Development and Evaluation of the Adherence to Refills and Medications Scale (ARMS) among Low-Literacy Patients with Chronic Disease

ObjectivesPatient literacy affects many aspects of medication use and may influence the measurement of adherence. The aim of the study is to design and evaluate a medication adherence scale suitable for use across levels of patient literacy.MethodsThe Adherence to Refills and Medications scale (ARMS) was developed, pilot tested, and administered to 435 patients with coronary heart disease in an inner-city primary care clinic. Psychometric evaluation performed overall and by literacy level, included an assessment of internal consistency, test–retest reliability, and factor analysis. Criterion-related validity was evaluated by comparing scores with Morisky's self-reported measure of adherence, medication refill adherence, and blood pressure measurements. Lexile analysis was performed to assess the reading difficulty of the instrument.ResultsThe final 12-item scale had high internal consistency overall (Cronbach's α = 0.814) and among patients with inadequate (α = 0.792) or marginal/adequate literacy skills (α = 0.828). Factor analysis yielded two subscales, which pertained to taking medications as prescribed and refilling medications on schedule. The ARMS correlated significantly with the Morisky adherence scale (Spearman's rho = ?0.651, P < 0.01), and it correlated more strongly with measures of refill adherence than did the Morisky scale. Patients with low ARMS scores (which indicated better adherence) were significantly more likely to have controlled diastolic blood pressure (P < 0.05), and tended to have better systolic blood pressure control. Lexile analysis demonstrated that the instrument had a favorable reading difficulty level below the eight grade.ConclusionThe ARMS is a valid and reliable medication adherence scale when used in a chronic disease population, with good performance characteristics even among low-literacy patients.     

Measuring precarious employment in times of crisis: the revised Employment Precariousness Scale (EPRES) in Spain

ObjectiveThis study examines the psychometric properties of the revised Employment Precariousness Scale (EPRES-2010) in a context of economic crisis and growing unemployment.MethodsData correspond to salaried workers with a contract (n = 4,750) from the second Psychosocial Work Environment Survey (Spain, 2010). Analyses included acceptability, scale score distributions, Cronbach's alpha coefficient and exploratory factor analysis.ResultsResponse rates were 80% or above, scores were widely distributed with reductions in floor effects for temporariness among permanent workers and for vulnerability. Cronbach's alpha coefficients were 0.70 or above; exploratory factor analysis confirmed the theoretical allocation of 21 out of 22 items.ConclusionThe revised version of the EPRES demonstrated good metric properties and improved sensitivity to worker vulnerability and employment instability among permanent workers. Furthermore, it was sensitive to increased levels of precariousness in some dimensions despite decreases in others, demonstrating responsiveness to the context of the economic crisis affecting the Spanish labour market.     

Predictors of Self-Reported Adherence to Antihypertensive Medicines: A Multinational,Cross-Sectional Survey

BackgroundNonadherence to antihypertensive medicines limits their effectiveness, increases the risk of adverse health outcome, and is associated with significant health care costs. The multiple causes of nonadherence differ both within and between patients and are influenced by patients’ care settings.ObjectivesThe objective of this article was to identify determinants of patient nonadherence to antihypertensive medicines, drawing from psychosocial and economic models of behavior.MethodsOutpatients with hypertension from Austria, Belgium, England, Germany, Greece, Hungary, The Netherlands, Poland, and Wales were recruited to a cross-sectional online survey. Nonadherence to medicines was assessed using the Morisky Medication Adherence Scale (primary outcome) and the Medication Adherence Rating Scale. Associations with adherence and nonadherence were tested for demographic, clinical, and psychosocial factors.ResultsA total of 2595 patients completed the questionnaire. The percentage of patients classed as nonadherent ranged from 24% in The Netherlands to 70% in Hungary. Low age, low self-efficacy, and respondents’ perceptions of their illness and cost-related barriers were associated with nonadherence measured on the Morisky Medication Adherence Scale across several countries. In multilevel, multivariate analysis, low self-efficacy (odds ratio = 0.73; 95% confidence interval 0.70–0.77) and a high number of perceived barriers to taking medicines (odds ratio = 1.70; 95% confidence interval 1.38–2.09) were the main significant determinants of nonadherence. Country differences explained 11% of the variance in nonadherence.ConclusionsAmong the variables measured, patients’ adherence to antihypertensive medicines is influenced primarily by their self-efficacy, illness beliefs, and perceived barriers. These should be targets for interventions for improving adherence, as should an appreciation of differences among the countries in which they are being delivered.     

Development and Validation of a New Spanish Instrument to Measure Health-Related Quality of Life in Patients with Allergic Rhinitis: The ESPRINT Questionnaire

ObjectivesTo develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations.MethodsAn initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test–retest (2–4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).ResultsThe new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score.ConclusionsThis new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.     

The Piper Fatigue Scale-Revised: translation and psychometric evaluation in Spanish-speaking breast cancer survivors

Background

Cancer-related fatigue (CRF) is the most common and distressing symptom reported by breast cancer survivors. The primary aim of this study was to translate and evaluate psychometrically for the first time a Spanish version of the Piper Fatigue Scale-Revised (S-PFS-R).

Methods

One hundred and eleven women with stage I–IIIA breast cancer who had completed their primary cancer therapy in the previous 6 months with the exception of hormone therapy completed the S-PFS-R, the Profile of Mood States (POMS) Fatigue (POMS-F) and Vigor subscales (POMS-V), and bilateral force handgrip testing. Data analysis included test–retest reliability, construct validity, criterion-related validity, and exploratory factor analyses.

Results

Test–retest reliability was satisfactory (r > 0.86), and all subscales showed moderate to high construct validity estimates [corrected item-subscale correlations (Pearson r = ≥ 0.65)]. The exploratory factor analysis revealed four dimensions with 75.5 % of the common variance explained. The S-PFS-R total score positively correlated with the POMS-F subscale (r = 0.50–0.78) and negatively with the POMS-V subscale (r = ?0.13 to ?0.44) confirming criterion-related validity. Negative correlations among force handgrip testing, subscales, and total scores were weak (r = ?0.26 to ?0.29).

Conclusions

The Spanish version of PFS-R shows satisfactory psychometric properties in a sample of breast cancer survivors. This is the first study to translate the PFS-R into Spanish and further testing is warranted.     

Psychometric properties of the revised Parental Monitoring of Diabetes Care questionnaire in adolescents with type 1 diabetes

PurposeWe evaluated the psychometric properties of a revised version of the Parental Monitoring of Diabetes Care questionnaire (PMDC-R) designed to evaluate parental supervision and monitoring of adolescent diabetes care behaviors. The revised measure was intended to capture a broad range of ways used by parents to gather information about youth adherence to diabetes care.MethodsTwo hundred sixty-seven caregivers of 12–18-year-old adolescents with type 1 diabetes completed the PMDC-R. Measures of parental knowledge of youth illness management, illness management behavior, and metabolic control were also obtained.ResultsThe PMDC-R demonstrated good internal consistency (alpha coefficient = .91) and test–retest reliability (r = .79, p < .001). Supporting the instrument's construct validity, a bifactor model with one primary factor and three secondary factors had an acceptable fit to the data (comparative fit index = .92, root mean square error of approximation = .06). Concurrent validity was also supported. In structural equation models, parental monitoring, as assessed by the PMDC-R, had a significant direct effect on parental knowledge of adolescent diabetes management and, through knowledge, an indirect effect on adolescent diabetes management and metabolic control.ConclusionsThe PMDC-R displayed strong psychometric properties and represents an important next step in refining the measurement of parental monitoring for youth with chronic illnesses.     

Diseño y validación de un instrumento sobre calidad de la planificación anticipada de decisiones para profesionales

ObjectiveTo develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality.MethodInstrumental questionnaire validation study. Scope: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. Participants: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges’ agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest–test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser–Meyer–Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha.ResultsPilot study with 28 professionals. Reliability ? = 0.917, α = 0.841, and test–retest correlation coefficient of 0.785 (95% confidence interval: 0.587–0.894; p < 0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ² = 1298,789] and KMO = 0.808; p < 0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841.ConclusionsThe ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.     

Electronic monitoring of treatment adherence and validation of alternative adherence measures in tuberculosis patients: a pilot study

Objective

To assess adherence to community-based directly observed treatment (DOT) among Tanzanian tuberculosis patients using the Medication Event Monitoring System (MEMS) and to validate alternative adherence measures for resource-limited settings using MEMS as a gold standard.

Methods

This was a longitudinal pilot study of 50 patients recruited consecutively from one rural hospital, one urban hospital and two urban health centres. Treatment adherence was monitored with MEMS and the validity of the following adherence measures was assessed: isoniazid urine test, urine colour test, Morisky scale, Brief Medication Questionnaire, adapted AIDS Clinical Trials Group (ACTG) adherence questionnaire, pill counts and medication refill visits.

Findings

The mean adherence rate in the study population was 96.3% (standard deviation, SD: 7.7). Adherence was less than 100% in 70% of the patients, less than 95% in 21% of them, and less than 80% in 2%. The ACTG adherence questionnaire and urine colour test had the highest sensitivities but lowest specificities. The Morisky scale and refill visits had the highest specificities but lowest sensitivities. Pill counts and refill visits combined, used in routine practice, yielded moderate sensitivity and specificity, but sensitivity improved when the ACTG adherence questionnaire was added.

Conclusion

Patients on community-based DOT showed good adherence in this study. The combination of pill counts, refill visits and the ACTG adherence questionnaire could be used to monitor adherence in settings where MEMS is not affordable. The findings with regard to adherence and to the validity of simple adherence measures should be confirmed in larger populations with wider variability in adherence rates.     

Psychometric Properties of a Short Self-Reported Measure of Medication Adherence Among Patients With Hypertension Treated in a Busy Clinical Setting in Korea

Background

We examined the psychometric properties of the Korean version of the 8-item Morisky Medication Adherence Scale (MMAS-8) among adults with hypertension.

Methods

A total of 373 adults with hypertension were given face-to-face interviews in 2 cardiology clinics at 2 large teaching hospitals in Seoul, South Korea. Blood pressure was measured twice, and medical records were reviewed. About one-third of the participants (n = 109) were randomly selected for a 2-week test-retest evaluation of reliability via telephone interview.

Results

Internal consistency reliability was moderate (Cronbach α = 0.56), and test-retest reliability was excellent (intraclass correlation = 0.91; P < 0.001), although a ceiling effect was detected. The correlation of MMAS-8 scores with scores for the original 4-item scale indicated that convergent validity was good (r = 0.92; P < 0.01). A low MMAS-8 score was significantly associated with poor blood pressure control (χ² = 29.86; P < 0.001; adjusted odds ratio = 5.08; 95% CI, 2.56–10.08). Using a cut-off point of 6, sensitivity and specificity were 64.3% and 72.9%, respectively. Exploratory factor analysis identified 3 dimensions of the scale, with poor fit for the 1-dimensional construct using confirmatory factory analysis.

Conclusions

The MMAS-8 had satisfactory reliability and validity and thus might be suitable for assessment and counseling regarding medication adherence among adults with hypertension in a busy clinical setting in Korea.Key words: medication adherence, self-report, questionnaires, psychometrics, hypertension     

Adaptation into Spanish of the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) and preliminary validation in a student sample

Purpose

There is growing interest in the assessment of positive mental health as a global indicator of societal wealth. We aimed to adapt the Warwick–Edinburgh Mental Well-being scale (WEMWBS) into Spanish and to perform a preliminary evaluation of its metric properties.

Methods

Forward and back-translations and cognitive debriefing were carried out. University students (n = 148) were recruited to evaluate the final Spanish version, following the UK original study. Distribution of WEMWBS responses, internal consistency, test–retest reliability, construct validity, and factor structure were assessed.

Results

Only 4 (out of 14) items of the initial Spanish version were not rated as conceptually and linguistically equivalent to the original and were modified. The final version was clear and comprehensible. Global score’s Cronbach’s alpha (0.90), item-total score correlations (0.44–0.76), and test–retest ICC (0.84) were all satisfactory. Moderate to high correlations (r = 0.45–0.70) were observed between the WEMWBS and validity scales. Preliminary confirmatory factor analyses did not support the hypothesis of a single factor.

Conclusions

A conceptually equivalent Spanish version of the WEMWBS was obtained with high internal consistency, good test–retest reliability, and similar construct validity as the original instrument. Further validity and factorial studies are necessary in larger and more heterogeneous samples.     

Validity and reliability of the Turkish version of the Hill–Bone compliance to high blood pressure therapy scale for use in primary health care settings

Abstract

Objectives: To assess the validity and reliability of the Turkish version of the Hill–Bone compliance to high blood pressure therapy scale for use in primary care in Turkey. Methods: To develop a Turkish version of the scale, it was translated into Turkish then back-translated into English. The final version was used in a survey in two urban primary health care centers in Izmir, Turkey. For assessing the validity of Turkish scale, we performed factor analysis to test construct validity. Reliability was assessed by calculating the Cronbach's alpha as a measure of internal consistency. Results: Factor analysis revealed a three–factor structure representing unintentional medication non-adherence; intentional medication non-adherence; and salt intake adherence. Percentages of explained variance were 33.3%, 14.6% and 11.2% respectively. When forcing a two-factor structure we found salt intake and medication adherence clusters. Cronbach's alpha was 0.72 and 0.83 for medication adherence and whole scale, respectively.

Conclusion: The Turkish Hill–Bone scale presented a factor structure consistent with the original scale, had a high level of internal consistency. It can be used for assessing hypertension patients’ compliance in Turkish primary care settings.     

Comparison of two self-rating instruments for medication adherence assessment in hypertension revealed insufficient psychometric properties

ObjectiveIn cases of insufficiently controlled blood pressure, it is important for practitioners to distinguish between “nonadherence” and “nonresponse” to antihypertensive drug treatment. A reliable and valid adherence measurement based on the patient's self-report may be helpful in daily practice.Study Design and SettingIn a primary care sample with 353 hypertensive patients, we applied two self-rating instruments to assess medication adherence (the “Hill-Bone Compliance to High Blood Pressure Therapy Scale” and Morisky's “Self-Reported Measure of Medication Adherence”) and compared their psychometric properties.ResultsBoth scales showed low acceptability and insufficiency to moderate internal consistency (Cronbach's α = 0.25 and 0.73, respectively). Their convergent validity as indexed by kappa = 0.39 could be judged as “fair” at best. Testing the power to predict blood pressure >140/90 mm Hg, both scales showed an accuracy of 57% and 62%, respectively. The positive likelihood, that is, the increase in likelihood of high blood pressure in cases of nonadherence was 1.00 and 1.32, respectively.ConclusionThe use of both scales cannot be recommended. They showed considerable floor effects, and their ability to identify medication adherence was inconsistent for nearly every third patient. The power of both scales to predict uncontrolled blood pressure was essentially a chance. The underlying conceptual framework of medication adherence therefore needs to be rethought.     

Diseño y validación de un cuestionario sobre las actitudes ante la prevención y promoción de la salud en atención primaria (CAPPAP)

ObjectiveTo develop and validate a questionnaire to measure attitudes towards prevention and health promotion.DesignCross-sectional study for the validation of a questionnaire.LocationPrimary Health Care (autonomous community of Andalusia, Spain).Participants282 professionals (nurses and doctors) belonging to the Public Health System.Main measurementsContent validation by experts, ceiling effects and floor effects, correlation between items, internal consistency, stability and exploratory factor analysis.ResultsThe 56 items of the tool (CAPPAP) obtained, including those from the review of other tools and the contributions of the experts, were grouped into 5 dimensions. The percentage of expert agreement was over 70% on all items, and a high concordance between prevention and promotion item was obtained, thus, duplicates were removed leaving a final tool with 44 items. The internal consistency, measured by Cronbach's alpha, was 0.888. The test retest indicated concordance from substantial to almost perfect. Exploratory factor analysis identified five factors that accounted for 48.92% of the variance.ConclusionsCAPPAP is a tool that is quick and easy to administer, that is well accepted by professionals, and that has acceptable psychometric results, both globally and at the level of each dimension.     

Version arabe du questionnaire diabetes attitude scale-3: fiabilité, validité et données normatives

ObjectiveThe aim of this study was to translate and analyze the psychometric properties of the third version of the Arabic Diabetes Attitude Scale.MethodsA methodological study of psychometric validation of the scale according to the guidelines of Vallerand cross-cultural validation was conducted. Type 1 and type 2 diabetics, aged 18 and over, without cognitive impairment or altered mental status were recruited on a convenience-sampling basis. An Arabic-language self-administrated developed questionnaire including diabetics’ demographic and clinical data and the experimental third version of the Diabetes Attitude Scale was used. All Vallerand cross-cultural validation steps were completed except for convergent validity and confirmatory analysis.ResultsA sample of 333 diabetics was recruited. Reliability and validity of the experimental version of the scale were satisfactory. Correlations between test and retest dimensions were close to 1, and overall Cronbach's alpha coefficient of the experimental version was 0.769. The content validity index was 0.82 proving the accuracy of the concept measurements by the scale. Principal components analysis, by orthogonal Varimax rotation, produced nine factors. Correlation coefficients between the five dimensions of the theoretical model of the scale ranged from 0.002 to 0.367, confirming that each dimension measured a single content.ConclusionThe third version of the Arabic Diabetes Attitude Scale has been proven valid and reliable. It is ready for use in clinical practice.     

Validation of the Osteoporosis-Specific Morisky Medication Adherence Scale in long-term users of bisphosphonates

Purpose

To examine the psychometric properties and validity of the 8-item Osteoporosis-Specific Morisky Medication Adherence Scale (OS-MMAS-8) in postmenopausal women prescribed bisphosphonates (BPs) for at least 15 months.

Methods

A random sample of women aged ≥55 years with osteoporosis prescribed daily or weekly BPs was identified. Pharmacy fill data were extracted to calculate the medication possession ratio (MPR). Eligible women were stratified by low (<0.50), medium (0.50–0.79), or high (≥0.80) MPR, with the a priori goal of recruiting 133 participants in each group. OS-MMAS-8 scores can range from 0 to 8 and were categorized as low (<6), medium (6 to <8), and high (8) adherence. Internal consistency reliability (Cronbach’s alpha), test–retest reliability [intraclass correlation coefficients (ICCs)] and convergent validity (correlating OS-MMAS-8 with MPR and other self-reported measures) were assessed.

Results

A total of 400 women out of 449 respondents reported that they were still taking their BPs at the time of the survey and completed OS-MMAS-8. Overall, 38.5, 34.3, and 27.3 % of participants had low, medium, and high OS-MMAS-8 scores, respectively. The mean (SD) MPRs according to OS-MMAS-8 scores (<6, 6 to <8 and 8) were 56.9 (22.6), 69.0 (24.9), and 76.7 (26.4), respectively. The correlation between OS-MMAS-8 and MPR was 0.36; p < 0.0001. Cronbach’s alpha was 0.74, and the ICC was 0.83 (95 % CI 0.76–0.88).

Conclusions

OS-MMAS-8 has acceptable psychometric properties for assessing medication adherence in postmenopausal women prescribed therapy for osteoporosis. Additional studies are needed to investigate the psychometric properties of OS-MMAS-8 in other settings and populations.     

Development of the Person-Centered Contraceptive Counseling scale (PCCC), a short form of the Interpersonal Quality of Family Planning care scale

ObjectivePerson-centeredness is a critical component of quality in family planning. We previously validated an 11-item Interpersonal Quality of Family Planning (IQFP) scale. We sought to create a parsimonious version of the scale in preparation for testing its appropriateness as a patient-reported outcome performance measure.Study designTo explore clarity and importance of each of the 11 items, we conducted English and Spanish cognitive interviews with patients who received contraceptive counseling (n = 33) at 3 publicly funded California clinics. We triangulated these results with psychometric analysis of previously collected IQFP data (n = 1097) to assess validity and reliability of selected item combinations.ResultsThe 11-item IQFP scale was reduced to a 4-item scale (the Person-Centered Contraceptive Counseling scale, or PCCC) that includes items evaluating provider performance regarding respect for patients, information provision, and eliciting and honoring patient preferences for birth control. Interview participants deemed the items included in the 4-item PCCC important and clear in both English and Spanish versions of the instrument. The 4-item PCCC retained the 11-item IQFP's psychometric properties, including internal consistency (Cronbach's alpha = 0.92 vs 0.97 for the PCCC and IQFP, respectively) and a consistent single factor analysis solution (factor loadings = 0.86–0.92 and 0.81–0.91). The 4-item PCCC additionally retained the construct and predictive validity of the IQFP.ConclusionsThe 4-item PCCC is a valid and reliable as a measure of person-centered contraceptive counseling that reflects patients’ perspectives on contraceptive counseling.ImplicationsPerson-centered measures such as the 4-item PCCC can help inform efforts to improve health care quality. Future work will investigate the validity and reliability of the 4-item PCCC as a performance measure to determine the appropriateness of its use in the quality improvement context.     

Salud del cuidador: adaptación y validación del cuestionario Experience of Caregiving Inventory (ECI) en población española

ObjectiveTo adapt and to validate the Experience of Caregiving Inventory (ECI) in a Spanish population, providing empirical evidence of its internal consistency, internal structure and validity.MethodPsychometric validation of the adapted version of the ECI. One hundred and seventy-two caregivers (69.2% women), mean age 57.51 years (range: 21-89) participated. Demographic and clinical data, standardized measures (ECI, suffering scale of SCL-90-R, Zarit burden scale) were used. The two scales of negative evaluation of the ECI most related to serious mental disorders (disruptive behaviours [DB] and negative symptoms [NS]) and the two scales of positive appreciation (positive personal experiences [PPE], and good aspects of the relationship [GAR]) were analyzed. Exploratory structural equation modelling was used to analyze the internal structure. The relationship between the ECI scales and the SCL-90-R and Zarit scores was also studied.ResultsThe four-factor model presented a good fit. Cronbach's alpha (DB: 0.873; NS: 0.825; PPE: 0.720; GAR: 0.578) showed a higher homogeneity in the negative scales. The SCL-90-R scores correlated with the negative ECI scales, and none of the ECI scales correlated with the Zarit scale.ConclusionsThe Spanish version of the ECI can be considered a valid, reliable, understandable and feasible self-report measure for its administration in the health and community context.     

Cross-cultural adaptation,content validity,and feasibility of the school physical activity and nutrition environment tool

ObjectiveTo perform a cross-cultural adaptation, content validity and feasibility of The School Physical Activity and Nutrition Environment Tool (SPAN-ET) for the Spanish context. It is a valuable tool for making comprehensive assessments of school environments in three environmental categories: policy, situation/social, and physical.MethodWe followed the cross-cultural adaptation guidelines which consist of a five-stage methodological approach: 1) forward translation, 2) synthesis, 3) back translation, 4) adaptation to the Spanish context, and 5) pilot testing. In addition, an expert panel performed a content validity analysis to assess the level of comprehensibility, applicability, and cultural appropriateness of the SPAN-ET for its use in Spain. The pilot test was carried out in five schools to assess the feasibility of the tool in the Spanish context.ResultsAfter applying the guidelines for the translation and cultural adaptation of the SPAN-ET into the Spanish context, the new tool (SPAN-ET-ES) preserves the main dimensions of the original document to evaluate school environments in Spain. The evaluation of the SPAN-ET-ES, done by an expert panel, concluded that items included in the revised version of the SPAN-ET-ES were relevant (S-CVI/Ave = 0.96), clear (S-CVI/Ave = 0.96), simple (S-CVI/Ave = 0.98), and non-ambiguous (S-CVI/Ave = 0.98) for the Spanish context. Finally, the pilot test offered empirical evidence for the feasibility and content validity of the SPAN-ET-ES at assessing school environments in Spain.ConclusionsSPAN-ET-ES is a feasible tool for assessing nutrition and physical activity environments at schools in Spain.     

Adaptación española de la Escala de Impacto de la Publicidad de Apuestas en adolescentes

Media pressure from gambling advertising has reached worrying levels. It constitutes a risk to the mental health of young people and adolescents by promoting a favourable attitude towards gambling, a higher frequency of gambling and a perception of greater accessibility. Currently, there is no instrument available to assess the impact of gambling advertising.ObjectiveThe present study aims to adapt and validate the Impact of Gambling Advertising Scale (IGAS).DesignThe IGAS scale was translated from English ensuring its linguistic, conceptual and metric equivalence. The psychometric properties were then tested.SiteComunidad Valenciana (España).Participants1724 adolescents with a mean age of 16.52 years (SD = .759).InterventionSelf-administered, paper-based questionnaire in a single measure.Main measurementsAdvertising impact, and gambling intention, severity and availability.ResultsInternal consistency and two-half reliability were good, Cronbach's α = .782 and α = .70, respectively. Confirmatory factor analysis concluded that the Spanish version replicates the original three-dimensional version. Convergent validity analyses showed direct and significant relationships with different aspects of gambling behaviour, and other predictors.ConclusionThe adapted version of the IGAS is a reliable and valid measure for the assessment of the impact of advertising on adolescents. The scale is a useful instrument for the diagnosis of risk level and the evaluation of preventive interventions.