Inter-rater reliability of the Pediatric Transplant Rating Instrument (P-TRI): challenges to reliably identifying adherence risk factors during pediatric pre-transplant evaluations

The purpose of this study was to assess the inter-rater reliability of the P-TRI, a 17-item instrument developed to identify risk factors associated with poor treatment adherence in pediatric solid organ transplant candidates. Because factors influencing treatment adherence may vary with age, the 89 subject samples were divided into pre-adolescent (0-11 yr) and adolescent (12-19 yr) groups. Each subject received two independent P-TRI ratings based on pretransplant psychosocial assessments separately conducted by a PSYC and a SWTC. Inter-rater reliability was assessed using the delta statistic. Overall, agreement was higher in the pre-adolescent group, with delta>0.70 for five items and delta<0.30 for two items. For the adolescent group, one item had a delta>0.70 and seven items had a delta<0.30. Overall, PSYC P-TRI ratings indicated fewer areas of concern on items assessing family dynamics compared with SWTC P-TRI ratings, whereas the reverse was true for items related to psychiatric history. Results highlight the challenges of conducting a reliable pretransplant assessment of adherence-related risk factors and suggest the need for revisions to the P-TRI prior to its use in clinical practice.     

Clinical measurement of addictions

Introduction and Aims. To conduct a systematic review of instruments for the clinical measurement of addictive behaviours and to determine whether substance addictive behaviours (SAB) and non‐substance addictive behaviours (NSAB) are similarly conceptualised in clinical research. Design and Methods. The analytic strategy employed comprised three steps: (i) major search engines were used to take stock of available clinical instruments for assessing addictive behaviours; (ii) an analysis grid was developed and validated, covering 21 parameters under four heuristic categories: dependence, temperament, social handicap and cognitive behaviour; and (iii) all instruments were analysed and compared via the grid. Results. The search yielded 157 questionnaires covering 14 addictive behaviours. The analysis grid allowed rating all questionnaire items on one parameter only; very good interrater agreement was maintained throughout. The categories most evaluated by the questionnaires were dependence and cognitive behaviour; temperament and social handicap were much less frequently considered. Patterns were generally similar in terms of categories, whether questionnaires concerned SAB or NSAB; however, differences within categories indicated a greater frequency of psychologically oriented parameters for NSAB. Conclusions. The measurement of addictive behaviours appears clinically cohesive, as determined by a validated analysis grid applied to an exhaustive set of questionnaires identified through a systematic literature review.[Cloutier R, Lesage A, Landry M, Kairouz S, Ménard J‐M. Clinical measurement of addictions. Drug Alcohol Rev 2012;31:33–39]     

Reliability and Comparability of Psychosis Patients’ Retrospective Reports of Childhood Abuse

An increasing number of studies are demonstrating an association between childhood abuse and psychosis. However, the majority of these rely on retrospective self-reports in adulthood that may be unduly influenced by current psychopathology. We therefore set out to explore the reliability and comparability of first-presentation psychosis patients’ reports of childhood abuse. Psychosis case subjects were drawn from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) epidemiological study and completed the Childhood Experience of Care and Abuse Questionnaire to elicit abusive experiences that occurred prior to 16 years of age. High levels of concurrent validity were demonstrated with the Parental Bonding Instrument (antipathy: r_s = 0.350–0.737, P < .001; neglect: r_s = 0.688–0.715, P < .001), and good convergent validity was shown with clinical case notes (sexual abuse: κ = 0.526, P < .001; physical abuse: κ = 0.394, P < .001). Psychosis patients’ reports were also reasonably stable over a 7-year period (sexual abuse: κ = 0.590, P < .01; physical abuse: κ = 0.634, P < .001; antipathy: κ = 0.492, P < .01; neglect: κ = 0.432, P < .05). Additionally, their reports of childhood abuse were not associated with current severity of psychotic symptoms (sexual abuse: U = 1768.5, P = .998; physical abuse: U = 2167.5, P = .815; antipathy: U = 2216.5, P = .988; neglect: U = 1906.0, P = .835) or depressed mood (sexual abuse: χ² = 0.634, P = .277; physical abuse: χ² = 0.159, P = .419; antipathy: χ² = 0.868, P = .229; neglect: χ² = 0.639, P = .274). These findings provide justification for the use in future studies of retrospective reports of childhood abuse obtained from individuals with psychotic disorders.     

The Attitudes to Disability Scale (ADS): development and psychometric properties

Background This paper describes the development of an Attitudes to Disability Scale for use with adults with physical or intellectual disabilities (ID). The aim of the research was to design a scale that could be used to assess the personal attitudes of individuals with either physical or ID. Method The measure was derived following standard WHOQOL methodology as part of an international trial. In the pilot phase of the study, 12 centres from around the world carried out focus groups with people with physical disabilities, people with ID, with their carers, and with relevant professionals in order to identify themes relevant for attitudes to disability. Items generated from the focus groups were then tested in a pilot study with 1400 respondents from 15 different centres worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with 3772 respondents, again with the use of both classical and modern psychometric methods. Results The outcome of the second round of data collection and analysis is a 16‐item scale that can be used for assessment of attitudes to disability in physically or intellectually disabled people and in healthy respondents. Conclusions The Attitudes to Disability Scale is a new psychometrically sound scale that can be used to assess attitudes in both physically and intellectually disabled groups. The scale is also available in both personal and general forms and in a number of different language versions.     

父亲在位问卷的初步修订

目的:引进父亲在位问卷(FPQ),初步检验其在大学生群体中的信效度,建立父亲在位问卷的中文修订版(FPQ-R)。方法:方便抽取705名大学生进行FPQ测试,对其中的414名被试同时施测父母教养方式量表父亲版(PBI-F),间隔4周后对144名大一被试进行FPQ重测。采用相关系数、Cron-bachα系数、因素分析进行分量表的调整,对修订后的问卷进行信效度分析。结果:父亲在位问卷中文修订版(FPQ-R)共96个条目,包含与父亲的关系、家庭代际关系、有关父亲的信念3个高阶维度,分为8个分量表。96个条目与所在分量表的相关系数为0.43～0.83。验证性因素分析发现8因子模型的拟合指数为χ2/df=3.03,NFI=0.92,NNFI=0.94,CFI=0.94,RM SEA=0.05;3因子高阶修正模型的拟合指数为χ2/df=3.08,NFI=0.91,NNFI=0.93,CFI=0.94,RM SEA=0.06。3个高阶维度内各分量表的相关系数为0.42～0.75,3个高阶维度间各分量表的相关系数为0.18～0.45。除高阶维度二的2个分量表外,其余6个分量表与PBI-F的关爱、鼓励自主因子及总分均呈正相关(r=0.17～0.66,均P0.01)。3个高阶维度和8个分量表的内部一致性Cronbachα系数都超过0.86,重测信度系数为0.59～0.80。结论:父亲在位问卷中文修订版具有较好的信效度,可以用于我国大学生群体。     

疾病观念与求医行为自评问卷的初步编制及信效度分析

目的:编制适合中国文化背景的疾病观念与求医行为自评问卷(SSICHSB)。方法:根据理论构想,初编了含60个条目的问卷,在昆明市选取不同年龄、职业和受教育程度的801例受试进行施测。4周后对其中的120例进行重测。结果:SSICHSB共16个条目,分为3个因子。16个条目与总分的相关在0.14～0.60之间,与所在因子的相关在0.43～0.71之间。验证性因素分析显示模型的拟合指数为χ2/df=1.5,NFI=0.89,CFI=0.92,IFI=0.92,RM SEA=0.04。整个问卷的Cronbachα系数为0.71,3个因子的α系数在0.62～0.79之间;整个问卷的重测信度为0.72,3个因子的重测信度为0.61～0.78之间。结论:疾病观念与求医行为自评问卷符合心理测量学要求,可用于疾病观念与求医行为的评估。     

Psychometric evaluation of a self-medication assessment tool in an elderly population

Background:

Most community-dwelling older adults are engaged in medication self-management activities. Deviation in these activities can lead to adverse outcomes for patients and an increased burden on the health care system. Successful medication self-management involves a complex interaction among cognitive, functional, and psychosocial variables. Several assessment instruments have been developed, but there remains a need for an effective and comprehensive tool.

Objective:

To evaluate the psychometric properties (inter-rater reliability, test–retest reliability, and validity), as well as the usability, of the Self-Medication Assessment Tool (SMAT), an instrument designed to measure elderly patients’ ability to manage their medications.

Methods:

The study enrolled patients 65 years of age or older who were living independently and were admitted to family medicine beds in a community hospital in eastern Canada. Three subsamples of the population were identified. The inter-rater reliability group was videotaped and scored independently by 2 pharmacists. The test–retest reliability group was tested with the SMAT and was retested with the same tool a week later. The usability group was interviewed after using the SMAT to determine their satisfaction. Standard neuropsychological measures (Cognitive Competency Test, clock-drawing test, and Mini Mental State Examination [MMSE]) were used to determine convergent and divergent validity. Pill counts, refill rates, and use of adherence aids or reminders before study enrolment were used as measures of concurrent validity.

Results:

A total of 121 patients (mean age 81.5 years) were enrolled. The scales of the SMAT were determined to have good internal consistency and high inter-rater and test–retest reliability. Convergent validity was evidenced by the high positive correlation between the functional scale of the SMAT and the results of the clock-drawing and Cognitive Competency tests (p < 0.01) and between the cognitive and recall scales of the SMAT and the results of the clock-drawing test (p < 0.05), the MMSE (p < 0.01), and the Cognitive Competency Test (p < 0.01). Patients reported being highly satisfied with their experience.

Conclusion:

The SMAT is a practical, reliable, comprehensive instrument with demonstrated convergent validity, strong patient acceptability, and various internally consistent scales that assess multiple dimensions of elderly patients’ ability to self-manage their medications. Further testing is required to show that the SMAT correlates with medication adherence.     

Validity and reliability of the Caregiver Reaction Assessment scale among primary informal caregivers for older persons in Singapore

Previous studies evaluating the validity and reliability of the Caregiver Reaction Assessment (CRA) scale (24 items; five subscales: schedule, health, finances, family support, and esteem) in different countries are not fully congruent. This article assesses the validity and reliability of the CRA among informal caregivers of older persons in Singapore. Data from a national survey of 1190 primary informal caregivers of Singaporeans aged ≥75 years with ≥1 activity of daily living limitation was analyzed. Fit of the five-factor model was tested in half of the sample using confirmatory factor analysis (CFA) and the other half subjected to exploratory factor analysis (EFA). The CRA was modified accordingly and again subjected to CFA. The CRA's measurement equivalence/invariance (ME/I) across language of administration (Chinese/English/Malay) was assessed. CFA showed a poor fit for the five-factor model. EFA suggested the presence of four factors, three items to have neither sufficient nor unique factor loadings and items on two of the subscales to load on a single factor. CFA of the ‘modified’ CRA (21 items; four subscales: schedule and health, finances, family support, and esteem) suggested a better fit for the four-factor model than for the five-factor model. ME/I analysis supported partial invariance of the CRA across language of administration. The CRA scale should be assessed for relevance in Asian settings. With the suggested modifications, it is suitable for assessing negative and positive effects of caregiving among informal caregivers of older persons with activity limitations in Singapore.