Computing Robust, Bootstrap-Adjusted Fit Indices for Use With Nonnormal Data

The Patient Health Questionnaire-9 (PHQ-9) has been widely used to screen depression symptoms. The present research aimed to assess the reliability and validity of PHQ-9, besides measurement invariance of the PHQ-9 across gender and age among Chinese university students. A total of 12,957 Chinese college students from 2 universities in Henan and Hainan provinces (China) completed the questionnaires via WeChat. This research reported the psychometric properties of PHQ-9 and measurement invariance of the PHQ-9 across gender and age among Chinese university students. Compared with 1-factor model, the 2-factor (affective factor and somatic factor) model of PHQ-9 showed a better fit index in Chinese university students. Without the last 2 items, the 2-factor model of the PHQ-9 showed satisfactory reliability, validity, and good fit index (e.g., Root mean square error of approximation = 0.060, Goodness-of-fit index = 0.982, Comparative fit index = 0.986, and Tucker-Lewis index = 0.974). The Cronbach's alpha of PHQ-9 was 0.874. Multi-group analysis across gender and age demonstrated that measurement equivalency for the 2-factor model of the PHQ-9 was established (e.g., Root mean square error of approximation < 0.08, Comparative fit index > 0.90 and Tucker-Lewis index > 0.90). The 2-factor model of the PHQ-9 without the items of "movement" and "desire to die" showed a better fit index in Chinese university students. The measurement equivalence across gender and age for the 2-factor model of the PHQ-9 can be established among Chinese university students.

Testing the stability of a family resilience model at 2 and 5 years after traumatic brain injury or spinal cord injury: A longitudinal study.

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.

BackgroundSince the emergence of the COVID-19 pandemic, vaccines have been developed to tackle the disease. However, many people worldwide were not confident enough to take the vaccines. Developing a questionnaire to measure COVID-19 vaccine hesitancy will give the health authorities and policymakers a clear picture to establish appropriate interventions addressing vaccine hesitancy among the community. MethodsIn this study, we used a mixed-method design over two phases. Phase 1 entailed a qualitative approach to developing the questionnaire, including a literature search, expert panel review, and focus group discussion. Phase 2 used a quantitative method for establishing the content and construct validity of the questionnaire via exploratory and confirmatory factor analysis (EFA & CFA). Internal consistency was checked using Cronbach's Alpha and intraclass correlation coefficient. ResultsWe developed a 50-item instrument designed to measure COVID-19 vaccine hesitancy among adults in the state of Qatar. The study involved 545 adult participants. In terms of content validity, our study showed a value of 0.92 for the scale-level content validity index based on the average and a value of 0.76 for the scale-level content validity index - universal agreement. In the EFA, the Kaiser-Meyer-Olkin measure of sampling adequacy was calculated at 0.78, with statistical significance (P = 0.001). Regarding model fit indices of the seven-factor model, our findings showed an acceptable model-data-fit, with a relative chi-square: 1.7 (<3), Root mean square error of approximation: 0.05 (<0.08), PCLOSE = 0.41, Comparative fit index: 0.909, Tucker-Lewis index: 0.902, Incremental Fit Index: 0.910 and, Standardized Root mean square residual: 0.067 (<0.08). The seven-factor model of the questionnaire met the criterion of good internal consistency (Cronbach's alpha = 0.73). ConclusionThis tool is deemed of methodological merits in terms of validity, reliability, and determining the underlying conceptual structure of COVID-19 vaccine hesitancy and its associating factors.

The purpose of this article is to adapt and validate the short form of the Posttraumatic Growth Inventory (PTGI-SF) in Spanish. The scale consists of 10 items distributed in 5 posttraumatic growth dimensions measured in the original instrument. The psychometric properties and dimensionality of the scale are examined in a sample of college students (N = 681). Results lend support to the validity and reliability (α = .83) of the PTGI-SF. The dimensions of PTGI-SF show correlations ranging between .29 and .52. In addition, the inventory correlates significantly with deliberate rumination (r = .39) and the search for meaning in life (r = .32). The factor loadings of the items in the confirmatory factor analysis varied between .52 and .87, showing good fit indexes (comparative fit index = .97, Tucker-Lewis index = .93, relative fit index = .90, incremental fit index = .97, normed fit index = .96, and root mean square error of approximation = .05). Multi-group confirmatory factor analysis supported invariance of the PTGI-SF across the 2 groups. Finally, significantly higher PTGI-SF scores were observed in subjects who were actively looking for meaning in life, or had found it after a seeking process, than in subjects who had not looked for meaning in life or had given up because they had not been successful.

Psychometric evaluation of the United States-adapted perceived perioperative competence scale-revised: A national survey

Cancer fatalism is the belief that cancer is uncontrollable and lethal. Individuals with less education are more likely to hold fatalistic beliefs about cancer, but the mechanism accounting for the relationship is unknown. We tested whether negative health information seeking experiences explain this relationship. Structural equation modeling was used to test this relationship across three datasets from the Health Information National Trends Survey. Across all datasets, the model showed good fit: Cycle 1 (coefficient of determination = .11, comparative fit index = .96, root mean square error of approximation = .047), Cycle 2 (coefficient of determination = .06, comparative fit index = .96, root mean square error of approximation = .046), and Cycle 3 (coefficient of determination = .08, comparative fit index = .95, root mean square error of approximation = .052). The link between lower education level and higher cancer fatalism was partially mediated by negative health information seeking experiences.

This study examines how innovation capacity influences market performance among small and medium enterprises (SMEs) in the UAE and offers both theoretical and practical contributions. Data from 133 SMEs were analyzed using Structural Equation Modeling to assess the effects of five innovation dimensions, namely knowledge management, creativity, collaboration (COL), leadership, and organizational learning (OL), on quick response (QR), product differentiation (PDIF), and market share. The results show that OL and COL play central roles in strengthening SMEs’ ability to respond quickly to customer and market requirements, as well as supporting greater PDIF. Practically, the findings assist SMEs in leveraging innovation capabilities to enhance competitiveness and sustain growth in dynamic market environments. The analysis proceeded in three stages. First, correlation analysis explored relationships among the five innovation capacity dimensions and the three performance indicators. Second, the relationships between QR, PDIF, and overall market performance were examined. Third, the influence of the innovation capacity dimensions on the performance variables was tested. Model fit was evaluated using maximum likelihood estimates and standard fit indices (Chi-square, Goodness-of-Fit Index, Adjusted GFI, Normed Fit Index, Relative Fit Index, Incremental Fit Index, Tucker–Lewis Index, Comparative Fit Index, and the Root Mean Square Error of Approximation). The model results confirm the adequacy of the proposed framework.

Objective To examine the reliability and validity of Chinese Military Job Burnout Scale(CMJBS).MethodsA test with CMJBS was carried out on 1 292 armymen chosen by stratified cluster sampling,and 130 of them were also tested by Chinese Military Occupational Stress Scale(CMOSS).SPSS17.0and Amos7.0were used to examine the reliability and validity of CMJBS.Results The Cronbach'sαcoefficient of total scale of CMJBS was 0.844,and those of subscales of CMJBS were0.683-0.800(P0.01);the split-half reliability of total scale was 0.834,and those of the subscales were 0.575-0.758(P0.01).The correlation coefficients between factors and total scale score were 0.655-0.809(P0.01);the correlation coefficients between total scale score of CMJBS and CMOSS was 0.538(P0.01).The results of exploratory factor analysis showed that the scale of the entries in the collation and factors named were consistent.The results of confirmatory factor analysis showed a higher degree of accordance between the sample data and the hypothesized structure of factors,with theχ2statistic being 1 465.447 and RMSEA(root mean square error of approximation)being 0.060,and with TLI(Tucker-Lewis index),CFI(comparative fit index),IFI(incremental fit index)and GFI(goodness of fit index)being 0.949,0.895,0.915,and 0.893,respectively.Conclusion The reliability and validity of CMJBS meet standards for scale designing and can serve as a tool for measuring the job burnout of Chinese armymen.

ObjectiveCultural adaptation of the Patient Health Questionnaire-PHQ-9 to Bolivian Quechua and analysis of the internal structure validity, reliability, and measurement invariance by sociodemographic variables.MethodsThe PHQ-9 was translated and back-translated (English-Quechua-English) to optimise translation. For the cultural adaptation, experts, and people from the target population (e.g., in focus groups) verified the suitability of the translated PHQ-9. For the psychometric analysis, we performed a Confirmatory Factor Analysis (CFA) to evaluate internal validity, calculated α and ω indices to assess reliability, and performed a Multiple Indicator, Multiple Cause (MIMIC) model for evaluating measurement invariance by sex, age, marital status, educational level and residence. We used standard goodness-of-fit indices to interpret both CFA results.ResultsThe experts and focus groups improved the translated PHQ-9, making it clear and culturally equivalent. For the psychometric analysis, we included data from 397 participants, from which 73.3% were female, 33.0% were 18–30 years old, 56.7% reported primary school studies, 63.2% were single, and 62.0% resided in urban areas. In the CFA, the single-factor model showed adequate fit (Comparative Fit Index = 0.983; Tucker-Lewis Index = 0.977; Standardized Root Mean Squared Residual = 0.046; Root Mean Squared Error of Approximation = 0.069), while the reliability was optimal (α = 0.869—0.877; ω = 0.874—0.885). The invariance was confirmed across all sociodemographic variables (Change in Comparative Fit Index (delta) or Root Mean Square Error of Approximation (delta) < 0.01).ConclusionsThe PHQ-9 adapted to Bolivian Quechua offers a valid, reliable and invariant unidimensional measurement across groups by sex, age, marital status, educational level and residence.

PurposeTo translate and culturally adapt the Taste and Smell Survey (TSS) in Chinese for cancer patients and assess its reliability and validity, and to provide a reference for clinical professionals to evaluate taste and smell alterations (TSAs) in cancer patients.MethodsWith authorization from the original authors, the survey was translated and back-translated following the standard procedure to generate the Chinese version of the TSS. 271 patients were enrolled from a tertiary hospital in China under treatment between January 2023 and February 2024 using a convenience sampling method for reliability and validity testing of the translated scale.ResultsThe overall Cronbach’s α for the Chinese version of the TSS was 0.872. Cronbach’s α for individual items ranged from 0.844 to 0.897. Content Validity Indices (I-CVI) for individual items ranged from 0.833 to 1.000, and the Average Scale-level Content Validity Index (S-CVI/Ave) was 0.972. All indices calculated in the Confirmatory Factor Analysis (CFA) were presented as follows: χ²/df = 3.446, the Goodness-of-fit Index (GFI) = 0.902, the Comparative Fit Index (CFI) = 0.946, the Incremental Fit Index (IFI) = 0.946, the Tucker‒Lewis Index (TLI) = 0.930, the Root Mean Square Residual (RMR) = 0.054, and the Root Mean Square Error of Approximation (RMSEA) = 0.095. All of the above results indicated good validity and reliability of the Chinese version of the TSS.ConclusionThe study has confirmed that the Chinese version of the TSS is a concise and effective tool that is easy to administer and demonstrates strong scientific quality, reliability, validity, and feasibility. It is expected to help clinical professionals provide evidence-based interventions related to TSAs in cancer patients undergoing treatments in the Chinese cultural context.

This study aims to validate the suitability of the Inventory of Depressive Symptomatology Self-Report (IDS-SR) for evaluating mood disorders in older adults with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). A total of 1670 participants aged ≥ 50 years were included (531 males; mean age 65.79 ± 7.39 years). Construct validity of the IDS-SR was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Criterion validity was examined using Pearson correlation analyses between IDS-SR scores and scores on the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA). Receiver operating characteristic (ROC) curve analysis was conducted to determine the ability of the IDS-SR and its subscales to distinguish mood disorders in SCD and MCI. Cronbach's α and the intraclass correlation coefficient (ICC) were employed to assess the reliability of the scale. The EFA demonstrated that the major factors explained 47.722% of the total variance. The CFA confirmed a three-factor model of the IDS-SR and indicated good construct validity. The fit indices were as follows: chi-square/degree of freedom (χ2/df) = 3.316, root mean square error of approximation (RMSEA) = 0.054, goodness of fit index (GFI) = 0.945, adjusted goodness-of-fit index (AGFI) = 0.928, comparative fit index (CFI) = 0.921, incremental fit index (IFI) = 0.922, and Tucker-Lewis index (TLI) = 0.908. The total Cronbach's α was 0.839. The ICC for the total scale was 0.952. The IDS-SR scale is a reliable and valid screening tool for detecting mood disorders in older adults with SCD and MCI. This study provides the first validation of the scale in this population.

The responsibilities of nurse managers are diverse and occasionally inadequately organized. Moreover, the role of nurse manager often lacks a clear job description. Few methodologies for evaluating the content of nurse managers' work exist. This study was designed to validate the Nurse Managers' Work Content Questionnaire (NMWCQ) instrument and to analyze the relationships between NMWCQ factors and background variables using structural equation modeling. A multicenter descriptive and cross-sectional study design was used. The NMWCQ, which includes 87 items across 13 components, was developed based on a comprehensive literature review and pilot study. The questionnaire was sent to all of the nurse managers ( N = 756) employed at eight Finnish hospitals in 2019. Exploratory and confirmatory factor analyses were used to psychometrically test and validate the NMWCQ, whereas Cronbach's alpha values were calculated to explore the internal consistency of the instrument. Structural equation modeling was applied to detect the relationships between the constructed factor structure and the background variables. Two hundred seven nurse managers participated in this study. The final solution for the NMWCQ included 75 items across 12 factors. The NMWCQ factors were as follows: responsibility for new employees, daily management, human resource management, decision making, clinical nursing, development, planning of processes, collaboration, ensuring knowledge, evidence-based management, ensuring care quality, and financial management. The items showed factor loadings that were either positive or negative, with values ranging from .314 to .846. The Cronbach's alpha values for the factors ranged between .605 and .851. All of the covariances and relationships between background variables and factors were found to be significant ( p ≤ .05). The structural equation modeling showed acceptable index results (incremental fit index = .954, comparative fit index = .951, and root mean square error of approximation = .048). The NMWCQ version assessed in this study shows a more robust structure than the previously published pilot version. Psychometric testing showed the NMWCQ as suitable for describing the diverse work requirements of nurse managers and may offer a framework for concretizing the job description of nurse managers.

Background: Despite an increasing number of studies among breast cancer survivors, little is known about how socio-behavioral factors influence the symptom experience of racial/ethnic minority breast cancer survivors, especially Asian American breast cancer survivors. The identified socio-behavioral factors could give directions for development of unique intervention components that are tailored to a specific population in needs. Purpose: This study examined the relationship of multiple socio-behavioral factors including attitudes, perceived barriers, social influences, and self-efficacy to the symptom experiences of Asian American breast cancer survivors. Methods: This secondary analysis was conducted using data collected from 195 Asian American female breast cancer survivors. Subjects were recruited from January 2017 to June 2020 through online and offline communities and groups. The study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences (QASPS); the Cancer Behavior Inventory (CBI); and the Memorial Symptom Assessment Scale-Short Form (MSAS-SF). The hypothetical model was built based on Bandura’s self-efficacy theory. Mediation analysis was conducted using structural equation modeling with SPSS version 26.0 and Amos 28. Results: The overall fitness of the hypothetical model to the data was acceptable (χ2=51.36, p&amp;lt;.001, the goodness of fit index [GFI] = .95, adjusted GFI [AGFI] = .89, comparative fit index [CFI] = .96, Tucker-Lewis index [TLI] = .94, normed fit index [NFI] = .94, and root mean square error of approximation [RMSEA] = .08 Attitude and perceived barrier and social influence had a significant direct effect on self-efficacy (direct effect, β = 0.247, p =.003; β = -0.552, p =.003; β = 0.241, p =.002, respectively). Attitudes indirectly influenced symptom distress scores through self-efficacy (β =-0.054, p = .019). Perceived barriers had a significant direct effect (β = 0.605, p=.003), indirect effect (indirect effect, β = 0.121, p =.024), and a total effect on symptom distress scores (total effect, β = 0.726, p =.004). In addition, social influence had an indirect effect on symptom distress scores through self-efficacy (β = -0.053, p = .017) Conclusions: The findings supported that the self-efficacy for coping had a mediating effect on their symptom experience among Asian American breast cancer survivors as well as identified meaningful associations with attitudes, perceived barriers and social influences and symptom experience. Future research and practice should consider socio-behavioral factors, especially self-efficacy, in symptom management of Asian American breast cancer survivors. Acknowledgments: The parent study was funded by the National Institutes of Health (NCI/NINR; 1R01CA203719). Citation Format: Seo Yun Kim, Heejung KIM, Wonshik Chee, Eun-ok Im. The relationship of socio-behavioral factors to the symptom experience of Asian American breast cancer survivors: a structural equation model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB145.

PurposeTo identify the best internal structure of the Brazilian version of the Anterior Knee Pain Scale (AKPS), comparing different instrument structures (structural validity) and correlating the scores of the versions (criterion validity).MethodsWe included Brazilian volunteers, aged ≥ 18 years, with patellofemoral pain (PFP) for at least 3 months. We used the confirmatory factor analysis and considered the following fit indices: chi-square/degrees of freedom (DF), comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA). We considered the structure with the lowest values of the Akaike information criterion (AIC), sample size adjusted Bayesian information criterion (SABIC), and assessed criterion validity using Pearson correlation coefficient (r) to correlate the long and short versions.ResultsThe study included 101 participants, mostly women (65.3%), young adults (~ 31 years old), overweight (BMI > 25 kg/m2), incomplete higher education (37.6%), and physically active (64.4%). The original 1-domain, 13-item structure showed adequate fit indices (chi-square/GL < 3.00, TLI and CFI > 0.90, and RMSEA < 0, 08). However, items 11 and 12 had a factorial load of less than 0.23. Therefore, we excluded items 11 and 12 and found adequate fit indices (chi-square/GL < 3.00, TLI and CFI > 0.90, and RMSEA < 0, 08) and lower AIC and SABIC values. We observed a correlation coefficient above the acceptable cutoff of 0.70 (r = 0.966, p-value < 0.001) between the versions.ConclusionThe 11-item AKPS (without items 11 and 12) is the version with the most adequate internal structure and correlates satisfactorily with the long version of the instrument.