Development and Validation of a Health Measure for Down Syndrome.

This study intended to developed test psychometric properties of a scale assessing Turkish preservice teachers’ self-efficacy regarding trauma informed teaching. Employing a sequential mixed-methods design, the study began with qualitative interviews with 30 experienced educators to generate item content. This was followed by pilot testing with 22 participants and psychometric validation with 629 preservice teachers (305 for exploratory factor analysis [EFA], 324 for confirmatory factor analysis [CFA]). Principal component analysis with oblique rotation revealed a two-factor structure - Understanding of Trauma Effects (6 items) and Trauma Intervention Skills (6 items) -accounting for 53.79% of the total variance, with an interfactor correlation of r = .550. CFA supported the two-factor model with excellent fit. Internal consistency was strong for both the total scale and the subscales. Likewise, split-half reliability coefficients were high. Convergent validity was supported by moderate positive correlations with social-emotional learning competencies, while discriminant validity was supported by predominantly weak correlations with experiential avoidance. The TICSES fills a critical measurement gap in trauma-informed education by offering a psychometrically sound tool for assessing preservice teachers’ readiness to support trauma-affected students and for evaluating the impact of related professional development efforts.

This study developed and validated the Critical Right Scale (CRS) to measure emerging critical right attitudes and revised the Critical Social Justice Attitudes Scale (CSJAS-R), replicating its psychometric evaluation. A nationwide convenience sample of Finnish adults (n = 626) completed an online survey. Item screening used exploratory factor analysis with oblique rotation and loading and residual correlation criteria. Confirmatory factor analysis (CFA) and measurement invariance testing were conducted in lavaan using full information maximum likelihood. The final CRS consisted of five items with high reliability (α = 0.89, ω = 0.90) and good model fit in both male and female subsamples, with pooled-sample residual misfit judged minor given subgroup results. The CSJAS-R comprised six items with strong reliability (α = 0.88, ω = 0.89) and excellent fit. Both scales met configural and metric invariance; partial scalar invariance was achieved after freeing a small number of item intercepts. CRS scores were strongly associated with right-wing and conservative self-placement with higher scores concentrated among Finns Party and Christian Democrat voters, and weakly linked to perceived oppression. CSJAS-R scores were strongly associated with left-wing and liberal self-placement with higher scores concentrated among Left Alliance and Greens voters, had a small-to-moderately associated with justification of political violence. CRS and CSJAS-R were strongly negatively correlated (r = -0.62), indicating divergent validity. Both CRS and CSJAS-R demonstrated strong psychometric properties and distinct ideological profiles, providing validated tools for studying political attitude structures at opposing ends of the ideological spectrum.

Introduction: Women in the perinatal phase experience significant physical and emotional changes, heightening their vulnerability to mental health disorders, particularly Perinatal Depression (PND). Healthcare Workers (HCWs) are often the first point of contact for expectant or new mothers, yet studies indicate poor awareness of PND among HCWs in India. This gap underscores the need for a validated tool to assess and improve HCWs’ understanding of PND. Aim: To develop and validate a tool to measure awareness of PND among HCWs. Materials and Methods: The cross-sectional study for instrument development and validation was conducted in Anand, Gujarat, Western India, using a three-round Delphi technique with 16 experts from Obstetrics, Psychiatry, Community Medicine, Social Work, and Paediatrics. Thirty questions were selected through consensus and rated for relevance on a 5-point Likert scale. After pilot testing, the tool was administered to 200 HCWs. Exploratory Factor Analysis (EFA) using principal axis factoring with oblique rotation was employed for validation. The number of respondents for the validation part was 170 for the 30 item questionnaire. Statistics and Data (STATA) 14 was used for analysis, with p<0.05 considered statistically significant. Results: EFA revealed a four-factor structure explaining 58.66% of the variance. The model showed excellent fit: Bartlett’s test of sphericity (p<0.001) and Kaiser-Meyer-Olkin (KMO=0.878). The factors included: Risk Factors and management strategies (9 questions), myths and misconceptions (4 questions), symptoms of maternal depression (3 questions), screening and treatment (2 questions). The tool demonstrated high internal consistency (Cronbach’s α=0.854). Conclusion: This validated 18-item scale reliably assesses PND awareness among HCWs in West India. It serves as a foundation for targeted educational interventions to enhance maternal mental healthcare.

To psychometrically validate a comprehensive core competence (3C) instrument to measure the core competence of healthcare professionals in clinical settings. Instrument development and validation study. This study focused on the fourth phase of instrument development and validation, which involves refining the scale and assessing its psychometric properties. Secondary data from self-reported assessments of core competency levels by healthcare professionals (628 nurses and 450 physicians) working at healthcare institutions in Oman were used. Structural validity was examined via exploratory factor analysis using oblique rotation (Promax). The stability of factorial validity was assessed through transformation analysis and invariance testing using confirmatory factor analyses. Internal consistency was evaluated using Cronbach's alpha. The development and validation process produced a 3C instrument including 39 items across 11 factors: research and innovation (4 items), patient sustainable care (5 items), strategic leadership (4 items), safety promotion (3 items), tech integration (3 items), quality excellence (4 items), collaborative care delivery (4 items), professional growth (3 items), communication excellence (3 items), ethics and compliance (3 items) and professional practice (3 items). The instrument explained 65.3% and 67.6% of the total observed variance for nurses and physicians, respectively, with Cronbach's alpha for each component above the minimum acceptable value of 0.70. The 3C instrument, developed through structured validation, comprehensively assesses healthcare professionals' core competencies, bridging the gap in existing tools with robust psychometric properties. Healthcare professionals must develop robust and versatile core competencies to address increasing quality and safety patient care demands, escalating costs, unsustainable delivery models and rising stakeholder expectations. The developed 3C instrument is valuable for (1) comprehensively assessing core competencies, (2) suggesting an immediate and short-term action plan and (3) stimulating policies to drive the transformation of the delivery system over the longer term. No patient or public contribution.

Linguistic and acculturation variables are known to influence cognitive performance on neuropsychological measures used to assess cognitive impairment and dementia. It is not clear, however, how to best measure these variables in an Australian context to improve cognitive assessment of older adults from culturally and linguistically diverse (CALD) backgrounds. We therefore developed a new measure, the Characterising Language Experience and Acculturation Questionnaire (CLEAr-Q) and used Exploratory Factor Analysis (EFA) to determine the underlying factor structure. An online version of the CLEAr-Q was developed using items drawn or modified from the literature with consultation from a CALD community working group via an adapted participatory research framework. It was administered in English via an anonymous survey. From the initial 52 items, 31 were considered for further analysis. EFA with oblique rotation (geomin) was used. The validation sample included 256 participants aged 60-93 (Table 1) born outside of Australia and reporting a native Language Other Than English (LOTE). EFA suggested a four-factor solution: Educational Exposure to English, English Proficiency and Identification with Majority Culture, Dominance of English Language and Culture, and Language Switching. The model fitted well with the data, with Comparative Fit Index (CFI)=0.98 and Standardised Root Mean Square Residual (SRMR)=0.07. In combination, these factors explained 58.9% of the variance. Table 2 presents factor loadings. The present study demonstrates the utility of the CLEAr-Q in characterising the diversity in linguistic and acculturation variables in an Australian CALD sample. Our results also inform item selection for a streamlined version of the CLEAr-Q. The factor structure provides evidence for the interwoven relationship between linguistic and acculturation variables and supports the need for a comprehensive tool, rather than simple proxies, to understand the influence of cultural and linguistic diversity on cognitive assessment. In future work we will investigate the relative importance of the four CLEAr-Q factors in predicting cognitive performance, which is expected to improve diagnostic accuracy of current neuropsychological measures in assessing cognitive impairment and dementia in older adults from CALD backgrounds.

Structural validity of the MABC-2 in European and African children: An analysis of age band 2.

BackgroundTranscultural adaptation and psychometric validation of cognitive assessment tools developed in high‐income countries (HICs) is essential for fair use in low‐ and middle‐income countries (LMICs). This study aims to evaluate the factor structure of a multi‐domain, multi‐modal (paper/pencil & digital) cognitive test battery and whether it conforms to globally recognized neuropsychological domains in cognitively unimpaired (CU) multilingual Kenyan adults.MethodA neuropsychological test battery was administered to an initial sample of 135 CU adults [36% males; mean (sd) age: 55 (7) y, range: 44‐ 79 y] and an independent validation sample of 218 CU adults (42% males; mean (sd) age: 52 (11) y, range: 35‐81 y). Exploratory factor analysis (EFA) was conducted in the initial sample using Principal Axis Factoring (PA) with oblique rotation (Promax) and confirmatory factor analysis was conducted in the independent sample. Input features were aligned across samples and included subtest scores from classic word list learning, story recall, and semantic fluency tests (NIH HCAP battery), as well as novel tablet‐based tests (Tablet‐based Cognitive Assessment Tool [TabCAT] Flanker, Match, Set‐Shifting, Birdwatch).ResultEFA revealed a three‐factor structure that explained 62.6% of the total variance. Episodic memory subtests loaded strongly on Factors 1 and 2. Factor 1 loadings included word learning (0.8), delayed word recall (1.0), and word recognition (0.7). Factor 2 loadings included immediate story recall (1.0) and delayed story recall (1.0). Factor 3 loadings included measures of attention, executive function, and visual associative memory from TabCAT (Match: 0.8, Set‐shifting: 0.9, Flanker: 0.5, and Birdwatch: 0.4). The language variable demonstrated very weak factor loadings across all 3 factors (PA1 = 0.1, PA2 = 0.2, PA3 = 0.3). The CFA showed moderate model fit, after adding one covariance between delayed story recall and word recognition, as per modification indices (χ 2 = 62.72, DF = 23, N = 218, p < .001, RMSEA = .089, CFI = . 963, TLI = .943, SRMR = .055).ConclusionFindings support the construct validity of a multi‐domain cognitive test battery in Kenyan adults, although the low loading of semantic fluency suggests the need for further modification to enrich the language domain in this multilingual population.

BackgroundAs the prevalence of dementia rises, organizations and communities have recognized the importance of having dementia‐friendly spaces and are developing programs to meet the needs of people living with memory loss and their families. Despite the increase in dementia‐friendly programs and settings, there is a dearth of tools to assess and measure the level of dementia‐friendliness in small communities such as churches and community centers.MethodIn partnership with African American church communities across the state of Georgia, we developed a person‐centered Dementia‐Friendly Community Assessment tool in multiple phases. Following our initial pilot testing and refinement through focus groups with church members, leaders, and advisory board members, we finalized and fielded a survey across 15 churches. The survey included questions about resources and environment modifications; dementia knowledge and skills; and three separate dementia‐related stigma scales administered based on self‐identified role. Following univariate and bivariate analyses, we conducted principal component analysis with oblique rotation to reduce items and identify the factor structure. We then conducted confirmatory factor analysis and assessed each component and the overall scale for reliability. Analyses were conducted using Stata v.18.5 and MPlus v.8.11.Result1,162 participants completed the survey. Nearly half (48.9%) of the participants were 60 or older and had at least a bachelor’s degree (48.45%). Just under 10% (9.3%) self‐identified as living with memory loss while 184 participants (15.8%) said they knew someone with memory loss and 694 people (59.7%) provided care to someone living with memory loss. Final analysis confirmed a five‐component scale: Information, Resources, Access, Worship, and Resource saturation with excellent model fit. Each individual component had good reliability (Cronbach’s alpha range 0.76 – 0.84) and overall scale reliability (α = 0.88). Higher overall scores were significantly associated with better scores on dementia knowledge and skills, and lower stigma on all stigma scales.ConclusionThis tool demonstrates appropriate and reliable measurement of dementia friendliness in relatively homogenous church communities and accommodates diverse geographic locations (i.e., urban, rural, suburban) and community sizes. The five components can be scored individually to assess areas of strength or improvement or used as an overall measure of dementia‐friendliness.

Introduction: Death anxiety is a salient psychological construct across the adult lifespan; however, few studies have examined the psychometric properties of the Spanish version of the Death Anxiety Scale (DAS) in university populations spanning diverse age ranges. Objectives: To evaluate the factorial structure, model fit, and reliability of the Spanish DAS in a heterogeneous academic cohort comprising traditional (younger) and non-traditional (older) adult learners. Methods: A total of 928 participants (aged 18–93 years) from a Spanish university completed the DAS. We conducted an exploratory factor analysis (EFA; principal axis factoring with oblique rotation) to identify latent dimensions, followed by a confirmatory factor analysis (CFA) to evaluate model fit. Internal consistency was assessed using Cronbach’s alpha and McDonald’s omega, and associations with sociodemographic variables (age, religious belief) were explored. Results: EFA supported a two-factor solution comprising Fear of Death and Peacefulness/Serenity towards Death. Factor reliability was acceptable (α = 0.818 and 0.734; total α = 0.789; ω_total ≈ 0.81). CFA indicated good fit to the two-factor model (χ2(89) = 401.19, RMSEA = 0.064, 90% CI [0.058–0.071], CFI = 0.940, TLI = 0.912, SRMR = 0.063), with information criteria (AIC = 17,018.33; BIC = 17,236.77) supporting model parsimony. Age and religious belief showed small-to-moderate associations with response patterns. Conclusions: The Spanish DAS demonstrates adequate factorial validity and reliability in a university sample spanning a wide age range. The identification of a Peacefulness/Serenity dimension may enrich interpretation, although its distinctiveness should be considered provisional and warrants replication. Future research should examine measurement invariance across age groups and assess applicability in clinical and longitudinal contexts.

Objective: To design and validate a questionnaire that evaluates the influence of food marketing on young Mexicans. Materials and method: An observational, cross-sectional and quantitative study was carried out. The sample consisted of 346 university students from different states in Mexico. A questionnaire based on theoretical models of consumer behavior was developed. Content validity was determined by expert judgment and construct validity through exploratory factor analysis (EFA) using principal axes and oblique rotation. Internal consistency was assessed using the omega coefficient (ω). Results: The EFA revealed a four-factor structure that explained 56.72% of the total variance. The factors identified were: (1) product exposure and advertising on social networks, (2) social and environmental responsibility, (3) product exposure and packaging, (4) brand experience and loyalty. The total scale showed adequate internal consistency (ω= .85) and a KMO measure of sampling adequacy of .84. Conclusions: The questionnaire developed proved valid and reliable for evaluating food marketing and its relationship to the purchasing decisions of young Mexicans, providing a useful tool for future research and intervention strategies. Keywords: Questionnaires; Evaluation studies; Marketing; Food; Adolescents.

Development of a novel scale to measure health care professionals' patient-centered contraceptive counseling competency.

Adaptation and validation of a scale to measure self-efficacy for health practices in adolescents.

Inequitable gender norms shape adolescents’ perceptions and behaviours, increasing the risk for adverse health outcomes as adults. However, there is a lack of reliable scales to measure these norms. The Gender and Adolescence: Global Evidence (GAGE) project proposes a scale for adolescents aged 10–19 years considered vulnerable, (i) distinguishing between individual-level gender attitudes and community-level gender norms (2 factors), and (ii) categorising items into five domains (e.g., education; 5 factors). As part of validating this scale, we analyse the two- and five-factor structure using GAGE datasets from Ethiopia and Bangladesh. We performed Explorative Factor Analyses (EFA) using Principal Axis Factoring and oblique rotation. We tested sampling adequacy using Bartlett’s test of sphericity and the Kaiser-Meyer Olkin measure. In the EFA, we tested the two-factor structure and refined the initial five-factor structure by removing variables that failed to load onto a factor or exhibited cross-loadings. Next, we removed variables with low communalities (<0.2) and low factor loadings (<0.3). The EFAs comprised 6,183 observations from the Ethiopia and 2,245 observations from the Bangladesh dataset. The initial five-factor solution seemed more appropriate than the two-factor (individual-community) distinction in both datasets, and only the refined five-factor structure provided a solution in which the items corresponded to the five domains. However, this only applies to 17 and 15 of the original 30 items in Ethiopia and Bangladesh, respectively, and two of the factors only include two variables each. The five-domain structure proved more suitable for the Ethiopia and Bangladesh contexts than the individual-community distinction, but only for a reduced set of items. We thus propose an adaptation for the GAGE gender norms scale in Ethiopia and Bangladesh. Conceptual challenges, such as questionable domain assignments, highlight the need to further refine the scale and to confirm the results by Confirmatory Factor Analysis.

Development of the County-Level Social Deprivation Index 2020 and Its Association With Health Outcomes in China.

377 Background: Greater patient participation in oncology care has been linked to enhanced patient-provider communication, improved symptom management, greater treatment adherence, and improved healthcare utilization among adults with cancer. While measures of patient engagement exist, few are tailored to the unique healthcare challenges and care decisions of patients with metastatic breast cancer (MBC); most also have limitations in terms of modality, cost, and potential for integration into oncology care. We sought to develop a measure of participatory care for MBC, referred to as the CORe-MBC (Capacity, Opportunity, and Resources in MBC), that would be easy for patients to complete as part of routine care. The purpose of the tool was to identify patients who have difficulty managing their care and to pinpoint the types of challenges encountered to help health systems better align limited resources. Methods: In consultation with MBC patients and oncologists, we conceptualized key components of participatory care, which included: 1) an individual’s capacity, or the knowledge and motivation needed to participate in MBC decision-making; 2) opportunity, or an inclusive healthcare environment with providers who listen to patients and seek to optimize MBC care in line with patient goals; and 3) resources, or the external factors that enable patients to manage their MBC. Candidate items for each domain were generated then refined following cognitive interviews with MBC patients. Resulting items were evaluated among English-speaking adults with MBC recruited from a large academic oncology center. Participants also completed structured surveys assessing health activation, self-efficacy, satisfaction with healthcare, and social support. Psychometric testing included exploratory factor analyses, using oblique rotations to evaluate factor structure, and parallel analysis to test for dimensionality. Results: A total of 130 patients were enrolled. Participants mostly identified as White (82%) and one-third (34%) had less than a college degree; the average age was 62.9 years (range 34-90). Candidate items loaded onto three factors (all factor loadings &gt; .5), reflecting the domains of capacity, opportunity, and resources. A total of 10 items were selected for the final measure. Items demonstrated high internal consistency ( α = 0.83). Domains of capacity, opportunity, and resources demonstrated moderate to high construct validity with measures of health activation ( r = 0.56, p &lt; 0.0001) and self-efficacy ( r = 0.31–0.40, p &lt; 0.0005), satisfaction with healthcare ( r = 0.42–0.55, p &lt; 0.0001), and social support ( r = 0.52–0.75, p &lt; 0.0001), respectively. Conclusions: The CORe-MBC appears to be a valid and reliable tool. Further studies are planned to test the tool among diverse populations in a large academic health center and community oncology center in Chicago, IL and Memphis, TN.

Purpose This study aimed to identify the key factors constituting financial resilience (FR) and financial well-being (FWB), to explore their interrelationships, to examine demographic differences in perceptions, and to evaluate which rotation method best explains the variance in the confirmatory model of these constructs. Design/methodology/approach A non-experimental, cross-sectional design was employed, utilizing both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). EFA was conducted with both orthogonal (Varimax and Quartimax) and oblique (Oblimin and Promax) rotation methods to uncover the underlying dimensions of FR and FWB, followed by CFA using Structural Equation Modeling (SEM) to validate the models. The study targeted undergraduate students in Veracruz, Mexico, with a non-probability, self-selection sampling approach. Findings The results revealed that FR and FWB are multidimensional and interconnected constructs, with key factors such as savings, financial planning, debt management and financial knowledge being crucial. The oblique rotation models (Oblimin and Promax) provided a better fit for explaining the interdependence between these factors compared with orthogonal models. Financial resilience factors like savings and debt control influenced financial well-being, aligning with existing literature, while highlighting the need for integrated financial education. Research limitations/implications The study's sample was restricted to undergraduate students in Veracruz, limiting the generalizability of the findings. The reliance on self-selection sampling may introduce bias, and the cross-sectional design restricts causal inferences. Practical implications The study challenges traditional views by highlighting the interconnectedness of financial resilience factors. It calls for a multidimensional approach to financial resilience that includes not only the ability to withstand financial shocks but also factors like financial education, digital literacy, and access to financial products. Social implications The findings suggest that policies should promote holistic financial education and create financial products that support resilience, particularly for vulnerable populations. Additionally, integrating technology into financial services is crucial for enhancing financial inclusion and resilience. Originality/value This research contributes to understanding financial resilience and well-being by employing exploratory and confirmatory analysis methods to assess their interdependence. The study is among the few to apply orthogonal and oblique rotation methods to explain the variance in these constructs, offering a novel perspective on the interaction between financial resilience and well-being.

The dual epidemics of HIV and sexual violence against women complicate HIV care engagement in South Africa. In settings with limited mental health treatment, robust measures to enhance screening and intervention for mental health specific to people with HIV are needed. The current study developed a 42-item assessment for coping with HIV and trauma in isiXhosa. In a randomized controlled trial, 350 participants completed measures of coping, anxiety, traumatic stress, and depression at their baseline assessments. Participants were women with HIV residing in Khayelitsha, South Africa, initiating or re-initiating antiretroviral therapy (ART) and histories of sexual abuse and trauma symptoms. We performed exploratory factor analysis with oblique rotation using parallel analysis and calculated Cronbach's alpha for each coping factor to assess internal consistency. Finally, we evaluated convergent and discriminant validity among the subsequently identified factors and assessments of depression, traumatic stress, and anxiety. The parallel analysis suggested the retention of three factors: active, avoidant, and social/spiritual coping. The final measure included 39 items with an overall Cronbach's Alpha of 0.825. The factor structure demonstrated robust goodness of fit. Convergent validity was demonstrated through significant positive correlations between active and social/spiritual coping, and between avoidant coping and the depression, anxiety, and traumatic stress. Significant negative correlations of active and social/spiritual coping with depression, anxiety, and traumatic stress scores also supported the discriminant validity between subscales.We conclude that the Coping with HIV measure provides a strong and validated measure of coping for use in populations in South Africa living with HIV.Clinical Trial Number: NCT04793217.

Background and Purpose: Several studies have used an adapted measure of stress related to COVID-19, although the psychometric properties of the tool are unknown. The purpose of this study was to evaluate the psychometric properties of an adapted measure in nurses. Methods: This was a secondary analysis of 744 nurses using data from a longitudinal study conducted during COVID-19 from May 2020 to May 2022. Results: Exploratory factor analysis using principal axis factoring with oblique rotation resulted in two correlated factors: personal risk and risk to others. The measure had acceptable internal consistency (α = .754 and α = .738 for factors 1 and 2, respectively) and demonstrated criterion validity between several indicators of mental health and well-being. Conclusions: The adapted measure was reliable and valid in nurses working during COVID-19.

PurposeWe aimed to examine and establish the psychometric properties of the Urdu version of the Brief Illness Perception Questionnaire (BIPQ) in patients with Type 2 Diabetes Mellitus.MethodsA standard forward–backwards translation procedure was adopted. The Urdu (lingua franca of Pakistan) version of BIPQ was approved by an independent expert panel and committee review. The intraclass correlation (ICC) established the consistency of the retained items in the questionnaire. The test-retest reliability for the pilot and field study was identified by using Cronbach’s coefficient. An Exploratory Factor Analysis, conducted using principal axis factoring extraction and oblique rotation with Kaiser normalization, was employed to validate the BIPQ in Urdu. The open-ended section of the BIPQ was discussed for reliability and validity through the Delphi method.ResultsThe 8-item translated version (later termed the Brief Illness Perception Questionnaire in Urdu, or BIPQ-U) exhibited an acceptable Cronbach’s alpha value of 0.814 (test) and 0.800 (re-test). The ICC for all eight items exhibited exceptional coefficient values of > 0.80. Internal consistency during the field study was also acceptable (α = 0.815). The appropriateness of psychometric assessment was confirmed through the Kaiser–Meyer–Olkin measure of sampling adequacy (0.855) and Bartlett’s Test of Sphericity (p<0.05). A statistically significant difference between females and males (p = 0.025) confirmed the discriminative validity through Mann–Whitney U-test. Based on initial eigenvalues > 1, four factors were extracted, accounting for a total variance of 75.96%. With acceptable commonalities of >0.30, all eight items of BIPQ-U were retained. Lastly, members of the Delphi group reached a mutual consensus on adding question number 9 to the validated BIPQ-U.ConclusionThe BIPQ-U is a reliable tool for assessing illness perception among Urdu-speaking patients. It can help healthcare providers better understand patient beliefs and improve care.