Authentic Leadership Questionnaire applied to Brazilian nurses: evidence of validity

The Patient Health Questionnaire-8 (PHQ-8) is a measure of depression symptom severity that is the 8-item version of the more widely used Patient Health Questionnaire-9 (PHQ-9). However, the PHQ-8 lacks the question about suicide ideation and is often used when questions about suicide ideation cannot be administered. A recent review of the literature on the PHQ-9 indicates mixed findings on factor structure, with evidence for both a unidimensional model and a 2-factor model of somatic and non-somatic symptoms. To date, few studies have explored the factor structure of the PHQ-8, and none to our knowledge have examined this in military samples. This secondary analysis examined this in a sample of military sexual assault survivors given their heightened risk for depression. Service members and veterans who experienced assault (N = 346; 49.1% female) completed the PHQ-8 in a previously published study. The parent study was approved by the Utah State University Institutional Review Board (IRB) and secondary analyses were exempted from IRB review by the Arizona State University IRB. Five structural models were tested using confirmatory factor analysis, including 1 unidimensional factor model and 4 2-dimensional factor models. The following goodness of fit statistics were compared between models: Chi-squared testing, Comparative Fit Index (CFI), Tucker Lewis Index (TLI), root mean square error of approximation (RMSEA), Bayesian Information Criterion (BIC) and standardized root mean square residual (SRMR). Strong model fit was determined by a CFI and TLI ≥ .95, RMSEA ≤ .06, and SRMR ≤ .08. The 2-dimensional model with anhedonia, depressed mood, feelings of worthlessness, concentration difficulties, and psychomotor agitation/retardation specified on the non-somatic factor, and sleep difficulties, fatigue, and appetite changes specified on the somatic factor had the most optimal fit (X2 [df] = 46.19 [19], CFI = 0.98, TLI = 0.97, RMSEA = 0.06, SRMR = 0.03, BIC = 6,130.98). Other models had adequate fit, though the fit for the unidimensional model was statistically inferior. The use of 2-factor models of depression might be superior compared to the unidimensional model in samples of military sexual assault survivors which may provide clinical utility in treating specific depression symptom clusters. Studies that wish to examine potential differences in outcomes as a function of somatic and non-somatic depressive symptoms may consider this model. Future studies should examine model fit in samples that may not have been exposed to military sexual assault.

The current study tested the one-dimensionality of the Center for Epidemiological Studies Depression Scale for Suicidal Ideation (CES-D-SI) and its reliability among high school students in Santa Marta, Colombia. A total of 1,462 tenth and eleventh-grade students from public and private schools completed the CES-D-SI. The students were between 13 and 17 years (M = 16.0, SD = 0.8), 60.3% were female, and 55.3% were in the tenth grade. A confirmatory factor analysis (CFA) was conducted, and the chi-square, root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR) statistics were calculated. The internal consistency of the dimension was calculated using Cronbach's alpha and McDonald's omega coefficients. The results of the CFA were as follows: chi-square = 26.51, df =2, p = .001; RMSEA = .092; 90% confidence interval = .063-.124; CFI = .983; TLI = .950; and SRMR = .019. Cronbach's alpha coefficient was .75, and McDonald's omega coefficient was .77. As conclusions, the scale exhibited a unidimensional structure similar to that in other studies and presented good reliability values. Hence, its use is recommended to screen suicidal ideation in school-aged adolescents in Santa Marta, Colombia.

Background and Aim: Community-based surveillance (CBS) is a critical mechanism for early detection of infectious diseases. Understanding the behavioral drivers of CBS participation is essential to strengthening community engagement. This study employed structural equation modeling (SEM) based on the theory of reasoned action (TRA) to investigate the impact of knowledge, subjective norms (SN), and attitudes on the intention and behavioral likelihood (BL) of participating in CBS activities. Materials and Methods: A cross-sectional survey was conducted among 470 schoolteachers selected through a multi-stage mixed sampling strategy across Kelantan, Malaysia. A structured questionnaire assessing sociodemographic factors, knowledge, attitudes, and perceptions toward CBS was developed and validated. Confirmatory factor analysis and SEM were employed with model parameters estimated using the robust maximum likelihood (MLR) approach. Model fit was assessed using comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR) indices. Results: The final model demonstrated good fit (CFI = 0.923; TLI = 0.913; RMSEA = 0.045; SRMR = 0.070). Knowledge (β = 0.335) and SN (β = 0.296) positively influenced intention to participate in CBS, whereas negative attitudes (β = −0.313) showed a significant negative association. Intention significantly predicted BL (β = 0.633). The model explained 40% of the variance in intention and 43% in BL. Intention mediated the effects of knowledge, norms, and attitudes on behavioral engagement. Conclusion: Knowledge, positive SN, and reduced negative attitudes are pivotal in fostering community participation in CBS initiatives. Intention emerged as a critical mediator linking cognitive and normative beliefs to actual behavioral engagement. These findings provide actionable insights for designing targeted interventions that enhance CBS participation and strengthen infectious disease surveillance at the community level. Keywords: community participation, community-based surveillance, infectious diseases, structural equation modeling, theory of reasoned action.

BackgroundThe Normalization MeAsure Development (NoMAD) questionnaire is used to assess implementation processes based on Normalization Process Theory (NPT). However, its psychometric properties have not been extensively evaluated. This study aimed to examine the factorial validity, internal consistency, and measurement invariance at both scale and item levels of the NoMAD across three hybrid effectiveness-implementation studies determining the impact of routine symptom surveillance and guideline-based symptom management interventions in ambulatory oncology care settings.MethodsA cross-sectional survey was conducted with 328 healthcare personnel (74.% clinicians) participating in the Improving the Management of SymPtoms during And following Cancer Treatment (IMPACT) Research Consortium between 2019 and 2024. Confirmatory factor analysis (CFA) tested the hypothesized four-factor structure (coherence, cognitive participation, collective action, reflexive monitoring). Internal consistency was assessed with McDonald's omega and Cronbach's alpha coefficients (> 0.70 acceptable). Measurement invariance was tested across research centers, professional roles, and years in current roles using multi-group CFA. Model fit was defined by standard fit indices (Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) values ≥ 0.95, Root Mean Square Error of Approximation (RMSEA) values ≤ 0.06, and Standardized Root Mean Square Residual (SRMR) values ≤ 0.08. Differential item functioning (DIF) was evaluated using ordinal logistic regression and item response theory methods (ΔR2 ≥ 0.02 indicative of meaningful DIF).ResultsThe four-factor model demonstrated good fit to the data (CFI = 0.97, TLI = 0.96, RMSEA = 0.06, SRMR = 0.05). All factor loadings were statistically significant (p < 0.001), ranging from 0.606 to 0.871. Internal consistency was satisfactory for all four constructs (Omega range: 0.789–0.864, Cronbach's alpha range: 0.782–0.863). The NoMAD exhibited configural, metric, and scalar invariance across research centers, roles, and years in the current role. One item ("The staff agree that the intervention is worthwhile") showed uniform DIF across healthcare systems (ΔR2 = 0.047), but no DIF was found by role or years in the current role.ConclusionsThis study supports the factorial validity, internal consistency, and measurement invariance of the NoMAD across three oncology implementation efforts. The presence of DIF in one item provides an opportunity for refinement in this healthcare context. Researchers and practitioners can use the NoMAD to assess and compare implementation processes, informing the development and evaluation of implementation strategies.Trial registration(ClinicalTrials.gov ID NCT03850912, NCT03892967, NCT03988543).

Household Nutrition Security Scale (HNSS): Further Establishing Validity and Reliability in a Statewide Sample in Massachusetts

Strategic Self‐Regulation for Speaking English as a Foreign Language: Scale Development and Validation

BackgroundLiterature suggests that most mental disorders have their onset in childhood and adolescence, but go undiagnosed until adulthood. Shorter versions of the screening tools such as the Patient Health Questionnaire with four items (PHQ-4) may help to improve screening coverage. This study assessed the psychometric properties of the PHQ-4 in screening for core symptoms of depression and anxiety among out of school adolescent girls and young women (AGYW).MethodsThis is a cross-sectional analysis of data from a cluster randomized controlled trial conducted among AGYW between June and July 2018 in North-West Tanzania. Two thousand four hundred twenty-six out-of-school AGYW aged 15 to 23 years were included. Data were collected on tablets using audio computer-assisted self-interviews (ACASI). Cronbach’s α was used to measure the reliability of the PHQ-4 while confirmatory factor analysis (CFA) and principal components analysis (PCA) were used for construct validity assessment. In CFA, three criteria were used to assess how well the model fits the data: Standardized Root Mean Square Residual (SRMR), the Comparative Fit Index (CFI), the Root Mean Square Error of Approximation (RMSEA) and 90% confidence interval for RMSEA.ResultsOf the 2426 participants, 33.8 and 35.5% screened positive for core symptoms of anxiety (GAD-2 ≥ 3) and depression (PHQ-2 ≥ 3), respectively. Cronbach’s α of the PHQ-4 was 0.81. Both items-correlation and corrected items-correlation of the PHQ-4 had total correlations above 0.5 (p < 0.01). CFA showed that all items loaded significantly onto the single factor, and loadings were strong, ranging from 0.67 to 0.77 (p < 0.01). CFA indicates that the PHQ-4 scale stand for a unidimensional construct with good model fit (CFI = 0.995, SRMR = 0.013, RMSEA = 0.054 and 90% CI for RMSEA (0.031–0.079)). PCA confirmed two distinct components; GAD-2 (anxiety) and PHQ-2 (depression). Those who reported having suicidal thoughts and social function problems had significantly higher scores on PHQ-2, GAD-2, and PHQ-4 screening items (p < 0.01).ConclusionsThe findings suggest that the PHQ-4 scale can reliably and validly screen for core symptoms of depression and anxiety among out of school AGYW. This tool is short and easy to administer. Thus, the PHQ-4 scale can be very useful in screening for anxiety and depression symptoms in the community, primary health facilities, research and programmatic settings.

Background The Revised Illness Perception Questionnaire (IPQ-R) has been adapted for the study of autism spectrum disorder (ASD), but its use has not been studied in Iran. In this study, we evaluated the psychometric properties of the Revised Illness Perception Questionnaire for Autism Spectrum Disorder (IPQ-R-ASD-Persian) and how Iranian parents’ perceptions of autism may be related to parental anxiety, depression, and affect. Method This study included 114 parents of children with ASD in Iran. A sociodemographic questionnaire, the IPQ-R-ASD-Persian, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Positive and Negative Affect Schedule were administered. Confirmatory factor analysis and the maximum likelihood method based on the variance-covariance matrix were employed to explore the IPQ-R-ASD factor structure. Four measures of goodness-of-fit were utilized, which included chi-square/degree of freedom (χ2/df), comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). Cronbach’s alpha and the corrected item-total correlation were used to measure internal consistency. The convergent validity was assessed by calculating the average variance extracted. Furthermore, we evaluated the test-retest reliability of the IPQ-R-ASD-Persian scales over two weeks using intra-class correlation coefficient (ICC). Results There was no floor or ceiling effect for the IPQ-R-ASD-Persian scales. Cronbach’s α values were consistently higher than 0.70, except for Timeline-Cyclical (α = 0.484). All scales of the IPQ-R-ASD-Persian except for the Timeline-Cyclical scale generally showed good test-retest reliability over two weeks. Confirmatory factor analysis indicated a seven-factor model (χ2/df = 1.62, CFI = 0.92, RMSEA = 0.064, SRMR = 0.098), similarly to the original IPQ-R instrument. Conclusions The IPQ-R-ASD-Persian demonstrated statistically acceptable reliability and validity levels supporting its use as a viable instrument for such research in Iran. As a result, this might be a useful approach for evaluating parents’ perceptions which is vital for supporting families and for developing effective interventions.

The Test of Gross Motor Development–3rd Edition (TGMD-3) is an instrument for measuring gross motor development in children with and without a disability. This study aims to evaluate the psychometric properties of the Persian version of the TGMD-3 in 3- to 10-year-old Iranian children. The TGMD-3 was administered to 1,600 children (M age = 6.56 ± 2.29 years; 50% boys). The content validity of the TGMD-3 was established by five experts while its reliability was assessed through calculating internal consistency, test–retest, intra-rater, and inter-rater reliability coefficients. All reliability indices were excellent (&gt;.82). The two-factor model was validated using confirmatory factor analysis. Adequate fit indices were found for the two-factor model (χ2 (64) = 389.02, p &lt; .05, root mean square error of approximation (RMSEA) = .056, goodnesss of fit index (GFI) = .96, adjusted goodness of fit index (AGFI) = .94, normed fit index (NFI) = .96, non-normed fit index (NNFI) = .96, comparative fit index (CFI) = .96, incremental fit index (IFI) = .96, standardized root mean square residual (SRMR) = .03). An alternative one-factor model was also tested. Adequate fit indices in a one-factor model were found (χ2 (65) = 615.88, p = .0001, RMSEA = .07, GFI = .94, AGFI = .92, NFI = .98, NNFI = .98, CFI = .98, IFI = .98, SRMR = .03). The psychometric properties of the Persian version of TGMD-3 in Iranian children were supported and users can confidently use this test to evaluate gross motor development in Iranian children.

AimThis study aims to clarify the construct and criterion‐related validity of the Questionnaire for Older Senior Citizens (QO) during the COVID‐19 pandemic.MethodsThis cross‐sectional study was conducted in Japan between November 11, 2020 and January 10, 2021. Of the 1645 (63.5%) older adults who responded, data from 900 participants were analyzed. First, we conducted an exploratory factor analysis (EFA) among older‐older adults (aged ≥75 years) and extracted the factors. Next, we conducted a confirmatory factor analysis (CFA) using structural equation modeling. We also conducted this analysis among younger‐older adults (aged ≥65 and <75 years) using the same model. Moreover, we compared each item of the QO with frailty status.ResultsResults of the EFA revealed six factors: social conditions and lifestyle, subjective conditions, cognitive functions, physical activity, oral functions, and physical functions. The results of the CFA were as follows: comparative fit index (CFI) = 0.971, adjusted goodness of fit index (AGFI) = 0.978, root mean square error of approximation (RMSEA) = 0.018, and standardized root mean square residual (SRMR) = 0.030. The results among the younger‐older adults were as follows: CFI = 0.880, AGFI = 0.940, RMSEA = 0.037, and SRMR = 0.048. Many QO items were significantly associated with frailty (P < 0.05).ConclusionsAmong the older‐older adults group, the model used for the QO has sufficient suitability and construct validity; among the younger‐older adults group, there also is sufficient questionnaire suitability. Moreover, the QO has criterion related validity with frailty. Geriatr Gerontol Int 2021; 21: 1018–1025.

While depression is a common mental disorder, the diagnosis of this condition is still challenging. Thus, there is a need to have a validated tool to help evaluate symptoms of depression. This study aimed to evaluate the reliability and validity of the Vietnamese version of the Hamilton D-17 scale. A cross-sectional, descriptive, and validation study was conducted on 183 patients including 139 depressed and 44 non-depressed patients at the University Medical Center of Medicine and Pharmacy University at Ho Chi Minh City. Internal reliability and inter-rater reliability was measured using Cronbach's alpha and intraclass correlation coefficients (ICC). Confirmatory factor analysis (CFA) was used to evaluate construct validity. The Patient Health Questionnaire (PHQ9) was used to measure concurrent validity of the Hamilton D-17. Area under the ROC curve was used to measure criterion validity. Both Cronbach alpha coefficient and ICC were at good level at alpha = 0.83 and ICC = 0.83. CFA with a second-order model consisting of four factors fitted the data at good to excellent level. The SRMR (Standardized Root Mean Squared Residual) was 0.066, RMSEA (Root Mean Square Error of Approximation) (90% CI) was 0.053 (0.036-0.069), CFI (comparative fit index) was 0.93, TLI (Tucker Lewis index) was 0.92. The Hamilton D-17 and the PHQ-9 had a correlation coefficient of r = 0.77 (p < 0.001). The Hamilton D-17 had a very high level of criterion validity with AUC of 0.93 (0.88-0.98). The Vietnamese version of the Hamilton D-17 scale has a high level of validity and reliability. The scale should be used to assess symptoms of depression among Vietnamese patients.

This study examined the effects of dyadic trust in physicians as a determinant of children's quality of life (QoL) in pediatric asthma. Actor and partner effects of children's and parents' trust towards physician were tested, and linear vs. curvilinear associations were compared within an Actor-Partner Interdependence Model (APIM). A longitudinal design included 222 child-mother dyads (children's Mage = 12.6 years) assessed at two time points 1 year apart. Children completed trust in physician scale and a QoL questionnaire; parents reported their own trust in physicians, asthma severity, adherence, and illness-related conflict with the child. The linear APIM demonstrated a good fit (χ2(12) = 24.53, Comparative Fit Index (CFI) = 0.97, Tucker-Lewis Index (TLI) = 0.93, Root Mean Square Error of Approximation (RMSEA) = 0.07, Standardized Root Mean Square Residual (SRMR) = 0.08) and explained 50% of the variance in children's QoL at Time 2. Both actor (β = .18, p = .018) and partner (β = .18, p = .007) effects of trust were significant and statistically equivalent (Wald χ2 (1) = 0.25, p = .62). The quadratic model showed poorer fit (CFI = 0.89, RMSEA = 0.11), and model comparisons favored the linear specification (Δχ2 (2) = 8.63, p = .013). Findings highlight children's and mothers' trust in physicians as a dyadic, mutually reinforcing predictor of children's well-being. In pediatric asthma, higher trust, whether from the child or the parent, consistently benefits QoL, supporting a linear rather than curvilinear relationship. Strengthening trust on both sides of the parent-child dyads may enhance adherence, engagement, and long-term health outcomes.

This study aimed to analyse the confirmatory factor structure of information and communication technology (ICT) competency among science teachers under the Uthai Thani Primary Educational Service Area Office. A quantitative research methodology was used. The sample comprised 500 science teachers selected through multistage sampling. The researcher developed a 77-item instrument using a five-point Likert rating scale. The instrument was validated by experts for content validity, and the content validity ratios for individual items ranged from 0.60 to 1.00, with item discrimination indices ranging from 0.44–0.92. The reliability coefficients, calculated using Cronbach’s alpha, ranged from 0.97–0.99. Data were analysed using confirmatory factor analysis (CFA) through statistical software, which indicated that the model demonstrated a good fit with the empirical data. The chi-square statistic was 107.331 with 98 degrees of freedom (p = 0.244), indicating good fit. The fit indices also indicated an excellent model fit, with a Tucker-Lewis Index (TLI) of 0.998, a Comparative Fit Index (CFI) of 0.999, a standardised root mean square residual (SRMR) of 0.022, and a Root Mean Square Error of Approximation (RMSEA) of 0.015. Among the factors, the highest factor loading was found in the knowledge component (0.940), followed by the skills component (0.896) and the attitude component (0.708), all of which were statistically significant at the .01 level. Future research should test the model in other contextually diverse regions and across different grade levels and investigate emerging variables relevant to contemporary ICT competencies.

The present study aimed to develop and validate a multidimensional Digital Literacy Scale (DLS) for Post Graduate (PG) teacher educators and evaluate their Digital Literacy (DL). A contextually relevant, updated scale needs to be developed for PG teacher educators in India. The scale focuses on the United Nations Educational, Scientific and Cultural Organization (UNESCO) DL Framework, which provides a holistic and standardized understanding through four key dimensions. Three-stage Scale development process followed; Item Development, Scale Refinement, and Scale Evaluation, resulting in 42 items across four dimensions. The expert validation yielded an average Content Validity Index (CVI) of 1.00, demonstrating excellent content validity. A crosssectional survey of 370 PG teacher educators using convenience sampling confirmed the construct validity of the 42-item scale through item analysis and Confirmatory Factor Analysis (CFA), showing strong factor loadings and excellent model fit: Comparative Fit Index (CFI) = 0.951, Tucker-Lewis Index (TLI) = 0.949, Root Mean Square Error of Approximation (RMSEA) = 0.041, Standardized Root Mean Square Residual (SRMR) = 0.036, Goodness-of-Fit Index (GFI) = 0.938). The overall scale, Cronbach’s Alpha (α) and Coefficient Omega (ω), was demonstrated to have excellent reliability (α = 0.901, ω = 0.903). The Heterotrait-Monotrait Ratio (HTMT) correlation values, all below 0.85, demonstrate good discriminant validity. The level of DL showed a moderate to high, with the highest mean in safety measures of digital tools (M = 4.04) and the lowest mean in creating digital content (M = 3.60). Significant differences were observed in DL based on academic stream, family income, experience, and purposes of using e-resources, whereas no significant differences were found for the other demographic variables. The psychometric analysis shows that the scale is reliable and valid; thus, it can be used to evaluate teacher educators’ digital literacy.

In structural equation modeling (SEM) studies with categorical data, researchers often use the root mean square error of approximation (RMSEA), comparative fit index (CFI), or standardized root mean squared residual (SRMR) to compare rival models. Model selection based on , , or is meaningful because (a) finding a better model is more scientific and easier than establishing a “good” model, (b) it avoids the problems with cutoffs for fit indices, (c) one is less likely to overlook other equally substantively plausible models, and (d) information criteria (e.g., AIC, BIC) are not applicable to categorical data SEM. In this paper, we propose point estimators and confidence intervals (CIs) for , , and under categorical data. Our methods are applicable to nonnested models and do not need a true model. Simulation results show our point estimators and CIs are all trustworthy, whereas the bias is large when estimating (, ) based on the common estimators in the current literature for RMSEA (CFI, SRMR).