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In multilevel analysis, Level-1 predictors that also explain variance at a higher level are called contextual predictors. In the multilevel manifest covariate model, the Level-2 component is modeled as the average of the Level-1 predictor scores within a cluster. In the multilevel latent covariate model, the predictor is decomposed into two latent variables at Level-1 and Level-2. Performance conditions of these modeling approaches for three-level models are largely unexplored. We investigate the two approaches' performance with respect to bias, coverage, and power in a three-level random intercept model. Results reveal differences in estimation quality and required sample sizes. We provide sampling recommendations for both approaches. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to translate the SAPE questionnaire (Scales of the Attitudes toward People with Epilepsy) questionnaire developed in Germany that assesses attitudes toward people with epilepsy (PWE) into Japanese and to examine its reliability and validity., Methods: We crafted the Japanese version of SAPE (SAPE-J) by drawing upon the original German version. On May 22nd and 23rd, 2023, we surveyed the general public registered with an online research survey service (Cross Marketing Group Inc., Tokyo, Japan) using an online questionnaire. Inclusion criteria were an age of ≥18 years, sufficient reading and speaking skills in Japanese, and the ability to comprehend the Japanese questionnaires. In addition to the translated SAPE-J, we asked about knowledge of epilepsy, personal experience with epilepsy, and gathered information about age, gender, employment status, education level, marital status, and household income in accordance with the validation of the German version of the SAPE., Results: 400 adults from the general public who had heard or read about epilepsy were asked to participate, granted informed consent, and completed the study questionnaire. The SAPE-J questionnaire has 6 scales: 1. Social Distance; 2. Stereotypes; 3. Concerns when encountering a person with epilepsy (PWE) and emotional reactions differentiated by 4.1 Fear, 4.2. Anger, and 4.3 Pity; with a total of 26 items. The reliability of these scales ranged between acceptable to high (Cronbach's alpha 0.74-0.92) and confirmatory factor analyses (CFA) confirmed the presumed six-factor structure of the SAPE (factorial validity). Multivariate generalized linear models (GLM) were used to investigate the construct validity and showed that, depending on subscale, different variables such as age, gender, education level, personal contact to PWE, and epilepsy specific knowledge were significant predictors of attitudes., Significance: The Japanese version of the SAPE proved reliable and valid for assessing attitudes toward PWE in the Japanese public. Increasing understanding about how to deal with and accept persons with epilepsy may help reduce negative attitudes and fears about the condition., Plain Language Summary: The study translated the German SAPE questionnaire, which measures attitudes toward people with epilepsy (PWE), into Japanese and tested its reliability and validity. The Japanese version (SAPE-J) was created and surveyed online among 400 adults in Japan. The SAPE-J has 6 scales covering social distance, stereotypes, and emotional reactions like fear, anger, and pity. Reliability was high (Cronbach's alpha 0.74-0.92), and factor analyses confirmed its structure. The study found age, gender, education, and personal contact with PWE influenced attitudes. The SAPE-J is reliable and valid for assessing attitudes toward PWE in Japan, potentially reducing negative views and fears about epilepsy., (© 2024 The Author(s). Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)