Development of an instrument based on the theory of planned behavior variables to measure factors influencing Iranian adults' intention to quit waterpipe tobacco smoking

Developing a feasible frailty screening instrument for older people in Sub-Saharan Africa: Exploratory and confirmatory factor analysis

AIM

Frailty screening is gaining significant attention in Sub-Saharan Africa. However, the frailty screening instruments used are developed and validated in high-income countries and may not capture the cultural nuances that are associated with frailty in this region. This study aimed to develop a feasible frailty screening instrument for older people in Sub-Saharan Africa.

METHODS

A cross-sectional secondary data analysis was conducted on a sample of 2860 community-dwelling older people aged 60 years and above from Kenya and Ghana. A 33-item Frailty Index was developed in each dataset using similar age-related deficits. Item-total correlation and exploratory factor analysis were performed on the Kenyan dataset to identify the underlying dimensions. Confirmatory factor analysis was conducted on the Ghanaian dataset to validate the factor structure identified in the exploratory factor analysis.

RESULTS

The initial 33 health deficits were reduced to 17 deficits after excluding items with poor correlation and factor loadings. The final 17-item frailty instrument yielded a robust five-factor structure, including social and emotional relationships, physical mobility and functional independence, psychological well-being, hearing ability, and vision. Confirmatory factor analysis confirmed the factor structure with good model fit indices. Reliability was excellent (>0.70) across the factors in both datasets, highlighting the instrument's suitability for frailty screening in Sub-Saharan Africa.

CONCLUSION

The new frailty instrument has a clear multidimensional structure that captures key aspects of aging in Sub-Saharan Africa. The tool offers a feasible and efficient means of identifying older people at risk for frailty to aid prompt interventions. Geriatr Gerontol Int 2025; ••: ••-••.

Development and psychometric evaluation of a theory of planned behavior model-based instrument for evaluation of determinants of oral health behaviors in mothers of children younger than six years in Iraq

BACKGROUND

The theory of planned behavior (TPB) is one of the most commonly used theories to explain oral health behaviors. To gain a deeper understanding of the determinants of oral health behaviors, we aimed to design and evaluate the psychometrics of a theory of planned behavior model-based instrument for assessing the determinants of oral health behaviors in mothers of children younger than six years in Iraq.

METHODS

Questionnaires and guidelines related to the topic were searched in 2023, and the appropriate items based on the domains of the TPB model were extracted. The items were revised and completed to develop the initial version of the instruments. Face validity and content validity of the instrument were assessed. The content validity index (CVI) and content validity ratio (CVR) were calculated subsequently. The construct validity was examined by confirmatory factor analysis (CFA). Cronbach's alpha, intra-class correlation coefficient (ICC), and percentage of agreement were employed to check the tool's internal consistency and reproducibility reliability. The data were analyzed using SPSS version 25 and Amos software.

RESULTS

The questionnaire had adequate content validity (CVR ≥ 0.75, CVI ≥ 0.75). The percentage of agreement, Kappa, and ICC coefficients were 57.1-95.3%, 0.52-0.89, and 0.43-0.90, respectively. The p-value for ICC was significant in all cases (p < 0.001). For the internal stability of the tool to keep Cronbach's alpha values > 0.7 for all domains, we had to omit three questions from attitude, one from subjective norms, and one from perceived behavioral control. In terms of construct validity, the results were as follows: the Goodness of Fit Index (GFI) was 0.942, the Comparative Fit Index (CFI) was 0.900, the Adjusted Goodness of Fit Index (AGFI) was 0.921, and the Root Mean Square Error of Approximation (RMSEA) was 0.046. These values indicate that the instrument demonstrates appropriate construct validity based on the TPB.

CONCLUSION

The psychometric evaluation of the designed instrument showed that it was a valid and reliable tool in Arabic-speaking countries for determining child-related oral health behaviors in mothers of children under six years old.

Translation, Cultural Adaptation, and Psychometric Properties of Hindi Rosenberg Self-esteem Scale in University Nursing Students

Background

Rosenberg's Self-esteem Scale (RSES) has been widely used without proper translation, cultural adaptation, and testing psychometric properties in Indian studies. The study aimed to translate and culturally adapt the 10-item Rosenberg Self-esteem Scale into Hindi and find psychometric properties.

Material and Methods

We have translated the scale using World Health Organization (WHO) guidelines. Using a cross-sectional design, the translated scale was administered to 143 undergraduate nursing students randomly selected. Content validity index (CVI) was used to assess content validity. Exploratory factor analysis (EFA) with principal axis factoring was used to estimate the construct validity. Cronbach's alpha (α) and intraclass correlation coefficient (ICC) were used to check internal consistency and test re-test reliability.

Results

The S-CVI for the Hindi RSES was 0.98. Kaiser-Meyer-Olkin (KMO) (=0.79), and Bartlette's test for sphericity was significant (χ 2 = 425.06, df = 45, P < .001). EFA extracted three common factors, explaining 62.62% of the total variance. The factor loading of all items suggests a good representation of their underlying construct; all items >0.47, except item 1 (= -0.373). The test re-test, an ICC was r = 0.76 (P < .001), and Cronbach's alpha (α) after deletion of item 1 was 0.81, suggesting excellent reliability.

Conclusion

The Hindi Rosenberg self-esteem scale is a psychometrically tested scale to assess self-esteem in the Hindi-speaking adult population. These findings provide empirical judgment for using the translated Hindi RSES to measure self-esteem among the adult population. The authors recommend verifying the psychometric properties in a more extensive and varied population.

Development and Preliminary Validation of the Chinese Version of the Totally Implantable Venous Access Port Self-Management Behavior Scale (CPTSMBS) for Patients with Cancer

Objective

This study aimed to develop the Chinese version of the totally implantable venous access port (TIVAP) self-management behavior scale for patients with cancer to provide a reliable tool for medical staff to judge patients with TIVAP self-management behavior.

Methods

This study employed a mixed-method exploratory design. The initial scale was developed through a literature review, expert meetings, and two-round Delphi expert consultation. The reliability indicators included retest reliability and Cronbach's alpha coefficients. The validity indicators included content, construct, convergent, discriminant, and criterion validity. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed for the validity analysis; 22 venous therapy experts participated in the Delphi expert consultation. A total of 500 patients were recruited from two third-class A hospitals in Guangdong Province, China, between July 2020 and January 2021 to test reliability and validity. A convenience sampling method was adopted.

Results

The final scale comprised seven dimensions and 29 items. The content validity index (S-CVI) was 0.990. Cronbach's alpha coefficient and retest reliability of the scale were 0.931 and 0.900, respectively. The EFA results indicated a seven-factor structure, accounting for 65.68% of the total data variance. The results of the CFA showed that the CMIN/DF value was 2.348; the root mean square error of approximation value was 0.06; and the values of comparative fit index, incremental fit index, and Tucker-Lewis index were all >0.90. The factor loadings for all the items were >0.50, the composite reliability value was >0.70, and the average variance extracted (AVE) value was >0.50. Moreover, all absolute values of the correlation coefficients were less than the square root of the AVE for the seven dimensions. The total scores between the health promoting lifestyle profile-II revise (HPLP-IIR) and CPTSMBS were positively correlated (r = 0.465, p < 0.01).

Conclusion

The scale demonstrated good reliability and validity and can be applied in clinical practice to evaluate self-management behavior among patients using a TIVAP.

Psychometric evaluation of a new instrument to hookah tobacco smoking-related factors in the Iranian female university students based on the Extended Parallel Process Model

BACKGROUND

The higher prevalence of hookah tobacco smoking (HTS) has become worrisome in women. Thus, it is essential to identify and measure the perceptions associated with this unhealthy behavior as well as the type of response to risk messages to design the effective programs. This study aimed to psychometric evaluation of a new instrument, named the Extended Parallel Process Model-Hookah Tobacco Smoking Questionnaire (EPPM-HTSQ), for female university students.

MATERIAL AND METHODS

This methodological study was conducted in 2019-2020 in central and western Iran. The first version of the instrument was developed with 97 items. Face, Content, and construct validity methods were used to assess the EPPM-HTSQ validity. The data viability for factorability was guided through Kaiser-Meyer-Olkin (KMO) measure of sample adequacy (Values >0.7) and Bartlett's test of Sphericity (P < 0.05). The Exploratory Factor Analysis (EFA) method with varimax rotation and SPSS software was performed to identify the main factors of the questionnaire and interpretable factors. The internal consistency and external reliability were determined. The test-retest was used for evaluating the stability of tools.

RESULTS

During the assessment of the face and content validity 71 items remained in the questionnaire. EFA led to the extraction of nine dimensions: "Focusing on superior rewards," "Response Efficacy," "Perceived physical threat," "Perceived social threat," "Self-efficacy," "Fear control," "Attitude," "Fear," and "Intention" Kaiser-Meyer-Olkin (KMO) test (0.957) and Bartlett's test (P < 0.001). Cronbach's alpha (0.871-0.951) and ICC (0.985-0.998) were approved for scale dimensions.

CONCLUSION

Important findings of the present study were the development and validation of the EPPM-HTSQ for measuring EPPM variables in relation to HTS; introducing a new variable "focusing on superior rewards"; as well as, the new classification of the concept of "perceived threat." The final version of the EPPM-HTSQ is a valid and reliable tool, but it is suggested to be re-evaluated in other studies with different populations and sample sizes.

The development of career planning scale for junior high school students based on cognitive information processing theory

Based on the career theory of Cognitive Information Processing (CIP), we selected scale items from literature reviews and expert guidance. The scale consisted of 28 items with 4 factors (interests, abilities, values, personality). To test the scale's factor structure, we used confirmatory factor analysis (CFA), and the model was modified according to CFA results. The second-order confirmatory factor analysis was applied to the model of the scale to prove the rationality of the total score. The internal consistency were evaluated using Cronbach's alpha coefficients. In addition, the composite reliability (CR) and average variance extraction (AVE) of the scale were also calculated to test the convergent validity. After related analyses, the scale was proved to have good psychometric properties, which can be used to measure junior high school students' career planning level in information technology course from the aspects of interest, ability, values, and personality. The effect of the first-order confirmatory factor analysis model constructed in this study is not ideal. Therefore, on this basis, a second-order confirmatory factor analysis model is constructed in combination with existing literatures, and the rationality of the model is verified through data, which highlights the novelty of this study.

The Intention of Waterpipe Tobacco Smoking by Women in the COVID-19 Pandemic and its Contributing Factors: a Nonparametric Path Analysis

Background

People with waterpipe tobacco smoking (WTS) seem to be more at risk for the serious complications of coronavirus disease 2019 (COVID-19). This study aimed at assessing the behavioral intention (BI) of WTS by women in the COVID-19 pandemic and its contributing factors.

Methods

This cross-sectional descriptive-correlational study was conducted in 2020 (ie, during the COVID-19 pandemic). Participants were 300 women randomly selected through multistage sampling from comprehensive healthcare centers in Khorramabad, Iran. Data collection instrument was a 42-item questionnaire with 4 main subscales, namely knowledge, attitude, differential association, and BI. Data were collected through both online and phone-based methods and were analyzed using non-parametirc path analysis.

Results

The prevalence of WTS among women was 13% (95% CI, 11.06-14.94) and the mean scores of attitude, differential association, and behavioral intention among participants with WTS were significantly higher than participants without WTS (P < 0.001). Moreover, 46.12% (95% CI, 38.12-54.08) of participants with WTS reported intention to quit WTS due to the COVID-19 pandemic and 43.6% (95% CI, 35.66-51.54) of women with WTS and 16.5% (95% CI, 14.20-18.80) of women without WTS believed in the protective effects of WTS against COVID-19. The path analysis model showed that the BI of WTS had a significant inverse relationship with knowledge and a significant direct relationship with attitude and differential association.

Conclusion

This study suggests the need for quality educational and counseling interventions for the general public to correct popular misconceptions about the protective effects of WTS against COVID-19.

[Development of a risk assessment scale and test of its validity and reliability for venous thromboembolism in adult burn patients]

Objective: To develop a venous thromboembolism (VTE) risk assessment scale for adult burn patients and to test its reliability and validity. Methods: The scale research method and multi-center cross-sectional survey method were used. Based on the results of literature analysis method and brain-storming method, the letter questionnaire for experts was formulated. Then 27 experts (9 doctors of burn department, 9 vascular surgeons, and 9 nurses) were performed with two rounds of correspondences by Delphi method, and the reliability of the experts was analyzed. The weight of each item was determined by optimal sequence diagram method and expert importance evaluation to form the VTE Risk Assessment Scale for Adult Burn Patients. A total of 223 adult burn inpatients, who were admitted to 5 tier Ⅲ grade A general hospitals including the Affiliated Hospital of Southwest Medical University, West China Hospital of Sichuan University, the Affiliated Hospital of North Sichuan Medical College, Nanchong Central Hospital, and the Second People's Hospital of Yibin City from October 1st 2019 to January 1st 2020, were selected as respondents by convenience sampling method. The first assessment was performed with the VTE Risk Assessment Scale for Adult Burn Patients within 24 hours of admission of patients, and real-time assessment was performed as the patients' condition and treatment changed. The highest value was taken as the result. Correlation coefficient method and critical ratio method were used for item analysis; Cronbach's α coefficient was used to test the internal consistency of scale; content validity index was used to analyze the content validity of the scale, and receiver's operating characteristic (ROC) curve was drawn to test the predictive validity of the scale. Data were statistically analyzed with chi-square test, Pearson correlation analysis, independent sample t test, and Z test. Results: As four questionnaires in the first round of correspondence were rejected as unqualified, and another 4 experts were selected for the 2 rounds of correspondence. Most of them were aged 41 to 50 years with postgraduate degrees, engaging in the current profession for 11 to 30 years, and all of them had professional titles of associate senior or above. The scale, constructed through literature analysis, group brainstorming, and two rounds of correspondence, includes 3 primary items and 50 secondary items. In the first round of correspondence, the recovery rate of valid questionnaires and the ratio with expert opinions were 85.2% (23/27) and 47.8% (11/23), respectively. In the second round of correspondence, the recovery rate of valid questionnaires and the ratio with expert opinions were 100% (27/27) and 11.1% (3/27), respectively. The average collective authority coefficients of experts were both 0.90 in the 2 rounds of correspondence. The mean values of importance assignment, full score rate, and selection rate above 4 were 4.21, 52.5%, and 77.2%, respectively, in the first round of correspondence, and 4.28, 45.2%, and 85.8%, respectively, in the second round of correspondence. The mean coefficients of variation and the mean value of Kendall's coefficient of harmony for each item were 0.21 and 0.30 in the first round of correspondence, respectively, and 0.16 and 0.36 in the second round of correspondence, respectively. In the first and second rounds of correspondence, the Kendall's coefficients of harmony of 3 primary items (age and underlying diseases, burn injury factors, and burn treatment factors) and total secondary items were statistically significant (with χ2 values of 121.46, 107.09, 116.00, 331.97, 169.97, 152.12, 141.54, and 471.70, P<0.01). The weights of primary items for age and underlying diseases, burn injury factors, and burn treatment factors were 0.04, 0.05, and 0.07, respectively. The weights of secondary items ranged from 0.71 to 0.99, with assigned values of 3 to 6. The total burn area of 223 patients ranged from 1% to 89% total body surface area, and the patients were aged from 19 to 96 years, with the risk assessment score from 0 to 98. Nine patients developed VTE, with a risk assessment score of 41 to 90. The scores of 37 items were significantly positively correlated with the total score of scale (with r values of 0.14 to 0.61, P<0.05 or P<0.01), and the items were retained. There were 36 secondary items with statistically significant differences between the patients in high-score group and low-score group (with Z values of -4.88 to -2.09, t values of -11.63 to -2.09, P<0.05 or P<0.01), and the items were retained. The total Cronbach's α coefficient of scale was 0.88. The total content validity index of scale was 0.95. The optimal threshold of the scale for the diagnosis of VTE was 40, at which the sensitivity was 88.9%, the specificity was 87.4%, the Youden index was 0.87, and the area under the ROC curve was 0.96 (with 95% confidence interval of 0.93 to 0.99, P<0.01). Conclusions: The age and underlying diseases, burn injury factors, and burn treatment factors are the risk factors for VTE in adult burn patients. The VTE risk assessment scale for adult burn patients developed based on these factors has good reliability and validity, and provide good reference value for clinical VTE risk assessment.

More Information, Greater Appreciation: The Correlation between Background Information and Aesthetic Judgment of Tourist Crafts

More information is often correlated with greater appreciation. Drawing on the model of aesthetic appreciation and aesthetic judgment in art psychology, this study aims to investigate changes in tourists' aesthetic judgments of tourist crafts when provided with different background information. Blue calico, an art form created through white pulp dyeing and printing, is an intangible cultural heritage of China. The photographs used in this study illustrate typical examples of blue calicos that are commonly sold in tourist gift shops in Wuzhen, China. Data from a sample of 133 participants (49 women and 84 men) was analyzed using Two-Way Repeated Measures ANOVA. We examined to what extent respondents varied their assessments of the calicos based on author manipulation of background factors, such as commentaries by the artist or details about the production process. We found that tourists' impressions of the aesthetics of blue calicos were predicted by background factors, especially those of tourists who were less interested in high arts. Specifically, blue calicos reported to tourists with names that conveyed an auspicious meaning predicted tourists' assessments of the calicos as more aesthetically pleasing. Explanations of the production process also predicted an increased appreciation of calico aesthetics. Conversely, artists' commentaries were not significantly correlated with an increased aesthetic merit of calicos. Understanding what may affect tourists' assessment of art could help those in the tourism industry market souvenirs to drive sales and enhance tourists' understanding and appreciation of intangible cultural heritage.

The role and importance of perceived risk in medical tourism. Applying the theory of planned behaviour

The main aim of the study was to investigate the role and importance of perceived risk in medical tourism (MT). The research demonstrates that the country of origin and an assessment of the respondents’ own health condition significantly moderates the impact of their attitudes on behavioral intention. The research shows a strong correlation between the risk perceived by the respondents and their attitudes towards MT services. This relationship is significantly moderated by risk awareness, aversion to risk and gender. Additionally, an important factor in the model is the level of satisfaction with medical services in their own country. The survey using a fully structured questionnaire was conducted among young consumers from Jordan, Poland and Turkey. To verify the hypotheses, a multiple regression model with interactions was used.

An Application of the Theory of Planned Behavior to Predict the Intention and Practice of Nursing Staff Toward Physical Restraint Use in Long-Term Care Facilities: Structural Equation Modeling

PURPOSE

Understanding the factors that affect nursing staffs' intention and practice of physical restraint (PR) on older adults help develop restraint-reduction programs. This study aimed to identify the relationship between the Theory of Planned Behavior (TPB) constructs and nursing staffs' practice to use PR in long-term care (LTC) facilities.

PATIENTS AND METHODS

A cross-sectional survey was conducted via convenience sampling among 316 nursing staff in six Chinese LTC facilities. PR-TPB questionnaire and the practice subscale of the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR were used to collect the data. Structural equation modeling (SEM) was used to examine the relationship between variables.

RESULTS

The SEM fit well with the data (χ2/df =1.639, RMSEA = 0.045, CFI= 0.955, GFI=0.945). Attitude (β=0.536, P<0.001) and perceived behavioral control (PBC) (β=0.139, P<0.05) predicted intention (R2 =0.359). PBC was a significant predictor of practice, with R2 accounting for 0.151.

CONCLUSION

TPB provided useful insight into better understanding nursing staffs' PR practices, although it did not support all the TPB principles significantly. Prospective studies may be conducted to design and implement multi-component interventions based on TPB and explore the effectiveness of PR reduction in LTC facilities in-depth.