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1.  Analysis of the Black Racial Identity Attitude scale in a substance-abusing population. 
Racial attitude characteristics of African Americans may have important implications for patient-therapist matching in substance abuse treatment. The Black Racial Identity Attitude Scale (BRIAS) is a questionnaire used to measure racial identity attitudes. This study tested the stability and internal consistency of the BRIAS in an African-American substance-abusing population. This is the first known test of the BRIAS in a clinical population. African-American veterans (n = 53) were administered the BRIAS to test for stability over time and internal consistency. Initial analysis of the instrument revealed that a majority of items were not stable over time. Using the initial results, we removed 26 problematic items. Three modified scales remained, each having marginal test-retest reliability. Two of the modified scales had moderately adequate internal consistency, and the third was minimally adequate. We found that the BRIAS did not demonstrate sufficient internal consistency or stability in this population to adequately identify the constructs of the Nigrescence Racial Identity Development theory of William Cross, Jr. There is a growing recognition of the need to explore the extent of racial, ethnic, and cultural factors in substance abuse behavior and treatment; therefore, we recommend that further attention be directed toward developing an instrument to reliably and accurately measure identity constructs among African-American clinical subjects.
PMCID: PMC2594395  PMID: 12078927
2.  Assessment of a Short Diabetes Knowledge Instrument for Older and Minority Adults 
The Diabetes educator  2013;40(1):68-76.
Purpose
The purpose of the study was to assess the performance of a short diabetes knowledge instrument (SDKI) in a large multi-ethnic sample of older adults with diabetes and to identify possible modifications to improve its ability to document diabetes knowledge.
Research Design and Methods
A sample of 593 African American, American Indian, and white female and male adults 60 years and older, with diabetes diagnosed at least two years prior, was recruited from eight North Carolina counties. All completed an interview that included a 16-item questionnaire to assess diabetes knowledge. A subsample of 46 completed the questionnaire a second time at a subsequent interview. Item-response analysis was used to refine the instrument to well-performing items. The instrument consisting of the remaining items was subjected to analyses to assess validity and test-retest reliability.
Results
Three items were removed after item-response analysis. Scores for the resulting instrument were lower among minority and older participants, as well as those with lower educational attainment and income. Scores for test-retest were highly correlated.
Conclusions
The SDKI (13 item questionnaire) appears to be a valid and reliable instrument to evaluate knowledge about diabetes. Assessment in a multi-ethnic sample of older adults suggests that this instrument can be used to measure diabetes knowledge in diverse populations. Further evaluation is needed to determine whether or not this instrument can detect changes in knowledge resulting from diabetes education or other interventions.
doi:10.1177/0145721713508824
PMCID: PMC3946961  PMID: 24163359
3.  Assessing negative cognitive style: Development and validation of a Short-Form version of the Cognitive Style Questionnaire 
Highlights
► We developed a Short-Form version of the Cognitive Style Questionnaire (CSQ). ► The CSQ Short Form (CSQ-SF) demonstrated satisfactory internal reliability. ► Test–retest reliability was also satisfactory. ► Scores demonstrated predicted correlations with measures of depression and anxiety. ► The CSQ-SF may be a useful research tool in assessing vulnerability to depression.
The Cognitive Style Questionnaire (CSQ) is a frequently employed measure of negative cognitive style, associated with vulnerability to anxiety and depression. However, the CSQ’s length can limit its utility in research. We describe the development of a Short-Form version of the CSQ. After evaluation and modification of two pilot versions, the 8-item CSQ Short Form (CSQ-SF) was administered to a convenience sample of adults (N = 278). The CSQ-SF was found to have satisfactory internal reliability and test–retest reliability. It also exhibited construct validity by demonstrating predicted correlations with measures of depression and anxiety. Results suggest that the CSQ-SF is suitable for administration via the Internet.
doi:10.1016/j.paid.2011.11.026
PMCID: PMC3289144  PMID: 22389545
Cognitive style; Depression; Anxiety
4.  The Short Anxiety Screening Test in Greek: translation and validation 
Background
The aim of the current study was to assess the reliability and validity of the Greek translation of the Short Anxiety Screening Test (SAST), for use in primary care settings. The scale consists of 10 items and is a brief clinician rating scale for the detection of anxiety disorder in older people, particularly, in the presence of depression.
Methods
The study was performed in two rural primary care settings in Crete. The sample consisted of 99 older (76 ± 6.3 years old) people, who fulfilled the participating criteria. The translation and cultural adaptation of the questionnaire was performed according to international standards. Internal consistency using the Cronbach α coefficient and test-retest reliability using the intraclass correlation coefficient (ICC) was used to assess the reliability of the tool. An exploratory factor analysis using Varimax with Kaiser normalisation (rotation method) was used to examine the structure of the instrument, and for the correlation of the items interitem correlation matrix was applied and assessed with Cronbach α.
Results
Translation and backtranslation did not reveal any specific problems. The psychometric properties of the Greek version of the SAST scale in primary care were good. Internal consistency of the instrument was good, the Cronbach α was found to be 0.763 (P < 0.001) and ICC (95% CI) for reproducibility was found to be 0.763 (0.686 to 0.827). Factor analysis revealed three factors with eigenvalues >1.0 accounting for 60% of variance, while the Cronbach α was >0.7 for every item.
Conclusions
The Greek translation of the SAST questionnaire is comparable with that of the original version in terms of reliability, and can be used in primary healthcare research. Its use in clinical practice should be primarily as a screening tool only at this stage, with a follow-up consisting of a detailed interview with the patient, in order to confirm the diagnosis.
doi:10.1186/1744-859X-9-1
PMCID: PMC2819236  PMID: 20051118
5.  Psychosocial predictors of depression among older African American cancer patients 
Oncology nursing forum  2013;40(4):394-402.
Purpose
To determine whether psychosocial factors predict depression among older African American cancer patients.
Design/Methods
A descriptive correlational study.
Setting
Outpatient oncology clinic of NCI designated Cancer Center in Southeastern U.S.
Sample
African American cancer patients aged 50 and over.
Methods
Fisher’s Exact and Wilcoxon Rank Sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not. Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates.
Main Variables
Religiosity, emotional support, collectivism, perceived stigma and depression.
Findings
African American cancer patients (n=77) were on average a median age of 58 years (IQR = 55–65), a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants in the lowest income category, not married, and male gender had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model.
Conclusions
Psychosocial factors are important predictors of depression. For these participants, emotional support and organized religious activities may represent protective factors against depression, while collectivism may increase their risk.
Implications
Nurses need to be especially aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance and lack of emotional support. Further, these treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment and side effects so they are empowered to meet the needs for support of the African American cancer patient.
doi:10.1188/13.ONF.394-402
PMCID: PMC3753674  PMID: 23803271
depression; stigma; religion; collectivism; social support; African American cancer patients
6.  Mental Health Treatment Seeking Among Older Adults with Depression: The Impact of Stigma and Race 
Objective
Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment seeking attitudes and behaviors among older adults with depression.
Method
Random digit dialing was utilized to identify a representative sample of 248 African American and White adults older adults (over the age of 60) with depression (symptoms assessed via the Patient Health Questionnaire-9). Telephone based surveys were conducted to assess their treatment seeking attitudes and behaviors, and the factors that impacted these behaviors.
Results
Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in, nor did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their White counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment.
Conclusion
Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.
doi:10.1097/JGP.0b013e3181cc0366
PMCID: PMC2875324  PMID: 20220602
Stigma; Depression; Treatment; Aging
7.  Predictors of Depression Among Older African American Cancer Patients 
Cancer nursing  2010;33(2):156-163.
Background
Depression is becoming an increasing concern in cancer patients because of its impact on quality of life. Although risk factors of having depression have been examined in the literature, there has been no research examining these factors in older African American cancer patients.
Objective
This study explores the demographic and illness-related risk factors in older African American cancer patients.
Methods
Two hundred eighty-three patients were recruited from outpatient oncology clinics. These older African American patients completed a questionnaire that included the Geriatric Depression Scale as well as sociodemographic characteristics and medical information. χ2 Tests, trend tests, and logistic regression were used to identify the demographic and illness-related factors that predict depression in the sample.
Results
The overall prevalence of depression in the sample was 27.2%. Younger age (<65 years), employment status, proximity to family, and multiple symptoms due to cancer or treatment were independent predictors of depression.
Conclusion
This study represents the first attempt to describe the risk factors of depression within older African American cancer patients. Findings indicate a high prevalence of depression in African American cancer patients which can be attributed to identifiable risk factors.
Implications for Practice
An understanding of the risk factors associated with depression can be used to identify those cancer patients at risk for depression and initiate early interventions to improve psychological outcomes and lessen the potential burden of cancer on these patients.
doi:10.1097/NCC.0b013e3181bdef76
PMCID: PMC2844350  PMID: 20142741
African Americans; Cancer; Depression
8.  Assessing negative cognitive style: Development and validation of a Short-Form version of the Cognitive Style Questionnaire 
The Cognitive Style Questionnaire (CSQ) is a frequently employed measure of negative cognitive style, associated with vulnerability to anxiety and depression. However, the CSQ's length can limit its utility in research. We describe the development of a Short-Form version of the CSQ. After evaluation and modification of two pilot versions, the 8-item CSQ Short Form (CSQ-SF) was administered to a convenience sample of adults (N = 278). The CSQ-SF was found to have satisfactory internal reliability and test-retest reliability. It also exhibited construct validity by demonstrating predicted correlations with measures of depression and anxiety. Results suggest that the CSQ-SF is suitable for administration via the Internet.
doi:10.1016/j.paid.2011.11.026
PMCID: PMC3289144  PMID: 22389545
Cognitive style; Depression; Anxiety
9.  THE MEANINGFUL ACTIVITY PARTICIPATION ASSESSMENT: A MEASURE OF ENGAGEMENT IN PERSONALLY VALUED ACTIVITIES* 
The Meaningful Activity Participation Assessment (MAPA), a recently developed 28-item tool designed to measure the meaningfulness of activity, was tested in a sample of 154 older adults. The MAPA evidenced a sufficient level of internal consistency and test-retest reliability and correlated as theoretically predicted with the Life Satisfaction Index-Z, the Satisfaction with Life Scale, the Engagement in Meaningful Activities Survey, the Purpose in Life Test, the Center for Epidemiologic Studies Depression Inventory and the Rand SF-36v2 Health Survey subscales. Zero-order correlations consistently demonstrated meaningful relationships between the MAPA and scales of psychosocial well-being and health-related quality of life. Results from multiple regression analyses further substantiated these findings, as greater meaningful activity participation was associated with better psychological well-being and health-related quality of life. The MAPA appears to be a reliable and valid measure of meaningful activity, incorporating both subjective and objective indicators of activity engagement.
PMCID: PMC3177298  PMID: 20649161
10.  Reliability and validity of the short form of the child health questionnaire for parents (CHQ-PF28) in large random school based and general population samples 
Study objectives: This study assessed the feasibility, reliability, and validity of the 28 item short child health questionnaire parent form (CHQ-PF28) containing the same 13 scales, but only a subset of the items in the widely used 50 item CHQ-PF50.
Design: Questionnaires were sent to a random regional sample of 2040 parents of schoolchildren (4–13 years); in a random subgroup test-retest reliability was assessed (n = 234). Additionally, the study assessed CHQ-PF28 score distributions and internal consistencies in a nationwide general population sample of (parents of) children aged 4–11 (n = 2474) from Statistics Netherlands.
Main results: Response was 70%. In the school and general population samples seven scales showed ceiling effects. Both CHQ summary measures and one multi-item scale showed adequate internal consistency in both samples (Cronbach's α>0.70). One summary measure and one scale showed excellent test-retest reliability (intraclass correlation coefficient >0.70); seven scales showed moderate test-retest reliability (intraclass correlation coefficient 0.50–0.70). The CHQ could discriminate between a subgroup with no parent reported chronic conditions (n = 954) and subgroups with asthma (n = 134), frequent headaches (n = 42), and with problems with hearing (n = 38) (Cohen's effect sizes 0.12–0.92; p<0.05 for 39 of 42 comparisons).
Conclusions: This study showed that the CHQ-PF28 resulted in score distributions, and discriminative validity that are comparable to its longer counterpart, but that the internal consistency of most individual scales was low. In community health applications, the CHQ-PF28 may be an acceptable alternative for the longer CHQ-PF50 if the summary measures suffice and reliable estimates of each separate CHQ scale are not required.
doi:10.1136/jech.2003.012914
PMCID: PMC1763365  PMID: 15598731
11.  Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS) 
Background
Self-compassion is a key psychological construct for assessing clinical outcomes in mindfulness-based interventions. The aim of this study was to validate the Spanish versions of the long (26 item) and short (12 item) forms of the Self-Compassion Scale (SCS).
Methods
The translated Spanish versions of both subscales were administered to two independent samples: Sample 1 was comprised of university students (n = 268) who were recruited to validate the long form, and Sample 2 was comprised of Aragon Health Service workers (n = 271) who were recruited to validate the short form. In addition to SCS, the Mindful Attention Awareness Scale (MAAS), the State-Trait Anxiety Inventory–Trait (STAI-T), the Beck Depression Inventory (BDI) and the Perceived Stress Questionnaire (PSQ) were administered. Construct validity, internal consistency, test-retest reliability and convergent validity were tested.
Results
The Confirmatory Factor Analysis (CFA) of the long and short forms of the SCS confirmed the original six-factor model in both scales, showing goodness of fit. Cronbach’s α for the 26 item SCS was 0.87 (95% CI = 0.85-0.90) and ranged between 0.72 and 0.79 for the 6 subscales. Cronbach’s α for the 12-item SCS was 0.85 (95% CI = 0.81-0.88) and ranged between 0.71 and 0.77 for the 6 subscales. The long (26-item) form of the SCS showed a test-retest coefficient of 0.92 (95% CI = 0.89–0.94). The Intraclass Correlation (ICC) for the 6 subscales ranged from 0.84 to 0.93. The short (12-item) form of the SCS showed a test-retest coefficient of 0.89 (95% CI: 0.87-0.93). The ICC for the 6 subscales ranged from 0.79 to 0.91. The long and short forms of the SCS exhibited a significant negative correlation with the BDI, the STAI and the PSQ, and a significant positive correlation with the MAAS. The correlation between the total score of the long and short SCS form was r = 0.92.
Conclusion
The Spanish versions of the long (26-item) and short (12-item) forms of the SCS are valid and reliable instruments for the evaluation of self-compassion among the general population. These results substantiate the use of this scale in research and clinical practice.
doi:10.1186/1477-7525-12-4
PMCID: PMC3896764  PMID: 24410742
Self-compassion; Validation; Spanish; Mindfulness
12.  Level of agreement between self-rated and clinician-rated instruments when measuring major depressive disorder in the Thai elderly: a 1-year assessment as part of the THAISAD study 
Purpose
Whether self-reporting and clinician-rated depression scales correlate well with one another when applied to older adults has not been well studied, particularly among Asian samples. This study aimed to compare the level of agreement among measurements used in assessing major depressive disorder (MDD) among the Thai elderly and the factors associated with the differences found.
Patients and methods
This was a prospective, follow-up study of elderly patients diagnosed with MDD and receiving treatment in Thailand. The Mini International Neuropsychiatric Inventory (MINI), 17-item Hamilton Depression Rating Scale (HAMD-17), 30-item Geriatric Depression Scale (GDS-30), 32-item Inventory of Interpersonal Problems scale, Revised Experience of Close Relationships scale, ten-item Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support were used. Follow-up assessments were conducted after 3, 6, 9, and 12 months.
Results
Among the 74 patients, the mean age was 68±6.02 years, and 86% had MDD. Regarding the level of agreement found between GDS-30 and MINI, Kappa ranged between 0.17 and 0.55, while for Gwet’s AC1 the range was 0.49 to 0.91. The level of agreement was found to be lowest at baseline, and increased during follow-up visits. The correlation between HAMD-17 and GDS-30 scores was 0.17 (P=0.16) at baseline, then 0.36 to 0.41 in later visits (P<0.01). The PSS-10 score was found to be positively correlated with GDS-30 at baseline, and predicted the level of disagreement found between the clinicians and patients when reporting on MDD.
Conclusion
The level of agreement between the GDS, MINI, and HAMD was found to be different at baseline when compared to later assessments. Patients who produced a low GDS score were given a high rating by the clinicians. An additional self-reporting tool such as the PSS-10 could, therefore, be used in such under-reporting circumstances.
doi:10.2147/CIA.S56683
PMCID: PMC3940641  PMID: 24596457
late-life depression; measurement; correlation
13.  Validity, reliability, and responsiveness of a new shortVisual Simplified Respiratory Questionnaire (VSRQ©) for health-related quality of life assessment in chronic obstructive pulmonary disease 
The Visual Simplified Respiratory Questionnaire (VSRQ) was designed to assess health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). It contains eight items: dyspnea, anxiety, depressed mood, sleep, energy, daily activities, social activities and sexual life. Psychometric properties were assessed during a clinical trial that evaluated the impact of tiotropium on HRQoL of COPD patients. These included the determination of structure, internal consistency reliability, concurrent validity with the St George’s Respiratory Questionnaire (SGRQ), test – retest reliability, clinical validity and responsiveness to change over two weeks. Minimal important difference (MID) was calculated; cumulative response curves (CRC) were based on the dyspnea item. Psychometric analyses showed that VSRQ structure was unidimensional. The questionnaire demonstrated good internal consistency reliability (Cronbach’s alpha = 0.84), good concurrent validity with SGRQ (Spearman = −0.70) and clinical validity, good test-retest reproducibility (ICC = 0.77), and satisfactory responsiveness (standardized response mean = 0.57; Guyatt’s statistic = 0.63). MID was 3.4; CRC median value of the ‘minimally improved’ patients was 3.5. In conclusion, VSRQ brevity and satisfactory psychometric properties make it a good candidate for large studies to assess HRQoL in COPD patients. Further validation is needed to extend its use in clinical practice.
PMCID: PMC2672786  PMID: 19436682
chronic obstructive pulmonary disease; VSRQ; SGRQ; health-related quality of life; minimal important difference
14.  A New Audience Segmentation Tool for African Americans: The Black Identity Classification Scale 
Journal of health communication  2010;15(5):532-554.
Many health communications target African Americans in an attempt to remediate race-based health disparities. Such materials often assume that African Americans are culturally homogeneous; however, research indicates that African Americans are heterogeneous in their attitudes, behaviors, and beliefs. The Black Identity Classification Scale (BICS) was designed as a telephone-administered tool to segment African American audiences into 16 ethnic identity types. The BICS was pretested using focus groups, telephone pretests, and a pilot study (n=306). The final scale was then administered to 625 Black adults participating in a dietary intervention study, where it generally demonstrated good internal consistency reliability. The construct validity of the BICS was also explored by comparing participants’ responses to culturally associated survey items. The distribution of the 16 BICS identity types in the intervention study is presented, as well as select characteristics for participants with core identity components. Although additional research is warranted, these findings suggest that the BICS has good psychometric properties and may be an effective tool for identifying African American audience segments.
doi:10.1080/10810730.2010.492563
PMCID: PMC3151736  PMID: 20677057
15.  Sociodemographic factors contribute to the depressive affect among African Americans with chronic kidney disease 
Kidney international  2010;77(11):1010-1019.
Depression is common in end-stage renal disease and is associated with poor quality of life and higher mortality; however, little is known about depressive affect in earlier stages of chronic kidney disease. To measure this in a risk group burdened with hypertension and kidney disease, we conducted a cross-sectional analysis of individuals at enrollment in the African American Study of Kidney Disease and Hypertension Cohort Study. Depressive affect was assessed by the Beck Depression Inventory II and quality of life by the Medical Outcomes Study-Short Form and the Satisfaction with Life Scale. Beck Depression scores over 14 were deemed consistent with an increased depressive affect and linear regression analysis was used to identify factors associated with these scores. Among 628 subjects, 166 had scores over 14 but only 34 were prescribed antidepressants. The mean Beck Depression score of 11.0 varied with the estimated glomerular filtration rate (eGFR) from 10.7 (eGFR 50–60) to 16.0 (eGFR stage 5); however, there was no significant independent association between these. Unemployment, low income, and lower quality and satisfaction with life scale scores were independently and significantly associated with a higher Beck Depression score. Thus, our study shows that an increased depressive affect is highly prevalent in African Americans with chronic kidney disease, is infrequently treated with antidepressants, and is associated with poorer quality of life. Sociodemographic factors have especially strong associations with this increased depressive affect. Because this study was conducted in an African-American cohort, its findings may not be generalized to other ethnic groups.
doi:10.1038/ki.2010.38
PMCID: PMC3114445  PMID: 20200503
AASK (African American Study of Kidney Disease and Hypertension); chronic kidney disease; clinical epidemiology; depression; quality of life
16.  Performance of Health Literacy Tests Among Older Adults with Diabetes 
ABSTRACT
BACKGROUND
Knowing a patient’s health literacy can help clinicians and researchers anticipate a patient’s ability to understand complex health regimens and deliver better patient-centered instructions and information. Poor health literacy has been linked with lower ability to function adequately in health care systems.
OBJECTIVE
We evaluated and compared three measures of health literacy and performance among older patients with diabetes.
DESIGN
Cross-sectional study utilizing in-person interviews conducted in participants’ homes.
PARTICIPANTS
A tri-ethnic sample (n = 563) of African American, American Indian, and white older adults with diabetes from eight counties in south-central North Carolina.
MAIN MEASURE
Participants completed interviews and health literacy assessments using the Short-Form Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimates of Adult Literacy in Medicine Short-Form (REALM-SF), or the Newest Vital Signs (NVS). Scores for reading comprehension and numeracy were calculated.
RESULTS
Over 90% completed the S-TOFHLA numeracy and approximately 85% completed the S-TOFHLA reading and REALM-SF. Only 73% completed the NVS. The correlation of S-TOFHLA total scores with REALM-SF and NVS were 0.48 and 0.54, respectively. Age, gender, ethnic, educational and income differences in health literacy emerged for several instruments, but the pattern of results across the instruments was highly variable.
CONCLUSIONS
A large segment of older adults is unable to complete short-form assessments of health literacy. Among those who were able to complete assessments, the REALM-SF and NVS performed comparably, but their relatively low convergence with the S-TOFHLA raises questions about instrument selection when studying health literacy of older adults.
doi:10.1007/s11606-011-1927-y
PMCID: PMC3326106  PMID: 22095571
health literacy; older adults; diabetes
17.  The Chinese version of the world health organization quality of life instrument-older adults module (WHOQOL-OLD): psychometric evaluation 
Background
Under 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).
Methods
We 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.
Results
Missing 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).
Conclusion
The 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.
doi:10.1186/1477-7525-11-156
PMCID: PMC3847352  PMID: 24034698
Elderly; Quality of life; Reliability; Validity; WHOQOL-OLD
18.  Validation of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in Older Black and White Women 
Sleep medicine  2011;13(1):36-42.
Objectives
Despite routine use with older adults, the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) have not been adequately validated in older samples, particularly those from diverse racial backgrounds. The objective of this study was to determine the reliability and validity of and to provide normative data for these questionnaires in community-dwelling older women.
Methods
Participants were 306 black and 2,662 white women aged ≥70 from the Study of Osteoporotic Fractures. Participants completed the PSQI and ESS, and provided self-reported assessments of mood, cognition, and functioning, and underwent wrist actigraphy for sleep-wake estimation.
Results
Good internal consistency in both black and white women was demonstrated for the PSQI and ESS. Two PSQI subscales, however, were found to have inadequate reliability (Medications, Daytime Dysfunction). Both the PSQI and ESS were associated with theoretically similar measures in the expected directions. The PSQI also differentiated participants with no reported sleep disorder from those reporting at least one sleep disturbance, such as insomnia, sleep apnea, and restless legs. The ESS only differentiated women reporting no sleep disorder from those reporting insomnia.
Conclusions
In general, findings suggest that the PSQI and ESS are internally consistent, valid measures of self-reported sleep conditions problems in older women. Additional research is required to evaluate the impact of removing the Medications and Daytime Dysfunction PSQI subscales on this measure's internal consistency in older women.
doi:10.1016/j.sleep.2011.04.005
PMCID: PMC3586742  PMID: 22033120
sleep; geriatric assessment; actigraphy; oldest old; women; aged
19.  Depressive Symptoms Among Older Adults in Mexico City 
Journal of General Internal Medicine  2008;23(12):1973-1980.
ABSTRACT
BACKGROUND
Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries.
OBJECTIVE
To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider.
DESIGN
Cross-sectional, multistage community survey.
PARTICIPANTS
A total of 7,449 persons aged 60 years and older.
MEASUREMENTS
Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire.
MAIN RESULTS
The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = −20.2, 95% CI = −21.3, −19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2).
CONCLUSIONS
According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.
doi:10.1007/s11606-008-0799-2
PMCID: PMC2596501  PMID: 18818976
aged; depression; comorbidity; primary healthcare
20.  The development of the Body Morph Assessment version 2.0 (BMA 2.0): Tests of reliability and validity 
Body image  2009;6(2):67-74.
This study tested the psychometric characteristics of the Body Morph Assessment version 2.0 (BMA 2.0). A sample of 563 adults composed of four groups classified by gender and ethnicity (Caucasian men and women and African-American men and women) were studied. Support for the internal consistency and test–retest reliability of the BMA 2.0 was found for both men and women. A study of convergent validity was conducted. The BMA 2.0 was found to have adequate reliability and validity. Norms were established for the BMA 2.0 estimates of current body size (CBS), ideal body size (IBS), and acceptable body size (ABS) for Caucasian and African-American men and women. In summary, the BMA 2.0 is a reliable and valid computerized measure of CBS, IBS, ABS, the CBS–IBS discrepancy (body dissatisfaction), and provides an estimate of over/underestimation of body size as compared to individuals of the same sex and body mass index.
doi:10.1016/j.bodyim.2009.01.006
PMCID: PMC2743122  PMID: 19244002
Body image; Eating disorders; Obesity; Morph; Body image assessment
21.  Psychometric Evaluation of a Coping Strategies Inventory Short-Form (CSI-SF) in the Jackson Heart Study Cohort 
This study sought to establish the psychometric properties of a Coping Strategies Inventory Short Form (CSI-SF) by examining coping skills in the Jackson Heart Study cohort. We used exploratory and confirmatory factor analysis, Pearson’s correlation, and Cronbach Alpha to examine reliability and validity in the CSI-SF that solicited responses from 5302 African American men and women between the ages of 35 and 84. One item was dropped from the 16-item CSI-SF, making it a 15-item survey. No significant effects were found for age and gender, strengthening the generalizability of the CSI-SF. The internal consistency reliability analysis revealed reliability between alpha = 0.58–0.72 for all of the scales, and all of the fit indices used to examine the CSI-SF provided support for its use as an adequate measure of coping. This study provides empirical support for utilizing this instrument in future efforts to understand the role of coping in moderating health outcomes.
PMCID: PMC3732399  PMID: 18180539
Measurement; psychometric analysis; coping; African Americans
22.  Development, reliability and factor analysis of a self-administered questionnaire which originates from the World Health Organization's Composite International Diagnostic Interview – Short Form (CIDI-SF) for assessing mental disorders 
Background
The Composite International Diagnostic Interview – Short Form consists of short form scales for evaluating psychiatric disorders. Also for this version training of the interviewer is required. Moreover, the confidentiality could be not adequately protected.
This study focuses on the preliminary validation of a brief self-completed questionnaire which originates from the CIDI-SF.
Sampling and Methods
A preliminary version was assessed for content and face validity. An intermediate version was evaluated for test-retest reliability. The final version of the questionnaire was evaluated for factor exploratory analysis, and internal consistency.
Results
After the modifications by the focus groups, the questionnaire included 29 initial probe questions and 56 secondary questions. The test retest reliability weighted Kappas were acceptable to excellent for the vast majority of questions. Factor analysis revealed six factors explaining 53.6% of total variance. Cronbach's alpha was 0.89 for the questionnaire and 0.89, 0.67, 0.71, 0.71, 0.49, and 0.67, for the six factors respectively.
Conclusion
The questionnaire has satisfactory reliability, and internal consistency, and might be efficient for using in community research and clinical practice. In the future, the questionnaire could be further validated (i.e., concurrent validity, discriminant validity).
doi:10.1186/1745-0179-4-8
PMCID: PMC2329624  PMID: 18402667
23.  Judgment of Line Orientation: An Examination of Eight Short Forms 
The Judgment of Line Orientation (JLO) test is a commonly used measure of visuospatial perception. Because of its length, several short forms have appeared in the literature. We examined the internal consistency of the JLO and eight of its published short forms among 128 undergraduates, 203 healthy older adults, and 55 chronic kidney disease patients. The full test demonstrated good reliability for traditional neuropsychological assessment, but the majority of short forms were adequate only for screening purposes, where greater measurement error is typically permitted in exchange for brevity. In contrast, a recently developed short form based upon item response theory (Calamia, Markon, Denburg, & Tranel, 2011) demonstrated promise as a stand-alone measure.
doi:10.1080/13803395.2012.760535
PMCID: PMC3668441  PMID: 23350928
Judgment of Line Orientation; short forms; reliability; psychometrics; visuospatial function
24.  Validity and Reliability of the Index of Self-Regulation Scale for Physical Activity in Older Korean Americans 
Nursing Research and Practice  2011;2011:329534.
The Korean version of the index of self-regulation (KISR) is a nine-item scale designed to measure individuals' level of self-regulation for physical activity. The purpose of this study was to test the psychometric properties of the KISR, including reliability and validity, in a group of older Korean Americans. The KISR was administered to a sample of older Korean Americans at a baseline interview (Time 1) and 12 week followup (Time 2). The internal consistency of the KISR was high at both time points, with Cronbach's alphas of .94 and .95, respectively. The test-retest reliability was moderate-to-high at .68. There was evidence of construct validity of the KISR based on its moderate to high significant correlations with theoretically relevant variables, including motivational appraisal and self-efficacy for physical activity. A principal axis factoring with an oblique rotation resulted in two factors, explaining 89% of the variance. The KISR is a reliable and valid measure to assess the level of self-regulation for physical activity behavior in older Korean Americans.
doi:10.1155/2011/329534
PMCID: PMC3169926  PMID: 21994821
25.  Assessing Depression among Older Persons with Arthritis: A Nationwide Health Status Survey 
ISRN Rheumatology  2013;2013:968343.
Objectives. This study aimed to assess the health status of a nationwide sample of elderly persons having arthritis and determine the prevalence of depressive symptomatology in this population. Methods. WebTV technology was utilized to administer health status and depression surveys to a nationally representative sample of 550 randomly selected older persons. Predetermined cutoff scores on Short Form-36 (SF-36) scale and Center for Epidemiological Scale for Depression (CES-D) were used to identify individuals with depressive mood. Results. Sixteen percent (n = 76) of the respondents were found to be at risk for depression. Key associations among health domains of SF-36 and CES-D variables were statistically significant and were in the expected direction. Discussion. The risk of depression among older adults who have arthritis is moderate. A significant decline in multiple domains of health of older persons is likely when depression coexists with arthritis. Early screening for depressive symptomatology and prompt treatment should be an essential part of arthritis management in primary care practice.
doi:10.1155/2013/968343
PMCID: PMC3728544  PMID: 23956874

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