Internal Structure of the Health-Related Quality of Life Instrument with 8-Items in a Nationally Representative Population

Purpose@#This study evaluated the internal structure (structural validity, internal consistency, and measurement invariance) of the Health-Related Quality of Life Instrument with Eight Items (HINT-8), developed to measure Korean people’s health-related quality of life. @*Methods@#A secondary analysis was conducted using data from the Korea National Health and Nutrition Examination Survey, involving 6,167 adults aged over 18 years. The structural validity of the HINT-8 was assessed using exploratory graph analysis and confirmatory factoranalysis. Internal consistency and measurement invariance were analyzed using McDonald’s omega (ω) and multigroup confirmatory factor analysis, respectively. @*Results@#The HINT-8 had a single dimension and good internal consistency (ω = .804). The one-dimension HINT-8 ex-hibited matric invariance but not scalar invariance across sociodemographic groups (sex, age, education, and marital status). Further, it exhibited scalar or partial scalar invariance across medical condition groups (hypertension, diabetes, depressive symptoms, and cancer). @*Conclusion@#The study finds that the HINT-8 demonstrated satisfactory structural validity and internal consistency, indicating its suitability for practice and research. However, the HINT-8 scores cannot be compared across different groups regarding sex, age, education, and marital status, as the interpretation varies within each sociodemographic category. Conversely, interpretation of the HINT-8 is consistent for individuals with and without hypertension, diabetes, depressive symptom, and cancer.

Psychometric properties of an instrument 2: structural validity, internal consistency, and cross-cultural validity/measurement invariance

Structural validity, internal consistency, and cross-cultural validity/measurement invariance are psychometric properties of the internal structure of an instrument. In psychometric studies published in Korean nursing journals, structural validity has mainly been assessed using confirmatory factor analysis. Cross-cultural validity/measurement invariance has rarely been evaluated. It is recommended for Korean nursing researchers to evaluate the internal structure of instruments using a greater variety of methods, such as item response theory, Rasch analysis, multi-group confirmatory factor analysis, and differential item functioning.

Updated Theory of Planned Behavior in Predicting Parents’ Intentions to Vaccinate Their Sons in Elementary School against Human Papillomavirus

Purpose@#This study was to determine how attitude, subjective norm, and perceived behavioral control (PBC) were related to parents' intentions to vaccinate their sons in elementary school against human papillomavirus (HPV), applying the updated theory of planned behavior. Two hypotheses were examined: PBC would moderate the relationship of attitude to intention and subjective norm to intention, respectively. @*Methods@#This was a cross-sectional study with 231 participants recruited in November, 2018. Inclusion criteria for the participants were parents with 5th-6th grade boys in elementary schools. The moderation effects of the hypotheses were analyzed using the PROCESS macro for SPSS. @*Results@#PBC significantly moderated the relationship of attitude to intention on HPV vaccination. The simple effect of attitude to intention was significant under three different levels of the PBC (low, moderate, and high), but the magnitudes of the relationships were not homogeneous. The magnitude of the relationship between attitude and intention was the lowest for the parents with the low level of the PBC. In the relationship of subjective norm to intention on HPV vaccination, the moderating effect of the PBC was not supported.Subjective norm and PBC directly predicted the intention on HPV vaccination. @*Conclusion@#In order to promote the parents' intentions to vaccinate their sons in elementary school against HPV, we need a program that can improve parents’ attitude, subjective norm, and PBC, requiring special attention to the parents with the low PBC.

Psychometric properties of an instrument 2: structural validity, internal consistency, and cross-cultural validity/measurement invariance

Structural validity, internal consistency, and cross-cultural validity/measurement invariance are psychometric properties of the internal structure of an instrument. In psychometric studies published in Korean nursing journals, structural validity has mainly been assessed using confirmatory factor analysis. Cross-cultural validity/measurement invariance has rarely been evaluated. It is recommended for Korean nursing researchers to evaluate the internal structure of instruments using a greater variety of methods, such as item response theory, Rasch analysis, multi-group confirmatory factor analysis, and differential item functioning.

Relationship of Workplace Violence to Turnover Intention in Hospital Nurses:Resilience as a Mediator

Purpose@#This study aimed to identify the relationship between workplace violence and turnover intention, and the mediation effect of resilience on the relationship in hospital nurses. @*Methods@#This was a cross-sectional study. A total of 237 registered nurses were recruited from three hospitals in South Korea from April to May 2019. Participants were invited to complete self-reported questionnaires that measure workplace violence, turnover intention, resilience, and demographic information. The data obtained were analyzed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval (5,000 bootstrap resampling). @*Results@#After controlling demographic covariates, workplace violence significantly accounted for the variance of turnover intention. It was also demonstrated that resilience partially mediated the relationship between workplace violence and turnover intention in hospital nurses. A 73.8% of nurses had experienced workplace violence (such as attack on personality, attack on professional status, isolation from work, or direct attack). Conclusion: Workplace violence directly influences turnover intention of nurses and indirectly influences it through resilience. Therefore, hospital administrators need to develop and provide a workplace violence preventive program and resilience enhancement program to decrease nurses’ turnover intention, and leaving.

A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes

Purpose@#The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. @*Methods@#The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. @*Results@#Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test–retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. @*Conclusion@#The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

Evaluation of Studies on the Measurement Properties of Self-Reported Instruments

Purpose@#The purpose of this study was to evaluate studies on the measurement properties of self-reported instruments. @*Methods@#This descriptive review included studies on measurement properties that were reported in Asian Nursing Research over a five-year period from 2016 to September 2020. Nine key measurement properties were reviewed for each study: content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses-testing construct validity, and responsiveness. @*Results@#The most commonly applied measurement properties were structural validity and internal consistency. However, structural validity using confirmatory factor analysis or item response theory/Rasch analysis needs to be rigorously analyzed and interpreted. None of the studies assessed measurement error and responsiveness. @*Conclusion@#It is recommended for nursing researchers to assess measurement properties beyond structural validity and internal consistency using more rigorous methodologies.

A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes

Purpose@#The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. @*Methods@#The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. @*Results@#Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test–retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. @*Conclusion@#The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

Evaluation of Studies on the Measurement Properties of Self-Reported Instruments

Purpose@#The purpose of this study was to evaluate studies on the measurement properties of self-reported instruments. @*Methods@#This descriptive review included studies on measurement properties that were reported in Asian Nursing Research over a five-year period from 2016 to September 2020. Nine key measurement properties were reviewed for each study: content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses-testing construct validity, and responsiveness. @*Results@#The most commonly applied measurement properties were structural validity and internal consistency. However, structural validity using confirmatory factor analysis or item response theory/Rasch analysis needs to be rigorously analyzed and interpreted. None of the studies assessed measurement error and responsiveness. @*Conclusion@#It is recommended for nursing researchers to assess measurement properties beyond structural validity and internal consistency using more rigorous methodologies.

The 21-Item and 12-Item Versions of the Depression Anxiety Stress Scales: Psychometric Evaluation in a Korean Population

PURPOSE: This study aimed to evaluate the psychometric properties of the Depression Anxiety Stress Scales 21 and 12 in a Korean population. METHODS: The Depression Anxiety Stress Scales were translated into Korean using a translation and backtranslation technique, and the content validity was assessed by an expert panel. Participants were recruited from six community health centers (n = 431) and two community mental health centers (n = 50). A field test of the psychometric properties of the instruments was conducted using confirmatory factor analysis with bootstrap maximum likelihood estimation involving 1,000 samples, Pearson's analysis, t test, and Cronbach's α coefficient. RESULTS: Confirmatory factor analysis of the Depression Anxiety Stress Scales 21 and 12 supported both three-factor and second-order three-factor models. The Scales 21 and 12 satisfied convergent validity with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Perceived Stress Scale-10 and discriminant validity with the Rosenberg Self-Esteem Scale. The scores for the Depression Anxiety Stress Scales 21 and 12 were higher for the psychiatric group than for the nonpsychiatric group, confirming the presence of known-groups validity. The Depression Anxiety Stress Scales 21 and 12 exhibited moderate-to-strong correlations with the Negative Affect. Cronbach's a coefficients for the Depression Anxiety Stress Scales 21 and 12 were .93 and .90, respectively. CONCLUSION: The Depression Anxiety Stress Scales 21 and 12 appear to be acceptable, reliable, and valid instruments. However, the shorter Depression Anxiety Stress Scales 12 may be more feasible to use in a busy practice and also be less burdensome to respondents.

Obesity and Related-factors in Patients with Chronic Mental Illness Registered to Community Mental Health Welfare Centers

PURPOSE: The purpose of study was to examine the relationship between obesity and its associated factors (psychiatric symptom, duration of illness, type of medication, physical activity, dietary habits, depressive symptom, and stress) in patients with chronic mental illness registered to community mental health welfare centers. METHODS: This was a cross-sectional correlation study using a convenience sampling. A total of 392 participants were recruited from community mental health welfare centers. The obtained data were analyzed using binary and multinomial logistic regression. RESULTS: Atypical antipsychotic medication, duration of illness, dietary habits (overeating, and drinking instant coffee) were significantly contributed variables into body mass index (BMI) obesity. Atypical antipsychotic medication and instant coffee were significantly related to abdominal obesity. CONCLUSION: These results emphasized the needs of tailored obesity-preventive management for the community-dwelling patients with chronic mental illness, topically focusing on the administration of atypical antipsychotic medication, duration of illness, and dietary habits.

A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes

PURPOSE: Health literacy has been attracting increasing attention because low health literacy is considered an important predictor of adverse health outcomes in many chronic conditions, including diabetes. However, it is unclear how health literacy is associated with health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life (HRQOL) in patients with type 2 diabetes. METHODS: cross-sectional survey design was employed, and 459 patients with type 2 diabetes were recruited from outpatient clinics in two university hospitals. The patients completed a pack of questionnaires. The hypothetical model was tested using structural equation modeling analysis. RESULTS: The values of multiple fit indices indicated that the proposed model provided a good fit to the data. Health literacy exerted not only a direct effect on self-care activities, but also an indirect effect on self-care activities via self-efficacy. However, health literacy exerted only an indirect effect on HRQOL. This structural model was invariant across hemoglobin-A1c-controlled and hemoglobin-A1c-uncontrolled groups. Based on R2 values, the final model accounted for 20.0% of the variance in selfefficacy, 61.0% of the variance in self-care activities, and 16.0% of the variance in HRQOL. CONCLUSIONS: This study suggests that self-care activities are crucial to the link between health literacy and HRQOL. Both health literacy and self-efficacy need to be considered in clinical practice for enhancing self-care activities in patients with type 2 diabetes. This approach may ultimately improve HRQOL in these patients.

Trends in Nursing Research in Korea: Research Trends for Studies Published from the Inaugural Issue to 2010 in the Journal of Korean Academy of Nursing and the Journals Published by Member Societies under Korean Academy of Nursing Science

PURPOSE: The purpose of this study was to identify trends for studies published in the Journal of Korean Academy of Nursing and journals published by member societies from inaugural issues to 2010. METHODS: A total of 6890 studies were analyzed using descriptive statistics. RESULTS: Quantitative studies accounted for 83.6% while qualitative studies accounted for 14.4%. Most frequently used research designs were quasi-experimental (91.1%) for experimental research and survey (85.2%) for non-experimental research. Most frequent study participants were healthy people (35.8%), most frequent nursing interventions, nursing skills (53.5%), and 39.8% used knowledge, attitude and behavior outcomes for dependent variables. Most frequently used keyword was elderly. Survey studies decreased from 1991 to 2010 by approximately 50%, while qualitative studies increased by about 20%. True experimental research (1.2%) showed no significant changes. Studies focusing on healthy populations increased from 2001-2005 (37.5%) to 2006-2010 (41.0%). From 1970 to 2010, studies using questionnaire accounted for over 50% whereas physiological measurement, approximately 5% only. Experimental studies using nursing skill interventions increased from 1970-1980 (30.4%) to 2006-2010 (64.0%). No significant changes were noted in studies using knowledge, attitude and behavior (39.9% ) as dependent variables. CONCLUSION: The results suggest that further expansion of true experimental, qualitative studies and physiological measurements are needed.

Erratum: Erratum to Review of the Psychometric Evidence of the Perceived Stress Scale Asian Nursing Research 6 (2012) 121-127

The publisher regrets that the Table 4 in the above mentioned article has been typeset incorrectly and the correct table is given below.

Eating patterns and use of nutritional information in breast cancer survivors treated with radiation therapy in South Korea / 한국영양학회지

The purposes of this study were 1) to investigate eating behaviors and patterns in breast cancer patients using a newly developed food frequency questionnaire and 2) to examine perception and use of nutritional information about breast cancer treatment among cancer patients treated with radiation therapy. Sixty breast cancer patients (case group) undergoing radiation therapy in Ajou University Hospital, Suwon, South Korea and 79 healthy women (control group) participated in this study. Mean age of subjects in the control group was 46.00 +/- 7.88 years and BMI was 23.12 +/- 2.85 kg/m2, and that of the case group was 50.06 +/- 11.64 years and 22.32 +/- 3.24 kg/m2. The results of eating behaviors showed several significant differences between control and case groups. Breast cancer patients ate meals on a more regular basis, on time, and more frequently compared to control subjects. In addition, they preferred more salty or spicy and bland food compared to healthy women. According to answers from the food frequency questionnaire, breast cancer patients consumed significantly lower amounts of boiled white rice, meats and processed food, fish and shellfish, coffee, milk, and cheese, whereas they consumed a significantly large amount of boiled multigrain rice, vegetable, seaweeds, soybean and processed food, and yoghurt compared to healthy women. This study also observed the way in which cancer patients and healthy control subjects obtain information about breast cancer treatment and its reliabilities. Results showed that healthy women did not hesitate to obtain information from mass media, while breast cancer patients would obtain nutritional information from specialists rather than mass media. Results of this survey confirmed that breast cancer patients avoided intake of red meat protein, even though they already recognized the importance of dietary protein intake for recuperation and treatment of the disease. These results could be used for future diet and nutrition guidelines for breast cancer patients.

Measurement Properties of Self-report Questionnaires Published in Korean Nursing Journals

PURPOSE: The purpose of this study was to evaluate measurement properties of self-report questionnaires for studies published in Korean nursing journals. METHODS: Of 424 Korean nursing articles initially identified, 168 articles met the inclusion criteria. The methodological quality of the measurements used in the studies and interpretability were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. It consists of items on internal consistency, reliability, measurement error, content validity, construct validity including structural validity, hypothesis testing, cross-cultural validity, and criterion validity, and responsiveness. For each item of the COSMIN checklist, measurement properties are rated on a four-point scale: excellent, good, fair, and poor. Each measurement property is scored with worst score counts. RESULTS: All articles used the classical test theory for measurement properties. Internal consistency (72.6%), construct validity (56.5%), and content validity (38.2%) were most frequently reported properties being rated as 'excellent' by COSMIN checklist, whereas other measurement properties were rarely reported. CONCLUSION: A systematic review of measurement properties including interpretability of most instruments warrants further research and nursing-focused checklists assessing measurement properties should be developed to facilitate intervention outcomes across Korean studies.

Prioritization of Research Topics of Korean Oncology Nurses

PURPOSE: The aim of this study was to determine the prioritization of research topics by Korean oncology nurses. METHODS: A descriptive and cross-sectional survey was conducted via the website of the Korean Oncology Nursing Society, with participation sought by email from all of its members. RESULTS: Overall, 'pain' and 'quality of life' were the most important among the 74 topics, 'cancer prevention' was ranked 47th, while 'informatics' and 'telehealth' were ranked 62nd and 72nd, respectively. Korean oncology nursing research needs to be expanded to include community-based cancer prevention. In addition, research on informatics and telehealth in the oncology nursing area is necessary given the current dramatic changes in the implementation of information technology in medical services. CONCLUSION: These findings may contribute toward the development of a Korean oncology nursing research agenda and the provision of information to funding agencies with respect to setting the priorities of oncology nursing research.

Review of the Psychometric Evidence of the Perceived Stress Scale

PURPOSE: The purpose of this study was to review articles related to the psychometric properties of the Perceived Stress Scale (PSS). METHODS: Systematic literature searches of computerized databases were performed to identify articles on psychometric evaluation of the PSS. RESULTS: The search finally identified 19 articles. Internal consistency reliability, factorial validity, and hypothesis validity of the PSS were well reported. However, the test-retest reliability and criterion validity were relatively rarely evaluated. In general, the psychometric properties of the 10-item PSS were found to be superior to those of the 14-item PSS, while those of the 4-item scale fared the worst. The psychometric properties of the PSS have been evaluated empirically mostly using populations of college students or workers. CONCLUSION: Overall, the PSS is an easy-to-use questionnaire with established acceptable psychometric properties. However, future studies should evaluate these psychometric properties in greater depth, and validate the scale using diverse populations.

Analysis of Trends and Contents of Nursing Doctoral Dissertations in Korea

PURPOSE: This study aimed to identify contents and trends of Korean nursing doctoral dissertations in terms of research methodology and theoretical characteristics. METHODS: The design of the study was descriptive study and a total of 1,089 quantitative studies completed between 1982 and 2010 were reviewed using the analytical framework developed by the researchers. RESULTS: The majority of studies utilized the experimental design (51.5%) and the others were survey design (38.8%) and methodological design (5.0%). Study subjects were shown as patients (45%), care givers (11.2%), ordinary persons (40.6%) and others (3.2%). There were growing trends in experimental design and patients as subjects. The prevailing data collection settings were hospitals (45.8%) and community (27.8%). The theoretical frameworks that studies were based on were the existing theories (37%) and a newly developed theoretical framework by a researcher (25.2%). a framework derived from other studies by the researcher (25.2%). Majority of studies (78.5%) employed a single theory as a theoretical framework. However, 31.8% of studies had no theoretical framework based on. CONCLUSION: Findings of this study provided the opportunities to shed new light on the current status of Korean doctoral dissertation and to deliberate on the future direction of nursing studies in Korea.

Monitoring the Use of Health-Related Quality of Life Measurements in Korean Studies of Patients with Diabetes

PURPOSE: The purpose of this study was to monitor the use of health-related quality of life (HRQOL) instruments in Korean studies of patients with diabetes. METHODS: Of 86 Korean studies initially identified, 17 studies met the inclusion criteria. For each study, a description of the instrument and its psychometric properties were monitored by the Instrument Review Criteria of the Scientific Advisory Committee. These criteria include conceptual definition, attributes, taxonomy, reliability, validity, responsiveness, administrative mode, and language adaptations. RESULTS: Five generic and one diabetes specific type questionnaires were identified from the 17 studies. Of those studies, conceptual definitions with the attributes of multi-dimension and subjectiveness were provided for 11 studies (71%). In the analysis of conceptual taxonomy, only 6 studies were classified as HRQOL, while other studies were done as QOL or health status. In monitoring of psychometric properties, reliability, validity, and responsiveness were reported for 88.2%, 64.7%, and 29.4%, respectively. One generic instrument was developed with a Korean population, while the other instruments were developed for Western countries. However, language adaptations were performed for only a few of the instruments. CONCLUSION: The psychometric properties including responsiveness of most instruments warrants further research, and the development of diabetes-specific HRQOL measurements should be sought to facilitate intervention outcomes across Korean studies of patients with diabetes.