Issues of reliability and validity in the measurement of challenging behaviour (behavioural difficulties) in learning disability: a discussion of implications for nursing research and practice

• ? The purpose of this paper is to contribute to the debate on issues related to the reliability and validity of measurement of challenging behaviour (behavioural difficulties) in learning disability. A number of practical, theoretical and methodological issues are discussed that have significance for the nurse both as practitioner and/or researcher in learning disability. These issues are equally important to both provider and purchaser of health care in order that resources can be most effectively targeted.
• ? The term ‘challenging behaviour’ would appear to be used both in literature and research synonymously with behavioural difficulties, this has implications for nurses in both their clinical practice and/or research. The author concludes by identifying a need to replace the term challenging behaviour, with ‘behavioural difficulties’. It is argued that such a term is much more explicit in meaning and amenable to operational definition, thus enabling empirical study. Such a proposal will not be accepted by all as justifiable; this is because some might argue that adopting the term behavioural difficulties may be a retrograde step that perpetuates negative imagery and inappropriate labelling of people with a learning disability.

     

SF-36用于肺结核的信度、效度及敏感性评价

目的　评价中文版SF - 36量表用于肺结核 (PTB)病人的生命质量测量的信度、效度、敏感性。方法　用自行研制的中文版SF - 36量表对肺结核病人及对照进行测量。采用Cronchbach’sα评价量表的信度 ,因子分析评价量表的效度 ,用配对t检验比较患者组和对照组的评分来评价量表的敏感性。结果　对于病人组和对照组 ,SF - 36量表效度 (因子分析聚合为 2个公因子 )、信度 (Cronchbach’sα >0 7)较好。肺结核病人各项得分均低于对照组 ,说明量表的敏感性较高。结论　中文版SF - 36量表是测量肺结核病人的生命质量的有效量表 ,但量表中个别词句的翻译仍须改动 ,并且有必要进行更大样本的调查 ,建立中国人的生命质量正常值标准 ,以利于生命质量的评价     

方差成分模型在职业紧张研究个体效度评价中的应用

目的探讨如何用方差成分模型评价职业紧张研究的个体效度,即量表是否反映了个体特征,以及个体是否如实完成了问卷的效度评价方法.方法通过方差成分模型获得单位内相关系数对个体效度进行评价.结果分析结果提示对一些填表随意性大,非临床一线科室及组织不力的科室个体效度偏低.结论方差成分模型可用于评价个体完成问卷的情况,对个体效度偏低的数据可以合理地剔除.     

儿童社交焦虑量表的中国城市常模

【目的】建立儿童社交焦虑量表(Social Anxiety Scale for Children,SASC)的中国城市常模并检验其信度和效度。【方法】在全国14个城市采样2 019例(男1 012,女1 007),平均年龄(11.29±2.34)岁,由学生填写SASC;焦虑组儿童填写SASC、SCARED,其父母填Achenbach儿童行为量表(Child Behavior Checklist,CBCL)。【结果】量表的重测信度为0.538~0.839、半分信度0.81、Crobach a系数0.58~0.79、项目与总分的一致性在0.27~0.76之间。量表的效度较好,与Achenbach CBCL、SCARED的相应分量表相关,社交焦虑组儿童得分高于常模组,对社交焦虑性障碍诊断的灵敏度为0.69,特异度为0.75。【结论】儿童社交焦虑量表可用于我国儿童社交焦虑症状的评估。     

新型农村合作医疗综合评价指标体系测评分析

目的 对新型农村合作医疗综合评价指标体系分析和验证。方法 采用相关和多元线性回归分析检验综合评价指标与内部指标问联系、信度分析和主成分因素分析，对综合评价指标体系进行评价。结果 新型农村合作医疗综合评价指标同内部指标具有正相关，内部指标具有独立性，总体指标克朗巴赫α系数为0．8889．指标体系内容效度极好。主成分分析表明指标体系具有较好的结构效度。结论 新型农村合作医疗综合评价指标体系的建立具有合理性、科学性和较好的信度与效度。     

《雌性实验猕猴情绪评价量表》建立及信度检验与效度估计

[目的]建立《雌性实验猕猴情绪评价量表》(《量表》),为情志病证猕猴模型情志评价提供客观衡量工具。[方法]对猕猴各种表情行为进行观察分析,建立《雌性实验猕猴情绪评价筛选表》(《筛选表》);采用非条件logistic逐步回归建立初步情志表情数学模型;建立《雌性实验猕猴量表观察表》(《观察表》);采用重测法和分半法对量表稳定性和一致性进行检验;采用等值法对效度标准稳定性进行检验;采用效标关联法对效度进行估计。[结果]愤怒、抑郁、快乐三种情绪重测信度较高,愤怒和抑郁情绪分半信度较高;除焦虑外,其余各情绪效标均较稳定;《量表》各情绪积分均能有效反映相关情绪变化,其中愤怒、抑郁、友善、性行为效度较高。[结论]《量表》虽然在测量某些情绪方面有效性不理想(焦虑),内部一致性差(友善与快乐),但对于愤怒和抑郁这两种主要情绪以及其他情绪测量的信度和效度都达到了量表标准,可较客观地评价雌性实验猕猴情绪表情行为。     

健康素养管理量表(HeLMS)在大肠癌初筛阳性居民中的适用性评估

 目的   对健康素养管理量表(Health Literacy Management Scale,HeLMS)的信度和效度进行评价,探讨其在大肠癌初筛阳性居民中的适用性。方法   采用HeLMS量表对上海市嘉定区2015—2016年1 959名大肠癌初筛阳性的居民进行问卷调查,用因子分析法、Cronbach α系数、相关系数等考察量表的信度和效度。结果    量表的总Cronbach α系数为0.961,量表各维度的Cronbach α系数为0.834~0.929;量表每个条目与其所属维度间的相关系数为0.511~0.936,且均有统计学意义;肠镜检查组的健康素养量表得分为128.99±12.83,显著高于未进行肠镜检查组的126.98±15.66 (P=0.002)。对年龄、性别、初筛阳性特点等进行分层分析,发现年龄>70岁、女性、风险评估及大便隐血均阳性者在肠镜组和非肠镜检查组患者量表得分差异上有统计学意义(P<0.05)。分半信度的Cronbach α系数0.976;因子分析法得到的结果与量表结构大致相符,各维度得分与量表总得分的相关系数为0.517~0.916,均有统计学意义;量表得分的三分位组别(高分、中分和低分)在量表各维度的差异均有统计学意义,提示量表区分效度较好。结论    HeLMS量表在大肠癌初筛阳性居民中具有较好的信度和效度,可用于评价其健康素养水平。     

Development of a new instrument for determining the level of chewing function in children

This study aimed to develop a chewing performance scale that classifies chewing from normal to severely impaired and to investigate its validity and reliability. The study included the developmental phase and reported the content, structural, criterion validity, interobserver and intra‐observer reliability of the chewing performance scale, which was called the Karaduman Chewing Performance Scale (KCPS). A dysphagia literature review, other questionnaires and clinical experiences were used in the developmental phase. Seven experts assessed the steps for content validity over two Delphi rounds. To test structural, criterion validity, interobserver and intra‐observer reliability, two swallowing therapists evaluated chewing videos of 144 children (Group I: 61 healthy children without chewing disorders, mean age of 42·38 ± 9·36 months; Group II: 83 children with cerebral palsy who have chewing disorders, mean age of 39·09 ± 22·95 months) using KCPS. The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used for criterion validity. The KCPS steps arranged between 0–4 were found to be necessary. The content validity index was 0·885. The KCPS levels were found to be different between groups I and II (χ² = 123·286, P < 0·001). A moderately strong positive correlation was found between the KCPS and the subscales of the BPFAS (r = 0·444–0·773, P < 0·001). An excellent positive correlation was detected between two swallowing therapists and between two examinations of one swallowing therapist (r = 0·962, P < 0·001; r = 0·990, P < 0·001, respectively). The KCPS is a valid, reliable, quick and clinically easy‐to‐use functional instrument for determining the level of chewing function in children.     

The Home Visit

The home visit has become a integral part of treatment programs for a large number of patients at the Spaulding Rehabilitation Hospital. It is especially useful for elderly patients, who represent a considerable share of the caseload, and has proven to be most beneficial for those individuals who are returning home to live alone or be alone part of the day. At Spaulding the hyome visit is most often conducted by an occupational and physical therapist team who follow a specific evaluation protocol examining the patient's home environment vis-à-vis anticipated functional status at discharge. Recommendations and suggestions for both use patterns and possible structural changes follow. In order to both evaluate the process and the results of home visits a chart audit was conducted from which various ways have been discovered to improve the value of this treatment activity and thereby enhance a patient's quality of life after discharge.     

Medial Olivocochlear-Induced Transient-Evoked Otoacoustic Emission Amplitude Shifts in Individual Subjects

Activation of the medial olivocochlear reflex (MOCR) can be assessed indirectly using transient-evoked otoacoustic emissions (TEOAEs). The change in TEOAE amplitudes when the MOCR is activated (medial olivocochlear (MOC) shift) has most often been quantified as the mean value in groups of subjects. The usefulness of MOC shift measurements may be increased by the ability to quantify significant shifts in individuals. This study used statistical resampling to quantify significant MOC shifts in 16 subjects. TEOAEs were obtained using transient stimuli containing energy from 1 to 10 kHz. A nonlinear paradigm was used to extract TEOAEs. Transient stimuli were presented at 30 dB sensation level (SL) with suppressor stimuli presented 12 dB higher. Contralateral white noise, used to activate the MOCR, was presented at 30 dB SL and was interleaved on and off in 30-s intervals during a 7-min recording period. Confounding factors of middle ear muscle reflex and slow amplitude drifts were accounted for. TEOAEs were analyzed in 11 1/3-octave frequency bands. The statistical significance of each individual MOC shift was determined using a bootstrap procedure. The minimum detectable MOC shifts ranged from 0.10 to 3.25 dB and were highly dependent on signal-to-noise ratio at each frequency. Subjects exhibited a wide range of magnitudes of significant MOC shifts in the 1.0–3.2-kHz region (median?=?1.94 dB, range?=?0.34–6.51 dB). There was considerable overlap between the magnitudes of significant and nonsignificant shifts. While most subjects had significant MOC shifts in one or more frequency bands below 4 kHz, few had significant shifts in all of these bands. Above 4 kHz, few significant shifts were seen, but this may have been due to lower signal-to-noise ratios. The specific frequency bands containing significant shifts were variable across individuals. Further work is needed to determine the clinical usefulness of examining MOC shifts in individuals.