Multilevel confirmatory factor analysis of the Effective Behavior Support Self-Assessment Survey.

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

BackgroundUnder the circumstance of global population aging, the issue on how to facilitate the quality of life (QOL) for older people brings us grand challenge. On the way to solve this problem, it is inextricable to measure QOL for older people accurately at onset. This study is aimed at evaluating the reliability and validity of the Chinese version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD).MethodsWe received 1005 valid WHOQOL-OLD questionnaires from 1050 respondents who were 60 and older by quota sampling method. To calculate the test-retest correlation coefficient we re-interviewed 101 participants from the community. Psychometric properties were evaluated from the aspect of feasibility, internal consistency reliability, test-retest reliability, content validity, construct validity and discriminant validity.ResultsMissing item responses took up 0.0%-2.7% in the scale. The WHOQOL-OLD showed satisfactory reliability with Cronbach’s Alpha coefficients ranging from 0.711 (Social participation) to 0.842 (Sensory ability) for each domain. The intra-class correlation coefficients (ICC) presenting test-retest reliability were all over 0.7. In Confirmatory Factor Analysis (CFA), Root Mean Square Error of Approximation (RMSEA) was 0.084 (a little more than 0.08) and comparative fit index (CFI) 0.95 (>0.90) which meant acceptable construct validity. There were higher correlation coefficients between items and their hypothesized domains than other domains (P < 0.001), indicating good content validity. The results of t-test showed good discriminant validity of the WHOQOL-OLD between the healthy group and the unhealthy group (P < 0.0083).ConclusionThe Chinese version of WHOQOL-OLD showed good feasibility, reliability and validity in this study. However, before it can be used national-widely, further research should be conducted in other areas of China.

The purpose of this Action Research study was to investigate what interventions are needed to improve student engagement and behaviors, academic growth, and attendance. The next part of the action research study was to understand how to implement these changes within School District A's student service support system and to adequately track these efforts to ensure that students are being adequately supported to improve behaviors, attendance, and academic growth. The need to increase support systems to serve children has always been a mission for School District A. The study concluded that intervening early and often, implementing positive behavior intervention strategies, and increasing collaboration and partnerships with staff, students, families, and community agencies will increase student success. The initial research in Cycle One confirmed that heightened communication, increased staff and family education, and constant feedback and revisions were all essential to leading and managing change within School District A's student service support systems. In addition, data-driven decision making based on tracking student attendance, student behavior reports, and academic growth scores were imperative in improving the implementation of positive behavior interventions and utilizing the intervention technique of intervening early and often. Ainscow (2016) found that school autonomy will result in a more successful system that will inevitably increase successes in student support and interventions. The author further explained that there is not a standard fit when it comes to supporting students and identifying needs. Therefore, intervening early and often allows for the process to support individual student needs (Ainscow, 2016). Analysis of approaches allows for strategies to be found and created that fit each school's and their students' needs. The main question is what interventions are needed to create a successful and equitable multi-tiered support system (MTSS) that intervenes preemptively before students are in crises. Staff, student, and family surveys identified that effective collaboration between stakeholders and participants within School District A does not exist. Surveys and interviews showed that communication and education is needed to improve student services and to intentionally intervene to improve student engagement, behaviors, and attendance. This study showed that positive behavior interventions and intervening early and often increased student engagement and academic growth, increased attendance, and decreased poor student behaviors. The study also showed best practices in leading and managing change. Education, communication, reflection, data driven decisions, and revisions were all proven to enable change within School District A's student service system.--Author's abstract

Background: Pediculosis is a common ectoparasitic infestation that involves especially the skin of children worldwide. Studying the children’s perception of the disease’s risk factors, the effectiveness of personal preventive measures, and its implications for their health could be a major leap forward in health promotion activities. Objectives: This study aimed to develop and evaluate the psychometric properties of the Children’s Perception Scale of Head Lice Infestation (CPS-HLI) and its initial feasibility assessment for use on Iranian and possibly other elementary school children. Methods: The scale’s items were retained based on an extensive literature search and classified into the underlying constructs of the extended health belief model (EHBM). An expert panel endorsed the qualitative content and face validity of the preliminary draft, and 47 items remained for quantitative validity testing on a sample of 362 elementary school students in the city of Paveh, West of Iran. Explanatory and confirmatory factor analyses (EFA and CFA) were employed to test the content and structural validity of the constructed instrument. Cronbach's alpha and intra-class correlation coefficients were calculated to assess the internal consistency and reliability of the scale. Results: The values of Lawshe's content validity index (0.90) and content validity ratio (0.77), the subscales’ Cronbach's alpha (0.59), and intra-class correlation (0.72) coefficients confirmed plausible internal consistency of the scale. The values of root mean square error of approximation (RMSEA) (&lt; 0.08 with χ2 &lt; 0.05), Tucker-Lewis index (TLI), and comparative fit index (CFI) &gt; 0.9 approved the applied statistical model’s goodness of fit. The ranges of Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy for the underlying subscales (0.49 - 0.74) and the statistically significant result of Bartlett’s test of sphericity (P &lt; 0.001) confirmed the patterned relationship among the constructed scale’s items. The principal component analysis that was performed using STATA favored the 11-factor solution. Conclusions: The study findings support the construct validity of CPS-HLI for use in studies on children’s perception of head lice infestation risk factors, the effectiveness of personal preventive measures, and the disease implications for their health and well-being. Further cross-cultural and cross-national validation studies are recommended for using the instrument in a wider range of populations and settings.

Much of children's activity occurs at school. Given the unique environmental characteristics of schools, this creates a degree of shared variance amongst the children that violates the assumption of independence underlying the General Linear Model. The degree of shared variance at the nested level can be calculated through intra-class correlations (ICCs). As random assignment often occurs at the school level, these ICCs are critical in determining the number of schools required for adequate power. Studies have published ICCs at the school-level for accelerometers. Surprisingly, there is relatively little data on ICCs for pedometers. Nor is there much information for ICCs at the class-level. This is problematic as classroom teachers implement many interventions, which creates a second level of nesting (i.e. child within classes within schools) to be modeled. PURPOSE: ICCs were calculated at the school (n=8), classroom (n=45) and within student levels (n=720) to determine if there was significant shared variance at each level of analysis. METHODS: In-school steps were collected through pedometer counts over 5 schools days. Research staff placed an OMRON HJ 104 pedometer on the hip of each child within 30 min of the onset of the school day, along with their removal within 30 min of dismissal. These procedures were repeated 6 months later. RESULTS: ICCs were calculated as the amount of variance due to a specific level of the model (e.g., schools) by the total amount of variance (i.e., the sum of the variances from the school, teacher, child, and within-child levels of the model). The ICCs for the pedometers were: 0.06 for schools, 0.06 for teachers, and 0.27 for the students. These are in-line with other school-based data for accelerometers that found ICCs of.057 for schools during 7-day assessments. CONCLUSION: Both the classroom and the school resulted in significant shared variance for the children nested within those levels. Thus, statistical models should be designed to model variance at both the classroom and school-levels. Interestingly, the magnitude of these effects was similar for studies of accelerometry. Thus, regardless of the mode of assessment, children show a consistent degree of shared variance at the school-level.

BackgroundThe Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a widely used questionnaire to measure the stigmatising attitudes of healthcare providers towards patients with mental health problems. The psychometric properties of the scale; however, have never been investigated in Hungary. We aimed to thoroughly explore the factor structure of the OMS-HC and examine the key psychometric properties of the Hungarian version.MethodsThe OMS-HC is a self-report questionnaire that measures the overall stigmatising attitude by a total score, and three subscales can be calculated: Attitude, Disclosure and Help-seeking, and Social Distance. Our study population included specialists and trainees in adult and child psychiatry (n = 211). Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. We calculated the test-retest reliability on a subgroup of our sample (n = 31) with a follow-up period of 1 month. The concurrent validity of the scale was measured with the Mental Illness: Clinician’s Attitudes-4 scale (MICA-4).ResultsThree factors were extracted based on a parallel-analysis. A bifactor solution (a general factor and three specific factors) showed an excellent model-fit (root mean square error of approximation = 0.025, comparative fit index = 0.961, and Tucker-Lewis index = 0.944). The model-based reliability was low; however, the general factor showed acceptable reliability (coefficient omega hierarchical = 0.56). The scale demonstrated a good concurrent validity with the MICA-4 [intraclass correlation coefficient (ICC) = 0.77]. The test-retest reliability was excellent for the general factor (ICC = 0.95) and good for the specific factors (ICC = 0.90, 0.88, and 0.84, respectively).ConclusionsThe three dimensions of the OMS-HC was confirmed, and the scale was found to be an adequate measure of the stigmatising attitude in Hungary. The bifactor model is more favourable as compared to the three correlated factor model; however, despite the excellent internal structure, its model-based reliability was low.

There is evidence that treatment of gynecologic cancer (GC) negatively affects body image and sexuality. The Sexual Adjustment and Body Image Scale (SABIS-G) was developed to assess disturbances after diagnosis of GC. The objective of this study was to confirm the factor structure using a confirmatory factor analysis (CFA). Women with a history of GC completed the SABIS-G, a 9-item self-report measure. Ninety randomly selected participants were used for the exploratory factor analysis (EFA). CFA was performed on the remaining participants (n = 204) to confirm the factor structure developed in the EFA against a one-factor model. Test-retest reliability between baseline and follow-up scores was assessed using the intraclass correlation coefficient. A total of 614 eligible patients were approached to participate: 398 (65%) consented to the study and 294 (74%) completed the SABIS-G. The median age was 53 years (range, 27-80 years) and the primary site of disease was: 120 (41%) uterine, 85 (29%) ovary, 82 (28%) cervix, and 7 (2%) other. A 2-factor structure was favored in the EFA, and the CFA fit indices indicated an excellent fit for the 2-factor measurement model (standardized root-mean-square residual = 0.05, non-normed fit index = 0.97, comparative fit index = 0.98). Internal consistency reliability was high for the Body Image (0.88) and Sexual Adjustment (0.91) subscales, as was test-retest reliability (0.89). These results confirm the 2-factor structure of the SABIS-G and provide evidence that this is a valid and reliable instrument to measure changes in body image and sexuality in women after a diagnosis of GC.

ObjectiveTo validate the Workplace COVID-19 Knowledge and Stigma Scale (WoCKSS) using item response theory (IRT), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).DesignCross-sectional psychometric validation.SettingManufacturing companies registered in Malaysia.ParticipantsA total of 137 factory workers participated in the exploratory phase and 300 in the confirmatory phase. Inclusion criteria were Malaysian nationality and ability to read Malay.MethodsThe knowledge domain was examined using the two-parameter logistic IRT model in two stages: an exploratory IRT analysis in phase 1 to screen items and a confirmatory IRT analysis in phase 2 to evaluate the final item set. The stigma domain was analysed using EFA followed by CFA. Reliability was assessed using Cronbach’s alpha and McDonald’s omega (ω). The development process and content and face validity results were previously published.Results14 knowledge items were retained after exploratory IRT and formed the final knowledge scale evaluated in confirmatory IRT. For these final items, discrimination parameters ranged from 0.77 to 3.17 and difficulty values from −4.47 to 0.23, with unidimensionality supported (p=0.644). EFA supported a three-factor stigma structure (stereotype, fear, prejudice), and CFA confirmed excellent model fit (χ2=8.91, df=11, p=0.630; root mean square error of approximation=0.00; Comparative Fit Index=1.00; Tucker-Lewis Index=1.00; standardised root mean square residual=0.021). Composite reliability by McDonald’s omega ranged from 0.691 to 0.893.ConclusionWoCKSS is a reliable and valid instrument for assessing workplace COVID-19 knowledge and stigma in industrial sectors in Malaysia.

Short-term impacts of breakfast consumption on diet quality and cognitive functioning have been reported, but more evidence is needed to draw causal inferences about long-term impacts of school breakfast on indicators of school engagement and academic achievement. To estimate the impact of a Breakfast in the Classroom (BIC) program on School Breakfast Program participation, school attendance, and academic achievement. This quasi-experimental study included a sample of 446 public elementary schools from a large, urban US school district that served predominantly low-income, racial/ethnic minority students. A total of 257 schools (57.6%) implemented a BIC program during the 2012-2013 academic year, whereas 189 (42.4%) did not. School- and grade-level data from 2012-2013 and grade-level achievement data from the prior year were collected from school district records across the elementary schools. Hypotheses that a BIC program would improve school breakfast participation at the school level, school attendance at the grade level (kindergarten through sixth grade), and academic achievement at the grade level (second through sixth grades) were tested using propensity score weights to adjust for demographic differences between the BIC and non-BIC schools. The BIC program was linked with increased breakfast participation during the academic year (F10,414=136.90, P<.001), with mean participation rates of 73.7% in the BIC group vs 42.9% in the non-BIC group. The BIC program was also linked with greater overall school attendance rates (95.5% vs 95.3% in the non-BIC group; F1,2772=8.40, P = .004). When performing attendance analyses in the subset of grade levels for which achievement data were available, results were mostly consistent, although there was a group × time interaction (F10,1891=1.94, P=.04) such that differences between least squares means in the BIC vs non-BIC groups did not reach statistical significance at every month. There were no group differences in standardized test performance in math (57.9% in the BIC group vs 57.4% in the non-BIC group; F1,1890=0.41, P=.52) or reading (44.9% in the BIC group vs 44.7% in the non-BIC group; F1,1890=0.15, P=.70). Findings add to the evidence that BIC can increase school breakfast participation substantially and suggest that it has the potential to improve overall school attendance rates. Additional research is needed to explore the generalizability of these findings and the potential impacts on achievement for longer periods and on additional outcomes, such as weight status.

Background: In 2023, the US state of Texas passed a bill on vaping in school – House Bill 114 (HB 114) – which took effect in Texas public schools on 1 September of that year. HB 114 mandates that any student caught vaping in school be placed on a Disciplinary Alternative Education Program (DAEP). The efficacy of HB 114 may be contingent, at least in part, on the manner in which it is implemented at the school level. This study examined school personnel’s experiences implementing HB 114 in Texas public schools. Methods: We conducted semi-structured interviews with 13 school personnel performing a variety of roles in a Texas public school district. Findings: Thematic analysis of interview data revealed eight themes covering three topics of interest. School personnel reported mixed attitudes towards HB 114 and expressed concern about students adopting more sophisticated covert behaviours to continue vaping undetected. Although vaping prevalence was not measured directly, school personnel did not believe that the policy was reducing the prevalence of student vaping. Schools used diverse strategies to inform students and parents about the policy (e.g. flyers, emails, and social media posting). While some middle and high schools provided vaping prevention education and training for students and school personnel, elementary schools almost exclusively did not have one. The most often cited facilitators for policy implementation were school personnel being cooperative and having the funding to purchase vape detectors. Barriers include limited space and staffing in DAEP, the need for training for school personnel on vaping, and financial strain for more vape detectors. Conclusions: Findings suggest future efforts discouraging vaping should provide additional resources (e.g. financial support) to schools, update school personnel on vaping, offer more prevention and cessation education, and call for more parental and community engagement.

PurposeTo validate the hepatitis B virus infection-related stigma scale (HBVISS) using Classical Test Theory and Item Response Theory in a sample of Chinese chronic HBV carriers.MethodsFeasibility, internal consistency reliability, split-half reliability and construct validity were evaluated using a cross-sectional validation study (n = 1,058) in Classical Test Theory. Content validity was assessed by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. The Item Response Theory (IRT) model parameters were estimated using Samejima’s graded response model, after which item response category characteristic curves were drawn. Item information, test information, and IRT-based marginal reliability were calculated. Measurement invariance was assessed using differential item functioning (DIF). SPSS and R software were used for the analysis.ResultsThe response rate reached 96.4% and the scale was completed in an average time of 5 min. Content validity of HBVISS was sufficient (+) and the quality of the evidence was high according to COSMIN criteria. Confirmatory factor analysis showed acceptable goodness-of-fit (χ2/df = 5.40, standardized root mean square residual = 0.057, root mean square error of approximation = 0.064, goodness-of-fit index = 0.902, comparative fit index = 0.925, incremental fit index = 0.926, and Tucker-Lewis index = 0.912). Cronbach’s α fell in the range of 0.79–0.89 for each dimension and 0.93 for the total scale. Split-half reliability was 0.96. IRT discrimination parameters were estimated to range between 0.959 and 2.333, and the threshold parameters were in the range-3.767 to 3.894. The average score for test information was 12.75 (information >10) when the theta level reached between-4 and + 4. The IRT-based marginal reliability was 0.95 for the total scale and fell in the range of 0.83–0.91 for each dimension. No measurement invariance was detected (d-R2 < 0.02).ConclusionHBVISS exhibited good feasibility, reliability, validity, and item quality, making it suitable for assessing chronic Hepatitis B virus infection-related stigma.

We aimed to assess the validity and reliability of the ten-item Connor-Davidson Resilience Scale (CD-RISC10) in patients with axial spondyloarthritis (axSpA) in Singapore. We used cross-sectional data from 108 patients with axSpA recruited from a dedicated axSpA clinic in a Singapore tertiary referral hospital from 2017 to 2018. Analyses were guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework. Face validity was assessed through cognitive debriefing interviews (CDIs). Internal consistency was assessed through Cronbach's alpha. Test-retest reliability was assessed through intraclass correlation (ICC). Measurement error was assessed through smallest detectable change (SDC). Construct validity was assessed through six a priori hypotheses through correlation of the CD-RISC10 score with other patient-reported outcome measures. Structural validity was assessed using confirmatory factor analysis (CFA). Fit indices evaluated were root-mean-square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TFI), and standardized root-mean-squared residual (SRMR). Ten patients completed the CDIs and face validity was supported. Among 108 patients (median age: 37(21-77), 81.5% males, 93.5% Chinese), the CD-RISC10 demonstrated good internal consistency (Cronbach's alpha = 0.94), and excellent test-retest reliability [ICC = 0.964 (95% CI 0.937-0.980)]. SDC was calculated as 1.88. Construct validity was established by meeting five out of the six a priori hypotheses. Structural validity was supported as CFA confirmed a one-factor model, with adequate fit statistics after adding three covariances (RMSEA = 0.077; CFI = 0.975; TLI = 0.964; SRMR = 0.036). This study supports the CD-RISC10 as a valid and reliable measure of resilience for use in patients with axSpA.

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

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.

ObjectivesCohort studies of ageing and cognitive decline typically do not begin fielding comprehensive cognitive assessments until older adulthood. However, for identifying preventable dementia risk factors, there is strong value in beginning at earlier ages. The case is especially compelling in sub-Saharan Africa, where the number of older individuals is expected to triple in the next three decades, and where risk factors may operate more intensively at earlier ages. This study reports on the adaptation and validity of the Harmonised Cognitive Assessment Protocol (HCAP) approach in the Kenya Life Panel Survey (KLPS), collected among middle-aged respondents.DesignTo evaluate the validity of the HCAP approach in Kenya, this study assesses model fit statistics from confirmatory factor analyses (CFA) and tests measurement invariance by respondent characteristics.SettingBoth rural and urban areas in Kenya.ParticipantsA sample of n=5878 individuals from the KLPS, who have been surveyed regularly since they were schoolchildren in the 1990s. The HCAP assessment was administered in 2023 at an average age of 37 years (10–90 range 34 to 41).Primary and secondary outcome measuresFor each individual, the CFA generates a general cognitive performance score, and cognitive performance scores for five distinct domains, including memory, executive functioning, language, orientation to time and place, and visuospatial functioning.ResultsFit of the models to the data was adequate for general cognitive performance (root mean squared error of approximation (RMSEA)=0.03; comparative fit index (CFI)=0.94; standardised root mean residual (SRMR)=0.05), language (RMSEA=0.02; CFI=0.95; SRMR=0.05) and good for memory (RMSEA=0.05; CFI=0.99; SRMR=0.02) and executive functioning (RMSEA=0.03; CFI=0.98; SRMR=0.03). The CFA indicate that the factor structure is consistent with findings from other countries and that reliability for the general cognitive performance score was high. Statistical models also suggest invariance at the scalar level for leading demographic (gender, age) and socioeconomic (education, occupational complexity) characteristics.ConclusionsThis study demonstrates that the cognitive functioning of mid-age Kenyans appears to be well captured by the adapted protocol. While there is a moderate decline in cognitive performance among older individuals, this relationship appears to be mediated by education, indicating that this KLPS HCAP provides a valuable baseline for studying future cognitive decline.