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1.  Assessing the reliability and validity of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in Ghanaian medical students 
We investigated the validity and reliability of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in preclinical students in Ghana.
The R-SPQ2F was administered to 189 preclinical students of the University for Development Studies, School of Medicine and Health Sciences. Both descriptive and inferential statistics with Cronbach’s alpha test and factor analysis were done.
The mean age of the students was 22.69± 0.18years, 60.8% (n=115) were males and 42.3% (n=80) were in their second year of medical training. The students had higher mean deep approach scores (31.23±7.19) than that of surface approach scores (22.62±6.48). Findings of the R-SPQ2F gave credence to a solution of two-factors indicating deep and surface approaches accounting for 49.80% and 33.57%, respectively, of the variance. The scales of deep approach (Cronbach’s alpha, 0.80) and surface approach (Cronbach’s alpha, 0.76) and their subscales demonstrated an internal consistency that was good. The factorial validity was comparable to other studies.
Our study confirms the construct validity and internal consistency of the R-SPQ2F for measuring approaches to learning in Ghanaian preclinical students. Deep approach was the most dominant learning approach among the students. The questionnaire can be used to measure students’ approaches to learning in Ghana and in other African countries.
PMCID: PMC4309935  PMID: 25112447
Learning; Statistical factor analysis; Medical students; Validity; Reproducibility of results; Ghana
2.  Measuring students’ approaches to learning in different clinical rotations 
BMC Medical Education  2012;12:114.
Many studies have explored approaches to learning in medical school, mostly in the classroom setting. In the clinical setting, students face different conditions that may affect their learning. Understanding students’ approaches to learning is important to improve learning in the clinical setting. The aim of this study was to evaluate the Study Process Questionnaire (SPQ) as an instrument for measuring clinical learning in medical education and also to show whether learning approaches vary between rotations.
All students involved in this survey were undergraduates in their clinical phase. The SPQ was adapted to the clinical setting and was distributed in the last week of the clerkship rotation. A longitudinal study was also conducted to explore changes in learning approaches.
Two hundred and nine students participated in this study (response rate 82.0%). The SPQ findings supported a two-factor solution involving deep and surface approaches. These two factors accounted for 45.1% and 22.5%, respectively, of the variance. The relationships between the two scales and their subscales showed the internal consistency and factorial validity of the SPQ to be comparable with previous studies. The clinical students in this study had higher scores for deep learning. The small longitudinal study showed small changes of approaches to learning with different rotation placement but not statistically significant.
The SPQ was found to be a valid instrument for measuring approaches to learning among clinical students. More students used a deep approach than a surface approach. Changes of approach not clearly occurred with different clinical rotations.
PMCID: PMC3527326  PMID: 23153333
Approaches to learning; Study Process Questionnaire (SPQ); Learning process; Clinical teaching
3.  Examining the Cross-Cultural Sensitivity of the Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) and Validation of a Dutch Version 
PLoS ONE  2013;8(1):e54099.
The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) is used to examine students’ study approaches in higher education. The questionnaire assumes to measure two factors: a deep and a surface study approach. Analyses into the validity and reliability of the original English R-SPQ-2F yielded positive results. In this study, we examined the degree to which these positive results can also be found for the Dutch version that we developed. By comparing our results with the results of earlier studies in different cultures, we conclude cross-cultural sensitivity is an important point to be borne in mind when using the R-SPQ-2F. Our research supports the validity and reliability of our Dutch version of the R-SPQ-2F.
PMCID: PMC3546932  PMID: 23342085
4.  Cultural adaptation and validation of the “Kidney Disease and Quality of Life - Short Form (KDQOL-SF™) version 1.3” questionnaire in Egypt 
BMC Nephrology  2012;13:170.
Health Related Quality of Life (HRQOL) instruments need disease and country specific validation. In Arab countries, there is no specific validated questionnaire for assessment of HRQOL in chronic kidney disease (CKD) patients. The aim of this study was to present an Arabic translation, adaptation, and the subsequent validation of the kidney disease quality of life-short form (KDQOL-SFTM) version 1.3 questionnaire in a representative series of Egyptian CKD patients.
KDQOL-SFTM version 1.3 was translated into Arabic by two independent translators, and then subsequently translated back into English. After translation disparities were reconciled, the final Arabic questionnaire was tested by interviewing 100 pre-dialysis CKD (stage 1-4) patients randomly selected from outpatients attending the Nephrology clinic at the Main Alexandria University Hospital. Test re-test reliability was performed, with a subsample of 50 consecutive CKD patients, by two interviews 7 days apart and internal consistency estimated by Cronbach’s α. Discriminant, concept, and construct validity were assessed.
All items of SF-36 met the criterion for internal consistency and were reproducible. Of the 10 kidney disease targeted scales, only three had Cronbach’s α <0.7: quality of social interaction (0.23), work status (0.28), and cognitive function (0.60). All disease specific scales were reproducible. Results from discriminant validity showed that the study questionnaire could discriminate between patients’ subgroups. As for concept validity, the correlation between all domains of the questionnaire with overall health ratewas significant for all domains except for the work status, sexual function, emotional wellbeing, and role emotional. Furthermore, the correlation between the disease specific domains and the two composite summaries of SF-36 (physical and mental composite summaries) was significant for all domains except for sexual function with mental composite summary. Construct validity was indicated by the observation that the majority of the domains of the kidney disease targeted scale of KDQOL-SFTM 1.3 were significantly inter-correlated. Finally, principal component analysis of the kidney disease targeted scale indicated that this part of the questionnaire could be summarized into 10 factors that together explained 70.9% of the variance.
The results suggest that this Arabic version of the KDQOL-SFTM 1.3 questionnaire is a valid and reliable tool for use in Egyptian patients with CKD.
PMCID: PMC3583144  PMID: 23237591
Chronic kidney disease; Egypt; Health-related quality of life; KDQOL-SFTM 1.3; Questionnaire validation
5.  Complaints of the arm, neck and shoulder among computer office workers in Sudan: a prevalence study with validation of an Arabic risk factors questionnaire 
Environmental Health  2008;7:33.
Complaints of the arm, neck and/or shoulders (CANS) in general and computer-related disorders in particular affect millions of computer office workers in Western developed countries. However, with the widespread use of computer systems in developing countries, the associated musculoskeletal complaints are yet to be investigated.
To study the prevalence of work-related CANS, among computer office workers in Sudan, and to test the psychometric properties of a translated Dutch questionnaire in Arabic language.
In 2005 282 computer office workers at a mobile telecommunication company and three banks in Khartoum, Sudan, received an Arabic language version of the validated Maastricht upper extremity questionnaire (MUEQ). The questionnaire holds 109 items covering demographic characteristics, in addition to six main domains (i.e. work station, body posture, break time, job control, job demands and social support) assessing potential physical and psychosocial risk factors. Forward/backward translation of the MUQE was done independently by two different translators. Prevalence over the past year were computed for CANS. Further, the psychometric properties of the Arabic questionnaire were investigated (i.e. factor structure and reliability) and cross-validation was carried out.
The response rate of the questionnaire was 88% (n = 250). The one-year prevalence of CANS showed that 53% of the respondents could be classified as mild cases. The highest incidences were found for neck and shoulder symptoms (64% and 41% respectively). The analysis of the psychometric properties of the scale resulted in the identification of 2 factors for each of the 6 domains (i.e. office equipment, computer position, head and body posture, awkward body posture, autonomy, quality of break time, skill discretion, decision authority, time pressure, task complexity, social support, and work flow). The calculation of internal consistency and cross validation provided evidence of reliability and lack of redundancy of items.
The prevalence of CANS among the targeted population seems to correspond strongly with prevalence of CANS in Western developed countries. The Arabic translation of the MUEQ has satisfactory psychometric properties to be used to assess work-related risk factors for the development of CANS among computer office workers in Sudan.
PMCID: PMC2474607  PMID: 18588691
6.  The educational impact of assessment: A comparison of DOPS and MCQs 
Medical Teacher  2013;35(11):e1598-e1607.
To evaluate the impact of two different assessment formats on the approaches to learning of final year veterinary students. The relationship between approach to learning and examination performance was also investigated.
An 18-item version of the Study Process Questionnaire (SPQ) was sent to 87 final year students. Each student responded to the questionnaire with regards to DOPS (Direct Observation of Procedural Skills) and a Multiple Choice Examination (MCQ). Semi-structured interviews were conducted with 16 of the respondents to gain a deeper insight into the students’ perception of assessment.
Students’ adopted a deeper approach to learning for DOPS and a more surface approach with MCQs. There was a positive correlation between an achieving approach to learning and examination performance. Analysis of the qualitative data revealed that deep, surface and achieving approaches were reported by the students and seven major influences on their approaches to learning were identified: motivation, purpose, consequence, acceptability, feedback, time pressure and the individual difference of the students.
The format of DOPS has a positive influence on approaches to learning. There is a conflict for students between preparing for final examinations and preparing for clinical practice.
PMCID: PMC3809925  PMID: 23808609
7.  Cross-cultural adaptation and validation of Behçet's disease quality of life questionnaire 
Currently, there is one Behçet's disease (BD) specific self reporting questionnaire developed and published in the literature, The Leeds BD-quality of life (QoL). We conducted a cross-cultural adaptation and validation of the Arabic version of the Leeds BD-QoL
A cross-sectional study was conducted among 41 consecutive patients attending rheumatology clinics at the American University of Beirut Medical Center between June and December 2007. The BD-QoL questionnaire, the Katz Index of Activities of Daily Living (ADL) and the Lawton Instrumental Activities of Daily Living (IADL) questionnaires were co-administered during the same visit, and severity scores were calculated. Cross-cultural adaptation of BD-QoL was performed using forward and backward translations of the original questionnaire. Internal consistency and test-retest reliability of the final version were determined. Exploratory Factor Analysis (EFA) was used to assess the dimensionality of the scale items. External construct validity was examined by correlating Arabic BD-QoL with the severity score, ADL and IADL.
The 30 items of the adapted Arabic BD-QoL showed a high internal consistency (KR-20 coefficient 0.89) and test-retest reliability (Spearman's test 0.91). The convergence of all 30 items suggests that the 30-item adapted Arabic BD-QoL scale is unidimensional. BD-QoL did not correlate with any of the patients' demographics. Still, it was positively correlated with patient severity score (r 0.4, p 0.02), and IADL (but not ADL).
This cross-cultural adaptation has produced an Arabic BD-QoL questionnaire that is now available for use in clinical settings and in research studies, among Arabic speaking patients.
PMCID: PMC3111402  PMID: 21507231
Behçet's disease; Quality of life; Arabic version of BD-QoL; Cross-cultural adaptation; Validity and reliability
8.  The reliability of the Arabic version of osteoporosis knowledge assessment tool (OKAT) and the osteoporosis health belief scale (OHBS) 
BMC Research Notes  2013;6:138.
Knowledge and awareness about osteoporosis and its related risk factors are important contributors to osteoporosis preventive behavior. There is a need to assess the reliability of international osteoporosis-related knowledge and belief measurement tools in Arabic community. This study aimed to assess the reliability of the Arabic version of Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale (OHBS) among Syrian women.
The study included two phases. The first phase included a forward and backward translation of the osteoporosis-related tools (OKAT and OHBS) followed by a pilot testing. The second phase was an assessment of the test-retest reliability of the tools among a convenience sample of one hundred working women at Damascus Faculty of Medicine and its teaching hospitals. For this purpose each instrument was administered twice to all women at an interval of two weeks. Data collection took place in the fall of 2011, and was facilitated by a trained interviewer whose task was to administer the tools and collect some background data from the women who consented to participate in the study.
A total of one hundred women were recruited in this study for the reliability test-retest of the Arabic version of the tools. The mean age of studied women was 37.1 (SD = 8.4) years. Most of the women were married and nearly one-half of them had a university education. The internal consistency values for OHBS (Cronbach’s alpha = 0.806) as well as the OKAT (Cronbach’s alpha = 0.824) met the 0.7 Cronbach’s alpha value requirement. Item analysis did not necessitate any omissions in either tool. McNemar’s test identified only three items on the OKAT questionnaire that significantly differed from the test to the retest. The OKAT mean score (SD) for the test was 9.4 (2.6) and that for the re-test was 10.1 (2.9). Paired t test did not show significant difference (P = 0.068).
The Arabic version of both the Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale (OHBS) was found to be reliable as well as acceptable. Further research is needed as to complete the validation of those tools and to use them at larger scale whether in knowledge assessment or in assessing interventions.
PMCID: PMC3630064  PMID: 23566522
9.  Psychometric Properties of the Arabic Version of the Obsessive Compulsive Beliefs Questionnaire-44 in a Student Population 
Iranian Journal of Psychiatry  2012;7(4):184-190.
We examined the psychometric properties of the Arabic version of the Obsessive Compulsive Beliefs Questionnaire-44 (OBQ-44) in a sample of Kuwait University students. This questionnaire was developed by the Obsessive Compulsive Cognitions Working Group in order to assess belief domains believed to be crucial in the development of obsessive compulsive symptoms.
The Arabic version of the OBQ-44 was developed according to the standard translation and back-translation methods. The Arabic versions of the OBQ-44, the Maudsley Obsessive - Compulsive Inventory (MOCI), and Beck Depression Inventory-Revised (BDI-II) were then administered on a sample of 200 Kuwait University students from the faculty of humanities chosen through random cluster sampling. Retest was administered within a 4 week time period.
The results of principle component factor analysis with varimax rotation indicated 6 factors which overlapped to a high degree. A 3 factor solution was chosen based on the scree plot and factor loadings which explained 36.12% of the variance. The factors were labeled as responsibility and threat estimation (RT), importance and control of thought (ICT) and perfectionism/Certainty (PC). The reliability coefficient of the three factors and the total score were assessed using three methods: Internal consistency, Test-retest reliability and Split-half reliability. Results showed an acceptable internal consistency for the Arabic version of the OBQ-44. Regarding the validity of OBQ-44, the instrument correlated with the total score of MOCI and most of its subscales.
These data support the reliability and validity of the OBQ-44 in a sample of Kuwait University students.
PMCID: PMC3570578  PMID: 23408782
Arabs; Obsessive Compulsive Disorder; Psychometrics; Questionnaire; Reproducibility of results
10.  Social Functioning in Chinese College Students with and without Schizotypal Personality Traits: An Exploratory Study of the Chinese Version of the First Episode Social Functioning Scale 
PLoS ONE  2013;8(5):e61115.
The First Episode Social Functioning Scale (FESFS) was designed to measure social functioning of young individuals with schizophrenia. The aim of this study was to validate a Chinese version of the FESFS in a sample of young Chinese adults.
The FESFS was translated to Chinese prior to being administered to 1576 college students. The factor structure, reliability, and validity of the scale were examined.
Two items were deleted after item analysis and the internal consistency of the whole scale was .89. A six-factor structure was derived by exploratory factor analysis. The factors were interpersonal, family and friends, school, living skills, intimacy, and balance. Estimates of the structural equation model supported this structure, with Goodness of Fit Chi-Square χ2 = 1097.53 (p<0.0001), the root mean square error of approximation (RMSEA) = 0.058, and the comparative fit index (CFI) = 0.93. Scale validity was supported by significant correlations between social functioning factors scores and schizophrenia personality questionnaire (SPQ) scores. Individuals with schizotypal personality features presented poorer social functioning than those without schizotypal personality features.
The Chinese revised version of the FESFS was found to have good psychometric properties and could be used in the future to examine social functioning in Chinese college students.
PMCID: PMC3653910  PMID: 23690922
11.  Patient satisfaction in an acute medicine department in Morocco 
Patients' satisfaction is an important indicator for quality of care. Measuring healthcare quality and improving patient satisfaction have become increasingly prevalent, especially among healthcare providers and purchasers of healthcare. This is mainly due to the fact that consumers are becoming increasingly more knowledgeable about healthcare. No studies of inpatients' satisfaction with hospital care have been conducted in Morocco. The first objective of the present study was to confirm the reliability and validity of the Arabic version of the EQS-H (Echelle de Qualité des Soins en Hospitalisation). The second objective was to evaluate patient satisfaction in an acute medicine department in Morocco by using the EQS-H questionnaire; and also to assess the influence of certain demographics, socioeconomics, and health characteristics in patient satisfaction.
it was a patient survey conducted in an acute medicine department of a Moroccan University Hospital. We surveyed their socio demographic status, and health characteristics at admission. We performed structured face to face interviews with patients who were discharged from hospital. The core of the EQS-H questionnaire was translated to Arabic, adapted to the present setting, and then used to measure patient satisfaction with quality of care. The internal consistency of the EQS-H scale was assessed by Chronbach's coefficient alpha. Validity was assessed by factor analysis. Factors influencing inpatients' satisfaction were identified using multiple linear regression.
The Arabic version of EQS-H demonstrated an excellent internal consistency for the two dimensions studied (0.889 for 'quality of medical information' (MI) and 0.906 for 'Relationship with staff and daily routine' (RS)). The principal component analysis confirmed the bidimensional structure of the questionnaire and explained 60% of the total variance. In the univariate analysis, urban residence, higher income, better perceived health status compared to admission, better perceived health status compared to people of the same age, and satisfaction with life in general were related to MI dimension; Otherwise, mal gender, urban residence, higher income, staying in double room, better perceived health status compared to admission, and satisfaction with life in general were related to RS dimension. The multiple linear regression showed that four independent variables were associated with higher satisfaction in MI: More than 2 prior hospitalizations, a longer length of stay (10-14 days) (P = 0.002), staying in double room (P = 0.022), and better perceived health status compared to admission (P = 0.036). Three independent variables were associated with higher satisfaction in RS: a longer length of stay (10-14 days) (P = 0.017), better perceived health status compared to admission day (P = 0.013), and satisfaction with life in general (P = 0.006).
Our current data assessing patient satisfaction with acute health care by the Arabic version of the EQS-H showed that the satisfaction rate was average on MI dimension; and good on RS dimension of the questionnaire. The majority of participants were satisfied with the overall care. Demographic, socioeconomic, and health characteristics may influence in-patients satisfaction in Morocco, a low/middle income country. An appreciation and understanding of these factors is essential to develop socio culturally appropriate interventions in order to improve satisfaction of patients.
PMCID: PMC2900260  PMID: 20525170
12.  The Sensory Perception Quotient (SPQ): development and validation of a new sensory questionnaire for adults with and without autism 
Molecular Autism  2014;5:29.
Questionnaire-based studies suggest atypical sensory perception in over 90% of individuals with autism spectrum conditions (ASC). Sensory questionnaire-based studies in ASC mainly record parental reports of their child’s sensory experience; less is known about sensory reactivity in adults with ASC. Given the DSM-5 criteria for ASC now include sensory reactivity, there is a need for an adult questionnaire investigating basic sensory functioning. We aimed to develop and validate the Sensory Perception Quotient (SPQ), which assesses basic sensory hyper- and hyposensitivity across all five modalities.
A total of 359 adults with (n = 196) and without (n = 163) ASC were asked to fill in the SPQ, the Sensory Over-Responsivity Inventory (SensOR) and the Autism-Spectrum Quotient (AQ) online.
Adults with ASC reported more sensory hypersensitivity on the SPQ compared to controls (P < .001). SPQ scores were correlated with AQ scores both across groups (r = .-38) and within the ASC (r = -.18) and control groups (r = -.15). Principal component analyses conducted separately in both groups indicated that one factor comprising 35 items consistently assesses sensory hypersensitivity. The SPQ showed high internal consistency for both the total SPQ (Cronbach’s alpha = .92) and the reduced 35-item version (alpha = .93). The SPQ was significantly correlated with the SensOR across groups (r = -.46) and within the ASC (r = -.49) and control group (r = -.21).
The SPQ shows good internal consistency and concurrent validity and differentiates between adults with and without ASC. Adults with ASC report more sensitivity to sensory stimuli on the SPQ. Finally, greater sensory sensitivity is associated with more autistic traits. The SPQ provides a new tool to measure individual differences on this dimension.
PMCID: PMC4005907  PMID: 24791196
autism spectrum conditions; sensory questionnaire; sensory perception quotient
13.  Development and Validation of a Personality Assessment Instrument for Traditional Korean Medicine: Sasang Personality Questionnaire 
Objective. Sasang typology is a traditional Korean medicine based on the biopsychosocial perspectives of Neo-Confucianism and utilizes medical herbs and acupuncture for type-specific treatment. This study was designed to develop and validate the Sasang Personality Questionnaire (SPQ) for future use in the assessment of personality based on Sasang typology. Design and Methods. We selected questionnaire items using internal consistency analysis and examined construct validity with explorative factor analysis using 245 healthy participants. Test-retest reliability as well as convergent validity were examined. Results. The 14-item SPQ showed acceptable internal consistency (Cronbach's alpha = .817) and test-retest reliability (r = .837). Three extracted subscales, SPQ-behavior, SPQ-emotionality, and SPQ-cognition, were found, explaining 55.77% of the total variance. The SPQ significantly correlated with Temperament and Character Inventory novelty seeking (r = .462), harm avoidance (r = −.390), and NEO Personality Inventory extraversion (r = .629). The SPQ score of the So-Eum (24.43 ± 4.93), Tae-Eum (27.33 ± 5.88), and So-Yang (30.90 ± 5.23) types were significantly different from each other (P < .01). Conclusion. Current results demonstrated the reliability and validity of the SPQ and its subscales that can be utilized as an objective instrument for conducting personalized medicine research incorporating the biopsychosocial perspective.
PMCID: PMC3332171  PMID: 22567034
14.  HURT (Headache Under-Response to Treatment) questionnaire in the management of primary headache disorders: reliability, validity and clinical utility of the Arabic version 
To support better headache management in primary care, the Global Campaign against Headache developed an 8-question outcome measure, the Headache Under-Response to Treatment (HURT) questionnaire. HURT was designed by an expert consensus group with patient-input. It assesses the need for and response to treatment, and provides guidance on actions to optimize therapy. It has proven content validity.
We aim to evaluate the Arabic version of HURT for clinical utility in primary care in Saudi Arabia.
HURT was translated according to the Global Campaign’s translation protocol. We assessed test-retest reliability in consecutive patients of four primary-care centres, who completed HURT at two visits 4-6 weeks apart while receiving usual care. We then provided training in headache management to the GPs practising in these centres, which were randomized in pairs to control (standard care) or intervention (care guided by implementation of HURT). We assessed responsiveness of HURT to clinical change by comparing base-line responses to HURT questions 1-6 with those at follow up. We assessed clinical utility by comparing outcomes between control and intervention pairs after 3 months, using locally-developed 5-point verbal-rating scales: the patient-satisfaction scale (PSS) and doctor-satisfaction scale (DSS).
For test-retest reliability in 40 patients, intra-class correlation coefficients were 0.66-0.78 for questions 1-4 and 0.90-0.93 for questions 5-7 (all P ≤ 0.001). For the dichotomous response to question 8, Kappa coefficient = 1 (P < 0.0001). Internal consistency was good (Cronbach’s alpha = 0.74). In 342 patients, HURT signalled clinical improvement over 3 months through statistically significant changes in responses to questions 1-6. PSS scores were higher among those in whom HURT recorded improvement, and also higher among those with less severe headache at baseline. Patients treated with guidance from HURT (n = 207) were more satisfied than controls (n = 135), but this did not quite reach statistical significance (P = 0.06).
The Arabic HURT Questionnaire is reliable and responsive to clinical change in Arabic-speaking headache patients in primary care. HURT showed clinical utility in this first assessment, conducted in parallel with studies elsewhere in other languages, but this needs further study. Other Arabic instruments are not available as standards for comparison.
PMCID: PMC3620405  PMID: 23565801
Headache; Management; HURT questionnaire; Primary care; Reliability; Validation; Global campaign against headache
15.  Screening for domestic violence in Jordan: validation of an Arabic version of a domestic violence against women questionnaire 
Abuse against women causes a great deal of suffering for the victims and is a major public health problem. Measuring lifetime abuse is a complicated task; the various methods that are used to measure abuse can cause wide variations in the reported occurrences of abuse. Furthermore, the estimated prevalence of abuse also depends on how abuse is culturally defined. Researchers currently lack a validated Arabic language instrument that is also culturally tailored to Arab and Middle Eastern populations. Therefore, it is important to develop and evaluate psychometric properties of an Arabic language version of the newly developed NorVold Domestic Abuse Questionnaire (NORAQ).
Design and methods:
The five core elements of the NORAQ (emotional abuse, physical abuse, sexual abuse, current suffering of the abuse, and communication of the history of abuse to the general practitioner) were translated into Arabic, translated back into English, and pilot tested to ensure cultural sensitivity and appropriateness for adult women in the Eastern Mediterranean region. Participants were recruited from the Jordanian Ministry of Health-Maternal and Child Health Care Centers in two large cities in Jordan.
A self administered NORAQ was completed by 175 women who had attended the centers. The order of factors was almost identical to the original English and Swedish languages questionnaire constructs. The forced 3-factor solution explained 64.25% of the variance in the measure. The alpha reliability coefficients were 0.75 for the total scale and ranged from 0.75 to 0.77 for the subscales. In terms of the prevalence of lifetime abuse, 39% of women reported emotional abuse, 30% physical abuse, and 6% sexual abuse.
The Arabic version of the NORAQ has demonstrated initial reliability and validity. It is a cost-effective means for screening incidence and prevalence of lifetime domestic abuse against women in Jordan, and it may be applicable to other Middle East countries.
PMCID: PMC3061851  PMID: 21445377
domestic violence; Middle East; Jordan; instrumentation
16.  Graduate entry and undergraduate medical students’ study approaches, stress levels and ways of coping: a five year longitudinal study 
Incorporating graduate students into undergraduate medical degree programs is a commonly accepted practice. However, it has only recently been recognized that these two types of students cope with their studies in various ways. The aim was to compare the learning approaches, stress levels and ways of coping of undergraduate (UG) and graduate entry medical students (GEMP) throughout their medical course.
From 2007–2011 each of the five year cohorts of undergraduate and GEMP students completed four components of the study. The components included demographics, The Biggs’ R-SPQ-2 F questionnaire which determines students’ approaches to learning, the Perceived Stress Scale (PSS) used to rate students perceived stress during the past four weeks, and the Ways of Coping (WOC) questionnaire used to assess students’ methods of coping with everyday problems.
There was a consistent difference between UG and GEMP students approaches to learning over the five years. GEMP students preferred a deep approach while the UG students preferred a superficial approach to learning. This difference became more obvious in the clinical years. There was no statistically significant difference between the groups in stress levels. There were consistent differences in the ways the two groups coped with stress.
There were significant differences in approaches to learning and ways of coping with stress between the UG and the GEMP students. These need to be considered when introducing curriculum change, in particular, redesigning an UG program for post graduate delivery.
PMCID: PMC4310038  PMID: 25616440
17.  Reliability and validity of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-30) in Saudi Arabia 
BMC Oral Health  2014;14(1):120.
To evaluate the reliability and validity of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-30) in Saudi Arabia.
A convenience sample of 200 subjects was approached, of which 177 agreed to participate giving a response rate of 88.5%. Rapid Estimate of Adult Literacy in Dentistry (REALD-99), was translated into Arabic to prepare the longer and shorter versions of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-99 and AREALD-30). Each participant was provided with AREALD-99 which also includes words from AREALD-30. A questionnaire containing socio-behavioral information and Arabic Oral Health Impact Profile (A-OHIP-14) was also administered. Reliability of the AREALD-30 was assessed by re-administering it to 20 subjects after two weeks. Convergent and predictive validity of AREALD-30 was evaluated by its correlations with AREALD-99 and self-perceived oral health status, dental visiting habits and A-OHIP-14 respectively. Discriminant validity was assessed in relation to the educational level while construct validity was evaluated by confirmatory factor analysis (CFA).
Reliability of AREALD-30 was excellent with intraclass correlation coefficient of 0.99. It exhibited good convergent and discriminant validity but poor predictive validity. CFA showed presence of two factors and infit mean-square statistics for AREALD-30 were all within the desired range of 0.50 - 2.0 in Rasch analysis.
AREALD-30 showed excellent reliability, good convergent and concurrent validity, but failed to predict the differences between the subjects categorized based on their oral health outcomes.
PMCID: PMC4190341  PMID: 25267119
REALD-30; Arabic; Health Literacy; Dental; Word recognition instrument
18.  The attractions of medicine: the generic motivations of medical school applicants in relation to demography, personality and achievement 
The motivational and other factors used by medical students in making their career choices for specific medical specialities have been looked at in a number of studies in the literature. There are however few studies that assess the generic factors which make medicine itself of interest to medical students and to potential medical students. This study describes a novel questionnaire that assesses the interests and attractions of different aspects of medical practice in a varied range of medical scenarios, and relates them to demographic, academic, personality and learning style measures in a large group of individuals considering applying to medical school.
A questionnaire study was conducted among those attending Medlink, a two-day conference for individuals considering applying to medical school for a career in medicine. The main outcome measure was the Medical Situations Questionnaire, in which individuals ranked the attraction of three different aspects of medical practise in each of nine detailed, realistic medical scenarios in a wide range of medical specialities. As well as requiring clear choices, the questionnaire was also designed so that all of the possible answers were attractive and positive, thereby helping to eliminate social demand characteristics. Factor analysis of the responses found four generic motivational dimensions, which we labelled Indispensability, Helping People, Respect and Science. Background factors assessed included sex, ethnicity, class, medical parents, GCSE academic achievement, the 'Big Five' personality factors, empathy, learning styles, and a social desirability scale.
2867 individuals, broadly representative of applicants to medical schools, completed the questionnaire. The four generic motivational factors correlated with a range of background factors. These correlations were explored by multiple regression, and by path analysis, using LISREL to assess direct and indirect effects upon the factors. Helping People was particularly related to agreeableness; Indispensability to a strategic approach to learning; Respect to a surface approach to learning; and Science to openness to experience. Sex had many indirect influences upon generic motivations. Ethnic origin also had indirect influences via neuroticism and surface learning, and social class only had indirect influences via lower academic achievement. Coming from a medical family had no influence upon generic motivations.
Generic motivations for medicine as a career can be assessed using the Medical Situations Questionnaire, without undue response bias due to demand characteristics. The validity of the motivational factors is suggested by the meaningful and interpretable correlations with background factors such as demographics, personality, and learning styles. Further development of the questionnaire is needed if it is to be used at an individual level, either for counselling or for student selection.
PMCID: PMC1397825  PMID: 16504048
19.  The Arabic version of the hospital survey on patient safety culture: a psychometric evaluation in a Palestinian sample 
A growing global interest in patient safety culture has increased the development of validated instruments to asses this phenomenon. The aim of this study is to investigate the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) and its appropriateness for Arab hospitals.
The 7-step guideline of the Agency for Healthcare Research and Quality was used to translate and validate the HSOPSC. A panel of experts evaluated the face and content validity indexing of the Arabic version. Data were collected from 13 Palestinian hospitals including 2022 healthcare professionals who had direct or indirect interaction with patients, hospital supervisors, managers and administrators. Descriptive statistics and psychometric evaluation (a split-half validation technique) were then used to test and strengthen the validity and reliability of the instrument.
With respect to face and content validity, the CVI analysis showed excellent results for the Arab context (CVI = 0.96). As to construct validity, the 12 original dimensions could not be applied to the Palestinian data. Furthermore, three of the 12 original dimensions were not reliable (α <0.6). The split-half technique resulted in an optimal 11-factor model.
Our study is the first study in the Arab world to provide an evaluation of the HSOPSC using Arabic data from Palestine. The Arabic translation of the HSOPSC comprises an 11-factor structure showing good validity and acceptable reliability. Despite the similarity between the Arab factor structure of the HSOPSC and that of the original one, and taking into account that our version may be applied in Arabic hospitals, there is a need for caution in comparing HSOPSC data between countries.
PMCID: PMC3750401  PMID: 23705887
20.  The validity and reliability of the Arabic version of the EQ-5D: a study from Jordan 
Annals of Saudi Medicine  2009;29(4):304-308.
EQ-5D is a generic measure that permits comparisons in quality of life across disease states, and which may provide useful data for health policy and resource allocation decision-making. There are no published reports on the acceptability and psychometric properties of the EQ-5D in the Arabic language. We therefore investigated the validity and reliability of the Arabic translation of the EQ-5D in Jordan.
The study was conducted on a convenience sample consisting of consecutive adult Arabic-speaking outpatients or visitors attending a university teaching hospital. Subjects were interviewed twice using a standardized questionnaire containing the EQ-5D, Short Form 36 Health Survey (SF-36). To assess the validity of the Arabic version of the EQ-5D, ten hypotheses relating responses to EQ-5D dimensions or the visual analogue scale (EQ-VAS) to SF-36 scores or other variables were examined and test-retest reliability was assessed.
The study included 186 subjects who had a mean age of 45.3 years and included 87 (47%) females. The major problem reported in more than 102 (55%) of the subjects was anxiety/depression. All of the ten a-priori hypothesis relating EQ-5D responses to external variables were fulfilled. Cohen's κ for test-retest reliability (n=52) ranged from 0.48 to 1.0.
The Arabic translation of EQ-5D appears to be valid and reliable in measuring quality of life in Jordanian people.
PMCID: PMC2841459  PMID: 19584581
21.  Reliability of Arabic ICIQ-UI short form in Saudi Arabia 
Urology Annals  2013;5(1):34-38.
The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) provides a brief measure of symptoms and impact of urinary incontinence on quality of life. It is suitable for use in clinical practice and research. An Arabic version of the ICIQ-UI SF was translated and validated in Egypt and Syria.
The objective was to assess the reliability of the Arabic version of the ICIQ-UI SF in women from Saudi Arabia.
Settings and Design:
A study at the Urogynecology Clinic was conducted from November 2010 until August 2011.
Materials and Methods:
Thirty-seven consecutive Saudi women attending urogynecologic clinic were recruited. Questionnaires were distributed for self-completion and then redistributed to the same set of respondents two to four weeks later as part of a test-retest analysis for assessing questionnaire's stability.
Statistical Analysis Used:
Agreement between two measurements was determined by weighted Kappa. Internal consistency was assessed using Cronbach's alpha coefficient.
Participants had a mean (SD) age of 39 (9.9), median parity of 4, and mean BMI (SD) of 30.9 kg/m2 (4.6). There were no differences in the frequency and amount of urine leaks or the impact of UI on quality of life observed between the two visits. Assessment of internal consistency was excellent with the Cronbach's alpha coefficient of 0.97 (95% CI: 0.88-0.98). Participants agreed that the questionnaire was clear, appropriate, and easy to understand.
The Arabic ICIQ-UI SF is a stable and clear questionnaire that can be used for UI assessment in clinical practice and research among Saudi women.
PMCID: PMC3643321  PMID: 23662008
ICIQ-UI short form; quality of life; questionnaire; reliability; Saudi Arabia; urinary incontinence
22.  The psychometric properties of three self-report screening instruments for identifying frail older people in the community 
BMC Public Health  2010;10:176.
Frailty is highly prevalent in older people. Its serious adverse consequences, such as disability, are considered to be a public health problem. Therefore, disability prevention in community-dwelling frail older people is considered to be a priority for research and clinical practice in geriatric care. With regard to disability prevention, valid screening instruments are needed to identify frail older people in time. The aim of this study was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added.
A questionnaire was sent to 687 community-dwelling older people (≥ 70 years). Agreement between instruments, internal consistency, and construct validity of instruments were evaluated and compared.
The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and the TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, the TFI and the SPQ was 0.73, 0.79 and 0.26, respectively. Scores on the three instruments correlated significantly with each other (GFI - TFI, r = 0.87; GFI - SPQ, r = 0.47; TFI - SPQ, r = 0.42) and with the GARS (GFI - GARS, r = 0.57; TFI - GARS, r = 0.61; SPQ - GARS, r = 0.46). The GFI and the TFI scores were, as expected, significantly related to age, sex, education and income.
The GFI and the TFI showed high internal consistency and construct validity in contrast to the SPQ. Based on these findings it is not yet possible to conclude whether the GFI or the TFI should be preferred; data on the predictive values of both instruments are needed. The SPQ seems less appropriate for postal screening of frailty among community-dwelling older people.
PMCID: PMC2868816  PMID: 20353611
23.  Relationships between dimensional factors of psychopathy and schizotypy 
Existing research has suggested that comorbid psychopathy may explain one trajectory of violent behavior in a subset of individuals with schizophrenia. However, it remains unclear which specific traits and symptoms are responsible for this relationship and whether it is limited to clinical and/or forensic categories, or if it reflects a dimensional relationship found in the general population. Therefore, the aim of this study was to examine differential relationships between specific factors of psychopathy and schizotypy in a non-psychiatric and non-forensic sample. Two hundred and twelve undergraduate students (50% female) completed the Schizotypal Personality Questionnaire (SPQ) and the Psychopathic Personality Inventory-Revised (PPI-R). After controlling for age and sex, regressions showed that the total SPQ score was positively related to the total PPI-R score and the Self-Centered Impulsivity factor, and negatively related to the Fearless Dominance factor. Self-Centered Impulsivity was positively related to all three SPQ factor scores, with the strongest relationship found with the Cognitive-Perceptual factor. In contrast, Fearless Dominance was negatively related to only the Interpersonal and Disorganized factors of the SPQ, with the strongest relationship found with the Interpersonal factor. Findings suggest that the comorbidity of schizotypy and the self-centered impulsivity aspect of psychopathy is not limited to extreme discrete populations, but exists in a more dimensional manner within a non-psychiatric sample. In addition, it appears that schizotypy is negatively related to the fearless dominance aspect of psychopathy, which appears to be a novel finding. Results provide preliminary findings that may have implications for developing appropriate prediction, assessment, and treatment techniques for violent behavior in schizophrenia-spectrum disorders.
PMCID: PMC3724119  PMID: 23898320
psychopathy; schizotypy; self-centered impulsivity; fearless dominance; schizophrenia
24.  Testing Measurement Invariance of the Schizotypal Personality Questionnaire-Brief Scores across Spanish and Swiss Adolescents 
PLoS ONE  2013;8(12):e82041.
Schizotypy is a complex construct intimately related to psychosis. Empirical evidence indicates that participants with high scores on schizotypal self-report are at a heightened risk for the later development of psychotic disorders. Schizotypal experiences represent the behavioural expression of liability for psychotic disorders. Previous factorial studies have shown that schizotypy is a multidimensional construct similar to that found in patients with schizophrenia. Specifically, using the Schizotypal Personality Questionnaire-Brief (SPQ-B), the three-dimensional model has been widely replicated. However, there has been no in-depth investigation of whether the dimensional structure underlying the SPQ-B scores is invariant across countries.
The main goal of this study was to examine the measurement invariance of the SPQ-B scores across Spanish and Swiss adolescents. The final sample was made up of 261 Spanish participants (51.7% men; M = 16.04 years) and 241 Swiss participants (52.3% men; M = 15.94 years).
The results indicated that Raine et al.'s three-factor model presented adequate goodness-of-fit indices. Moreover, the results supported the measurement invariance (configural and partial strong invariance) of the SPQ-B scores across the two samples. Spanish participants scored higher on Interpersonal dimension than Swiss when latent means were compared.
The study of measurement equivalence across countries provides preliminary evidence for the Raine et al.'s three-factor model and of the cross-cultural validity of the SPQ-B scores in adolescent population. Future studies should continue to examine the measurement invariance of the schizotypy and psychosis-risk syndromes across cultures.
PMCID: PMC3861321  PMID: 24349180
25.  Validation of the Arabic Version of the Epworth Sleepiness Scale in Oman 
Oman Medical Journal  2013;28(6):454-456.
The Epworth sleepiness scale is a self-administered eight-item questionnaire that was developed as a tool to measure subjective sleepiness in adults. The validity of the Epworth sleepiness scale has been validated and tested in different populations and ethnic groups. However, it has yet to be validated or tested in an Omani or other Arabic speaking population. Thus, the aim of this study is to test the validity and reproducibility of the Epworth sleepiness scale in an Omani population.
Subjects were recruited from the general population and were asked to participate in the study. The study enrolled 97 Omani volunteers and was conducted between May and October 2008. An Arabic version of the original English questionnaire was used. The study was approved by the Research and Ethics committee of the institution. Lin’s concordance correlation coefficient along with Bland-Altman plots were used to test the agreement between the Arabic and English versions of the Epworth sleepiness scale.
The study included a total of 37 males (38%) and 60 females (62%) with age ranging between 18-75 years. Concordance correlation results revealed a substantial concordance (RhoC) of 0.914, but one that does not approach 1 (95% CI: 0.881, 0.947). This results from both lack of perfect correlation (Pearson’s r=0.914) and bias (C_b = 1.000). The Bland and Altman’s limits-of-agreement measured at 0.000 (95% CI: -2.684, 2.684), indicating insignificant average departure from agreement between the two versions of the Epworth sleepiness scale.
The results indicate agreement between the two versions of ESS (English and the Arabic).
PMCID: PMC3815862  PMID: 24223253
Sleepiness; Arabic ESS; Bland Altman

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