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Background: Chronic fatigue, depression, burnout syndrome, and alcohol addiction have been identified as significant mental health problems in young medical doctors. Given the lack of prospective studies in this area in Poland, the POLski LEKarz (POLLEK) cohort study was created. The goal of the POLLEK study is to assess the quality of life and health status (including mental health) of medical students and young physicians. The aim of the presented paper was to assess the reliability and compatibility of paper and electronic versions of the POLLEK questionnaire. Methods: Between 1 October 2019 and 28 February 2020, all medical students (N = 638) of the first year in the Medical University of Silesia were invited to participate in a cross-sectional study. Three hundred and fifty-three students (55.3%) who accomplished both versions were included in the current analysis. Results: Values of Cronbach&rsquo, s alpha &gt, 0.7 proved both modes of delivery to have good internal consistency, except for the individual Alcohol Use Disorder Identification Test (AUDIT) domains and the Environmental domain of the WHOQOL-BREF (paper version). Similarly, interclass correlation coefficients equal to or greater than 0.9 denoted an excellent reproducibility. Conclusions: We documented very good accordance and reproducibility of POLLEK questionnaire (both paper and electronic versions). These findings legitimize the use of the questionnaire interchangeably.

E-hailing industry is a new concept in the taxi services whereby private cars can register with online transport. Despite the rapid popularity of e-hailing services, there are major public concerns pertaining to cyber security behavior issues both to the passengers and the drivers such as hit and run accident, robbery, rape, sexual harassment, murder, rude drivers and grab driver scams. Hence, this study intends to investigate the predictors of cyber security behaviors of e-hailing services in Malaysia. The prevailing factors to be examined are perceived threats, perceived privacy, fraud victimization, response efficacy, perceived vulnerability, security self-efficacy, perceived benefit and government policy. The research methods to be used are quantitative and qualitative research design. The sampling technique is to collect data passengers and drivers of e-hailing services operating in Malaysia. The measurement of the twelve main variables consists of 90 items. The data will be collected using self-administered survey and analyzed using SMART PLS 3.0. The expected finding is a new cyber security behavior model for Malaysia, provide new inputs for e-hailing regulation and policy improvement in line with Industrial Revolution 4, new suggestions for e-hailing market segmentation according gender and generation gaps, enhancement of the existing applications according to research findings, set new guidelines on the development of similar application in line with industrial Revolution 4 and the installation of panic button in e-hailing automobile. From the pilot study results, all scales were found to be consistent and reliable with Cronbach's alpha readings above 0.70.

Objective To survey the knowledge, attitude, and practices of Vietnamese pharmacists regarding the COVID-19 pandemic. Method This cross-sectional, paper-based study was conducted from June to August 2020. A validated questionnaire (Cronbach’s alpha = 0.84) was used to interview 1,023 pharmacists in nine provinces of Vietnam. Analysis of covariance was employed to identify factors associated with the knowledge of pharmacists. The best model was chosen by using the Bayesian Model Averaging method in R software version 4.0.4. Results The mean knowledge score was 12.02 ± 1.64 (range: 6–15), which indicated that 93.4% of pharmacists had good knowledge of COVID-19. There was no difference in the average score between males and females (p > 0.05). The multivariate linear regression model revealed that the knowledge was significantly associated with pharmacists’ age, education level, and residence (p < 0.001). About attitude and practices, pharmacists daily sought and updated information on the COVID-19 pandemic through mass media and the internet (social network and online newspapers). Nearly 48% of them conceded that they communicated with customers when at least one person did not wear a face mask at the time of the COVID-19 outbreak. At medicine outlets, many measures were applied to protect pharmacists and customers, such as equipping pharmacists with face masks and hand sanitizers (95.0%), using glass shields (83.0%), and maintaining at least one-meter distance between two people (85.2%). Conclusion The pharmacists’ knowledge of COVID-19 transmission, symptoms, and prevention was good. Many useful measures against the spread of this perilous virus were applied in medicine outlets. However, pharmacists should restrict forgetting to wear face masks in communication with medicine purchasers. The government and health agencies should have practical remedies to reduce the significant differences in the COVID-19 knowledge of pharmacists among provinces and education-level groups.

Integration of e-Health technologies for purposes of both assessment and intervention has recently become an interest area in pediatric psychology. The purpose of this study is to present psychometric characteristics of a technology-based (i.e., tablet administration) approach for measuring quality of life (QOL) in children. Eighty children (8-12 years) completed the Quality of Life Systemic Inventory for Children (QLSI-C) twice over a 2-week delay, in a crossover design that used paper and tablet-based modes of administration. Equivalence of scores across methods was examined using intraclass correlation coefficients (ICC), augmented by paired t test and Pearson's correlations. Test-retest reliability was assessed using paired t test and Pearson's correlations while internal consistency was assessed using Cronbach's coefficient. Results showed a good concordance across methods of administration (ICCs = .72 to .91; r = .56 to .83). Paired t test showed no significant differences between the tablet and paper version of the QLSI-C. Internal consistency reliability yielded acceptable Cronbach's alphas for all QLSI-C scores, with all α > .70. Test-retest reliability for the tablet-administered QLSI-C was good (r = .66 to .90). Paired t test showed no significant difference between Time 1 and 2 for the QLSI-C scores, except for the state score. Findings established the reliability of the tablet-administered QLSI-C scores. This technology approach to assessment is more attractive for children, decreases time for administration, and enhances the ease of scoring. These advantages might encourage both clinicians and researchers to consider using e-Health developments in assessment in pediatric psychology. (PsycINFO Database Record

Current advances in technology have enabled the development of a computer-based questionnaire that provides advantages over the paper-based mode of administration, such as automatic data entry, storage and calculations. However, before implementing a computer-based questionnaire, its equivalence with the original paper-based questionnaire must first be demonstrated. The purpose of this study was to evaluate the measurement equivalence of the computerized Diabetes-Specific Quality-of-Life questionnaire (cD-QOL) with its original paper-based counterpart. A two-period crossover design was used in this study. The measurement equivalence was evaluated using quadratic weighted kappa coefficients, intraclass correlations and Cronbach's alpha comparisons. The cD-QOL was equivalent to its original paper-based counterpart. Participants preferred the cD-QOL over the paper-based questionnaire and reported that it was easy to use.

Purpose This trial assessed the ability to enhance healthrelated quality of life (HRQL) and patient-reported outcome (PRO) evaluation in trials and patient management using computer assistance with a handheld device, called a personal digital assistant. The study assessed ease of use and psychometric properties of this approach, comparing the Lung Cancer Symptom Scale (LCSS) paper form with the electronic (eLCSS-QL). Objectives were to: (1) measure completion times; (2) evaluate acceptability by patients, nurses, and physicians; (3) determine the correlation of the eLCSS-QL with the paper version; and (4) determine the feasibility of using a shorter visual analogue scale (VAS) in the electronic version. Patients and methods Patients were entered at 12 COMET clinics. All had: (a) stage III or IV non-small cell lung cancer, (b) Karnofsky performance status (KPS)≥60, (c) no prior chemotherapy, and (d) received initial courses of docetaxel + platinum. Of the148 patients enrolled, characteristics were: men, 57 %; median, KPS 80 %; and median age, 67 years. Of these, 131 patients completed the evaluation form. Results The eLCSS-QL had excellent acceptance by patients, nurses, and physicians. Patients required 2.2 min (mean) to complete the eLCSS-QL. Reliability coefficients using Cronbach’s alpha were high for the paper (0.84) and electronic (0.88) versions. The correlation coefficient between forms was high (0.92). The length of the VAS on the handheld pc (53 mm versus 100 mm on the paper format) resulted in nearly identical scores. Conclusions The high acceptance rate by patients and professionals, the rapid completion time, ease of use, and strong psychometric properties confirm that the electronic LCSS (eLCSS-QL) is practical for use in trials and patient management. This study indicates that computer assistance helps overcome barriers associated with evaluating HRQL and PROs.

Background: Patients’ perspectives provide valuable information on quality of care. This study evaluates the feasibility and validity of Internet administration of Service Satisfaction Scale for Cancer Care (SCA) to assess patient satisfaction with outcome, practitioner manner/skill, information, and waiting/access. Patients and methods: Primary data collected from November 2007 to April 2008. Patients receiving cancer care within 1 year were recruited from oncology, surgery, and radiation clinics at a tertiary care hospital. An Internet-based version of the 16-item SCA was developed. Participants were randomised to Internet SCA followed by paper SCA 2 weeks later or vice versa. Seven-point Likert scale responses were converted to a 0–100 scale (minimum–maximum satisfaction). Response distribution, Cronbach’s alpha, and test–retest correlations were calculated. Results: Among 122 consenting participants, 78 responded to initial SCA. Mean satisfaction scores for paper/Internet were 91/90 (outcome), 95/94 (practitioner manner/skill), 89/90 (information), and 86/86 (waiting/access). Response rate and item missingness were similar for Internet and paper. Except for practitioner manner/skill, test–retest correlations were robust r = 0.77 (outcome), 0.74 (information), and 0.75 (waiting/access) (all P < 0.001). Conclusions: Internet SCA administration is a feasible and a valid measurement of cancer care satisfaction for a wide range of cancer diagnoses, treatment modalities, and clinic settings.

ObjectiveTo compare online and paper-based screening for depression and anxiety in adults with cystic fibrosis (CF).Design and settingCross-sectional study in CF clinics in Ireland and through the Cystic Fibrosis Ireland online community.Participants160 adult patients aged 18 or above were recruited. Of these, 147 were included in the analysis; 83 online and 64 paper-based. The remaining 13 were excluded because of incomplete data.MeasuresDepression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Data on pulmonary function (forced expiratory volume in 1 s %) and body mass index were self-reported based on clinical assessments. Sociodemographic data were collected.ResultsCompared with the paper-based participants, the online participants were more likely to be female (61.7% vs 48.4%), older (mean 32.2 vs 28.2 years) and were more likely to be married (32.5% vs 15.6%), living with their spouse or partner (42.5% vs 22.6%) and working either full time (33.7% vs 15.9%) or part time (30.1%vs 17.5%). The prevalence rates of elevated anxiety and depression were not significantly different (P=0.71 and P=0.56). HADS anxiety and depression scores were not statistically different between online (P=0.83) and paper-based (P=0.92) participants based on Mann-Whitney U test. A significant negative correlation was found between depression and pulmonary function (r=−0.39, P=0.01) and anxiety and pulmonary function (r=−0.36, P=0.02). Based on Cronbach’s alpha, there were no statistically significant differences between the online and paper-based participants on the internal consistency of the HADS anxiety (P=0.073) and depression (P=0.378) scales.ConclusionsOur findings suggest that online and paper-based screening for depression and anxiety in adult patients with CF yield comparable findings on prevalence rates and scores, associations with health and internal consistency of subscales. This study highlights that online screening offers an alternative method to paper-based screening. Further research with a larger sample and assessment of measurement equivalence between online and paper based screening is needed to confirm our results.

Aims To evaluate the psychometric properties of an online versus paper US-English version of the International Consultation on Incontinence Questionnaire-Bowel (ICIQ-B). Methods The ICIQ-B includes 17 items under 3 domains: bowel pattern (5 items), bowel control (7 items), and quality of life (5 items). We recruited community-dwelling adults seeking treatment for ≥monthly bowel leakage from specialty clinics within a VA medical center and university affiliate. An online versus paper version was evaluated at baseline, 2 weeks later, and 3 months after nonsurgical treatments per usual care. We assessed test-retest reliability (Pearson correlations) at 2 weeks, internal consistency (Cronbach's alpha), and convergent validity (Pearson correlations). Sensitivity to change was the difference between the baseline and post-treatment (3-month) scores. Results Mean age was 58.0 ± 11.9; 36% Veterans, 52% women. At baseline, 2 weeks, and 3 months, we found no differences in the online vs paper scores for the bowel control and quality of life domains. The ICIQ-B demonstrated fair internal consistency for the bowel pattern domain (Cronbach's α = 0.36–0.54). Internal consistency on the bowel pattern domain was better with the paper version than the online version at 2 weeks (P 0.80), good retest reliability (r ≥ 0.70, P

The aim of this paper was to assess the validity and reliability of the touch-screen standard Portuguese version of the following patient-reported outcomes (PROs), compared with paper format, in patients with rheumatoid arthritis (RA) and spondyloarthritis: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life scale (ASQoL), Short-Form 36 (SF-36), Health Assessment Questionnaire (HAQ) and visual analogue scales (VAS) measuring pain and burden of disease. Adult patients with RA and spondyloarthritis attending the Portuguese Institute of Rheumatology were recruited from March 2013 to January 2014. Patients filled the paper and touch-screen formats of the standard Portuguese versions of the PROs. Two groups of VAS were used, RA and psoriatic arthritis (Global VAS) and another specific for spondyloarthrites (Spa-VAS). Paper questionnaires were filled 15 min before touch-screen formats. Agreement between formats (validity) was assessed by intraclass correlation coefficient (ICC), while internal consistency of scales (reliability) was assessed by Cronbach's alpha. Overall, 134 patients were included with a mean age of 51 years, 74.6 % female and 57.5 % presenting RA. BASDAI, BASFI, HAQ and ASQoL showed high ICC between paper and touch-screen formats (0.977, 0.958, 0.974 and 0.940, respectively). ICC for Global VAS ranged from 0.906 to 0.921, while Spa-VAS ranged from 0.867 to 0.943. The mean ICC for all SF-36 domains was 0.889 (ICC for each domain ranged from 0.781 to 0.944). Touch-screen standard Portuguese formats of these PROs may be valid and reliable tools for PRO measurement in rheumatology.

Aims This observational study compared data values, reliability, consistency and compliance collected by electronic and paper diaries of differing durations. Methods Subjects ≥18 years with overactive bladder (OAB) on stable antimuscarinic treatment for ≥12 weeks were assigned to one of five, 15-week diary schedules in this randomized, parallel-group observational study. Sample size was sufficient to assess reliability and consistency of diary data with adequate precision. Reliability was assessed via intraclass correlation coefficients, variability with ANCOVAs, and consistency using Cronbach's alpha. Results Demographic characteristics of randomized subjects were representative of OAB trial populations. For mean volume voided, reliability was comparable across diary groups. For incontinence, reliability improved with increasing diary duration. For micturition frequency, electronic 7-day diary results had highest reliability and lowest variability. Lowest overall reliability was observed in the 3-day paper diary. Consistency was highest in the electronic continuous groups; Cont A (daily measurements throughout the study period [fully Continuous]) and Cont B (daily measurements for some but not all endpoints of interest [Partially Continuous]). Compliance was generally high; across groups ≥90% of diaries had at least one entry per day. There was no significant change in average micturition frequency with diary duration, suggesting no diary fatigue. One-third of subjects in the electronic Cont B group also reported micturitions as incontinence when they only needed to report incontinence; they also reported lowest satisfaction with the study. The electronic 7-day and electronic Cont A schedules (who reported incontinence and micturitions throughout the study) had lowest residual errors. Conclusions For future OAB trials, 7-day or continuous electronic diaries may improve accuracy and reliability of micturition and incontinence frequency data compared with shorter collection periods and paper diaries. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Aim: To investigate the reliability of the COntext Assessment for Community Health (COACH) tool on mobile phone versus pen-paper in Nairobi, Kenya. Background: One of the barriers to the progress of the MDGs has been the failure of health systems in many LMICs to effectively implement evidence-based interventions As a result of the “know-do” gap, patients do not benefit from advances in healthcare and are exposed to unnecessary risks. Better mapping of context improves implementation by allowing tailoring of strategies and interpretation of knowledge translation. COACH investigates healthcare contexts for LMICs and has only been used on pen-paper. With 5 billion mobile phone users globally, mobile technologies is being recognized as able to play a formal role in health services. Methods: Comparative study with 140 nurses/midwives and doctors in four hospitals in Nairobi. 70 were randomly assigned to mobile phone and pen-paper each. The tool was administered twice with a two week interval and test-retest reliability, internal consistency and interrater reliability were assessed. Findings: Excellent test-retest reliability for both pen-paper and mobile phone (ICC >0.81). 45% (pen-paper) and 34% (mobile phone) moderate agreement between individual questions in round 1 and 2. Acceptable average Cronbach’s alpha (>0.70). Conclusion: Both mobile phone and pen-paper were reliable and feasible for data collection. The findings are a good first step towards using COACH in Kenya. Additional research is needed for individual settings. Using mobile phones could increase healthcare facilities’ accessibility in implementation research, helping to close the “know-do” gap and reach the SDGs.

Assessing anatomy in a way that tests higher cognitive domains and clinical application is not always straightforward. The old "spotter" examination has been criticized for only testing low level "identify" knowledge, whereas other assessment modalities such as multiple choice questions do not reflect the three dimensional and application nature of clinical anatomy. Medical curricula are frequently integrated and subject specific examinations do not reflect the case based, spiral, integrative nature of the curricula. The integrated anatomy practical paper (IAPP) is a hybrid of the old "spotter" and an objective structured clinical examination but it demonstrates how higher levels of taxonomy can be assessed, together with clinical features and integrates well with other disciplines. Importantly, the IAPP has shown to be reliable and practical to administer. Data gathered from the Bachelor of Medicine five-year program over two academic years for four IAPP examinations, each being 40 minutes with (K = 60 items) based on 440 students revealed consistently strong reliability coefficients (Cronbach alpha) of up to 0.923. Applying Blooms taxonomy to questions has shown a marked shift resulting in an increase in the complexity level being tested; between 2009 and 2013 a reduction of 26% in the number of low level "remember knowledge" domain questions was noted with up to an increase of 15% in "understanding" domain and 12% increase in the "applying" knowledge domain. Our findings highlight that it is possible to test, based in a laboratory, anatomy knowledge and application that is integrated and fit for practice. Anat Sci Educ. © 2014 American Association of Anatomists.

Objectives This study aimed to examine the validity and reliability of a Web-based version of the epidemiology of prolapse and incontinence questionnaire (EPIQ). Methods Participants included 876 women age 38 to 65 years attending primary care clinics in the Salt Lake Valley. Women completed a single Web- or paper-based version of the symptom bother questions from EPIQ, and a subset repeated the same or opposite method at 2 separate time points. To assess subscales for the Web-based version factor, analysis of the 22 EPIQ items related to pelvic floor disorder symptoms was performed using principal components analysis and varimax rotation. Internal consistency was assessed using coefficient α. Test-retest and intermethod reliability were assessed using intraclass correlation coefficients for domain scores. Correlations above 0.70 were considered acceptable. Results Overall, 384 and 492 women completed at least 1 Web and 1 paper EPIQ and 93% were white with mean age of 50 (7) years. Of these, 63 completed Web-Web, 57 Web-paper, 47 paper-Web, and 109 paper-paper test-retest. Overall, factor analyses were consistent with the 7 domains of the original EPIQ. Cronbach α for the 4 symptomatic pelvic floor disorder domains and range of test-retest reliability for the various administration methods were similar to the original EPIQ instrument. Correlations for domain scores were above 0.70, except the anal incontinence scale (intraclass correlation coefficients, 0.68.) Conclusions Web administration of the EPIQ has similar psychometric properties with comparable internal consistency and test-retest reliability when administered in the same modality. Reliability between both methods of administration is acceptable.

Vaccine hesitancy (VH) has emerged as a recognized threaten to contain the COVID-19 pandemic. Historically, low vaccine acceptance rates had been described among patients with rheumatic diseases (RMDs). The study objective was to determine COVID-19 VH among Mexican outpatients with RMDs and validate the COVID-19 VH questionnaire. This cross-sectional study was developed in three steps. Step 1 consisted of translation/cultural adaptation of the Oxford-COVID-19-VH questionnaire. Step 2 consisted of pilot testing and questionnaire feasibility, content, construct and criterion validity, reliability (internal consistency and temporal stability) and questionnaire sensitivity to change. Step 3 consisted of VH phenomenon quantification in patients from two metropolitan tertiary-care-level centers. Step 1 followed ISPOR-task-force recommendations. Patients who participated in step 2 (n = 50 for pilot testing/feasibility and n = 208 for questionnaire validation [91 in test–retest and 70 in questionnaire-sensitivity to change]) and step 3 (n = 600) were representative outpatients with RMDs. The seven-item COVID-19 VH questionnaire was found feasible, valid (experts’ agreement ≥80%; a 1-factor structure accounted for 60.73% of the total variance; rho = 0.156, p = .025 between COVID-19 VH questionnaire and score from the Spanish version of the Vaccine Hesitancy Scale; and lower questionnaire scores in patients who reported 5 years-previous influenza vaccination), reliable (Cronbach’s ɑ = 0.889, intra-class correlation coefficient = 0.933 and 95% confidence interval = 0.898–0.956) and sensitive to change (effect size = 1.17 and 0.86, respectively, in patients who decreased [n = 34] and increased [n = 31] questionnaire-score after intervention). VH phenomenon was 35.5%. VH phenomenon was present in a substantial number of Mexican patients with RMDs. The COVID-19 VH questionnaire showed good psychometric properties to assess COVID-19 VH in our population.

ObjectivesDysfunction after transient ischaemic attack (TIA) and minor stroke is often underestimated by clinical measures. Patient-reported outcome measures used in value-based healthcare may help in detecting these problems. The Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10 Global Health) is a concise patient-centred outcome measuring tool proposed for assessing health status in patients who had stroke. This study aims to address the validity of the Dutch PROMIS-10 in patients who had stroke in the Netherlands and also aims to compare telephone versus on-paper assessment.DesignObservational cohort study.SettingSingle-centre hospital in the Netherlands.Participants75 patients who were diagnosed with TIA or minor stroke and discharged without rehabilitation treatment 1 year ago (between December 2014 and January 2016) completed the study.Primary and secondary outcome measuresPROMIS-10 physical (PH) and mental health (MH) scores assessed 1 year poststroke on paper (n=37) and by telephone (n=38) was compared with RAND-36 physical and mental component scores assessed on paper.ResultsPROMIS-10 and RAND-36 correlated significantly in PH, r=0.81 (95% CI 0.69 to 0.88), and MH, r=0.76 (95% CI 0.64 to 0.85). Paper-and-pencil assessed correlations were r=0.87 and 0.79 for PH and MH, respectively. Telephone assessed correlations were r=0.76 and 0.73 for PH and MH, respectively. Internal consistency analysis indicated high reliabilities for both health components of the PROMIS-10, all Cronbach’s α>0.70.ConclusionsThe Dutch PROMIS-10 was found to strongly correlate with the RAND-36. Paper-and-pencil assessment was found to have a higher correlation than telephone assessment. This study provides support for the use of the Dutch PROMIS-10 in assessing health status in patients after TIA and minor stroke.

PURPOSE The aim of this study was to determine whether two methods of documentation, print and electronic forms, for the assessment of patient-reported outcomes (PRO) in complete denture wearers provide comparable results. The study also quantified the time needed for filling the forms by each method. MATERIALS AND METHODS Thirty participants enrolled in a university clinic answered two forms (a questionnaire for denture satisfaction and OHIP-EDENT). They provided answers with two application methods in a random order, with a one-month interval between them: (1) electronic forms on a tablet computer; and (2) print forms. The methods were compared in terms of mean results, correlation/agreement, internal consistency, and spent time. RESULTS Mean results for both methods were similar for each denture satisfaction item (100-mm VAS) and OHIP-EDENT summary score. Both questionnaires presented good internal consistency regardless of the application method (Cronbach's α=0.86 or higher). Correlation and agreement between the methods regarding specific items was at least moderate for the majority of cases. Mean time for the electronic and print forms were 9.2 and 8.5 minutes, respectively (paired t test, P=.06, non-significant). CONCLUSION The electronic method is comparable to print forms for the assessment of important PRO of prosthetic treatment for edentulism, considering the results and time needed. Findings suggest the viability of replacing print forms with a tablet for applying the tested inventories in clinical trials.

Objective: The International Classification of Functioning and Disability (ICF) centres on participation as the ultimate outcome for persons with disabling conditions. In the ICF, participation is defined as involvement within a life situation and encompasses personal maintenance, mobility, information exchange, social relationships, home life, education, work and employment, economic life and community, social, and civic life. Children's participation needs to be considered in the context of school, home, and broader community environments. This study aimed to investigate the validity, reliability, sensitivity to change, feasibility, accessibility, and practicality of use of measurements of participation of primary school children with hemiplegia. Design: A systematic review. Method: Inclusion criteria: assessments that measure primary school aged children (5-13y) with cerebral palsy or physical disabilities AND participation (at least 30% content), but may also include activity and environmental factors. Exclusion criteria: papers not published in English that assess quality of life, impairments, communication, or interpersonal relationships. Three raters independently assessed all papers and reached consensus. Results: Systematic searching identified 17 assessments. Consensus agreement was reached for the Canadian Occupational Performance Measure (COPM); School Function Assessment (SFA);' Assessment of Life Habits (LIFE-H for children 1.0);2 Children's Assessment of Participation and Enjoyment(CAPE);3 Goal Attainment Scaling (GAS); and School Outcomes Assessment. The Children Helping Out: responsibilities, Expectations and Supports (CHORES) was selected by two of the raters. The CAPE, SFA, and LIFE-H were found to have the best clinimetric properties. The LIFE-H covers 13 life habit areas. Content validity is good and test retest reliability for most areas is adequate (ICC=O.314.74).* The SFA is judgement based, with specific assessment of participation in school. It has high internal consistency (coefficient alpha=0.924.98), excellent test retest reliability (ICC=0.824.98),and adequate interrater reliability (ICC=0.624.73).' Four studies have supported content and construct validity. The CAPE measures participation in non-school mandated activities. Test development and standardization indicates sufficient internal consistency (0.42 formal domain, 0.76 informal domain), test retest reliability (ICC=0.64-0.86) and validity3 Conclusion: The most suitable measures of participation for primary school children with hemiplegia are the CAPE and LIFE-H for home and broader community environments and the SFA for the school environment. The results of this review will further inform the outcome measures for the participation domain in a randomized trial of upper limb training in children with hemiplegia.

The purpose of this study was to test whether the web version is an alternative to the paper version of the short version of the World Health Organization Quality of Life assessment (WHOQOL-BREF). Two studies were conducted. Study 1 used crossover self-controlled trials with 80 participants to compare the web and paper versions and to determine the test–retest reliability of the web version. Study 2 used data from 1,016 web participants to analyze the internal consistency and concurrent and construct validity of the web version. The correlations of domain scores between the web and paper versions ranged from 0.71 to 0.85. Dependent t tests showed no significant differences in domain scores between these two versions. The intra-class correlation coefficients (ICC) for test–retest reliability of web version ranged from 0.79 to 0.91. The Cronbach’s α for internal consistency reliability ranged from 0.60 to 0.83. Multiple regression models indicated that the web version has good concurrent validity. Confirmatory factor analysis (CFA) for the second-order hierarchical factor model also supported the construct validity of the web version. The web version of the WHOQOL-BREF can be the alternative to the paper version for health-related quality of life (HR-QOL) evaluation.

Background Digital mental health interventions are being used more than ever for the prevention and treatment of psychological problems. Optimizing the implementation aspects of digital mental health is essential to deliver the program to populations in need, but there is a lack of validated implementation outcome measures for digital mental health interventions. Objective The primary aim of this study is to develop implementation outcome scales of digital mental health for different levels of stakeholders involved in the implementation process: users, providers, and managers or policy makers. The secondary aim is to validate the developed scale for users. Methods We developed English and Japanese versions of the implementation outcome scales for digital mental health (iOSDMH) based on the literature review and panel discussions with experts in implementation research and web-based psychotherapy. The study developed acceptability, appropriateness, feasibility, satisfaction, and harm as the outcome measures for users, providers, and managers or policy makers. We conducted evidence-based interventions via the internet using UTSMeD, a website for mental health information (N=200). Exploratory factor analysis (EFA) was conducted to assess the structural validity of the iOSDMH for users. Satisfaction, which consisted of a single item, was not included in the EFA. Results The iOSDMH was developed for users, providers, and managers or policy makers. The iOSDMH contains 19 items for users, 11 items for providers, and 14 items for managers or policy makers. Cronbach α coefficients indicated intermediate internal consistency for acceptability (α=.665) but high consistency for appropriateness (α=.776), feasibility (α=.832), and harm (α=.777) of the iOSDMH for users. EFA revealed 3-factor structures, indicating acceptability and appropriateness as close concepts. Despite the similarity between these 2 concepts, we inferred that acceptability and appropriateness should be used as different factors, following previous studies. Conclusions We developed iOSDMH for users, providers, and managers. Psychometric assessment of the scales for users demonstrated acceptable reliability and validity. Evaluating the components of digital mental health implementation is a major step forward in implementation science.

In the context of the COVID-19 pandemic, vaccination-induced behavioral complacency in adherence to COVID-19 appropriate behavior emerged as a significant concern. This study was conducted among a convenience sample of 540 oral health care professionals in India and the United States. This was a retrospective pretest-post-test design, a choice to eliminate response-shift bias, where the participants responded online on their adherence or otherwise to COVID-19 precautionary measures before and after vaccination. The difference between post-test and retrospective pretest scores was used in assessing the magnitude of complacency demonstrated by the individual as a function of getting vaccinated, and the process was validated using exploratory factor analysis (EFA) with principal axis factoring and confirmatory factor analysis (CFA) on two randomly split subsets of the overall sample. It was observed that there had been a decline in the adherence to all the considered COVID-19 precautionary measures from the time before vaccination to the time of achievement of the fully vaccinated status. EFA performed on the randomly split sub sample of 240 subjects returned a two factor solution with five items in factor 1 and seven items in factor 2. Items in both the factors demonstrated adequate internal consistency in reliability analysis (Cronbach's alpha 0.84 and 0.82, respectively). The two factor solution obtained in EFA demonstrated good model fit in CFA [RMSEA (90%CI) - 0.077 (0.063-0.092); TLI - 0.872; CFI - 0.897; SRMR - 0.056]. These results highlight the vaccination-induced complacency in observing COVID-19 appropriate behavior among oral health professionals in India and the United States.

Purpose To evaluate the measurement properties of a new version of the Swedish Knee Self-Efficacy Scale (K-SES) in samples of individuals with an anterior cruciate ligament (ACL) injury and after ACL reconstruction. A secondary aim was to translate the new version of K-SES into English in order to prepare for future complete cross-cultural adaptation. Methods The reliability, structural validity, internal consistency and construct validity of the new, 18-item version of the K-SES (K-SES18) were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for evaluating methodological quality. The Swedish version of the K-SES18 was translated to English using recommended guidelines. Results The test-retest reliability for the K-SES18 subscale present and the K-SES18 subscale future showed an Interclass Correlation Coefficient (ICC) = 0.92. In addition, the K-SES18 had a Cronbach’s α ranging from 0.93 to 0.96 for the K-SES18 subscale present and from 0.81 to 0.91 for the K-SES18 subscale future. No floor and ceiling effects were identified for the subscale present or the subscale future of the K-SES18. A factor analysis produced 2 factors of importance; K-SES18present and K-SES18future. Seven predefined hypotheses were confirmed. Conclusion The K-SES18 has acceptable reliability and validity to assess knee self-efficacy in patients up to 18 months after ACL injury and reconstruction. Level of evidence IV.

Use of Internet versions of questionnaires may have several advantages in clinical and epidemiological research, but we know little about if Internet versions differ with respect to validity and reliability. We aimed to compare Internet- and pen-and-paper versions of short form-36 (SF-36) with respect to test-retest reliability and internal consistency. Women referred to mammography (n = 782) were randomised to receive either a paper version with a prepaid return envelope or a guideline on how to fill in the Internet version. A subgroup was asked to answer the questionnaire once again in the alternative version. Test-retest reliability was assessed by the intra-class correlation coefficient. Internal consistency was calculated as Cronbach's alpha. The between-version test-retest reliability for the eight subscales were between 0.63 and 0.92. Cronbach's alpha for the two versions were all between 0.75 and 0.93 with minor differences between the Internet- and the pen-and-paper version. We found little or no evidence of a difference in test-retest reliability and internal consistency when we compared an Internet- and a pen-and-paper version of SF-36.

This study reports results from a format comparison between Web-based and pencil and paper questionnaires measuring two well-validated measures of psychological distress among 530 frequent Internet users studying at an on-line University (Open University of Catalonia, UOC). A four-item version of the Perceived Stress Scale (PSS) and a seven-item version of the Center for Epidemiological Studies-Depression Scale (CESD) were randomly administered in Web-based and pencil and paper format. Internal consistency analyses showed that these two brief versions were reliable for on-line assessment. Also, no differences in Cronbach αs were found between formats. Exploratory as well as multigroup factor analysis techniques showed that factor structures were invariant across formats. Overall, results revealed that respondents did not bias their responses in the Web-based condition. As these findings suggest, when familiarity with technology is high among respondents and sample procedures are followed to maximize control for potential participants, Web-based and paper and pencil formats are virtually equivalent, as in the two brief measures of psychological distress used in this study.

This study assessed the degree of equivalence between paper and Internet administration of three measures of panic and agoraphobia-related cognition and behavior: Body Sensations Questionnaire (BSQ), Agoraphobic Cognitions Questionnaire (ACQ), and Mobility Inventory (MI). Participants were 110 people with panic disorder who had registered for an Internet-based treatment program in Sweden (n = 54) or Australia (n = 56). Participants were randomly assigned to complete the questionnaires via the differing administration formats in a counterbalanced order. Results showed broadly equivalent psychometric properties across administrations, with strong significant intraclass correlations between them, and comparable Cronbach's alpha coefficients. A significant mean difference between administration formats was found for the BSQ only. In contrast to previous research, Internet administration did not generate higher scores than paper administration. No effect was found for order of administration. The findings suggest that each questionnaire can be validly administered via the Internet and used with confidence.

Objective This study aimed to assess the psychometric properties of three generic preference-based measures and compare their performance in a sample of Hong Kong general population. Methods Data used for this analysis were obtained from a cross-sectional telephone-based survey in July 2020. Participants were asked to complete several measures, including The EuroQol five-dimensional five levels (EQ-5D-5L), Recovering Quality of Life-Utility Index (ReQoL-UI) and ICEpop CAPability measure for adults (ICECAP-A). Acceptability, reliability, convergent and discriminant validity of three measures were assessed as well as the agreement between these instruments. Results Based on data from 500 participants to the survey, a lower mean score of the ICECAP-A (mean = 0.85) was observed compared to the other two measures (meanReQoL-UI = 0.92; meanEQ-5D-5L = 0.92). All three measures showed an acceptable internal consistency reliability (Cronbach’s alpha = 0.74, 0.82 and 0.77, respectively) as well as good test–retest reliability (intra-class correlation coefficient = 0.74, 0.82 and 0.77, respectively). Correlation analyses confirmed satisfactory convergent validity and the ability of the measures to differentiate between participants with different health or from socioeconomic status groups. The Bland–Altman plot revealed poor agreement between the three measures. Conclusions This study confirmed that EQ-5D-5L, ReQoL-UI and ICECAP-A were psychometrically robust to measure HRQoL in the general HK population. The EQ-5D-5L was more suitable for assessing physical HRQoL, whereas the ICECAP-A and ReQoL-UI were more appropriate for measuring interventions aimed at improving people’s well-being and mental health.

Introduction This study aimed to develop a scale to measure prenatal smoking cessation counseling for Japanese public health nurses (PHNs). Methods A cross-sectional study was conducted via an anonymous, self-administered questionnaire. The sample included 1933 PHNs working in 424 municipal health centers nationwide, which were randomly selected. We created the draft scale based on semi-structured interviews, previous studies, and preliminary survey. Additionally, we conducted back translation for English version of the draft scale to be applicable in English countries. The analytic strategy consisted of item analysis, exploratory factor analysis, and differentiation by 'known groups'. Results A total of 550 responses (28.5%) were included in the analysis. Most of the respondents were female (98.2%) and the mean age was 37.5±9.37 years. In the exploratory factor analysis, two factors were extracted and the factor loadings for all items were greater than 0.40. The first factor with eleven items was named as 'basic counseling' and the second factor with seven items was named as 'advanced counseling'. The Cronbach's alpha of the scale was 0.918, and the cumulative contribution was 44.908%. Multiple comparisons by experience years working as a PHN revealed significant differences in the scale and two factors. Conclusions In this study, we initially developed the prenatal smoking cessation counseling scale for Japanese PHNs, and the reliability and validity of the scale were considered to be acceptable.

Introduction Inflammatory bowel disease (IBD) is a group of chronic gastrointestinal diseases with frequent systemic complications that are incurable according to current knowledge. These diseases adversely affect various areas of life, lowering patients' quality of life. One of the most frequently reported symptoms is fatigue. Aim Translation and validation of the IBD-F patient self-assessment scale with a Polish IBD population. Material and methods After consent from the author of the questionnaire had been obtained, the questionnaire was translated using the forward- and back-translation method. After arriving at the final Polish version of the questionnaire and ensuring that the questions and statements were comprehensible, the questionnaire was validated with a group of 129 IBD patients. Results High values of intraclass correlation coefficient (ICC) were achieved for overall results in both parts of the IBD-F questionnaire between test and retest (values exceeding 0.75). A high Cronbach's α consistency coefficient was achieved for the entire IBD-F questionnaire, both in the test and in the retest (0.968 and 0.975, respectively). Broken down into parts, Cronbach's α coefficient for Section I (presence and severity of fatigue) of the IBD-F questionnaire was 0.883, and for Section II (impact of fatigue on the person's life) it was 0.966. All patients evaluating the Polish version of the IBD-F questionnaire deemed the content of the questions comprehensible. Conclusions The analysis of the results obtained, the Polish version of the IBD-F questionnaire was considered valid, reliable, and clinically useful.

In this study the internal consistency and predictive validity of the Paper and Pencil Games (PPG) Level 3 for a group of isiXhosa-speaking learners in Grade 4 were investigated. The internal consistency for the verbal, non-verbal and total scales was established by means of Cronbach's coefficient alpha. The internal consistency of the total and non-verbal scales was high and the internal consistency of the verbal scale notably lower. The predictive validity of the PPG was investigated by calculating Pearson correlation coefficients between the verbal, non-verbal and total scores of the PPG and achievement in the different school subjects and the overall achievement. The total scale of the PPG was the best predictor of achievement in English, Mathematics, Science, Geography, History and Health Science as well as overall achievement. The verbal scale was the best predictor of achievement in Afrikaans and the non-verbal scale of achievement in isiXhosa. Local norms in the form of stanines were also calculated for the group of isiXhosa-speaking learners.

Background The Patient Perception of Patient-Centeredness (PPPC) questionnaire was revised, and there is a need for the questionnaire to be tested in diverse primary care populations. Objectives This study aimed to examine the factor structure of the Revised PPPC questionnaire (PPPC-R) in French-speaking patients with multimorbidity. Design Secondary analysis from baseline data of the French arm of Patient-Centered Innovations for Persons with Multimorbidity Study (PACEinMM Study). Setting and participants Participants were adult patients with multimorbidity attending primary health-care settings. Outcome measures Exploratory factor analyses were applied to examine the factor structure of the PPPC-R. Cronbach's alpha values were calculated to assess the internal consistency of the whole questionnaire and of each factor explored. Results There were 301 participants, mean age 61.0, 53.2% female. The PPPC-R showed very good internal consistency, with three factors: Patient-Centered Clinical Method (PCCM) Component 1-Exploring the health, disease and illness experience + PCCM Component 4-Enhancing the patient-clinician relationship (Factor 1); PCCM Component 2-Understanding the whole person (Factor 2); and PCCM Component 3-Finding common ground (Factor 3). There was a good internal consistency within each factor (Cronbach's α = 0.87 for 8 items in Factor 1, 0.77 for 5 items in Factor 2 and 0.87 for 5 items in Factor 3). Discussion and conclusions The French PPPC-R factor structure was in accordance with the underpinning conceptual model and presented with three factors. Further assessment of its validity and reproducibility are needed to allow its use as a measure of patient's perception of patient-centeredness.

This study was conducted to assess the self-reported and observed food safety practices (FSP) of food handlers, who deliver food products that are prepared and cooked at home during the COVID-19 pandemic in the Philippines. 751 participated in the online survey who were selected using criterion sampling. A questionnaire developed by the researcher was used to gather data with Cronbach Alpha of 0.91. t-test, ANOVA, and Fleiss kappa were performed to treat data. There were no significant differences between self-reported FSP in four dimensions and demographic characteristics, except for age, where a significant difference exists between the FSP of the four age groups along food preparation (F ​= ​4.530,ρ, Graphical abstract Image 1, Highlights • Online food business is growing due to restrictions brought about by the pandemic. • Self-reported FSP of food handlers reveal compliance to food safety standards. • Food handlers violate food safety protocols based on expert observations. • There is significant difference between the self-reported and the observed FSP. • Food safety training involving food handlers in online businesses is imperative.

[Abstract] The Edmonton Frail Scale (EFS) is an index employed to measure alterations related to frailty. The main objective in this research was to develop the EFS short-form (EFS-SF) and to evaluate its validity, reliability, and sensitivity to predict frailty disability outcomes in elderly patients with foot disabilities. Results: Exploratory factor analysis (EFA) of the EFS-SF revealed the presence of three components, as in the original EFA. There were significant differences (p < 0.05) in the study population for several of the EFS and 5-item FRAIL scale indicators. The highest correlation (Pearson R = 0.871; p < 0.001) was found for the first component of the EFS-SF. Finally, the Cronbach alpha was 0.864 which indicated a high level of internal consistency. Conclusion: The EFS-SF is a reliable and valid instrument to measure frailty in patients with and without foot disabilities. Method: A cross sectional descriptive study was carried out. The study population was aged over 60 years (n = 66) and comprised 29 men and 37 women. Frailty disorders were registered by using the EFS, 5-item FRAIL scale, and the Geriatricians’ Clinical Impression of Frailty (GCIF) scale. EFA was employed to locate potential constituents of the EFS, with scores ranging from 0.596 to 0.946 for each of the sub scales: (1) cognitive and general health status; (2) medication and nutrition status; and (3) functional and physiological status, thus revealing that the EFS-SF comprised three components, a reduction compared to the nine in the original EFS. This research was funded by the Generalitat Valenciana, grant number GV/2020/061 and A.P.C. was funded by the Universitat de València Generalitat Valenciana; GV/2020/061

BackgroundSatisfactory psychometric properties in offline questionnaires do not guarantee the same outcome in Web-based versions. Any construct that is measured online should be compared to a paper-based assessment so that the appropriateness of online questionnaire data can be tested. Little research has been done in this area regarding Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. ObjectiveThe objective was to simultaneously collect paper-based and Web-based ADHD questionnaire data in adults not diagnosed with ADHD in order to compare the two data sources regarding their equivalence in raw scores, in measures of reliability, and in factorial structures. MethodsData from the German versions of the Connors Adult ADHD Rating Scales (CAARS-S), the Wender Utah Rating Scale (WURS-k), and the ADHD Self Rating Scale (ADHS-SB) were collected via online and paper questionnaires in a cross-sectional study with convenience sampling. We performed confirmatory factor analyses to examine the postulated factor structures in both groups separately and multiple group confirmatory factor analyses to test whether the postulated factor structures of the questionnaires were equivalent across groups. With Cronbach alpha, we investigated the internal consistency of the postulated factors in the different questionnaires. Mann-Whitney U tests with the effect size “Probability of Superiority (PS)” were used to compare absolute values in the questionnaires between the two groups. ResultsIn the paper-based sample, there were 311 subjects (73.3% female); in the online sample, we reached 255 subjects (69% female). The paper-based sample had a mean age of 39.2 years (SD 18.6); the Web-based sample had a mean age of 30.4 years (SD 10.5) and had a higher educational background. The original four factor structure of the CAARS-S could be replicated in both samples, but factor loadings were different. The Web-based sample had significantly higher total scores on three scales. The five-factor structure of the German short form of the WURS-k could be replicated only in the Web-based sample. The Web-based sample had substantially higher total scores, and nearly 40% of the Web-based sample scored above the clinically relevant cut-off value. The three-factor structure of the ADHS-SB could be replicated in both samples, but factor loadings were different. Women in the Web-based sample had substantially higher total scores, and 30% of the Web-based sample scored above the clinically relevant cut-off value. Internal consistencies in all questionnaires were acceptable to high in both groups. ConclusionsData from the Web-based administration of ADHD questionnaires for adults should not be used for the extraction of population norms. Separate norms should be established for ADHD online questionnaires. General psychometric properties of ADHD questionnaires (factor structure, internal consistency) were largely unaffected by sampling bias. Extended validity studies of existing ADHD questionnaires should be performed by including subjects with a diagnosis of ADHD and by randomizing them to Web- or paper-based administration.

The aim of this study is to develop an attitude scale towards online teaching and learning for higher education teachers. It included 687 participants (77 Professors, 67 Associate Professors and 543 Assistant Professors) from various colleges and Universities of India. This tool development was a part of research conducted to examine the preparedness of Indian higher education teachers during the period of lockdown due to Covid-19 pandemic. After reviewing related literature, initially 37 items related with the attitude of teachers towards online education were framed. Later on, 11 items were modified and four were deleted as per the opinions of the experts. The draft scale consisting of 33 items was administered on teachers and data was collected with the help of Google forms. Item analysis was carried out using t-value and r-value. Reliability of scale was determined by using Cronbach Alpha value (0.88) and split-halt correlation (0.82). After item analysis, the scale items were reduced to 30 and four factors were established as a result of factor analysis (Principal Component Analysis). Psychometric scale analyses have shown that this scale is valid, reliable and thus can be used in the evaluation of teachers ‘attitudes towards online teaching and learning.

Objective:The Child Eating Behaviour Questionnaire (CEBQ), a widely used instrument that has been validated mostly in high-income countries, has limitations in its factorial validity when used among different cultures. This study examines whether the CEBQ instrument is culturally appropriate and valid to be used in a low- and middle-income country (LMIC) in a setting where child undernutrition remains prevalent.Design:The study employed a qualitative process to validate the content of items relative to the culture and setting, which was followed by a survey to test the psychometric properties of the instrument. Tests of factorial validity, convergent validity and reliability were performed.Setting:Three different socio-economic settings of Yogyakarta, Indonesia.Participants:The participants of this study were mothers of children aged 25–60 months. In-depth interviews were conducted with twenty-four mothers and the questionnaire validation process involved 238 mothers in the survey.Results:A Confirmatory Factor Analysis model with eight subscales provided the best fit (root-mean-square error of approximation = 0·048 (90 % CI 0·040, 0·057); Comparative Fit Index = 0·95 and Tucker Lewis Index = 0·95) after three new items and eight items from the original CEBQ were removed. Convergent validity with child’s weight was found for two subscales, slowness in eating and satiety responsiveness. Reliability measured using Cronbach’s alpha provided values between 0·62 and 0·78.Conclusion:The original eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity with mothers of preschool children living in a LMIC where child nutrition remains a significant public health issue.

Objective:There has been increasing interest in identifying individuals with pathological healthy eating behaviours, or orthorexia nervosa (ON). This study aimed to investigate the validity (construct- and criterion-related) and reliability (internal consistency) of the Eating Habits Questionnaire (EHQ) as a measure of ON. A secondary aim was to examine how the EHQ would predict a distinct feature of ON, adequate dietary intake.Design:Cross-sectional online questionnaire incorporating existing measures of ON and dietary intake.Setting:Participants were recruited online via social media and a university’s research webpage.Participants:Women (n 286) ranging in age from 17 to 73 years.Results:Exploratory factor analysis established that the EHQ represented four ON dimensions (Healthy Eating Cognitions, Dietary Restriction, Diet Superiority and Social Impairment), inconsistent with the scale’s original three dimensions (Problems, Knowledge and Feelings). Cronbach’s α coefficients ranged from 0·72 to 0·80 for the four subscales and was 0·89 for the total EHQ scale. Criterion-related validity revealed a significant moderate to strong correlation (r = −0·54, P < 0·001) between the EHQ and ORTO-10 (a ten-item version of ORTO-15). The EHQ, particularly the EHQ–Diet superiority subscale, was found to be predictive of better, as opposed to, poorer dietary adequacy.Conclusions:Findings suggest that improvements still need to be made to the EHQ for it to be a valid and reliable measure of ON. Ideally, new assessment tools based on established diagnostic criteria are needed to advance our understanding of ON.

Objectives:The aim of the current study is to develop a valid and reliable instrument with psychometric qualities to measure effect of social media usage on eating behaviour in university students.Design:A thirty-eight-item draft scale developed by the researchers. After content validity, twenty-two items are remained and was used to collect the data. In the analysis of the data, confirmatory factor analyses were performed to test construct validity. For the reliability of the scale, Cronbach alpha coefficient was calculated for the whole of the scale.Setting:The participants attended from various departments of different universities in Ankara.Participants:The scale was administered to the study group consisting of 247 university students.Results:Four items that had total correlation value less than 0·40 were removed from scale. The reliability coefficient of the whole eighteen-item scale was found to be 0·928.Conclusions:It has been shown that the scale developed as a result of the validity and reliability analyses performed for the scale is a valid and reliable measurement tool and can be used in studies.

Introduction Children with high dental anxiety display uncooperative behavior during dental procedures. Different self-assessment questionnaires are in use to estimate the prevalence of dental fear and anxiety (DFA) in children but they need to be tested for reliability and validity in different populations. Objectives The aim of this study was to test the reliability and validity of two scales for the assessment of child dental fear and anxiety in a sample of Croatian children. Material and Methods The sample comprised 202 pairs consisting of children and their mothers (97 boys and 105 girls) aged 5 - 12 years. Two scales were used to assess children’s DFA: the Children’s Fear Survey Schedule – Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale - face version (MCDAS-f). The Corah’s Dental Anxiety Scale (CDAS) was used in the sample of children’s mothers. The average scores of cooperative children and children with behavior management problem (BMP) were compared. Results Cooperative children displayed significantly lower CFSS-DS scores than children with BMP (M = 28. 46 vs. M = 39. 36; P < 0.001). The average MCDAS-f score was significantly higher in children with BMP than in cooperative children (M = 28. 07 vs. 20. 01; P < 0.001). The CFSS-DS showed high internal consistency (Cronbach’s α = 0. 90), while internal consistency of MCDAS-f was good (α = 0. 73). The maternal CDAS showed good internal consistency (α = 0, 89). The correlations with other self-report measurements of DFS show good validity of all scales. The correlations between CFSS-DS and MCDAS-f were highly significant (r = 0.482; P < 0. 01) as well as the correlations of CFSS-DS and MCDAS-f with CDAS scores (r = 0.223; P < 0. 01 and r = 0.198; P < 0. 01, respectively. Conclusion The obtained results suggest that both the CFSS-DS scale and the MCDAS-f scale are reliable and valid scales for measuring dental fear and anxiety in children in a sample of Croatian children. The MCDAS-f scale has shown slightly lower internal consistency but it is suitable for use in young children. In addition, the MCDAS-f scale is simple to administer.

Introduction. Recently it has been shown that body image during sexual activities is a better predictor of the diversity of sexual experience than body image as a psychological trait. To measure contextual body image (as a state) the Body Exposure During Sexual Activity Questionnaire (BESAQ) was developed. Material and methods. 845 women aged 18-55 years were included in the study. The original model was first translated into Polish and consulted to create the version to be further validated. The original model was tested using confirmatory factor analysis (CFA). The population was divided in two equal groups – group 1 was used for exploratory factor analysis. Discriminant and convergent validity were checked. Sexual function was assessed by the Changes in Sexual Function Questionnaire. Results. The Polish model of BESAQ (BESAQ-PL) consisted of 28 items with 2 lower-order factors. It had a satisfactory goodness of fit – comparative fit index (CFI) = 0.93, Tucker-Lewis index (TLI) = 0.94, root-mean-square error of approximation (RMSEA) = 0.06 and c2 = 1360.0, df = 337, p < 0.001, excellent internal consistency measured by Cronbach’s a = 0.88 and satisfactory discriminate validity. State body image (BESAQ-PL) did not predict sexual functioning. Face was the most important for self-consciousness during sexual contact in the population of Polish women. Conclusions. State body image correlates with sexual functions but is not a major factor influencing sexual performance. Women in Poland are not anxious about body exposure during sexual activity. The BESAQ-PL may be used in the population of Polish women between 18 and 55 years of age.

ObjectivesValid and reliable instruments for the measurement of mindfulness are crucial for people living with HIV. However, there was no Myanmar version of such an instrument.MethodsWe adapted the English version of the 12-item Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) based on standard cross-cultural procedures. By randomly sampling methods, a sample of 248 eligible people living with HIV was contacted from a closed Myanmar Facebook group; 159 PLHIV completed the initial 12-item version of the adapted survey.ResultsThree items were removed due to low item-to-total correlations of the corrected item-total correlation as well as having infit and outfit mean squares outside the range of 0.6 to 1.4. After deleting the 3 items, the three-factor structure was confirmed by confirmatory factor analysis, which indicated good model fit. The resultant 9-item CAMS-R in Myanmar (CAMS-R-M-2) achieved good internal reliability (Cronbach’sαof 0.75 to 0.87, and the corrected item-total correlation ranged from 0.44 to 0.81). Construct validity of the scale was demonstrated by significant association with self-reported HIV stigma and social support levels (r = 0.63, and − 0.53). In Rasch analysis, the infit and outfit mean squares for each item ranged from 0.49 to 1.24, and the person reliability was 2.17 and the separation index was 0.83.ConclusionsThe 9-item CAMS-R-M-2 with a three-factor structure has good reliability and validity. Higher total scores and subscale score reflected greater mindfulness qualities in people living with HIV in Myanmar.

BackgroundThe aim of this study was to adapt and modify the HIV/AIDS Stigma Instrument-Patient to develop the COVID-19 Stigma Instrument-Patient (CSI-P) and validate its psychometric characteristics, as well as explore how affected individuals in China experienced COVID-related stigma and its associated variables, including depressive symptomology and quality of life (QOL).MethodsFrom September to October 2020, 151 COVID-19 survivors recruited in Shanghai, China, completed a set of measures of demographic characteristics, depression, stigma, and QOL.ResultsThe 15-item CSI-P-2 achieved a Cronbach's α of 0.67 to 0.91. The six-factor structure was obtained by exploratory factor analysis. The mean score for the CSI-P-2 in Chinese COVID survivors was 8.14±9.98. Regression analysis showed that survivors' age, comorbid diseases, education levels, and loneliness level were the factors influencing their COVID-19 stigma, explaining 37.80% of the total variance (F=19.25, p&nbsp

This is the first in a short series of papers on measurement theory and practice with particular relevance to intervention research in nursing, midwifery, and healthcare. In this article I discuss reliability, its origins in classic measurement theory, important issues to consider when operationally defining reliability for a particular study, correlational procedures for assessing the reliability of data once collected, including test–retest reliability, split-half reliability, and Cronbach's coefficient α . Some important insights into reliability provided by attenuation theory are also offered.

A test measuring the behavioral aspects of the personality trait of persistence, The Persistent Effort Test, was constructed and psychometric properties assessed. The original version consisted of 12 items, each one a nonsense block of six letters. The task of 9 men and 9 women was to construct as many correct Swedish words as possible from letter combinations. The total time spent on this task and the number of correct words constituted the dependent variables. A Persistence Effort Quotient was calculated. The reliability calculated on the quotient for the 12-item version was acceptable (Cronbach alpha = .86) and an item analysis indicated that the test could be shortened by six items with increased reliability (Cronbach alpha =.87). A validity analysis also using the quotient performed with a second sample of subjects using classmates' ratings on two separate rating scales of specific aspects of persistence, yielded acceptable validity (Pearson r = .69 for the first scale and .71 for the second scale). This indicates that the shortened 6-item version is a reliable and valid test of persistence even though it is necessary with more studies to address the issues of predictive validity and norms for different groups of people.

Background Large‐scale transformation depends on effective engagement of diverse stakeholders. With the evolution of the role of the ‘patient partner’ in health‐care decision making, understanding the motivations of these individuals is essential to the success of engagement initiatives. This study reports on motivational factors associated with patient engagement in health care. Methods Patient co‐investigators and a researcher co‐designed and conducted this study. A survey was administered to patients and family members. Key informant interviews and previous research informed the development of the survey tool. The survey data were analysed using exploratory factor analysis to identify the underlying dimensions in the data. Cronbach's alpha was used to determine reliability. Results A total of 1449 individuals participated in the survey. Of these, 543 completed and 427 partially completed the survey (67% complete rate). The mean age of the respondents was 54 years. The majority of participants were female, well‐educated, retired, married and lived in an urban centre. Seven motivational factors explained 65% of the total variance. Analysis of internal consistency revealed acceptable reliability for all items. The seven motivations were as follows: Self‐fulfillment, Improving Healthcare, Compensation, Influence, Learning New Things, Conditional and Perks. Conclusion The results of this research describe a sample of patient and family members currently engaged with health systems. We identified seven motivational factors underlying their engagement. A deeper knowledge of volunteer motivations will not only create meaningful engagement opportunities for patients, but also enable health organizations to gain from the experience of these individuals, thereby enhancing quality and sustainability of patient engagement programmes.

Objective: Vaccine hesitancy is a complex problem. We previously demonstrated that motivational interviewing (MI) could be helpful to enhance parents’ motivation to vaccinate their child. The aim of this study is to develop a new, simple and robust evaluation tool that is suitable for evaluating MI learning of vaccination health professionals. Methods: We designed the Motivational Interviewing Skills in Immunization (MISI), a short written questionnaire to evaluate the MI knowledge and skills of participants in an immunization context. It covers three key areas: knowledge of MI, ability to apply MI-related skills, participant self-confidence in using MI. Questionnaire content and face validity were assessed by MI experts and internal consistency, reliability and effect size were analyzed using a multiple pretest-posttest design. Results: Psychometric measures showed good to excellent internal consistency of the questionnaire for all three areas (Cronbach’s and KR coefficient: 0.70 to 0.88). Test-retest reliability showed good measurement stability (ICC: 0.53). Good sensitivity to change was also obtained (Cohen’s d: 0.80 to 1.66). Conclusion: The MISI questionnaire is the first paper/pencil evaluation method to assess MI training specific to immunization. Psychometric measures showed high reliability. Practice implications: This questionnaire could provide a convenient and inexpensive method to evaluate knowledge and competencies following immunization-specific MI training.

Background The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees. Aims The aim of this study was to explore the psychometric properties and factor structure of the Arabic version of the WHODAS 2.0 among a population of Syrian refugees in a Jordanian refugee camp setting. The tool was used as part of a screening procedure for a randomised controlled trial assessing the effectiveness of a low-intensity psychological intervention. Method A representative sample of Syrian refugees (n = 650) were screened to assess levels of functional impairment and psychological distress. The screening results were used to explore the internal consistency and dimensionality of the WHODAS 2.0. We assessed level of convergence with the validated Kessler 10-item Psychological Distress Scale (K10), which assesses psychological distress. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore the construct validity and factor structure of the WHODAS 2.0. Results The mean baseline WHODAS 2.0 score was 20.5 (s.d. = 7.6). The internal consistency was acceptable (Cronbach's alpha 0.74), with all 12-items appearing to be related to the same construct. The WHODAS 2.0 was positively correlated with the K10 (r = 0.57, P < 0.001). The results of the EFA identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care. CFA results indicated good fit of the three-factor solution. Conclusions The results indicated that the WHODAS 2.0 has a three-factor solution and is an acceptable screening tool for use among Syrian refugees.

HIV stigmatizing attitudes are embedded in social context, making it important to develop culturally specific tools for accurate measurement. The goal of this study was to develop and evaluate the psychometric properties of the HIV Stigmatizing Attitudes Scale (HSAS) in Moshi, Tanzania. Items were adapted based on a scale developed by Visser et al. which was one of the first to measure HIV stigmatizing attitudes in the general population (i.e., people not living with HIV). Items were translated into Swahili and modified with iterative feedback. The HSAS was administered to participants (N = 1494) in an HIV stigma reduction intervention study at two antenatal care clinics in Moshi, Tanzania. The HSAS was found to have strong domain coherence and high reliability based on Cronbach’s alpha, Omega 6 coefficient values, and the composite reliability coefficient, and high validity based on content-oriented evidence, relations to other variables, and response process. Factor analysis revealed a two-factor structure (Moral Judgment and Interpersonal Distancing), consistent with the original Visser scale. The HSAS provides a robust way to measure HIV stigma in the Tanzanian context and can be culturally adapted to other settings. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03506-3.

Quality of life (QoL) is significantly impaired in patients with pulmonary fibrosis, however reliable tools to assess QoL issues specific for this group of patients are still missing. We thus aimed to develop a new questionnaire called "Quality of life in patients with idiopathic pulmonary fibrosis" (QPF) to measure QoL in patients with fibrotic idiopathic interstitial pneumonias (IIP). An item pool was created on the basis of a German expert group with support of patients suffering from pulmonary fibrosis. In a 1st step, this version of the questionnaire was completed by 52 patients with idiopathic pulmonary fibrosis (IPF) or non-specific interstitial pneumonia (NSIP). Following this, an item- and an exploratory factor analysis was carried out and a 2nd version created. In a multicenter validation study in a one-group pre-post design, the questionnaire was filled in by 200 patients with IIP (IPF = 190, iNSIP = 10) at 2 time points with an interval of 6 months. Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ). The mean age of the patients was 71.0 years (50-90 years), 82.5 % were male. Item analysis revealed that most of Cronbach alpha and selectivity values of QPF-scales could be considered as sufficient (e. g. QPF-scale "condition" [alpha = 0.827], "impairment" [alpha = 0.882]). At scale level, there were significant differences in terms of a deterioration or improvement in the QPF-condition and QPF-breathlessness scales and also in the SGRQ-activity scale. Analysis of construct validation of QPF and SGRQ showed moderate correlations between both questionnaires. A deterioration in health status from the patient's and doctor's perspective was seen in the scales "impairment", "shortness of breath" and "health status" of the QPF. The QPF was able to detect a change in the patient's mood ("condition" scale) in the course of treatment. This newly developed questionnaire maps the special needs of the patients well. The QPF is suitable for screening of quality of life as well as for supplementing the medical history and for monitoring the course of disease in fibrotic IIPs. Die Lebensqualität (QoL) ist bei Patienten mit Lungenfibrose erheblich vermindert. Messinstrumente der QoL für diese spezielle Patientengruppe sind bislang nicht in ausreichender Art und Weise vorhanden. Deshalb entwickelten wir einen spezifischen Fragebogen bei Patienten mit Idiopathischer Lungenfibrose (IPF) und Nicht-spezifischer Lungenfibrose (NSIP). Ein Fragenkatalog wurde von einer Expertengruppe der Deutschen Gesellschaft für Pneumologie für Patienten mit Idiopatischer Lungenfibrose und Nicht-spezifischer Lungenfibrose zusammengestellt. In einem ersten Schritt wurden diese Fragen an 52 Patienten dieser Krankheitsentitäten getestet und einer Item- und explorativen Faktor-Analyse unterzogen und anschließend so eine zweite Version des Fragenkatalogs erstellt und mit Patienten dieser Krankheitsentitäten diskutiert und evaluiert.In einer multizentrischen Studie an 200 Patienten (IPF 190, NSIP 10) wurde der Fragebogen in einem Pre-post-Design zweizeitig in einem Abstand von 6 Monaten getestet. Ein Vergleich mit dem eingeführten St. Georges Respiratory Questionaire (SGRQ) wurde zeitgleich durchgeführt. Das mittlere Alter der Patienten betrug 71,0 Jahre (50–90 Jahre). Die Itemanalyse erfolgte mittels Cronbachʼs alpha und Werte für Befindlichkeit (alpha = 0.827) sowie Beinträchtigungen (alpha = 0.882) wurden als statistisch ausreichend angesehen.Es wurden signifikante Änderungen in Bezug auf Verschlechterungen oder Verbesserungen in den Fragen zur „Befindlichkeit“ und „Atemnot“ und auch in der Skala „Aktivität“ gefunden.Der Vergleich mit dem SGRQ zeigte eine moderate Übereinstimmung beider Fragebögen. Eine Verschlechterung des Gesundheitsstatus aus der Patientenperspektive sowie aus der ärztlichen Perspektive wurde bei den Skalen „Beeinträchtigungen“, „Atemnot“ und „allgemeiner Gesundheitsstatus“ analysiert.Der Fragebogen zur Lebensqualität bei Patienten mit Idiopathischer Lungenfibrose und Nicht-spezifischer Lungenfibrose ist in der Lage, Änderungen der Lebensqualität im Verlauf der Erkrankung zu erkennen.

The lack of a reliable approach to assess quality of pain care hinders quality improvement initiatives. Rule-based natural language processing algorithms were used to extract pain care quality (PCQ) indicators from documents of Veterans Health Administration primary care providers for veterans diagnosed within the past year with musculoskeletal disorders with moderate-to-severe pain intensity across 2 time periods 2013 to 2014 (fiscal year [FY] 2013) and 2017 to 2018 (FY 2017). Patterns of documentation of PCQ indicators for 64,444 veterans and 124,408 unique visits (FY 2013) and 63,427 veterans and 146,507 visits (FY 2017) are described. The most commonly documented PCQ indicators in each cohort were presence of pain, etiology or source, and site of pain (greater than 90% of progress notes), while least commonly documented were sensation, what makes pain better or worse, and pain's impact on function (documented in fewer than 50%). A PCQ indicator score (maximum = 12) was calculated for each visit in FY 2013 (mean = 7.8, SD = 1.9) and FY 2017 (mean = 8.3, SD = 2.3) by adding one point for every indicator documented. Standardized Cronbach alpha for total PCQ scores was 0.74 in the most recent data (FY 2017). The mean PCQ indicator scores across patient characteristics and types of healthcare facilities were highly stable. Estimates of the frequency of documentation of PCQ indicators have face validity and encourage further evaluation of the reliability, validity, and utility of the measure. A reliable measure of PCQ fills an important scientific knowledge and practice gap.

Background Researchers developing personal health tools employ a range of approaches to involve prospective users in design and development. Objective The aim of this paper was to develop a validated measure of the human- or user-centeredness of design and development processes for personal health tools. Methods We conducted a psychometric analysis of data from a previous systematic review of the design and development processes of 348 personal health tools. Using a conceptual framework of user-centered design, our team of patients, caregivers, health professionals, tool developers, and researchers analyzed how specific practices in tool design and development might be combined and used as a measure. We prioritized variables according to their importance within the conceptual framework and validated the resultant measure using principal component analysis with Varimax rotation, classical item analysis, and confirmatory factor analysis. Results We retained 11 items in a 3-factor structure explaining 68% of the variance in the data. The Cronbach alpha was .72. Confirmatory factor analysis supported our hypothesis of a latent construct of user-centeredness. Items were whether or not: (1) patient, family, caregiver, or surrogate users were involved in the steps that help tool developers understand users or (2) develop a prototype, (3) asked their opinions, (4) observed using the tool or (5) involved in steps intended to evaluate the tool, (6) the process had 3 or more iterative cycles, (7) changes between cycles were explicitly reported, (8) health professionals were asked their opinion and (9) consulted before the first prototype was developed or (10) between initial and final prototypes, and (11) a panel of other experts was involved. Conclusions The User-Centered Design 11-item measure (UCD-11) may be used to quantitatively document the user/human-centeredness of design and development processes of patient-centered tools. By building an evidence base about such processes, we can help ensure that tools are adapted to people who will use them, rather than requiring people to adapt to tools.