ABSTRACT
Purpose: This study aimed to investigate the measurement properties, according to the Rasch Measurement Theory, of the anterior cruciate ligament return to sport after injury scale (ACL-RSI) in patients treated with ACL reconstruction in Sweden. Methods: ACL-RSI responses from 1065 patients treated with ACL reconstruction were extracted from a rehabilitation-specific registry. Rasch analyses were performed on ACL-RSI item response data using the RUMM2030plus software. The analyses focused on targeting (person-item threshold distribution), item hierarchy, response category thresholds, overall and individual item and person fit, differential item functioning (DIF), unidimensionality and reliability. Results: The ACL-RSI had compromised fit to the Rasch model, including DIF and malfunctioning response categories. Several items correlate with each other and the presumptions to aggregate item responses into one single score were not met. When accounting for local dependency, the measurement properties of the ACL-RSI improved in terms of model fit and DIF and unidimensionality were supported. Conclusion: The ACL-RSI was found to have signs of multidimensionality and local dependency, that is, the answers to one item are influenced by the answers to other items. As such, researchers should be careful when using the ACL-RSI as one single score to evaluate patients treated with ACL reconstruction, unless local dependency is accounted for in the scoring process. Level of Evidence: Level III.
ABSTRACT
BACKGROUND: Globally as well as in Sweden, diseases that are caused by unhealthy lifestyle habits are the most common causes of death and disability. Even though there are guidelines that oblige all health-care professionals to counsel patients about lifestyle, studies have shown that it is not prioritized within healthcare. One reason for this among nurses has been shown to be lack of confidence in knowledge and counselling skills. This study aimed to develop, and quality assess the psychometric properties of an instrument to measure self-efficacy in lifestyle counselling. METHODS: An instrument inspired by an American instrument, following Bandura's recommendations for development of self-efficacy measures, was developed according to Swedish national guidelines for disease-prevention. The instrument was revised after cognitive interviews with nursing students, university teachers within health sciences, and clinical experts, then administrated to 310 nursing students at different levels in their education. The instrument was tested with Rasch Measurement Theory, with focus on dimensionality, local dependency, targeting, reliability, response category functioning, Rasch model fit, and differential item functioning by age, gender, educational level and previous health care education. RESULTS: The development of the instrument resulted in 20 + 20 items, 20 items about self-efficacy in knowledge, and 20 items about self-efficacy in ability to counsel persons about their lifestyle. The analyses showed that knowledge and ability are two different, but related, constructs, where ability is more demanding than knowledge. The findings provide support (considering dimensionality and local dependency) for that all 20 items within the knowledge construct as well as the 20 items within the ability construct can be summed, achieving two separate but related total scores, where knowledge (reliability 0.81) is a prerequisite for ability (reliability 0.84). Items represented lower self-efficacy than reported by the respondents. Response categories functioned as expected, Rasch model fit was acceptable, and there was no differential item functioning. CONCLUSIONS: The SELC 20 + 20 was found to be easy to understand with an acceptable respondent burden and the instrument showed good measurement properties.
Subject(s)
Quality of Life , Self Efficacy , Humans , Psychometrics/methods , Reproducibility of Results , Quality of Life/psychology , Surveys and Questionnaires , Life StyleABSTRACT
BACKGROUND: Cardiovascular disease and type 2 diabetes are among the largest public health challenges in Sweden. Research indicates that a healthy lifestyle can prevent most cases. The health dialogue is an evidence-based public health programme for primary care with positive results in several regions of Sweden. This study aimed to describe health care professionals' experiences and perceptions of health promotion through the health dialogue intervention during the pilot phase in the Scania region of Sweden. METHODS: The study consists of 12 individual interviews with health care professionals educated in the health dialogue method, implementing the intervention in Scania. Qualitative content analysis with an inductive approach was used. RESULTS: The analysis resulted in 10 sub-categories and the four main categories: A more health-promoting mindset would benefit primary care; Empower individuals; Facilitate sustainable lifestyle changes; Challenges, tools and support for the implementation of the health dialogue. One overarching theme emerged: "Health dialogue, a potential start of a paradigm shift in Swedish primary care". CONCLUSIONS: Conclusions imply that the health dialogue is a well-structured method with tools to make health promotion and primary prevention an integrated part of primary care. A respectful and motivating approach during the health dialogue is recommended. It is important to have an ongoing discussion about the approach among the health care professionals. Incorporating the Health Belief Model in the health care professionals' education in the method could increase the focus on self-efficacy during counselling, which could favour the participants' change process.
