Psychometric evaluation of the Dutch Resilience Scale RS-nl on 3265 healthy participants: a confirmation of the association between age and resilience found with the Swedish version

The aim of this study was to complete a thorough psychometric evaluation of the 'RS-nl', a Dutch adaptation of the Wagnild and Young Resilience Scale. All of the 25 items of the original RS were retained, but a 4-point rather than a 7-point response was used and one item was reworded by removal of the negation. Psychometric analyses on 3265 healthy participants revealed a significant positive association between age and the total resilience score, confirming the findings with the Swedish version by Lundman et al. To a lesser extent, associations between education and the subscale 'Personal Competence' and between gender and the subscale 'Acceptance of Self and Life' was found. There was, however, no strong evidence for a five factor structure reflecting the five characteristics described by Wagnild and Young, mainly because of high secondary loadings. Therefore, in accordance with the 25-item RS, a two factor model (creating the subscales 'Personal Competence' and 'Acceptance of Self and Life') was maintained. The RS-nl seems to be a valid and useful screening instrument to detect persons at risk, who could benefit from closer and prolonged psychological help.     

Validity evidence and use of the IPEC Competency Self-Assessment,Version 3

ABSTRACT

To guide interprofessional education (IPE), a variety of frameworks have been suggested for defining competency in interprofessional practice, but competency-based assessment remains challenging. One self-report measure developed to facilitate competency-based assessment in IPE is the IPEC Competency Self-Assessment. It was originally described as a 42-item measure constructed on the four domains defined by the Interprofessional Education Collaborative (IPEC) Expert Panel. Response data, however, identified only two factors labeled Interprofessional Interaction and Interprofessional Values. In this study, we tested a revised 19-item, two-factor scale based on these prior findings with a new sample (n = 608) and found good model fit with three items not loading on either factor. This led to a 16-item instrument, which was then tested with an additional sample (n = 676). Internal consistency was high, and scores for both subscales showed variance based on prior healthcare experience. The interprofessional interaction subscale was primarily comprised of items from the Teams and Teamwork domain, with one item each based on competencies from the Interprofessional Communication and Values/Ethics domains; and scores varied by year of enrollment. The interprofessional values subscale was comprised solely of items from the Values/Ethics domain. Scores for both subscales were strongly correlated with scores from the Interprofessional Socialization and Valuing Scale. This study further establishes the validity, reliability, and usability of an assessment tool based on interprofessional competency. The findings also suggest the constructs underlying the subscales may be affected differently by experience and training. Additional study using longitudinal data is needed to test this hypothesis.     

The Chronic Pain Acceptance Questionnaire: confirmatory factor analysis and identification of patient subgroups

Over the past decade, the importance of acceptance of chronic pain has been demonstrated. Acceptance has often been assessed using the 20-item, two-factor Chronic Pain Acceptance Questionnaire (CPAQ; McCracken, Vowles, Eccleston, Pain 2004;107:159-66). This two-factor model has been supported but awaits further confirmation. The present investigation sought to address this issue in two large samples of pain suffers. Exploratory factor analyses (N=333) examined a number of solutions, ranging from two to five factors. Evaluation indices provided clear support for a 20-item, two-factor solution. Confirmatory factor analyses, using the second sample (N=308), examined a number of models. Fit indices demonstrated that the model identified in the exploratory analyses had the best fit. Finally, a series of cluster analyses were performed using a combined sample (N=641). Results indicated three clusters: one with high scores on both subscales (n=146), one with low scores on both subscales (n=239), and one with discrepant scores that were high on the Activity Engagement subscale and low on the Pain Willingness subscale (n=286). Follow-up analyses indicated significant differences among the clusters across multiple measures of functioning. The cluster with low CPAQ scores reported more difficulties in comparison to the group with high scores, while the group with discrepant CPAQ scores generally reported difficulties that fell in between. These results provide further support for the 20-item, two-factor CPAQ and indicate that it is both theoretically and practically useful.     

Structure of the Collett-Lester Fear of Death and Dying Scale

The study examined the factor and cluster structures and internal consistency reliabilities of the Collett-Lester Fear of Death Scale. Data were reanalyzed from an earlier study of 88 subjects who completed the scale under neutral conditions. The four subscales showed only weak recovery in the four-factor solution and gender loaded on the factor reflecting the Fear of Death of Others subscale. The two-factor solution showed that items reflecting the death and dying of “self tended to had on the first factor whereas items concerning “others” boded on the second factor. A Ward's cluster analysis yielded five meaningful clusters of items. Not surprisingly, the four subscales showed only moderate internal consistency reliabilities whereas the overall scale was acceptable. Comments are presented for improving the scale as well as for using the scale in applied settings.     

Beyond translation ... cultural fit

Reaching non-English-speaking families, the economically disadvantaged, and those who are disproportionately represented in disease and injury statistics is challenging. This article describes the process of making a questionnaire developed in English, culturally appropriate for low-income, monolingual, Mexican and Mexican American mothers. The questionnaire, guided by the Health Belief Model, assesses maternal childhood injury health beliefs and was originally used with a 96% African American, English-speaking sample in the Eastern United States. Two research assistants from the target population worked with the non-Hispanic, bilingual investigator to redesign the questionnaire's language and presentation and to collect data. Sixty monolingual Latina mothers participated in the study to determine the internal consistency of the 42-item Spanish language Maternal Childhood Injury Health Belief Questionnaire (MCIHB). Cronbach's alpha coefficients ranged from .76 (Benefits subscale) to .90 (Consequences subscale).     

The Chronic Pain Acceptance Questionnaire (CPAQ)-further validation including a confirmatory factor analysis and a comparison with the Tampa Scale of Kinesiophobia

Acceptance of pain and distress has lately appeared as an important factor in determining peoples’ ability to restore functioning in the presence of chronic pain. Although treatments based on cognitive behaviour therapy are beginning to incorporate acceptance strategies, there is still a lack of reliable and valid instruments to assess relevant processes in such interventions. The Chronic Pain Acceptance Questionnaire (CPAQ) was originally constructed as part of the development of an acceptance oriented treatment approach for pain patients. A revised 20-item version of the instrument with two subscales has shown adequate reliability and validity. In the present study, a Swedish translation of CPAQ was evaluated with 611 participants reporting chronic pain and symptoms of whiplash associated disorders. This study sought to further assess the psychometric properties of the instrument and to investigate its relation to another important measure of pain adjustment, the Tampa Scale of Kinesiophobia. Due to low intercorrelations with other items, item 16 was excluded. Exploratory and confirmatory factor analyses supported the previously suggested two-factor solution. Furthermore, the internal consistencies were good for the subscales (activities engagement and pain willingness) as well as the total scale. Hierarchical regression analyses illustrated strong relations with criteria variables (e.g. disability and life satisfaction). In general, the activities engagement subscale contributed more than pain willingness to the prediction of criteria variables. Furthermore, results illustrated that CPAQ explained more variance than the Tampa Scale of Kinesiophobia in pain intensity, disability, life satisfaction, and depression.     

Testing equivalence of Spanish and English versions: the LaMonica-Oberst (revised) patient satisfaction with nursing care scale

Despite recent emphasis on outcome measurement and an increasing proportion of Spanish speakers in the United States, most patient satisfaction studies exclude Spanish-speaking participants because Spanish versions of instruments are not available. A Spanish translation of the 15-item LaMonica-Oberst Patient Satisfaction Scale, completed by 64 Spanish-speaking patients living in the northeast and of predominantly Puerto Rican ancestry, produced two factors explaining 86.3% of score variation (alpha=.94 and.58). Evidence for equivalence to the English version and concurrent validity is presented. Generalizability and decision studies indicate that four additional items are needed on the dissatisfaction subscale to attain an acceptable dependability coefficient.     

Scale to measure patient satisfaction with physical therapy

BACKGROUND AND PURPOSE: Patient satisfaction can be one indicator of quality of care. In this study, a patient satisfaction questionnaire for physical therapy was developed. SUBJECTS: The subjects were a consecutive sample of 1,024 patients who received physical therapy between January and March 1999 at a teaching hospital in Geneva, Switzerland. METHODS: A cross-sectional mail survey was conducted in which a structured questionnaire measuring patient satisfaction with various aspects of physical therapy followed by open-ended questions was sent to the subjects. RESULTS: Overall, 528 of 1,024 patients (52%) responded (patient demographics for 501 respondents who provided demographic data: mean years of age=58.6, SD=18.9, range=15-95; 258 men, 243 women). Factor analysis was used to identify main domains of satisfaction, and a scale was constructed to measure satisfaction with each dimension: treatment subscale (5 items), admission subscale (3 items), logistics subscale (4 items), and a global assessment subscale (2 items). All subscales had good acceptability and small floor and ceiling effects. Internal consistency coefficients varied between.77 and.90, indicating good reliability for all subscales. Scale validity was supported by a logical grouping of items into subscales, according to their content, and by correlations of satisfaction scores with the patient's intention to recommend the facility and with the number of positive and negative comments to open-ended questions. Younger patients were less satisfied than older patients for 2 of the subscales (admission and logistics). DISCUSSION AND CONCLUSION: The 14-item instrument is a promising tool for the evaluation of patient satisfaction with physical therapy in both inpatients and outpatients.     

Psychometric properties of the Swedish version of the Resilience Scale

The aim of this study was to investigate resilience in relation to age and gender, and to elucidate the underlying structure of the Swedish version of the Resilience Scale (RS). The RS, originally created by Wagnild and Young is a 25 items scale of Lickert type with possible scores ranges from 25 to 175, the higher the score, the stronger resilience. A standardized procedure was used for translation. The analysis was based on 1719 participants, 1248 women and 471 men, from eight different samples, aged from 19 to 103 years. We found that the participants estimated their resilience as relatively high. There was a significant relationship between age and resilience, for every year RS score increased with 0.134 units. There was no relation between gender and resilience. From a factor analyses five factors emerged, equanimity, meaningfulness, perseverance, existential aloneness and self-reliance reflecting the five dimensions described by Wagnild and Young. We concluded that the resilience is related to age, the older, the stronger resilience. Five underlying dimensions was identified, which can be seen as reflection of the theoretical assumptions behind the RS scale. The RS scale seems applicable to a Swedish population.     

14-item resilience scale (RS-14): psychometric properties of the Brazilian version

The Resilience Scale (RS) was developed to evaluate the levels of resilience in the general population. Its reduced version (RS-14) has presented reliable internal consistency and external validity. However, its psychometric properties have not been systematically evaluated. The objective of this study was to present the psychometric properties of the Brazilian RS-14. A total of 1,139 subjects selected by convenience (62.9% women) from 14 to 59 years old (M = 26.1, SD = 11.61) participated in the study. Exploratory factor analyses (EFAs) and parallel analysis were conducted in order to assess the factor structure of the scale. A 13-item single-factor solution was achieved. Confirmatory factor analyses (CFA) and multigroup CFA (MGCFA) corroborated the goodness of fit and measurement invariance of the obtained exploratory solution. The levels of resilience correlated negatively with depression and positively with meaning in life and self-efficacy.     

Factors associated with sleep disturbance in women of Mexican descent

heilemann m.v., choudhury s.m., kury f.s. & lee k.a. (2012)?Factors associated with sleep disturbance in women of Mexican descent. Journal of Advanced Nursing68(10), 2256-2266. ABSTRACT: Aims. The aims were to identify the most useful parameters of acculturation in relation to self-reported sleep disturbance and describe risk factors for sleep disturbance in women of Mexican descent. Background. Little is known about acculturation as a factor for poor sleep in the context of other personal factors such as income or sense of resilience or mastery for Latinas in the United States. Design. This study was a secondary analysis of cross sectional survey data. Methods. Personal factors were incorporated into a modification of the Conceptual Framework of Impaired Sleep to guide our secondary analysis of self-reported sleep disturbance. Data were collected from a convenience sample of 312 women of Mexican descent of childbearing age (21-40?years) located in an urban California community were collected and previously analysed in relation to depressive symptoms and post-traumatic stress disorder. The General Sleep Disturbance Scale (in English and Spanish) was used to assess sleep disturbance. Data was collected in 1998 from September through December. Results. Early socialization to the United States during childhood was the most useful acculturation parameter for understanding self-reported sleep disturbance in this sample. In a multivariate regression analysis, three factors (higher acculturation, lower income and higher depressive symptoms) were statistically significant in accounting for 40% of the variance in sleep disturbance. Conclusion. When low income Latinas of Mexican descent report sleep problems, clinicians should probe for environmental sleep factors associated with low income, such as noise, over-crowding and exposure to trauma and violence, and refer the woman to psychotherapy and counselling rather than merely prescribing a sleep medication.     

United States Spanish short-form-36 health survey: scaling assumptions and reliability in elderly community-dwelling Mexican Americans

BACKGROUND: Measuring health status is challenging in Mexican Americans and other diverse groups, because most health measurement instruments were developed and tested in English. Thus, it is difficult to determine whether measured health disparities are the result of actual differences or due to measurement error resulting from translation or conceptual differences. OBJECTIVES: The purpose of this study was to test the metric equivalence of the United States (US) Spanish Short-Form-36 Health Survey (SF-36) in a group of elderly Mexican Americans. In addition, the SF-36 scores of elderly Mexican American women in our sample were compared with normed scores for the SF-36 scales in the general population of elderly US women. METHOD: Health status was measured by the US Spanish SF-36 in telephone surveys conducted entirely in Spanish. The sample (N = 65) was elderly (mean age 75.3) and primarily female (78%). Most had less than 7 years of education and an annual income below $10,000. RESULTS: Missing data were negligible, and did not indicate difficulty with particular items. The item response values were well distributed and item response means were generally similar within a scale. Most item correlations were higher with the item's hypothesized scale than with other scales, though some items in the Mental Health, Vitality, and Social Functioning scales were highly correlated with other scales. Internal consistency reliability (Cronbach alpha) was.80 or above on all scales except Social Functioning (.69). SF-36 scale scores were lower in elderly Mexican American women than in elderly women in the general US population. DISCUSSION: The US Spanish SF-36 was a generally satisfactory measure of health status in a sample of elderly Mexican Americans with little formal education. The performance of some items in the Mental Health, Vitality, and Social Functioning scales warrants further research.     

Reliability and validity of the Functional Assessment of Chronic Illness Therapy-Palliative care (FACIT-Pal) scale

The Functional Assessment of Chronic Illness Therapy (FACIT) system provides a general, multidimensional measure of health-related quality of life (FACT-G) that can be augmented with disease or symptom-specific subscales. The 19-item palliative care subscale of the FACIT system has undergone little psychometric evaluation to date. The aim of this paper is to report the internal consistency, factor structure, and construct validity of the instrument using the palliative care subscale (FACIT-Pal). Two hundred fifty-six persons with advanced cancer in a randomized trial testing a palliative care psychoeducational intervention completed the 46-item FACIT-Pal at baseline. Internal consistency was greater than 0.74 for all subscales and the total score. Seventeen of the 19 palliative care subscale items loaded onto the four-factor solution of the established core measure (FACT-G). As hypothesized, total scores were correlated with measures of symptom intensity (r=-0.73, P<0.001) and depression (r=-0.75, P<0.001). The FACIT-Pal was able to discriminate between participants who died within three months of completing the baseline and participants who lived for at least one year after completing the baseline assessment (t=-4.05, P<0.001). The functional well-being subscale discriminated between participants who had a Karnofsky performance score of 70 and below and participants with a Karnofsky performance score of 80 and above (t=3.40, P<0.001). The findings support the internal consistency reliability and validity of the FACIT-Pal as a measure of health-related quality of life for persons with advanced cancer.     

Assessing psychosocial distress in diabetes: development of the diabetes distress scale

OBJECTIVE: The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. RESEARCH DESIGN AND METHODS: In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158). RESULTS: Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001). CONCLUSIONS: The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.     

Psychometric testing of the social support survey on a Taiwanese sample

BACKGROUND: The Medical Outcomes Study Social Support Survey (MOS-SS) is a multidimensional, self-administered instrument used to assess various functional dimensions of social support. Less is known regarding its value for a Chinese population. OBJECTIVE: The aim of this study was to assess the psychometric properties of the MOS-SS on an adult sample in Taiwan. METHODS: A total of 265 adult family caregivers of patients with cancer from four different hospitals in the north, middle, and south regions of Taiwan completed the MOS-SS. RESULTS: In the original five-factor model, unsatisfactory item discriminant validity was found in almost half of the items; the item-own subscale correlation was lower than the item-other subscale correlation. A two-factor model accounting for 68.98% of the variance was found using exploratory factor analysis. The first factor (emotional support) accounted for 62.28% of the total variance, whereas the second factor (tangible support) accounted for 6.7%; the interfactor correlation was .71. The two-factor model seemed to have satisfactory reliability and validity and better discrimination between different subscales than did the original five-factor model. DISCUSSION: Good reliability and validity were demonstrated in the MOS-SS when applied to an adult sample in Taiwan. A two-factor model, instead of a five-factor model as found in the Western countries, was found for this sample. Confirmation of the two-factor model and exploration of the two-factor model in related concepts are suggested for future studies.     

Psychometric evaluation of the Spanish and English versions of the spiritual coping strategies scale

The Spiritual Coping Strategies (SCS) Scale measures how frequently religious and nonreligious (spiritual) coping strategies are used to cope with a stressful experience. This study's purpose is to evaluate the psychometric properties of the newly translated Spanish version of the SCS. A total of 51 bilingual adults completed the SCS in Spanish and English, with 25 completing them again 2-3 weeks later. Internal consistency reliability for the Spanish (r = 0.83) and English (r = 0.82) versions of the SCS in the total sample were good. Test-retest reliability was .84 for the Spanish and .80 for the English version. Spanish and English responses to the SCS items and the resulting score for the subscales and the total scale were not significantly different. Scores on the English and Spanish versions were correlated as expected with time since the stressful event and happiness with family and with spouse or partner, supporting the validity of the Spanish SCS. Study findings support the reliability and validity of the newly translated Spanish SCS.     

A simplified stroke rehabilitation assessment of movement instrument

BACKGROUND AND PURPOSE: An efficient, reliable, and valid instrument for assessing motor function in patients with stroke is needed by both clinicians and researchers. To improve administration efficiency, we applied the multidimensional Rasch model to the 30-item, 3-subscale Stroke Rehabilitation Assessment of Movement (STREAM) instrument to produce a concise, reliable, and valid instrument (simplified STREAM [S-STREAM]) for measuring motor function in patients with stroke. SUBJECTS AND METHODS: The STREAM (consisting of 3 subscales: upper-limb movements, lower-limb movements, and mobility) was administered to 351 subjects with first stroke occurrence and a median time after stroke of 12.5 months. The unidimensionality of each subscale of the STREAM first was verified with unidimensional Rasch analysis. Each subscale of the STREAM then was simplified by deleting redundant items on the basis of expert opinion and the results of the Rasch analysis. The Rasch reliability of the S-STREAM and the concurrent validity of the S-STREAM with the STREAM were examined with multidimensional Rasch analysis and the intraclass correlation coefficient (ICC), respectively. RESULTS: After deleting the items that did not fit the Rasch model, we found that the 8-item upper-limb movement subscale, the 9-item lower-limb movement subscale, and the 10-item mobility subscale assessed single, unidimensional upper-limb movements, lower-limb movements, and mobility, respectively. We selected 5 items from each subscale to construct the S-STREAM and found that the reliability of each subscale of the resulting simplified instrument was high (Rasch reliability coefficients of > or =.91). The agreement between the subscale scores (Rasch estimates) of the S-STREAM and those of the STREAM was excellent (ICC of > or =.99, with a lower limit for the 95% confidence interval of > or =.985), indicating good concurrent validity of the S-STREAM with the STREAM. DISCUSSION AND CONCLUSION: The S-STREAM demonstrates high Rasch reliability, unidimensionality, and concurrent validity with the STREAM in patients with stroke. Furthermore, the S-STREAM is efficient to administer, as it consists of only half the number of items in the original STREAM. Additional studies to examine other psychometric properties (eg, predictive validity and responsiveness) of the S-STREAM or its psychometric properties in various recovery stages after stroke are needed to further establish its utility in both clinical and research settings.     

A Spanish language version of the Health-Promoting Lifestyle Profile

The development and initial psychometric evaluation of a Spanish language version of the Health-Promoting Lifestyle Profile (HPLP) is described. The 48-item instrument was translated into Spanish and found to be culturally relevant and reliable in a pilot study. The Spanish version was then administered to a diverse but predominantly Mexican-American group of 485 Hispanics residing in metropolitan and surrounding rural areas. In a principal components factor analysis, all but one item loaded significantly on six factors similar to those isolated previously during psychometric assessment of the English language version. Those six dimensions comprise the HPLP subscales of self-actualization, health responsibility, exercise, nutrition, interpersonal support, and stress management. The six factors explained 45.9% of the variance in the measure. Second-order factor analysis yielded a single factor, interpreted as health-promoting lifestyle. The alpha reliability coefficient for the total scale was .93 and 2-week test-retest reliability was .86; alpha coefficients for the subscales ranged from .70 to .87.     

Factor structure of the Maslach burnout inventory: An analysis of data from large scale cross-sectional surveys of nurses from eight countries

Background

Job burnout is an important predictor of nurse retention. Reliable and valid measures are required to monitor this phenomenon internationally.

Objective

To evaluate the applicability of the Maslach burnout inventory (MBI) in international nursing research.

Design

Secondary analysis of cross-sectional hospital nurse survey data from eight countries.

Settings

Hospitals in the U.S., Canada, the U.K., Germany, New Zealand, Japan, Russia and Armenia.

Participants

54,738 direct care professional nurses from 646 hospitals in eight countries.

Methods

Confirmatory and exploratory factor analysis were undertaken to identify the factor structure of the MBI. The internal consistencies of the subscales were investigated.

Results

Exploratory factor analysis revealed three factors being extracted from the 22-item Maslach burnout inventory. In nearly all countries the two items (6 and 16) related to the “stress” and “strain” involved in working with people loaded on the depersonalization subscale rather than the emotional exhaustion subscale to which they were initially assigned. The three subscales exhibited high reliability with Cronbach alphas exceeding the critical value of 0.70. The correlation coefficients for the emotional exhaustion and depersonalization subscales were strong and positive.

Conclusions

The 22-item Maslach burnout inventory has a similar factor structure and, with minor modifications, performed similarly across countries. The predictive validity of the emotional exhaustion and depersonalization subscales might be improved by moving the two items related to stress and strain from the emotional exhaustion to the depersonalization subscale. Nevertheless, the MBI can be used with confidence as a burnout measure among nurses internationally to determine the effectiveness of burnout reduction measures generated by institutional and national policies.