Significant Differential Item Functioning Research Articles

Exploring the Remote Administration of a Performance-Based Functional Assessment.

Performance-based assessments of instrumental activities of daily living (IADL) can detect subtle functional impairments better than self-reported questionnaires. While most performance-based IADL assessments were developed for in-person administration, remote administration could increase access to vulnerable older adults. This study compared in-person and remote administration of IADL tasks from the Performance Assessment of Self-Care Skills. Community-dwelling older adults completed tasks (shopping, checkbook balancing, and medication management) at baseline (in-person) and follow-up (either in-person or remote, with modifications) two years later. Scores between the two follow-up groups, change in scores from baseline to follow-up, and differential item functioning (DIF) between the two administration methods at follow-up were examined. There were no differences in scores between methods of administration, but remote tasks took longer, and one item had significant DIF (ps < .01). Clinicians found remote administration acceptable and feasible. With minor adaptations, remote administration of the three tasks was supported. Further validation research is needed.

Differential Item Functioning and Clinical Utility of the Subjective Memory Complaints Questionnaire in a Multi-Ethnic Cohort

Introduction: This study evaluated the psychometric properties of the Subjective Memory Complaints Questionnaire (SMCQ) in a non-Hispanic White (NHW) and Mexican American (MA) sample from Texas in the USA. Methods: Data were obtained from the Health and Aging Brain Study – Health Disparities (HABS-HD; N = 1,691, age = 66.5 ± 8.7, education = 12.4 ± 4.8, 60.6% female, 33.2% MA Spanish speaking). Unidimensionality of the SMCQ was evaluated with confirmatory factor analysis. Differential item functioning (DIF) of the SMCQ was assessed across age, sex, education, and ethnicity/language using item response theory/logistic ordinal regression. Associations of the SMCQ in relation to cognitive status, Alzheimer’s disease (AD) blood-based biomarkers, and psychological distress were examined. Results: The SMCQ showed excellent fit in a single-factor model (CFI = 0.97, TLI = 0.97, RMSEA [95% CI] = 0.05 [0.04, 0.05], SRMR = 0.07). Significant item-level DIF was detected by education level and ethnicity/language, but not by age or sex; when detected, DIF was not salient (i.e., adverse). The SMCQ was associated with greater psychological distress, worse Clinical Dementia Rating scores, and greater disease burden as measured by total tau and neurofilament light. Conclusions: Practically negligible item-level bias was identified across education and ethnicity/language. Detected DIF can be described as benign, indicating that some items manifested differently between groups but had minimal impact on measurement properties. These results demonstrate that the SMCQ performs appropriately across demographic variables. Our findings also provide support for the associations of SMCQ scores with self-reported mood, cognitive status, and AD blood-based biomarkers.

A person-reported cumulative social risk measure does not show bias by income and education

BackgroundSocial risk such as housing instability, trouble affording medical care and food insecurity are a downstream effect of social determinants of health (SDOHs) and are frequently associated with worse health. SDOHs include experiences of racism, sexism and other discrimination as well as differences in income and education. The collective effects of each social risk a person reports are called cumulative social risk. Cumulative social risk has traditionally been measured through counts or sum scores that treat each social risk as equivalent. We have proposed to use item response theory (IRT) as an alternative measure of person-reported cumulative social risk as IRT accounts for the severity in each risk and allows for more efficient screening with computerized adaptive testing.MethodsWe conducted a differential item functioning (DIF) analysis comparing IRT-based person-reported cumulative social risk scores by income and education in a population-based sample (n = 2122). Six social risk items were analyzed using the two-parameter logistic model and graded response model.ResultsAnalyses showed no DIF on an IRT-based cumulative social risk score by education level for the six items examined. Statistically significant DIF was found on three items by income level but the ultimate effect on the scores was negligible.ConclusionsResults suggest an IRT-based cumulative social risk score is not biased by education and income level and can be used for comparisons between groups. An IRT-based cumulative social risk score will be useful for combining datasets to examine policy factors affecting social risk and for more efficient screening of patients for social risk using computerized adaptive testing.

Revisiting the English Short Measure for Adult Playfulness (SMAP): An Investigation of Reliability, Validity, and Cross-Cultural Comparisons

Adult playfulness describes the personality of the quick initiation and strong intensity of enjoyable experiences coupled with the frequency of engaging in playful behaviors. In addition to examining the reliability and validity of the Short Measure for Adult Playfulness (SMAP), we compared the psychometric properties of the SMAP across (a) 4- and 7-point answer formats; (b) German and English language versions; and (c) gender. The SMAP and criterion validity measures were distributed across three independent samples from Canada (N total = 1,177) and a German sample (N = 660). Results supported a unidimensional solution with strong factor loadings for all items (>.50 across all samples) and high test-retest reliability (r = .67, BF10>100). In item response theory analyses, high discrimination parameters were found across the latent continuum. Although both the four-point and seven-point Likert scale versions showed robust item properties, the seven-point Likert scale version yielded more precise measurement of higher playfulness (θ > 1.50). No significant differential item functioning was located across gender or language. Finally, results supported external construct validity via associations with broad personality traits, humor, and orientations to happiness. The present investigation provides support for the reliability and validity of the English SMAP for concise adult playfulness measurement.

Comparison of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale and Hospital Anxiety and Depression – Depression subscale scores by administration mode: An individual participant data differential item functioning meta-analysis

Administration mode of patient-reported outcome measures (PROMs) may influence responses. We assessed if Patient Health Questionnaire-9 (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale – Depression subscale (HADS-D) item responses and scores were associated with administration mode. We compared (1) self-administration versus interview-administration; within self-administration (2) research or medical setting versus private; and (3) pen-and-paper versus electronic; and within interview-administration (4) in-person versus phone. We analysed individual participant data meta-analysis datasets with item-level data for the PHQ-9 (N = 34,529), EPDS (N = 16,813), and HADS-D (N = 16,768). We used multiple indicator multiple cause models to assess differential item functioning (DIF) by administration mode. We found statistically significant DIF for most items on all measures due to large samples, but influence on total scores was negligible. In 10 comparisons conducted across the PHQ-9, EPDS, and HADS-D, Pearson's correlations and intraclass correlation coefficients between latent depression symptom scores from models that did or did not account for DIF were between 0.995 and 1.000. Total PHQ-9, EPDS, and HADS-D scores did not differ materially across administration modes. Researcher and clinicians who evaluate depression symptoms with these questionnaires can select administration methods based on patient preferences, feasibility, or cost.

Initial evaluation of measurement properties of the Work Environment Impact Questionnaire (WEIQ) - using Rasch analysis

BackgroundTo provide both preventive and rehabilitative conditions in a workplace, one must understand how employees experience work demands. Such an understanding can be obtained from each individual with valid and quality-assured questionnaires. The Work Environment Impact Questionnaire (WEIQ) is a new questionnaire for measuring employees’ self-perceived work ability in relation to their specific workplace environment. The purpose of this study was to assess the measurement properties in terms of construct validity of the WEIQ.MethodsA cross-sectional survey study was conducted with 288 respondents from three different workplaces involving assisted living personnel, vocational rehabilitation personnel and personnel at a research institute. The measurement properties of the WEIQ were assessed according to Rasch Measurement Theory (RMT), including assessment of item-to-sample targeting, threshold ordering, item fit statistics, unidimensionality and reliability.ResultsItem fit, i.e., fit residuals, item characteristic curves (ICC) and chi square values, were all satisfactory, and no disordered thresholds were present after collapsing the lowest response categories. However, issues with local dependent (LD) item correlations was present in 7.6% cases, four items showed statistically significant differential item functioning (DIF), where 11% of the respondents had person fit residuals outside the recommended range of ± 2.5 and the t-test for unidimensionality did not meet the criterion of 5%. Scale-to-sample targeting and reliability (0.92) were good. LD could be resolved with testlets and at the same time maintaining fit and improving dimensionality, but then the reliability decreased to 0.82.ConclusionsThis study provides an initial validation of the WEIQ to be used for assessing employees’ self-perceived work ability. Most measurement properties were acceptable, but further exploration of LD, DIF and unidimensionality in additional work settings and with larger sample sizes is warranted.Trial registrationNot applicable.

Optimizing Item Construction in Diagnostic Mathematics Test

The diagnostic mathematics test is a critical tool for measuring students' abilities to understand and apply mathematical concepts, with the design of good test items being paramount to ensure validity. This study leverages Item Response Theory (IRT) models and Differential Item Functioning (DIF) methods to refine the construction of test items, specifically focusing on rational numbers. Engaging 929 junior high school students from three public schools in Cirebon, West Java The research utilized R Software to analyze the most suitable IRT models and investigate DIF methods. The findings underscore the efficacy of the Parameter Logistic 3PL model based on Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), -2 loglikelihood, and Standardized Root Mean Square Residual (SRMSR) values, alongside item fit, highlighting that nearly all analyzed items were suitable except one that required replacement. Additionally, the identification of items with significant DIF effects points to potential biases, suggesting avenues for enhancing test fairness and reliability. The study's broader implications extend to improving diagnostic assessment practices, informing item design in educational evaluations, and guiding future research towards creating more equitable and precise measures of mathematical understanding. This contributes to a nuanced comprehension of student abilities, offering valuable insights for educators, assessment designers, and policymakers aimed at fostering improved learning outcomes in mathematics education.

Psychometric evaluation of the pictorial scale of perceived movement skill competence in Chinese children: An item response theory analysis.

This study aimed to investigate the psychometric characteristics of the Pictorial Scale of Perceived Movement Skill Competence (PMSC) in Chinese children, utilizing the principles of item response theory (IRT). A total of 284 children (147 boys), aged 4-10years (Mage = 7.39, SD = 2.18), from four schools were recruited for testing, adhering to the principle of random sampling. The Rasch model was applied to evaluate the rating scale validity, local independence, scale dimensionality, person and item fit statistics, and differential item functioning (DIF). (1) The rating scale validity was confirmed by the monotonically increasing trend in both average item difficulty measures and Andrich thresholds. (2) However, the observation that standardized residual correlations for all items remained below 0.3 unequivocally confirmed the presence of local independence among the variables. (3) The scale's dimensions were substantiated, with Rasch measures explaining 40.6% of total variance, exceeding the 40% threshold. Additionally, the first contrast had an eigenvalue of 1.8 and explained 8.80% of the variance, both exceeding the minimum 3:1 ratio. Consequently, the unidimensionality assumption of the item was supported. (4) Person and item fit statistics indicated requisite reliability and separation, with all achieving suitable infit and outfit measures, and point-biserial correlations exceeding 0.55. (5) Regarding gender DIF, it was observed that the majority of items did not exhibit statistically significant gender DIF effects (p > 0.05) except item 8 (Bounce a ball, t = -2.74, p < 0.01, DIF = -0.51). Rasch analysis revealed that the instrument exhibited strong scale validity among Chinese children, adhering to the Rasch model's unidimensionality and local independence principles, with robust person and item reliability and separation. All items demonstrated a good fit. Additionally, the significant gender difference in item 8 (Bounce a ball) warrants further consideration. In conclusion, PMSC is suitable for assessing the PMSC of Chinese children.

Parkinson's Disease Inequities in Daily Cognitive Activities: An Intersectional Approach.

Intersectionality approaches to examining differences in Parkinson's disease (PD) based on racialized group, gender identity, and socioeconomic status (SES) are not well covered in the literature. Additionally, the differences in daily cognitive activities for persons diagnosed with PD by racialized group, gender, and SES are undetermined. This study was conducted to explore the differences in PD daily cognitive activities for diverse racialized groups by gender and SES. This study was a secondary analysis of the Michael J. Fox Foundation's Fox Insight online clinical dataset. Persons with PD were partitioned into 16 racialized by gender groups (Black women, Indigenous men, Latina/x women, Asian men, etc.) that were used in within-group comparisons of low-, middle-, and high-SES-a new variable comprising education and income. Intersectional analyses revealed most items differed between low-SES and high-SES except for items associated with Black and Indigenous men, for whom significant differential item functioning was found between mid-SES and high-SES. These findings revealed that within-group differences exist and may be missed in research in which social factors are adjusted for instead of included in the model.

Development of the PROMIS pediatric stigma and extension to the PROMIS pediatric stigma: skin item banks.

To develop the PROMIS Pediatric Stigma (PPS) and Skin (PPS-Skin) by constructing a common metric for measuring stigma in children with various conditions, while capturing the unique features of each condition. Data from 860 children, ages 8-17, with a diagnosis of epilepsy, pNF (neurofibromatosis type 1 associated neurofibroma plexform), MD (muscular dystrophy), cancer, or skin conditions recruited from three projects were analyzed. Children with epilepsy, pNF and MD (sample-1) completed the original 18-item Neuro-QoL Stigma, while children with cancer and skin conditions (e.g., atopic dermatitis, psoriasis, and genetic skin disorders; sample-2) completed a 16-item version and 6 additional skin related items. Exploratory factor analysis (EFA) and confirmatory analysis (CFA) were used to evaluate unidimensionality of 24 stigma items. Differential item functioning (DIF) was used to evaluate measurement equivalence on group, gender, age, and conditions. Item response theory model (IRT) was used to construct the final measure. Sufficient unidimensionality was supported by both EFA and CFA. No items showed significant DIF indicating stable measurement properties across groups of comparison. All items fit the IRT model and were able to be calibrated together to form the PPS which consists of 18 core items. The PPS-Skin (18 cores items + 6 skin items) was developed by calibrating 6 skin items onto the common metric as the PPS. We used IRT techniques to successfully develop the PPS and the PPS-Skin, which share a common metric and account for unique and common concerns related to chronic conditions.

FURTHER EVALUATION OF A MODIFIED VERSION OF THE HOSPICE PHILOSOPHY SCALE: A DIFFERENTIAL ITEM FUNCTIONING ANALYSIS

Abstract The hospice philosophy of care (HPOC) is a set of values applicable to all interdisciplinary group members that drives organizational and individual approaches to hospice care. As the only established measure of HPOC attitudes, we aimed to extend previous exploratory psychometric evaluation of the eight-item Hospice Philosophy Scale (HPS-8). An interdisciplinary convenience sample of 481 hospice clinicians participated in this cross-sectional study. Participants were recruited through hospice and palliative care membership associations representing the core members of the Medicare Hospice Benefit-designated hospice interdisciplinary group (physicians, nurses, social workers, chaplains). After examining uniformity through confirmatory factor analysis, we tested HPS-8 items for differential item functioning (DIF) by professional discipline using multiple indicators, multiple causes models. We compared models via nested chi-square difference tests. Our final model assessed uniform DIF for the HPS-8 factor, controlling for DIF-indicated items. We also assessed internal consistency reliability. After correlating errors for two similarly worded items, global fit indices met prevailing thresholds, χ²(19)=55.18, p&amp;lt;.001 (RMSEA=.06, SRMR=.03, CFI=.98, TLI=.97). The uniform DIF model indicated two items with DIF. Chaplains endorsed the need for mental and spiritual preparation for death more than physicians (β=0.21, p&amp;lt;.001). Nurses endorsed involving patients and families in deciding treatments and services more than physicians (β=0.21, p=.006). Despite statistically significant DIF on these items, statistically significant differences among professions were not observed at the factor level (p&amp;gt;.50 for all). Composite reliability estimates satisfied internal consistency thresholds (CR=.76). Results support the HPS-8’s use as a valid and reliable measure for assessing HPOC in hospice clinicians.

30 Item response theory and differential item functioning of the AD8: The High School &amp; Beyond Study

Objective:The AD8 is a validated screening instrument for functional changes that may be caused by cognitive decline and dementia. It is frequently used in clinics and research studies because it is short and easy to administer, with a cut off score of 2 out of 8 items recommended to maximize sensitivity and specificity. This cutoff assumes that all 8 items provide equivalent “information” about everyday functioning. In this study, we used item response theory (IRT) to test this assumption. To determine the relevance of this measure of everyday functioning in men and women, and across race, ethnicity, and education, we conducted differential item functioning (DIF) analysis to test for item bias.Participants and Methods:Data came from the 2021 follow up of the High School &amp; Beyond cohort (N=8,690; mean age 57.5 ± 1.2; 55% women), a nationally representative, longitudinal study of Americans who were first surveyed in 1980 when they were in the 10th or 12th grade. Participants were asked AD8 questions about their own functioning via phone or internet survey. First, we estimated a one-parameter (i.e., differing difficulty, equal discrimination across items) and two-parameter IRT model (i.e., differing difficulty and differing discrimination across items). We compared model fit using a likelihood-ratio test. Second, we tested for uniform and non-uniform DIF on AD8 items by sex, race and ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), education level (high school or less, some college, BA degree or more), and survey mode (phone or internet). We examined DIF salience by comparing the difference between original and DIF-adjusted AD8 scores to the standard error of measurement of the original score.Results:The two-parameter IRT model fit the data significantly better than the one-parameter model, indicating that some items were more strongly related to underlying everyday functional ability than others. For example, the “problems with judgment” item had higher discrimination (more information) than the “less interest in hobbies/activities” item. There were significant differences in item endorsement by race/ethnicity, education, and survey mode. We found significant uniform and non-uniform DIF on several items across each of these groups. For example, for a given level of functional decline (theta) White participants were more likely to endorse “Daily problems with thinking/memory” than Black and Hispanic participants. The DIF was salient (i.e., caused AD8 scores to change by greater than the standard error of measurement for a large portion of respondents) for those with a college degree and phone respondents.Conclusions:In a population representative sample of Americans ∼age 57, the items on the AD8 contributed differing levels of discrimination along the range of everyday functioning that is impacted by later life cognitive impairment. This suggests that a simple cut-off or summed score may not be appropriate since some items yield more information about the underlying construct than others. Furthermore, we observed significant and salient DIF on several items by education and survey mode, AD8 scores should not be compared across education groups and assessment modes without adjustment for this measurement bias.

Validation of two brief instruments (the SURE and CollaboRATE) to measure shared decision-making in patients with restless legs syndrome.

Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk-benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.

Confirmatory structural validation and refinement of the Recurrent Urinary Tract Infection Symptom Scale.

To confirm the structural validity of the Recurrent Urinary Tract Infection Symptom Scale (RUTISS), determining whether a bifactor model appropriately fits the questionnaire's structure and identifying areas for refinement. Used in conjunction with established clinical testing methods, this patient-reported outcome measure addresses the urgent need to validate the patient perspective. A clinically and demographically diverse sample of 389 people experiencing recurrent UTI across 37 countries (96.9% female biological sex, aged 18-87 years) completed the RUTISS online. A bifactor graded response model was fitted to the data, identifying potential items for deletion if they indicated significant differential item functioning (DIF) based on sociodemographic characteristics, contributed to local item dependence or demonstrated poor fit or discrimination capability. The final RUTISS comprised a 3-item symptom frequency section, a 1-item global rating of change scale and an 11-item general 'rUTI symptom and pain severity' subscale with four sub-factor domains measuring 'urinary symptoms', 'urinary presentation', 'UTI pain and discomfort' and 'bodily sensations'. The bifactor model fit indices were excellent (root mean square error of approximation [RMSEA] =0.041, comparative fit index [CFI] =0.995, standardised root mean square residual [SRMSR] =0.047), and the mean-square fit statistics indicated that all items were productive for measurement (mean square fit indices [MNSQ] =0.64 - 1.29). Eighty-one per cent of the common model variance was accounted for by the general factor and sub-factors collectively, and all factor loadings were greater than 0.30 and communalities greater than 0.60. Items indicated high discrimination capability (slope parameters >1.35). The 15-item RUTISS is a patient-generated, psychometrically robust questionnaire that dynamically assesses the patient experience of recurrent UTI symptoms and pain. This brief tool offers the unique opportunity to enhance patient-centred care by supporting shared decision-making and patient monitoring.

An Analysis of the DIF Sources of ABIDE Mathematics Self-Efficacy Scale by means of a Latent Class Approach

This study aims to identify the sources of Differential Item Functioning (DIF) using the Mixture Ordinal Logistic Regression (Mixture OLR) method, a contemporary approach for detecting DIF. To analyze mathematics self-efficacy, data from a scale comprising 9 items were obtained from 5000 8th-grade students as part of the ABIDE-2016 project. The study compared the presence and extent of DIF by gender using two methods and examined the sources of DIF for items displaying DIF with Mixture OLR. The OLR analysis revealed that five items exhibited DIF at level A, but no DIF was observed with Mixture OLR. Furthermore, it was found that the magnitude of DIF (B) for an item showing DIF at level A changed due to Mixture OLR. The results indicate that the homogeneity of the data affects both the number of items displaying DIF and the magnitude of DIF. Three items did not exhibit significant DIF according to both methods. One significant finding in the study highlights the moderating effect of latent class on item 8, where DIF was observed. However, the source of DIF was not related to gender but rather stemmed from different ecological variables. An analysis of latent class characteristics revealed that students with significant DIF effects had lower absenteeism and fewer siblings. Additionally, students in this class had greater access to books at home and participated in more out-of-school mathematics courses. Surprisingly, these students were found to engage less in social activities. Various factors can influence how students respond to test items, potentially leading to DIF. These factors may include cultural background, gender, social environment, school, teacher, family interest/attitude toward the child, and home climate. Therefore, when developing and administering tests, it is crucial to test for data homogeneity and consider the impact of these variables, in addition to gender, to identify any sources of DIF in test items.

Rasch analysis of the Chinese version of the clinically useful depression outcome scale in patients with major depressive disorder

ObjectiveTo examine the psychometric properties of the Chinese version of the Clinically Useful Depression Outcome Scale (CUDOS) in the Chinese patients with major depressive disorder (MDD) using Rasch analysis.MethodsThe sample consisted of 283 patients with MDD (69% females). The Rasch model was applied to examine the overall fit of the Chinese version of CUDOS and the fit of the 18 items. Dimensionality, item-model fit, differential item functioning (DIF), reliability, ordering of response category and targeting were tested to examine the psychometric properties of the Chinese version of CUDOS.ResultsRasch analysis demonstrated the unidimensionality of the Chinese version of CUDOS. Of the 18 items, three items (item 4, item 5, item 6) showed misfit in the model. After merging item 4 into item 3 and item 6 into item 5, the overall model fit improved. The person separation index (PSI) was 3.0 and the person reliability coefficient was 0.90. No evidence of significant DIF was found when associated with gender and age. No disordered category and threshold of the rating response were observed, which meant the response category setting was reasonable. The mean ability of person was − 0.53.ConclusionThe results suggested that the Chinese version of CUDOS has acceptable psychometric properties. In order to improve the quality and applicability of the Chinese version of CUDOS, the merging of item 4 into item 3 and item 6 into item 5 are suggested.

Attitudes towards death and dying among intensive care professionals: A cross-sectional design evaluating culture-related differential item functioning of the frommelt attitudes toward care of the dying instrument

ObjectiveThe objective is to examine whether one of the most used instruments for measuring attitudes towards caring for dying patients, the Frommelt Attitude Toward Care of the Dying (FATCOD-B) instrument, has the same meaning across different societal contexts, as exemplified by Swedish and Saudi Arabian intensive care professionals. MethodsA cross-sectional design used the 30-item FATCOD-B questionnaire. It was distributed to intensive care professionals from Sweden and Saudi Arabia, generating a total sample of 227 participants. Ordinal logistic regression models were used to examine the differential item functioning (DIF) for each item. ResultsUp to 12 of the 30 items were found to have significant DIF values related to: (a) Swedish and Saudi Arabian intensive care professionals, (b) Swedish and Saudi Arabian registered nurses (RNs), (c) RNs’ levels of experience and (d) RNs and other intensive care professionals in Saudi Arabia. ConclusionsThe results indicate that FATCOD should be used cautiously when comparing attitudes towards death and dying across different societal and healthcare contexts.

Development and evaluation of the Norwegian Fatigue Characteristics and Interference Measure (FCIM) for stroke survivors: cognitive interviews and Rasch analysis

PurposeThere is need for a comprehensive measure of post-stroke fatigue with sound measurement properties. This study aimed to develop the Norwegian Fatigue Characteristics and Interference Measure (FCIM) and assess its content validity, structural validity, and internal consistency.MethodThis study consisted of three steps: (1) an expert panel developed version 1.0 of the Norwegian FCIM, (2) its content validity was assessed in cognitive interviews with stroke patients (N = 15), (3) a convenience sample of stroke patients (N = 169) completed an online questionnaire with the FCIM, Fatigue Severity Scale, and sociodemographic information; validity and reliability were assessed using Rasch analysis.ResultsFCIM version 1.0 included a 10-item characteristics subscale, a 20-item interference subscale, and two pre-stroke fatigue items. The cognitive interviews revealed content validity issues, resulting in two interference items being removed and five items being flagged but retained for Rasch analysis (version 2.0). Rasch analysis led to removal of four items from the characteristics subscale and six more from the interference subscale. The final six-item characteristics subscale and 12-item interference subscale (version 3.0) both showed adequate fit to the Rasch model with indications of unidimensionality and local independence. The interference subscale had a high person separation index. No significant differential item function (DIF) was found in relation to gender, but one item demonstrated DIF in relation to age.ConclusionThe cognitive interviews and Rasch analysis demonstrated that the Norwegian version of the FCIM has high content validity, structural validity, and internal consistency. Future research should assess its construct validity, reliability, and responsiveness.

Evaluation of psychometric properties of the Dental Anxiety Inventory (DAI-36) questionnaire using iterative hybrid ordinal logistic: Differential item functioning (DIF).

Dental Anxiety Inventory (DAI-36) questionnaire is an instrument for assessing dental anxiety. The different perceptions of the questionnaire items in the individual at the same level of underlying dental anxiety may lead to different reported dental anxieties. This study aims to determine the differential item functioning (DIF) of the DAI-36 measure items. The DAI-36 was completed by 950 participants. An iterative hybrid ordinal logistic regression model was used to detect DIF across gender, education, and age groups. DIF analysis was done by lordif package in R3.1.3 software. The chi-square statistics declared 7, 7, and 4 nonuniform DIF items, and 2, 5, and 4 uniform DIF items across gender, education, and age groups, respectively. ΔR2 was always lower than 0.07 in all uniform and nonuniform DIF items. However, Δβ1 revealed significant uniform DIF in items 1 and 8 across gender (Δβ1(item 1)=0.0137, Δβ1(item 8)=0.0124) and items 22 and 27 across age categories (Δβ1(item 22)=0.0110, Δβ1(item 27)=0.0136). DIF items had no large magnitude or cancel out each other, so statements phrased in the DAI-36 questionnaire have equivalent meaning across participants, regardless of their gender, education, and age groups.

Differential language performance of Mandarin-speaking children with and without hearing loss

ABSTRACT The current study investigated the differential item functioning (DIF) on language assessment between Mandarin-speaking children with and without hearing loss (HL). Particularly, it explored the differences between the children in specific linguistic aspects. A total of 253 Mandarin-speaking children, aged three to six years old, participated, including 140 children without HL and 113 with HL. All children took the Revised Preschooler Language Assessment (RPLA) to assess their language ability. The RPLA items were categorized into different linguistic aspects, including semantics, syntax and pragmatics. The DIF analysis was conducted and the results revealed several statistically significant DIF items favouring children with and without HL, showing both the advantages and difficulties faced by children with HL. Items that favoured children with HL included directional words (semantics), comparative sentences (syntax), analogies (semantics), producing complete sentences (pragmatics/syntax), and retelling stories (pragmatics). Items that favoured children without HL included wh-questions (semantics), sentences containing connectives (syntax), logical words (semantics), comprehension of long paragraphs (semantics), and identifying semantic features (semantics). The results shed light on the advantages, which may benefit children with HL due to early intervention. In addition, suggestions on the difficulties were also provided, which these children may encounter compared to their hearing counterparts.