Evaluation of the Psychometric Properties of the Musculoskeletal Health Questionnaire (MSK-HQ) in a Population of Professional Basketball Players: A Cross-Sectional Study

Background and Objective: Musculoskeletal disorders affect a large portion of the population worldwide. The musculoskeletal health questionnaire is a helpful tool for assessing the health state of patients with these disorders. The primary goal of this study is to evaluate the psychometric properties of the MSK_HQ-IT in a population of professional basketball players. The secondary aim is to assess the prevalence of musculoskeletal disorders. Material and Methods: The study was performed from September to October 2022. The questionnaire was completed using an online or paper form, to which personal data were collected. Data were collected by submitting a translated version of the musculoskeletal health questionnaire directly to professional athletes. Results: A total of 63 basketball players were recruited. Regarding functional limitations, the body parts mentioned by the sample were the left ankle (23.8%) and the right ankle (17.5%), followed by the lumbar column and right hip (15.9%). Regarding pain, the data are more homogeneous, with a distribution in line with functional limitations. A peak of pain was perceived in the left foot, with a mean score of 4. Cronbach's alpha showed a value of 0.85. Conclusions: The musculoskeletal health questionnaire shows promising results in evaluating the health state of a population of professional athletes. Further studies are needed to enlarge the sample and possibly open it to more categories of professional sports.

Cross-Cultural Adaptation and Validation of the Malay-Translated Version of the Food Neophobia Scale for Malaysian Young Adults

The Food Neophobia Scale (FNS) is a research instrument, originally developed in English, to assess an individual's level of food neophobia. However, it has not yet been translated and validated for Malaysians. Therefore, we aimed to translate and validate a Malay-translated version of the FNS. Respondents were 200 young adults (mostly females, 73%; and students, 82.0%; M age = 22.3 years, SD = 2.3). We first translated the FNS into Malay using the forward-backward translation method, and a panel of nutrition and dietetics experts then reviewed it for item relevance, clarity, simplicity, and ambiguity. The translated FNS suggested good content validity with an item-level content validity index (I-CVI) > .8, a scale-level content validity index (S-CVI)/average = .8 and a S-CVI/universal agreement = .96. Principal component analysis revealed a two-factor model: (i) willingness and trust; and (ii) rejection and fear. Cronbach's alpha for the Malay-translated FNS was .808, demonstrating high internal consistency and reliability among young Malaysian adults. Future investigators can now use this Malay-translated FNS instrument to determine levels of food neophobia among Malaysians.

Maximum Augmented Empirical Likelihood Estimation of Categorical Marginal Models for Large Sparse Contingency Tables

Categorical marginal models (CMMs) are flexible tools for modelling dependent or clustered categorical data, when the dependencies themselves are not of interest. A major limitation of maximum likelihood (ML) estimation of CMMs is that the size of the contingency table increases exponentially with the number of variables, so even for a moderate number of variables, say between 10 and 20, ML estimation can become computationally infeasible. An alternative method, which retains the optimal asymptotic efficiency of ML, is maximum empirical likelihood (MEL) estimation. However, we show that MEL tends to break down for large, sparse contingency tables. As a solution, we propose a new method, which we call maximum augmented empirical likelihood (MAEL) estimation and which involves augmentation of the empirical likelihood support with a number of well-chosen cells. Simulation results show good finite sample performance for very large contingency tables.

Validation of the Cantonese version of the Traditional Chinese Medicine (TCM) Body constitution Questionnaire in elderly people

BACKGROUND

The Traditional Chinese Medicine (TCM) Body Constitution Questionnaire (For Elderly People) (TCMECQ) is a patient-reported outcome questionnaire developed in Mandarin in 2013 to differentiate the body constitutions of the elderly aged 65 and above. Considering the cultural and linguistic differences between Mainland China and Hong Kong (HK) Special Administrative Region, the TCMECQ was translated into Cantonese following "back translation" policy and validated in proper process.

METHODS

Ten Chinese Medicine Practitioners (CMPs) and 30 senior citizens aged 65 or above were recruited to evaluate the first version of the Traditional Chinese Medicine Body Constitution Questionnaire (For Elderly People) (Cantonese version) (TCMECQ-C). Based on their comments, the second version was developed and discussed in the panel meeting to form the third version, validated the third version on 270 recruited seniors. Based on the validation results, a panel of 5 experts finalized the Questionnaire as the final version. The TCMECQ-C developers finalized the Questionnaire as the validated endorsed third version (i.e. final version).

RESULTS

The item-level content validity index of most items of the TCMECQ-C (First Version) were ranging from 0.80 to 1.00 in terms of clarity, relevance and appropriateness. Factor loadings of Qi-deficiency Constitution ranging from 0.37 to 0.71, Yang-deficiency Constitution ranging from 0.36 to 0.65, Yin-deficiency Constitution ranging from 0.36 to 0.65, and Stagnant Qi Constitution ranging from 0.68 to 0.82. The chi-squared degree-of-freedom ratio was 2.13 (928.63/436), Goodness-of-Fit Index (0.83), Adjusted Goodness-of-Fit Index (0.79), Normed Fit Index (0.66), Comparative Fit Index (0.78), Incremental Fit Index (0.78), Relative Fit Index (0.61) and Tucker-Lewis Index (0.75), and Root Mean Square Error of Approximation (0.07) and Standardized Root Mean Square Residual (0.07), implied acceptable Confirmatory Factor Analysis model fit of the overall scale. A Pearson correlation coefficient (r) showed the sufficient convergent validity for excessive subscales (Phlegm-dampness Constitution and Dampness-heat Constitution with r = 0.35, p < 0.01). Cronbach's alpha coefficient ranged from 0.56 to 0.89, including Qi-deficiency Constitution (0.67), Yang-deficiency Constitution (0.84), Yin-deficiency Constitution (0.59), Stagnant Blood Constitution (0.56), Stagnant Qi Constitution (0.89), Inherited Special Constitution (0.76) and Balanced Constitution (0.73), indicating acceptable internal consistency for subscales. The intra-class correlation coefficients of the TCMECQ-C ranged from 0.70 to 0.87 (p < 0.001), indicating moderate to good test-retest reliability.

CONCLUSION

TCMECQ-C is a valid and reliable questionnaire for assessing the body constitution in Cantonese elderly.

Measurement of Prosocial Tendencies: Meta-Analysis of the Generalization of the Reliability of the Instrument

The Prosocial Tendencies Measure (PTM) and its revised version (PTM-R) are used internationally to measure prosocial behaviors in different life situations. To obtain accumulated evidence of the report and the reliability of its scores, a meta-analysis of the reliability of internal consistency was performed. The databases of Web of Science (WoS) and Scopus were reviewed and all the studies that applied it from 2002 to 2021 were selected. Results: Only 47.9% of the studies presented the index of reliability of PTM and PTM-R. The meta-analytic results of the reliability report of the subscales that the PTM and the PTM-R have in common were: Public 0.78 (95% CI: 0.76-0.80), Anonymous 0.80 (95% CI: 0.79-0.82), Dire 0.74 (95% CI: 0.71-0.76), and Compliant 0.71 (95% CI: 0.72-0.78). Each one of them presents high levels of heterogeneity derived from the gender of the participants (percentage of women), the continent of the population, the validation design, the incentive to participate, and the form of application. It is concluded that both versions present acceptable reliabilities to measure prosocial behavior in different groups and situations, as adolescents and young people, but their clinical use is discouraged.

A systematic review of the psychometric properties of Quebec user evaluation of satisfaction with assistive technology (QUEST)

PURPOSE

The aim of this systematic review was to evaluate the psychometric properties of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST).

MATERIALS AND METHODS

Searches were conducted in August 2021 on four electronic databases: MEDLINE, CINAHL, Scopus, and Web of Science. Eligible papers included cross-sectional validation studies evaluating the psychometric properties of all QUEST versions. Cronbach's alpha, intraclass correlation coefficient, and comparison tools were reported. Study quality and risk of bias were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

RESULTS

Nineteen studies were included in this systematic review. Results showed that the QUEST and QUEST 2.0 were available in 10 languages, and most validation studies analysed this tool in patients using mobility devices in various clinical conditions. One article analysed the child version (QUEST 2.1) in English. The most analysed psychometric property was Cronbach's alpha for internal consistency in 14 out of 19 studies, with values ranging between 0.74 and 0.79. Overall, 17 out of 19 studies were of adequate quality, though responsiveness was never studied.

CONCLUSION

Our systematic review showed that the QUEST and its subsequent versions are reliable and valid measurement instruments to evaluate satisfaction in patients with different disabilities using various assistive technologies. This study provides useful information on the instrument's psychometric properties in different populations and cultures.IMPLICATION FOR REHABILITATIONThis systematic review verify the appropriateness of the "Quebec User Evaluation of Satisfaction with Assistive Technology" (QUEST), as a measure of satisfaction;This systematic review allow clinicians to keep up to date with new versions of the tool, new countries of validation and population in which it can be used.This study supports clinicians in making informed decisions when choosing assessment tools.

Linkage of job ranks and personality traits with augmented stress: a study on Indian marine engineers in the context of the COVID-19 pandemic

BACKGROUND

Marine engineering is a profession that affects a high level of physical and psychological stress. Such a high level of stress was further aggravated during the coronavirus disease 2019 (COVID-19) pandemic. On the other hand, personality traits and perceived stress are linked with each other, while job ranks also influence stress levels among employees. However, very few clinical studies are available on this mechanism in seafarers. This study explores the hidden area through the collection of cross-sectional data.

MATERIALS AND METHODS

Big Five personality traits instrument, along with a stress augmentation questionnaire, were administered among 280 Indian marine engineers across job ranks who have sailed prior to and during the COVID-19 pandemic. The collected data were analysed using Kruskal-Wallis test and structural equation modelling.

RESULTS AND CONCLUSIONS

The analysis reveals significant differences among Indian marine engineers across their job ranks towards their perception of augmented stress levels. It also indicates that, except for extraversion, personality traits have linkages with levels of augmented stress among Indian marine engineers during the pandemic.

Cronbach's alpha in mathematics education research: Its appropriateness, overuse, and alternatives in estimating scale reliability

Critiques of coefficient alpha as an estimate of scale reliability are widespread in the literature. However, the continuous overuse of this statistic in mathematics education research suggests a disconnection between theory and practice. As such, this article argues, in a non-technical way, for the limited usefulness of coefficient alpha, its overuse, and its alternatives in estimating scale reliability. Coefficient alpha gives information only about the degree of the interrelatedness of a set of items that measures a construct. Contrary to the widely circulated misconceptions in mathematics education research, a high coefficient alpha value does not mean the instrument is reliable, and it does not imply the instrument measures a single construct. Coefficient alpha can only be dependable as an estimate of reliability under verifiable and restrictive conditions. I expose these conditions and present steps for their verification in empirical studies. I discuss some alternatives to coefficient alpha with references to non-technical articles where worked examples and programming codes are available. I hope this exposition will influence the practices of mathematics education researchers regarding estimation of scale reliability.

Bayesian Estimation of Single-Test Reliability Coefficients

Popular measures of reliability for a single-test administration include coefficient α, coefficient λ₂, the greatest lower bound (glb), and coefficient ω. First, we show how these measures can be easily estimated within a Bayesian framework. Specifically, the posterior distribution for these measures can be obtained through Gibbs sampling - for coefficients α, λ₂, and the glb one can sample the covariance matrix from an inverse Wishart distribution; for coefficient ω one samples the conditional posterior distributions from a single-factor CFA-model. Simulations show that - under relatively uninformative priors - the 95% Bayesian credible intervals are highly similar to the 95% frequentist bootstrap confidence intervals. In addition, the posterior distribution can be used to address practically relevant questions, such as "what is the probability that the reliability of this test is between .70 and .90?", or, "how likely is it that the reliability of this test is higher than .80?" In general, the use of a posterior distribution highlights the inherent uncertainty with respect to the estimation of reliability measures.

Development and validation of Daycare Anesthesia Satisfaction (DAS) questionnaire to assess patient's satisfaction with daycare anesthesia

Background and Aims

The patient's satisfaction can be considered as a unique indicator of the quality of healthcare provided. The advantages of patient satisfaction surveys rely heavily on using standardized, psychometrically tested data collection approaches. There is a lack of a proper, psychometrically robust instrument to evaluate the patient's perioperative satisfaction following all types of anesthesia in daycare facility. Hence, this study aimed to develop a Daycare Anesthesia Satisfaction (DAS) questionnaire to measure the patient's satisfaction with the experience of daycare anesthesia services.

Material and Methods

A preliminary pool of questions was generated from research literature, expert consultations, and pilot tested on patients. The internal consistency and reliability of the preliminary questionnaire was evaluated by calculating Cronbach's alpha, intraclass correlation coefficient (ICC), and feasibility with the formation of a final 27-item questionnaire. In the next step, the questionnaire was distributed to a larger group of patients in the phase 2 of postanesthesia care unit (PACU). The results were subjected to confirmatory factor analysis to determine the goodness of fit of the questions under each domain.

Results

The internal consistency of the preliminary questionnaire as measured by Cronbach's alpha was 0.929. Intraclass correlation coefficient measured for test-retest reliability was 0.97 (95% confidence interval [CI]). Feasibility was confirmed, as 75% of the patients could fill the questionnaire within 15 min. In the second step of confirmatory factor analysis (CFA), questionnaire has been shown to have goodness of fit with Bentler's comparative fit index (CFI) of 0.99 that is greater than the suggested cutoff of 0.90. The root mean square error of approximation (RMSEA) of 0.09 is also close to the suggested cutoff of 0.06.

Conclusion

This systematically developed and validated, 27-item DAS questionnaire can be tentatively recommended to be used to measure patient's satisfaction with day care anesthesia services following all types of surgical procedures, under various types of anesthesia.

KR20 and KR21 for Some Nondichotomous Data (It's Not Just Cronbach's Alpha)

This article presents some equivalent forms of the common Kuder-Richardson Formula 21 and 20 estimators for nondichotomous data belonging to certain other exponential families, such as Poisson count data, exponential data, or geometric counts of trials until failure. Using the generalized framework of Foster (2020), an equation for the reliability for a subset of the natural exponential family have quadratic variance function is derived for known population parameters, and both formulas are shown to be different plug-in estimators of this quantity. The equivalent Kuder-Richardson Formulas 20 and 21 are given for six different natural exponential families, and these match earlier derivations in the case of binomial and Poisson data. Simulations show performance exceeding that of Cronbach's alpha in terms of root mean square error when the formula matching the correct exponential family is used, and a discussion of Jensen's inequality suggests explanations for peculiarities of the bias and standard error of the simulations across the different exponential families.

The Youth Attitudes about Vaccines (YAV-5) scale: adapting the parent attitudes about childhood vaccines short scale for use with youth in German, French, and Italian in Switzerland, exploratory factor analysis and mokken scaling analysis

No validated measures of vaccine hesitancy (VH) for youth vaccination currently exist. We adapted the Parent Attitudes about Childhood Vaccines survey (PACV-15) for use in youth to create the version Youth Attitudes about Vaccines survey (YAV-14 and YAV-5), then translated it into three languages (German, French, and Italian). We administered the YAV-14 to 1,003 youth aged 15-26 years in Switzerland. We used exploratory factor analysis and Mokken scale analysis to explore the psychometric properties, Cronbach's alpha to investigate the reliability for the YAV-14 and the YAV-5, but we only report results of the YAV-5 analysis here. We determined construct validity by logistic regression of the association between youth VH as measured by the YAV-5 and non-receipt of the first human papillomavirus (HPV) vaccine dose. EFA produced a single scale in German and French while two factors were obtained in Italian. All language versions fit the Mokken scale models with medium-scale strength. There was a significant association between VH and HPV vaccine non-receipt for the full sample (odds ratio (OR); 1.93, 95% confidence interval (CI); 1.31-2.85). Language-stratified analyses found a significant association between VH and non-immunization in the German-language sample. Our results demonstrate that the German version of YAV-5 is a valid and reliable scale for identifying vaccine hesitant youth regardless of sex, and the French version is a valid and reliable scale for identifying vaccine hesitant female youth. Further validation is needed for Italian and French-speaking male youth.

The adaptation of Turkish health literacy scale for literate Syrian adult refugees living in Turkey: a reliability-validity study

Background

Turkey hosts the world’s largest refugee population of whom 3.5 million are Syrians and this population has been continuously growing since the year 2011. This situation causes various problems, mainly while receiving health-care services. In planning the migrant health-care services, for the policy makers of host countries, health literacy level of migrants is an important measure. Determination of health literacy level of Syrian refugees in Turkey would be supportive for planning some interventions to increase health-care service utilization, as well as health education and health communication programs. An “original health literacy scale” for 18–60 years of age Turkish literate adults (Hacettepe University Health Literacy Scale-HLS) was developed to be used as a reference scale in 2018. Since it would be useful to compare the health literacy levels of Turkish adults with Syrian adult refugees living in Turkey with an originally developed scale, in this study, it was aimed to adapt the HLS-Short Form for Syrian refugees.

Methods

This methodological study was carried out between the years 2019–2020 in three provinces of Turkey where the majority of Syrians reside. The data was collected by pre-trained, Arabic speaking 12 interviewers and three supervisors via a questionnaire on household basis. At first, the original Scale and questionnaire were translated into Arabic and back translated into the original language. The questionnaire and the Scale were pre-tested among 30 Syrian refugees in Ankara province. A total of 1254 refugees were participated into the main part of the study; 47 health-worker participants were excluded from the validity-reliability analysis. Confirmatory factor analysis (CFA) was performed. Cronbach’s alpha and Spearman–Brown coefficients were calculated.

Results

Of the participants, 52.9% was male; 26.1% had secondary education level or less; almost half of them had moderate economic level; 27.5% could not speak Turkish. The Cronbach’s Alpha was 0.75, Spearman–Brown Coefficient was 0.76; RMSEA = 0.073, CFI = 0.93, TLI = 0.92 and GFI = 0.95 for the Scale. The Cronbach’s Alpha was 0.76, Spearman–Brown Coefficient was 0.77; RMSEA = 0.085, CFI = 0.93, TLI = 0.91 and GFI = 0.95 for self-efficacy part.

Conclusion

In conclusion, the adapted HLS would be a reliable instrument to evaluate the health-literacy level of Syrian refugees living in Turkey and could allow for a comparison of the host country’s health literacy level to that of the refugees using the same scale.

Application of the Parent Attitudes about Childhood Vaccines (PACV) survey in three national languages in Switzerland: Exploratory factor analysis and Mokken scale analysis

Vaccine hesitancy (VH) is a complex and context-specific phenomenon that is linked to under-immunization and poses challenges to immunization programs. The Parent Attitudes about Childhood Vaccines (PACV) is an instrument developed to measure VH. We translated the PACV into three languages (German, French and Italian) and administered it to 1388 Swiss parents. We used exploratory factor analysis (EFA) to confirm the scale sub-domains, Cronbach's alpha to assess internal consistency reliability, and Mokken scale analysis (MSA), to explore unidimensionality of each language version. We determined to construct validity by linking parental PACV score to children's immunization status for the first dose of measles vaccine. For the 15-item PACV, EFA extracted three sub-domains in German and French and four sub-domains in Italian. Cronbach's alpha was >0.8 across the three languages, and MSA produced a 13-item German, 14-item French, and 11-item Italian PACV. EFA and MSA of the short version PACV extracted a single factor and scale with Cronbach's alpha >0.7 in all three language versions. VH was significantly associated with non-timely receipt of the first dose of measles in all languages (odds ratio of 20.7, 21.3, and 8.3 for German, French, and Italian languages, respectively). The translated and revised PACV-15 versions are valid and reliable instruments for VH measurement. The structure and reliability of the short version of the PACV was as good as the long version. Our results suggest that the PACV can be used to measure parental VH outside the US in the validated languages.

Design and validation of a questionnaire in Spanish language for software usability evaluation

BACKGROUND

Usability is an essential characteristic of software development, which needs to be evaluated mainly through questionnaires. However, the questionnaires available in Spanish are limited and not available for most software's developers and users.

OBJECTIVES

This work aimed to design and validate a new questionnaire to evaluate software usability, considering the characteristics of efficiency, effectiveness, and satisfaction as defined by the International Standards Organization.

METHODS

The Software Usability Assessment Questionnaire or SUAQ in Spanish language was designed and validated using Kendall's coefficient, Cronbach's Alpha, Factorial Analysis and Scree test.

RESULTS

The questionnaire's validation was carried out by five experts through an evaluation of the clarity, coherence, and relevance of the proposed items. Once the questionnaire was administered to 95 participants, an overall reliability value of Cronbach's alpha of 0.839 was obtained. The factorial analysis is viable since a value of 0.757 was found in the Kaiser-Meyer-Olkin (KMO) test, and a significant value was obtained in Bartlett's sphericity test.

CONCLUSIONS

The proposed questionnaire proved to be valid and reliable, and therefore, suitable to evaluate software usability in the Spanish language.

Clarifying the Effect of Test Speededness

In the context of high-stakes tests, test takers who do not have enough time to complete a test rush toward the end and may engage in speeded behavior when tests do not penalize guessing. Using mathematical derivations and simulations, previous research showed that random guessing responses should attenuate interitem correlations, and therefore, decrease estimates of reliability. Meanwhile, other researchers showed that random guessing could in fact inflate reliability estimates using real data. We provide analytical derivations on how speededness could affect correlations between two dichotomous items in multiple ways, depending on the manifestation and prevalence of test speededness. Furthermore, we provide two simulation studies that evaluate the magnitude of impact of test speededness on interitem correlations and Cronbach's alpha. We found that the impact of test speededness can vary between item pairs and that it depends on the manifestation of test speededness and item level characteristics. Furthermore, speeded responses will, in general, attenuate or not affect reliability estimates, depending on the prevalence of such responses and conceptual interpretation of speeded responses. Implications of the findings are discussed.

Validation of a diabetes knowledge test for Indian children, adolescents and young adults with type 1 diabetes mellitus

INTRODUCTION

Diabetes knowledge has a large impact on glycemic control. There is a pressing need for creation of validated tests of knowledge for different ethnic groups.

OBJECTIVE

To create and validate a diabetes knowledge test (DKT) for young Indians with type 1 diabetes mellitus (T1DM).

METHODS

We created a 34 item Hindi language DKT, with basic (19-questions) and advanced (15-questions) components. It was administered to 77 consecutive patients who had previously received in-hospital diabetes education. We hypothesized that the test scores would be higher for patients residing in urban regions, for patients with higher maternal education, and those with lower HbA1c. Cronbach's alpha (α) was used to calculate the test reliability.

RESULTS

The DKT score was significantly higher in families with higher (>class 12th) maternal formal education compared with lower [70.0 (95% C.I. 67.2-73.5) vs 54.2 (95% C.I. 44.0-57.3), p<0.001] and urban residence compared with rural [68.5 (95% C.I. 63.4-70.6) vs 54.5 (95% C.I. 42.5-61.7), p<0.001]. It had negative correlation with HbA1c (r=-0.268, p=0.019). The Cronbach's α was 0.87 for the entire test, and for the basic and advanced components was 0.78 and 0.74 respectively.

CONCLUSION

The DKT India is a valid and reliable instrument to evaluate diabetes knowledge in Hindi speaking Indian children, adolescents and young adults with T1DM.

SANRA-a scale for the quality assessment of narrative review articles

Background

Narrative reviews are the commonest type of articles in the medical literature. However, unlike systematic reviews and randomized controlled trials (RCT) articles, for which formal instruments exist to evaluate quality, there is currently no instrument available to assess the quality of narrative reviews. In response to this gap, we developed SANRA, the Scale for the Assessment of Narrative Review Articles.

Methods

A team of three experienced journal editors modified or deleted items in an earlier SANRA version based on face validity, item-total correlations, and reliability scores from previous tests. We deleted an item which addressed a manuscript’s writing and accessibility due to poor inter-rater reliability. The six items which form the revised scale are rated from 0 (low standard) to 2 (high standard) and cover the following topics: explanation of (1) the importance and (2) the aims of the review, (3) literature search and (4) referencing and presentation of (5) evidence level and (6) relevant endpoint data. For all items, we developed anchor definitions and examples to guide users in filling out the form. The revised scale was tested by the same editors (blinded to each other’s ratings) in a group of 30 consecutive non-systematic review manuscripts submitted to a general medical journal.

Results

Raters confirmed that completing the scale is feasible in everyday editorial work. The mean sum score across all 30 manuscripts was 6.0 out of 12 possible points (SD 2.6, range 1–12). Corrected item-total correlations ranged from 0.33 (item 3) to 0.58 (item 6), and Cronbach’s alpha was 0.68 (internal consistency). The intra-class correlation coefficient (average measure) was 0.77 [95% CI 0.57, 0.88] (inter-rater reliability). Raters often disagreed on items 1 and 4.

Conclusions

SANRA’s feasibility, inter-rater reliability, homogeneity of items, and internal consistency are sufficient for a scale of six items. Further field testing, particularly of validity, is desirable. We recommend rater training based on the “explanations and instructions” document provided with SANRA. In editorial decision-making, SANRA may complement journal-specific evaluation of manuscripts—pertaining to, e.g., audience, originality or difficulty—and may contribute to improving the standard of non-systematic reviews.

A Review on Sample Size Determination for Cronbach's Alpha Test: A Simple Guide for Researchers

Background

Reliability studies are commonly used in questionnaire development studies and questionnaire validation studies. This study reviews the sample size guideline for Cronbach’s alpha test.

Methods

Manual sample size calculation using Microsoft Excel software and sample size tables were tabulated based on a single coefficient alpha and the comparison of two coefficients alpha.

Results

For a single coefficient alpha test, the approach by assuming the Cronbach’s alpha coefficient equals to zero in the null hypothesis will yield a smaller sample size of less than 30 to achieve a minimum desired effect size of 0.7. However, setting the coefficient of Cronbach’s alpha larger than zero in the null hypothesis could be necessary and this will yield larger sample size. For comparison of two coefficients of Cronbach’s alpha, a larger sample size is needed when testing for smaller effect sizes.

Conclusions

In the assessment of the internal consistency of an instrument, the present study proposed the Cronbach’s alpha’s coefficient to be set at 0.5 in the null hypothesis and hence larger sample size is needed. For comparison of two coefficients’ of Cronbach’s alpha, justification is needed whether testing for extremely low and extremely large effect sizes are scientifically necessary.

The Effects of Vignette Scoring on Reliability and Validity of Self-Reports

The research presented in this article combines mathematical derivations and empirical results to investigate effects of the nonparametric anchoring vignette approach proposed by King, Murray, Salomon, and Tandon on the reliability and validity of rating data. The anchoring vignette approach aims to correct rating data for response styles to improve comparability across individuals and groups. Vignettes are used to adjust self-assessment responses on the respondent level but entail significant assumptions: They are supposed to be invariant across respondents, and the responses to vignette prompts are supposed to be without error and strictly ordered. This article shows that these assumptions are not always met and that the anchoring vignette approach leads to higher Cronbach's alpha values and increased correlations among adjusted variables regardless of whether the assumptions of the approach are met or violated. Results suggest that the underlying assumptions and effects of the anchoring vignette approach should be carefully examined as the increased correlations and reliability estimates can be observed even for response variables that are independent random draws and uncorrelated with any other variable.

Reliability and acceptability of the Multiple Sclerosis Quality of Life-29 questionnaire in an English-speaking cohort

BACKGROUND

Multiple Sclerosis Quality-of-Life Questionnaire-54 (MSQoL-54) is a disease-specific instrument for assessing health-related quality of life (HRQoL). Due to the number of items, the time taken to complete it is long. A shorter 29-item version, Multiple Sclerosis Quality-of-Life Questionnaire-29 (MSQoL-29) is yet to be evaluated in English.

OBJECTIVE

To assess reliability and acceptability of English version of MSQoL-29.

METHODS

Among 100 participants with MS who first completed both MSQoL-54 and MSQoL-29, 91 completed MSQoL-29 after 4-8 weeks. We looked for internal consistency (Cronbach's alpha), acceptability, reliability (intraclass correlation coefficients (ICCs)) and agreement (Bland-Altman plots).

RESULTS

ICCs were strongly positive between MSQoL-54 and MSQoL-29 (Physical Health Composite (PHC) -ICC = 0.914, confidence interval (CI) = 0.872-0.942; Mental Health Composite (MHC) - ICC = 0.875, CI = 0.814-0.916) and between the two MSQoL-29 (PHC - ICC = 0.970, CI = 0.955-0.980; MHC - ICC = 0.937, CI = 0.904-0.958). On Bland-Altman plots, the MSQoL-29 scores of 95% of participants during two visits were within the limits of agreement (LOAs). Time taken to complete MSQoL-29 was 7.2 ± 2.9 minutes and MSQoL-54 was 19.79 ± 5.4 minutes (p = 0.0001).

CONCLUSION

MSQoL-29 has good test-retest reliability in English-speaking population and was quicker to complete.

Resampling-Based Inference Methods for Comparing Two Coefficients Alpha

The two-sample problem for Cronbach's coefficient [Formula: see text], as an estimate of test or composite score reliability, has attracted little attention compared to the extensive treatment of the one-sample case. It is necessary to compare the reliability of a test for different subgroups, for different tests or the short and long forms of a test. In this paper, we study statistical procedures of comparing two coefficients [Formula: see text] and [Formula: see text]. The null hypothesis of interest is [Formula: see text], which we test against one-or two-sided alternatives. For this purpose, resampling-based permutation and bootstrap tests are proposed for two-group multivariate non-normal models under the general asymptotically distribution-free (ADF) setting. These statistical tests ensure a better control of the type-I error, in finite or very small sample sizes, when the state-of-affairs ADF large-sample test may fail to properly attain the nominal significance level. By proper choice of a studentized test statistic, the resampling tests are modified in order to be valid asymptotically even in non-exchangeable data frameworks. Moreover, extensions of this approach to other designs and reliability measures are discussed as well. Finally, the usefulness of the proposed resampling-based testing strategies is demonstrated in an extensive simulation study and illustrated by real data applications.

Validation of a questionnaire for ICU nurses to assess knowledge, attitudes and behaviours towards medication errors

AIM

Medication errors are dangerous for the patients in an intensive care unit (ICU). Little is known about knowledge, attitudes and professional behaviour of nurses towards prevention of errors and clinical risk management can reduce errors during the preparation and administration phases of intravenous drugs. In this study we have evaluated the reliability and validity of the questionnaire to examine knowledge, attitudes and professional behaviour of ICU nurses.

METHODS

Reliability analysis was tested and content validity evaluated using Cronbach's alpha to check internal consistency with the intention to obtain no misunderstanding with the results. The questionnaire composed of seven sections for a total of 36 items, was administrated among ICU nurses working in a university hospital in Rome, Italy. Data were collected in October 2015. Statistical analysis was performed with the statistical software for Windows SPSS, version 22.0.

RESULTS

The questionnaire was administered to 30 ICU nurses' in anonymous, voluntary and self-administered form with close-ended type of questions, except for the socio-demographic characteristics. The highest value of Cronbach's alpha resulted on 19 items (alpha= 0,776) meaning that the questionnaire has a satisfactory internal validity. The study highlights that nurses (80%) are aware that appropriate knowledge on the calculation of medication's dose is essential to reduce medication errors during the phase of drugs'preparation.

CONCLUSION

This study demonstrated that a short version of the questionnaire has very good reliability properties in the study and this needs to be taken into account for future studies.

We need more replication research - A case for test-retest reliability

Following debates in psychology on the importance of replication research, we have also started to see pleas for a more prominent role for replication research in medical education. To enable replication research, it is of paramount importance to carefully study the reliability of the instruments we use. Cronbach's alpha has been the most widely used estimator of reliability in the field of medical education, notably as some kind of quality label of test or questionnaire scores based on multiple items or of the reliability of assessment across exam stations. However, as this narrative review outlines, Cronbach's alpha or alternative reliability statistics may complement but not replace psychometric methods such as factor analysis. Moreover, multiple-item measurements should be preferred above single-item measurements, and when using single-item measurements, coefficients as Cronbach's alpha should not be interpreted as indicators of the reliability of a single item when that item is administered after fundamentally different activities, such as learning tasks that differ in content. Finally, if we want to follow up on recent pleas for more replication research, we have to start studying the test-retest reliability of the instruments we use.

Reliability and validity of general health questionnaire (GHQ-12) for male tannery workers: a study carried out in Kanpur, India

BACKGROUND

The purpose of this study was to test the reliability, validity and factor structure of GHQ-12 questionnaire on male tannery workers of India. We have tested three different factor models of the GHQ-12.

METHODS

This paper used primary data obtained from a cross-sectional household study of tannery workers from Jajmau area of the city of Kanpur in northern India, which was conducted during January-June, 2015, as part of a doctoral program. The study covered 286 tannery workers from the study area. An interview schedule containing GHQ-12 was used for tannery workers who had completed at least 1 year at their present occupation preceding the survey. To test reliability, Cronbach's alpha test was used. The convergent test was used for validity. Confirmatory factor analysis was used to compare three factor structures for the GHQ-12.

RESULTS

A total of 286 samples were analyzed in this study. The mean age of the tannery workers in this study was 38 years (SD = 1.42). We found the alpha coefficient to be 0.93 for the complete sample. The value of alpha represents the acceptable internal consistency for all the groups. Each item of scale showed almost the same internal consistency of 0.93 for the male tannery workers. The correlation between factor 1 (Anxiety and Depression) and factor 2 (Social Dysfunction) was 0.92. The correlation between factor 1 (Anxiety and Depression) and factor 3 (Loss of confidence) was the highest 0.98. Comparative fit index (CFI) estimate best-fitted for model-III that gave the CFI value 0.97. The SRMR indicator gave the lowest value 0.031 for the model-III.

CONCLUSIONS

The findings suggest that the Hindi version of GHQ-12 is a reliable and valid tool for measuring psychological distress in male tannery workers of Kanpur city, India. Study found that the model proposed by the Graetz was the best fitted model for the data.

Face Perception and Test Reliabilities in Congenital Prosopagnosia in Seven Tests

Congenital prosopagnosia, the innate impairment in recognizing faces, is a very heterogeneous disorder with different phenotypical manifestations. To investigate the nature of prosopagnosia in more detail, we tested 16 prosopagnosics and 21 controls with an extended test battery addressing various aspects of face recognition. Our results show that prosopagnosics exhibited significant impairments in several face recognition tasks: impaired holistic processing (they were tested amongst others with the Cambridge Face Memory Test (CFMT)) as well as reduced processing of configural information of faces. This test battery also revealed some new findings. While controls recognized moving faces better than static faces, prosopagnosics did not exhibit this effect. Furthermore, prosopagnosics had significantly impaired gender recognition—which is shown on a groupwise level for the first time in our study. There was no difference between groups in the automatic extraction of face identity information or in object recognition as tested with the Cambridge Car Memory Test. In addition, a methodological analysis of the tests revealed reduced reliability for holistic face processing tests in prosopagnosics. To our knowledge, this is the first study to show that prosopagnosics showed a significantly reduced reliability coefficient (Cronbach’s alpha) in the CFMT compared to the controls. We suggest that compensatory strategies employed by the prosopagnosics might be the cause for the vast variety of response patterns revealed by the reduced test reliability. This finding raises the question whether classical face tests measure the same perceptual processes in controls and prosopagnosics.

Evaluation of a German version of the tonsil and adenoid health status instrument

Background

To create and validate a German version of the Tonsil and Adenoid Health Status Instrument (TAHSI) for evaluation of tonsillectomy outcome in adult patients with chronic or recurrent tonsillitis.

Subjects and methods

46 healthy volunteers were assessed twice in a 6 week interval with the TAHSI questionnaire. Their results were compared with 45 patients suffering from chronic tonsillitis before tonsillectomy and 6 months following surgery. For internal consistency, Cronbach’s alpha was calculated; to identify normal score values, the optimum cutoff between healthy and diseased individuals was identified with receiver operating characteristic analysis; and responsiveness was assessed using Guyatt’s Responsiveness Index (GRI).

Results

Cronbach’s alpha for all questions was 0.92. Test- retest intraclass correlation coefficient was 0.89 (95% confidence interval 0.80-0.94 p < 0.001). Mean score for the healthy individuals was 7.0 (95% confidence interval 4.2-9.7). The optimum cut off score between healthy and diseased was 20 with a sensitivity of 80% and a specificity of 90% to differentiate controls from tonsillectomy patients.

Conclusion

The TAHSI performed well in this validation tests and is considered a favorable instrument to evaluate the effectiveness of tonsillectomy in adults with chronic or recurrent tonsillitis.

How to estimate the measurement error variance associated with ancestry proportion estimates

To show how the variance of the measurement error (ME) associated with individual ancestry proportion estimates can be estimated, especially when the number of ancestral populations (k) is greater than 2. We extend existing internal consistency measures to estimate the ME variance, and we compare these estimates with the ME variance estimated by use of the repeated measurement (RM) approach. Both approaches work by dividing the genotyped markers into subsets. We examine the effect of the number of subsets and of the allocation of markers to each subset on the performance of each approach. We used simulated data for all comparisons. Independently of the value of k, the measures of internal reliability provided less biased and more precise estimates of the ME variance than did those obtained with the RM approach. Both methods tend to perform better when a large number of subsets of markers with similar sizes are considered. Our results will facilitate the use of ME correction methods to address the ME problem in individual ancestry proportion estimates. Our method will improve the ability to control for type I error inflation and loss of power in association tests and other genomic research involving ancestry estimates.