The importance of content and face validity in instrument development: lessons learnt from service users when developing the Recovering Quality of Life measure (ReQoL)

Measuring honesty in nursing: scale development and validation

BACKGROUND

Honesty is considered a desirable trait that can impact happiness and job performance. The clinical environment can present ethical challenges for nurses. A lack of honesty can lead to significant issues for both nurses and patients. Existing tools for measuring honesty have limitations and do not focus specifically on nurses. This study aimed to design and psychometrically evaluate a scale to measure honesty among nurses.

METHODS

This methodological study involved the design and validation of an honesty measurement tool for nurses. The study employed an inductive-deductive approach to generate items. The face (10 nurses), content (10 nursing experts), and construct validity (320 hospital nurses) of the scale were assessed, along with reliability using internal consistency and stability methods. The Item Impact Method was used for quantitative face validity determination. Content validity was assessed using qualitative and quantitative methods, with the participation of researchers and nursing experts. Cronbach's alpha was used to assess internal consistency, and the test-retest method and Intraclass Correlation Coefficient (ICC) were used to assess reliability. Exploratory factor analysis (EFA) was used to assess construct validity.

RESULTS

The study resulted in an 8-item tool with two dimensions: behavioral honesty and verbal honesty. The tool explained 51.034% of the total variance. Cronbach's alpha for the entire scale was 0.823, and McDonald's omega was 0.898. The Intraclass Correlation Coefficient (ICC) was reported as 0.918, with a 95% confidence interval of 0.827 to 0.961.

CONCLUSION

The developed tool is a reliable and valid instrument for measuring honesty among nurses. This study contributes to the field by providing a tool to measure honesty in nurses. The tool's scoring system effectively distinguishes between different levels of honesty in nursing practice, with elevated scores reflecting greater adherence to honest professional conduct. This tool can be used by managers and organizational decision-makers to enhance the quality of management planning.

CLINICAL TRIAL NUMBER

Not applicable.

Baby Boomer Gay Men's Experiences with Primary Healthcare

This research explored baby boomer gay men's experiences with primary healthcare and their perspectives of future long-term care. Baby boomer gay men's perspectives about primary healthcare remain understudied in the United States. A descriptive qualitative study was conducted with 30 baby boomer men in the Southwest USA. We used semi-structured interviews to assess participants' initiation and maintenance of primary healthcare, disclosure of sexual orientation to providers, and perspectives about future healthcare needs, including long-term care. Data were analyzed with a latent thematic analysis. We found baby boomer gay men anticipate discrimination because of their sexual orientation whenever they establish healthcare with new providers. Participants identified circumstantial comfort in the new healthcare setting as a key motivator to disclose their sexual orientation. Thus, baby boomer gay men specifically sought gay or gay-friendly healthcare providers to ease the burden of managing disclosure and to permit free discussion of their sexual orientation and healthcare needs. Participants faced recurring anticipation of rejection and discrimination from healthcare providers, which extends to their perceptions of current healthcare encounters and future long-term care placement. Healthcare providers would benefit from understanding the practice implications of this dynamic. Future research on primary healthcare inclusivity is needed.

Development and Psychometric Properties of Ethical Competence Questionnaire for Nursing Students

Background and Aims

Existing tools for measuring ethical competence in nursing students have limitations, often failing to comprehensively assess the general concept and are frequently developed for practicing nurses, limiting their applicability to students. This study aimed to develop and psychometrically evaluate an ethical competence tool specifically designed for nursing students.

Method

This methodological study employed an instrument-development approach. The process involved developing an ethical competence measure for nursing students followed by a thorough psychometric evaluation. The tool's psychometric properties were assessed using face, content, and construct validity, as well as reliability through internal consistency and stability methods. Statistical analyses were conducted using SPSS version 27, JASP version 0.14, Microsoft Excel 2007, and Amos 25.

Results

A 26-item tool with two dimensions-"commitment to professional ethics and humanistic care" (19 items) and "interaction and cooperation in the clinical environment" (7 items)-was developed. The tool demonstrated excellent psychometric properties, explaining 68.427% of the total variance. Individual item factor loadings ranged from 0.549 to 0.875. Cronbach's alpha and McDonald's omega coefficients for the total scale were 0.883 and 0.898, respectively, indicating high internal consistency. Test-retest reliability also yielded strong results, with the intracluster correlation coefficient calculated at 0.998 (95% CI: 0.995-0.999). The tool effectively captures key components of ethical competence in nursing students.

Conclusion

The newly developed tool provides a reliable and valid measure of ethical competence in nursing students. This study offers educational managers in the healthcare field a valuable resource for designing a system to assess ethical competence among Iranian nursing students.

Systematic review on the measurement properties of patient-reported outcome measures (PROMs) for measuring well-being in young children

OBJECTIVE

This systematic review aims to summarise and assess the measurement properties of existing instruments for measuring child well-being.

DESIGN

A systematic review of measurement properties following the COnsensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline and the Joanna Briggs Institute methodology was performed.

DATA SOURCES

A search was performed in PubMed, Medline Complete, CINAHL Plus, Psychology & Behavioral Sciences (via EBSCOHost) and GoogleScholar (last search August 2024).

ELIGIBILITY CRITERIA

This review focused on studies that evaluated the measurement properties of instruments to measure the well-being of children ages 2-7 years, published between 2000 and 2023. We excluded studies that used the child well-being instrument as an outcome measure or to validate another instrument.

RISK OF BIAS AND DATA SYNTHESIS

The methodological quality of eligible studies was evaluated using the COSMIN Risk of Bias checklist, the measurement properties of the instruments per study were assessed using the updated criteria for good measurement properties and an overall rating for the measurement property of each instrument is determined and compared against the criteria for good measurement properties. The quality of evidence was evaluated using the modified Grading of Recommendations Assessment, Development and Evaluation approach, and measurement recommendations were formulated. Results were presented using a narrative synthesis and tables.

RESULTS

Three measures from three studies were included, and they presented moderate to high quality evidence for structural validity, internal consistency and construct validity. However, limited evidence was available for content validity.

CONCLUSION

Few instruments to measure the well-being of children aged 2-7 years are available, and only three measurement properties were fully evaluated in these studies. This review was conducted even if there was incomplete or unavailable information regarding their content validity. Further research is recommended before these measures may be recommended for use.

PROSPERO REGISTRATION NUMBER

CRD42023428953.

Translation and psychometric evaluation of the Witness Perceived Safety Scale of prehospital emergency care

BACKGROUND

Timely, effective and safety out-of hospital care and transfer to hospital by prehospital emergency medical services significantly impacts patient outcomes. This study aimed at translation and psychometric evaluation of the witness perceived safety scale of prehospital emergency care.

METHODS

The methodological design was utilized to verify the validity and reliability of the Witness Perceived Safety Scale across two phases: the translation process and an assessment of its validity and reliability. Construct validity was assessed using confirmatory factor analysis. The convergent validity, discriminant validity, and reliability of the scale were also evaluated.

RESULTS

The Witness Perceived Safety Scale comprises 10 items that were retained following cross-cultural translation. Both face and content validity were deemed acceptable. The fit indices from the confirmatory factor analysis supported the model's appropriate fit (χ²/df = 2.41; IFI = 0.96; CFI = 0.96; RMSEA = 0.075). Cronbach's α coefficient for the total scale was 0.899.

CONCLUSION

The Persian version of the Witness Perceived Safety Scale provides a reliable assessment of witnesses' perceptions of safety during emergency assistance and transfers.

CLINICAL TRIAL NUMBER

Not applicable.

Development and validation of a self-management questionnaire for people living with HIV in low- and middle-income countries (HIV-SM LMIC tool)

PURPOSE

The main objective of this research is to develop and validate a comprehensive self-management tool for PLWH (HIV-SM LMIC tool) in Ethiopia.

METHOD

Item development followed a recommended procedure. Item concepts were based on two previously published articles by the same authors, guided by the Individual Family Self-management (IFSMT) theoretical framework. The developed items were translated from English into Amharic (a local language in Ethiopia). Two rounds of face and content validation were conducted with HIV program experts, academics, people outside the health sector, and HIV patients. A total of 61 participants (52 in the first round and 9 in the second round) participated in the validation process. All participants evaluated the content and face validity of each item and provided qualitative judgments, comments, and suggestions.

RESULTS

In the first round of validation, most participants were health professionals (53.8%), followed by HIV patients (19.2%) and HIV program experts/researchers (9.6%). Nine participants took part in the second round. Initially, 117 draft items were refined into 63 for validation. I-FVI (individual face validity index) values ranged from 0.56 to 0.98, with 43 items (68%) scoring ≥ 0.80, indicating high face validity. I-CVI (individual content validity index) values ranged from 0.76 to 1.00, with 61 items (97%) scoring ≥ 0.80, demonstrating high content validity. Common qualitative feedback highlighted translation and contextualization issues in the Amharic version and overlapping concepts. Based on FVI, CVI, and qualitative feedback, particularly patient comments, 26 items were dropped or merged, resulting in a 37-item tool. In the second round, 31 items scored above 0.80 on the CVI. Three items were removed due to low CVI (< 0.70) and redundancy, while two were dropped based on participant feedback. The remaining 32 items had kappa values > 0.74, indicating excellent relevance. Both English and Amharic versions were revised.

CONCLUSION

A comprehensive 32-item HIV-SM LMIC tool tailored to HIV patients in low- and middle-income countries was developed following a rigorous psychometric evaluation process. Further research on its construct validity, criterion validity and reliability are recommended before its use. In addition, future studies should assess the cross-cultural validity of the final instrument.

Development and content validation of a questionnaire identifying patients' functional priorities and abilities after hip or knee arthroplasty

PURPOSE

To develop a self-report questionnaire evaluating functional priorities after hip or knee arthroplasty and evaluate patients' understanding of its items and conceptual relevance.

METHODS

A self-report questionnaire was first developed based on the International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis (OA). In the second stage, two research physiotherapists thoroughly reviewed and refined the questionnaire, and another physiotherapist conducted cognitive think-aloud interviews with 18 patients to assess the face and content validity of the questionnaire.

RESULTS

All categories and corresponding activities of ICF core set for OA were used to develop the questionnaire. Several questionnaire issues were identified and addressed. Most challenges were related to comprehension, followed by item ordering and visual elements. Patients identified ambiguous wording which we subsequently simplified. Ten activities of the core set were excluded due to lack of face validity, two activities were added, and four activities were modified.

CONCLUSION

The findings suggest that the ICF core set for OA needs to be adjusted for patients undergoing hip or knee arthroplasty and highlight the feasibility of applying a modified core set to assess functional priorities after hip or knee arthroplasty.

Bridging the gap: empowering patients as research partners through a structured training program

BACKGROUND

Engaging patients as partners in the research process is a mutually beneficial endeavor. However, patients may need skills training in order to meaningfully contribute to a project. The present paper describes the training program "A Front Row SEAT to Research," which equipped patient partners to independently lead focus groups and interpret their associated data. The focus groups were an aim of a larger project evaluating the face validity of a scale measuring patient engagement in research.

MAIN BODY

The nine-week training program, created by Patient Engaged Research Center qualitative research experts, empowered patient partners to conduct qualitative research. The structure of the program included asynchronous video lessons, workbook exercises, and live sessions for practice. Topics covered included a comprehensive overview of the scientific process, qualitative research methods, focus group moderation, planning, coding, data interpretation, and dissemination of findings. A hands-on approach to learning, coupled with the collection of continuous feedback, were hallmarks of the program.

CONCLUSION

The training program emphasized clear expectations, accessibility, and providing resources to build the capacity of patient partners. Trust was established through a dedicated support person, a collaborative group dynamic, and regular engagement, ensuring patient partners felt valued and empowered. This approach allowed patients to meaningfully contribute to the research and develop a sense of shared ownership in the project.

Assessing the knowledge and attitudes of semi-professional netball players in the Western Cape district regarding netball injuries: a cross-sectional study

BACKGROUND

Netball, with its dynamic movements, poses a high injury risk, notably to the ankles and knees. This study examined the injury knowledge and attitudes of semi-professional netball players in the Western Cape, South Africa.

METHODS

In this study 117 semi-professional female netball players from eight clubs in the Western Cape district were conveniently sampled. A self-administered researcher-generated questionnaire collected data on the players' sociodemographic characteristics, as well as their knowledge and attitudes regarding netball injuries. Independent samples t-test, Pearson's correlation coefficient, and the χ2 tests were employed for data analyses.

RESULTS

Results showed that most players (62.4%) had good knowledge of injury prevention and recovery, though a minority held negative attitudes (39.0% and 29.0%, respectively). Those with over three years of experience demonstrated superior knowledge (85.7%) and more positive attitudes (61.9% and 71.4%). Conversely, a minority (37.6%) exhibited poor knowledge, while a majority (61.00%) displayed positive attitudes. Furthermore, a moderate positive correlation (r=0.552; P<0.001) was observed between overall knowledge and attitudes towards injury prevention and recovery.

CONCLUSIONS

While most semi-professional netball players possess adequate injury knowledge, those with longer experience show more positive attitudes. Establishing educational programs emphasizing injury prevention and recovery could benefit players, especially those starting later in life, promoting both knowledge and positive attitudes towards injury management.

Reliability and validity of Persian version of the nurses' willingness to engage in palliative care scale

INTRODUCTION

Nurses play an essential role in providing palliative care to improve the quality of life of people with chronic diseases. The Willingness of nurses to engage in this cares is a necessary issue. Therefore, the evaluation of their willingness requires the use of valid, reliable, and suitable tools in the health system of Iran. This study was conducted to translate and validate the psychometric properties of the Persian version of the nurses' willingness to engage in the palliative care scale.

METHODS

This methodological study was conducted in 2023. 440 nurses were included using the convenience sampling in Baqiyatallah Hospital in Tehran. The translation was done using the forward-backward method. Face validity was done with a cognitive interview with 15 clinical nurses. Content validity was done using the opinions of 15 palliative expert nurses, and construct validity was done using exploratory factor analysis (n = 240) and confirmatory factor analysis (n = 200). The reliability was done using internal consistency and assessment of stability. The data were analyzed using SPSS v.25 and LISREL v.8.8.

RESULTS

In the face validity assessment, the items did not change. Brief changes were made in items 8 and 18, in the content validity assessment. In the exploratory factor analysis, 4 factors same as the original version were extracted with a cumulative variance of 59.52%. The results of confirmatory factor analysis showed that the 4-factor model was fit (RMSEA = 0.062, CFI = 0.97, NFI = 0.93, IFI = 0.97, GFI = 0.88). The internal consistency using Cronbach's alpha was 0.9 also the stability was 0.79.

CONCLUSION

The Persian version of nurses' willingness to engage in palliative care scale has sufficient validity and reliability for nurses in the Iranian population. Therefore, this tool can be used to measure nurses' willingness to engage in the palliative care and identify effective strategies. This tool can be used in clinical trials and research in order to improve the ability of nurses in palliative care in Iranian society.

Health App Review Tool (HART): Content validation through expert panel review

The Health App Review Tool (HART) is an evaluation tool that is designed to help the users in evaluation of the health apps for Alzheimer's Disease and Related Dementias (ADRD) population. As the development of the HART continues, the domain items that HART addresses require evaluation to determine if they meet the intended required criteria for the users.To complete content validation of the HART 10 health care professions provided content validation of the HART via a content validation form. Specifically, data collection took place virtually through Microsoft Teams and Qualtrics-based content validity index. Following, revisions were made through a consensus process involving 3 rehabilitation experts, minimizing potential conflicts.Findings indicate 76 of 109 items were considered acceptable, 19 items were in need of review and 14 items in need of revision. In sum 30% of the total HART items required either review or revision to improve HART validity. The changes were implemented through consensus revisions.

Exploring the involvement of people with lived experience of mental disorders in co-developing outcome measures: a systematic review

People with lived experience of mental health difficulties have highlighted that research outcomes do not capture issues they feel are important. This mismatch might affect the validity of trials, such that beneficial effects could be missed or results could be counted as a benefit when they are not. Co-development of patient-reported outcome measures ensures patient perspectives are captured adequately. To identify mental health outcome measures that meet a strict definition of being co-developed and to describe the methods and quantity of involvement at each pre-defined stage of measure co-development, we searched five electronic databases (MEDLINE, Web of Science, Scopus, PsycINFO, and Embase) for relevant papers, alongside a search of the non-peer reviewed literature and handsearching. The study was registered on PROSPERO (CRD42024520941). Retrieved papers were independently screened and quality was assessed following PRISMA guidelines. Extracted data were synthesised narratively. The search identified 23 mental health outcome measures from 34 papers. The most frequent types of involvement to co-develop outcomes were service-user researchers and lived experience groups as advisors undertaking activities such as leading qualitative exercises, but there were gaps. Many benefits were reported such as increased relevancy and acceptability of the measures. Based on these findings, recommendations for methods and a novel scale for judging quantity of involvement for co-development were identified, but challenges for co-development remain. The reviewed papers show that co-development is possible and could provide more relevant and meaningful outcomes for clinical practice and research.

Association Between Breastfeeding Peer Support and Confidence in Breastfeeding

BACKGROUND

Peer support programs may be effective for supporting breastfeeding among diverse groups, and in reducing disparities. This study provides insight regarding the implementation and outcomes of a peer breastfeeding support program.

RESEARCH AIMS

(1) to examine how participation affected the outcomes of breastfeeding motivation, confidence, and coping strategies; and (2) to evaluate satisfaction with the program.

METHOD

This was a cross-sectional, retrospective study. Seven pilot sites in the United States uniquely implemented a federally-funded peer support program for low-income women. Data were collected using a survey and focus groups/interviews. Over 12 months, 1,296 women participated, comprising 615 peer support pairs. A total of 401 women responded to the survey. Twenty-three focus groups and 63 interviews were conducted across the seven sites.

RESULTS

Participants who enrolled in the program during pregnancy: t (189) = -6.55, p < 0.001, and after the baby was born: t (170) = -2.59, p = 0.001, gained confidence in breastfeeding. More satisfied participants were more likely to breastfeed longer: F (7,352) = 12.75, p < 0.001, and cope with breastfeeding challenges: F (7,352) = 7.83, p < 0.001.

CONCLUSION

Effective operation strategies of the peer breastfeeding support program have significantly influenced participant satisfaction. Introducing peer support for low-income women to share their breastfeeding experiences would be beneficial in enhancing breastfeeding rates. However, the generalizability of these findings may be limited to this U.S. federally-funded peer support program.

Cross-cultural adaptation and validation of the Persian version of the Preparedness Assessment for the Transition Home After Stroke instrument: a methodological study

BACKGROUND

The successful transition of stroke patients from hospital to home relies on the preparedness of caregivers. Assessing this preparedness is crucial, but existing tools need adaptation and validation for Iranian caregivers.

OBJECTIVES

This study aimed to translate, culturally adapt, and validate the Persian version of the "Preparedness Assessment for the Transition Home After Stroke" (PATH-s) for use among Iranian caregivers of stroke survivors. It also assessed the association of patient and caregivers' characteristic association with the final PATH score.

METHODS

The PATH-s was translated and culturally adapted using the Backward-Forward translation method and expert consultations. Face and content validity were ensured through input from both caregivers and experts. Participants were recruited from two referral hospitals in Tehran, Iran. The sample consisted of 386 caregivers, 74.4% female with a mean age of 47.18 years (SD = 12.2). Construct validity was assessed using Exploratory and Confirmatory Factor Analyses (EFA and CFA). Convergent validity was evaluated through the correlation with Zarit Burden Interview scores. Reliability was tested through internal consistency (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficient, ICC).

RESULTS

The factor analysis revealed a seven-factor structure with robust fit indices (CFI = 0.92, TLI = 0.90, RMSEA = 0.068, SRMR = 0.074). Convergent validity was supported by a significant negative correlation with the Zarit Burden Interview (r = -0.27, p < 0.001). Reliability analysis showed good internal consistency (Cronbach's alpha = 0.84) and excellent test-retest reliability (ICC = 0.96).

CONCLUSIONS

The Persian version of PATH-s is a valid and reliable tool for assessing caregiver preparedness in Iran. Its use can improve patient outcomes and caregiver support during hospital-to-home transitions.

Original Research: Exploring the Use of Passive vs. Active Insulin Safety Pen Needle Devices in a Pediatric Population: A Feasibility Study

BACKGROUND

Insulin pens are the mainstay of insulin delivery in the pediatric population, especially among patients unable to use an insulin pump. Safety pen needle (SPN) devices have been embraced by both nurses and patients because they limit the risks of needlestick injury and exposure to blood-borne pathogens. With the commonly used traditional passive SPN device, however, it can be difficult to observe that the dose has been accurately or fully administered.

PURPOSE

The purpose of this study was to determine nurses' perceptions about the feasibility of using an active SPN device (specifically the Unifine SafeControl insulin pen needle), compared with the currently used passive SPN device, in pediatric patients ages 21 years or younger who require subcutaneous insulin injections.

METHODS

This feasibility study was conducted on a pediatric inpatient unit at 1 pediatric hospital in the southeastern United States. A total of 49 RNs completed both a pre-device change survey regarding the currently used passive SPN device and a post-device change survey regarding the active SPN device. The RNs also completed daily evaluations assessing the ease of teaching patients and their caregivers how to use the active SPN device. Participation consent was also obtained for 132 pediatric patients with diabetes who were admitted to the unit.

RESULTS

The majority of the RNs (87.8%) reported overall satisfaction with the active SPN device, compared to about half (52.7%) who reported overall satisfaction with the passive SPN device. Almost all the RNs (98.6%) reported that the active SPN device was easy or very easy to use. Nearly all the nurses (93.9%) reported feeling completely or very confident that the active SPN device allowed them to deliver the full intended dose; and nearly all reported that it was easy or very easy to teach patients (98.2%) and their caregivers (96.4%) how to use the active device.

CONCLUSIONS

As frontline workers in patient care, nurses can lead the innovation and development of new treatment approaches, protocols, and equipment. This nurse-led study explored the nurses' perceptions about the feasibility of a new active SPN device versus the passive SPN device in terms of safety, ease of use, ease of and confidence in dose administration, and ease of teaching device use to pediatric patients and their caregivers. The RNs' clear preference for the active over the passive SPN device suggests that the newer, active devices warrant more widespread use in hospital settings, with further research also recommended.

Psychometric evaluation of Persian version of the oral presentation evaluation scale in nursing students

BACKGROUND

Nurses should possess the ability to deliver concise oral presentations. Strong oral presentation skills can improve the quality of nurse-client communication, enhance teamwork among healthcare professionals, and contribute to professional development, leadership, and promotion. This study aimed to determine psychometric evaluation of the Persian version of the oral presentation evaluation scale in nursing students.

METHODS

The study aimed to translate the oral presentation evaluation scale (OPES) into Persian using the standard translation and re-translation method. After the translation, the scale was distributed among 474 nursing students of various levels using the available sampling method. The scale's reliability was assessed using Cronbach's alpha coefficient and test-retest repeatability. The construct validity was determined using the confirmatory factor analysis.

RESULTS

The Persian questionnaire consists of 15 items and is divided into three categories: accuracy of content, effective communication, and speech clarity. The overall score for the content validity index (S-CVI) was 0.94. The three-factor questionnaire's fitness indices were RMSEA = 0.070, comparative fit index (CFI) = 0.96, goodness-of-fit index (GFI) = 0.91, and adjusted goodness-of-fit index (AGFI) = 0.88. The intra-cluster correlation index (ICC) was 0.965, and Cronbach's alpha was 0.875.

CONCLUSION

The study found that the 15-item oral presentation evaluation scale Persian Survey is reliable for assessing nursing students' oral presentation skills.

Machine-Learning Applications in Thrombosis and Hemostasis

The use of machine-learning (ML) algorithms in medicine has sparked a heated discussion. It is considered one of the most disruptive general-purpose technologies in decades. It has already permeated many areas of our daily lives and produced applications that we can no longer do without, such as navigation apps or translation software. However, many people are still unsure if ML algorithms should be used in medicine in their current form. Doctors are doubtful to what extent they can trust the predictions of algorithms. Shortcomings in development and unclear regulatory oversight can lead to bias, inequality, applicability concerns, and nontransparent assessments. Past mistakes, however, have led to a better understanding of what is needed to develop effective models for clinical use. Physicians and clinical researchers must participate in all development phases and understand their pitfalls. In this review, we explain the basic concepts of ML, present examples in the field of thrombosis and hemostasis, discuss common pitfalls, and present a methodological framework that can be used to develop effective algorithms.

"Developing the tool SDM:KOMPASS. Supporting shared decision making implementation processes"

Shared decision-making (SDM) involves patients in choosing their treatment or care options. SDM enhances patient engagement and treatment satisfaction. SDM has proved difficult to implement and sustain in routine clinical practice, hence a supportive tool is needed. This quality improvement study focuses on the development of a generic tool, labeled SDM:KOMPASS, which is intended to support hospital settings by facilitating the visualization of their formative progress and the setting of goals for the SDM implementation into routine clinical practice. The main objective of the present paper is to describe the development of this generic tool. A six-step development process was performed to develop a tool and investigate the tool's overall perceived usability. Qualitative methods, such as observations, individual and focus group interviews, provided insights. A 10-item quantitative survey gauged informants' immediate attitudes towards the tool. Purposefully sampled informants (N = 20), including healthcare professionals and patients, contributed diverse perspectives regarding; 1) The tool's readability and clarity, 2) the construct's domains and content, and 3) the tool's perceived usability. In alignment with real-world challenges, SDM:KOMPASS emerges as a potentially valuable resource for healthcare organizations embedding SDM. The six-step development process revealed how the tool SDM:KOMPASS has potential to enhance SDM implementation's manageability, goal-setting, and focus. Professionals engaged in strategic implementation within somatic and mental hospital departments find the tool potentially beneficial and feasible. The tool shows promise and usability but requires careful attention due to its comprehensiveness. The next step is to alpha test the tool in clinical practice.

Development and Validation of the Immediate Postpartum Care Adherence Questionnaire: An Application of the Theory of Planned Behavior among Healthcare Professionals

Background

The postpartum period is critical for women and newborns. Many complications, such as deaths, are preventable by utilizing appropriate postpartum care. We aimed to assess healthcare professionals' adherence to the World Health Organization's (WHO) immediate postpartum care guidelines, investigating factors influencing their adoption at Jordanian hospitals.

Materials and Methods

A methodological study design, developing, and testing the psychometric properties of the Immediate Postpartum Care Adherence Questionnaire (IPCAQ) was created based on the Theory of Planned Behavior, extensive literature review, and the WHO guidelines following a manual construct questionnaire, and using a deductive method. The IPCAQ was developed using four steps: domain identification, scale construction, judgmental evidence, and psychometric evaluation.

Results

The final draft of IPCAQ consisted of four domains and 63 items deductively formulated from the theoretical constructs. The domains are attitudes, behavioral intention, subjective norms, and perceived behavioral control. They were subsumed by four subthemes, general caring assessment, counseling, subjective norms, and perceived behavioral control. The IPCA showed high content (0.94) and face validity indices (0.97), moderate content scale universal agreement (0.77), and excellent face agreement (0.81) for the 63 items. IPCAQ is a reliable instrument that measures adherence to immediate postpartum care guidelines.

Conclusions

IPCAQ is reliable and valid in the current sample. The IPCAQ can be used to assess healthcare professionals' adherence to immediate postpartum care guidelines, identify factors influencing the adoption of standardized care to overcome barriers to adherence, and facilitate high-quality care.

Updated-Food Choice Questionnaire: Cultural Adaptation and Validation in a Spanish-Speaking Population from Mexico

BACKGROUND

Determinants and motives related to food selection have evolved in a globalized and changing world. The traditional and useful Food Choice Questionnaire (FCQ), created in 1995, needs to be updated, adapted to new scenarios, and validated.

OBJECTIVES

This study aimed to: (1) assess face validity (FV) of the original 36-item FCQ, (2) generate an Updated-FCQ (U-FCQ) and assess its content validity (CV) (instrument suitability), and (3) evaluate its construct validity and reliability in a Spanish-speaking population from Mexico.

METHODS

FV involved a panel of nutrition professionals (NPs) rating the original items' clarity, relevance, specificity, and representativeness. A literature review process updated the FCQ by adding new items. CV with a second NP panel allowed calculating content validity ratio (CVR). Construct validation was performed via exploratory and confirmatory factor analysis (EFA-CFA). Internal consistency through Cronbach's alpha (CA) and test-retest reliability via intra-class correlation (ICC) were assessed.

RESULTS

The FV (n = 8) resulted in the modification of 11 original items. The literature review added 36 new items (15 from previous adaptations and 21 original items). The CV (n = 13) identified nine items (non-acceptable CVR), prompting reformulation of seven and removal of two. The NPs' feedback added six new items. The EFA-CFA (n = 788) developed a 75-item U-FCQ with eight dimensions: sensory appeal, mood, health and nutritional content, price, food identity, environmental and wildlife awareness, convenience, and image management. CA ranged from 0.74-0.97 (good-excellent) and ICC from 0.51-0.78 (moderate-good).

CONCLUSIONS

This study provides a useful instrument for the assessment of food choices and lays the groundwork for future cross-cultural comparisons, expanding its applicability in wider settings.

Initial Validation of AUGS-PERFORM: Construct Validity and Test-Retest Reliability

IMPORTANCE

The American Urogynecologic Society's Prolapse pERFORmance Measure (AUGS-PERFORM) patient-reported outcome measure contains 11 items designed to assess symptoms relevant for assessing the quality of treatment for pelvic organ prolapse.

OBJECTIVE

The aim of the study was to test AUGS-PERFORM's construct validity and test-retest reliability.

STUDY DESIGN

For this prospective validation study, we recruited English-speaking adult participants, at a single academic institution, seeking care for pelvic organ prolapse. Participants completed AUGS-PERFORM, the Pelvic Floor Distress Inventory, and several Patient-Reported Outcomes Measurement Information System short forms at baseline. We compared the 11 AUGS-PERFORM items against items testing the same concepts on other questionnaires using percent agreement, kappa statistics, and linear regression to determine construct validity. Two weeks later and before any pelvic organ prolapse therapy, participants completed AUGS-PERFORM a second time. Test-retest reliability was assessed using intraclass correlation coefficients.

RESULTS

We enrolled 148 participants between 27 and 86 years of age: 81% self-identified as White, 56% were sexually active, and 84% elected surgery for treatment. The AUGS-PERFORM items assessing bulge presence and bother had a high percent agreement with the Pelvic Floor Distress Inventory item #3 (83.5 and 70%, respectively). The percent agreement ranged from 69% to 75% for items assessing urinary and defecatory symptoms and from 49% to 56% for pain-related questions. Sexual function items had a strong negative correlation (expected direction based on scoring) with validated sexual function questionnaires. The intraclass correlation coefficient was estimated to be 0.86, indicating excellent test-retest reliability.

CONCLUSIONS

The AUGS-PERFORM demonstrated good construct validity for prolapse, urinary incontinence, defecatory dysfunction, and sexual function questions, and moderate construct validity for pain-related questions. There was excellent test-retest reliability.

"Doctor, What Would You do if You Were Me?" - A Survey of Physician Perspectives Toward Glioblastoma Resection

OBJECTIVE

How maximal safe resection of glioblastoma (GBM) is implemented in the clinical setting remains understudied. Here, we utilized a survey-based approach to understand physician perspectives on this matter.

METHODS

Scenarios involving GBMs were presented to physicians who were asked to select from planned subtotal resection, gross total resection (GTR), medical therapy only, or palliative care. Demographic, experience, and Likert scales of value assessment were collected.

RESULTS

In the scenario involving a corpus callosum GBM, 2.33% opted for GTR. For a right frontal GBM, 91.7% opted for GTR. In contrast, only 30.8% chose GTR of a right motor strip GBM (P < 0.001). When presented with a left motor strip GBM, fewer respondents (12.7%, P < 0.001) opted for GTR. Physicians who placed a high value on preserving physical independence were more likely to forgo GTR for right motor GBMs (hazard ratio = 0.068, 95% confidence interval: 0.47-0.97, P = 0.035), and physicians who placed a high value on their faith were more likely to opt for surgical treatments that differ from the general consensus, for instance opting for GTR of the corpus callosum GBM (hazard ratio = 4.18, 95% confidence interval: 1.63-10.74, P = 0.003). No other associations were found between the choice for GTR and other variables collected.

CONCLUSIONS

Our results suggest that while maximal safe resection remains a guiding principle for GBM resection, physician preference in terms of the extent of resection varies significantly as a function of tumor location and personal values.

Exploring the relationship between telehealth utilization and treatment burden among patients with chronic conditions: A cross-sectional study in Ontario, Canada

One in five Canadians lives with one or more chronic conditions. Patients with chronic conditions often experience a high treatment burden because of the work associated with managing care. Telehealth is considered a useful solution to reduce the treatment burden among patients with chronic conditions. However, telehealth can also increase the treatment burden by offloading responsibilities on patients. This cross-sectional study conducted in Ontario, Canada examines the association between telehealth utilization and treatment burden among patients with chronic conditions. This study aimed to explore whether and to what extent, telehealth use is associated with treatment burden among patients with chronic conditions. The secondary objective was to explore which sociodemographic variables are associated with patients' treatment burden. An online survey was administered to community-dwelling patients with one or more chronic conditions. The Treatment Burden Questionnaire (TBQ-15) was used to measure the patient's level of treatment burden, and a modified telehealth usage scale was developed and used to measure the frequency of telehealth use. Data was analyzed using descriptive statistics, correlations, analyses of variance, and hierarchical linear regression analysis. A total of 75 patients completed the survey. The participants' mean age was 64 (SD = 18.93) and 79% were female. The average reported treatment burden was 72.15 out of 150 (a higher score indicating a higher level of burden). When adjusted for demographic variables, a higher frequency of telehealth use was associated with experiencing a higher treatment burden, but the association was not statistically significant. Additionally, when adjusted for demographic variables, younger age, and the presence of an unpaid caregiver were positively related to a high treatment burden score. This finding demonstrates that some patient populations are more at risk of experiencing high treatment burden in the context of telehealth use; and hence, may require extra support to utilize telehealth technologies. The study highlights the need for further research to explore how to minimize the treatment burden among individuals with higher healthcare needs.

Design and Psychometric Evaluation of Nurses' Mobile Health Device Acceptance Scale (NMHDA-Scale): Application of the Expectation-Confirmation Theory

BACKGROUND

The use of mobile tools in nursing care is indispensable. Given the importance of nurses' acceptance of these tools in delivering effective care, this issue requires greater attention.

OBJECTIVE

This study aims to design the Mobile Health Tool Acceptance Scale for Nurses based on the Expectation-Confirmation Theory and to evaluate it psychometrically.

METHODS

Using a Waltz-based approach grounded in existing tools and the constructs of the Expectation-Confirmation Theory, the initial version of the scale was designed and evaluated for face and content validity. Construct validity was examined through exploratory factor analysis, concurrent validity, and known-group comparison. Reliability was assessed using measures of internal consistency and stability.

RESULTS

The initial version of the scale consisted of 33 items. During the qualitative and quantitative content validity stage, 1 item was added and 1 item was removed. Exploratory factor analysis, retaining 33 items, identified 5 factors that explained 70.53% of the variance. A significant positive correlation was found between the scores of the designed tool and nurses' attitudes toward using mobile-based apps in nursing care (r=0.655, P<.001). The intraclass correlation coefficient, Cronbach α, and ω coefficient were 0.938, 0.953, and 0.907, respectively.

CONCLUSIONS

The 33-item scale developed is a valid and reliable instrument for measuring nurses' acceptance of mobile health tools.

Construction and validation of an instrument for event-related sterility of processed healthcare products

OBJECTIVE

To construct and validate an instrument to assess events related to maintaining the sterility of processed healthcare products.

METHODS

This methodological study developed the instrument through analysis by a panel of experts, focusing on the integrity of commonly used packaging: spunbond-meltblown-spunbond and medical-grade paper. The instrument was analyzed using the Content Validity Index and Content Validity Ratio (≥ 0.80) and modified Kappa (≥ 0.74). The instrument underwent pre-testing.

RESULTS

Six experienced professionals participated in the expert panel. After two rounds, the final version of the instrument contained five dimensions. In the pre-test, 30 nursing professionals participated, of whom 86.67% considered the instrument good, and 90% found it understandable.

CONCLUSION

The construction and validation followed literature recommendations. The instrument is available, aiding in the safe use of processed healthcare products.

Assessment of patients with head and neck cancer using the MD Anderson Dysphagia Inventory: Results of a study into its comprehensiveness, comprehensibility and relevance to clinical practice

BACKGROUND

The MD Anderson Dysphagia Inventory (MDADI) is a widely used patient-reported outcome measure (PROM) which assesses dysphagia-related quality of life (QoL) in head and neck cancer (HNC). Despite its common use in HNC research and clinical practice, few of its psychometric properties have been reappraised since its inception. The aim of this study was to perform a survey-based qualitative analysis of UK HNC clinicians' perceptions of the content validity of the MDADI, evaluating it across the parameters of relevance, comprehensiveness and comprehensibility as per the COSMIN guideline for PROM assessment.

RESULTS

Four themes relating to the content validity of the MDADI were identified: (1) MDADI items lack clarity of definition of the terms 'swallowing', 'eating' and 'dysphagia'; (2) the MDADI is perceived to be overly negative in tone including items that service users may find distressing or disempowering; (3) items in the tool are exclusory to specific subgroups of patients, such as those who are nil by mouth or socially isolated; and (4) modifications to the MDADI were suggested and encouraged to make it more clinically useful and patient-centred.

CONCLUSIONS

This study indicates that MDADI's content validity is 'insufficient' when rated by COSMIN parameters. This has significant implications for its continued use in HNC research and clinical practice. Further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research.

WHAT THIS PAPER ADDS

What is already known on the subject The MD Anderson Dysphagia Inventory (MDADI) patient-reported outcome measure of dysphagia-related quality of life is widely used in clinical practice and international clinical trials. Content validity is considered to be the most important property of a tool when assessing its psychometric strengths and weaknesses; however, the MDADI's content validity has not been reappraised since its initial development. What this paper adds to existing knowledge This study presents UK speech and language therapists' opinions and experience of the content validity of the MDADI and this first reappraisal of its content validity since its initial development highlights several issues with this psychometric parameter of the tool. This study highlights that further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research. What are the potential or actual clinical implications of this work? Clinicians cannot assume that commonly used outcomes tools have strong psychometric profiles. Consideration of the content validity of outcomes tools during selection for use in clinical and research practice should be key, as this will encourage use of tools that produce relevant, valid data that can contribute meaningfully to patient-centred care.

Multidimensional frailty assessment: Development and validation of the Tilburg Frailty Indicator-Indonesia version

The aim of this study was to develop and examine the psychometric properties of the Tilburg Frailty Indicator-Indonesian version (TFI-I). 308 community-dwelling older adults aged ≥60 years participated. The TFI-I exhibited favorable internal consistency (Cronbach's alpha = 0.775) and test-retest reliability (intraclass correlation coefficient = 0.94). The physical, psychological, and social domains of the TFI-I correlated closely with the similar constructs of other scales, including the Short Physical Performance Battery (P < .001), Fried Frailty Phenotype (P < 0.001), Geriatric Depression Scale (P < .001), and the World Health Organization Quality of Life scale (P = 0.041), indicating its favorable construct validity. Significant differences were identified between the robust and frailty groups on the Barthel Index (P = .001) and Lawton Instrumental Activity of Daily Living Scale (P < .001). Overall, the TFI-I is valid and reliable when used to evaluate frailty status in clinical and research settings.

The development of a digital intelligence quotient scale: A new measuring instrument for primary school students in China

The development of a Digital Intelligence Quotient (DQ) scale for primary school students is the basis for research on the DQ of primary school students, which helps to scientifically diagnose the level and the current average DQ among Chinese primary school students. This study developed and validated a scale applicable to the assessment of DQ in Chinese primary school students where, the initial scale was first constructed; Then 1109 valid datasets were collected through purposive sampling and divided into Sample A and Sample B; Sample A was subjected to exploratory factor analysis and Sample B was tested by confirmatory factor analysis; The final validated scale consists of 22 items in 7 dimensions: digital identity, digital use, digital safety, digital security, digital emotional intelligence, digital literacy and digital rights. The scale has high reliability and validity and thus can be used as a reliable instrument for assessing DQ in Chinese primary school students.

Reducing anxiety and enhancing satisfaction in thyroid patients with DietLens application during radioactive iodine therapy: A quasi-experimental study

Hyperthyroidism and thyroid cancer significantly impact health, and often require Radioactive Iodine (RAI) therapy. Anxiety is common in patients undergoing RAI, particularly related to dietary compliance. This study aimed to assess the effectiveness of the mobile health application, DietLens in reducing anxiety and increasing satisfaction in patients preparing for RAI therapy, focusing on low-iodine diet (LID). A quasi-experimental study was conducted in a Singapore tertiary hospital outpatient department from March 13, 2019 to March 27, 2020, involving patients scheduled for their first RAI treatment. Participants were divided into a control group receiving standard care and an intervention group using DietLens alongside standard care. Anxiety levels were assessed using the Zung Self-Rating Anxiety Scale, and satisfaction levels were measured through self-reported questionnaires. In the study, 56 participants were initially divided into control (n = 28) and intervention (n = 28) groups. After accounting for dropouts, 50 participants finished the study, with each group comprising 25 individuals. Anxiety levels were similar between groups pre-intervention. Post-intervention, the intervention group displayed a significant decrease in anxiety levels compared to the control group (independent t-test: t (48) = 2.50, p = 0.02). The multivariate linear regression analysis indicated that being in the intervention group was significantly associated with a decrease in post-intervention anxiety score (β = -4.03, 95 % CI: -7.33 to -0.72, p = 0.02). Fisher's Exact Test revealed a borderline significant difference in satisfaction with educational materials and the overall treatment process, with 100 % of the intervention group expressing satisfaction compared to 80 % in the control group, resulting in a p-value of 0.052 in both instances. DietLens was effective in reducing anxiety and enhancing satisfaction related to RAI therapy preparation, particularly in managing a LID, highlighting a beneficial role for digital interventions in healthcare settings.

A Systematic Review and Quality Assessment of Cardiovascular Disease-Specific Health-Related Quality-of-Life Instruments Part I: Instrument Development and Content Validity

OBJECTIVES

Health-related quality-of-life (HRQoL) instruments for cardiovascular diseases (CVD) have been commonly used to measure important patient-reported outcomes (PROs) in clinical trials and practices. This study aimed at systematically identifying and assessing the content validity of CVD-specific HRQoL instruments in clinical studies.

METHODS

The research team searched Cumulative Index to Nursing and Allied Health Literature, Embase, and PubMed from inception to January 20, 2022. The research team included studies that reported the development and content validity for CVD-specific instruments. Two reviewers independently assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methods on evaluating content validity of PROs. Content analysis was used to categorize the items included in the instruments.

RESULTS

The research team found 69 studies reporting the content validity of 40 instruments specifically developed for CVD. Fourteen (35.0%) were rated "sufficient" with very low to moderate quality of evidence. For PRO development, all instruments were rated "doubtful" or "inadequate." Twenty-eight (70.0%) instruments cover the core concepts of HRQoL.

CONCLUSIONS

The quality of development and content validity vary among existing CVD-specific instruments. The evidence on the content validity should be considered when choosing a HRQoL instrument in CVD clinical studies and health economic evaluations.

Cadaveric Biomechanical Laboratory Research Can Be Quantitatively Scored for Quality With the Biomechanics Objective Basic Science Quality Assessment Tool: The BOBQAT Score

PURPOSE

To develop a quality appraisal tool for the assessment of cadaveric biomechanical laboratory and other basic science biomechanical studies.

METHODS

For item identification and development, a systematic review of the literature was performed. The content validity index (CVI) was used either to include or exclude items. The content validity ratio (CVR) was used to determine content validity. Weighting was performed by each panel member; the final weight was either up- or downgraded to the closest of 5% or 10%. Face validity was scored on a Likert scale ranked from 1 to 7. Test-retest reliability was determined using the Fleiss kappa coefficient. Internal consistency was assessed with Cronbach's alpha. Concurrent criterion validity was assessed against the Quality Appraisal for Cadaveric Studies scale.

RESULTS

The final Biomechanics Objective Basic science Quality Assessment Tool (BOBQAT) score included 15 items and was shown to be valid, reliable, and consistent. Five items had a CVI of 1.0; 10 items had a CVI of 0.875. For weighting, 5 items received a weight of 10%, and 10 items a weight of 5%. CVR was 1.0 for 6 items and 0.75 for 9 items. For face validity, all items achieved a score above 5. For test-retest reliability, almost-perfect test-retest reliability was observed for 10 items, substantial agreement for 4 items, and moderate agreement for 1 item. For internal consistency, Cronbach's alpha was calculated to be 0.71. For concurrent criterion validity, Pearson's product-moment correlation was 0.56 (95% confidence interval [CI] = 0.38-0.70, P = .0001).

CONCLUSIONS

Cadaveric biomechanical and laboratory research can be quantitatively scored for quality based on the inclusion of a clear and answerable purpose, demographics, specimen condition, appropriate bone density, reproducible technique, appropriate outcome measures, appropriate loading conditions, appropriate load magnitude, cyclic loading, sample size calculation, proper statistical analysis, results consistent with methods, limitations considered, conclusions based on results, and disclosure of funding and potential conflicts.

CLINICAL RELEVANCE

Study quality assessments are important to evaluate internal and external validity and reliability and to identify methodological flaws and misleading conclusions. The BOBQAT score will help not only in the critical appraisal of cadaveric biomechanical studies but also in guiding the designs of such research endeavors.

Cross-cultural validation of Malay version of perceived professionalism among dental patients

BACKGROUND

Professionalism is a dynamic construct that requires constant revision based on contemporary practices and attitudes.

OBJECTIVES

The purpose of this study was to cross-culturally adapt an already validated English questionnaire assessing patient perceptions of professionalism among dentists, into the Malay language.

METHODS

An original 24-item questionnaire was cross-cultural adapted in the Malaysian context through two phases. Phase I included content and face validity from experts' evaluation which was followed by translation into the Malay language. Phase II involved psychometric assessment including construct validity and reliability analysis.

RESULTS

Expert evaluation indicated that all items demonstrated excellent content validity for the characteristics of relevance (CVI = 0.75-1.00 Kappa = 0.72-1.00) and clarity (CVI = 0.75-1.00 and Kappa= 0.72-1.00). A total of 300 dental patients completed the questionnaire. EFA was done on the first dataset and the second dataset was subjected to CFA which showed composite reliability (CR) ranging between 0.741 and 0.897 indicating acceptable reliability among items. The final questionnaire had 20 items with 3 domains; Patient expectation of a dental care provider, Ethics and Dentist's professional responsibilities, Patient communication and confidentiality.

CONCLUSION

This study has successfully validated the questionnaire for patient perception of professionalism in the Malaysian context.

Translation, cultural adaptation and validation of the Swahili Pain Catastrophizing Scale among refugees who survived torture and/or war trauma in Kenya: An observational study

Background and Aims

Accurate assessment of any patient relies on the use of appropriate measurements which are culturally- and linguistically-applicable and valid. The following study aimed to translate, cross-culturally adapt and test the nomological validity, structural validity, internal consistency, test-retest reliability, sensitivity-to-change and feasibility of the Swahili version of the Pain Catastrophizing Scale (Swa-PCS) among refugees who survived torture/war trauma living with chronic pain in Kenya.

Methods

An observational study was conducted. Translation and cultural adaptation of the original PCS for the Swahili-speaking refugee population in Kenya, who survived torture or war trauma was undertaken. Following this process, a validation study was conducted on the newly-adapted instrument, to ascertain the psychometric properties (nomological validity, structural validity, internal consistency, test-retest reliability, sensitivity-to change, and ceiling and floor effects).

Results

Fifty participants were included in this study. Correlations between pain catastrophization and fear-avoidance behavior measures were significant (r = 0.538, p < 0.01). Ceiling effects were 42-48% with no floor effects. Standard errors of measurement values were between 0.938 and 3.38. Minimal-detectable-change values were between 2.17 and 7.82. Internal consistency was satisfactory to good, for the whole and subsections respectively (range α = 0.693-0.845). Magnification had the lowest α. Test-retest reliability was also satisfactory to good (range ICC =  0.672-0.878). Confirmatory factor analysis confirmed that the Swa-PCS had three factors which explained the majority of the variance. Root mean square error of approximation and comparative fit index were calculated for goodness-of-fit assessment, and were 0.18 and 0.83, respectively.

Conclusion

This study showed that the adapted Swa-PCS displayed overall satisfactory to good internal consistency, test-retest reliability and sensitivity-to-change. Furthermore, the Swa-PCS scores were related to fear-avoidance behavior scores as expected (nomological validity). Structural validation of the Swa-PCS requires further investigation. Further testing of the psychometric properties of the Swa-PCS is however warranted.

Managing Shifting Visitor Restrictions in Hospitals during the COVID-19 Pandemic from National Authority Level to Charge Nurses' Practice: A Descriptive Study

Introduction

Little is known about how shifting hospital visitor restrictions issued by national health authorities were communicated, managed, and adapted by hospital charge nurses during the COVID-19 pandemic.

Aims

To describe the shifting visitor restrictions and the passing on of restrictions from the national authority level to charge nurses and secondly describe charge nurses' management of the restrictions and their challenges when enforcing them.

Methods

The study consisted of a document analysis and a cross-sectional survey including open-ended questions. Descriptive statistics and qualitative content analysis were used. The survey was distributed online to 88 charge nurses in somatic units in a Danish university hospital from March 2020 to April 2021.

Results

Restrictions were communicated from national authority level in an effective administrative cascade. The charge nurses led their enforcement in each unit. In total, 71 charge nurses (81%) responded to the survey. For 70%, the wording of the restrictions was clear, while 31% found them challenging to handle. On a weekly or daily basis, 68% of the charge nurses deviated from the restrictions. They identified both upsides and downsides to the absence of relatives. Communication, collaboration, and leadership were experienced as key tools in the ongoing processes of adapting to shifting restrictions.

Conclusion

During this severe health crisis, essential information was passed on through well-defined management levels in an effective communication pathway. Charge nurses and their professional values were challenged when balancing shifting national restrictions against individual needs of patients and relatives. Implications for Nursing Management. Charge nurses serve as vital intermediaries between national authorities and frontline nursing practice in managing shifting visitor restrictions during a pandemic. Their experiences can contribute to further qualifying nurse managers' considerations when designing family-centred hospital visitor policies for the future. Also, they may strengthen the handling of future sudden major organizational changes.

Cross-cultural adaptation and validation of a Spanish version of the self-administered foot evaluation questionnaire (SAFE-Q)

BACKGROUND

The self-administered foot evaluation questionnaire is a comprehensive measure for assessing the perception of patients regarding their foot-related problems. However, it is currently only available in English and Japanesse. Therefore, this study aimed to cross-culturally adapt the questionnaire to Spanish and assess its psychometric properties.

METHODS

The methodology recommended by the International Society for Pharmaco Economics and Outcomes Research for translating and validating patient-reported outcome measures was followed for the Spanish translation. After a pilot study with 10 patients and 10 controls, an observational study was carried out between March and December 2021. The Spanish version of the questionnaire was filled by 100 patients with unilateral foot disorders, and the time spent to complete each questionnaire was recorded. Cronbach's alpha was calculated to analyze the internal consistency of the scale and Pearson's correlation coefficients for the degree of inter-subscale associations.

RESULTS

The maximum correlation coefficient for the Physical Functioning, Daily Living, and Social Functioning subscales was 0.768. The inter-subscale correlation coefficients were significant (p < 0.001). Additionally, the value of Cronbach's alpha for the whole scale was 0.894 (95% confidence interval, 0.858-0.924). The values of Cronbach's alpha varied between 0.863 and 0.889 when the value of one of the five subscales was suppressed, which can be considered a measure of good internal consistency.

CONCLUSION

The Spanish version of the questionnaire is valid and reliable. The method followed for its transcultural adaptation ensured its conceptual equivalence with the original questionnaire. Health practitioners can use the self-administered foot evaluation questionnaire as a complementary method to assess the interventions performed for ankle and foot disorders among native Spanish speakers; however, further research is necessary to assess its consistency for use by populations from other Spanish-speaking countries.

Psychometric evaluation of the endometriosis impact questionnaire (EIQ) in an Iranian population

BACKGROUND

Endometriosis is a benign and chronic gynecological estrogen-dependent disease. Considering the prevalence and the importance of measuring the long-term effects of endometriosis in affected women's lives t the EIQ scale was designed and psychometrically analyzed in English in Australia, in three recall periods (last 12 months, 1 to 5 years ago and more than 5 years ago). It has never been used in Iran and its validity and reliability have not been assessed either. Therefore, the present study aimed to translate and investigate the psychometric properties of the EIQ.

METHODS

In this study, 200 women were selected through random sampling in 2022. After forward and backward translation, the face validity, content validity, and construct validity of EIQ (through Corrected Item-Total Correlation) were examined. To assess the reliability of the scale, both internal consistency (Cronbach's alpha) and test-retest stability methods were employed.

RESULTS

Impact Score with a score above 1.5 was approved. CVI and CVR values of the EIQ tool were 0.97 and 0.94, respectively. The Item to total Correlation confirmed the construct validity of all seven dimensions of the tool, more than the cut-off (0.3) except lifestyle. Cronbach's alpha coefficient and Intra Correlation Coefficient (ICC) were acceptable for all dimensions.

CONCLUSION

The Persian version of EIQ is a valid and reliable scale. This tool is valid and reliable for investigating the long-term impact of endometriosis in Iranian society.

University makes me angry: Investigating stimulus-response (S-R) and cognitive-mediation (C-M) emotion beliefs in undergraduate students

Emotion regulation through cognitive reappraisal is well-studied, but less so are the predispositional and superordinate beliefs that influence reappraisal. Recently, researchers developed the cognitive mediation beliefs questionnaire (CMBQ), which measures two emotion beliefs, namely stimulus-response (S-R) generation beliefs and cognitive mediation (C-M) change beliefs. In working populations S-R generation beliefs are inversely related to cognitive reappraisal tendencies and positive mental health, and positively related to emotion reactivity. C-M change beliefs are positively related to cognitive reappraisal tendencies, and inversely related to emotion reactivity and positive mental health. As yet, there is no evidence for the validity of the CMBQ within student samples, or for the associations between its subscales and cognitive reappraisal, emotion reactivity, and positive mental health. Therefore, in the present study the CMBQ is tested for factorial, convergent (associations with cognitive reappraisal), and concurrent (associations with emotion reactivity and positive mental health) validity in a cohort of 621 undergraduate students in the United Kingdom (U.K.). Results indicate support for the factorial and convergent validity of the CMBQ, with mixed evidence for the concurrent validity of the CMBQ. A CM-SR discrepancy score appeared to provide a promising variable when associated with emotion reactivity and positive mental health. The findings are discussed in terms of practical and research implications of the findings.

Reliability and validity of the Arabic version of the modified falls efficacy scale

PURPOSE

The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument.

MATERIALS AND METHODS

The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the 'forward-back' translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years).

RESULTS

The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach's alpha = 0.98) and test-retest reliability scores (ICC = 0.96, 95% CI; 0.95-0.97). And also showed strong correlations with both the Falls Efficacy International (r = -0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser-Meyer-Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79).

CONCLUSION

The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.

Item development for a patient-reported measure of compassionate healthcare in action

BACKGROUND

Compassionate care is a fundamental component of healthcare today; yet, many measures of compassionate care are subjective in focus and lack clarity around what compassionate care looks like in practice. Measures mostly relate to physical healthcare settings, neglecting mental healthcare. They also lack significant involvement of people with lived experience (PLE) of healthcare delivery in their development. This study aimed to begin the process of developing a new patient-reported measure, one that captures the observable actions of compassionate care delivery or 'compassionate healthcare in action' by any healthcare professional working in any care setting. The study involves PLE of healthcare delivery, both patients and staff, throughout.

METHODS

A multistage mixed-methods scale development process was followed. First, items were derived inductively from reflexive thematic analysis of patient and clinician interviews about what compassionate care meant to them (n = 8), with additional items derived deductively from a literature review of existing measures. Next, a panel of patient, clinician and researcher experts in compassionate care was recruited (Round 1: n = 33, Round 2: n = 29), who refined these items in a two-round modified online Delphi process.

RESULTS

Consensus was reached on 21 items of compassionate care in action relating to six facets: understanding, communication, attention, action, emotional sensitivity and connection. These items will form the basis for further scale development.

CONCLUSIONS

This item development work has laid the foundation of a potential new tool to systematically measure what compassionate healthcare in action looks like to patients. Further research is underway to produce a valid and reliable version of this proposed new measure. We have outlined these initial stages in detail in the hope of encouraging greater transparency and replicability in measure development, as well as emphasising the value of involving PLE throughout the process.

PATIENT OR PUBLIC CONTRIBUTION

This study involved PLE of both physical and mental healthcare (as staff, patients and service users) throughout the development of the new measure, including initial project conceptualisation and participation in item generation and refinement stages.

Quality of life assessment after microvascular head and neck reconstruction: a systematic review of available tools

In this study, we aimed to appraise the quality and psychometric properties of quality of life (QOL) assessment tools used after microsurgical reconstruction for head and neck cancers. A systematic review of QOL assessment tools used in head and neck cancer patients after microsurgical reconstruction was performed; emphasis was placed on psychometric properties and validity. Fifty-four studies published between January 2010 and February 2023 fulfilled the criteria; in these, twenty-three different QOL assessment tools were identified. The most commonly used instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck version (EORTC-H&N). No assessment tool fulfilled all the quality criteria; no single tool presented evidence from all the components of validity. Almost all reported reliability coefficients were above 0.7; most papers reported an internal consistency coefficient (Cronbach's alpha) for the global score. The array of available tools allows for the choice of the most appropriate one depending on the context faced by the clinician or researcher.

GenPup-M: A novel validated owner-reported clinical metrology instrument for detecting early mobility changes in dogs

OBJECTIVE

To use a previously validated veterinary clinical examination sheet, Liverpool Osteoarthritis in Dogs (LOAD) questionnaire, combined with kinetic and kinematic gait analysis in dogs with/without mobility problems to demonstrate the capacity of a novel clinical metrology instrument ("GenPup-M") to detect canine mobility impairments.

DESIGN

Quantitative study.

ANIMALS

62 dogs (31 with mobility impairments and 31 without mobility impairments).

PROCEDURE

The dogs' clinical history was obtained from owners and all dogs underwent a validated orthopaedic clinical examination. Mobility impairments were diagnosed in the mobility impaired group based on clinical history and orthopaedic examination. Owners were asked to complete GenPup-M along with a previously validated mobility questionnaire (Liverpool Osteoarthritis in Dogs (LOAD)) to identify construct validity. As a test of criterion validity, the correlation between instrument scores and the overall clinical examination scores, along with force-platform obtained peak vertical forces (PVF) were calculated. GenPup-M underwent internal consistency and factor analysis. Spatiotemporal parameters were calculated for dogs with/without mobility impairments to define the gait differences between these two groups.

RESULTS

Principal Component Analysis identified GenPup-M had two components with Eigenvalues >1 ("stiffness/ease of movement" and "willingness to be active/exercise"). Cronbach's α was used to test internal consistency of GenPup-M and was found to be "good" (0.87). There was a strong, positive correlation between GenPup-M and LOAD responses (r2 = 0.69, p<0.001) highlighting construct validity. Criterion validity was also shown when comparing GenPup-M to clinical examination scores (r2 = 0.74, p<0.001) and PVF (r2 = 0.43, p<0.001). Quantitative canine gait analysis showed that there were statistically significant differences between peak vertical forces (PVF) of mobility impaired and non-mobility impaired dogs (p<0.05). Analyses of PVF showed that non-mobility impaired dogs more evenly distributed their weight across all thoracic and pelvic limbs when compared to mobility impaired dogs. There were also consistent findings that mobility impaired dogs moved slower than non-mobility impaired dogs.

CONCLUSION AND CLINICAL RELEVANCE

GenPup-M is a clinical metrology instrument (CMI) that can be completed by dog owners to detect all mobility impairments, including those that are early in onset, indicating the versatility of GenPup-M to assess dogs with and without mobility impairments. Results of the study found that GenPup-M positively correlated with all three objective measures of canine mobility and consequently showed criterion and construct validity. Owner-reported CMIs such as GenPup-M allow non-invasive scoring systems which veterinary surgeons and owners can use to allow communication and longitudinal assessment of a dog's mobility. It is anticipated that GenPup-M will be used by owners at yearly vaccinations/health checks, allowing identification of any subtle mobility changes, and enabling early intervention.

Screening Children in India: Translation and Psychometric Evaluation of the Parents' Evaluation of Developmental Status and the Strength and Difficulties Questionnaire

Timely screening and surveillance of children for developmental delay and social-emotional learning difficulties are essential in Low- and Middle-Income Countries like India. Screening measures like the Parents' Evaluation of Developmental Status (PEDS) and Strength and Difficulties Questionnaire (SDQ) are considered suitable for India due to their low cost, easy accessibility, and no training requirement for administration. However, India lacks validated screening measures, and the PEDS and SDQ have yet to be validated for children in India. The study aimed to translate the PEDS and SDQ from English to Hindi and psychometrically evaluate the same measures on children aged 4-8 years in India. The original PEDS and SDQ forms and their translations were pilot tested on 55 participants and evaluated using data from 407 children with typical development (TD) and 59 children with developmental disability (DD). Parents and teachers reported no meaningful discrepancy between the original and translated (Hindi) questionnaires. Internal consistency for the PEDS was acceptable, but unacceptable for most subscales on the SDQ, for both TD and DD samples. Test-retest reliability was poor for the PEDS but adequate for the SDQ. Results from known-group validity testing showed that the PEDS scores could be used to distinguish between the TD and DD samples. The results from this study provide further support for the use of the PEDS and SDQ in developing countries like India.

Motivations and Experiences of Teaching Assistants in a First-Year Integrated Medical Course

Peer teaching is used in many medical schools and is recognized as beneficial to the student teacher and learner. We surveyed a cohort of teaching assistants (TAs) in a first-year course to determine their motivations to serve as TAs and the perceived benefits. TAs served because they wanted to help, solidify their knowledge, and have an opportunity to teach. They perceived that their experience helped them develop their communication skills and encouraged them to pursue future teaching opportunities. This information will help in recruiting students into teaching and also in developing a standardized student-as-teacher program to foster the next generation of physician educators.

Development and Psychometric Evaluation of the Clinical Nursing Cultural Competence Scale

Background and Purpose: Cultural competence in clinical nurses can lead to comprehensive care for patients from different cultures. Currently, an appropriate instrument to assess cultural competence in clinical nurses is limited. This study aimed to design and determine the psychometric properties of the clinical nursing cultural competence scale (CNCCS). Methods: This methodological study was conducted in 2018-2019 in two phases. In the first phase, a literature review and semistructured interviews with 18 clinical nurses from Isfahan and Ahvaz were conducted, and the results were used for item generation. In the second phase, the face, content, construct validity, and reliability of the questionnaire were assessed. For construct validity assessment through exploratory factor analysis (EFA), 200 clinical nurses were purposefully recruited to fill out CNCCS. Results: In the first phase, 140 items were produced. In the second phase, the item number was reduced to 40 after the face and content validity assessment. In EFA for construct validity assessment, 13 more items were deleted, and the remaining 27 items were loaded on six factors. The Cronbach's alpha and the test-retest intraclass correlation coefficient were CNCCS 0.86 and 0.93, respectively. Conclusions: The CNCCS had acceptable psychometric characteristics in Iranian nurses and can be used for assessing cultural competence among clinical nurses. The use of this scale can help nursing policymakers and managers develop their understanding of nursing cultural competence and develop strategies for its improvement.

Translation and psychometric evaluation of the reflective capacity scale in Iranian medical education

BACKGROUND

Examining the reflective capacity in medical students is a principal step for the development of effective educational strategies to improve it. Reflection scales available in Iran are inadequate due to the lack of focus on students' willingness and tendency to participate in reflection. This study aimed at translation and psychometric evaluation of "Reflective Capacity Scale" in Iranian medical education.

METHODS

This methodological research was completed in two parts: translation and psychometric evaluation. After getting permission from the main developer of the tool, the translation process was done based on Polit and Yang model in Persian language. Then, face validity and content validity of the tool were established using a qualitative method. Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 320 medical students, who were selected using convenience sampling. The reliability of the tool was also checked with two methods of internal consistency and stability. The gleaned data were analyzed with SPSS20 and AMOS.

RESULTS

"Reflective Capacity Scale" includes 16 items that were retained after cross-cultural translation. Face validity and content validity were acceptable. By performing exploratory factor analysis, four factors were identified that accounted for 63.79% of the total variance. In the confirmatory factor analysis, the values of the fit indices confirmed the appropriate fit of the model. The internal consistency reliability of the whole tool was equal to 0.83 and the intra-class correlation coefficient was equal to 0.98.

CONCLUSION

The translated and validated "Reflective Capacity Scale" provides a robust tool for assessing reflective capacity among Iranian medical students. Its validity and reliability underscore its potential for measuring the reflective capacity of medical students.

Content validation of a mental wellness measuring instrument for adolescents living with HIV: a modified delphi study

A growing body of evidence suggests that improving the mental wellness of adolescents living with HIV (ALHIV) will also result in improved adherence to antiretroviral therapy (ART), as well as improving their general health and wellbeing as they age into adulthood. However, to develop effective strategies and interventions aimed at improving mental wellness, we require age and culturally appropriate instruments to build an evidence base. Currently, there is a lack of mental wellness measures developed for ALHIV, especially in the African context. To address this gap, we developed a measure of mental wellness following modified guidelines set out by DeVellis [1] and Godfred et al. as a guiding framework [2]; (1) Identifying the gap, (2) Set the theoretical foundations and identify domains and (3); Instrument development and initial validation. For the first two steps, we conducted a systematic review, photovoice study and integrative review - which we briefly describe as the findings have been published. Following this we describe the processes to develop the instrument and to establish content validity through a modified Delphi Study. Through this process we were able to refine the instrument which will be subject to further testing.Implications and Contribution: This study aims to add to the body of knowledge on promoting mental health (mental wellness) among adolescents living with HIV in South Africa through developing an appropriate and valid measure of mental wellness for this population. This study reports on the results of a Delphi Study aimed at improving the content validity of the instrument Mental Wellness Measure for Adolescents Living with HIV (MWM-ALHIV).

An update on mobility assessment of dogs with musculoskeletal disease

Mobility impairments associated with musculoskeletal diseases, such as osteoarthritis and degenerative joint disease, affect approximately 200,000 dogs annually and pose a notable challenge to canine health and welfare. Osteoarthritis causes the remodelling of synovial joints, alongside inflammation and impaired mechanical function which can be extremely debilitating. Secondary osteoarthritis commonly affects dogs and can be exacerbated by previous joint abnormalities, such as patellar luxation or cranial cruciate ligament rupture. Although musculoskeletal diseases can affect dogs of any age, the early subtle signs of gait abnormalities are perhaps missed by owners, thus, dogs may be in the latter stages of osteoarthritis progression when they are presented to veterinarians. Dogs showing subtle signs of gait abnormalities must be presented to veterinary practices for acute diagnosis to prevent long-term deterioration. Musculoskeletal diseases, such as osteoarthritis and degenerative joint disease, are commonly diagnosed via visible radiographic changes. However, veterinarians can use a combination of subjective and objective clinical scoring systems, such as clinical metrology instruments and gait assessment in conjunction with radiography to aid their diagnosis and longitudinal monitoring of musculoskeletal diseases. These scoring systems may be more sensitive to earlier signs of mobility impairments in dogs, ultimately, promoting increased canine health and welfare by enabling pain reduction, improvement of muscle strength and preservation of joint function. Current canine mobility scoring systems available to veterinarians will be discussed in turn throughout this review for implementation into clinical practice.

Translation and measurement properties of the pelvic floor distress inventory-short form (PFDI-20) in Iranian reproductive age women

BACKGROUND

Every year, millions of women worldwide suffer in silence from pelvic floor disorders (PFDs) as an annoying health problem. Despite the high prevalence rate and negative effects of PFDs on the quality of life, the validity and reliability of pelvic floor distress inventory-short form (PFDI-20) has not been confirmed for Iranian women of reproductive age. Hence, this study aimed to determine measurement properties of PFDI-20 among women of reproductive age in Tabriz, Iran.

METHODS

The current study was cross-sectional research that selected 400 women of reproductive age referring to health centers in Tabriz City, by using cluster random sampling from May 2022 to September 2022. Measurement properties of the Persian version of PFDI-20 were determined and evaluated through five steps, including content and face validity within two quantitative and qualitative parts, structural validity by using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and reliability testing through internal consistency, test-retest reliability, and measurement error. Moreover, ceiling and floor effects were investigated.

RESULTS

In this research, CVI (content validity index) and CVR (content validity ratio) of PFDI-20 equaled 0.94 and 0.97, respectively. In addition, the EFA process was applied to 20 items and derived the structure of three factors, which explained 58.15% of the total variance. In CFA phase, values of fit indicators (RMSEA = 0.07, SRMR = 0.07, TLI = 0.97, CFI = 0.99, x2/df = 3.19) confirmed the model validity. To determine reliability, Cronbach's alpha = 0.84; McDonald's omega (95% CI) = 0.84 (0.82 to 0.87) and Intraclass Correlation Coefficient (95% CI) = 0.98 (0.97 to 0.99) were obtained. Also, the SEM was 2.64, and the SDC indicating the smallest individual change was 8.91. Regarding the inventory feasibility, the ceiling effect was not observed in total value and subscales, while the floor effect in the total score of PFDI-20 equaled 24.0. The latter rate equaled 45.8, 38.3, and 50.8 for subscales POPDI-6, CRADI-8, and UDI-6, respectively.

CONCLUSIONS

Persian version of PFDI-20 is a valid and reliable scale used to evaluate PFDs in Iranian women of reproductive age. Healthcare professionals can use this scale to screen PFDs, and researchers can consider it a reliable tool for their studies.

Assessment of the general public's knowledge of atrial fibrillation through social media: a cross-sectional study

BACKGROUND

Early detection and timely treatment of atrial fibrillation (AF) remains pivotal to preventing AF-related complications. Public involvement in recognising potential AF symptoms and managing AF is vital for early detection and treatment of AF.

OBJECTIVE

The aim of the study is to assess the general public's knowledge of AF using an online survey, disseminated via social media.

METHODS

A cross-sectional online survey of the general public was conducted between November to December 2021. The survey's URL was shared on National University Heart Centre, Singapore's official Facebook page. Digital marketing strategies were employed to recruit members of the public. The 27-item survey assessed public's knowledge across five domains: basic information about AF, risk factors of AF, detection of AF, prevention of AF, and management of AF.

RESULTS

The survey involved 620 participants. Approximately two-thirds were between the ages 21 to 40 years (64.5%), female (60%) and had at least a degree (64.7%) as their highest level of education. Participants obtained a mean percentage score of 63.3 ± 26.0 for their AF knowledge. One-way ANOVA was done to examine the associations between the participants' characteristics and their knowledge of AF. There were no statistically significant differences in the AF knowledge scores across the various sociodemographic subgroups.

CONCLUSIONS

Members of the public recruited from Facebook and via digital marketing had moderately good knowledge of AF. However, public awareness pertaining to preventing AF has potential for improvement. The utility of social media in reaching the general public was illustrated through this study.