Utility of the PedsQL™ family impact module: assessing the psychometric properties in a community sample

Purpose

Research on families coping with pediatric chronic illnesses has established that children and parents are affected by the illness. Therefore, optimal assessment of parent and family functioning is clinically important. The PedsQL? family impact module (FIM) assesses parents’ health-related quality of life (HRQOL) and family functioning. While the FIM has been shown to be reliable and valid in multiple chronic illness groups, there is little data on its use in non-clinical groups. The study’s objective was to assess the reliability, validity, and factor structure of the FIM in a community sample.

Methods

Nine hundred and twenty-nine community parents of children 2–17 years old completed an anonymous online survey. The mean age of the participants was 37.6 years (SD = 8.6), and the majority were mothers (63.6 %), white (82.9 %), and married (74.8 %). The mean age of the children being reported on was 8.8 years (SD = 3.9), and the majority were female (52.3 %) and 41.2 % were reported as having at least one chronic condition.

Results

All of the FIM’s scales demonstrated excellent internal consistency reliability. Confirmatory factor analysis of the measure supported the current structure. The measure correlated in the expected direction with validated measures of anxiety, depression, child HRQOL, and number of chronic conditions endorsed. Independent t tests indicated that the measure has discriminant validity between parents who reported having a child with a chronic condition to those who did not.

Conclusion

The results of this study suggest the FIM is a reliable and valid measure of parent HRQOL and family functioning within a community sample, and facilitate its use in comparative studies.     

Assessment of proximal outcomes of self-management programs: translation and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ™)

Purpose

This paper describes the translation, cultural adaption, and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ?), a widely used generic instrument assessing a wide range of proximal outcomes of self-management programs.

Methods

The translation was carried out according to international standards and included forward and backward translations. Comprehensibility and content validity were tested using cognitive interviews with 10 rehabilitation inpatients. Psychometric properties were examined in rehabilitation inpatients (n = 1,202) with a range of chronic conditions. Factorial validity was assessed using confirmatory factor analysis; concurrent validity was explored by correlations with comparator scales.

Results

The items of the German heiQ? were well understood by rehabilitation inpatients. The structure of the eight heiQ? scales was replicated after minor adjustment. heiQ? scales had higher correlations with comparator scales with similar constructs, particularly mental health concepts than with physical health. Moreover, all heiQ? scales differentiated between individuals across different levels of depression.

Conclusion

The German heiQ? is comprehensible for German-speaking patients suffering from different types of chronic conditions; it assesses relevant outcomes of self-management programs in a reliable and valid manner. Further studies involving its practical application are warranted.     

The role of point-of-care β-hydroxybutyrate testing in the diagnosis of diabetic ketoacidosis: a review

The number of patients with diabetes and diabetes-related complications is increasing. Rapid and accurate diagnosis is key to efficiently providing the appropriate level of care for patients with diabetes. When faced with a hyperglycemic patient (ie, blood glucose level > 250 mg/dL), the prevailing attitude among health care providers is to "think worst first," and common clinical practice is to perform an evaluation for diabetic ketoacidosis (DKA). Traditionally, diagnosing DKA in accordance with the American Diabetes Association guidelines requires performing ≥ 2 (possibly 3) tests to obtain measurements for blood glucose, serum bicarbonate, serum pH, and serum anion gap levels, as well as measurements of either urine or serum ketone bodies. Recently, commercial point-of-care β-hydroxybutyrate measurement devices have become readily accessible and less expensive. These devices offer the potential to simplify clinicians' diagnostic approach to hyperglycemic patients. In this evidence-based literature review, we describe the use of point-of-care β-hydroxybutyrate testing for diagnosing DKA, and discuss its limitations in determining DKA severity.     

“Areas of Worklife scale” (AWS) short version (Spanish): a confirmatory factor analysis based on a secondary school teacher sample

Background

This study examines the construct validity of the Areas of Worklife Short Scale, a practical instrument to measure employees’ perceptions of their work environments in the sample of secondary obligatory education teachers in Spain.

Methods

Conducted in 33 centers of secondary obligatory education in Spain (N?=?677). Confirmatory Factor analysis for 3 different models for the 29-items version and 1 model for the 18-items version was tested.

Results

Results confirmed that the short AWS short version had the best fit to the data than any other model proposed (GFI-Satorra-Bentler scaled chi-squared?=?320.19, ×?2/df?=?2.337) and good fit indices (CFI?=?0.911; RMSEA?=?0.046).

Conclusions

This analysis ultimately supports the appropriateness of AWS short version to explore areas of worklife and therefore can indicate the factors that contribute to burnout in the sample of secondary obligatory education teachers in Spain. Therefore it has been confirmed that this tool is able to assess the 6 domains of work environment of secondary schools teachers.

     

Quality of life among testicular cancer survivors: a case–control study in the United States

Introduction  

Evidence from previous studies has suggested there may be physical and mental changes in health among testicular cancer survivors. No studies have been conducted in the United States, however.     

The planning of cervical cancer screening programmes in Eastern Europe: is viral testing a suitable alternative to smear testing?

Cervical cancer screening with human papillomavirus (HPV) DNA testing has potential advantages over conventional smear testing in that it can predict cases in which invasive cancers are more likely to develop, may be cheaper to implement and improve compliance. In areas of the world where little formalised cervical cancer screening takes place, or where health resources are limited, HPV testing has been suggested as a possible alternative for primary screening. In this paper we demonstrate the use of mathematical modelling to evaluate the effects of setting up screening programmes in Eastern Europe with HPV DNA testing as the primary screening tool and compare it with conventional smear testing. The impact of screening is measured in terms of the life years gained and the resulting resource usage and cost. We investigate several screening options with different screening intervals and age ranges for the target population. This revised version was published online in July 2006 with corrections to the Cover Date.     

The researchers’ role in knowledge translation: a realist evaluation of the development and implementation of diagnostic pathways for cancer in two United Kingdom localities

Background

In examining an initiative to develop and implement new cancer diagnostic pathways in two English localities, this paper evaluates ‘what works’ and examines the role of researchers in facilitating knowledge translation amongst teams of local clinicians and policy-makers.

Methods

Using realist evaluation with a mixed methods case study approach, we conducted documentary analysis of meeting minutes and pathway iterations to map pathway development. We interviewed 14 participants to identify the contexts, mechanisms and outcomes (CMOs) that led to successful pathway development and implementation. Interviews were analysed thematically and four CMO configurations were developed.

Results

One site produced three fully implemented pathways, while the other produced two that were partly implemented. In explaining the differences, we found that a respected, independent, well-connected leader modelling partnership working and who facilitates a local, stable group that agree about the legitimacy of the data and project (context) can empower local teams to become sufficiently autonomous (mechanism) to develop and implement research-based pathways (outcome). Although both teams designed relevant, research-based cancer pathways, in the site where the pathways were successfully implemented the research team merely assisted, while, in the other, the research team drove the initiative.

Conclusion

Based on our study findings, local stakeholders can apply local and research knowledge to develop and implement research-based pathways. However, success will depend on how academics empower local teams to create autonomy. Crucially, after re-packaging and translating research for local circumstances, identifying fertile environments with the right elements for implementation and developing collaborative relationships with local leaders, academics must step back.

     

The impact of second-line agents on patients’ health-related quality of life in the treatment for non-small cell lung cancer: a systematic review

Purpose

In advanced non-small cell lung cancer (NSCLC), progressive disease burdens patients considerably. Second-line (2L) chemotherapy improves survival marginally but humanistic outcomes (i.e., quality of life, QOL) are underreported. The impact of 2L therapy remains an important consideration for patients and caregivers, and there have been QOL reviews for 1L, but not 2L, therapies. This review assessed QOL outcomes of approved, guideline-supported 2L chemotherapy with docetaxel, erlotinib, gefitinib, and pemetrexed in advanced NSCLC.

Methods

Clinical trial reports of approved, guideline-supported 2L or maintenance therapy for NSCLC published from 2000 to 2010 were identified from PubMed/Medline and clinical meetings. Outcomes were stratified by overall QOL impact, domain/symptom-specific effects, effect over time, and subgroup effects.

Results

Of 145 studies identified, 24 full-text articles were retained. Studies with docetaxel versus best supportive care (n = 1) and active comparators (n = 4) reported non-significant overall QOL improvements, as did studies of gefitinib versus placebo and active comparator (n = 7). Overall QOL improvements were seen for gefitinib versus docetaxel (n = 2) and gefitinib in a single-arm study (n = 1). At the symptom level, studies of docetaxel (n = 4/7), gefitinib (n = 7/9), and pemetrexed (n = 1) reported non-significant results. Subgroup analyses indicated improved QOL outcomes for gefitinib-treated responders versus non-responders, worse QOL for gefitinib-treated smokers versus placebo, worse QOL for gefitinib-treated Asian patients versus placebo, and longer time to symptom deterioration in erlotinib versus placebo-treated elderly patients.

Conclusions

Significant improvements in overall QOL with 2L chemotherapy for advanced NSCLC were infrequent. Single-arm studies and those with less toxic regimens more commonly provided statistically significant improvements in QOL outcomes. Methodological heterogeneity impedes cross-study QOL comparisons.     

Development and psychometric testing of the intention to engage in children’s healthy weight (iCHeW) guideline scale for dental staff

Statement of problemIn the evaluation of interdisciplinary interventions for childhood overweight and obesity, behavioural determinants can provide valuable insight into the reasons behind lack of adherence, or ineffectiveness of the intervention. Therefore, it is vital to assess the behavioural determinants of staff when evaluating the implementation of such interdisciplinary interventions. This study aimed to develop and psychometrically evaluate the intention to engage in Children’s Healthy Weight guideline (iCHeW) scale, which assesses the behavioural determinants influencing dental staff’s intention to conduct children’s growth assessments.MethodsInitial items were generated based on review of the literature and the dimensions of the integrative model of behavioural prediction (IM). To test this scale, a cross-sectional survey design was undertaken consisting of three phases: (i) face validity; (ii) content validity; and (iii) psychometric evaluation of the iCHeW scale with a national sample of 125 dental staff.ResultsThe 35 items generated for the iCHeW scale were revised following feedback from a reference group. These 35 items were then appraised by an expert panel, yielding 27 items for psychometric testing. Using exploratory factor analysis, a five-factor solution was extracted, which corresponded to the IM domains, with the deletion of two items. Overall, Cronbach’s alpha of the iCHeW scale was 0.95, with the following values for each subscale: (i) attitudes, 0.93; (ii) behavioural constraints, 0.83; (iii) perceived norms, 0.93; (iv) self-efficacy, 0.94; and (v) behavioural intention, 0.95.ConclusionsThe iCHeW scale is valid and reliable for assessing dental staff’s intention to provide routine growth assessments to children and demonstrates potential for use with non-dental staff.     

Psychometric properties of the Korean version of the effort–reward imbalance questionnaire: a study in a petrochemical company

Objective To evaluate the criterion validity, factorial validity, and internal consistency of Korean version of effort–reward imbalance (ERI) for the scales of effort, reward, and overcommitment as well as to examine the effect of psychosocial factors on physical and mental illness among petroleum refinery workers in South Korea. Methods The Korean version of ERI questionnaire was constructed using the translation and back-translation technique, and its psychometric properties were explored among 908 male workers in a large petroleum refinery in South Korea in 2002. Cronbach’s alpha coefficient was used to test internal consistency. An exploratory factor analysis was conducted on all items of the instrument. Confirmatory factor analyses were conducted on each dimension of effort, reward and overcommitment. Physical and mental health was measured by self-rated health (SF-8). The lowest tertiles of the scores were defined as illness. Multiple logistic regression models were used to test the effect of job stress on the physical and mental health (criterion validity of ERI scales). Results The Cronbach’s alpha coefficients for effort, reward, and overcommitment were 0.71, 0.86, and 0.75, respectively, indicating satisfactory internal consistency. Exploratory factor analysis found three latent factors, which closely corresponded to the theoretical structure of the ERI model. Acceptable construct validity was shown using confirmatory factor analysis. The highest tertile of effort–reward ratio was significantly associated with physical illness (OR 2.4, 95% CI 1.7–3.6) and mental illness (OR 2.9, 95% CI 2.0–4.2), compared to lower tertiles. Overcommitment was significantly associated with mental illness, but not with physical illness. Conclusions These findings contribute to the validity and reliability of the Korean ERI questionnaire. Importantly, in the context of a rapid change in the labour market, the lack of reciprocity between efforts and rewards at work is strongly associated with self-rated physical and mental health.     

The Chinese version of the Pediatric Quality of Life Inventory™ (PedsQL™) Family Impact Module: cross-cultural adaptation and psychometric evaluation

Background  

A pediatric chronic health condition not only influences a child's life, but also has impacts on parent health-related quality of life (HRQOL) and family functioning. To provide care and social support to these families, a psychometrically well-developed instrument for measuring these impacts is of great importance. The present study is aimed to evaluate the psychometric properties of the Chinese version of the PedsQL™ Family Impact Module.     

The Spanish version of the “STarT Back Screening Tool” (SBST) in different subgroups

ObjectiveThe aim of this study was to translate and culturally adapt the original version of the STarT Back Screening Tool (SBST) to Spanish for different population subgroups.DesignTranslation and cultural adaptation of a questionnaire.SettingPrimary care settings.MethodThirty-eight people distributed by: gender; adults and elderly; and with or without pain. Phases: a) Forward translation (English-Spanish); b) Evaluation of the clarity, the acceptability and the familiarity of the content of the obtained Spanish version by means of cognitive interviews to participants, and c) Translation of the final Spanish version of the questionnaire back into the original language.ResultsThe participants interviewed indicated that most of the items of the questionnaire were clear and comprehensible, showing greater difficulty in understanding in the dimensions of disability and anxiety. Furthermore, the questionnaire was more difficult to undertand by the elderly and patients with a previous non-specific low back pain episode.ConclusionThe Spanish version of the SBST questionnaire was obtained, which was shown to be comprehensible and adapted to the general population in Spain. Due to being short and easy to use, it is a potentially useful tool for use in primary care.     

Perceptions of postnatal depression and health care needs in a South African sample: the “mental” in maternal health care

Background

Maternal mental health care is a neglected area in low and middle income countries (LAMIC) such as South Africa, where maternal and child health care priorities are focused on reducing maternal and infant mortality and promoting infant physical health. In the context of a paucity of mental health specialists, the aim of this study was to understand the explanatory models of illness held by women with maternal depression with the view to informing the development of an appropriate counselling intervention using a task sharing approach.

Methods

Twenty semi-structured qualitative interviews were conducted with mothers from a poor socio-economic area who were diagnosed with depression at the time of attending a primary health care facility. Follow-up interviews were conducted with 10 participants in their homes.

Results

Dimensions of poverty, particularly food and financial insecurity and insecure accommodation; unwanted pregnancy; and interpersonal conflict, particularly partner rejection, infidelity and general lack of support were reported as the causes of depression. Exacerbating factors included negative thoughts and social isolation. Respondents embraced the notion of task sharing, indicating that counselling provided by general health care providers either individually or in groups could be helpful.

Conclusion

Counselling interventions drawing on techniques from cognitive behavioural therapy and problem solving therapy within a task sharing approach are recommended to build self-efficacy to address their material conditions and relationship problems in poorly resourced primary health care facilities in South Africa.

     

The impact of media coverage of the suicide of a well-known Quebec reporter: the case of Gaëtan Girouard

Evidence of a media impact on suicide is mixed and needs further research. The main objective of this article is to document the effects of the media coverage following the suicide of a well-known and popular television reporter in Quebec, Canada. A content analysis of the printed media and an analysis of suicide rates during the following year, of coroners' records and of calls to Suicide Prevention Centres during the following 3 months was conducted. Most guidelines for responsible reporting of a suicide were not applied. The results showed a rise in the suicides rates immediately after the reporter's suicide, especially by hanging as in the original case. A cluster of six suicides by hanging also took place in the small municipality where the reporter's suicide occurred. There was also an indication of direct influence in the coroners' records and a rise in calls to Suicide Prevention Centres. This research indicates that the reporting of the suicide of a popular figure preceded an important rise in the number of suicides. A possible theoretical explanation is that a positive role model appeared to suddenly fail to cope with life, thus creating high distress and cognitive dissonance in the audience. The news media should apply more caution and follow recommended guidelines in reporting this type of news.