Valid Instrument Research Articles

Exploring the Relationship between Reward Practices and Employee Engagement among County Governments in North Rift Region, Kenya

County governments in Kenya have not had systematic practices of employee engagement. The few that did adopt these practices did so in an isolated, informal, and uncoordinated manner, which was unlikely to yield any meaningful results. Effective human resource practices can have a significant impact on employee engagement. Low employee engagement can result in various issues, including high employee turnover, low productivity, and reduced organizational effectiveness. This study sought to establish the effect of employee reward practices on employee engagement among selected county governments in the North Rift Region, Kenya. The study was anchored on Human Capital Theory. The target population comprised 10,009 employees working in three North Rift counties comprising of Elgeyo Marakwet, Uasin Gishu, and Nandi Counties. The target population was made up of 2,611 employees from Elgeyo Marakwet County, 3,164 employees from Uasin Gishu County, and 4,234 employees from Nandi County. Cluster and simple random sampling techniques were used to select the 385 employees. The data was collected using structured questionnaires. A pilot study was conducted to examine the validity and reliability of the research instrument. Quantitative data from the closed-ended questions was analyzed using descriptive statistics. The study used descriptive statistics, including mean, frequencies, percentages, and standard deviation, to assess respondents' levels of agreement with the statements in the questionnaire. Furthermore, regression analysis was conducted to establish the relationship between employee reward practices and employee engagement. The results were presented using tables. The findings revealed that the model was significant in explaining the relationship between employee reward practices and engagement (F = 142.299, p = 0.000). The study also found that employee reward practices (B=0.358, p<0.001) had positive and significant effect on employee engagement. Consequently, the study recommends that County governments should focus on revising and strengthening their reward practices to ensure fairness and competitiveness. Additionally, the managements of the three counties should develop competitive and equitable reward systems that recognize and reward employees' contributions effectively. Keywords: Reward Practices, Employee Engagement, Public Sector Motivation, County Governments, North Rift Region

Validity and Reliability of the Peds QLᵀᴹ 4.0 Generic Core Scale in Indonesian Version in Children with Chronic Kidney Disease Undergoing Hemodialysis in the Dialysis Unit of Cipto Mangunkusumo Hospital

Background: The Peds QLᵀᴹ 4.0 Generic Core Scales is a modular instrument for measuring health-related quality of life (HR-QoL) in children and adolescents aged 2 to 18 years. The Peds QLᵀᴹ 4.0 GCS consists of 23 items applicable to healthy school and community populations and populations of children with acute and chronic health conditions. The Pediatric Quality of Life Inventory (Peds QLᵀᴹ 4.0 Generic Core Scales) is a modular instrument designed to measure health-related quality of life (HR-QoL) in children and adolescents aged between two and thirteen years. It measures health-related quality of life (HR-QoL) in children and adolescents with progressive chronic kidney disease (CKD), regardless of the underlying etiology, due to the need for regular follow-up visits, strict medication regimens, and dietary intake. Purpose: This study aimed to evaluate the validity and reliability of the Peds QLᵀᴹ 4.0 GCS Indonesian version in children with CKD undergoing hemodialysis (HD) in the Dialysis Unit of Cipto Mangunkusumo Hospital. Methods: This type of research is analytical and observational in nature. The Peds QLᵀᴹ 4.0 GCS were administered to 30 children and 30 parents recruited from a pediatric dialysis unit. This study was conducted at a pediatric dialysis unit at Cipto Mangunkusumo Hospital Jakarta, Indonesia, in Mei-Juni 2024. Validity was tested using Pearson product moment, and reliability was tested using Cronbach's alpha. Results: A total of 30 children and 30 parents undergoing hemodialysis agreed to participate. The average age of the patients was 8–18 years old. Cronbach’s alpha coefficient for the total Peds QLᵀᴹ 4.0 GCS (α child self-report 0.918; α parent proxy report 0.928). Conclusion: The Indonesian versions of The Peds QLᵀᴹ 4.0 GCS were valid and reliable instruments to measure the HR-QoL of children with CKD on hemodialysis. The Peds QLᵀᴹ 4.0 GCS can be applied to provide relevant evidence that helps the function of quality of life among Indonesian patients on hemodialysis in evaluating health programs.

Assessing Mindfulness Barriers: Turkish Validation of the Fears and Resistances to Mindfulness Scale (FRM) via a Bifactor Model Approach

The Fears and Resistances to Mindfulness Scale (FRM) is a self-report measure to help identify who may fear of, have blocks against, and show resistances to mindfulness. The goal of the present study was to evaluate psychometric properties of the Turkish version of the FRM. The study recruited a sample of 448 participants. Participants completed several instruments including the Fears and Resistances to Mindfulness Scale, Depression, Anxiety, and Stress Scales, Multidimensional Existential Meaning Scale, Satisfaction with Life Scale, and Mental Health Continuum-Short Form. Factor analyses confirmed the original two-factor structure of the FRM with good internal consistency and a bifactor model of the FRM. Measurement invariance analyses across gender showed consistent psychometric properties across gender. The subscales and the general factor had positive associations with depression, anxiety, and stress, whereas they predominantly were negatively associated with well-being indicators or irrelevant. This study confirms the original factor structure of the FRM in a non-Western context along with a bifactor model. The Turkish version of the FRM is a valid and reliable instrument.

Validation of ELPO-PT: A Risk Assessment Scale for Surgical Positioning Injuries in the Portuguese Context

Background/Objectives: Surgical procedures carry inherent risks, including injuries from surgical positioning, which impact patient safety and healthcare quality. An instrument to assess and prevent these injuries is essential. This study aimed to validate and culturally adapt the ELPO-PT for the Portuguese population to ensure its applicability and effectiveness in assessing the risk of injury from surgical positioning. Methods: A validation study was conducted with 126 adult patients undergoing surgical procedures at a central hospital in northern Portugal. Statistical analyses, including the calculation of Cronbach’s alpha coefficient, assessed the internal reliability of the scale. Additionally, sensitivity and specificity analyses evaluated the ELPO-PT’s diagnostic accuracy in identifying patients at risk of developing positioning-related injuries. Results: The validation showed a Cronbach’s alpha coefficient of 0.782, indicating reasonable internal reliability. Sensitivity analysis revealed an 85% accuracy rate in identifying patients at risk of positioning injuries, while specificity analysis demonstrated a 90% accuracy rate for patients not at risk. Conclusions: The ELPO-PT is a valid and reliable instrument for aiding nurses in clinical decision-making, with significant sensitivity and specificity in identifying the risk of positioning-related injuries, including pressure ulcers, in adult patients during the intraoperative period. Its implementation is expected to be beneficial in healthcare settings, contributing to the prevention of complications associated with surgical positioning.

Speaking Skill Assessment Instrument Validity: An Investigation into Instructors’ Perceptions

To EFL learners, speaking the target language with satisfactory fluency is a highly significant aspect of learning the language. Assessment of learners’ progress and achievement in speaking skills is equally significant to identify the course of further action, whether it is for feedback, placement, or grading. At the English Language Institute (ELI), King Abdulaziz University in Saudi Arabia, learners’ proficiency in spoken English is assessed for end-of-the-term grading using Interview and Speaking Project as test instruments. The Interview questions are random, while the Speaking Project involves collection of materials on a chosen topic and report writing, followed by presentation and question-answer session. An empirical research study was conducted to examine ELI teachers’ perceptions on the reliability and validity of the two assessment instruments to accurately measure learners’ proficiency in speaking skill and meeting the requirements to reflect the learning outcomes designed for the speaking English course. The data were collected through a survey questionnaire and a structured interview. The surveyed instructors were also encouraged to express their opinions on the role of formative assessment in determining learners’ final grades in English speaking skill.

Relationship between Student-Teachers’ Academic Interaction and Academic Self-Esteem in Public Secondary Schools in Nakuru County, Kenya

The learners’ academic self-esteem and academic interaction shape the learning environment of students. The purpose of this study was to examine students’ academic interaction and academic self-esteem relationships in public secondary schools in Nakuru County, Kenya. Correlational research design and both quantitative and qualitative research approaches were used in the study. The population of the study comprised 23,309 that is 11,938 boys and 11,371 girls form three students from 294 public secondary schools in Nakuru County. A total of 29 public secondary schools and 378 form three students were selected using stratified random sampling. The study used purposive sampling to sample 29 class teachers from the selected public secondary schools in Nakuru County. The total sample size for this study was therefore 407 respondents. The study used closed-ended questionnaires to collect data from students and interview schedule to collect data from class teachers. To ensure content validity of the research instruments, the researcher developed questionnaires and an interview schedule in line with the objectives of the study in consultation with experts on counseling and educational foundations. To test the reliability of the questionnaire, a pilot study was done on one secondary school that was not part of the actual study. Cronbach’s Alpha test of internal consistency was established whereby the items had reliability coefficients of 0.871 (for the student-teacher academic interactions tool) and 0.873 (for student academic self-esteem tool) which were considered acceptable. Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 24 while qualitative data was analyzed using NVivo version 12. The study established that there was a statistically significant relationship between student-teachers’ academic interaction and academic self-esteem in public secondary schools in Nakuru County, Kenya. The study recommends Kenyan teachers training institutions to advance teaching methods that seeks to improve student-teachers’ academic interaction and academic self-esteem for better academic achievement.

Evaluating off-target drug effects seen in RCTs using proteomics and mendelian randomisation

Abstract Introduction Serious adverse drug effects are often not detected until late in drug development after thousands of patients have been exposed to an investigational drug in long and costly clinical trials. More efficient approaches are desirable. Proteomics-informed Mendelian randomisation (MR) can identify potential molecular mechanisms underlying off-target effects of pharmaceuticals and drug repurposing opportunities. Purpose As a demonstration of this approach, we used findings from a previous plasma proteomics study nested within a clinical trial of torcetrapib, which was terminated early because of an increased risk of cardiac events and mortality, in which 200 plasma proteins significantly increased (n=68) or decreased (n=132) after three months of torcetrapib use. We surveyed potential plasma protein-mediated causal effecs of torcetrapib on a wide array of relevant phenotypes in three broad domains: cardiovascular(n=10), immunological(n=9) and cancer(n=4), representing major categories of adverse outcomes that were more common in the treatment arm. Methods We performed three-sample MR on torcetrapib-associated proteins. First, we identified independent cis-pQTL instruments for these proteins in the Atherosclerosis Risk in Communities (ARIC) Study. Then, we used pQTL effect estimates from the deCODE study, to reduce the potential for bias due to winner’s curse and to increase precision. Lastly, we conducted MR analyses on disease-relevant phenotypes using a debiased-IVW estimator and summary results from the largest available GWAS on these phenotypes: coronary artery disease, ischaemic stroke, blood pressure, lipids, heart rate, QT interval, eGFR, serious infections, blood cell counts, immune cell fractions, and several cancers. The significance level for causal protein-phenotype associations was p=1.85E-5 (0.05/(104*26)), correcting for the 104 proteins with valid instruments and the 26 tested outcomes. Results Thirty-three proteins had evidence of a causal association with at least one phenotype. Seventeen proteins were associated with cardiovascular outcomes, including 8 for blood pressure and 9 for lipid levels. We identified more proteins, 25, associated with immune-related phenotypes. One protein was associated with cancer. Of note, 9 proteins had pleiotropic effects across several domains. Conclusions Our approach of using Mendelian randomisation to investigate the causal effects of plasma proteins impacted by medication with known off-target adverse effects revealed several novel causal relationships, highlighting the role of immune function in the development of cardiovascular disease. These results support the use of intermediate omics evaluation to identify potential biomarkers for safety monitoring for drug development and reveal avenues of investigation for drug repurposing.

Vaccination health literacy: cultural validation and pilot testing of the HLS19-VAC instrument

Abstract Introduction Vaccinаtion health literacy (VHL) is considered an extremely important aspect of health literacy. HLS19-VAC questionnaire is a 14-item ‘subjective’ perception-based instrument used for measuring VHL in the M-POHL Health Literacy Survey 2019-2021, which Serbia was not part of. Aim Translation and cultural validation of the HLS19-VAC questionnaire and using the validated Serbian version (HLS19-VAC_RS) for pilot study research. Materials and methods The English version of HLS19-VAC was translated using a systematic approach; three forward and one back-translations were synthesized and compared by an expert committee. Thereafter, cognitive interviews with 11 participants produced a version that was culturally validated by an expert panel. We conducted a cross-sectional pilot study using a HLS19-VAC_RS, on a convenient sample of the general population in Serbia. VHL was assessed by calculating the score for 4 out of 14 questions. Additional data were collected through a general questionnaire with 30 questions. Descriptive and inferential statistics were used. Results Cognitive interviews showed some problems in wording, and cultural adaptation resulted in minor refinements to eight out of 14 items. The instrument was pretested by 11 experts who adjusted it accordingly to produce culturally validated HLS19 -VAC_RS. Of 439 respondents in a pilot study, 15% had problematic VHL, while the levels of sufficient and excellent VHL were nearly the same (38.5% and 35.1%, respectively). There was difficulty in deciding whether to receive the flu vaccine (15.0%) and to find information about recommended vaccines (12.3%). There was a significant statistical difference in responses to VHL and monthly income and alcohol consumption. Most of the respondents contacted pharmacists as primary sources of information about medication (42.7%). Conclusions HLS19 -VAC_RS could be implemented in a local context as culturally appropriate. Further testing on a population level is needed. Key messages • HLS19-VAC_RS Questionnaire is culturally appropriate for assessing vaccination health literacy in Serbia. • Majority of respodents had sufficient or excellent vaccination health literacy.

Content validation of a test battery for assessing sleep quality in adolescents in Slovenia

Abstract Background Sleep constitutes a fundamental biological necessity, occupying approximately one-third of our lifespan. Consequently, the field of sleep research has experienced an increase in interest, prompted by the recognition of insufficient sleep as a significant public health challenge. As the majority of existing questionnaires in Slovenia have yet to undergo official translation and validation processes, the aim of our study was to conduct content validation of a questionnaire designed to assess the sleep quality among adolescents. Methods We developed a test battery for assessing the sleep quality of adolescents by combining a diverse array of questionnaires. We employed the Adolescent Sleep-Wake Scale, Pediatric Daytime Sleepiness Scale, Epworth Sleepiness Scale for Children and Adolescents, and Children’s Morningness-Eveningness Scale. Following the development of the entire test battery, a process of back-translation from English to Slovene occurred, followed by cultural adaptation. Results The designed questionnaire underwent content validation by a panel of 10 experts drawn from diverse disciplines. Evaluation of questionnaire items followed a planned methodology tailored for the content validation of measurement instruments, focusing on content relevance, clarity, and classification into subscales or factors. Our analysis revealed that the individual questionnaires demonstrate content validity, supported by notably high indices of content validity. Conclusions Translated questionnaires demonstrate decent content validity, thus rendering them valid clinical and research tools for assessing sleep quality in adolescents in Slovenia. Key messages • Our research indicates the availability of content-valid tools for sleep research. • Further investigation is needed to determine the reliability, specificity, sensitivity, and appropriateness of the factorial structure of measures for the quality of sleep.

Development of a novel Patient-Reported Outcome Measure (PROM) for adults with an Inherited Cardiac Condition (ICC)

Abstract Background Research on the quality-of-life (QoL) among patients with inherited cardiac conditions (ICC) is limited. Existing evidence from a systematic review indicates that most studies rely on generic measures of health-related QoL, which may not adequately capture ICC-specific factors. The current study aims to develop a disease-specific patient-reported outcome measure to address this gap. Methods Using a qualitative study design, we first conducted focus groups until data saturation was achieved (n=15). Additionally, an expert panel of healthcare professionals was interviewed to ascertain their perspectives on patient-centered care and to evaluate face validity. Transcripts of all focus groups and interviews were analyzed thematically using Atlas.ti, qualitative analysis software, to identify concepts and formulate survey items for the initial instrument. We used the ‘Centre for Health Promotion’ QoL model, consisting of three domains- Being, Belonging, and Becoming- as the theoretical framework for our analysis. Results Our analysis revealed alignment with specific QoL domains of the overarching framework and identified a gap in genetic-specific domains. A novel overarching theme, genetic well-being, was identified, encompassing specific constructs related to future uncertainty, reproductive concerns, and the anticipation of disease development, thus enriching the conceptualization of QoL in the context of inherited cardiac conditions. The discussion will include an exploration of the face validity of the draft instrument. Conclusion Patients diagnosed with an inherited cardiac condition (ICC) face a spectrum of challenges originating from both disease-related stressors and hereditary factors alike. Recognizing that relying solely on objective clinical assessment may fail to capture the full impact of the disease, there has been an increasing focus on incorporating patient-reported measures into disease evaluation. This qualitative study contributes to developing a comprehensive patient-reported outcome measure tailored to individuals with ICC.PROM development study

6.D. Skills building seminar: Family Vulnerability Scale: Why and how to use at Primary Health Care to promote health equity?

Abstract Family vulnerability encompasses multiple perspectives that are interconnected with the health needs of each family member. Families experiencing vulnerability face heightened risks of poor health outcomes. Nonetheless, these vulnerabilities are further compounded by systemic inequalities within healthcare systems, where biological or clinical factors are exclusively considered to organize and/or prioritize access, especially given the scarcity of valid instruments to measure family vulnerability. Primary Health Care (PHC) plays a pivotal role in addressing health inequalities, especially considering its bond with community. From this context, the Family Vulnerability Scale for Brazil (EVFAM-BR, in Portuguese) was developed and validated, been composed of 14 items about four dimensions (income, healthcare, family and violence) (2019-2023). By reducing the gap between science and practice, the implementation process of EVFAM-BR was started at the same year the scale was validated (2023). First, it occurred at 14 PHC services in São Paulo (Southeast Region, Brazil) and second, since 2024 has been implemented at Boa Vista (North Region, Brazil). Also, between 2024 and 2026, the implementation of EVFAM-BR is expected to take place in other Brazilian states participating in the third phase of the PlanificaSUS project, which is developed aiming to support State health departments to implement the Health Care Planning method to organize and integrate PHC and specialized outpatient care based on population health care needs. At this stage, capacity building is needed to align the concept of family vulnerability and to train PHC managers and health professionals on how to apply and use results from EVFAM-BR. This training has already been performed for around 1,000 health professionals from two different regions of Brazil, including managers, Community Health Workers, nurses, and physicians. The present workshop proposal aims to disseminate the EVFAM-BR and to offer the EVFAM-BR experience. It proposes knowledge transferring throughout participants engagement at three activities. Activity 1) “Family Vulnerability: From concept to a scale validity and application”: it is designed to engage participants to discuss about the family vulnerability concept and applicability at PHC, and to discuss on how EVFAM-BR implementation process has been occurring at Brazil and how can be tailored to other contexts. Activity 2) “Role Play: Practicing EVFAM-BR”: Two cases will be used for role play dynamics that will take place in trios, in which one will represent the community health worker, another will be the patient and the third will be the observer. Activity 3) That ones that assumed observer role will share their experiences of using EVFAM-BR. Finally, a discussion will be facilitated based on the participants’ impressions and a review of the main points covered throughout the workshop. Key messages • Family vulnerability stratification (through EVFAM-BR) is essential to plan services achieving equity and qualified population-based care management and to qualify patient approach and care. • Family Vulnerability Scale (EVFAM-BR) training represents efforts to reduce the gap between research and practice and contributes to address social determinants of health on healthcare.

Portuguese Version of the Oral Frailty Index-8: Instrument Validation Study.

The concept of oral frailty has gained scientific and clinical relevance in recent years, and early detection can facilitate timely intervention to manage its progression. The Oral Frailty Index-8 (OFI-8) was developed to assess community-dwelling older adults at risk for oral frailty. This study aims to investigate the psychometric validity of the OFI-8 in the Portuguese population, named the Portuguese version of the OFI-8 (OFI-8-PT), which may serve as a reference for future studies related to longevity and oral function. This study included 2 main phases, involving patients aged 60 years or older, Portuguese speakers, and those who consented to participate in the study. First, the researchers translated and cross-culturally adapted the original questionnaire to make it suitable for native Portuguese speakers. The translated tool was then assessed for psychometric validation, which consisted of test-retest reliability, internal consistency, construct validity, and sex invariance measurement. A total of 159 older adults participated in the baseline survey, with almost equal numbers of male (n=79, 49.7%) and female participants (n=80, 50.3%). The OFI-8-PT demonstrated good reliability (Cronbach α=0.95) and construct validity (goodness-of-fit index=0.96; comparative fit index=0.85; and root mean square error of approximation=0.05, 90% CI 0.00-0.09). The study found sex invariance, indicating that the OFI-8-PT is equally valid for male and female participants, and the tested-retest reliability of the OFI-8-PT was good, indicating consistent results over time. The OFI-8-PT showed psychometric validity and good reliability to be used in the Portuguese population.

Psychometric Properties of the Chinese Version of the Psy-Flex Among Parents of Children with Autism Spectrum Disorder.

This research aimed to translate the original English version of the Psy-Flex, a scale of psychological flexibility, into Chinese and to test its psychometric properties among parents of children with autism spectrum disorder (ASD). Two phases were conducted: (1) translation from English to Chinese (Psy-Flex-C), followed by a semantic equivalence evaluation between two versions, a pre-test, and an evaluation of the Psy-Flex-C in terms of face validity with 20 parents of autistic children, and content validity of the Psy-Flex-C with eight experts. (2) A cross-sectional study with 248 parents of autistic children was conducted for validation, and a subgroup of 50 participants was randomly selected to assess the test-retest reliability at a 2-week interval. The Psy-Flex-C showed satisfactory semantic equivalence with the original version and demonstrated adequate internal consistency (Cronbach's α = 0.84) and test-retest stability (weighted kappa statistic = 0.88). Concurrent validity was supported by a moderate correlation between the Psy-Flex-C and the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (Pearson's r = 0.54, p < 0.01). The Psy-Flex-C showed a significant mean score difference between parents with high and low parenting stress (t = 5.43, p < 0.001). Similar to the original scale, confirmatory factor analysis showed the best fitting one-factor structure of the Psy-Flex-C (X2/df = 1.62, p = 0.13, RMSEA = 0.05, GFI = 0.99, CFI = 0.99, TLI = 0.98, SRMR = 0.023). The Psy-Flex-C can be a reliable and valid instrument to self-report psychological flexibility in parents of children with ASD. Future research is recommended to test the Psy-Flex-C using diverse samples from different cultures and contexts to enhance its generalizability.

Is Serum Vitamin D Associated with Depression or Anxiety in Ante- and Postnatal Adult Women? A Systematic Review with Meta-Analysis.

To collect evidence from studies that explored the associations between serum vitamin D (25[OH]D) concentrations/status and the presence of depressive/anxiety symptoms in the ante- and/or postnatal periods (PROSPERO-CRD42023390895). Studies that assessed serum 25[OH]D concentrations in adult women during the ante/postnatal periods and those that used valid instruments to identify the experience/severity of depressive/anxiety symptoms were included. Independent researchers performed the identification/selection of studies, data extraction, risk of bias (RoB) assessment, and bibliometric analysis steps. Of the total of 6769 eligible records, 15 cohort studies [high (n = 3), moderate (n = 7), and low (n = 5) RoB], nine cross-sectional studies [moderate (n = 3) and low (n = 6) RoB], and one case-control study [moderate RoB] were included (n = 25). Depression (n = 24) and anxiety (n = 4) symptoms were assessed. A significant difference in antenatal serum 25[OH]D concentrations between the groups of women with and without depression was identified (mean difference: -4.63 ng/mL; 95% confidence interval [95% CI]: -8.88; -0.38). Postnatal serum 25[OH]D concentrations were found to be, on average, -2.36 ng/mL (95% CI: -4.59; -0.14) lower in women with postnatal depression than in those without. Maternal antenatal anxiety was associated with significantly lower concentrations/deficiency of 25[OH]D in only one included study. Based on very low/low-quality evidence, it was observed that reduced serum 25[OH]D concentrations in the ante- and postnatal period are associated with the presence of ante- and postnatal depressive symptoms, respectively. Low/deficient antenatal serum 25[OH]D concentrations may not be related to the presence of anxiety symptoms before childbirth. Well-designed longitudinal studies are needed to explore the estimated pooled effect of these associations.

Evaluation of the measurement properties of the parental perceptions of children's exposure to tobacco smoke instrument translated and adapted to the Brazilian context.

Given the need to measure parents' perceptions of their children's exposure to tobacco smoke, the Parental Perceptions of Children's Exposure to Tobacco Smoke (PPE) instrument was developed and validated in Hebrew and later translated into English and Portuguese. The PPE has already been translated and adapted to the Brazilian context but a more robust sample is necessary to investigate the measurement properties. Thus, this study evaluated the measurement properties of the Brazilian version of the PPE instrument. Reliability and validity study were conducted with 161 parents with children up to 18 years of age. Perception of parental smoking status was investigated using analysis of variance. The instrument showed excellent reliability (Cronbach α = 0.92 and intraclass correlation coefficient = 0.91). The exploratory factor analysis identified 4 factors with a total accumulated variance of 71.6%. Confirmatory factor analysis validated this structure with 4 factors. It was necessary to exclude a question that presented low commonality. Analysis of variance demonstrated that nonsmoking and former smoking parents have similar scores, although they are higher than those of current smokers. Our findings provide evidence that the PPE version translated and adapted for the Brazilian context is a reliable and valid instrument. Thus, it can help us understand how parents cope with exposure to tobacco smoke.

Development of Diagnostic, Formative and Summative Assessment Instruments in the PjBL Model to Stimulate Students' Critical and Creative Thinking Skills

It is hoped that current education can produce human resources who have strong critical and creative thinking abilities. Students must have critical and creative thinking skills to be able to solve problems efficiently and effectively. The benchmark for determining student success in learning is through evaluation which includes measurements and assessments. The aim of this research is to develop diagnostic, formative and summative assessment instruments in the PjBL model to stimulate critical and creative thinking skills. This type of research is research &amp; development using the ADDIE model. The results of this research obtained the validity of the assessment instrument in the project based learning model with a valid category. The level of practicality of the assessment instrument was categorized as practical by teachers and students. The results of the effectiveness of the knowledge aspect with the results of the pretest and posttest are seen from the classical completeness of each skill which has reached a level of completeness above the minimum expected score. The N-Gain value shows results that meet the high criteria.

VALIDITAS PENGEMBANGAN MULTIMEDIA INTERAKTIF ADOBE FLASH CS6 PADA PEMBELAJARAN PENDIDIKAN PANCASILA SEKOLAH DASAR

This research is based on the minimal use of technology-based media in the teaching and learning process in elementary schools, especially in Pancasila Education subjects. Teachers more often use surrounding objects and books as media, which makes students feel bored during learning. The aim of this research is to develop interactive multimedia using Adobe Flash CS6 for learning Pancasila Education, especially the Elements of the 1945 Constitution, in class V of SD Gugus 2, Nanggalo District, Padang City, which has high validity, practicality and effectiveness. This research is a type of research and development (Research &amp; Development) by applying the ADDIE model which includes the stages of analysis, design, development, implementation and evaluation. The instruments used to collect data include validation, practicality and effectiveness instruments. Data was analyzed through validity, practicality and effectiveness analysis. The development of interactive multimedia Adobe Flash CS6 for learning Pancasila education in class V of SD Gugus 2, Nanggalo District, Padang City uses the ADDIE model. The results show that the average assessment of the three expert validators is 93.74%, which is categorized as very valid. The results show that any media is very suitable for use.

DEVELOPMENT AND IMPLEMENTATION OF A FIVE-TIER DIAGNOSTIC TEST TO IDENTIFY STUDENT MISCONCEPTIONS ON FRACTIONS: A SIGNIFICANT STEP TOWARDS IMPROVING MATHEMATICS EDUCATION

Misconceptions in fractions, a significant challenge in mathematics education, occur when students' conceptions do not align with scientific conceptions, yet they firmly believe in the correctness of their conceptions. These deeply rooted misconceptions are difficult to eliminate and not easily identified with conventional instruments. Therefore, this study aims to develop a valid and reliable five-tier diagnostic test instrument to identify students' misconceptions about fractions effectively. The design of this development research involves qualitative and quantitative methods using the 4D model (define, design, develop, disseminate). Sixty-eight seventh-grade students were involved in quantitative instrument quality testing; data were analyzed using SPSS. The final result of the development of this instrument was 12 questions declared valid and reliable. Furthermore, the instrument was applied to 30 seventh-grade students in different schools to identify their misconceptions about fractions. Based on the analysis of the combination of students' answers, it was obtained that 36.4% of students understood the concept, 8.9% were in the false positive category, 7.2% were false negative, 9.7% lacked knowledge, and 37.8% had misconceptions. It was found that the most dominant description of misconceptions (33%), namely, students assume that the smaller the denominator of a fraction, the smaller the value of the fraction. Then, it was also found that students' thinking, in general, causes misconceptions to occur. The practical implication of the results of this study is that teachers can use the instrument and identify misconceptions to develop more effective teaching methods, thereby improving mathematics education by helping students avoid and anticipate misconceptions.

Self-stigma in alcohol dependence scale: development and validity of the short form

BackgroundSelf-stigma is associated with low self-esteem, high shame and reduced drinking-refusal self-efficacy in people with alcohol use disorder (AUD). The Self-Stigma in Alcohol-Dependence Scale-Short Form (SSAD-SF) was designed to enable a brief, but valid assessment of AUD self-stigma.MethodsWe reduced the 64-item SSAD, originally derived from 16 stereotypes towards people with AUD, by removing the most offensive items based on perspectives of people with lived experience. The newly created scale was then assessed and validated in a cross-sectional study involving 156 people reporting alcohol issues in various treatment settings.ResultsThe 20-item SSAD-SF includes five stereotypes, with good internal consistency for each subscale and the overall scale. It reflects the four-stage progressive model of self-stigmatization with decreasing scores over the stages awareness of stereotypes, agreement with stereotypes, self-application of stereotypes, and harmful consequences for self-esteem, and highest correlations between adjacent stages. The subscales apply and harm were associated with internalized stigma, shame, reduced self-esteem, and lower drinking-refusal self-efficacy, as supported by multivariate regression models.DiscussionThe SSAD-SF is a valid instrument for measuring the process of self-stigmatization in people with AUD. Self-stigma is a consistent predictor of reduced self-esteem, higher shame and lower drinking-refusal self-efficacy in people with AUD. We discuss merits of the progressive model for understanding and addressing self-stigma in AUD.

Cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitudes Examination (VAX-U) scale.

Martin and Petrie developed the Vaccine Attitudes Examination (VAX) scale with an aim to document general vaccination attitudes. Vaccine acceptance plays an important role in curbing COVID-19 infections. Thus, it was important to assess vaccination attitudes of Pakistani people towards novel COVID-19 vaccines. The VAX scale was not available in Urdu language for Pakistani population. The study aimed to carry out cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitude Examination (VAX) scale in a selected population sample from Pakistan. A cross sectional study was conducted in September 2021 in an outpatient department of a healthcare facility in Karachi, Pakistan. Adult visitors, eligible for COVID-19 vaccine and spoke Urdu as first language were invited. Convenient sampling was used, and sample size was based on an item response ratio of 1:20. An Urdu version of the VAX scale was developed. The reliability was assessed using Cronbach's alpha (α) and intraclass correlation coefficient (ICC). The model fitness was evaluated using confirmatory factor analysis (CFA) and fit indices namely goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). A structural equation model (SEM) was also developed. IBM SPSS and AMOS were used to analyse the data. The study had ethical clearance. A total of 211 responses were analysed. The reliability (Cronbach's α) was 0.821. The ICC was 0.831 (95% CI: 0.795-0.863). CFA using a 4-factor model revealed the following values for fit indices; GFI = 0.944, AGFI = 0.909, TLI = 0.953, CFI = 0.966, and RMSEA = 0.051. All values reported were in the acceptable range. The VAX Urdu version is a reliable and valid instrument for use in an Urdu speaking population and will enable clinicians to assess the public's attitude towards general vaccination including COVID-19 vaccination. Clinicians can use the VAX-U to document a person's vaccine hesitancy and tailor their counselling to address the issues in vaccine uptake.