Developing conceptually sound items for a clinical courage questionnaire.

BackgroundLocation of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada.MethodsWe analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to “cure-oriented interactions” and tends to be more task-oriented focusing on the patient’s health concerns and reason for the appointment. In contrast, socioemotional communication refers to more “care-oriented interactions” that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship.ResultsThe physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building.ConclusionsDespite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional communication may ultimately lead to better patient outcomes, which implies that health differences between rural and urban settings could be linked to differences in doctor-patient communication styles.

Objective: We developed and validated the psychometric properties of a scale to assess healthy lifestyle in adolescents aged 12 to 18. Methods: A pilot sample of 404 adolescents (54% males and 46% females) and a confirmatory sample of 1713 adolescents (48.7% males and 51.3% females) were considered. Results: In the pilot study, we performed an exploratory factor analysis (EFA), where the toxic relations dimension was changed to the social relations dimension. In the confirmatory study, we performed a confirmatory factor analysis (CFA), where the second-order general factor model presented adequate adjustment indices (CFI = .94; TLI = .93; RMSEA = .04[90% CI = .039-.044]; SRMR = .05). In addition, the global scale presented an adequate composite reliability index (CRI = .87) along with the 8 proposed dimensions: social relationships (.62), leisure habits (.55); risk-taking behaviors (.82), eating habits (.66); search for clean air (.57); sun protection (.79); physical activity (.65) and water drinking (.68). Conclusions: The results of the study contribute to an adequate measurement of the construct and evidence for the existence of a second-order general factor model. Furthermore, the study provides a conceptual and statistical basis for the psychometric development of the WMS scale in subsequent studies.

Attention-deficit/hyperactivity disorder (ADHD) is presumed to be heterogeneous, but the best way to describe this heterogeneity remains unclear. Considerable evidence has accrued suggesting that inattention versus hyperactivity-impulsivity symptom domains predict distinct clinical outcomes and may have partially distinct etiological influence. As a result, some conceptualizations emphasize two distinct inputs to the syndrome. Yet formal testing of models that would accommodate such assumptions using modern methods (e.g., second-order factor and bifactor models) has been largely lacking. Participants were 548 children (321 boys) between the ages of 6 and 18 years. Of these 548 children, 302 children met DSM-IV criteria for ADHD, 199 were typically developing controls without ADHD, and 47 were classified as having situational or subthreshold ADHD. ADHD symptoms were assessed via parent report on a diagnostic interview and via parent and teacher report on the ADHD Rating Scale. A bifactor model with a general factor and specific factors of inattention and hyperactivity-impulsivity fit best when compared with one-, two-, and three-factor models, and a second-order factor model. A bifactor model of ADHD latent symptom structure is superior to existing factor models of ADHD. This finding is interpreted in relation to multi-component models of ADHD development, and clinical implications are discussed.

Three studies were conducted to develop an age-appropriate scale to assess children’s self-compassionate reactions by using a vignette technique. In Study 1, a scale employing vignette technique was developed first based on self-compassion theory and interview with children. Next, based on further item analysis with 161 children, two items were eliminated and three were modified to form the Self-Compassionate Reactions Scale for Children (SCRS-C), including 4 vignettes and 24 items. In Study 2, serial CFAs (N = 637) were conducted to investigate the structure, factorial invariance, and equivalence across gender of the SCRS-C. The reliability, convergent and discriminate validity, and concurrent validity were also examined. Study 3 explored the test-retest reliability of the scale over 6 weeks (N = 77). A two second-order factor model (compassionate and uncompassionate reaction) with six first-order factors (self-kindness, common humanity, mindfulness, self-judgment, isolation, and over-identification) was found to best fit the data. In addition, the factorial invariance of the second-order factor structure across gender was verified, and the internal consistency reliability was satisfactory. The scale showed satisfactory convergent, discriminate and concurrent validity and test-retest reliability. The SCRS-C shows promise as a reliable and valid scale of self-compassion suited for children aged 9–12 for both boys and girls.

The current research aims to test the new measurement model of COVID-19 stressors which includes four stressor types: infection fears, lockdown, economic, and grief in one second-order factor. Using a sample of 2732 from 11 Arab countries and measures for COVID-19 stressors, PTSD, depression, anxiety, and executive function, we conducted exploratory and confirmatory factor analyses, multigroup invariance, and correlations. A second-order factor with four first-order factors model fit the data well. All factors were significantly correlated with PTSD, depression, anxiety, working memory, and inhibition deficits. The measure and its four subscales have robust psychometrics and were invariant across genders.

ObjectivesThe study aimed to develop and validate a model to measure psychosocial factors at work among medical staff in China based on confirmatory factor analysis (CFA). The second aim of...

The aim of the present research was to provide school psychologists with valid instruments with which to assess the goals and reputations of young children. This was achieved by ascertaining whether the factor structures and the second-order factor models of the high school versions of the Importance of Goals (Carroll, et al., 1997) and Reputation Enhancement Scales (Carroll, et al., 1999) could be replicated with a primary school sample. Eight hundred and eighty-six 10 to 12 year old children were administered modified versions of the two scales, which were combined and renamed the Children's Activity Questionnaire. For the two scales, the factor structure proved replicable and reliable with the primary school sample. A comparison between the factor loadings of the primary school and the high school samples using the coefficient of congruence procedure demonstrated similarity indicating that the scales are replicable and able to be used with a younger primary school sample. Structural equation modelling indicated that the second-order factor structure of the Importance of Goals Scale was acceptable but this was not the case for the second-order factor structure of the Reputation Enhancement Scale.

There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. Building the workforce for this population is a national priority. We investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics. We developed and pilot-tested a qualitative interview guide based on a conceptual model of training and learning. We conducted individual semistructured interviews in 2018 with diverse clinical and nonclinical staff at 3 rural primary care sites in Washington state that used ongoing collaborative care and telepsychiatric consultation. Two qualitative researchers independently analyzed transcripts with iterative input from other research team members. A total of 17 clinical, support, and administrative staff completed interviews. Participants' feedback supported the view that telepsychiatric case review-based consultation enhanced skills of diverse clinical team members over time, even those who had not directly participated in case reviews. All interviewees identified specific ways in which the consultations improved their capacity to identify and treat psychiatric disorders. Perceived benefits in implementation and sustainability included fidelity of the care process, team resilience despite member turnover, and enhanced capacity to use quality improvement methods. Weekly systematic case reviews using telepsychiatric consultation served both as a model for patient care and as a training and workforce development strategy in rural primary care sites delivering collaborative care. These are important benefits to consider in implementing the collaborative care model of behavioral health integration.

Bifactor latent structures were introduced over 70 years ago, but only recently has bifactor modeling been rediscovered as an effective approach to modeling construct-relevant multidimensionality in a set of ordered categorical item responses. I begin by describing the Schmid-Leiman bifactor procedure (Schmid & Leiman, 1957) and highlight its relations with correlated-factors and second-order exploratory factor models. After describing limitations of the Schmid-Leiman, 2 newer methods of exploratory bifactor modeling are considered, namely, analytic bifactor (Jennrich & Bentler, 2011) and target bifactor rotations (Reise, Moore, & Maydeu-Olivares, 2011). Then I discuss limited- and full-information estimation approaches to confirmatory bifactor models that have emerged from the item response theory and factor analysis traditions, respectively. Comparison of the confirmatory bifactor model to alternative nested confirmatory models and establishing parameter invariance for the general factor also are discussed. Finally, important applications of bifactor models are reviewed. These applications demonstrate that bifactor modeling potentially provides a solid foundation for conceptualizing psychological constructs, constructing measures, and evaluating a measure's psychometric properties. However, some applications of the bifactor model may be limited due to its restrictive assumptions.

Background:Chronic obstructive pulmonary disease (COPD) is a common disease with considerable consequences for patients’ daily lives. The Clinical COPD Questionnaire (CCQ) was designed to measure these consequences in daily practice. Although the CCQ is widely used, its original structure has never been tested.Aims:This study examines the psychometric properties of the CCQ with regard to its latent structure in a sample of primary care patients with COPD.Methods:Two cross-sectional studies were conducted; in study 1 (N=243) exploratory analyses, including exploratory factor analysis (EFA) and Mokken scale analysis, were performed to explore the latent structure of the CCQ. In study 2 (N=244), confirmatory factor analysis (CFA) was conducted to evaluate the model fit of the structure found in study 1.Results:Both EFA and Mokken scale analysis revealed a structure of two dimensions (‘general impact’ α=0.91 and ‘cough’ α=0.84). This structure, however, was not confirmed in study 2, nor was the original structure. However, subsequently removing items that violated the assumption of a normal response distribution did result in an excellent model fit with two dimensions measuring ‘dyspnoea’ and ‘cough’ (CFA: comparative fit index (CFI) 0.98; normed fit index (NFI) 0.97; root mean squared error of approximation (RMSEA) 0.08 (0.04)).Conclusions:In primary care, factor analyses on the CCQ revealed a two-component structure measuring ‘general impact’, and ‘cough’. A shortened and more specific version of the CCQ could be regarded as a useful instrument to screen for exacerbations by measuring dyspnoea, coughing and producing phlegm.

Latent structure and factor invariance of somatic symptoms in the patient health questionnaire (PHQ-15)

BackgroundDepressive symptoms have been recognized as one of the most frequent complaints among natural disaster survivors. One of the most frequently used self-report measures of depressive symptoms is the Center for Epidemiologic Studies Depression Scale (CES-D). To our knowledge, no study has yet examined the factor structure, reliability, and validity of the CES-D in a sample of natural disaster survivors. Thus, the present study investigated the factor structure, reliability, and validity of a Korean language version of the CES-D (KCES-D) for natural disaster survivors.MethodsWe utilized two archived datasets collected independently for two different periods in 2008 in the same region of Korea (n = 192 for sample 1; n = 148 for sample 2). Participants were survivors of torrential rains in the mid-eastern region of the Korean peninsula. For analysis, Samples 1 and 2 were merged (N = 340). Confirmatory factor analysis was performed to evaluate the one-factor model, the four-factor model, and the bi-factor models, as well as the second-order factor model. Composite reliability was computed to examine the internal consistency of the KCES-D total and subscale scores. Finally, Pearson’s r was computed to examine the relationship between the KCES-D and the trauma-related measures.ResultsThe four-factor model provided the best fit to the data among the alternatives. The KCES-D showed adequate internal consistency, except for the ‘interpersonal difficulties’ subscale. Also regarding concurrent validity, weak to moderate positive correlations were observed between the KCES-D and the trauma-related measures.ConclusionsThe results support the four-factor model and indicate that the KCES-D has adequate psychometric properties for natural disaster survivors. If these findings are further confirmed, the KCES-D can be used as a useful, rapid, and inexpensive screening tool for assessing depressive symptoms in natural disaster survivors.

The Barratt Impulsiveness Scale (Version 11; BIS-11; Patton, Stanford, & Barratt, 1995) is a gold-standard measure that has been influential in shaping current theories of impulse control, and has played a key role in studies of impulsivity and its biological, psychological, and behavioral correlates. Psychometric research on the structure of the BIS-11, however, has been scant. We therefore applied exploratory and confirmatory factor analyses to data collected using the BIS-11 in a community sample (N = 691). Our goal was to test 4 theories of the BIS-11 structure: (a) a unidimensional model, (b) a 6 correlated first-order factor model, (c) a 3 second-order factor model, and (d) a bifactor model. Among the problems identified were (a) low or near-zero correlations of some items with others; (b) highly redundant content of numerous item pairs; (c) items with salient cross-loadings in multidimensional solutions; and, ultimately, (d) poor fit to confirmatory models. We conclude that use of the BIS-11 total score as reflecting individual differences on a common dimension of impulsivity presents challenges in interpretation. Also, the theory that the BIS-11 measures 3 subdomains of impulsivity (attention, motor, and nonplanning) was not empirically supported. A 2-factor model is offered as an alternative multidimensional structural representation.

The present study examines the factorial structure and assesses the psychometric properties of the adapted multidimensional Health-Promoting Lifestyle Profile II Scale, considering a sample of Italian university students who participated to an online survey. The original 52-items Scale showed a high overall internal consistency. Four of the six subscales were associated with good values of the Cronbach’s α coefficient, whereas two subscales had lower values. Hence corrected item-total correlation was calculated and 26 items that decreased the scale’s reliability were deleted. The remaining 26 items were first subjected to Principal Component Analysis that suggested a conceptually meaningful five-factor model. This result was further supported by the first-order confirmatory factor analysis, in which all the factor loadings were statistically significant. The internal consistency and the composite reliability for the reduced version of the Scale and its subscales have shown a good reliability for the measurement models. The multidimensionality of the scale was also confirmed by a second-order factor model.

From the system perspective, this paper classifies the open courseware organization mechanism into seven parts, which include course selection mechanism, teaching contents and methods design mechanism, video fabricating mechanism, intellectual property protection mechanism, service & feedback mechanism, publicity & promotion mechanism, and operation mechanism, aimed at constituting a structural equation model composed of such seven first-order factors. The analysis of questionnaire data using confirmatory factor analysis method indicates the first-order structural model is tenable, and there is higher correlation between factor constructs; the second-order factor model is also tenable and gives an interpretation of the correlation between the first-order factors. The research outcome will serve as a reference for developing an open courseware organization mechanism for China's higher education institutions.