Internal Consistency Reliability Of Scale Research Articles

Reliability and validity analysis of Turkish version of the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-10 questionnaire.

To evaluate the validity and reliability of the Turkish version of the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10). In this, single-centre study, patients between 18 and 65 years old, who were suffering from lower urinary tract symptoms (LUTS) without any known urinary tract disease and on no medication, were enrolled. The control group consisted of participants, who were admitted to our clinic suffering from any complaint except LUTS and met all of the other inclusion and exclusion criteria. Participants' demographics such as age, sex, and level of education were recorded. The Turkish version of the LURN SI-10, International Prostate Symptom Score (IPSS) and Overactive Bladder Questionnaire (OAB-V8) were administered to all participants. Construct validity was evaluated by confirmatory factor analysis and concurrent validity was evaluated with correlations to similar measures. Internal consistency (Cronbach's alpha) was used to establish the scale's internal consistency reliability. A total of 164 participants were included in the final analysis. Of those, 57% were male. The individuals were identified as being in the "patient group" (n = 86) and a "control group" (n = 78). The mean age was 48.24 ± 14.30 years. The median total LURN SI-10 scores of patient group and control group were 12.0 (9-18.25) and 4.0 (2.75-6), respectively. The LURN SI-10 questionnaire showed a high correlation with the IPSS and the OAB-V8 questionnaires (r: 0.761; p: 0.001; r: 0.737; p: 0.001, respectively) in concurrent validity analysis. Cronbach's alpha coefficient of the LURN SI-10 was 0.850. This promising measurement tool can be used to evaluate LUTS in Turkish women and men. Further studies should be conducted to assess the clinical usefulness of this questionnaire.

Development and validation of a comprehensive health literacy tool for adults in Hong Kong.

Health literacy (HL) refers to an individual's ability to process and use health information to make health-related decisions. However, previous HL scales did not fully cover all aspects of this concept. This study aimed to develop a comprehensive Hong Kong HL scale (HLS-HK) and evaluate its psychometric properties among Chinese adults. A scale of 31-item covering Nutbeam's framework, namely functional and interactive HL (FHL and IHL), and critical HL (CHL) within three subdomains: critical appraisal of information, understanding of social determinants of health, and actions to address social determinants of health, was developed based on previous literature review and Delphi survey. Cognitive interviews were performed to examine all items' face validity in terms of three aspects: comprehensiveness, clarity, and acceptability. A cross-sectional survey was conducted to investigate the scale's psychometric properties, including its internal consistency reliability, factorial structure validity, convergent validity, and predictive validity. Nine interviewees participated in the cognitive interviews in October 2021. Based on the input from respondents, two items were deleted, two items were combined, and several items' wording was revised. The other items were clear and readable. Finally, 28 items remained. A total of 433 adults completed the questionnaire survey between December 2021 and February 2022. After excluding one item with low inter-item correlations, the scale's internal consistency reliability was acceptable, with a Cronbach's alpha of 0.89. Exploratory factor analysis produced a five-factor model, as shown in the original theoretical framework. These factors accounted for 53% of the total variance. Confirmatory factor analysis confirmed that the fit indices for this model were acceptable (comparative fit index = 0.91, root mean square error of approximation = 0.06, and root mean square residual = 0.06). The scale is also significantly correlated with theoretically selected variables, including education and self-rated health. The HLS-HK is a valid and reliable tool for evaluating HL. Compared with existing tools, this scale extended the operationalization of FHL, IHL, and CHL and fully operationalized the CHL via three subdomains. It can be used to understand the difficulties and barriers that people may encounter when they use health-related information and services.

Psychometric properties of the Chinese version of female self-advocacy in cancer survivorship scale

ObjectiveTo translate Female Self-Advocacy in Cancer Survivorship (FSACS) scale and evaluate the psychometric properties of Chinese version of FSACS scale among female cancer survivors in China. MethodsThis study employed a cross-sectional design. FSACS scale was forward–backward translated and cognitive interviews were conducted for cultural adaptation. The newly translated tool was distributed to female cancer survivors to test psychometric properties, including item analysis, content validity, construct validity, criterion validity, internal consistency, and test-retest reliability. ResultsA total of 436 female cancer survivors were recruited in a Chinese tertiary cancer center from May to August in 2021. Item analysis showed statistical significance (P < 0.05) for each one and no ceiling or floor effect. The item-level content validity index ranged from 0.86 to 1.00 and the scale-level content validity index was 0.98. Three factors were extracted based on parallel analysis, and confirmatory factor analysis proved a good model fit with the original 3-factor structure. Pearson's correlation coefficient showed acceptable criterion validity. The Cronbach's α of 0.880 demonstrated the scale's internal consistency reliability, and the Alpha coefficients were 0.826, 0.763, and 0.859 for its three dimensions, respectively. The interclass correlation coefficients for test-retest reliability was 0.904 (0.870–0.891, P < 0.01) which confirmed the external reliability of the scale. ConclusionsThe Chinese version of FSACS scale proved to be a valid and reliable instrument that can be applied among Chinese female cancer survivors. Further research could be conducted in larger populations or people in different cancer stages.

Translation and psychometric validation of the Arabic Gestational Diabetes Management Self-Efficacy Scale (GDMSES)

IntroductionThe assessment of self-efficacy for adherence to healthy behaviours among women with gestational diabetes (GDM) is undermined by the unavailability of validated tools. Therefore, this study aimed at translating, culturally adapting and assessing the psychometric properties of the Arabic version of Gestational Diabetes Management Self-Efficacy Scale (GDMSES). Materials and methodsThis methodological study was conducted in the Antenatal Clinic at Sultan Qaboos University Hospital in Oman between October 2016 and January 2017. A total of 90 forms of the Arabic GDMSES tool were completed by Omani pregnant women with gestational diabetes. The study has a multiphase design: (1) cultural and linguistic validation; (2) content and face validity; (3) construct validity; (4) internal validity. ResultsThe Arabic GDMSES showed satisfactory content validity (CVI between .8 and 1), acceptable overall scale internal consistency reliability (Cronbach's alpha=0.85) and stability overtime (Pearson correlation coefficient>.6). Four factors emerged for construct validity using exploratory factor analysis: nutrition and body weight, adaptation to healthy eating, physical activity and treatment and blood sugar. Our sample size of 90 was considered adequate in determining these factors (Kaiser–Meyer–Olkin=.78). ConclusionsGDMSES is a valid and reliable tool, thus providing a quick and easy self-efficacy assessment tool for antenatal nurses dealing with pregnant women with GDM.

Psychometric properties of the Illness Attitude Toward COVID-19 Scale (IATCS).

This study examines the psychometric properties of the Illness Attitude Toward COVID‐19 Scale (IATCS). The IATCS was tested on a sample of individuals who were living in Kuwait during the COVID‐19 pandemic (n = 1413). The reliability and validity of the scale were examined to assess the scale's internal consistency reliability, criterion validity, and factorial validity. The results of the study showed alpha values that were satisfactory for the overall scale and for five subscales. The findings support the criterion and factorial validity of the scale. The findings also support the use of the scale in surveys and for educational and trainings purposes.

Reliability and validity of the Caregiver Reported Early Development Instruments (CREDI) in impoverished regions of China

BackgroundThere is a great need in low- and middle- income countries for sound qualitative and monitoring tools assessing early childhood development outcomes. Although there are many instruments to measure the developmental status of infants and toddlers, their use in large scale studies is still limited because of high costs in both time and money. The Caregiver Reported Early Development Instruments (CREDI), however, were designed to serve as a population-level measure of early childhood development for children from birth to age three, and have been used in 17 low- and middle-income countries. This study aimed to examine the reliability and validity of the CREDI in China, which is still unknown.MethodsThe CREDI and the ASQ-3 was administered to a sample of 946 children aged 5–36 months from urban and rural communities, in which 248 children was administered with Bayley-III.ResultsThe internal consistency of the CREDI was high, which indicates that the scale internal consistency reliability is quite good. The results also indicated that the concurrent validity of the CREDI with the Bayley-III scale was high in general. Ordinary least squares regression showed that the CREDI is highly consistent with previous widely used instruments in some key predictors (such as the home stimulation) of early childhood development level.ConclusionsAll the results in the current study indicate that the CREDI may be considered an appropriate instrument to measure early childhood development status on a large scale in impoverished regions of China.

Validation of the Spanish version of the Cancer Symptom Scale in Hispanic cancer patients.

To assess the validity of the translated Spanish Cancer Symptom Scale. Instruments to facilitate comprehensive and objective assessments of the cancer symptom experience in underrepresented populations are essential. The Cancer Symptom Scale was translated into Spanish, and a back translation was conducted. During June 2016, a sample of 121 Hispanic Puerto Rican patients with any cancer diagnosis, all undergoing cancer treatments, completed four paper surveys. A subgroup of 15 patients agreed to complete the Spanish Cancer Symptom Scale a second time after a short delay of 1 to 2hours. Construct validity and reliability (internal consistency via Cronbach alpha and test-retest reliability) was evaluated. All the Intensity Items of the Spanish Cancer Symptom Scale correlated significantly with the matched items on the MD Anderson Symptom Inventory. In a subgroup of 77 participants, each Cancer Symptom Scale subscale total of scores correlated significantly with the total scores from the Functional Assessment of Cancer Therapy-General. Discriminant validity was demonstrated between those receiving chemotherapy and those from post treatment. The Spanish Cancer Symptom Scale internal consistency reliability was 0.98. The Spanish Cancer Symptom Scale has excellent evidence of validity and reliability for assessing cancer-therapy-related symptoms.

Development of Patient Safety Nurse Competency Evaluation Scale and its reliability and validity test

Objective To develop a Patient Safety Nurse Competency Evaluation Scale, and evaluate its reliability and validity. Methods The Patient Safety Nurse Competency Evaluation Scale was developed through literature review, semi-constructed interview and experts consultation. A total of 590 nurses in 5 Class ⅢGrade A hospitals in Beijing were selected by convenient sampling methods and investigated by self-evaluation and peer evaluation. Results The final instrument included 35 items, organized into 6 composites by exploratory factor analysis, with the cumulative contribution of 65.983%. The factor analysis confirmatory showed that χ2/df was 2.742, and RMSEA was 0.064. Correlation coefficients between composites and total scale ranged from 0.694 to 0.812, and correlation coefficients between composites ranged from 0.367 to 0.647, with statistical significance (P<0.05) . The content validity index (S-CVI) was 0.933. The total scale internal consistency reliability was 0.942. The retest reliability coefficient of the general scale was 0.832. The correlation coefficients between self-evaluation and peer evaluation ranged from 0.342 to 0.517 in medium correlation. Conclusions The Patient Safety Nurse Competency Evaluation Scale demonstrates adequate reliability and validity. It is culturally appropriate for nurses self-evaluation and peer evaluation on patient safety competency. Key words: Nurses; Patient Safety Nurse Competency Evaluation Scale; Self-evaluation; Peer evaluation

Severity of Alcohol Dependence Questionnaire: Validity and Reliability of the Turkish Version

The aim of the study is to determine the validity and reliability of Turkish version of Severity of Alcohol Dependence Questionnaire (SADQ) developed by Tim Stockwell and colleagues in 1983 for the purpose of evaluating the severity of dependence in people with alcohol use disorder. The present study was conducted with an adult sample of 200 participants with alcohol use disorder according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) who applied to Ege University Institute on Drug Abuse, Toxicology and Pharmaceutical Science. Regarding validity analysis, item-total score correlation coefficients and principal component analysis were calculated. The scale was compared with Michigan Alcoholism Screening Test (MAST). Reliability analysis was performed with internal consistency reliability and test-retest reliability. Considering the internal consistency reliability of scale, Cronbach's Alpha Reliability Coefficient was found to be α=0.914. Item and Total Score Correlation Coefficients of the scale items were found between 0.309 and 0.730 (p<0.01). The mean test-retest scores of the scale and its sub-dimensions were calculated with t-test for dependent groups and the difference was not statistically significant. Testretest correlation coefficient of the scale was found 0.855 (p<0.01). Exploratory factor analysis explained 70.5% of the total variance and four sub-dimensions were identified. Factor loadings of these sub-dimensions were estimated between 0.49-0.91. The correlation between SADQ and MAST was statistically significant (r=0.557, p<0.01). The results of this study suggest that the Turkish version of the SADQ with four sub-dimensions is a reliable and valid instrument in determining severity of alcohol dependence.

Cancer Health Literacy Test-30-Spanish (CHLT-30-DKspa), a New Spanish-Language Version of the Cancer Health Literacy Test (CHLT-30) for Spanish-Speaking Latinos

This article describes the adaptation and initial validation of the Cancer Health Literacy Test (CHLT) for Spanish speakers. A cross-sectional field test of the Spanish version of the CHLT (CHLT-30-DKspa) was conducted among healthy Latinos in Louisiana. Diagonally weighted least squares was used to confirm the factor structure. Item response analysis using 2-parameter logistic estimates was used to identify questions that may require modification to avoid bias. Cronbach’s alpha coefficients estimated scale internal consistency reliability. Analysis of variance was used to test for significant differences in CHLT-30-DKspa scores by gender, origin, age and education. The mean CHLT-30-DKspa score (N = 400) was 17.13 (range = 0–30, SD = 6.65). Results confirmed a unidimensional structure, χ2(405) = 461.55, p = .027, comparative fit index = .993, Tucker–Lewis index = .992, root mean square error of approximation = .0180. Cronbach’s alpha was .88. Items Q1-High Calorie and Q15-Tumor Spread had the lowest item–scale correlations (.148 and .288, respectively) and standardized factor loadings (.152 and .302, respectively). Items Q19-Smoking Risk, Q8-Palliative Care, and Q1-High Calorie had the highest item difficulty parameters (difficulty = 1.12, 1.21, and 2.40, respectively). Results generally support the applicability of the CHLT-30-DKspa for healthy Spanish-speaking populations, with the exception of 4 items that need to be deleted or revised and further studied: Q1, Q8, Q15, and Q19.

Development and validation of the simulation-based learning evaluation scale

BackgroundThe instruments that evaluate a student's perception of receiving simulated training are English versions and have not been tested for reliability or validity. PurposeThe aim of this study was to develop and validate a Chinese version Simulation-Based Learning Evaluation Scale (SBLES). MethodsFour stages were conducted to develop and validate the SBLES. First, specific desired competencies were identified according to the National League for Nursing and Taiwan Nursing Accreditation Council core competencies. Next, the initial item pool was comprised of 50 items related to simulation that were drawn from the literature of core competencies. Content validity was established by use of an expert panel. Finally, exploratory factor analysis and confirmatory factor analysis were conducted for construct validity, and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Two hundred and fifty students who had experienced simulation-based learning were invited to participate in this study. ResultsTwo hundred and twenty-five students completed and returned questionnaires (response rate=90%). Six items were deleted from the initial item pool and one was added after an expert panel review. Exploratory factor analysis with varimax rotation revealed 37 items remaining in five factors which accounted for 67% of the variance. The construct validity of SBLES was substantiated in a confirmatory factor analysis that revealed a good fit of the hypothesized factor structure. The findings tally with the criterion of convergent and discriminant validity. The range of internal consistency for five subscales was .90 to .93. Items were rated on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree). ConclusionsThe results of this study indicate that the SBLES is valid and reliable. The authors recommend that the scale could be applied in the nursing school to evaluate the effectiveness of simulation-based learning curricula.

Tracing the Steps of Survey Design: A Graduate Medical Education Research Example

Surveys are frequently used to collect data in graduate medical education (GME) settings.1 However, if a GME survey is not rigorously designed, the quality of the results is likely to be lower than desirable. In a recent editorial we introduced a framework for developing survey instruments.1 This systematic approach is intended to improve the quality of GME surveys and increase the likelihood of collecting survey data with evidence of reliability and validity. In this article we illustrate how researchers in medical education may operationalize this framework with examples from a survey we developed during the recent integration of 2 independent internal medicine (IM) residency programs.

The development and psychometric testing of the Satisfaction with Simulation Experience Scale

This paper reports the development and psychometric testing of the Satisfaction with Simulation Experience Scale, an instrument designed to measure and compare differences in satisfaction levels between nursing students exposed to medium and high fidelity human patient simulation manikins. Student satisfaction is important to engaged and meaningful learning and it facilitates active and purposeful participation in simulation experiences. There are suggestions that student satisfaction may have some correlation with performance. Few studies have explored in a rigorous way the impact of manikin fidelity on nursing students' satisfaction with simulation experiences. The items for the Satisfaction with Simulation Experience Scale were identified following a critical review of the literature. Content validly was established by use of an expert panel. During 2009 and 2010 the instrument was tested with second year (n=268) and third year nursing students (n=76) from one Australian university. Exploratory factor analysis with varimax rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Differences in satisfaction levels between groups were analysed using an independent t test. Responses to an open ended question were categorised using thematic content analysis. The scale demonstrated satisfactory internal consistency (alpha 0.77). Exploratory factor analysis yielded a three-component structure termed Debriefing and Reflection, Clinical Reasoning, and Clinical Learning; each subscale demonstrated high internal consistency: 0.94; 0.86; 0.85 respectively. Mean satisfaction scores were high for each group. However, statistically significant differences were not apparent between second or third year students exposed to medium and high fidelity manikins. Content analysis identified 13 main categories including supplementing versus replacing clinical placements and the need for increased exposure to simulation sessions. The results of this study indicate that simulation is highly valued by students, irrespective of the level of fidelity. This raises questions about the value of investing in expensive simulation modalities. The Satisfaction with Simulation Experience Scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work.

Some psychometric properties of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQLTM) in the general Serbian population

The aim of this study was to evaluate the general measurement properties of the Serbian version of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL™) self-report versions for children and adolescents (8-18 years). The PedsQL™ was completed by 238 children and adolescents. The version was descriptively analyzed first. Afterward, internal consistency and construct and convergent validity were analyzed using the classic test theory psychometrical procedures. The PedsQL™ scale score means ranged 70.65-88.34, with the total score was 80.74. Scale internal consistency reliability determined by Cronbach's coefficient was above 0.7 for all except the School, 0.65, and Emotional Functioning Scale, 0.69. The statistics assessing the adequacy of the model in confirmatory factor analysis revealed poor model fit for the current structure of the PedsQL™. Finally, the PedsQL™ total and psychosocial health showed convincing negative correlations with emotional and conduct problems, hyperactivity/inattention, and peer relationship problems. The Serbian PedsQL™ scales have appropriate internal consistency reliability, sufficient for group evaluations, and good convergent validity against psychological constructs. However, there are problems regarding its current construct validity (factorial validity).

A Validity and Reliability Study Investigating the Turkish Version of the Infant Colic Scale

The Infant Colic Scale is used to diagnose colic and to determine factors that cause colic. This study aimed to establish the validity and reliability of the Infant Colic Scale for the Turkish population. The research sample included mothers (N = 110) of 132 infants with colic registered at three public health clinics in the Denizli province. Language validity, content validity, and construct validity were examined. On the basis of the Infant Colic Scale's internal consistency reliability analysis, three items were removed. Factor analysis resulted in five subscales. The Cronbach's alpha coefficients were .55 to .89 for the subscales, and .73 for the total scale. The scale's test-retest reliability was .65. The Infant Colic Scale was found to be a valid and reliable measurement tool for the Turkish population.

The Decision to Adopt Evidence-Based and Other Innovative Mental Health Practices: Risky Business?

A risk-based decision-making framework was used to examine the decision to adopt innovative mental health practices, including both evidence-based and other research-guided practices. Seventy-eight projects involving decisions to adopt one of four innovative mental health practices were the focus of this study. Key informants with direct knowledge about the adoption decision provided data for hypothesis testing. As predicted, the propensity to adopt an innovative practice-as measured by decision stage-was negatively related to the perceived risk of adopting the practice, positively related to expected capacity to manage risk, and positively related to an organization's past propensity to take risks. Further, perceived risk, anticipated resource availability, and exposure to field-based evidence explained a substantial part of what differentiated adopters from nonadopters. Finally, several features of innovations known to influence innovation adoption decisions were found to be related in expected ways to perceived risk, capacity to manage risk, and risk propensity. This research supports the view that the decision to adopt an innovative mental health practice is a decision made in consideration of risk. Contrary to popular views that early adopters of innovations are willing to take enormous risks, these data offer the novel idea that early adopters act because they see the risks associated with adopting as lower than their nonadopter counterparts, partly because the risks are seen as more manageable. Implications of results are discussed for organizations considering adoption of innovative health care practices and for state or local mental health authorities hoping for a higher level of adoption in their areas.

Using the Effective Behavior Supports Survey to Guide Development of Schoolwide Positive Behavior Support

As the use of school-based positive behavior support (PBS) spreads nationwide, the development of assessment strategies to identify intervention priorities becomes more critical. This study addresses the validity of the Effective Behavior Supports Survey (Lewis &amp; Sugai, 1999) by examining reliability, determining whether rating differences exist across the four PBS systems and among schools, and reporting the use of the scale in schoolwide planning. Total scale internal consistency reliability reflects a moderate to high level, suggesting that the instrument does contain a cohesive set of items. A large effect size was also found differentiating ratings for the PBS systems, indicating that Individual Student Systems were considered least in place. A case example illustrating the use of the scale as a vehicle for collaborative action planning in a middle school is also discussed.

Development of the 12-Item Expectations Regarding Aging Survey

This study describes the development of a short version of the Expectations Regarding Aging Survey (ERA-38), a 38-item survey measuring expectations regarding aging. In 1999, surveys containing the ERA-38 were mailed to 588 adults aged > or = 65 years who were recruited through physicians; 429 individuals (73%) returned completed surveys. The mean age of participants was 77 years; 76% were White. In 2001, we surveyed 643 adults aged > or = 65 years recruited at 14 senior centers. The mean age of participants was 78 years; 37% were Latino and 16% were African American. With the 1999 data, we selected items for the shorter version of the ERA-38 by using qualitative criteria and by evaluating the items' factor structure, internal consistency reliability of scales, and correlations with age and self-reported measures of health. Then, using the 2001 data, we evaluated the selected items with confirmatory factor analysis, and we reevaluated the internal consistency reliability and associations of the scales with age and self-reported measures of health. The factor analyses of the ERA-12 on both samples provided support for three 4-item scales (expectations regarding physical health, expectations regarding mental health, and expectations regarding cognitive function), and one global expectations regarding aging scale combining all 12 items. In both samples, internal consistency reliability estimates for all scales exceeded 0.74, and the 12 items together explained over 88% of the variance in the ERA-38 total score. We found comparable associations of the ERA-12 scales with age and self-reported health measures in both samples. The ERA-12 demonstrated acceptable reliability and validity to estimate expectations regarding aging.

Parents' Perceptions of Primary Care: measuring parents' experiences of pediatric primary care quality.

A measure of pediatric primary care quality that is brief, practical, reliable, and valid would be useful to patients and pediatricians, policymakers, and health system leaders. Parents have a unique perspective from which to report their experiences with their child's primary care, and these reports may be valid indicators of pediatric primary care quality. The research objective was to develop a brief parent report of their children's primary care, the Parent's Perceptions of Primary Care measure (P3C), and to test its reliability and validity as a measure of pediatric primary care quality. The P3C was based on the elements of primary care as defined by the Institute of Medicine. Pretesting of domain content and item clarity was accomplished via focus interviews. The P3C was developed in English and translated to Spanish, Vietnamese, and Tagalog. The 23-item P3C yields a total score, as well as subscale scores for continuity, access, contextual knowledge, communication, comprehensiveness, and coordination. The P3C was administered to 3371 parents of children in kindergarten through sixth grades in a large, urban school district. The percentage of missing values for the overall sample was 1.88%, indicating acceptable feasibility. Range of measurement, assessed via floor and ceiling effects, was moderate to good. Cronbach's coefficient alpha, an indicator of scale internal consistency reliability, was 0.95 for the P3C total scale. Factor analysis supported the subscale structure, and P3C scores were higher for children with health insurance, whose parents completed the survey in English, and who had a regular physician. P3C scores were positively related to parent reports of the child's health-related quality of life. The P3C is a practical, reliable, and valid measure of parents' reports of pediatric primary care quality. This brief measure could be used alone, or in conjunction with other measures, to enhance outcomes and evaluate the impact of systems changes on the delivery of the main elements of primary care.

Constructivist learning environments in a crossnational study in Taiwan and Australia

This article focuses on the validation and use of English and Chinese versions of the Constructivist Learning Environment Survey (CLES) in a cross-national study of high school science classrooms in Australia and Taiwan. The CLES was administered to 1,081 students from 50 classes in Australia and 1,879 students from 50 classes in Taiwan. Data analysis supported each scale's internal consistency reliability, factor structure and ability to differentiate between classrooms, and revealed interesting differences between average scale scores in Taiwan and Australia. The questionnaire data were used to guide the collection of qualitative data in each country to explain patterns and differences in mean scale scores in Australia and Taiwan. Interviews with students also provided precautionary information regarding students' understanding of some items and the use of a Western survey to measure constructivist learning environments in an Eastern country.