Root Mean Square Error Of Approximation Research Articles

Development and psychometric evaluation of a theory of planned behavior model-based instrument for evaluation of determinants of oral health behaviors in mothers of children younger than six years in Iraq

BackgroundThe theory of planned behavior (TPB) is one of the most commonly used theories to explain oral health behaviors. To gain a deeper understanding of the determinants of oral health behaviors, we aimed to design and evaluate the psychometrics of a theory of planned behavior model-based instrument for assessing the determinants of oral health behaviors in mothers of children younger than six years in Iraq.MethodsQuestionnaires and guidelines related to the topic were searched in 2023, and the appropriate items based on the domains of the TPB model were extracted. The items were revised and completed to develop the initial version of the instruments. Face validity and content validity of the instrument were assessed. The content validity index (CVI) and content validity ratio (CVR) were calculated subsequently. The construct validity was examined by confirmatory factor analysis (CFA). Cronbach’s alpha, intra-class correlation coefficient (ICC), and percentage of agreement were employed to check the tool’s internal consistency and reproducibility reliability. The data were analyzed using SPSS version 25 and Amos software.ResultsThe questionnaire had adequate content validity (CVR ≥ 0.75, CVI ≥ 0.75). The percentage of agreement, Kappa, and ICC coefficients were 57.1–95.3%, 0.52–0.89, and 0.43–0.90, respectively. The p-value for ICC was significant in all cases (p < 0.001).For the internal stability of the tool to keep Cronbach’s alpha values > 0.7 for all domains, we had to omit three questions from attitude, one from subjective norms, and one from perceived behavioral control. In terms of construct validity, the results were as follows: the Goodness of Fit Index (GFI) was 0.942, the Comparative Fit Index (CFI) was 0.900, the Adjusted Goodness of Fit Index (AGFI) was 0.921, and the Root Mean Square Error of Approximation (RMSEA) was 0.046. These values indicate that the instrument demonstrates appropriate construct validity based on the TPB.ConclusionThe psychometric evaluation of the designed instrument showed that it was a valid and reliable tool in Arabic-speaking countries for determining child-related oral health behaviors in mothers of children under six years old.

First psychometric evaluation of the Mexican Spanish version of the 11-item BPFSC-11 and convergence with maladaptive self and interpersonal functioning.

The Borderline Personality Features Scale for Children (BPFSC-11) is a well-used, short, and easy-to-administer measure of borderline traits in young people. The aim of the current study was to evaluate the psychometric properties of the Mexican Spanish version of the BPFSC-11 in a large community-based sample of Mexican adolescents. In addition, we evaluated the convergence between the borderline construct as measured by the BPFSC-11 and general personality functioning consistent with more contemporary personality disorder formulations to assess the nomological net of the BPFSC-11 total score. A sample of 1212 adolescents (52.6% female, mean age = 15.11, SD = 1.74) were recruited from the community through schools in Mexico City and Michoacán area. Reliability of the BPFSC-11 was good (α = 0.805; ω = 0.806). A confirmatory factor analysis (CFA) model testing the unidimensional factor structure of the 11 items of the BPFSC-11 provided good fit (X2[44] = 137.96, p < 0.001; root mean square error of approximation (RMSEA) = 0.04 [90% CI: 0.03, 0.05]; comparative fit index (CFI) = 0.96; standardized root mean square residual (SRMR) = 0.03). Both configural and metric invariance for gender and age were demonstrated; however, only partial scalar invariance could be demonstrated with some items showing "bias" for gender and age. The Mexican Spanish BPFSC-11 also showed strong convergence with measures assessing contemporary conceptualization of general personality functioning. The Mexican Spanish BPFSC-11 appears to show similarly strong psychometric properties of other versions of the BPFSC-11; and the borderline construct as assessed with the BPFSC-11 shows good conversion with general personality functioning in adolescents.

SOCIO-ECONOMIC AND ENVIRONMENTAL IMPACTS OF ADOPTING GREEN BUILDING TECHNIQUES IN FEDERAL CAPITAL CITY, ABUJA NIGERIA

This study employed a Descriptive-Survey Research Design with a mixed-method approach, combining both quantitative and qualitative data collection techniques to assess the socio-economic and environmental impacts of adopting green building techniques in Abuja, Nigeria. Data were collected from primary sources through structured surveys, semi-structured interviews, field observations, and secondary sources, including literature reviews. A multi-stage sampling method was used to select key stakeholders, such as developers, architects, government officials, and property owners. The Krejcie and Morgan sample size determination table was applied to ensure statistical validity. The quantitative data focused on financial metrics, cost analysis, and perceptions of stakeholders regarding green buildings. The qualitative data provided insights into construction practices through interviews and observations. Statistical techniques, including AMOS (Structural Equation Modeling), were applied to analyze key sustainability indicators, economic viability, and policy frameworks. Results indicated that the adoption of green building techniques offers substantial socio-economic benefits. The economic viability of green buildings was highlighted by reduced operational costs, energy savings, and water conservation strategies. The environmental benefits included significant reductions in carbon emissions, improved air quality, and waste reduction. However, challenges such as high initial costs, limited technical expertise, weak policy enforcement, and a lack of awareness among stakeholders were identified as barriers to widespread adoption. The findings suggest that green building practices can contribute to Abuja’s urban sustainability goals, but further improvements in policy, training, and public awareness are necessary to maximize these benefits. Statistical results, such as a Chi-squared/degree of freedom ratio (ChiSq/df) of 2.331, a Goodness of Fit Index (GFI) of 0.916, and Root Mean Square Error of Approximation (RMSEA) of 0.066, supported the model’s adequacy. Furthermore, the overall Cronbach's alpha coefficient for the reliability test was 0.956, indicating high internal consistency.

The Effect of Patient-Centeredness and Competence on the Provision of OTC Medication Information: The Role of Saudi Community Pharmacist

Objectives: This study aimed to discover the Saudi community pharmacist's contribution to the transmission of prescription information by analyzing the relationship between two variables: the pharmacist's patient-centeredness and competence. This cross-sectional study was conducted from September to November 2024. Using a 14-item self-report questionnaire that had been previously tested and validated Data were collected using an online questionnaire. Convenience sampling method of 400 respondents was targeted; 233 valid questionnaires were returned, representing an effective response rate of 58.2%. To test the study’s hypotheses, path analysis with structural equation modeling (Amos 24) was applied. Regarding the 233 pharmacists in the study, the Chi-square test for the model fit hypothesis showed statistically significant results: χ (74) = 145.2, P &lt; 0.001). The model accurately represented the data, as evidenced in the root mean square error of approximation (RMSEA) value of 0.027, PCI. The latent variables involved in the model were immediately evident to be both positively and strongly correlated. The associations among the latent as well as observable variables were all statistically significant. The model fit will be substantially and adversely affected by the removal of any latent variable. In the SEM, PAT was the main independent variable. PAT applied a significant direct positive influence on INF. (β = 0.88, P = 0.002). PAT demonstrated a significant direct impact on COM. (β = 0.93, P = 0.001), PAT exerted a substantial indirect influence on COM through the mediation by INF. The study reveals that pharmacists with patient-centered attitudes are more effective in delivering essential pharmacological information, especially in terms of over-the-counter medications, highlighting the critical role of Saudi community pharmacists in providing this type of medication.

Psychometric Validation and Development of the Persian Short Form of the Big Three Perfectionism Scale for Iranian Adults

Background: Perfectionism, a multidimensional trait, impacts psychological well-being with both adaptive and maladaptive effects. Existing tools, such as the Frost Multidimensional Perfectionism Scale (FMPS) and Hewitt and Flett Multidimensional Perfectionism Scale (HMPS), face limitations in non-western contexts, including Iran. The Big Three Perfectionism Scale–Short Form (BTPS-SF), a concise 16-item scale, retains the core dimensions of perfectionism while enhancing usability in large-scale studies. Objectives: This study aimed to translate and validate the Persian version of the BTPS-SF, providing a reliable, culturally adapted tool for research and clinical applications in Iranian populations. Methods: This psychometric validation study employed advanced validation methods to assess the factor structure and psychometric properties of the short form of the BTPS-SF among Iranian adults. A sample of 1,271 participants, aged 18 to 50, was selected from Karaj using cluster sampling. Data collection involved the BTPS-SF and BTPS, with rigorous translation and cultural adaptation processes. Validity and reliability were assessed through content, concurrent, and construct validity, as well as internal reliability measures. Data analysis was conducted using SPSS 18 and Lisrel 8.8 software. Results: The BTPS-SF demonstrated robust content validity, with content validity ratio (CVR) and Content Validity Index (CVI) values exceeding the established benchmarks. Concurrent validity revealed a strong positive correlation (r = 0.82, P = 0.001) between the BTPS-SF and BTPS scores. Exploratory factor analysis (EFA) confirmed a three-factor structure, explaining 70.77% of the variance. Confirmatory factor analysis (CFA) demonstrated an excellent model fit, with a root mean square error of approximation (RMSEA) of 0.035 and a Comparative Fit Index (CFI) of 0.99. The scale demonstrated high reliability, with Cronbach's alpha values ranging from 0.887 to 0.916, and split-half reliability coefficients of 0.940, confirming its robust psychometric properties. Conclusions: The Persian BTPS-SF is a valid and reliable tool for assessing multidimensional perfectionism in Iranian adults. Despite limitations, such as self-reporting, the geographic focus on Karaj, and the cross-sectional design, the findings provide a solid foundation for future studies. Expanding the sample and adopting longitudinal designs could further refine its applicability across diverse contexts.

Development of the children's primitive reflex integration assessment scale

ObjectiveNon-integrated primitive reflexes (PRs) in children can lead to issues in motor function and psychological wellbeing, while prior studies have shown correlations between PR integration and neurodevelopmental disorders in children. However, measurement methods for PR integration remain unestablished. Therefore, in the present study, we describe the development of a measurement scale for PR integration, a novel assessment tool to evaluate PR integration in children.MethodsCombining a literature review, practical experience, and results of specialized group discussions, a preliminary draft of the Children's Primitive Reflex Integration Measurement Scale (CPRIMS) was formulated. Employing a convenience sampling method, participants were selected from first and second-grade students in three primary schools in Liaoning province, Shenyang city, from May to July 2023. Item Discrimination Method (IDM), Critical Ratio Method (CRM), and Internal Consistency Coefficient Method (ICCM) were used for item analysis of pilot testing data. For formal testing data, Cronbach's α assessed the reliability of the scale, while fit indices such as chi-square value/degrees of freedom (χ2/df), Root Mean Square Error of Approximation (RMSEA), and Comparative Fit Index (CFI), along with tests of construct validity, evaluated the scale's validity.ResultsOverall, 555 participants were selected, 234 children with a mean age of 7.59 ± 0.71 years participated in the pilot testing, while 321 children with a mean age of 7.73 ± 0.71 years participated in the formal testing. CPRIMS comprises seven dimensions and seventeen items, including the Moro reflex (MR), Asymmetrical Tonic Neck Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR), Tonic Labyrinthine Reflex (TLR), Spinal Galant Reflex (SGR), Spinal Perez Reflex (SPR), and Landau Reflex (LR), explaining 88.2% of the total variance. Confirmatory factor analysis revealed a good model fit (χ2/df = 1.631, RMSEA = 0.044, NFI = 0.950, CFI = 0.980, IFI = 0.932, TLI = 0.972). Cronbach's α coefficients for the seven dimensions ranged from 0.730 to 0.945, demonstrating strong reliability.ConclusionCPRIMS, which includes dimensions such as MR, ATNR, STNR, TLR, SGR, SPR, and LR, demonstrates strong reliability and validity, indicating that this measure could serve as a reliable and effective tool for assessing the integration levels of PRs in children aged 6 to 9 years old.

Reliability and validity validation of the Chinese version of the family vitiligo impact scale

BackgroundThe Family Vitiligo Impact Scale (FVIS) is the first reliable and valid instrument to evaluate the psychological and social impact on family members with vitiligo. However, the FVIS has not yet been validated in China.ObjectiveThis study aimed to adapt the FVIS across cultures and utilize a cross-sectional design to validate its reliability and validity in evaluating the quality of life of family members with vitiligo in China.MethodsThe original version scale was first translated into Chinese using Brislin back- translation method. This study was conducted among adult individuals in China (N = 348). The participants were aged 18 to 70 years, with a mean age of 33.6 years (SD = 11.3). The sample consisted of 50.9% females (n = 177) and 49.1% males (n = 171). Respondents completed the Chinese versions of the FVIS and Family Dermatology Life Quality Index (FDLQI). Exploratory factor analysis (EFA) and confrmatory factor analysis (CFA) were used to test the construct validity of the scale, and the content validity of the scale was assessed through the content validity index. The internal consistency of the scale was assessed by calculating Cronbach’s alpha coefcient, Omega coefcient, split-half reliability, and test-retest reliability.ResultsEFA supported a three-factor structure, explaining 79.208% of cumulative variance. CFA demonstrated satisfactory construct validity for the FVIS, with excellent model fit: chi-square degree of freedom (χ2/df) = 2.019, root mean square error of approximation (RMSEA) = 0.072, standardized root mean square residual (SRMR) = 0.0145, Comparative Fit Index (CFI) = 0.983, and Tucker Lewis Index (TLI) = 0.978. The content validity index of the scale was 0.979. The Cronbach’s alpha coefcient was 0.975, Omega coefcient was 0.964, the split-half reliability coefcient was 0.977, and the test–retest reliability was 0.959.ConclusionThe Chinese FVIS showed satisfactory reliability and validity for assessing vitiligo’s psychosocial impact on family membersin Chinese clinical and research settings.

Simplified Jaw Functional Limitation Scale for Temporomandibular Disorders: Psychometric Evaluation.

This study aimed to simplify the Jaw Functional Limitation Scale (JFLS) and evaluate its reliability and validity in assessing jaw function in patients with temporomandibular disorders (TMD) in primary care. TMD patients and non-TMD participants were assessed using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Demographic data and the 8-item JFLS questionnaire were collected to quantify jaw functional restriction. Confirmatory factor analysis tested the validity of JFLS-8 using chi-square, comparative fit index (CFI), root mean square error of approximation (RMSEA), and root mean square residual (RMR). The study selected key items from each domain to create a 4-item JFLS for further testing. Exploratory factor analysis, reliability, and validity tests were conducted. Analysis included 671 valid questionnaires (502 TMD patients, 169 non-TMD participants). JFLS-8 exhibited satisfactory fit among TMD patients (RMSEA = 0.143, CFI = 0.881, RMR = 0.567). JFLS-4 retained items with high factor loadings: JFLS1 (0.935), JFLS2 (0.923), JFLS7 (0.766), and JFLS5 (0.713). The simplified JFLS-4 showed good reliability (Cronbach's alpha 0.714) and validity (Kaiser-Meyer-Olkin 0.558, Bartlett's test < 0.001) among TMD patients. A 4-item JFLS was developed and validated, demonstrating good reliability and validity in assessing mandibular function in TMD patients, exhibiting the potential to streamline evaluation processes in clinical practice.

Stigmatized HIV Over Knowledge and Support: A Quantitative Study to Develop and Measure Bangladeshi Women's Social Support When Living With HIV-Related Stigma

Abstract Recognizing the unique context of Bangladeshi women living with HIV-related stigma in a patriarchal society is central to social scientists developing a culturally appropriate instrument for examining the impact of meaningful interventions. Working with 200 Bangladeshi women with HIV who responded to 77 items from three instruments, we used exploratory factor analysis and identified five latent constructs: emotional support, felt normative stigma, incorrect HIV transmission knowledge, correct HIV transmission knowledge, and tangible support. Confirmatory factor analysis model specifications for the Comparative Fit Index, Tucker Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA) were analyzed and all moderately fit. We thus present the Stigmatized HIV Over Knowledge and Support (SHOKS) model as pioneering work facilitating social scientists in developing a culturally appropriate instrument to generate interventions and better support Bangladeshi women living with HIV-related stigma.

Development and Psychometric Validation of the Cyber-Self Scale (CSS) in Saudi Arabia.

Measuring adolescents' and youths' perception of their Cyber-Self can enhance the understanding of how digital technology influences identity formation. While psychological literature offers numerous measures of the self, there is a notable lack of studies addressing the measurement of the Cyber-Self. This study aims to evaluate the reliability, factorial- and criterion-related validity, and measurement invariance of the Cyber-Self Scale (CSS) across age and gender among the youth and adolescents in Saudi Arabia. The Cyber Relationship Motives (CRM) and E-Emotional Questionnaire (EEQ) were administered to students at Umm Al-Qura University (N = 335), aged 17-31 years (39.7% male, 60.3% female; mean (M) = 21.75, standard deviation (SD) = 2.17). The results indicated significant positive correlations between the sub-components of the CRM and EEQ. One item was selected based on two criteria: the highest correlation with other items and the highest correlation with the general factor. A total of 12 items were identified as the final form of the CSS, which demonstrated acceptable internal consistency for both male and female participants. Confirmatory factor analysis (CFA) revealed that the CSS model fit the data well, with all 12 items meeting the fit criteria for chi-square and root mean square error of approximation (RMSEA). The Arabic version of the CSS is sufficiently reliable and valid for use among Arabic-speaking adolescents and youth. Further research is recommended to examine its measurement invariance over extended periods.

The Virtual Client Experience Survey for Mental Health and Addictions: Revalidation of a Survey to Measure Client and Family Experiences of Virtual Care.

The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients' perspectives on virtual mental health care quality will be critical to informing future policies and practices. This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care. The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach α coefficient. The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an α lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001). This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances.

Examining factor structure and psychometric properties of Ethical Leadership Questionnaire with Healthcare Professionals in Saudi Arabia.

The study aimed to examine the factor structure and psychometric properties of ethical leadership questionnaire (ELQ) by using a healthcare professional sample in Saudi Arabia. A cross-sectional study was conducted, and a total of 387 healthcare professionals completed the 15-items ELQ questionnaire between 18 October, 2023 and 17 January, 2024. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a reliability test were performed on the obtained data. It was found that the ELQ involved four factors including honesty (four items), integrity (four items), sets example (three items), and concern for values (four items). The study was able to explain 74.14% of the total variance. The model comparative fit index (CFI) was 0.952, the goodness-of-fit index (GFI) was 0.915, the standardized root mean squared residual (SRMR) was 0.0536, and the root mean square error of approximation (RMSEA) was 0.076. The reliability value was obtained by using Cronbach's alpha, and the results of each subscale were higher than 0.80, which means they were deemed adequate and reliable. The results from these fit indices indicated that the four-factor model with EC offered the utmost fit. The ELQ is a reliable and valid instrument that can be used on this population to determine employees' perceptions of their leaders' ethical behavior.

Development of a Structural Model for Predicting Organizational Performance of Bank Employees in Western Tehran Branches Based on Career Path Resilience and Psychological Capital: The Mediating Role of Professional Ethics

Objective: The objective of the present study was to develop a structural model for predicting the organizational performance of bank employees in the western Tehran branches based on career path resilience and psychological capital, with the mediating role of professional ethics. Methodology: The research method was descriptive-correlational, with a structural equation modeling approach. The statistical population consisted of all bank employees in the western Tehran branches in 2023. The sampling method was convenience sampling. The sample size was 430 individuals, who were evaluated using questionnaires on organizational performance (Andre de Waal et al., 2017), career path resilience (Morgen Lyon, 2001), psychological capital (Luthans, 2007), and professional ethics (Kadous, 2002). The findings were analyzed using structural equation modeling. Findings: Based on the analysis of the research findings, all fit indices derived from the analysis supported the acceptable fit of the structural model with the collected data. The chi-square to degrees of freedom ratio was 2.21, the Comparative Fit Index (CFI) was 0.959, the Goodness of Fit Index (GFI) was 0.938, the Adjusted Goodness of Fit Index (AGFI) was 0.913, and the Root Mean Square Error of Approximation (RMSEA) was 0.057. Additionally, the results showed that career path resilience, psychological capital, and professional ethics together explained 62% of the variance in organizational performance among bank employees. Conclusion: It can be concluded that professional ethics among bank employees mediates the relationship between psychological capital and career path resilience with organizational performance.

Investigating the Relationships between Internet Addiction and Suicidal Ideation in Adolescent Girls

Objective: Suicidal ideation (SI) signifies a psychiatric crisis, and individuals with SI are at a significantly higher risk of suicide attempts compared to those without. According to previous research, three factors that affect SI in adolescent girls are externalization problems, alexithymia, and perceived social support (PSS). As a result, the present research aimed to examine whether internet addiction (IA) is associated with SI through the mediating roles of PSS, externalizing problems, and alexithymia among adolescent girls in Tehran, Iran. Method: The current correlational study employed a structural equation modeling approach. Model fit indices such as the Chi-square to degrees of freedom ratio (CMIN/DF), normed fit index (NFI), root mean square error of approximation (RMSEA), Tucker-Lewis index (TLI), and goodness-of-fit index (CFI) were reported to assess the model’s adequacy. A total of 441 adolescent girls were selected from high school and between the ages of 11 and 19 using a convenience sampling method. Participants completed the Multidimensional Scale of Perceived Social Support (MSPSS), the Beck Scale for Suicidal Ideation (BSSI), the Cell-Phone Over-Use Scale (COS), the Youth Self-Report (YSR), and the Toronto Alexithymia Scale-20 (TAS-20) in a written manner. Data analysis was done using SPSS 25 and AMOS 22. Results: Results revealed a significant positive correlation between IA and SI (P &lt; 0.001). The study's most significant findings indicate that PSS, externalizing problems, and alexithymia significantly mediate the relationship between SI and IA. The coefficient of determination for the SI variable was 0.33, which means that predictor variables can explain 33% of the variance in SI (IA, PSS, alexithymia, and externalizing problems). Conclusion: IA showed direct and indirect effects on SI. Using these findings, we can elucidate the mechanism of how IA affects individual SI, providing critical information for the development and implementation of targeted strategies and interventions to reduce SI among Iranian adolescent girls. Psychological interventions that address the role of externalizing behaviors, alexithymia, and PSS in adolescents with IA may help reduce SI.

Unraveling the Multifactorial Determinants of Miscarriage: Insights from SEM Analysis of Maternal Characteristics, Lifestyle Factors, and Antenatal Care

Background: This paper establishes that miscarriage is still a major determinant of maternal health, with the implication that factors such as maternal age, lifestyle factors, socioeconomic status and antenatal care visits affect the condition. This knowledge of factors involved can help in designing ways of ensuring they do not lead to miscarriages. Objective: The purpose of this work was to examine the relationship between a range of maternal lifestyle behaviors, education, visits to the antenatal care facility, and miscarriage rates by using structural equation modelling (SEM). Methods: Assuming a female population of 2000, data was generated on Maternal Age, education, Smoking, alcohol, exercise, Antenatal Care visits and an outcome variable representing miscarriage. SEM was employed to test the hypothesized relationships of these variables with Latent Lifestyle Risks captured under the observed behavior (smoking, alcohol use, exercise). To check the model fit, the following fit measure was used; Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR). Results: Consequently, the assumption of good model fit in the current SEM was obtained with CFI = 0.984, TLI = 0.971, RMSEA = 0.033, and SRMR = 0.021. Hence in this study maternal age was significantly related to miscarriage risk (Estimate = 0.028, p &lt; 0.001), while higher level of education was inversely inclined to miscarriage (Estimate = -0.042, p &lt; 0.001). Latent Lifestyle Risks were identified to have a positive relationship with miscarriages (Estimate = 0.200, p &lt; 0.001 while antenatal care visits have a negative association with miscarriage risks (Estimate = -0.022, p &lt; 0.001). Conclusions: Descriptive findings also reveal that maternal age, specific lifestyle patterns, educational attainment and utilization of antenatal care services are potential determinants of miscarriage. We found that offering changes to lifestyle behaviors and increasing the accessibility of antenatal care could lower miscarriage risk, and hence there can be great potential in public health approaches which address such factors to enhance the quality of maternal health.

Development and Validation of the Self-Objectification Scale for Assessing Psychological Well-Being in Educational Context

Presently, the youth suffer from much psychological distress due to overly emphasized outlooks and physical appearances by the media and society. This study aimed at the development and validation of the Self-Objectification Scale (SOS). The first phase involved conceptualizing the scale and generating relevant items. The interviews were conducted, transcribed, and analyzed, leading to the creation of items aligned with McKinley and Hyde's self-objectification theory. In the second phase, the scale items underwent content validity by expert evaluation. The third phase involved a try-out study. In the fourth phase, Exploratory Factor Analysis (EFA) was conducted on a sample of 306 adolescents selected by random sampling, aged between 19 and 25 years. A Confirmatory Factor Analysis (CFA) was conducted on another sample of 256 participants by random sampling. Results for EFA showed KMO yielded a value of .873 and Bartlett's Test of Sphericity was statistically significant. The CFA yielded a Normed Fit Index (NFI) of .95, a Comparative Fit Index (CFI) of .97, a Goodness Fit Index (GFI) of .97, and a Root Mean Square Error of Approximation (RMSEA) of .07. These results suggested that the model fully meets the conventional criteria for the good fit indices. Cronbach's alpha was found to be 0.70. The Pearson correlation for concurrent validity between the SOS and Objectified Body Consciousness Scale is 0.24, a significant positive relationship. Conclusively, to measure the phenomenon of body objectification, a reliable and valid instrument of SOS is developed for the Pakistani youth.

The influential factors of depression among caregivers of children with Cleft Lip and/or Palate: a path analysis based on diathesis-stress theoretical model

BackgroundDepression is the most common psychological phenomenon among caregivers of children with Cleft Lip and/or Palate and affects the quality of life, treatment satisfaction, children’s self-esteem and parent–child relationship. However, Existing studies have limited explanations for the mechanisms that lead to depression in caregivers of children with Cleft Lip and/or Palate. The present study aimed to identify factors influencing depression among caregivers of children with Cleft Lip and/or Palate and to provide a reference point and new ideas for future research.MethodsThis cross-sectional study investigated 248 caregivers at two Cleft Lip and/or Palate treatment centers in China, spanning from April 2019 to July 2020. The diathesis-stress model was used to construct the model, and data analysis was conducted using SPSS 26.0 and AMOS 25.0. Path analysis was employed to test the hypothetical model, and the fit of the model was evaluated using Chi-Square/degree of freedom, Goodness-of-Fit Index, Normed Fit Index, Relative Fit Index, Incremental Fit Index, Tacker-Lewis Index, Comparative Fit Index and Root Mean Square Error of Approximation.ResultsThe study found that the average level of depression among caregivers of children with Cleft Lip and/or Palate was 4.83 (4.79). Additionally, 43.5% of caregivers exhibited depressive symptoms. The fit of the modified path model was found to be satisfactory, with the following indices: Chi-Square/degree of freedom = 1.881, Goodness-of-Fit Index = 0.986, Normed Fit Index = 0.973, Relative Fit Index = 0.919, Incremental Fit Index = 0.987, Tucker-Lewis Index = 0.960, Comparative Fit Index = 0.987, and Root Mean Square Error of Approximation (RMSEA) = 0.060. The results indicated that parenting stress had the greatest direct impact on depression, followed by hope. Indirect effects on depression were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress.ConclusionsThis study suggests that depression in caregivers of children with Cleft Lip and/or Palate was leadingly influenced by parenting stress and hope. Strategies aimed at the key factors are expected to decrease depression.

Translation and validation of the Chinese version of the Attitudes Related to Trauma-Informed Care (ARTIC-C) scale in nursing inters: a psychometric analysis

BackgroundNursing interns, the future nurses, often find it challenging to interact with trauma survivors due to their lack of experience and training. Assessing their attitudes and knowledge in trauma-informed care can improve their clinical performance.ObjectiveTo culturally adapt and assess the reliability and validity of the Attitudes Related to Trauma-Informed Care Scale in Chinese nursing interns.DesignQuantitative cross-sectional design.MethodsThe translation of Attitudes Related to the Trauma-Informed Care (ARTIC) Scale followed guidelines for the cross-cultural adaptation process. A survey was conducted with 490 nursing interns from two colleges in China in February and May 2024, and seven experts evaluated the content equivalence of each item. Reliability and validity were assessed using item analysis, exploratory factor analysis, confirmatory factor analysis, internal consistency reliability, and test–retest reliability.ResultsThe Chinese version of the ARTIC-C retained 35 items and demonstrated high content validity. Exploratory factor analysis revealed a 6-factor structure, explaining 61.887% of the total variance. Confirmatory factor analysis indicated that the 6-factor model adequately represented the scale structure: chi-square/degree of freedom (CMIN/DF) = 1.544, root mean square error of approximation (RMSEA) = 0.045, comparative fit index (CFI) = 0.969, incremental fit index (IFI) = 0.969, Tucker Lewis index (TLI) = 0.966, and standardized root mean square residual (SRMR) = 0.046. The scale had a Cronbach's alpha of 0.916 and test–retest reliability of 0.876.ConclusionsThe Chinese version of the ARTIC-C scale has demonstrated strong reliability and validity, making it an effective tool for measuring Chinese nursing interns' attitudes and knowledge regarding trauma-informed care.

Patients’ views on physicians’ communication skills in telemedicine: Validation of Communication Assessment Tool among Bangladeshi sample

ABSTRACT Background Technological advancement has added new dimensions to the communication between physicians and their patients in healthcare settings worldwide. This study aimed to measure patients’ views about physicians’ interpersonal communication during telemedicine consultations by cultural adaptation and validation of the communication assessment tool (CAT) in Bangladesh. Methods A cross-sectional phone survey was conducted among 400 patients who received healthcare services from a telemedicine centre in Bangladesh. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to test the dimensionality of the CAT-Bangla scale. The goodness of fit of the CFA was assessed using the comparative fit index (CFI), Tucker–Lewis index (TLI), Chi-square values, root-mean-square error of approximation (RMSEA) and standardized root mean squared residual (SRMR). The internal consistency reliability of the CAT-Bangla scale was assessed using Cronbach's alpha. Results Factor analysis findings suggest that the CAT-Bangla scale is unidimensional with good internal consistency (Cronbach's α = 0.876). The individual item analysis findings suggest that most of the patients felt that the physicians treated them with respect (81% rated ‘excellent’) and allowed them to talk without interruption (73.5% rated ‘excellent’). Overall, the level of satisfaction among patients regarding physicians’ communication skills was high with a mean score of 4.36 (SD = 0.30) across all the 14 items. However, the patients were not satisfied with the amount of time that physicians spent with them as none of them reported ‘excellent’ in that domain. Conclusion The CAT-Bangla scale is feasible, valid, and internally consistent for measuring physicians’ communication skills in the telemedicine environment. This study can contribute to policymakers regarding the integration of learning communication skills of future physicians to competently deliver healthcare in the telemedicine environment. It would also help to understand various aspects of doctor-patient communication in a telemedicine context.

Assessing the Psychometric Properties of Academic Engagement Questionnaire in Nursing Students

Background: Academic Engagement is considered as one of the important factors related to the learners’ academic achievement. It is known as a significant research issue in higher education. The present study aimed to make an instrument for investigating academic engagement among nursing students of Ilam University of Medical Sciences. Methods: The present study is a methodological and cross-sectional research. To localize the academic engagement questionnaire, first, it was translated into Persian using forward-backward method. Then, its content and face validity were evaluated and approved. In order to determine the validity and reliability, the questionnaire was delivered to 120 nursing students and their comments were collected and analyzed. SPSS and AMOS software, statistical tests of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for data analysis. Results: According to the results, the internal consistency of the questionnaire was confirmed by calculating Cronbach's alpha coefficient (α = 0.906). The EFA and CFA were used to examine the dimensionality of three domains of vigor, dedication, and absorption. Values of Goodness of Fit Index (GFI), Non-Normed Fit Index (NFI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA) indices were 0.89, 0.92, 0.90 and 0.97, respectively Conclusion: The reliability and validity of the translated academic engagement questionnaire were relatively acceptable in reviewing the academic engagement of medical students, especially nursing students. Future studies should focus on more samples and examine the impact of nurses' background and educational variables on academic engagement.