Likert-type Format Research Articles

A brief scale for assessing patients' satisfaction with care in outpatient psychiatric services.

The authors evaluated the reliability and preliminary validity of the Charleston Psychiatric Outpatient Satisfaction Scale, a 15-item measure of patients' satisfaction designed for use in outpatient settings. The instrument uses a 5-point Likert-type response format that minimizes positive response bias and optimizes variability and predictive validity. The Charleston Psychiatric Outpatient Satisfaction Scale was administered to 282 patients seen in psychiatric outpatient clinics affiliated with a public-academic psychiatric institution over a one-week period in 1995. The internal reliability of the instrument was high (alpha=.87), and its convergent validity was supported by the significant correlation of all items with anchor items that measured overall satisfaction with care and likelihood of recommending the clinic to others. The best predictors of overall ratings of care were the items measuring patients' satisfaction with helpfulness of the services and with the respect shown for patients' opinions about treatment. The best predictors of recommendation of the program to others were the items measuring satisfaction with matching of the treatment plan to patients' individual needs and with the respect shown for patients' opinions about treatment. Mean scores for all items ranged from 3.6 (satisfaction with parking) to 4.5 (satisfaction with helpfulness of the secretary and with the overall quality of care), indicating that overall satisfaction in this sample was high. The results provide preliminary support for the reliability and validity of the Charleston Psychiatric Outpatient Satisfaction Scale:

Measuring comfort in caregivers and patients during late end-of-life care.

The purpose of this study was to test several formats of end-of-life comfort instruments for patients and closely involved caregivers. Kolcaba's Comfort Theory was the theoretical framework utilized. Different response formats for two end-of-life (EOL) comfort questionnaires (for patients and caregivers, respectively), and horizontal and vertical visual analog scales for total comfort (TC) lines were compared in two phases. Evaluable data were collected from both members of 38 patient-caregiver dyads in each phase. Suitable dyads were recruited from two hospice agencies in northeastern Ohio. Cronbach's alpha for the EOL comfort questionnaire (six response Likert-type format) tested during phase I for patients was .98 and for caregivers was .97. Test-retest reliability for the vertical TC line tested during phase I for patients was .64 and for caregivers was .79. The implications of this study for nursing practice and research are derived from the American Nursing Association (ANA) position statement about EOL care, which states that comfort is the goal of nursing for this population. These instruments will be useful for assessing comfort in actively dying patients and comfort of their caregivers as well as for developing evidence-based practice for this population.

Following medical school graduates into practice: residency directors' assessments after the first year of residency.

Following medical school graduates into practice: residency directors' assessments after the first year of residency.

Empirical evidence for the nature of holistic comfort.

The nursing outcome of holistic comfort encompasses physical, psychospiritual, social, and environmental aspects of human nature. The primary purpose of this study was to test four propositions about the nature of comfort: (a) Comfort has equal proportions of state and trait characteristics; (b) comfort is sensitive to changes over time; (c) when subjects are exposed to an effective intervention, they demonstrate differences in comfort that increase in a linear way compared to a control group; and (d) the whole (total comfort) is greater than the sum of its parts (relief plus ease plus transcendence). A secondary purpose of this study was to present preliminary concurrent validity between two types of comfort instruments, a traditional questionnaire with a Likert-type format and visual analog scales. Findings were positive for all theoretical propositions and moderate concurrent validity between the Radiation Therapy Comfort Questionnaire and the visual analog scale for total comfort was demonstrated.

Patient satisfaction in a dental school.

The objective of this study was to measure patients' satisfaction with the facility, services and treatment received at a dental school clinic. The 31-item questionnaire consisted of demographic items and items in a 5-point Likert-type format addressing issues such as security, satisfaction with the facility, helpfulness of the staff, progress of treatment, fees, universal precautions taken, quality of care and treatment with dignity and compassion. The questionnaire also asked whether the patient would recommend the school to others seeking dental care. In 1997, patients completed the survey in the clinic waiting room prior to their dental appointment for that day. The survey was conducted over 3 months until 500 patients had participated, representing about 16% of the active patient population. %s of responses were computed and cross tabulations were used to compare responses based on demographics. The most frequently reported reason for wanting to be a patient at the dental school was low cost (67%) followed by up-to-date care (19%). 45% of patients indicated that a friend, neighbour or relative referred them, followed by 34% indicating referral by a dentist. More than 90% responded positively to the items concerning issues related to treatment except for satisfaction with progress of treatment and comparison of care received at the school to care elsewhere. For these 2 items, at least 80% responded positively. 99% indicated they would recommend the dental school to others seeking dental care. Results indicate that the vast majority of the patients surveyed are satisfied with the facility, services and treatment received. Comments that addressed areas of concern included the length of time to get an appointment and the length of time the appointment took, and it was recommended that the process of treatment be expedited.

The development of the Child Psychotherapy Process Scales (CPPS)

This article presents the development of a new measure to describe and evaluate the process of child psychotherapy. Consisting of 15 child and 18 therapist items in five-point Likert-type format, the Child Psychotherapy Process Scales (CPPS) were modeled after widely used adult process scales. Three raters reliably scored 105 twenty-minute segments of child psychotherapy using the 33 items. Principal component analyses revealed three child factors (therapeutic relationship, child therapeutic work, and child readiness) and three therapist factors (therapist technical work, therapeutic relationship, and technical lapse) which described both positive and negative aspects of the therapy process. Confirmatory P-technique analyses revealed that the structure of therapist and child insession discourse differed significantly across high and low CPPS-scored sessions. Discussion relates CPPS factors to those obtained in the adult literature and to child process factors obtained using clinician and child self-report...

The structure and measurement of death obsession

A new concept of death obsession has been introduced and its scale has been constructed. The scale contains 15 items with a Likert-type format. It has good face, construct, concurrent and discriminant validity, as well as good internal consistency and stability. Three factors were disclosed: death rumination, death domination and death idea repetition. It correlated positively with death anxiety, death depression, general obsession, general anxiety, and general depression. Two high-loaded factors were extracted: death distress and general neurosis. The Death Obsession Scale correlated positively with neuroticism, while its correlation with extraversion was not significant. There were no gender differences between the mean scores.

Academic Deansʼ Views on Curriculum Content in Medical Schools

To determine which of 33 topics academic deans identify as worthy of greater emphasis in medical curricula. Also, to assess the barriers to needed curricular changes. In March 1996 a questionnaire was developed and mailed to the academic deans of all U.S. schools affiliated with the Association of American Medical Colleges (n = 126) and all schools associated with the American Association of Colleges of Osteopathy (n = 17). There were 46 questions in a five-point Likert-type format (1 = not at all, 5 = to a great extent) and one open-ended question. The deans were queried as to what extent each of 33 topics (1) was included in medical students' required learning experiences (current emphasis) and (2) should be included in medical students' required learning experiences (ideal emphasis). The deans were also asked to what extent they believed 12 different factors would be barriers to needed curriculum changes in their programs. Primary data analysis focused on simple comparisons of response means and frequencies. Two separate mailings resulted in the return of 100 questionnaires (70%): 85 from the allopathic schools (67%) and 15 from the osteopathic schools (88%). "Effective patient-provider relationships/communication," "outpatient/ambulatory care," and "health promotion/disease prevention" had the three highest mean ratings for ideal emphasis by the allopathic school deans. "Primary care," "professional values," and "use of electronic information systems" also had high mean rankings for ideal emphasis. "Primary care," "outpatient/ambulatory care," and "health promotion/disease prevention" had the three highest mean ratings for ideal emphasis by the osteopathic school deans. Changes in health care delivery and an increasing generalist orientation are influencing academic deans' perspectives on needed curriculum changes, and there appears to be considerable support for medical school curricula that will foster a broader, more humanistic role for physicians.

Development and psychometric properties of the Ethics Environment Questionnaire.

The author reports on the development and the psychometric properties of the Ethics Environment Questionnaire (EEQ), an instrument by which to measure the opinions of health-care providers about ethics in their clinical practice organizations. The EEQ was developed to increase the number of valid and reliable measures pertaining to ethics in health-care delivery. The EEQ is a 20-item self-administered questionnaire using a Likert-type 5-point format, offering ease of administration. It is applicable to a cross-section of health-care practitioners and health-care facilities. The mean administration time is 10 minutes. The EEQ represents testing on 450 respondents in acute care settings among a cross-section of acute care facilities. Internal consistency reliability using Cronbach's alpha coefficient is 0.93, and the test-retest reliability is 0.88. Construct, content, and criterion validity are established. The scale is unidimensional, with factor loadings exceeding the minimum preset criterion. Mean score is 3.1 out of 5.0, with scores of 3.5 and above interpreted as reflective of a positive ethics environment. The EEQ provides a measure of ethics in health-care organizations among multi-practitioners in clinical practice on a valid, reliable, cost effective, and easily administered instrument that requires minimum investment of personnel time.

Effects of Number and Type of Response Choices on Internal Consistency Reliability

The purpose of this study was to examine the effects on Cronbach coefficient alpha, an estimate of internal consistency reliability, of altering the number and type of item-response choices on measures administered to two independent samples ( ns, 492 and 730). An increase in the number and type of response choices (from true/false format to four-choice Likert-type format) significantly increased the internal consistency reliability estimate.

The Making of an Oral Sex Questionnaire

The Oral-Genital Sex Attitude and Behavior (OSAB) questionnaire was developed as an assessment instrument for the investigation of oral-genital sex attitudes and behaviors. The OSAB questionnaire consists of 52 positively and negatively worded statements, presented in a Likert-type format. Statements pertained to receiving and performing oral-genital sex. Data were collected from 274 male and female undergraduate introductory psychology students who participated for partial fulfillment of course credit. Analysis of the OSAB revealed a test-retest reliability of r = .81, p < .001 with an average interitem correlation of .04. It contains seven major factors, accounting for 50.9% of the variance. The OSAB has been determined to possess high face validity.

Self-scenarios as a repeated measures outcome measurement of self-schemas in short-term cognitive therapy

As the role of self-representation has begun to figure more prominently in clinical theories of emotional disorder, a number of assessment methodologies have been developed to measure this construct. This report describes the construction and use of self-scenarios, an idiographic interview-based measure of self-schemas. Self-scenarios depict highly distressing events that consist of four components, which reflect schematic structure: a stimulus situation and cognitive, affective, and motoric responses. They are scaled in a 9-point Likert-type format on multiple parameters and can be rated following each therapy session, thus providing for longitudinal tracking of self-schemas over the course of treatment. This study of a repeated single-subject design analyzed data of eight cases with variable outcome from short-term cognitive therapy. The results indicated high intraclass correlation coefficients calculated from ratings on clinical relevance of the components by the patient, therapist, and third-party observer who constructed the scenarios, thus supporting the interrater reliability and concurrent validity of the measurement methodology. They also provided some evidence of discriminant validity, based on differences between patient initial parametric ratings of clinically

The development of an idiographic measure of self-schemas: An illustration of the construction and use of self-scenarios.

This article describes self-schema as a theoretically integrative construct, reviews the literature, and presents an assessment approach called selfscenarios. Self-scenarios represent an idiographic measure of dysfunctional schemas, defined as cognitive-aff ectivemotoric structures. They depict highly distressing events that consist of a stimulus situation and cognitive, affective, and motoric responses, which reflect schematic structure. They are scaled in a Likert-type format on the following parameters: frequency, preoccupation, accessibility, alternative thinking, self-efficacy, self-view, interpersonal-view, and chronicity. This article also includes results regarding the psychometric properties of selfscenarios and their use in a singlesubject outcome study of a time-limited psychotherapy.

The Development and Concurrent Validity of the Procrastination Scale

The purpose of this study was to develop a self-report measure of procrastination tendencies and to investigate its relationship to a behavioral measure of procrastination and to a self-report measure of general self-efficacy. In a pilot study, the 72-item scale in a 4-point Likert-type response format was developed and administered to 50 college juniors and seniors. A factor analysis of the results yielded two factors which formed the basis for reducing the scale to 35 items with a resulting reliability of .90. The relationship between scores on the 35-item instrument and performance on a self-regulated performance task called the Voluntary Homework System (VHS) yielded a correlation of -.54, and a coefficient of -.47 was observed between the 35-item scale and the General Self-Efficacy Test (GSE; both correlations of p &lt; .001). The correlation between GSE and VHS scores was .29 ( p &lt; .05). In a subsequent study of 183 college students, a factor analysis of scores on the 35-item scale yielded a single-factor structure and a condensed scale of 16 items with a reliability of .86. This shortened version of the procrastination scale was recommended for use as a means of detecting students who may tend to procrastinate in the completion of college requirements.

Some scales for assessing personality based on Carl Rogers' theory: Further evidence of validity

The Feelings, Reactions, and Beliefs Survey (FRBS) is designed to assess nine personality variables derived from Carl Rogers' theory of the structure of personality. The variables are: Focusing Conscious Attention (FCA), Openness to Feelings in Relationships (OFR), Trust in Self as an Organism (TSO), Fully Functioning Person (FFP), Feeling Uncomfortable with People (FUP), Struggling with Feelings of Inferiority (SFI), Feeling Ambivalent in Relationships (FAR), Openness to Transcendent Experiences (OTE), and Religio-spiritual Beliefs (RSB). Sample items are given for each scale, with responses of high and low scorers (given as direction on a Likert-type response format). Scale reliabilities, intercorrelations, and external validity data are given on a large sample of college students ( n = 463), and compared with previous results from the same population. Results for the two samples were comparable in most respects.

Measurement of stress in clinical nursing

The Nurse Stress Checklist was developed to measure stress in clinical nursing as a multidimensional construct. The instrument was formulated within a transactional model of stress. The items were derived from five domains thought to contribute to nurse stress in clinical settings and were organized into a questionnaire. Holmes Schedule of Recent Events was included as a validity measure. The instrument was tested on 104 staff nurses working in three institutions in an urban community. Exploratory factor analysis was applied to the 74 items presented to subjects in Likert-type format. Five factors were derived and subjected to psychometric evaluation. Internal consistency reliability for the five factors was good, ranging from 0.80 to 0.91. Means and measures of dispersion supported the potential of the five subscales to discriminate among respondents on the attributes being measured. Intercorrelations of the factors provided evidence of the distinctiveness of the five components of stress, although factor loadings showed some overlap between Personal Reactions and Work Concerns and Work Concerns and Work Completion Concerns. Validity of the factors also was supported by correlations with Holmes' Schedule of Recent Events. Content validity was supported by comparison of these results with findings of other investigators. Limitations of the results are discussed, and recommendations for future work on the instrument are offered.

The QUALCARE Scale: developing an instrument to measure quality of home care

In previous research, the theoretical and methodological problems associated with operationalizing elder abuse have been multiple. The QUALCARE Scale was developed in response to the documented problems. The scale is an observational rating scale designed to quantify the quality of family caregiving to home-dwelling elders in six areas: physical, medical management, psychosocial, environmental, human rights and financial. The scale is a 53 item scale in a Likert type format. The QUALCARE Scale is completed by professional nurses after a nursing assessment of the degree to which the caregiver meets the needs of the elder in the six dimensions. The nursing assessment involves both observations and verbal data gathering. In this paper, the development of the scale and the methodological issues associated with scale development are discussed.

A rating scale for assessing dysphoria in youth.

A rating scale (RSD) for children and adolescents was developed consisting of 12 items from the Peer Nomination Inventory of Depression (Lefkowitz & Tesiny, 1980) converted to a Likert-type format for obtaining self-ratings or ratings by significant others of dysphoria. The measure was administered to 784 mothers whose children's modal age was 10 years. Longitudinal data were gathered for 124 of these mother-child pairs after an interval of 2 years and for 133 mother-child pairs after an interval of 4 years. At the second interval, 82 of the 133 children's fathers also contributed RSD data. Analyses of reliability and validity indicate that the RSD possesses adequate psychometric properties and may be used for purposes of research and screening, and, experimentally, for clinical assessment.

Latent Class Analysis of Survey Questions that Include Don't Know Responses

Latent Class Analysis of Survey Questions that Include Don't Know Responses

The Revised Asthma Problem Behavior Checklist.

The Asthma Problem Behavior Checklist (APBC) has proved to be an accurate and invaluable instrument for pinpointing potential behavioral problems in children with the disorder. This article presents the Revised Asthma Problem Behavior Checklist (RAPBC). The value of the RAPBC is that: (a) it has proven reliability when tested with asthmatic adults; (b) the change from a dichotomous yes/no format, used in the APBC, to a 5-point Likert-type answer format adds greater sensitivity to the instrument; and (c) data gathered with the RAPBC compare favorably to information gathered in two previous studies with the APBC. Considering the reliability and validity of the RAPBC, it should prove useful in both clinical and research settings.