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Parenting predicts a wide range of developmental outcomes. Thus, improved assessment of parenting has critical implications for screening into services, identifying additional needs during interventions, and monitoring intervention progress. While there is rising interest in family research focusing on racial and ethnic diversity, there is an unmet need for valid, reliable, and equitable assessments of parenting in racially and ethnically diverse populations. The Multidimensional Assessment of Parenting Scale (MAPS) is a measure of parenting with strong psychometric properties. Despite its high utility, the MAPS is limited in that it was developed in a predominantly White sample (87%). Yet, minoritized racial and ethnic groups currently comprise 40% of the U.S. population. Therefore, this project extended the utility of the MAPS to racially and ethnically diverse families by (a) refining MAPS items using n = 100 cognitive interviews with parents from racially and ethnically diverse backgrounds to enhance racial and ethnic representation, (b) quantitatively establishing the Revised MAPS factor structure, and (c) assessing reliability, validity, and measurement invariance by race and ethnicity among N = 1,699 parents (25.2% non-Hispanic White, 22.2% non-Hispanic Asian, 23.8% non-Hispanic Black, and 25.6% Hispanic). Following revisions guided by cognitive interviews to improve and add items, the factor structure of the MAPS was replicated in the Revised MAPS. Further, measurement invariance, reliability, and validity of the Revised MAPS were partially supported. Using a multimethod approach, this revision increases the utility of the MAPS by extension to this historically underrepresented segment of the U.S. population. [ABSTRACT FROM AUTHOR]

• In China, there are no questionnaires that are able to accurately localize the exact site of pelvic pain and its extent. • Use the Chinese version of the ENDOPAIN-4D to provide an accurate and comprehensive assessment of pelvic pain in patients. • It can facilitate the identification and quantification of the pain experience of patients, as well as provide insight into the efficacy of pain treatment. The aim of this study was to cross-culturally translate a questionnaire about gynecological and pelvic pain symptoms (ENDOPAIN-4D) patient-reported outcome measurement (PROM) into Chinese and evaluate its reliability and validity. The questionnaire was translated according to Brislin's classic back-translation model. We conducted cultural debugging through cognitive interviews with Chinese-speaking women who had experienced pelvic pain (n = 24). Following the patient-reported outcome and a consensus-building process, the research team developed the Chinese version of the ENDOPAIN-4D. Structure, reliability, and structural validity were subsequently verified in a sample of patients with chronic pelvic pain (n = 552). The results of the cognitive discussion indicated that some interviewers exhibited ambiguity in their comprehension of 16 items. All items except Item 21, whose critical ratio was 0.847, indicating no statistically significant difference, were included in the questionnaire. However, this study retained Item 21 as an additional item because of the distinctive features of endometriosis and the original author's suggestion. The overall Cronbach's α coefficient for the questionnaire was 0.87. The Chinese version of the ENDOPAIN-4D demonstrated a moderate correlation with the corresponding standard validity tools (r = 0.57). The Chinese version of the ENDOPAIN-4D exhibited satisfactory reliability and validity, rendering it a productive instrument for assessing pelvic discomfort in patients. [ABSTRACT FROM AUTHOR]

This study aimed to validate an Indonesian version of the teaching questionnaire measuring the competencies of interprofessional education (IPE) facilitators and the characteristics of good clinical educators described by Kerry et al. (2021). A cross-cultural adaptation was developed and consisted of the following steps: forward–backward translation, content validity index measurement, cognitive interviews and a pilot study to measure content validity and reliability, exploratory factor analysis (EFA) to identify the new dimensionality, and confirmatory factor analysis (CFA) to confirm the measurement model. The pilot study results confirmed that the Indonesian version of the questionnaire assessing teaching competencies had good internal consistency (ω= .74 for the competencies of facilitators and ω= .88 for the characteristics of good clinical educators). The questionnaire was then administered to 209 clinical educators from five health professions. The EFA revealed two factors for the competencies (ω1= .86, ω2 = .70) and one factor for the characteristics of good IPE clinical educators (ω= .90). The CFA showed that the proposed model had a good fit with the observed data with (chi-square test: p > .05; CMIN/df, TLI, CFI, GFI, and AGFI were within the expected ranges; and RMSEA approximately .05) [ABSTRACT FROM AUTHOR]

Background: Globally, the number of individuals identifying as transgender and gender-diverse [TGD] has grown in the last decade. This study aimed to perform a Danish linguistic translation and cultural adaptation of the GENDER-Q, a new patient-reported outcome measure [PROM] designed to evaluate outcomes of gender-affirming care. Methods: The field test version of the GENDER-Q (959 items) was translated into Danish using guidelines from the International Society of Pharmacoeconomics and Outcomes Research and the World Health Organization to ensure accuracy, cultural relevance, and validity. This included two forward translations, a backward translation, an expert panel meeting, and two rounds of patient cognitive interviews. Results: The forward translations resulted in revisions of 142 items, which were then harmonized to form the backward translation version. A comparison of the back translation to the original questionnaire led to a total of 43 changes to items and response options. The revised version was reviewed in an expert panel meeting and minor changes were made with 28 patient participants using cognitive debriefing interviews. The translated version was proofread, resulting in the Danish translation of the GENDER-Q. Conclusions: The GENDER-Q was translated and culturally adapted for use in the Danish TGD adult population. The GENDER-Q has the potential to enhance the understanding and improvement of treatment and health-related quality-of-life outcomes for adults seeking gender-affirming care. Level of Evidence: Not gradable. [ABSTRACT FROM AUTHOR]

Objective: To explore the interventions for change in oral health behaviour that are effective in improving oral health behaviours in 8 to 18-year-old children during oral health promotion. Methods: The Joanna Briggs Institute framework of evidence synthesis for conducting a scoping review was implemented for the methodology. Included studies related to the objective, measured clinical or non-clinical outcomes, were in English, 2011–2023, and were experimental, observational or reviews. PUBMED, Science-Direct, Scopus and Sabinet were systematically searched with predetermined search strings. Studies were selected by appraisal of the title, abstract and full text. Data were extracted using a standardised template and the key questions were addressed via a qualitative analysis. Results: Searches yielded 407 articles from electronic databases. Of these, 290 articles were excluded, and 47 full-text studies were assessed for eligibility, with 23 studies and two systematic reviews finalised for inclusion. In addition, a PEARL search was conducted from the reference lists of other studies. Most studies (91.3%) focused on educating children directly; 8.7% indirectly influenced parents, guardians, and teachers. Interventions focused largely on traditional oral health education presented in diverse forms and via different platforms. Studies differentiated clinical outcomes (indices) from non-clinical outcomes (knowledge, behaviour). All included RCTs were of different quality regarding selection, performance and detection bias. But all studies indicated a low risk of bias in attrition and Reporting bias. Seventeen of the 25 studies (68%) were not based on any behaviour change theory. Conclusions: Oral health interventions based on motivational interviewing and the social cognitive theory have been shown to be to be effective. Interventions could also include practical tooth brushing activities, gamification, audio-visual components, as well as reinforcement and repetition in the longer term. Future oral health promotion in children should be designed to include these elements. There is a need for higher quality studies in this field, with future research being urged to provide detailed intervention descriptions and incorporate longer follow-up periods. [ABSTRACT FROM AUTHOR]

Introduction: Professional identity formation requires students' ability to reflect, which can be supported by constructive feedback from teachers. Feedback practice faces many challenges, including those related to sociocultural aspects. Feedback can be optimised by implementing a model suitable to the attributes of students, teachers, and the clinical environment. This study aimed to develop a suitable feedback model and test its effectiveness in promoting reflection. Methods: The model was designed based on the theoretical framework and identified feedback-related attributes in FMUI. Expert reviews and cognitive interviews were conducted before the model was tested. The model's effectiveness was tested using a quasi-experimental design involving 74 students in the Paediatric Module. Students were asked to reflect on their mini-CEX experience after receiving feedback from teachers, and the depth of reflection was compared between students in the intervention and control group. The depth of reflection was measured using Kember scoring, and bivariate analysis was conducted using SPSS 20.0. Results: The model consists of 5 steps including: Rapport building, Acknowledge students' strengths, Identify aspect(s) that need improvement, Share teachers' experiences, and Establish a plan to improve. Deep reflection was more frequently found in the intervention group. Mann-Whitney test showed that the difference between groups was statistically significant (Z=2.964, p=0.003), indicating that reflection in the intervention group was deeper than the control group. Conclusion: The feedback model formulated based on feedback-related attributes in FMUI was named the RAISE model. Upon testing, students receiving the model could reflect more deeply compared to those receiving the standard model. [ABSTRACT FROM AUTHOR]

Introduction: Recovery of lower urinary tract (LUT) and lower gastrointestinal tract (LGIT) is a high priority for people with lived experience following spinal cord injury (SCI). A universally accepted validated patient‐reported outcome (PRO) measure of the individual sensory and motor components of LGIT and LUT function, which allows tracking of recovery is lacking. To address this literature gap, the SCI Bladder and Bowel Control Questionnaire (SCI‐BBC‐Q) was developed. Methods: The SCI‐BBC‐Q was developed as a direct assessment of the micturition and defecation experiences of an individual with SCI with possible neurogenic LUT and LGIT dysfunction. The SCI‐BBC‐Q development process consisted of two phases, measure development and evaluation. Measure development was guided by a conceptual framework, review of existing instruments and literature, and an iterative process of item incorporation, review, feedback, and consensus revision. Evaluation included cognitive interviewing, and assessments of feasibility, reliability, and content validity. Results: The final 6‐item SCI‐BBC‐Q is a PRO, which assesses motor and sensory function related to micturition and defecation, requiring ~5 min to complete. Assessments of clarity of the instrument components with regard to understanding of what is being asked in the questionnaire, feasibility of administration, reliability, internal consistency, and agreement with proxy measures have demonstrated that the SCI‐BBC‐Q provides consistent, stable, and reproducible data. Significant correlations were found between SCI‐BBC‐Q scores and the anorectal motor and sensory components of the International Standards for the Neurological Classification of SCI. Conclusion: The SCI‐BBC‐Q is a practical and reliable method for baseline and ongoing evaluation of patients with neurogenic LUT and LGIT dysfunction, especially in the acute and subacute period when function is changing due to neurological plasticity. It is also appropriate for use in monitoring response to treatments related to neurological recovery. [ABSTRACT FROM AUTHOR]

Background: Activity-based therapy (ABT) has shown promise as a viable therapeutic intervention to promote neurorecovery in people with spinal cord injury/disease (SCI/D). Tools that track the details of ABT sessions may facilitate the collection of data needed to inform best practice guidelines for ABT. Objective: The purpose of this study was to evaluate the content validity of a prototype ABT tracking tool. Methods: Nine clinicians and five individuals with SCI/D from three community-based ABT clinics in Canada used the prototype tracking tool over three ABT sessions and then participated in individual cognitive debriefing interviews. The interview guide was developed based on recommendations by Brod and colleagues for establishing content validity (i.e., appropriate, comprehensive, comprehensibility). Interviews were transcribed verbatim and analysed using deductive followed by inductive content analysis. Results: Overall, the ABT tracking tool was found to have good content validity. Identified categories included: (1) Content validity of the ABT tracking tool. Participants found the tool to be comprehensive and appropriate for all levels and severities of injury. Recommendations to improve the tool included adding a comment section and additional parameters to each activity. (2) Facilitators of tool use, dissemination and implementation. Using the tool during rest breaks or after the session were suggested to maximize therapy time. Providing the tool as an app and offering education and training on use of the tool were highly recommended. Advertising through community clinics and social media may facilitate dissemination of the tool. (3) Barriers of tool use, dissemination and implementation. The paper format of the tool, added workload, learning curve and challenge to adopt a new documentation system were considered barriers to tool use. Conclusions: The prototype ABT tracking tool was validated for content using cognitive debriefing interviews. Recommendations will be used to improve the tool and assist in dissemination and implementation efforts. [ABSTRACT FROM AUTHOR]

Treatment of HIV has historically required taking daily oral antiretroviral therapy (ART). A recent alternative to daily oral ART is long-acting injectable ART with cabotegravir plus rilpivirine, administered monthly or every 2 months. The purpose of this qualitative study was to evaluate the concept relevance and interpretability of five previously developed questions: one treatment preference question and four questions designed to assess how the emotional burden associated with HIV treatment impacts treatment preferences. Thirty adults in the United States currently receiving HIV treatment were enrolled in a cross-sectional study involving one-on-one concept confirmation and cognitive debriefing interviews. Concept confirmation interviews included topics, questions, and probes designed to elicit information about the emotional burden of HIV and current perceptions of a participant's treatment regimen. Cognitive debriefing assessed the relevance and clarity of instructions, questions, response options, and recall periods. Transcripts were analyzed with MAXQDA. Mean age of participants was 49 years (range: 29–68), with 60% being male and 40% female. Racial demographics included Blacks (40%), Whites (40%), and other (20%). During concept confirmation, participants endorsed concepts relevant to HIV treatment preference: fear of disclosure of HIV status (47%), forgetting to take daily oral medication (40%), and current treatment regimen as a bothersome daily reminder of HIV status (40%). During cognitive debriefing, participants interpreted the instructions, question, response options, and recall periods as intended for the treatment preference question. Additionally, participants confirmed that the preference question's response options were appropriate and relevant to the experiences of people living with HIV. Participants also consistently interpreted the questions related to fear of disclosure of HIV status, anxiety associated with forgetting to take HIV medication, and HIV medication being an uncomfortable reminder of HIV status; however, participants provided variable responses to the question designed to assess treatment ease of use. These results support the concept relevance and interpretability of the single treatment preference question and three of the four emotional well-being questions among adults living with HIV. [ABSTRACT FROM AUTHOR]

Background: Measuring palliative care quality requires the application of evaluation methods to compare clinically meaningful groups of patients across different settings. Such protocols are currently lacking in Poland. The Australian Palliative Care Outcome Collaboration (PCOC) concept of Palliative phases precisely defines patients, enables episodes of care extraction for benchmarking and further assessment of service delivery. The present study is aimed at developing cross-cultural adaptation and psychometric validation for a Polish translation of Palliative phases. Methods: Forward and backward translation was performed to obtain a Polish draft version regarding definitions of the PCOC phases. The draft was then subjected to linguistic and graphical transformations in the process of cognitive interviewing. The acceptability of the Polish version was assessed based on staff perceptions of fit, ease of assignment and familiarity with the patient's and family's situation. Finally, cross-sectional analysis was conducted among 313 hospice and home-care palliative patients. The attending doctor and nurse independently evaluated the same patients using the Polish version of the PCOC phases to establish inter-rater reliability values. Then, to determine its construct validity, the PCOC indicators were referred to patients' prognosis, functioning level and PALCOM scale scores. Results: A Polish draft version of the PCOC phases was prepared. Seven of the 13 interviewees reported problems with comprehending this proposal. This prompted changes being made to linguistic and graphical aspects of the tool. The majority of respondents preferred the final graphical scheme of phases, prepared after round-two of interviews. Scheme application acceptability was confirmed in a practical trial. The respondents' overall conviction regarding degree of fit and assignment ease was high. Seventy percent of PCOC phase assignments was in agreement, and a moderate level or inter-rater reliability was obtained (kappa 0.573). The highest proportion of totally bed-bound patients with the shortest survival prognosis was observed for the terminal phase, while the highest complexity of palliative care needs was noted for the unstable one. Conclusions: The PCOC phases tool appears to be a valuable resource for specialists in palliative care settings to support audit measures. Practical training is recommended prior to its implementation in routine practice. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsThe current study tested the feasibility and acceptability of a novel, Instagram-based intervention designed to reduce alcohol use and promote mindfulness and protective behavioral strategies among young adults who binge drink.Participants were 50 college students with active Instagram accounts who reported regular binge drinking over the past 3 months. Participants followed the Instagram intervention page for forty-two consecutive days. Intervention content contained at least one of the following motivational interviewing or cognitive behavioral therapy techniques: affirmations, norm referencing, protective behavioral strategies, and mindfulness exercises. Participants were instructed to ‘like’ the study posts as they appeared on their newsfeed. Some participants were exposed to additional story posts (‘Stories’) during the intervention. Feasibility was measured using retention rates. Acceptability of intervention content was measured using 5-point Likert scales across six dimensions. Alcohol consumption, alcohol-related consequences, protective behavioral strategies, and mindfulness practices were assessed before and after the intervention.Over half of eligible participants (61.4%) completed the baseline survey. The vast majority of participants (98%) followed the study Instagram page at baseline. Of those who followed the study page, all stayed followed for the intervention duration. Most participants completed the mid-intervention (90%) and post-intervention (84%) surveys. Participants rated the intervention as moderately-to-very acceptable. Preliminary analyses indicate post-intervention decreases in past-month total drinks, drinking days, binge drinking episodes, and mindfulness practices.Data support the feasibility and acceptability of delivering this intervention to college students. Future directions include testing intervention efficacy, increasing engagement, and optimizing dose. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Methods Results Conclusion Heavy menstrual bleeding (HMB) affects up to 37% of adolescents. Given the paucity of available tools to assess health‐related quality of life (HRQoL) in adolescents with HMB, we developed the adolescent menstrual bleeding questionnaire (aMBQ), a valid and reliable measure of bleeding‐related quality of life. The aim of this study was cross‐cultural translation and adaptation of the English aMBQ into French to ensure accessibility for more Canadian adolescents who menstruate.A five‐step process was followed: (1) forward translation from English to Canadian French; (2) backward translation from French to English; (3) review of source and translated aMBQ to create a reconciled version; (4) cognitive debriefing to ensure linguistic and clinical equivalence and (5) review of cognitive debriefings to produce the final version of the French aMBQ. Results of cognitive debriefings were reviewed after every three participants; items were revised if presented as an issue by ≥2 participants. These changes were implemented and tested in cognitive debriefings until saturation was reached.Linguistic changes were made to nine (33%) of the questions and one (3.7%) answer options. Major changes were made to four of the 27 questions (15%), and minor changes were made to five of the 27 questions (19%).Professional translators, clinical experts and patient input through cognitive debriefing are pivotal to successful cross‐cultural translation. Results of cognitive debriefing interviews suggest the French aMBQ is easily understood and confirms its face validity. [ABSTRACT FROM AUTHOR]

Background: Cancer-treatment toxicity is common and symptoms must be identified quickly and accurately. Since symptom reporting during consultations is hampered by time constraints and patient/oncologist biases, patient-reported outcome-measure (PROM) questionnaires are useful. A strong shift to at-home cancer treatment has led to growing interest in remote symptom monitoring via electronic-PROMs (ePROMs). However, because PROMs are generally designed for medical-staff use, ePROMs must be adapted to patient comprehension/abilities. Here, to meet the oncological-healthcare needs of our region, we developed QuestOnco, a mobile-phone ePROM application. It is based on the symptom descriptions and severity grades of the PRO-CTCAE PROM and is designed for real-time on-demand reporting of 34 common or life-threatening cancer-treatment symptoms. This study describes the development of QuestOnco and its content validation relative to two comparators: PRO-CTCAE and the medical records. Methods: The cohort study was conducted in a tertiary-care hospital in 2021 and consisted of two stages. Stage I assessed the comprehensibility of QuestOnco for patients: 24 cancer-therapy patients were asked to try the application for 30 min and then underwent semi-structured cognitive interviews. Stage II tested QuestOnco-content validity against the comparators: patients starting a ~ 6-week cancer-therapy cycle were asked to use QuestOnco in an on-demand fashion and to complete weekly paper PRO-CTCAEs. Total QuestOnco, PRO-CTCAE, and medical-record symptom reports were compared in terms of symptom and symptom-severity frequencies. Severity concordance of each reported symptom was assessed by Kendall's tau-b rank-correlation coefficients. Results: In the second round of 12 Stage-I patients (total Stage-I enrollment rate = 100%), 0% reported comprehension difficulties. 110 patients were recruited for Stage II (enrollment rate = 23%). QuestOnco, PRO-CTCAE, and the medical records detected 85%, 100%, and 62% of the target symptoms at least once, respectively, and reported grade-1, -2, -3, and -4 toxicities with similar frequencies (56–67%, 23–32%, 6–10%, and 2–3%, respectively). Overall symptom-severity concordance was moderate with PRO-CTCAE (tau-b = + 0.21, range = -0.03 to + 0.38) and strong with the medical records (tau-b = + 0.33, range = -0.01 to + 0.61). Few remarkable discrepancies were observed. Conclusions: The QuestOnco application was well-understood by patients and demonstrated good content validity compared to its parent PROM and the medical records. Trial registration: ClinicalTrials.gov No. NCT04915274. [ABSTRACT FROM AUTHOR]

Background: Heart Failure (HF) is a global public health issue with high morbidity and mortality rates. Symptom management improves HF patients' quality of life and demonstrates a potential reduction in hospitalisation, particularly among individuals aged 65 and over. Early identification of patients at higher risk of hospitalisation is essential to guide patient-centred interventions. This study aimed to translate, cross-culturally adapt and evaluate the psychometric properties of the Heart Failure Symptom Tracker (HFaST) tool for the Portuguese population. Additionally, it aimed to test the hypothesis that higher scores of the HFaST are associated with increased hospitalisations due to HF decompensation. Methods: This cross-sectional study was conducted in two phases. The first phase involved the linguistic translation and cross-cultural adaptation of the HFaST tool into European Portuguese. Content validity was assessed by a panel of ten experts, who evaluated the clarity, relevance and equivalence of the pre-final version. A pre-test, using cognitive interviews with a sample of forty individuals was conducted to assess the item comprehensibility of the adapted tool. The second phase involved the psychometric validity in a sample of sixty HF patients. Participants completed a demographical and clinical assessment, the Portuguese version of the HFaST tool and the Portuguese version of the KCCQ-23 questionnaire. Additionally, the association between HFaST scores and HF hospitalisations were analysed. Results: Equivalence between versions showed substantial to perfect agreement, with Fleiss' k ranging from 0.678 to 1.000. Necessary adjustments were performed. Pre-test confirmed 95% comprehensibility. Internal consistency was acceptable, with a Cronbach's Alpha of 0.724, moderate to strong inter-item correlations, and significant correlations between the HFaST and the KCCQ-23 items were observed. Higher HFaST scores were significantly associated with increased hospitalisations, highlighting its role as a predictive tool for clinical risk stratification. Conclusions: The Portuguese version of the HFaST demonstrated to be a reliable and valid self-management tool for HF patients in Portugal. By predicting the likelihood of hospitalisation risk, the HFaST enables clinicians to implement early interventions, potentially reducing hospital admissions, improving patients' outcomes and contributing to a better quality of life. Clinical trial number: not applicable. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases contribute to a significant global burden of disease and are associated with modifiable risk factors such as physical inactivity, unhealthy diet, tobacco use and excessive alcohol consumption. These risk factors are closely related with lifestyles and eating patterns which are often culturally embedded and managed differently in various health care settings. Aim of the study: To assesses the applicability and feasibility of the KAPS (Knowledge, attitude, and practice) survey in generating data about knowledge, attitudes, and practices about healthy lifestyles within eastern Mediterranean settings and providing foundations for testing other models or development of a newer model in this area which captures and influence behavior changes towards healthy lifestyles. Methods: The KAP survey was tailored to capture the construct of healthy lifestyles (within the context of Qatar primary care settings) by reviewing existing surveys, adaptation to local context, expert consultation and feedback, pilot testing, feedback analysis, cognitive interviews and translation and validation. Results: The study reports that most participants found the content comprehensive, relevant, easy to understand but considered it lengthy. Analysis of grading of the 73 questionnaire items (complete questionnaire included as supplementary document) included by the panel of experts (n = 13) demonstrated that more than half of questions (52.1%) have a CVR value of 1. Thematic analysis of overall perceptions of the service users (n = 11) pertaining to the feasibility of the KAP survey identified three important themes which included i) clarity & readability of the questions ii) relevance of the instrument and iii) factors influencing service users' participation in survey. Conclusion: A culturally sensitive and region specific KAP tool specifically designed for healthy lifestyles can aid in health advocacy, monitoring modifiable risk factors, capturing rich epidemiological data to design preventive interventions, surveillance of high risks patients and strengthening the existing health information systems. Further research is needed to explore evidence-based methodologies to formulate an age-specific and shorter version of KAPs survey without compromising the validity of the tool within specific regional primary healthcare settings. [ABSTRACT FROM AUTHOR]

AbstractObjective: This study explored the relationship between concussion history and cognition/mood in former collegiate athletes in middle-to-later adulthood. Method: 407 former collegiate athletes aged 50+ (M = 61.4; 62.7% male) participated in the College Level Aging AThlete Study (CLEAATS) and completed the Cognitive Function Instrument (CFI), 40-item Telephone Interview for Cognitive Status (TICS-40), PHQ-8, GAD-7, and self-report questionnaires, including concussion history. Kruskal-Wallis tests assessed for differences among groups based on concussion history (0, 1–2, 3–4, 5+ concussions). Hierarchical multiple regressions including demographic factors as covariates examined relationships between concussion history, emotional symptoms, and subjective/objective cognition. Results: Participants with 5+ concussions reported significantly greater subjective cognitive concerns and depressive symptoms than other concussion groups, but no differences were found in objective cognition. Hierarchical regression revealed concussion history and emotional symptoms explained 29% and 15% of the variance in subjective and objective cognition, respectively. The number of concussions accounted for unique variance in subjective cognition but was not significantly associated when mood symptoms were added to the model. Neither diagnosed concussions nor emotional symptoms were associated with objective cognition. Conclusions: When accounting for concussion history, those with 5+ concussions reported greater subjective cognitive symptoms than those with 0–2 concussions, and greater depressive symptoms than those with 0 concussions. Concussion history was not significantly related to subjective cognition when compared to mood, and concussion history and mood symptoms were not associated with objective cognition. Results highlight the importance of considering mood symptoms when evaluating the relationship between concussion history and cognition in former athletes. [ABSTRACT FROM AUTHOR]

Despite the interest in mindfulness research, there is a dearth of studies about mindfulness assessment in India. Particularly, little is known about the extent to which the Five Facet Mindfulness Questionnaire (FFMQ) represents content relevant for experienced meditators in Indian cultural and spiritual contexts. A sequential explanatory mixed-method design was used for this study. Six experienced meditators completed the standard FFMQ along with corresponding perceived importance items, followed by retrospective cognitive interviews. In addition to quantitative analysis related to reliability, content validity, and agreement, qualitative data from cognitive interviews were used to explore the reasons for high and low ratings of some items. Most of the items on the FFMQ facets act with awareness (75%), and nonreact (85.7%) were rated by all participants as being important. For 87.5% of the items in the describe facet, there was moderate agreement among the meditators regarding their importance. Only one out of eight items in each of the observe and nonjudge facets were rated as important by all participants. The qualitative statements supported the quantitative results by throwing some light on the reasons for high and low agreement. The observe and nonjudge facets were found to have questionable content validity for use with meditators in India who are non-Buddhist and also do not practice in mindfulness-based interventions contexts. Future psychometric work in India will need to explore to what extent a shortened version, excluding the low validity items of the FFMQ, may be a suitable alternative. Public Significance Statement: This article examines the content validity of the multidimensional model (five-facet) of mindfulness as assessed by the Five Facet Mindfulness Questionnaire (FFMQ). The study focuses on experienced meditators from non-Buddhist and nonmindfulness-based intervention (non-MBI) contexts in India. The research holds broader implications due to the lack of consensus in the West regarding the FFMQ's applicability across diverse cultures, philosophies, religious, and meditative practices. Through evaluating a popular mindfulness assessment tool, this research endeavors to help confirm its reliability and validity for measuring mindfulness in meditators within non-MBI settings globally. [ABSTRACT FROM AUTHOR]

Effective interprofessional collaborative practice (IPCP) requires not only collaboration competencies but also strong professional and interprofessional identities, which require personal, professional, and interprofessional reflection. No instrument is available to assess students' reflection abilities covering their personal, professional and interprofessional identities. Therefore, this study developed a student self-reflection questionnaire in the interprofessional education (IPE) context. This study used an exploratory sequential mixed-methods approach, which began with a scoping review and focus groups (FGs) with 122 respondents, followed by an expert review, cognitive interviews (involving 14 fourth-year students), and a pilot study (involving 52 fourth-year students). The last step was validation using the exploratory factor analysis (EFA) method involving 630 seventhsemester students from medical and health professions. The scoping review and FGs suggested 92 items that were reviewed by eight experts and resulted in 64 relevant items. Fifty-three items were selected through cognitive interviews, and 50 items resulted from the pilot study. A total of 50 items were analysed with EFA and resulted in three factors: (a) self-awareness and the development of interprofessional collaborative teams (22 items, Cronbach alpha: 0.946); (b) openness/readiness and efforts for adaptation in interprofessional collaborative teams (14 items, Cronbach alpha: 0.938); and (c) reliability and interaction in interprofessional collaborative teams (14 items, Cronbach alpha:0.824). Each factor contained personal, professional, and interprofessional aspects. This study resulted in a valid and reliable instrument for assessing students' self-reflection abilities in IPE and exploring students' IPE self-reflection in the personal, professional and interprofessional aspects to support identity formation and interprofessional collaboration. [ABSTRACT FROM AUTHOR]

Assessing cognition with interview-based measures could be a low-resource alternative to traditional cognitive tests. We previously adapted the Cognitive Assessment Interview (CAI) into Amharic (CAI-A) for use with people with schizophrenia (PWS) in Ethiopia. This study examined the convergent and structural validity of the CAI-A in a group of 350 PWS sub-sampled from the Neuropsychiatric Genetics of African Populations – Psychosis (NeuroGAP-Psychosis) study, who fulfilled the inclusion criteria. Data were analyzed using confirmatory factor analysis (CFA), Spearman's correlation coefficient (ρ), multiple regression, and Item Response Theory (IRT). A one-factor solution best fits the items in the tool (factor loadings between 0.58 and 0.79), suggesting structural validity. The total score of the CAI-A moderately correlated with functioning (ρ = 0.44, p < 0.001) and symptom dimensions (ρ between 0.38 and 0.46, p < 0.001), suggesting convergent validity. Multiple regression showed that age (β = −0.06, 95 % CI (−0.12, 0.00), p = 0.044), the duration of illness (β = 0.08, 95 % CI (0.01, 0.14), p = 0.033), and medication side effects (β = 0.35, 95 % CI (0.21, 0.50), p < 0.001) were positively and significantly associated with the CAI-A total score. The IRT analysis suggested that the tool best functions among participants with moderate to severe impairment (difficulty coefficient between 0.05 and 2.73). We found that the CAI-A is a valid tool for use in Ethiopia. The moderate correlation with symptom and functional measures suggested that self-reported cognitive symptoms parallel other symptom dimensions and functional disability. The CAI-A can be used in clinical practice and research activities in PWS in Ethiopia when subjective assessment of cognition is desired. • The CAI-A is the first adapted interview-based cognitive measure in low-income settings. • The CFA analysis confirmand that the CAI-A has a one-factor structure. • The CAI-A is found to have good convergent validity with PANSS and WHODAS-2.0. • The IRT analysis showed that the CAI-A gives much information in participants with moderate to severe impairment. [ABSTRACT FROM AUTHOR]

Background Multimorbidity is a growing problem. The number and complexity of (non-)pharmaceutical treatments create a great burden for patients. Treatment burden refers to the perception of the weight of these treatments, and is associated with multimorbidity. Measurement of treatment burden is of great value for optimizing treatment and health-related outcomes. Objective We aim to translate and validate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for use in the Dutch population with multimorbidity and explore the level of treatment burden. Methods Translating the MTBQ into Dutch included forward–backward translation, piloting, and cognitive interviewing (n = 8). Psychometric properties of the questionnaire were assessed in a cross-sectional study of patients with multimorbidity recruited from a panel in the Netherlands (n = 959). We examined item properties, dimensionality, internal consistency reliability, and construct validity. The level of treatment burden in the population was assessed. Results The mean age among 959 participants with multimorbidity was 69.9 (17–96) years. Median global NL-MTBQ score was 3.85 (interquartile range 0–9.62), representing low treatment burden. Significant floor effects were found for all 13 items of the instrument. Factor analysis supported a single-factor structure. The NL-MTBQ had high internal consistency (α = 0.845), and provided good evidence on the construct validity of the scale. Conclusion The Dutch version of the 13-item MTBQ is a single-structured, valid, and compact patient-reported outcome measure to assess treatment burden in primary care patients with multimorbidity. It could identify patients experiencing high treatment burden, with great potential to enhance shared decision-making and offer additional support. [ABSTRACT FROM AUTHOR]

Introduction Nicotine withdrawal is a well-established construct that prompts continued nicotine product use and contributes to failed cessation efforts. Despite ongoing public health concerns about nicotine e-cigarette use in adolescents and young adults (AYAs), no psychometrically sound measure of nicotine e-cigarette withdrawal exists for this population. Aims and Methods A mixed methods approach comprising a literature review to identify existing nicotine withdrawal items; subject matter expert feedback on existing items and novel item generation; cognitive interviews assessing the measure's instructions, items, and response options; and a large quantitative validation survey (N  = 997) was employed to develop the novel retrospective measure of nicotine e-cigarette withdrawal. Results A 25-item solution comprising four subscales—negative affect, negative physical symptoms, craving, and appetite/food—and an overall withdrawal score was supported. Internal reliability was excellent (mean alpha = 0.91), and scalar measurement invariance was reached for all subgroups tested (eg, sex, age, exclusive e-cigarette use vs. dual tobacco product use, and daily vs. non-daily nicotine vaping). Overall withdrawal and its subscales evidenced concurrent validity with time to first vape in the morning, e-cigarette dependence, and previous vaping cessation attempts, although not each subscale was associated with each outcome. Importantly, cross-sectional incremental validity analyses indicated that retrospective withdrawal accounted for variance in each outcome above and beyond e-cigarette dependence. Conclusions The novel retrospective AYA Nicotine E-cigarette Withdrawal Scale (AYA NEWS) evidenced strong psychometric properties for use in this population. Future research can determine whether the AYA NEWS can be used to assess acute e-cigarette nicotine withdrawal. Implications While e-cigarette use remains the most prevalent form of nicotine product use among AYAs, there are limited options for psychometrically sound measures of e-cigarette-related constructs in this population. Withdrawal from nicotine is associated with failed cessation attempts and continued use of nicotine-containing products, making it a critical construct within tobacco-related research. This study outlines the development and preliminary psychometric evaluation of a novel, retrospective measure of nicotine e-cigarette withdrawal. Study findings support using the Adolescent and Young Adult Nicotine E-cigarette Withdrawal Scale (NEWS) to assess retrospective withdrawal from nicotine e-cigarettes in young people. [ABSTRACT FROM AUTHOR]

Purpose: For patients with celiac disease (CeD), the only current management option is adherence to a strict gluten-free diet (GFD); however, many patients on a GFD continue to experience symptoms with a significant impact on quality of life. Potential new treatments for CeD are under development and a validated patient-reported outcome measure is required to evaluate their utility in clinical trials. The purpose of this article is to provide a history of the development of the Celiac Disease Symptom Diary (CDSD) 2.1© for use in clinical trials. Methods: Qualitative and quantitative studies were conducted from 2010 to 2021, including concept elicitation and cognitive debriefing interviews with adult and adolescent participants with CeD (N = 93) diagnosed via biopsy and/or serology and input from eight interviews with CeD clinical experts. During these studies, different iterations of the CDSD were presented to the US Food and Drug Administration and the European Medicines Agency, and modifications were made in line with their feedback. Results: These studies ultimately led to the development of CDSD 2.1©, a daily diary which focuses on key symptoms of CeD (abdominal pain, bloating, diarrhea, nausea and tiredness). This patient-reported outcome measure was readily understood by adult and adolescent participants with CeD and content validity was demonstrated in both populations. Conclusion: CDSD 2.1© is a content-valid patient-reported outcome measure developed in accordance with best practices and regulatory guidance. A thorough exploration of the psychometric properties of CDSD 2.1© for both adult and adolescent participants with CeD is ongoing to support utilization in clinical trials. [ABSTRACT FROM AUTHOR]

The article discusses the shift to virtual pediatric pulmonary fellowship interviews since 2020, with concerns raised about the limitations of virtual interactions compared to in-person interviews. A study conducted by the Pediatric Pulmonary Training Directors Association (PEPTDA) explored a hybrid model that allows applicants to choose between in-person and virtual interviews. Results showed that both trainees and program directors favored a hybrid model, with considerations for factors influencing interview format preferences. The article highlights the ongoing discussions and efforts to address equity, bias, and effectiveness in the fellowship interview process, ultimately endorsing the hybrid model for future recruitment cycles. [Extracted from the article]

This paper investigates the disparities in adopting cognitive interviewing techniques between local and federal law enforcement agencies in the USA. Despite the established benefits of these techniques for enhancing witness recall accuracy and reducing false confessions, adoption at the local level lags significantly behind federal practices. Through a qualitative synthesis of existing literature and public reports, this study identifies the main barriers to adoption, which include resource limitations, training deficiencies, and cultural resistance within local agencies. The analysis suggests that comprehensive training programs, legislative mandates, and cultural shifts within law enforcement are critical to overcoming these barriers. Recommendations for promoting broader adoption include enhancing resource allocation for training, implementing national standards for investigative practices, and leveraging successful models from federal agencies. The paper underscores the need for a unified approach to improve investigative outcomes and justice across all levels of law enforcement. [ABSTRACT FROM AUTHOR]

Abstract Background Sexual and reproductive empowerment (SRE) is an important determinant of women’s and girls’ health yet measuring it is complex due to cultural and domain-specific variations. This study describes the process of adapting an SRE scale consisting of four domains (self-efficacy; future orientation; social support; and safety) and testing its psychometric properties among Arabic speaking adolescent girls in Lebanon. Methods An SRE scale developed in a Western context was adapted in four steps: (1) reviewing the scale and selecting culturally appropriate domains for translation to standard Arabic; (2) conducting cognitive interviews with 30 11-17-year-old adolescent girls in Lebanon; (3) administering the scale to 339 refugee adolescent girls who participated in an early marriage intervention; and (4) conducting confirmatory factor analysis (CFA) on the data to assess the scale’s psychometric properties. Results The original model for the 13-item, four-domain adapted scale demonstrated poor fit in CFA. After iteratively removing two items, scale properties were improved, albeit were not optimal. The validity and reliability results for the self-efficacy domain were acceptable. Cognitive interview data revealed that Arab adolescent girls understood self-efficacy in relational terms, recognizing that autonomous decision-making is not necessarily favored but is influenced by parents and family. Conclusions This study presents an effort to customize an SRE scale for use in studies on the health of adolescent girls in an Arab cultural context. Findings from cognitive interviews highlight the importance of taking into consideration relationality in adolescent sexual and reproductive decision-making. The self-efficacy domain in the adapted scale demonstrates acceptable psychometric properties and is recommended for use in health studies to capture SRE.

Simple and easy to use kits for SARS-Cov-2 self-testing during epidemic waves are needed to optimize diagnostic capacity in low- and middle-income countries. SARS-Cov-2 self-testing kits are available, but application of these novel diagnostic technologies is less understood in low and middle-income contexts. We investigated the ability to understand and perform instructions for use (IFUs) for STANDARD Q COVID-19 Ag Test (SD Biosensor) and Panbio COVID-19 Ag Rapid Test Device (Abbott Rapid Diagnostics) for anterior nares (AN) nasal self-sampling and self-testing for COVID-19 in rural and urban Malawi. Qualitative research methods using iterative cognitive interview approach was used to investigate the ability of healthcare providers and lay community members to understand and perform a COVID-19 self-sample or self-test using the manufacturer's instructions for use. A total of 120 iterative cognitive interviews were done with healthcare providers and lay community members for self-sampling (N = 76) and self-testing (N = 44). Cognitive interviews began with the manufacturers version of instructions for use followed by subsequent iterations to refine problematic instructions. Structured interview guide and an observation checklist were used to collect data which was then coded inductively. A framework analysis approach was used to synthesize qualitative data. Study participants were generally proficient at performing a COVID-19 self-sampling and self-testing using the two COVID-19 Rapid Testing Devices. Several of design and content problems within manufacturer's instructions for use made their contextual application sub-optimal. Overall, participants experienced difficulties because of the omission of essential elements within instructions, use of short texts/phrase or lack of a word instruction, the lack of labels on where to open the package; the inconsistencies between word instructions within the instructions for use and the physical contents of the test package; the inability to digest and apply certain technical concepts and the lack of clarity in the phrasing of some text instructions. As expected, healthcare providers experienced fewer problems compared to lay community members. The refinement of these instructions greatly improved comprehension among lay community members. Self-sampling and self-testing for COVID-19 can be performed lay community members with fidelity in a scaled context if the manufacturer's instructions for use have been refined and tailored to the context. In the current study, we have used the study findings to map the optimisation process of manufacturer's IFU'S for self-testing RDT's intended for low literacy contexts including Malawi. [ABSTRACT FROM AUTHOR]

Background: Shared decision making in healthcare is a fundamental right for patients. Healthcare professionals' perception of their own abilities to enable shared decision making is crucial for implementing shared decision making within service. IcanSDM (I can shared decision making) is a brief measure to investigate healthcare professionals' perception of shared decision making approaches to their practices. It was developed in Canada with French and English versions, and recently translated into German. This study aims to adapt the IcanSDM measure for Danish-speaking healthcare professionals, and evaluate its psychometric properties. Methods: Cultural adaptation and translation based on Beaton et al.'s approach was applied. A forward translation by ten people and a backward translation by two people were performed. To assess comprehensibility, cognitive interviews were conducted with 24 healthcare professionals. Eighty healthcare professionals who were trained in shared decision making for either one hour (n = 65) or one day (n = 15) participated in the psychometric evaluation. The evaluation concerned acceptance, item characteristics, skewness, item difficulties, corrected item-total correlations, inter-item correlations, factorial structure, internal consistency, and responsiveness. Results: The forward and backward translation revealed few discrepancies, and participants understood the items well. The psychometric evaluation showed a high completion rate and acceptable item difficulties and discrimination values. Both the factor analysis and the internal consistency showed a 2-factor structure: 1) healthcare professionals' capacity to implement shared decision making; and 2) healthcare professionals' capacity to practise shared decision making. The IcanSDM_Danish obtained a Cronbach's alpha coefficient of 0.74. The evaluation of responsiveness showed improvement, but was not statistically significant. Conclusion: The IcanSDM_Danish has good cross-cultural validity and internal consistency, and a 2-factor structure. The IcanSDM_Danish is capable of providing reliable and valid measurement when evaluating constructed knowledge about shared decision making, and may be able to support the implementation of shared decision making training and evaluation of its impact. [ABSTRACT FROM AUTHOR]

According to the World Health Organization (WHO, 2013), violence inflicted by an intimate partner is one of the most common forms of violence against women, and constitutes a social problem of which the population must be made aware, for its prevention and detection (Government of Spain, 2004). Despite this, there are not many studies that focus on how language acts as a vehicle of violence in the context of high-proximity relationships, in general, and within the couple, in particular. The objective of this work is to identify, in the statements of a victim, signs of gender-based violence exerted by her partner during the relationship, since language functions as a reflection of the social behaviours of individuals (Fuentes-Rodríguez & Alcaide-Lara, 2008: 9-10). The initial hypothesis is that the victim’s testimony, obtained through an Enhanced Cognitive Interview (Vilariño Vasquez et al., 2012), will include traces of having suffered psychological violence –such as those described by Galán Jiménez et al. (2019)–, as well as techniques of discourtesy, and remarks that damage the victim’s face and show control and abuse of power by the aggressor. For the qualitative analysis of the informant’s statements, the 23 criteria for the evaluation of verbal credibility in victims of gender violence (Juárez López et al., 2007) were followed. In the victim’s testimony, different manifestations of the violence transmitted verbally by her partner are observed, sometimes through explicit messages, and other times with more implicit utterances. [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusions Affective disturbances and cognitive impairment are common sequelae of intracerebral hemorrhage (ICH), yet predictive models for these outcomes remain limited, especially for spontaneous supratentorial ICH with small hematomas (<30 mL). The aim of this study was to investigate predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage.We retrospectively analyzed 1692 patients with spontaneous supratentorial ICH between January 2018 and December 2020 at the First Affiliated Hospital of Harbin Medical University. Of these, 1563 patients completed a median follow‐up of 3.5 years. Cognitive function was evaluated using the modified Telephone Interview for Cognitive Status, and affective disturbances using the Hamilton Depression Scale and the Hamilton Anxiety Scale. Restricted cubic spline analyses were employed to examine the relationships between predictors and outcomes.In this cohort, 58.5% had cognitive impairment, 52.8% reported depressive symptoms, and 39.4% exhibited anxiety symptoms. Logistic regression models using Boruta's algorithm demonstrated strong predictive capacity, with areas under the curve of 0.82 for cognitive impairment, 0.78 for depressive symptoms, and 0.73 for anxiety symptoms. Hematoma volume was significantly linked to depressive symptoms (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.38–1.76) and inversely to cognitive impairment (OR 0.67, 95% CI 0.59–0.77). Uric acid levels displayed a nonlinear relationship with cognitive impairment (OR 0.70, 95% CI 0.61–0.81). Hospitalization days significantly raised the risk of both depressive (OR 1.16, 95% CI 1.03–1.30) and anxiety symptoms (OR 1.17, 95% CI 1.04–1.31).The logistic regression model, enhanced by Boruta's algorithm, provides a valuable tool for predicting affective disturbances and cognitive impairment after ICH. It facilitates early identification and improves risk assessment for these neuropsychiatric outcomes in patients with small hematomas. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The aim of this study was to develop an outcome measure for caregivers of children with food allergy.A community‐informed measure development process was utilised to generate a novel parent‐reported outcome tool for caregivers of children with food allergy. We conducted focus groups with parents and caregivers of food‐allergic (n = 18) children, following which a team of coders identified themes and generated an initial set of candidate items. These items were reviewed by content‐area experts (n = 10) using content validity indices. We then conducted a series of cognitive interviews with parents of children with food allergy (n = 12) validating the instrument draft.We describe the results of these development steps as well as future steps to produce the final, validated form of the measure. The resultant 91‐item measure is intended for parents of children ages two to 12 years.This measure fills a unique need in the field by leveraging key stakeholders' perspectives to develop and subsequently validate a novel parent‐reported measure of parent and family food allergy impacts of children ages two to 12 years old. [ABSTRACT FROM AUTHOR]

Background: While Type 2 Diabetes Mellitus (T2DM) prevalence is increasing among younger individuals, few studies have examined how age at T2DM diagnosis relates to dementia risk in diabetic populations. We aimed to investigate the association between age at T2DM diagnosis and subsequent dementia risk, and to determine whether obesity moderates this relationship. Methods: We conducted a prospective cohort study using data from the Health and Retirement Study (2002–2016) matched with its 2003 Diabetes Mail-Out Survey. The study included 1,213 dementia-free adults aged ≥50 with diagnosed T2DM. Primary exposures were age at T2DM diagnosis (categorized as <50, 50–59, 60–69, and ≥70 years) and obesity status (BMI ≥30 kg/m2). The outcome was incident dementia, assessed using the Telephone Interview for Cognitive Status. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sociodemographic factors, health behaviors, health status, and diabetes medication use. Results: Over a median follow-up of 10 (interquartile range, 6–14) years, 216 (17.8%) participants developed dementia. Compared to participants diagnosed with T2DM at age ≥70 years, those diagnosed at younger ages had increased dementia risk: HR 1.70 (95% CI, 1.03–2.80) for 60–69 years, 1.72 (95% CI, 1.06–2.79) for 50–59 years, and 1.90 (95% CI, 1.14–3.18) for <50 years. Obesity significantly moderated this relationship, with obese individuals diagnosed with T2DM before age 50 showing the highest dementia risk (HR 3.05; 95% CI 1.23–7.56) compared to non-obese individuals diagnosed at ≥50 years. Conclusions: Younger age at diagnosis of T2DM was significantly associated with a higher risk of dementia, particularly among individuals with obesity. Interventions specifically targeting obesity may be more effective in preventing dementia for adults with a younger onset of T2DM. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to investigate the construct validity of a survey focussing on the use of technology and teaching techniques to promote religious moderation, employing exploratory factor analysis (EFA). A total of 116 educators, who teach character development courses, were recruited to participate in the study. The developed instrument is based on the Technology Pedagogical Content Knowledge (TPACK) framework and has been validated through expert and cognitive interviews with religious education lecturers. The study’s results demonstrate that participants were able to discern conceptual distinctions between TPACK domains. Four factors were identified: TPACK, Pedagogical Content Knowledge (PCK), Technological Knowledge (TK), and Pedagogical Knowledge (PK). TPACK encompasses both Technological Pedagogical Knowledge (TPK) and Technological Content Knowledge (TCK), while PCK includes Content Knowledge (CK). Additionally, Rasch statistical analysis was employed to determine that the instrument measures a single latent variable, namely religiously moderated TPACK, with high reliability based on the fit of the scale to the Rasch model. The statistical data from the EFA and Rasch analyses suggest that this survey can serve as a valuable tool for researchers and educators interested in exploring TPACK within the context of religious moderation. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aims to translate and culturally adapt the Toronto Extremity Salvage Score (TESS) for Latin American Spanish–speaking patients, enhancing the tool's accessibility for evaluating postsurgical functional outcomes in sarcoma patients across Latin America. Methods: The TESS questionnaires for lower extremity (LE) and upper extremity (UE) were translated and adapted following international guidelines. The process included forward and backward translation, expert committee review, and pretesting with cognitive interviewing. Patients treated for bone or soft tissue tumors in LE or UE were recruited to complete the adapted questionnaires. Test–retest reliability was evaluated by having participants complete the questionnaire again 2 weeks after the initial assessment. Results: A total of 89 participants completed the questionnaires. The study found high internal consistency, with Cronbach's alpha values reaching 0.9437 for LE and 0.9402 for UE. An agreement rate of 98.4% for the global score of TESS‐LE (95% confidence interval [CI]: 0.909–1.059) and 93.9% for TESS‐UE (95% CI: 0.882–0.995) was observed, demonstrating strong test–retest reliability. Conclusions: The Latin American Spanish version of TESS for both lower and upper extremities is a reliable and culturally appropriate tool for assessing physical function in limb sarcoma patients. Further validation across diverse Latin American populations is encouraged to strengthen its broad applicability. [ABSTRACT FROM AUTHOR]

Current feedback models advocate learner autonomy in seeking, processing, and responding to feedback so that medical students can become feedback-literate. Feedback literacy improves learners' motivation, engagement, and satisfaction, which in turn enhance their competencies. However, there is a lack of an objective method of measuring medical student feedback literacy in the empirical literature. Such an instrument is required to determine the level of feedback literacy amongst medical students and whether they would benefit from an intervention. Therefore, this research protocol addresses the methodology aimed at the development of a comprehensive instrument for medical student feedback literacy, which is divided into three phases, beginning with a systematic review. Available instruments in health profession education will be examined to create an interview protocol to define medical students' feedback literacy from the perspectives of medical students, educators, and patients. A thematic analysis will form the basis for item generation, which will subsequently undergo expert validation and cognitive interviews to establish content validity. Next, we will conduct a national survey to gather evidence of construct validity, internal consistency, hypothesis testing, and test-retest reliability. In the final phase, we will distribute the instrument to other countries in an international survey to assess its cross-cultural validity. This protocol will help develop an instrument that can assist educators in assessing student feedback literacy and evaluating their behavior in terms of managing feedback. Ultimately, educators can identify strengths, and improve communication with students, as well as feedback literacy and the feedback process. In conclusion, this study protocol outlined a systematic, evidence-based methodology to develop a medical student feedback literacy instrument. This study protocol will not only apply to medical and local cultural contexts, but it has the potential for application in other educational disciplines and cross-cultural studies. [ABSTRACT FROM AUTHOR]

Introduction: Currently, no quality‐of‐life instrument exists that captures the full experience of the mental health outlook (MHO), a coreHEM core outcome, in people with haemophilia, including the potential transformational experience of receiving gene therapy. Aim: To describe the methods used to develop a content validated patient‐reported outcome measure (PROM) that measures MHO for people with haemophilia. Methods: A conceptual framework, developed from a literature/evidence review, was used to create an interview guide and draft a questionnaire. Males aged 15 or older with severe/moderate haemophilia were eligible to participate in concept elicitation or cognitive debriefing interviews. The conceptual framework was refined based on a thematic analysis of concept elicitation interviews and PROM items were developed from the conceptual framework. Cognitive debriefing sessions that prioritised relevance and understanding of the PROM were held in two rounds; items were updated iteratively. Results: A conceptual framework with five domains (stigma, anxiety, depression, life interference and identity) was constructed from over 300 identified MHO concepts. Fifty‐three participants took part in interviews. After 32 concept elicitation interviews, the framework was updated by including eight new sub‐concepts and eliminating two. Updates to the questionnaire included items added or removed and improved wording. The final coreHEM MHO PROM has 26 questions in two sections (general mental health associated with haemophilia, and a gene therapy section). Conclusions: The instrument is content‐validated and can be used as an exploratory outcome. MHO scores can be measured and compared to give more insight into patient quality of life. [ABSTRACT FROM AUTHOR]

Rumination (self-referential and repetitive thinking), attentional biases (AB), and impaired cognitive control are theorized as being integral factors in depression and anxiety. Yet, research examining the relationship between rumination, mood, and AB for populations with reduced cognitive control, e.g., people living with dementia (PwD), is lacking. To explore whether literature-based relationships are demonstrated in dementia, PwD (n = 64) and healthy controls (HC) (n = 75) completed an online self-report survey measuring rumination and mood (twice), and a telephone cognitive status interview (once). Rumination was measured as an emotion-regulation style, thinking style, and response to depression. We examined the test-retest reliability of PwD's (n = 50) ruminative-scale responses, ruminative-scale internal consistency, and correlations between rumination, age, cognitive ability, and mood scores. Also, nine participants (PwD = 6, HC = 3) completed an AB measure via eye-tracking. Participants fixated on a cross, naturally viewed pairs of facial images conveying sad, angry, happy, and neutral emotions, and then fixated on a dot. Exploratory analyses of emotional-face dwell-times versus rumination and mood scores were conducted. Except for the HC group's reflective response to depression measure, rumination measures were reliable, and correlation strengths between rumination and mood scores (.29 to.79) were in line with literature for both groups. For the AB measure subgroup, ruminative thinking style scores and angry-face metrics were negatively correlated. The results of this study show that literature-based relationships between rumination, depression, and anxiety are demonstrated in dementia, but the relationship between rumination and AB requires further investigation. [ABSTRACT FROM AUTHOR]

Background Loneliness is a biopsychosocial stressor linked to poor health outcomes including dementia. Few studies have focused on this association among men and even fewer have examined racial disparities in loneliness and cognitive functioning among this group. The purpose of this study was to examine racial differences in the association between loneliness and cognitive functioning among men in the 2016 wave of the Health and Retirement Study. Methods This cross-sectional study included Black and White men who completed the core questionnaire and the Leave Behind Questionnaire (n  = 2 227). Any cognitive impairment was the primary outcome and was measured by a dichotomous variable derived from a modified version of the Telephone Interview for Cognitive Status. Loneliness was the primary independent variable and was derived from the 3-item University of California, Los Angeles (UCLA) Loneliness Scale. Modified Poisson regression models with robust standard errors were estimated to generate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs). Results Black men comprised 18.4% of the study sample; however, the proportion of this group with scores indicating cognitive impairment (35.9%) doubled the corresponding percentage of white men (17.6%). Findings from race-stratified modified Poisson regression models indicated that loneliness was associated with a higher prevalence of any cognitive impairment for White men (PR = 1.24, CI: 1.05–1.47), but not for Black men (PR = 0.92, CI: 0.73–1.16). Conclusions Our results underscore the complexity of race when investigating the association between loneliness and cognitive impairment among older men. Additional studies are needed to further examine how loneliness may have racially distinct implications for cognitive outcomes among the population. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment in Huntington's disease (HD) is a key driver of disability that can have deleterious impacts on everyday functioning. Currently available patient-reported outcome measures may not adequately capture the impact of HD-related cognitive impairment on daily life, particularly higher-order executive functioning (i.e., processing information, decision making, multi-tasking, planning, etc.). Objective: To address the unmet need to better quantify the functional sequelae of HD-related cognitive impairment by developing the Huntington's Disease Everyday Functioning (Hi-DEF) scale. Methods: Qualitative interviews were conducted in two adult cohorts (25–65 years) with early stages of HD (i.e., huntingtin [mHTT] gene carriers with self-reported cognitive complaints but could still function independently). Cohort 1 included 10 dyads of participants with HD and their care partners, who completed concept elicitation interviews to identify cognitive challenges impacting everyday tasks, which was used to design a draft item-set. Cohort 2, which included 15 additional participants with HD, cognitively debriefed this item-set. Results: In Cohort 1, issues with executive functioning were reported 32 times by participants with HD and 22 times by care partners, and challenges with functioning were reported 46 times by participants with HD and 20 times by care partners. Based on these reports, the Hi-DEF scale was developed and cognitive debriefing interviews evaluated its content validity, relevance, clarity, interpretation, and acceptability. Psychometric validation of the Hi-DEF scale is reported elsewhere. Conclusions: These interviews revealed the impact of HD-related cognitive impairment on everyday functioning and supported the content validity, relevance, clarity, interpretation, and acceptability of the Hi-DEF scale. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: With young people and teenage children, India has recently become a hotspot for a multiple-fold increase in internet users. The objective of our study was planned to create a psychometric scale specially targeting school and college students with appropriate validation and cut-off derivation, as these groups are collective and also holds a major burden of internet addiction and also a potential risk group for developing internet addiction disorder. Methods: This was a cross-sectional study with a sample size of 1530 done among college students and school students studying between IX to XII standard with habit of internet usage. A google form survey questionnaire was used and study was conducted for a period of 2 months. Domain identified was Internet addiction which was followed by Item generation done by both Inductive, Deductive method and Content validity obtained from the field experts. After Cognitive Interviewing, survey was conducted by circulating the constructed scale in the Google form questionnaire to the eligible participants. After collecting the required data from the participants, the scale was subjected to Item Reduction Analysis. Results: The mean age of the study participants was 18.96 ±3.68 years and most of them were females. All the individual items had discrimination index value of higher than 0.75 and Cronbach's alpha of 0.75. The total weighed score calculated by adding the individual weighed score came as 21078. Correction factor obtained by dividing the weighed score to the raw score was 0.89. Using the Internet Addiction Scale for School and College Students (IASSCS) having a cut off value of 16 to delineate a person to have Internet addiction and No Internet addiction, around 63% of the study participants were found to have internet addiction and 37% of them were not having Internet addiction and among them a greater number of Internet addicts were found to be male compared to females. Conclusion: Due to the fact that internet addiction is linked to numerous physical and mental health problems, it may be more beneficial to use scale reports as screening tools at the primary health care level in order to identify high-risk groups for health problems caused by internet addiction at the earliest. [ABSTRACT FROM AUTHOR]

Objective: To identify factors that influence response processes for patients providing quantitative self-report data. Secondly, due to the lack of integrative and explanatory models in this area, to develop a model of patients' response processes that can guide what to look for when considering validity evidence and interpreting scores on individual items. Methods: Participants (n = 13) were recruited from a specialized substance use disorder treatment clinic and interviewed while responding to items from a clinical feedback system implemented for routine outcome monitoring in that setting. The interview approach was based on cognitive interviewing. Data collection and analysis were inspired by a grounded theory approach. Results: We identified several variables that influenced the participants' response processes. The variables were organized into five categories: context-related variables; item-related variables; response base variables; reasoning strategies; and response selection strategies. We also found that the participants' responses for many items were affected by different aspects of the response process in ways that are relevant to interpretation but not necessarily discernible from the numerical scores alone, and we developed response categories to capture this. Conclusion: The findings suggest that patients providing quantitative self-report data encounter conditions in the response process that challenge and influence their ability to convey meaning and accuracy. This results in responses that for many of the items reflect messages important for interpretation and follow-up, even if it does not appear from the numerical scores alone. The proposed model may be a useful tool when developing items, assessing validity, and interpreting responses. [ABSTRACT FROM AUTHOR]

Cognitive interviewing in the form of probing is key for developing methodologically sound survey questions. For a long time, probing was tied to the laboratory setting, making it difficult to achieve large sample sizes and creating a time-intensive undertaking for both researchers and participants. Web surveys paved the way for administering probing questions over the Internet in a time- and cost-efficient manner. In so-called web probing studies, respondents first answer a question and then they receive one or more open-ended questions about their response process, with requests for written answers. However, participants frequently provide very short or no answers at all to open-ended questions, in part because answering questions in writing is tedious. This is especially the case when the web survey is completed via a smartphone with a virtual on-screen keypad that shrinks the viewing space. In this study, we examine whether the problem of short and uninterpretable answers in web probing studies can be mitigated by asking respondents to complete the web survey on a smartphone and to record their answers via the built-in microphone. We conducted an experiment in a smartphone survey (N  =   1,001), randomizing respondents to different communication modes (written or oral) for answering two comprehension probes about two questions on national identity and citizenship. The results indicate that probes with requests for oral answers produce four to five times more nonresponse than their written counterparts. However, oral answers contain about three times as many words, include about 0.3 more themes (first probing question only), and the proportion of clearly interpretable answers is about 6 percentage points higher (for the first probing question only). Nonetheless, both communication modes result in similar themes mentioned by respondents. [ABSTRACT FROM AUTHOR]

We describe the prevalence and nature of cognitive interviewing (CI) for testing survey questionnaires in the United States and compare our results to those from Blair and Presser's similar study of three decades ago when such testing was relatively new. We find that although CI is now much more common than in 1993, there are still many organizations that do not use it. In addition, we find that there has been only a modest reduction in the great variation of ways CI is conducted both within and across organizations. We interpret this variability mainly as a reflection of the lack of consensus about best practices and call for research that will make consensus about best practices more likely. [ABSTRACT FROM AUTHOR]

Background and Aims: Falling is a serious threat for patient safety in hospitals. This study aimed to identify the risk factors of fall amongst rehabilitation patients and to use them for developing and validating the Persian version of Fall Risk Assessment Scale (FRAS). Methods: The current methodological study was conducted in two phases. In the first phase, based on the review of the literature and investigation of the medical records of 251 patients selected via purposive sampling, the risk factors of fall were extracted and the FRAS was developed accordingly. In the second phase, the face and content validities of the designed scale were determined by cognitive interview and Content Validity Index (CVI) and to evaluate the construct validity, known‐groups comparison was performed. Its inter‐rater reliability was analyzed using the weighted Kappa Coefficient (κ*). The study adhered to COSMIN guidelines. Results: Fall was significantly associated with disease diagnosis, used medications, history of fall, cognitive impairments, and three items of the Functional Independence Measure (toilet transfer, bed transfer, and shoer transfer). The CVI of the scale was 0.94. The risk for falls group had a significantly higher perceived fall risk than the no risk for falls group, thus establishing known‐group validity. Its weighted kappa coefficient was >0.85, its sensitivity was 73%, and its specificity was 82%. Conclusion: The valid and reliable FRAS may accurately assess the level of Fall Risk patients in Rehabilitation wards, helping to predict fall during hospitalization. So, enabling the planning and implementation of effective caring interventions. [ABSTRACT FROM AUTHOR]

Multiple-choice tests are widely used to measure learning outcomes. Consequently, constructing high-quality test items is critical, and many authors have advanced item-writing guidelines. One frequently mentioned guideline is to arrange the response options vertically. However, evidence to support this recommendation is scarce and has only been obtained for items with text-based options. This study aimed at understanding whether the arrangement of options affects performance at solving items with large-sized options, such as graphs and pictures, using objective and subjective measures. Fifty-seven high-school students completed a multiplechoice science and mathematics test with 24 four-choice items, options being graphs or pictures presented in one of four arrangements: vertical without page break, vertical with page break, Z, and inverted N. Response accuracy, response time, and perceived difficulty were obtained for each item. Subsequently, students participated in a cognitive interview about their experiences, practices, perceptions, and beliefs regarding the arrangement of options. Objective measures show that the arrangement of options hardly affected performance, the only effect being that vertical condition with page break resulted in significantly longer response times. Subjective measures show that most students favored the vertical arrangement they consider more common but negatively perceived vertical condition with page break and considered squared arrangements (Z, inverted N) to facilitate visual exploration and comparison between options, as opposed to the vertical arrangement. Results suggest that the vertical arrangement does not offer clear advantages over squared arrangements for items with large-sized options. [ABSTRACT FROM AUTHOR]

Background: Decision-making and problem-solving processes are powerful activities occurring daily across all healthcare settings. Their empowering potential is seldom fully exploited, and they may even be perceived as disempowering. We developed the EMPOWER-UP questionnaire to enable assessment of healthcare users' perception of empowerment across health conditions, healthcare settings, and healthcare providers' professional backgrounds. This article reports the initial development of EMPOWER-UP, including face and content validation. Methods: Four grounded theories explaining barriers and enablers to empowerment in relational decision-making and problem-solving were reviewed to generate a preliminary item pool, which was subsequently reduced using constant comparison. Preliminary items were evaluated for face and content validity using an expert panel of seven researchers and cognitive interviews in Danish and English with 29 adults diagnosed with diabetes, cancer, or schizophrenia. Results: A preliminary pool of 139 items was reduced to 46. Independent feedback from expert panel members resulted in further item reduction and modifications supporting content validity and strengthening the potential for generic use. Forty-one preliminary items were evaluated through 29 cognitive interviews, resulting in a 36-item draft questionnaire deemed to have good face and content validity and generic potential. Conclusions: Face and content validation using an expert panel and cognitive interviews resulted in a 36-item draft questionnaire with a potential for evaluating empowerment in user-provider interactions regardless of health conditions, healthcare settings, and healthcare providers' professional backgrounds. Plain Language Summary: Users of healthcare services living with long-term health conditions may need empowerment-based support from healthcare providers to discover and develop their inherent capacity to be responsible for their own life. This ensures that healthcare users develop the skills needed to manage the many decisions and problems they face. Yet many healthcare users still experience lack of involvement and support in decision-making and problem-solving. Therefore, we developed the EMPOWER-UP questionnaire to allow healthcare users to evaluate the empowering qualities of their interactions with healthcare providers regardless of their diagnosis, where the interactions take place, and with whom. The aim of this article was to describe the development of EMPOWER-UP and to present the results of early evaluations of its content. The questionnaire was developed in Danish based on thorough qualitative research explaining distinct, complex patterns in user-provider interactions and translated to English during the evaluation process. We used individual feedback from a panel of expert researchers and interviews conducted with healthcare users diagnosed with diabetes, cancer, or schizophrenia to evaluate EMPOWER-UP's content. Interviews were conducted while the participants answered preliminary versions of the questionnaire. As a result of these evaluations, several items in the questionnaire were adjusted, some were deleted, and some new items were developed. We believe that EMPOWER-UP can be an important tool to help evaluate the effectiveness of interventions aimed at ensuring empowering support from healthcare providers. Thus, EMPOWER-UP may help to identify the most effective interventions for specific healthcare contexts. [ABSTRACT FROM AUTHOR]

Background: Native Hawaiian and Pacific Islanders (NHPI) are disproportionately burdened by pregnancy-related deaths in the United States and have the lowest engagement in prenatal care compared to all other US racial groups. Aside from access barriers, studies suggest that NHPI face challenges with patient-clinician communication, perceived discrimination, and cultural conflicts within healthcare settings. This paper describes the cultural adaptation of the 14-item Mothers On Respect index for NHPI, originally developed by Vedam et al. (2017) for diverse communities in British Columbia, Canada, and reports the findings of the preliminary psychometric assessment of the adapted measure. Methods: Data from 26 interviews with NHPI women, expert, and cognitive interviews were conducted to inform the adaptation. An online survey was administered to a sample of 90 NHPI women to assess construct validity, convergent validity, and internal reliability of the adapted measure using exploratory and confirmatory factor analyses. Results: The adaptation resulted in substantial changes to the original measure, mainly by the addition of items related to 'feeling cared for by and connected to the provider' and 'perceived threats hindering communication.' The psychometric analyses identified a three-factor structure for the culturally adapted index and confirmatory factor analyses were employed to refine the measure. The result was a 25-item index with acceptable goodness of fit indices, high internal reliability (Cronbach's alpha of 0.96, 95% CI =.94-.97) and convergent validity with a related scale. Overall, participants in this sample indicated high levels of respectful care; however, people who received < 8 prenatal care visits had significantly lower ratings on average. Conclusions: Our findings suggest that the elements valued by NHPI are not fully captured in existing measures of respectful maternity care. Efforts to assess more discrete aspects of the patient-provider relationship for culturally distinct and racialized groups could help improve the quality of care and advance equity in maternal and perinatal health marginalized communities. [ABSTRACT FROM AUTHOR]

Background: Individuals exhibit varying degrees of flexibility depending on different characteristics, conditions, and diagnoses. The Flexibility Scale is a comprehensive informant-report measure used to assess multiple aspects of flexibility in autistic and non-autistic children and youth, with an emphasis on cognitive aspects. This tool has not been adapted nor validated for use in Spain. Methods: In this paper we aim to provide a culturally adapted and validated version of the Flexibility Scale for Spain. We detail the procedure followed by our research team to obtain a cultural adaptation of the scale for Spain, including forward and back translations, cognitive interviews, feedback from experts, and preliminary validation. Our participants in the validation process were 75 autistic and 39 typically developing children and adolescents between the ages of 6 and 17. Results: We reached a culturally adapted and preliminary validated version of the Flexibility Scale for Spain (Escala de Flexibilidad). Conclusions: We make the scale available to researchers and practitioners working in Spain. This contributes to laying the groundwork for further testing and adaptations in Spanish-speaking countries and communities worldwide. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions One of the most common assessment tools for examining the competencies of health professionals is the Objective Structured Clinical Examination (OSCE).In this study, an Educational Effects of OSCE Questionnaire (EEOQ) was developed and validated in seven steps: (1) Reviewing the literature, (2) Holding focus groups, (3) Synthesizing the results of literature review and focus groups, (4) Developing items, (5) Evaluating content validity, (6) Conducting cognitive interviews, and (7) Implementing a pilot test.The analysis of the literature review and focus groups revealed that the educational effects of OSCE are influenced by factors related to the test, the examiner, the peers, and the student. Initially, 22 items were developed, but one item was excluded based on the results of the I‐CVR and I‐CVI indices. In the Exploratory Factor Analysis, the KMO index was computed to be 0.85, and the significance of Bartlett's test of sphericity was confirmed (p < 0.001). The Total Variance Explained table showed that the educational effects of OSCE were grouped into four factors: content, structure, reflection and review, and feedback along with OSCE.This study found good evidence of validity and reliability for a questionnaire measuring the educational effects of OSCEs. It was discovered that OSCE can have different effects on student learning processes. [ABSTRACT FROM AUTHOR]

Algorithms play a significant role in shaping our experiences of interacting with intelligent information systems but also inherit and amplify data biases, potentially leading to unfair decisions or discriminatory outcomes. This motivates us to investigate users' algorithm literacy, which covers the awareness and knowledge of algorithms and the skills to intervene in the operations of personalization algorithms when interacting with recommendation systems. Since vulnerable groups are more likely to suffer from the negative consequences of algorithmic decision‐making, investigating algorithm literacy among such groups is critical. This study aims to examine older adults' algorithm literacy, who are often considered a vulnerable group and labeled as digital laggards in contemporary information society. The empirical evidence collected from 21 participants in in‐depth interviews and cognitive mapping studies demonstrated that almost all participants are algorithm‐aware to some extent and identified (1) three types of information and sources collected by algorithms in user understanding, (2) two paradigms of how respondents understand personalized recommendations, and (3) two sets of strategies they develop to employ algorithms for improving user experience. The findings shed light on designing human‐centered intelligent information systems for unbiased personalization and developing a more inclusive AI‐assisted society that equally benefits people of all ages. [ABSTRACT FROM AUTHOR]