conditions necessary for MAR. These examples show that RG responses, when treated as missing under the effort-moderated model, do not introduce bias into ability estimates if the missingness mechanism is properly accounted for. Conversely, using a standard item response theory (IRT) model (scoring RG responses as if they were valid) instead of the effort-moderated model leads to considerable biases, underestimating group means and overestimating standard deviations when the item parameters are known, or overestimating item difficulty if the item parameters are estimated.

Piloting an Educational Approach to Assess eHealth Literacy and Evidence-Based Medicine in Integrative Health: A Feasibility and Validation Study.

Introduction: Low rates of online health literacy put consumers at risk of misinformation, but this could be mitigated through practitioner engagement. Integrative health (IH) crosses health care disciplines, so it is well-positioned to improve health information sharing. IH practitioners require evidence-based medicine (EBM) and electronic health literacy (eHL) competencies to make such impact. Several EBM assessments exist, but none are IH-specific. The Fresno Test of EBM FEBM is a validated, performance-based assessment used in medical education. We sought to assess feasibility of incorporating eHL and EBM assessments into graduate coursework while adapting and validating the FEBM for an IH audience (FEBM-IH). Methods: A pilot observational design was used to adapt, evaluate, administer, and validate the FEBM-IH. Revalidation of the FEBM-IH began with a discipline-focused adaptation, which was reviewed by an expert panel. The FEBM-IH was then administered to IH students and faculty. Independently scored assessments determined inter-rater reliability, internal consistency, item discrimination, and item difficulty. eHL assessments (eHEALS and General Health Numeracy Test-6) were also embedded in the online course. Results: Outcome completion rates suggest the FEBM-IH and eHL assessment tools are feasible to include in online courses, with 68.9% (102/148) eligible participants joining and 76.5% (78/102) completing all questions in all measures. The FEBM-IH demonstrated excellent assessor agreement (kappa = 0.97, p < 0.001), high internal consistency (α = 0.799), and acceptable item discrimination (0.26-0.68). Median self-perceived eHL scores increased from 30/40 to 33/40 points by course's end, suggesting some increase in eHL. Conclusions: Tools were feasible to integrate; FEBM-IH maintains acceptable validity; and further exploration of the relationship between EBM and eHL is warranted.

Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for Gestational Age Across Racial and Ethnic Groups.

Preterm birth and small for gestational age (SGA) are significant public health concerns in the United States, with pronounced disparities across racial and ethnic groups. Traditional prenatal care adequacy indices have limitations in fully capturing their multifaceted nature. Our study introduces the Comprehensive Prenatal Care Index (CPCI) to provide a more holistic assessment of prenatal care by integrating key elements of prenatal counseling and health promotion. This cross-sectional study used the Pregnancy Risk Assessment Monitoring System 2016-2021 data. The CPCI was developed based on a comprehensive literature review, incorporating components such as timing, frequency, and content of prenatal visits. The index was validated using Item Response Theory (IRT) and compared with the Kotelchuck and Kessner Indices. The study included 139,181 pregnant women. The CPCI demonstrated strong internal consistency (Cronbach's α, 0.75; ω total, 0.81). IRT analysis confirmed the index's ability to capture variability in the quality of prenatal care, with item difficulty parameters ranging from -2.93 to +2.10. CPCI scores were significantly associated with reduced odds of adverse birth outcomes. Adequate CPCI care was linked to a 63% reduction in the odds of preterm birth among non-Hispanic White women, with similar reductions observed in Hispanic women (odds ratio [OR], 0.59) and Asian women (OR, 0.38). For SGA, adequate care was protective among non-Hispanic White (OR, 0.86) and Hispanic women (OR, 0.82) but showed mixed results in other groups. The CPCI provides a more inclusive measure of the quality of prenatal care compared with traditional indices. The study's findings suggest a significant role of comprehensive prenatal care in reducing adverse birth outcomes and addressing racial and ethnic disparities. Future research should focus on refining the CPCI and exploring its applicability in diverse populations to inform targeted and culturally sensitive prenatal care strategies.

Development of a Japanese version of the Fresno test for family physicians to measure evidence‐based medicine competence

Development of a Japanese version of the Fresno test for family physicians to measure evidence‐based medicine competence

Growth across Grades and Common Item Grade Alignment in Vertical Scaling Using the Rasch Model

AbstractVertical scales are frequently developed using common item nonequivalent group linking. In this design, one can use upper‐grade, lower‐grade, or mixed‐grade common items to estimate the linking constants that underlie the absolute measurement of growth. Using the Rasch model and a dataset from Curriculum Associates’ i‐Ready Diagnostic in math in grades 3–7, we demonstrate how grade‐to‐grade mean differences in mathematics proficiency appear much larger when upper‐grade linking items are used instead of lower‐grade items, with linkings based on a mixture of items falling in between. We then consider salient properties of the three calibrated scales including invariance of the different sets of common items to student grade and item difficulty reversals. These exploratory analyses suggest that upper‐grade common items in vertical scaling are more subject to threats to score comparability across grades, even though these items also tend to imply the most growth.

Adaptation, calibration, and validation of a cognitive assessment battery for telephone and video administration.

Events such as global pandemics can force rapid adoption of new modes of assessment. We describe the evaluation of a modified neuropsychological assessment for web and telephone administration. Telephone and video conferencing-based neuropsychological assessment procedures were developed and implemented within an ongoing observational study, the Successful Aging following Elective Surgery II (SAGES) study (N = 420 persons). Repeated cognitive assessments were used (N = 2008 observations). Analyses using latent variable psychometric methods were used to compare the measurement modes, and a nested validation sub-study (N = 100 persons) was used to test for measurement equivalence. We used item response theory methods to calibrate data collected by different assessment modes. Measurement equivalence was assessed with Bland-Altman plots and regression analysis. Only small differences were detected between in-person and video modes of assessment. The largest difference among factor loadings was shared for the Boston Naming Test and Visual Search and attention test, but the effects were very small (Cohen's q = 0.06) and not statistically significant (95% confidence interval on q, -0.06, +0.18). In terms of item difficulty differences between in-person and video, the Digit Span Backwards test was less difficult by video with a small-to-moderate effect size (Cohen's d of -0.28, 95% CI, -0.54, -0.01). The contrast of in-person and telephone assessment was larger, with telephone assessment being less difficult than in-person (largest shift in item difficulty for digit span backwards, d = -1.12 95% CI -1.35, -0.90). Calibrated scores from telephone and videoconference demonstrated good agreement (r = 0.72, 95% CI 0.61, 0.80), and the differences could be corrected with latent variable measurement models. Videoconference based neuropsychological assessment can be as precise as in-person. Calibration of ability estimates using latent variable measurement models can address measurement differences and generate scores without evidence of systematic bias.

APPLICATION OF THE ITEM RESPONSE THEORY IN IMAGE PROCESSING

The Item Response Theory (IRT) was applied to image processing where the item's difficulty parameter was used to reconstruct a region of interest in an image contaminated with noise. Shannon's entropy was used for the dichotomization of the image pixels. To demonstrate the efficiency of the proposed method, it was used on simulated data that can be related to functional magnetic resonance imaging (fMRI). The results on simulated data showed that IRT achieved a high percentage of accuracy in identifying the region of interest in the image and that, on average, the estimation converges to the true region of interest, thus proving to be a promising method for the analysis of such data.

Analysis of biology midterm exam items using a comparison of the classical theory test and the Rasch model

In biology learning, test instruments are essential for assessing students' understanding of complex concepts. A test instrument is a crucial factor in learning evaluation; however, its implementation remains minimal. This descriptive quantitative study aims to analyze the quality of test items using the classical approach in terms of validity, reliability, difficulty index, discrimination power, distractor effectiveness, and the Rasch model analysis. The data consists of 30 multiple-choice questions from a biology midterm exam administered to 40 students. Classical test data analysis uses Microsoft Excel, while Rasch model analysis uses Winsteps software. The validity test results from both approaches show 14 valid questions and 16 invalid ones. The reliability scores are 0.619 (adequate) for the classical approach's Cronbach's Alpha, 0.85 (good) for the Rasch model, and 0.65 (weak) for personal reliability. The classical test theory and the Rasch model categorize item difficulty into four levels. The classical approach produces five categories for item discrimination, while the Rasch model identifies three groups based on the item separation index (H=3.45) and two groups based on respondent ability (H=1.96). Distractor effectiveness shows 93.3% functional distractors in the classical test and 80% in the Rasch model. The Rasch model offers greater precision in measuring student ability and detecting bias. Both models should be integrated for comprehensive item analysis. Future tests should focus on improving invalid items and the quality of distractors.

Development and Psychometric Assessment of a Chinese Version of the Ultra-Low Vision Visual Functioning Questionnaire-50.

To develop a short form of Chinese ULV-VFQ-50 based on the ULV-VFQ-150 and compare the psychometrical properties of the two questionnaires. We selected candidate items from the ULV-VFQ-150, considering the item response among ultra-low vision (ULV) participants, the even distribution of item measures, visual aspects, and visual domains, to construct a 50-item ULV-VFQ-50 questionnaire. Then, ULV participants were recruited to evaluate its psychometric characteristics by using Rasch analysis. In total, 79 out of 79 completed questionnaires of ULV-VFQ-50 were collected, of which 11 filled questionnaires were excluded because the participants' vision did not meet the inclusion criteria. Thus 68 valid questionnaires were analyzed (valid response rate 91.9%). The average age of the eligible responders was 45.0 years (standard deviation [SD] = 16.7), with 42.6% females (29/68). As per Rasch analysis, the person measures ranged from -1.74 to 4.91 logits, and the item measures ranged from -1.56 to 1.15 logits. The mean value of item difficulty was 0.00 logits, whereas the mean value of personnel distribution was -0.35 logits. The item reliability was 0.95, and the person reliability was 0.98. The items conform to unidimensionality as indicated by principal component analysis of the residuals, which showed that the first principal component unexplained only 5.5% of the total variance, and each component after that unexplained even less. The Chinese ULV-VFQ-50 exhibits excellent psychometric properties. The short form of Chinese ULV-VFQ, with fewer items and less administration time is better suited for clinical practice and research settings. The Chinese version of ULV-VFQ-50 is a reliable assessment of the visual function for people with ULV in China.

Measuring healthcare professionals’ perceptions of their ability to adopt shared decision making: Translation and psychometric evaluation of the Danish version of the IcanSDM questionnaire

BackgroundShared decision making in healthcare is a fundamental right for patients. Healthcare professionals' perception of their own abilities to enable shared decision making is crucial for implementing shared decision making within service. IcanSDM (I can shared decision making) is a brief measure to investigate healthcare professionals' perception of shared decision making approaches to their practices. It was developed in Canada with French and English versions, and recently translated into German. This study aims to adapt the IcanSDM measure for Danish-speaking healthcare professionals, and evaluate its psychometric properties.MethodsCultural adaptation and translation based on Beaton et al.'s approach was applied. A forward translation by ten people and a backward translation by two people were performed. To assess comprehensibility, cognitive interviews were conducted with 24 healthcare professionals. Eighty healthcare professionals who were trained in shared decision making for either one hour (n = 65) or one day (n = 15) participated in the psychometric evaluation. The evaluation concerned acceptance, item characteristics, skewness, item difficulties, corrected item-total correlations, inter-item correlations, factorial structure, internal consistency, and responsiveness.ResultsThe forward and backward translation revealed few discrepancies, and participants understood the items well. The psychometric evaluation showed a high completion rate and acceptable item difficulties and discrimination values. Both the factor analysis and the internal consistency showed a 2-factor structure: 1) healthcare professionals' capacity to implement shared decision making; and 2) healthcare professionals' capacity to practise shared decision making. The IcanSDM_Danish obtained a Cronbach’s alpha coefficient of 0.74. The evaluation of responsiveness showed improvement, but was not statistically significant.ConclusionThe IcanSDM_Danish has good cross-cultural validity and internal consistency, and a 2-factor structure. The IcanSDM_Danish is capable of providing reliable and valid measurement when evaluating constructed knowledge about shared decision making, and may be able to support the implementation of shared decision making training and evaluation of its impact.

Patient-Reported Outcomes in RLBP1 Retinal Dystrophy: Longitudinal Assessment in a Prospective Natural History Study.

To evaluate the performance of two non-disease-specific patient-reported outcome (PRO) instruments, the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and the Low Luminance Questionnaire (LLQ), in patients with retinaldehyde-binding protein 1 retinal dystrophy (RLBP1 RD). PROs were assessed using the VFQ-25 and LLQ. Rasch analysis was conducted to estimate person and item measures of the VFQ-25 and LLQ questionnaires to determine the association between the two PROs. In addition, the association between these two instruments and their correlations to weighted measures of visual function and disease progression were analyzed in this three-year PRO-focused sub-study of a five-year prospective natural history study. Forty-two patients participated, with most of them having completed at least two PRO follow-up visits at least one year apart. The mean VFQ-25 scores were lowest for distance activities (39.2-49.0) and peripheral vision (37.5-52.4), with mean LLQ subscale scores generally low (<41), except for the emotional distress subscale. Using Rasch analysis, calibrated item and person measures along with their standard errors were estimated for both ePROs. This indicated that the distribution of the VFQ-25 and LLQ item measures well covered the distribution of person function in this group. This suggests that the item difficulties well cover the person-level performance in this population. As well, the two PROs showed a strong and significant correlation at all assessed time points as assessed with Pearson correlation coefficient (0.81, 0.91, 0.81 and 0.87 at baseline, 1/1.5, 2/2.5 (P < 0.001) and 3/3.5 years (P = 0.002)). The composite scores of both PRO questionnaires strongly correlated with clinical measures of visual function. At 2 to 2.5 years of follow-up, meaningful statistically significant declines in peripheral vision (both VFQ-25 and LLQ), distance vision (VFQ-25), and extreme lighting in dark and bright light (LLQ) subscales were noted. This study demonstrated a strong association between VFQ-25 and LLQ scores and their association with clinical measures of visual function. PRO instruments can provide insights into the specific disabilities of this unique patient population and help to guide appropriate outcome measures for future clinical trials.

Developing and Validating the Health Literacy Scale for Migrant Workers: Instrument Development and Validation Study.

Research concerning health literacy among migrant workers in South Korea has been limited, especially given the lack of validated instruments and the lack of focus on the cultural diversity of migrant workers. This study aimed to develop and validate a health literacy scale for unskilled migrant workers (HLS-MW) in South Korea. We first generated a pool of potential items based on a literature review and in-depth interviews with 23 migrant workers. Subsequently, we reviewed empirical referents from the first step to select relevant medical terminologies and passages, ultimately choosing 709 words. The study team initially generated 35 items with 709 health-related terms through empirical referent reviews. After content validity testing by an expert panel, 28 items comprising 89 terms on the 2 subscales of prose and documents were selected for psychometric testing. Overall, 402 unskilled migrant workers in South Korea completed a web-based survey between August and September 2021, with 334 responses included in the final analysis. We used multiple analytic approaches, including exploratory factor analysis, Rasch analysis (item response theory), and descriptive analysis, to examine the new scale's validity and reliability. The final sample primarily included young male workers from South Asian countries. The HLS-MW yielded 2 factors: prose and documents. The item difficulty scores ranged from -1.36 to 2.56. The scale was reduced to 13 items (10 prose and 3 document items), with the final version exhibiting good internal reliability (Kuder-Richardson index=0.88; intraclass correlation coefficient=0.94, 95% CI 0.93-0.95) and test-retest reliability (r=0.74, 95% CI 0.57-0.92). HLS-MW scores differed significantly by Korean language proficiency (F2,331=3.54, P=.004). The HLS-MW is a reliable and valid measure to assess health literacy among migrant workers in South Korea. Further studies are needed to test the psychometric properties of the HLS-MW in diverse migrant groups in South Korea while also establishing cutoffs to help identify those in need of health literacy support.

Psychometric properties of a COVID-19 health literacy scale in a sample of German school principals applying Rasch analysis

BackgroundDuring the COVID-19 pandemic, health literacy was found to be an asset to manage health-related information. The HLS-COVID-Q22 has been developed to measure COVID-19 health literacy. External validation needs to be assessed in different populations to verify the questionnaire’s functioning. The present study aimed to evaluate the psychometric properties of the HLS-COVID-Q22 in a sample of German school principals.MethodsThe sample consisted of 2187 German school principals who completed the HLS-COVID-Q22 online from April to March 2021. The data was analyzed using Rasch analysis, applying the Partial Credit Model for polytomous data. Dimensionality, item fit statistics and rating scale functioning was tested. Values for item difficulty and person ability as well as reliability indices were computed.ResultsUnidimensionality could be confirmed. The rating scale categories worked as intended, participants used every rating step category. Generally, item fit was verified. One item showed potential misfit but could remain in the questionnaire as excluding the item did not reduce reliability. A person separation index of 3.41 and person reliability of 0.92 showed excellent differentiation between COVID-19 health literacy levels. Furthermore, the values for item separation of 20.08 and item reliability of 1.0 indicate good construct validity.ConclusionsThe German version of the HLS-COVID-Q22 appears to be a reliable measurement tool for the target population. Evidence for construct, statistical and fit validity was collected. Future studies need to test additional types of validity like convergent and divergent validity to further evaluate the questionnaire. Moreover, the psychometric properties of the translated versions of the HLS-COVID-Q22 should be compared using Rasch analysis.

Psychometric properties of the Ethiopian national licensing exam in medicine: an analysis of multiple-choice questions using classical test theory

Background : The Ethiopian Ministry of Health introduced medical licensure examinations to maintain high standards in medical practice and build public trust in healthcare professionals. Studies also suggested significant issues in clinical competence among Ethiopian junior doctors as well concerns regarding unlicensed practice. Given the need to ensure safe health care, we investigated the psychometric properties of the multiple-choice items comprising the Ethiopian national licensing exam (NLE). These analyses help to provide an argument for the validity and reliability of the test scores. Method : We used a cross-sectional study design to analyze data from three cohorts of undergraduate medicine licensing examinations in Ethiopia (2020-2022, N = 2,213). Using Classical Test Theory, we assessed the psychometric properties of 600 MCQ items with 2400 single best answer choices, specifically item difficulty, item discrimination, and the number of nonfunctional distractors, and scale reliability. We provide results regarding the overall test and its sub-domains. Results : Ethiopia’s undergraduate medical licensure examination demonstrated acceptable reliability (Alpha > 0.80), with significant variability in item difficulty and examinee performance. Although these results indicate a sufficiently defensible exam, our results point to issues regarding item statistics, especially a high number of nonfunctional distractors. Conclusions : This study provides first evidence regarding the psychometric soundness of the Ethiopian NLE. However, a significant number of items should be carefully reviewed and possibly revised. As the examination is relatively new, ongoing refinement to item-development and review processes is essential to improve and ensure its quality.

Dysphagia-Specific Instrument Based on Item Response Theory and International Classification of Functioning, Disability and Health.

This study aimed to identify functional challenges faced by individuals with non-esophageal dysphagia and to offer a tool for quantitatively evaluating the person abilities within the framework of the International Classification of Functioning, Disability and Health (ICF). Additionally, this study attempted to differentiate the personal abilities of individuals with dysphagia and hierarchize item difficulties using the ICF-based Item Response Theory (IRT) modeling approach. This cross-sectional study enrolled a cohort of 150 patients with dysphagia (105 male and 45 female) from a tertiary hospital in China. Participants were assigned to evaluate the 114-item ICF dysphagia questionnaire. To further assess their swallowing capabilities, eating patterns, quality of life, and nutritional status, participants underwent a battery of five additional scales. The ICF qualifiers underwent data shaping including dichotomization and missing value imputation, Mokken scale analysis (MSA) for checking unidimensionality, local independence, monotonicity, and invariant item ordering (IIO), and parametric IRT modeling for identifying an optimal model from the 1-parametric logistic model (1PLM), 2PLM, 3PLM, and 4PLM. Finally, we tested the robustness of the optimal model via Monte Carlo simulation and illustrated the usefulness of the model by its person-item map. The 1PLM emerged as the optimal model with a total of 50 ICF items (12 'd-Activities and Participation', 33 'b-Body Functions', and 5 'e-environmental' items). The final scale presented strong reliability with Cronbach's Alpha = 0.967. Furthermore, the scale showed good validity with a significant positive correlation (p < 0.001, = 0.60) between model-estimated person abilities and swallowing-quality of life (SWAL-QoL) scores. The findings also demonstrated measurement equivalence of the final model for individuals with different genders or across various age groups. The utilization of the person-item map can effectively compare the difficulty levels of items with the abilities of patients, thereby facilitating the delivery of tailored care and precise rehabilitation strategies that match the individual competency of those suffering from dysphagia. This study developed a parsimonious dysphagia-specific ICF outcomes tool derived from the IRT, named iSWAL-Performance Scale. The findings complement quantitative information on the psychometric characteristics of this 50-item scale.

The Wellbeing Thermometer in Patients with Colorectal Cancer: A Validation Study.

Wellbeing is a valuable outcome with benefits for patients and the wider healthcare system. Different instruments are available to measure wellbeing; however, each has its own limitations. Existing wellbeing models focus mostly on a single aspect (e.g., social). The Wellbeing Thermometer (WbT) was developed based on a more holistic framework for wellbeing. The aim of this research was to validate the WbT on patients receiving treatments using a sample of patients with colorectal cancer in England. A survey, including GAD-7, PHQ-9, WHO-5, and WbT, was administered to two independent cohorts of adult patients diagnosed with colorectal cancer. The WbT consists of 25 questions/items: 5 for each domain of health, thoughts, emotions, spiritual, and social. We investigated the psychometric properties of the WbT to characterize item difficulty, discrimination, and reliability. Pearson's correlation coefficient was used to compare WbT scores to those from other validated tools. A multivariable logistic model explored associations between WbT domains and other validated tools. Cronbach's alpha for WbT was 0.872 (95% confidence interval: 0.829-0.902), indicating good internal consistency. The item difficulty for WbT showed low scores for questions 6 (0.39) and 9 (0.49) and high scores for the other items. Item 3 in the health subgroup indicated weak discrimination towards the health item score (r = 0.35) and no discrimination towards the total score (r = 0.03). Item 1 in the spiritual subgroup showed weak discrimination towards the spiritual item score (r = 0.37). The WbT showed moderate to strong correlation with all other validated tools (r range: GAD-7, -0.49 to -0.77; PHQ-9, -0.69 to -0.83; WHO-5, 0.66 to 0.85). For Cohort 1, the WbT thought domain was associated with GAD-7 (p = 0.004) and WHO-5 (p = 0.002), and the health domain was associated with PHQ-9 (p = 0.014). For Cohort 2, the WbT thought domain was associated with GAD-7 (p = 0.02), the health domain was associated with WHO-5 (p = 0.02), and the emotion domain was associated with WHO-5 (p = 0.02). The WbT is a valid tool for assessing wellbeing in patients with colorectal cancer. The WbT may be a useful addition to both clinical practice and future research and may help shed light on a new area with regards to patients with cancer, specifically how they feel and function. This will ultimately increase wellbeing and reduce suffering.

Development of Essential Thinking Test Instrument using the Presseisen Taxonomy on Ecosystem Material for Grade X High School Students

The test instrument is a measuring tool in the assessment process used to obtain information in the form of data on student learning outcomes, both cognitive aspects and thinking skills. The use of test instrument to measure students' thinking skills is still rarely used. This study aims to develop an essential thinking test instrument using the Presseisen taxonomy on valid and reliable ecosystem material. This research uses the Research Development (RD) method with the 3D modified development model combined with the test development stages consisting of 6 stages. Data collection in this research was carried with interviews, tests, and test instrument validation sheets. The analysis included content validity analysis, interrater reliability, and Rasch model analysis. The results showed that all items were valid based on content validity. Interrater reliability has a value of 0.783 with a good category. All items are declared fit, but item number 7 contains bias so it needs to be discarded. Cronbach's alpha has a value of 0.68 in the enough category, person reliability has a value of 0.50 in the weak category, and item reliability has a value of 0.99 in the excellent category. The item difficulty level group consists of 2 very difficult questions, 4 difficult questions, 2 easy questions, and 2 very easy questions. Based on the result of the research, it can be concluded that there are 9 items that are declared valid and reliable for use.