Valid Response Rate Research Articles

Characteristics of Nurses in Japanese Hospitals Who Detect Errors of One-self and Others

Background: Nurses who often detect errors in medical practice are highly esteemed for their capacity to prevent medical accidents. However, information on particular characteristics of such nurses is limited at this time. The aim of this study was to identify characteristics of nurses who are able to detect errors during medical practice, both their own and those of others. Methods: Anonymous questionnaires were distributed to 2908 nurses in 11 Japanese hospitals whose working career was three years and longer to collect information regarding experiences in detecting errors of one’s own making and errors of others during medical practice, the actual experiences of making errors, social skills, a safety climate in the wards, and general characteristics of the participants. The valid response rate was 64.0 %. Principal component analysis was used to form composite measures using a smaller set of error experiences (clinical errors). Multiple logistic regression analysis was performed to determine factors related to experiences in detecting errors. Results: Of the participants, 77.4% had experienced detecting their own errors, and 84.1% had experienced detecting errors of others. Significant factors related to the experience of detecting one’s own errors were: having experienced their own errors detected by others, clinical errors, feedback and communication about errors, and a medical accident. Significant factors related to the experience of detecting errors of others were: the experience of having their own errors detected by others, experience of detecting one’s own errors, communication openness, night shift duty, experience as a safety committee member, and planning skills. Conclusion: Experiencing errors plays a role in detecting future errors of one’s own making and of others. Adequate feedback is preferable for detecting one’s own errors. Open communication in the ward is recommended for detecting errors of others, as one facet of medical safety control.

Physical activities impact sense of coherence among community-dwelling older adults.

The objective of the present study was to investigate bidirectional longitudinal relationships between sense of coherence (SOC) and physical activities (PA) among community-dwelling older adults. Self-administered questionnaires were sent to 508 community-dwelling adults aged 65-85 years who expressed their intention to participate in our surveys including cognitive function tests and physical performance tests. Of these, 427 people responded to the baseline survey, and 223 of them participated in the follow-up survey 1 year later. Finally, the number of eligible respondents who had no missing values in all data was 179 (valid response rate: 35.2%). We used the 13-item five-point version of the Sense of Coherence Scale to assess SOC variables, and the Physical Activity Scale for the Elderly to assess PA variables. A structural equation modeling method was used to analyze bidirectional longitudinal relationships between SOC and PA. Cross-lagged effects and synchronous effects models were applied to analyze these relationships. Demographic variables (age, sex, education, living arrangements, medical histories, employment status), cognitive function and physical performance were used as control variables. Leisure-time PA had a cross-lagged effect (β = 0.117, P < 0.05) and a synchronous effect (β = 0.217, P < 0.001) on SOC. In contrast, no significant effect of SOC on any type of PA was observed in either the cross-lagged effects model or the synchronous effects model. Leisure-time PA might contribute to enhancing SOC in community-dwelling older adults. Geriatr Gerontol Int 2017; 17: 2208-2215.

Menu Sustainability in the Egyptian Upscale and Fine Dinning Restaurants: Descriptive Approach

Sustainability is considered as one of the most important issues in food trends over the globe. Research about menu sustainability still needs more empirical investigations. This research aims to explore if restaurateurs in Egypt are adapting principles and practices of sustainability in constructing their restaurant’s menus. The current research adopted a deductive approach using the questionnaire strategy as a data collection instrument. The population of the study was the general managers and assistant general managers who are working in the upscale and fine dining restaurants in Greater Cairo (Cairo and Giza). Simple random sampling was chosen as the most proper sampling technique to achieve the study objectives. 300 questionnaires were distributed to managers of the sampled restaurants. The returned and valid questionnaires for analysis were 284, with a valid response rate estimated to be 94.3%. Research findings highlighted that the investigated restaurants responded effectively to the growing needs of the consumers who become more concerned with environmental friendly and sustainable products and services

The association between health-related quality of life/dietary satisfaction and perceived food environment among Japanese individuals with spinal cord injury.

Cross-sectional. To examine the association between health-related quality of life (HRQOL)/dietary satisfaction and perceived food environment in community-dwelling individuals with spinal cord injury (SCI). Members of the Spinal Injuries Japan organization. Subjects were 2007 Japanese individuals with SCI. A questionnaire conducted in 2015 included items addressing sociodemographic characteristics, HRQOL, dietary satisfaction and eight perceived food environment items. Responses from 506 individuals were analyzed (valid response rate=25%). Dependent variables were the physical and mental summary scores of the HRQOL and dietary satisfaction. The independent variable was the perceived food environment. We used a univariate analysis (in Model 1) and a multivariate analysis (in Models 2 and 3) as part of a binominal logistic regression analysis. In Model 3, we divided and analyzed the perceived food environment variable into 'access to food' and 'access to information'. Both physical and mental summary scores were related to 'dietary information acquisition in the community'. Dietary satisfaction was related to 'balanced meals in the household', 'food and health information available from family' and 'right health and dietary information acquisition from the media'. HRQOL and dietary satisfaction were differentially associated with perceived food environment factors in community-dwelling individuals with SCI. HRQOL was positively related to dietary information of perceived food environment in the community. Dietary satisfaction was positively related to perceived food environment in the household.

What strategies do ulcerative colitis patients employ to facilitate adherence?

BackgroundOverall, 30%–45% of patients with ulcerative colitis (UC) are non-adherent and have difficulties taking their medications; this non-adherence increases the risk of clinical relapse 1.4- to 5.5-fold. This study aimed to clarify the strategies patients employ to facilitate adherence and determine whether the strategies had an impact on good adherence.MethodsThis was a cross-sectional survey using a self-administered questionnaire and review of medical records. Patients diagnosed as having UC and attending one of the outpatient clinics of four urban hospitals from June 2009 to December 2012 were enrolled. A questionnaire was developed to identify the strategies patients employ to facilitate adherence and then administered to patients with UC. Adherence to 5-aminosalicylic acid was calculated, and univariate and multiple logistic regression analyses were performed to determine the strategies that were associated with good adherence.ResultsThe final analyses included 671 participants (mean age 40.2 years; 54.3% males). The valid response rate was 96.9%; 186 (27.7%) participants were classified as non-adherent, the mean adherence rate being 86.1% (standard deviation [SD] 17.9). Seven strategies that patients employ to facilitate adherence were identified, the following two being significantly associated with good adherence: “I keep my medicines where I eat meals” and “I keep each day’s medicine in a pill case or something similar to make sure I have taken them”.ConclusionThe identified strategies might be used to develop a program to improve medication adherence in patients with UC.

A cross-sectional study on the factors related to cognitive decline in community-dwelling elderly.

The aim of this study was to examine the relationship between cognitive decline and physical activity, sitting time, and social participation among elderly people living independently in a local community. In January 2015, 1,133 independently-living elderly individuals from a local Japanese community completed self-administrated questionnaires. A total of 929 participants completed the questionnaire (valid response rate: 82.0%). A multiple logistic regression analysis was conducted to examine the relationship between cognitive decline, physical activity, sitting time, and social participation. The factors related to cognitive decline were examined using three statistical models: (1) Model 1 was not adjusted for any factors; (2) Model 2 was adjusted for age, education level, smoking status, and drinking status; and (3) Model 3 was adjusted for the covariates in Model 2, plus depression. Cognitive decline was observed in 33% of men and 26% of women. The results indicated that decreased social participation was significantly related to cognitive decline in Models 1 and 2. For men, local community activity and political/economic activity were significantly associated with cognitive decline in Models 1 and 2. Among women, physical activity was significantly related to cognitive decline in Model 1. There was also a significant association between social participation and cognitive decline in Models 1 and 2; decreased volunteer activity was significantly related to cognitive decline in all three models. The results of the present study indicated that attending volunteer activities was significantly related to cognitive decline in women.

Factors Related to Affective Occupational Commitment among Japanese Nurses

We identified the factors related to affective occupational commitment among nurses in Japan by conducting a cross-sectional survey in 12 hospitals in the Tohoku and Kanto districts of Japan in 2013. Of the 4046 nurses in these hospitals, 1330 completed the self-report questionnaire (valid response rate: 32.9%). High job satisfaction, high professional autonomy, having a scholarship loan, and being married were strongly related to affective occupational commitment. Conversely, having a high effort-reward imbalance and fewer overtime work hours indicated a low level of such commitment. The findings suggest that professional autonomy and job satisfaction are key factors for developing affective occupational commitment. Programs that promote professional autonomy and make people feel more appreciated for their work should be created to improve such commitment, and it would be important to provide adequate organizational resources to increase job satisfaction and reduce effort-reward imbalance. The fact that longer working hours are related to affective occupational commitment suggests that excessive emotional commitment to one’s occupation can lead to overtime work. Therefore, nurse managers should consider the staff’s working situations more thoroughly.

The Association of Autism Spectrum Disorders and Symptoms of Asthma, Allergic Rhinoconjunctivitis and Eczema among Japanese Children Aged 3 - 6 Years

There is insufficient epidemiological evidence on the relationship between autism spectrum disorder (ASD) and allergic diseases. We performed a cross-sectional survey to elucidate the associations between them using validated screening tools. The participants were children aged 3 - 6 years attending kindergarten or nursery school in Shika Town, Japan (n = 417; valid response rate = 80.4%). Autism spectrum features were scored on the Social Communication Questionnaire (SCQ). Allergic symptoms (asthma, allergic rhinoconjunctivitis, and eczema) were determined according to the criteria of the International Study of Asthma and Allergies in Childhood. A total of 15 children (4.5%) had an SCQ score of 11 points or higher. The prevalence of symptoms was 14.7% for asthma, and 5.3% for allergic rhinoconjunctivitis, and 11.4% for eczema. Logistic regression indicated that symptoms of eczema were significantly associated with SCQ scores of 11 points or higher [odds ratio (OR), 4.38; 95% confidence interval (CI), 1.41 - 13.59]. The association persisted after adjustment for age, sex, and BMI (OR, 3.84; 95% CI, 1.20 - 12.24). Moreover, asthmatic symptoms were significantly associated with male sex (OR, 2.09; 95% CI, 1.12 - 3.92) and overweight status (OR, 2.45; 95% CI, 1.03 - 5.83). This suggests that higher SCQ scores, which imply more autism spectrum features, are associated with higher prevalence of eczema symptoms. While no causal relationships can be made, ASD might be associated with eczema.

Perceived Difficulties Regarding HIV/AIDS Services among Public Health Nurses in the Kinki Region of Western Japan: Implications for Public Health Nursing Education in Japan

Objective: To determine the perceived difficulties in providing HIV/AIDS services among public health nurses and to identify their correlates, we carried out a cross-sectional study in the Kinki region of western Japan. Methods: Structured self-administered questionnaires were distributed to all public health nurses in the region, and 1535 valid questionnaires were retrieved (valid response rate 78.7%). Results: More than half of the participants (52.8%) reported difficulties with HIV/AIDS services. The factors associated with perceived difficulties were having a negative attitude towards consultations on sexual matters (adjusted odds ratio [AOR] 2.2, p p = 0.002 and AOR 1.8, p p p = 0.016), and low permissiveness of the diversity of sexual behavior (AOR 2.0, p < 0.001). Conclusions: Overall, our results suggest that nursing and public health nursing education in Japan should cover sexual issues and HIV/AIDS in a more systematic way.

Snoring habits among healthy persons attending a tertiary care center in Chittagong, Bangladesh: A questionnaire-based study

Introduction: Snoring is a common health condition which is unexplored in the context of Bangladesh. Hence, the objective of the present study is to find out the frequency of snoring among the healthy Bangladeshi people attending tertiary care center in Chittagong using a questionnaire. Methods: It was a single center, cross-sectional study conducted in the Department of Internal Medicine of a tertiary care hospital of Bangladesh among 119 apparently healthy adults who were the attendants of patients. A “Snore Survey” questionnaire adopted from an Indian study which was based on Berlin questionnaire was used. Results: With a 88.1% valid response rate, present study included 63 (52.94%) male and 56 (47.06%) female. Among all, 47.9% of (57) individuals were <30 years of age. Majority (82.4%) were recruited from urban locality. Frequency of snoring was 28 (23.5%) of total individuals. Nearly 33.3% of males and 12.5% of females were snorers. The frequency of snoring ranged from daily (25.0%) to monthly (28.6%) episodes. Some had very loud (25.0%) sound during sleep, and others had variable loudness. Male snorers were significantly taller, weighed more and had broader neck circumference than female (P < 0.05). Conclusion: Snoring is not an uncommon medical condition among healthy young people in Bangladesh. Considering the population of Bangladesh, the sample size is very small and a large scale study would certainly help create awareness among the patients as well as healthcare professionals about this neglected but very significant health problem.

The prevalence and basic characteristics of knee pain in community-dwelling independent elderly: A complete survey.

Objectives The objectives of this study were to determine the prevalence of knee pain in independent community-dwelling elderly people and to examine the basic characteristics (sex and age) of those experiencing knee pain.Methods Survey on the health status and lifestyle habits was conducted for all (6,790) independent elderly who were 65 years or older, living in Tsuru City, Yamanashi Prefecture, Japan. The survey was carried out using a mailing questionnaire for 1 month from January 12 to February 11, 2016. Knee pain was defined as subjective pain in and around the knee joint in either one or both knees, on most days during the past month. Participants answered "Yes" if they were experienced knee pain, and "No" if they did not experience knee pain. Sex and age were investigated as basic characteristics of the participants by the questionnaire. The prevalence rate of knee pain was calculated as follows: the total number of people with knee pain divided by the total number of the respondents in the study. To examine the relationships between knee pain and age or sex, these basic characteristics were analyzed using a Chi-square test for the prevalence of knee pain within sex and age groups.Results The number of survey respondents was 5,328 (response rate: 78.5%). The number of valid respondents with complete data was 5,186 (valid response rate: 76.4%). The number of subjects who responded "with knee pain" was 1,733. The prevalence rate of knee pain was 33.4%. In addition, sex and age demonstrated strong associations with the prevalence of knee pain (both, P<0.001). In other words, the prevalence rate was higher in the elderly women than in elderly men and increased with age.Conclusion The present study suggested that one in three independently living elderly who live in medium-sized local municipalities in Japan experience chronic knee pain. The basic characteristics of a community-dwelling independent elderly with knee pain are to be a woman and older age.

Social computing for internet addiction disorder analysis from a psychological perspective

This study adopts needs theory and affective ambivalence to explore how people obtain psychological satisfaction through internet usage, and to explore how such usage behaviour can lead to the development of a sense of dependence. Few previous studies have incorporated these four perspectives. Data mining techniques are used to identify association rules between needs theory, affective ambivalence, internet use behaviour and internet addiction. This study distributed paper-based and electronic questionnaires, receiving a total of 502 valid responses for a valid response rate of about 88%. From the affective ambivalence perspective, we found that emotional state varies with behaviour and age, leading to different patterns of personal expression and creativity. In addition, empirical results show our findings are consistent with Maslow's hierarchy of needs in that people only seek to address their higher-order needs once their lower-order needs are satisfied. Thus, once internet users have satisfied their needs for security, their attention then turns to demands for social interaction and self-esteem.

Teachers' support and depression among Japanese adolescents: a multilevel analysis.

Depression is a major cause of suicide among adolescents. Therefore, childhood and adolescent depression is an important public health concern. This study explored factors as class and individual levels that may influence depression among adolescents in Japan. A questionnaire survey among junior high school students (N=2968) from two cities in Japan was conducted. Depression was assessed using the Depression Self-Rating Scale for Children; teachers' support was assessed using the Scale of Expectancy for Social Support. The class average score of teachers' support was calculated to indicate what we termed the "homeroom teachers' support." Multilevel analysis was applied to clarify the relation between homeroom teachers' support and depression. Finally, 2466 students completed the questionnaire without missing variables (valid response rate, 83.1%). There was no random effect of the teachers' support at the class level on depression, although there was a significant association between teachers' support and depression for 9th graders (β=-0.12, p=0.009). Moreover, there were significant associations between economic status, having a best friend, and experiencing unforgettable stress at the individual level and depression in all grades. There was no significant random effect of homeroom teachers' support in class level although there might be marginal negative association between teacher's support and depression. It is suggested that homeroom teachers need to promote population approaches to mental health.

Association between Municipal Health Promotion Volunteers' Health Literacy and Their Level of Outreach Activities in Japan.

ObjectivesTo explore the association between health literacy and levels of three types of core activities among health promotion volunteers (developing a healthy lifestyle, outreach to family, and outreach to community members).Study DesignA cross-sectional, anonymous, self-administered postal survey of registered health promotion volunteers in the Konan area in Shiga Prefecture in Japan, conducted in January 2010. The study sample was 575 registered health promotion volunteers.MethodsThe survey collected data on health literacy, gender, age, education, self-rated health, perceptions about the volunteer organization, and perceptions of recognition in the community. The level of engagement in health promotion activities was measured by the extent to which the participants engaged in seven healthy behaviors and promoted them to family members and the community. The authors compared the health literacy level and other characteristics of the participants by core health promotion activities, using a chi-squared test, to examine the associations between demographic and other variables and the three core activities (healthy lifestyle, outreach to family, and outreach to community).Logistic regression analysis was conducted to examine the association between the degree to which the volunteers engaged in core activities (“healthy lifestyle,” “outreach to family,” “outreach to community”) and the levels of health literacy (low, medium, high) among health promotion volunteers, controlling for the effects of age, gender, health condition, education which may also have an impact on volunteers’ outreach activities.ResultsFour hundred and fifty-four questionnaires were returned, a 79.0% response rate. Excluding 16 cases with missing values on health literacy or the degree of health promotion activities, 438 research subjects were included in the analysis (valid response rate: 76.2%). Health literacy and a few demographic and other characteristics of the volunteers were associated with the three core health promotion activities. In bivariate analyses, active participation in the core activities was more prevalent among older volunteers (p<0.001 for all three activities). Self-rated health condition was associated with both outreach to family (p = 0.018) and community (p = 0.046). Years of experience as volunteer and perception of being recognized in the community also had statistically significant association with outreach to the community (p<0.001). In multiple logistic regression, those with higher level of health literacy were more likely than others to actively engage in outreach to family (OR = 1.70, 95% CI 1.03 to 2.80; OR = 1.76, 95%CI 1.04 to 3.00 for medium and high, respectively) and outreach to community (OR = 2.26, 95%CI 1.34 to 3.83; OR = 2.61 95%CI 1.49 to 4.58 for medium and high, respectively). Perception of being recognized in the community also had a statistically significant and positive impact on outreach to the community (OR = 1.52, 95%CI 1.17 to 1.99).ConclusionsVolunteers with higher health literacy were more likely to actively engage in outreach to family and outreach to community. Providing educational programs to improve volunteers’ health literacy may facilitate their work.

Assessment of Surgery Resident Competency Provided by Patients.

The objective of this study was to assess the competency of surgery residents from the patient perspective in the current healthcare environment in China. The authors performed an assessment of 508 surgery residents in Liaoning province. Seven patients were as a group to complete the self-administered questionnaires on the survey for each individual corresponding resident. A 5-point rating scale with an unable-to-evaluate category was used to assess surgery resident competency by patients. Reliability and validity were assessed by Cronbach alpha (α) and exploratory factor analysis, respectively. Statistical analysis was performed using SPSS 13.0. The surveys on 421 residents were valid, and the valid response rate was 82.8%. A total of 2947 questionnaires from patients were analyzed in this study. The Cronbach α coefficient was 0.92. The 4 factors emerging in the exploratory factor analysis reached a cumulative contribution rate of 66.98%. The items of “promotes health maintenance (talks about preventive care)” (206/7.0%), “tells me about any side effects of the medicine” (177/6.0%), “spends enough time with me” (189/6.4%), and “answers my questions thoroughly” (168/5.7%) were scored <4 by higher percentage of patients. The instrument provided an acceptable means for patients to evaluate the competency of Chinese surgery residents. Surgery residents should improve their competencies on preventive care, patient safety, and communication skills.

Nationwide epidemiological study of insomnia in Japan

BackgroundThis study was a nationwide epidemiological study of insomnia in Japan. It was conducted because very few studies on this topic have previously been performed for the general Japanese population. MethodsAn interview survey on symptoms of insomnia (difficulty initiating sleep, difficulty maintaining sleep with difficulty resuming sleep, and early morning awakening with difficulty resuming sleep) and daytime dysfunction was conducted on the general nationwide population in the winter (February) and summer (August) of 2008. Data from 2614 participants who provided valid responses (age range 20–95 years, valid response rate 54.2%) were analyzed. ResultsThe prevalence of difficulty initiating sleep, difficulty maintaining sleep with difficulty resuming sleep, and early morning awakening with difficulty resuming sleep was 8.3%, 5.8%, and 5.8%, respectively, in men, and 11.0%, 8.1%, and 7.4%, respectively, in women. The prevalence of insomnia was 12.2% in men and 14.6% in women, and the prevalence of insomnia with daytime dysfunction was 3.2% in men and 4.2% in women. The results of logistic regression analyses indicated that the factors aggravating insomnia for men were unemployment and having mental health issues, and for women they were being aged ≥70 years, completing fewer years of schooling, and having mental health issues. Seasonality and regionality in association with insomnia were also examined, but no significant associations were found. ConclusionIn the present survey, insomnia was defined by using criteria that were closer to the clinical diagnostic criteria (eg, coexistence of both difficulty resuming sleep and daytime dysfunction was considered). Therefore, it is believed that the results of this study were representative of the clinical actuality of insomnia in Japan.

Critical Factors Influencing Decision to Adopt Human Resource Information System (HRIS) in Hospitals.

The aim of this research is to explore factors influencing the management decisions to adopt human resource information system (HRIS) in the hospital industry of Bangladesh—an emerging developing country. To understand this issue, this paper integrates two prominent adoption theories—Human-Organization-Technology fit (HOT-fit) model and Technology-Organization-Environment (TOE) framework. Thirteen factors under four dimensions were investigated to explore their influence on HRIS adoption decisions in hospitals. Employing non-probability sampling method, a total of 550 copies of structured questionnaires were distributed among HR executives of 92 private hospitals in Bangladesh. Among the respondents, usable questionnaires were 383 that suggesting a valid response rate of 69.63%. We classify the sample into 3 core groups based on the HRIS initial implementation, namely adopters, prospectors, and laggards. The obtained results specify 5 most critical factors i.e. IT infrastructure, top management support, IT capabilities of staff, perceived cost, and competitive pressure. Moreover, the most significant dimension is technological dimension followed by organisational, human, and environmental among the proposed 4 dimensions. Lastly, the study found existence of significant differences in all factors across different adopting groups. The study results also expose constructive proposals to researchers, hospitals, and the government to enhance the likelihood of adopting HRIS. The present study has important implications in understanding HRIS implementation in developing countries.

The impact of exploration and exploitation learning on organisational innovativeness among hospitals: an open innovation view

ABSTRACTThis study tries to explore the impact of exploration and exploitation learning on organisational innovativeness among health service organisations from an open innovation view. We developed several constructs including realised absorptive capacity (RACAP), breadth and depth of external knowledge acquisition and tried to explore the roles of these constructs in the influence process of organisational learning on organisational innovativeness. The mail survey was used to collect research data from top hospital managers in Taiwan. The overall valid response rate was 44.23%. We applied a structural equation model to test the research hypothesis. Results indicated the breadth and depth of external knowledge acquisition would affect organisational innovativeness through RACAP. Exploration learning had a directly positive influence on RACAP and also had an indirect impact through the mediation of breadth and depth of external knowledge acquisition among health service organisations.

Validity, reliability, and acceptability of the brief version of the self-management knowledge, attitude, and behavior assessment scale for diabetes patients

To evaluate the validity, reliability, and acceptability of the brief version of the self-management knowledge, attitude, and behavior (KAB) assessment scale for diabetes patients. Diabetes patients who were managed at the Xinkaipu Community Health Service Center of Tianxin in Changsha, Hunan Province were selected for survey by cluster sampling. A total of 350 diabetes patients were surveyed using the brief scale to collect data on knowledge, attitudes, and behaviors of self-management. Content validity was evaluated by Pearson correlation coefficient between the brief scale and subscales of knowledge, attitude, and behavior. Structure validity was evaluated by factor analysis, and discrimination validity was evaluated by an independent sample t-test between the high-score and low-score groups. Reliability was tested by internal consistency reliability and split-half reliability. The evaluation indexes of internal consistency reliability were Cronbach's α coefficients, θ coefficient, and Ω coefficient. Acceptability was evaluated by valid response rate and completion time of the brief scale. A total of 346(98.9%) valid questionnaires were returned, with average survey time of (11.43±3.4) minutes. Average score of the brief scale was 78.85 ± 11.22; scores of the knowledge, attitude, and behavior subscales were 16.45 ± 4.42, 21.33 ± 2.03, and 41.07 ± 8.34, respectively. Pearson correlation coefficients between the brief scale and the knowledge, attitude, and behavior subscales were 0.92, 0.42, and 0.60, respectively; P-values were all less than 0.01, indicating that the face validity and content validity of the brief scale were achieved to a good level. The common factor cumulative variance contribution rate of the brief scale and three subscales was from 53.66% to 61.75%, which achieved more than 50% of the approved standard. There were 11 common factors; 41 of the total 42 items had factor loadings above 0.40 in their relevant common factor, indicating that the brief scale and three subscales had good construct validity. Patients were divided into a high-score group and a low-score group, then scores of the brief scale and three subscales were compared between the groups using a t-test. The results were all significant, indicating that the brief scale and three subscales had good discriminate validity. Mean scores of the brief scale and three subscales of the high-score group were 91.55±6.81, 19.51±2.17, 22.74±1.88, and 49.30±6.20, respectively; these were higher than the low-score group (65.89±5.79, 12.29±4.76, 20.22±1.88, and 33.39±6.17, respectively) with t-values 27.76, 13.31, 9.20, and 17.56 (P-values were less than 0.001). The Cronbach's α coefficient, θ coefficient, Ω coefficient, and split-half reliability of the brief scale were 0.83, 0.87, 0.96, and 0.84, respectively. These values for the three subscales were all above 0.70, except for the θ coefficient of the attitude subscale with 0.64, indicating that the brief scale and three subscales had acceptable internal consistency reliability. The brief version of the diabetes self-management knowledge, attitude, and behavior assessment scale showed good acceptability, validity, and reliability, to responsibly evaluate self-management KAB among patients with diabetes.

The Consequence of Customer Verbal Aggression

This study integrated research on stimulus–organism–response and COR theory to examine whether customer verbal aggression lead to employee service sabotage through emotional dissonance and whether person-organization fit moderate the relationship between customer verbal aggression and emotional dissonance. To achieve this goal, this study surveyed flight attendants employed by six airlines in Taiwan. Out of 1000 questionnaires distributed, 504 valid questionnaires were returned, yielding a valid response rate of 50.4 percent. The research results demonstrate that emotional dissonance partially mediates the relationship between the customer verbal aggression and service sabotage. Additionally, person-organization fit negatively moderates the relationship between customer verbal aggression and emotional dissonance. Based on these results, suggestions regarding service management are presented as a reference for airlines.