Factors associated with antiretroviral therapy adherence among adolescents living with HIV in Addis Ababa, Ethiopia: structural equation modeling.

ObjectivesDevelop and validate short and rapid forms of the 36-item Menstrual Practice Needs Scale (MPNS-36).DesignItem reduction prioritised content validity and was informed by cognitive interviews with schoolgirls in Bangladesh, performance...

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.

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.

Objective: to establish the psychometric properties of the Authentic Leadership Questionnaire (ALQ) applied to Brazilian nurses. Method: cross-sectional observational study with a non-probabilistic sample. The psychometric properties of the RATER and SELF versions of the ALQ were calculated using confirmatory factor analysis with the WLSMV robust estimation method. The following indices were used to assess the goodness-of-fit of the model: chi-square by degrees of freedom (χ2/df), Tucker-Lewis Index (TLI), Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Squared Residual (SRMR). Data reliability was analyzed using the ordinal coefficient alpha and composite reliability. Results: 181 nurses participated of the study (female gender: 80.1%; mean age of 34.6 years; working time of less than five years: 76.3%). The complete ALQ RATER and ALQ SELF models did not present an adequate fit. Therefore, the refined models presented a better fit to the sample data (ALQ RATER: χ2/df=2.77; CFI=0.97; TLI=0.97; RMSEA=0.10; SRMR=0.05; ALQ SELF: χ2/df=2.74; CFI=0.94; TLI=0.92; RMSEA=0.10; SRMR=0.08). In the ALQ RATER model, items 1, 7 and 13 were excluded. Due to the high correlation between the factors Relational Transparency and Moral Perspective, a three-factor model based on the combination of the factors mentioned above was proposed. In the ALQ SELF model, items 2, 5, 9 and 10 were excluded. Likewise, a three-factor model based on the combination of two factors, now called Self-Awareness Balance, was proposed. Conclusion: the data obtained with the Authentic Leadership Questionnaire with Brazilian nurses were valid and reliable.

IntroductionFemale sex workers (FSWs) in Uganda experience numerous barriers to antiretroviral therapy (ART) adherence. We used the planned behavior theory to help explore the enablers and barriers to ART adherence among FSWs. Understanding the barriers to ART adherence may help contribute to the development of interventions to improve ART adherence among the FSWs.Materials and methodsA descriptive qualitative study was conducted in Fort portal City. We conducted 30 in-depth interviews among FSWs who had been taking ART for at least six months. Furthermore, six key informant interviews were conducted with healthcare workers and leaders of the FSWs initiative. Data collection lasted for two months. Thematic deductive analysis was applied to analyse the data through the lens of the theory of planned behavior.FindingsThe attitudes, subjective norms, and perceived behavioral control influenced adherence to ART. Positive attitudes including perceived benefits of ART, and experiencing positive outcomes from taking ART were seen to enable its adherence. Subjective norms such as social support, disclosure of HIV status, seeing others take ART, and aspirations of longer life enabled ART adherence. Taking ART in the morning, responsive and respectful healthcare workers, and availability of food/basic needs facilitated compliance with ART adherence. Negative attitudes such as misconceptions and fear of side effects hindered ART adherence. Social disapproval of sex work and or HIV, lack of social support, gender-based violence, non-disclosure, stigma, and abandonment hindered the use of ART among FSWs. Socio-economic constraints (e.g., food scarcity), and occupation-related factors (substance use, incarceration, busy and predictable schedules, and abrupt migrations) were the additional barriers to ART adherence.ConclusionART adherence among FSWs was influenced by attitudes, subjective norms, and perceived behavioral control. Addressing these barriers in ART adherence through targeted interventions could facilitate ART adherence and improve health outcomes among FSWs.

Antiretroviral therapy (ART) adherence behavior is heterogeneous among adolescents and young adults (AYAs) with HIV and influenced by individual and interpersonal psychosocial factors. The primary objective of this study is to characterize ART adherence phenotypes and psychosocial symptom clusters, as related to ART adherence and HIV viral load suppression. This analysis included 60 AYAs with HIV enrolled in an ART adherence support clinical trial. Self-reported ART adherence at baseline, 12-weeks, and 24-weeks was used to define four ART adherence phenotypes: consistently high adherence (YY), early-only adherence (YN), late-only adherence (NY), and consistently low adherence (NN). Symptom clusters were empirically derived from baseline psychosocial measures, including adherence self-efficacy, ART knowledge, HIV stigma, psychological distress (depression, anxiety, trauma), and social support. Linear mixed-effects models were used to examine psychosocial symptom outcomes at three timepoints (baseline, 12-weeks, and 24-weeks) and across groups with different adherence or viral load phenotypes. Using hierarchical clustering, four distinct clusters were identified, underscoring heterogeneity of psychosocial symptoms and patterns of ART and viral suppression. Findings from this analysis are among the first known characterizations of ART adherence phenotypes and psychosocial symptom clusters among AYAs with HIV. Heterogeneity in clusters underscores the need to examine other factors, such as resilience, not captured in the present study. Overall, these study findings contribute to improved understanding of the multi-level psychosocial influences of ART adherence and viral load suppression.

BackgroundMotivational interventions are used as preventive measures in occupational health. However, existing studies primarily focus on motivation methods and not the stage of motivation—the process from extrinsic to intrinsic motivation. The treatment self-regulation questionnaire (TSRQ) can predict workers’ health at each motivational stage. Accordingly, this study examined the reliability and validity of the Japanese version of the TSRQ (Diet and Exercise) in occupational health settings.MethodsResponses of 912 workers were analyzed. In this study, the Cronbach’s alphas were 0.85 for Diet and 0.84 for Exercise after excluding items with low Item-Total correlations. Regarding convergent validity, there was a weak correlation between behavior modification stages and the TSRQ. Regarding structural validity, confirmatory factor analysis was performed assuming a four-factor structure.ResultsThe goodness-of-fit indices were: Comparative Fit Index (CFI) = 0.94, Tucker Lewis Index (TLI) = 0.92, and Root Mean Square Error of Approximation (RMSEA) = 0.07 for Diet and CFI = 0.92, TLI = 0.91, and RMSEA = 0.08 for Exercise.ConclusionThe Japanese version of the TSRQ has a certain degree of reliability and validity. It can measure motivation for Diet and health-related behaviors in occupational health settings. The findings of this study may serve as a basis for promoting primary and secondary prevention.

BackgroundStudies increasingly show an association between internalized stigma and increased symptoms, and poorer social and occupational functioning. Fewer studies have informed about protective traits, attitudes, and factors that may attenuate the impact of internalized stigma on psychopathology and psychosocial functioning. The current study used path analysis to examine putative intervening roles for resilience, coping, and recovery attitudes consistent with hope, empowerment, strengths, and self-direction on the effect of internalized stigma on psychopathology and function.MethodsParticipants were individuals diagnosed with either schizophrenia or schizoaffective disorder (N=84). All participants had completed training and certification as peer support specialists and included 49 individuals currently employed and 35 currently unemployed. Using mailed surveys, participants were administered the Life Stressors Inventory, Internalized Stigma of Mental Illness, the Connors Davidson Resilience Scale, Maryland Assessment of Recovery in Serious Mental Illness, the Brief Symptom Inventory, Brief COPE, Social Functioning Scale, and the Social Support Questionnaire. Path analytic models were estimated using Mplus5. Three path models were estimate designating psychopathology, social support, and community function as dependent variables. Goodness of Fit indices including the Comparative Fit Index (CFI), Tucker Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA), and the Standardized Root Mean Squared Residual were used to evaluate the fit of the models to the data.ResultsThere were associations between five subdomains of the ISMI—Alienation (r=0.47, p<0.001), Stereotype Endorsement (r=0.29, p<0.001), Discriminatory Experiences (r=0.40, p<0.001), Social Withdrawal (r=0.47, p<0.001), and Stigma Resistance(r=-0.28, p<0.01) and the severity of psychopathology. There was a significant association between internalized stigma and overall functioning (r=0.46, p<0.001). In addition, the five subdomains of the ISMI—Alienation (r=-0.53, p<0.001), Stereotype Endorsement (r=-0.40, p<0.001), Discriminatory Experiences (r=-0.39, p<0.001), Social Withdrawal (r=-0.40, p<0.001), and Stigma Resistance(r=0.35, p<0.001) were associated with ratings of the satisfaction with social support. Associations with reported amount of social support ranged from r=0.25 for Stigma Resistance to r= -0.39 for Alienation.The final path models for the severity of psychopathology (CFI/TLI = 0.955/0.933, RMSEA=0.091, SRMR =0.049), social support (CFI/TLI = 0.957/0.935, RMSEA=0.085, SRMR =0.072), and community functioning (CFI/TLI = 0.928/0.901, RMSEA=0.087, SRMR =0.09) produced adequate goodness-of-fit estimates. In all three models, the use of maladaptive coping but not the use of adaptive coping mediated the effect of internalized stigma on the dependent variable. Recovery attitudes did not significantly predict psychopathology when resilience was included in the model, suggesting possibly collinear constructs.DiscussionThe study demonstrates that coping styles, recovery, and resilience attitudes are associated with functional outcomes in people with schizophrenia spectrum disorders. However, the impact of internalized stigma on psychopathology, social, and community functioning may be mediated the use of maladaptive coping styles and attitudes consistent with resilience and adaptability.

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.

ObjectiveThis study describes the development and validation of the Menstrual Practice Needs Scale (MPNS-36), which measures the extent to which respondents’ menstrual practices and environments meet their needs.MethodsA 54-item pool...

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.

Four tertiary hospitals in 2017. Methods The provision of pharmaceutical care was investigated.A cross-sectional questionnaire survey covering different constructs of communicative relationship quality model was conducted and the associations among pairs of the study constructs were explored. Based on the results of confirmatory factor analysis, path analysis was conducted to validate the proposed communicative relationship quality model. Main outcome measure Model fit indicators including Tucker-Lewis index (TLI), comparative fit index (CFI), root mean square error of approximation (RMSEA) and weighted root mean square residual(WRMR). Results There were 589 patients included in our study. The final path model had an excellent fit (TLI = 0.98, CFI = 0.98, RMSEA = 0.05; WRMR = 1.06). HCP participative behavior/patient-centeredness (β = 0.79, p < 0.001) and interpersonal communication (β = 0.13, p < 0.001) directly impact the communicative relationship quality. But patient participative behavior was not a predictor of either communicative relationship quality or patient satisfaction. Conclusion HCP participative behavior/patient-centeredness and interpersonal communication are positively related to relationship quality, and relationship quality is mediator between HCP participative behavior and interpersonal communication with patient satisfaction.

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).

Depression is a very common psychiatric disorder in worldwide. Globally, Human Immunodeficiency Virus (HIV) is highly prevalent among women, and are disproportionately affected by depression. Antiretroviral Therapy (ART) adherence which could highly be affected by depression is yet to be explored effectively. Depression affects overall poor HIV clinical outcomes, socioeconomic and social interactions. However, it is not well understood specifically how depression affects ART adherence in women living with HIV (WLWHIV). Investigating the effects of depression on ART adherence is critical in order to develop nuanced new evidence to address non-adherence in WLWHIV. To conduct a meta-analysis on the correlation between depression and adherence to antiretroviral therapy among women living with HIV in the globe. Using population, exposed and outcome approach, we searched Scopus, PubMed, EMBASE, Cochrane Library, Psych info, Web of science and google scholar for cohort and cross-sectional studies globally. The search strategy was structured comprising terms associated with antiretroviral therapy and adherence, women living with HIV and depression. We evaluated the paper quality, using the Newcastle-Ottawa Scales (NOS). The fixed effect model was used to analysis the effect of depression on ART adherence. A total of 8 articles comprise 6474 participants were included in this study. There were controversial findings related to the effect of depression to ART adherence. Among three cross-sectional study, one article demonstrating, depression was associated with ART adherence. Of the five cohort studies, four cohort studies reported association. The overall pooled estimated effect of depression on ART adherence was 1.02 [RR = 1.015 with 95% CI (1.004, 1.026)] with a p-value of 0.005. Depression was the risk factor for ART adherence among women living with HIV. It is therefore, necessary for clinician to note this and perform screening for ART adherence. The review protocol was developed with prospero registration: CRD42023415935.

BackgroundTo the best of our knowledge, the Cyberchondria Severity Scale-12 (CSS-12) has not been translated into Arabic; therefore, our objective was to assess the psychometric properties of the Arabic version of the CSS (CSS-12-Ar) among a sample of Lebanese adults.MethodsParticipants were enrolled in January 2021. A confirmatory factor analysis (CFA) was carried out using the MPlus software v.7.2, reporting several goodness-of-fit indicators: Relative Chi-square (χ2/df), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Tucker Lewis Index (TLI). To evaluate measurement invariance across gender, we conducted higher-order multiple group confirmatory analysis using lavaan software.Results449 participants enrolled in this study (mean age: 24.34 ± 8.22 years, 70.6% females). Since the correlations between the four-factor model were very high (r > 0.8), we ran the higher-order CFA in which all first-order latent variables were loading a general factor. The analyzed model was well-fitted to the data χ2(50) = 173.34; p < 0.001; CFI = 0.926; RMSEA = 0.074 [0.062, 0.086]. The Cronbach’s alpha values were good for the total score (0.92), as well as for excessiveness (0.80), distress (0.77), reassurance (0.81) and compulsion (0.76). The results provided evidence of full scalar invariance across gender. The comparison of latent mean scores revealed no significant differences across gender, in either the cyberchondria total score or its facets. The CSS-12 score was positively associated with anxiety (r = 0.10; p = 0.003) (convergent validity), OCD (r = 0.11; p = 0.016) and stress (r = 0.35; p < 0.001) (concurrent validity).ConclusionThe CSS-12-Ar was deemed a suitable scale to measure the severity of cyberchondria among Lebanese university students. We hope that researchers and clinicians can benefit now from this scale.