Latent Factor Analysis of Regional Growth in Belarus Using Structural Equation Modeling

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.

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

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.

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.

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.

Teacher leadership is gaining momentum in the school improvement program nowadays. School reformation depends on teacher leaders' ability to implement new approaches and help colleagues develop their skills, values, and expertise. Thus, this study aimed to develop and validate the teacher leadership instrument to measure the aspect of value using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), which has 31 items. The data were analyzed using Statistical Packages for the Social sciences version 22 and Structural Equation Modelling version 20.0. This study was administered to 320 teachers in 19 secondary schools in Kuala Lumpur, Malaysia, using questionnaires. The Exploratory Factor Analysis (EFA) yielded a 29 items three-factor model termed as Being a Consultant (PR), Fostering a Cooperation Culture (MBK), and Leading the Teaching and Learning Process (PPdP). The Confirmatory Factor Analysis yielded 17 items demonstrating three factors that achieved the model fit index, with Chi-squared/degree of freedom (Chisq/df) = 2.541, Tucker-Lewis Index (TLI) = 0.934, Comparative Fit Index (CFI) = 0.944; and Root Mean Square Error of Approximation (RMSEA) = 0.070. The composite reliability and average variance extracted of the domains ranged from 0.54 to 0.57 and 0.85 to 0.89. The study found that the instrument is valid and reliable in measuring the values aspect of teacher leadership models. This model's development can have a huge impact on teachers' leadership training through the teachers' professionalism improvement programs.

Background The Inventory of Parental Representations (IPR), a self-administered questionnaire, was developed primarily to identify styles of attachment in adolescence. However, it did not present stable psychometric properties in the various American studies carried out. The aim of this study was to adapt the IPR in French and to provide a shorter version with improved psychometric properties and sound content.MethodsThe cross-cultural adaptation and content validity were carried out based on qualitative analysis by an Expert Committee and 10 non-clinical adolescents. For the quantitative analyses a cohort of 535 adolescent volunteers was enrolled, corresponding to 1070 responses, and divided into two groups: development and validation. The study of the metric properties of the adapted version of the IPR was realized in the development group, a sample of 275 responses. In case of mediocre results in the Confirmatory Factor Analysis, the development of a new and reduced IPR structure was planned using a mixed method including Classical Test Theory and Rasch Modelling in the development group. Subsequently, the study of the psychometric properties of the short, adapted version was confirmed in an independent sample of 795 responses (validation group).ResultsOut of 62 items translated, 13 needed adaptations. The analysis of their metric properties produced mediocre results. Content and psychometric property analyses generated two Short version of the IPR in the development group: a paternal scale for Fathers (Short IPRF) with 15 items and a maternal scale for Mothers (Short IPRM) with 16 items. The sound content and good psychometric properties were confirmed in the validation group (Short IPRF: Comparative Fit Index = 0.987, Tucker-Lewis Index = 0.982, Root Mean Square Error of Approximation = 0.027; Short IPRM: Comparative Fit Index = 0.953, Trucker-Lewis Index = 0.927, Root Mean Square Error of Approximation = 0.068). Using Rasch modelling, the attachment was correctly measured overall especially for insecure attachment.ConclusionsA step-by-step process involving led to the generation of two questionnaires: a paternal scale, the Short IPRF, and a maternal scale with the Short IPRM providing opportunities to use this self-questionnaire to assess attachment among adolescents. Further work will provide a solid rating for this new tool.

There is a great deal of variation in the extent to which people with tinnitus find it distressing, which cannot be explained solely by differences in perceived loudness. The Cognitive Behavioral Model of Tinnitus Distress proposes that tinnitus becomes and is maintained as a distressing problem due to a process of interaction between negative thoughts, negative emotions, attention and monitoring, safety behavior, and beliefs. This study used path analysis to assess how well different configurations of this model fit using questionnaire data obtained from people with tinnitus. This was a cross-sectional study. Three hundred forty-two members of the public with tinnitus volunteered to complete a survey comprising a series of questionnaires and subscales of questionnaires measuring each of the constructs contained within the Cognitive Behavioral Model of Tinnitus Distress. The optimum factor structure of each measure for the study population was established, and the resulting factors were used to construct a series of path models based on the theoretical model. Path analysis was conducted for each of these, and the goodness of fit of the models was assessed using established fit criteria. Five of the six path models tested reached the threshold for adequate fit, and further modifications improved the fit of the three most parsimonious of these. The two best-fitting models had comparable fit indices which approached the criteria for good fit (Root Mean Square Error of Approximation = 0.061, Comparative Fit Index = 0.984, Tucker Lewis Index = 0.970 and Root Mean Square Error of Approximation = 0.055, Comparative Fit Index = 0.993, Tucker Lewis Index = 0.982). They differed principally in the placement of tinnitus magnitude and the inclusion/noninclusion of control beliefs. There are theoretical arguments to support both a beliefs-driven and a loudness-driven model, and it may be that different configurations of the Cognitive Behavioral Model of Tinnitus Distress are more appropriate to different groups of people with tinnitus. Further investigation of this is needed. This notwithstanding, the present study provides empirical support for a model of tinnitus distress which provides a clinical framework for the development of more effective psychological therapy.

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.

Adolescents living with HIV experience persistent challenges in achieving optimal adherence to antiretroviral therapy (ART), threatening viral suppression and long-term treatment success. In sub-Saharan Africa, including Ethiopia, developmental transitions, limited resources, and socio-cultural factors further complicate adherence. This study aims to develop and validate a model of antiretroviral therapy (ART) adherence determinants among Ethiopian adolescents living with HIV by extending the information-motivation-behavioral skills (IMB) model through the integration of HIV-related stigma as an additional construct, given its significant influence on adherence in this population. A cross-sectional study was conducted from March to October 2024 among 219 adolescents living with HIV in ALERT hospital, Addis Ababa. The data were analyzed via SPSS and the lavaan 0.6-18 package in R. The pathways through which the study constructs influenced ART adherence were estimated via the diagonally weighted least squares (DWLS) method. Model fit was evaluated via the chi-square to degrees of freedom ratio (χ²/df), comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean square error of approximation (RMSEA). A total of 210 adolescents were included in the final analysis, of whom 68.6% were adherent to ART. The proposed model demonstrated excellent fit to the data (χ²/df = 1.23, CFI = 0.99, TLI = 0.98, RMSEA = 0.033). Treatment self-efficacy mediated the effects of ART knowledge and ART attitude on ART adherence. While social support exerted both significant direct (β = 0.20, p = .029) and indirect effects via treatment self-efficacy, resulting in a significant total effect on ART adherence (β = 0.26, p = .004), HIV-related stigma did not demonstrate significant direct or indirect effects on ART adherence. Interventions that strengthen ART-related knowledge, foster positive treatment attitudes, enhance social support, and build treatment self-efficacy may substantially improve ART adherence among adolescents living with HIV.

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...

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.

Objective: The objective of this study was to evaluate the determinants of sugary drink consumption among overweight and obese adults attempting to lose weight using the Integrative Model of Behavioural Prediction (IMB). Design: Cross-sectional design. Method: Determinants of behavioural intentions (attitudes, perceived norms and perceived behavioural control [PBC]) and sugary drink consumption (intentions, skills/abilities, environment and PBC) were evaluated using data collected at a weight loss clinic in a southwestern US city ( n = 338). Determinants of attitudes, injunctive norms, descriptive norms and PBC were evaluated using salient beliefs, which were derived from an elicitation study. Results: Using structural equation modelling, two separate models were evaluated. Both models had good fit (combined model – Comparative Fit Index [CFI] = .970, Tucker–Lewis Index [TLI] = .921, Root Mean Square Error of Approximation [RMSEA] = .062; expanded model – CFI = .966, TLI = .911, RMSEA = .060) and accounted for a significant amount of variance for intentions (40.7%–42%) and sugary drink consumption (16.2%). Conclusion: The IMB appears to be an effective model for planning health education interventions. Health practitioners should operationalise behaviour change techniques and strategies that target attitudes, perceived norms and PBC using the salient beliefs evaluated in this study.

To clarify the underlying relationship between community-built environment and self-rated health in rapidly urbanizing China and examine the chained mediation effects of sleep quality and family functioning. Data were derived from a community-based cross-sectional survey conducted in Gaoping District, Sichuan Province. The Chinese versions of the Neighborhood Environment Walkability Scale-Abbreviated, the 36-Item Short Form Health Survey, the Insomnia Severity Index, and the Family Assessment Device were used to assess the community-built environment, self-rated health, sleep quality, and family functioning. Based on the Structural Equation Model, a structural equation model was constructed, and the weighted least squares mean- and variance-adjusted estimator was used to test the model. After the preliminary confirmatory factor analysis, model fit was evaluated using the comparative fit index, Tucker-Lewis's index, root mean square error of approximation, and standardized root mean square residual. This study included 2,705 adults (mean age 51.8 ± 18.3 years; 60% female). After adjusting for socioeconomic characteristics, the community-built environment was not significantly associated with self-rated health (all p > 0.05). In contrast, better sleep quality was identified as the strongest predictor of higher self-rated health (β = 0.383, p < 0.001). The hypothesized serial mediation effect was not statistically significant (β = -0.008, p = 0.068). In the mixed urban-rural context of western China, the community-built environment was not significantly associated with the self-rated health among community-dwelling adults. Notably, sleep quality was identified as the predominant factor affecting self-rated health outcomes.

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.