Psychometric evaluation of the subjective well-being measure GP-CORE in a group of older adults in Sweden.

BACKGROUND: The world's growing population of older adults is one population that needs to be focused more regarding subjective well-being. It is therefore important to evaluate self-report instruments that measures general well-being for this specific group - older adults. The aim of the present study was to investigate psychometric properties of the Swedish translation of the GP-CORE (general population - Clinical Outcomes in Routine Evaluation) in a group of older adults (> 65 years). METHODS: In this study, a psychometric evaluation of the GP-CORE is presented for 247 Swedish older adults (> 65 years), 184 women and 63 men who applied for home care assistance for the first time. RESULTS: The psychometric evaluation showed high acceptability; provided norm values in terms of means, standard deviations and quartiles; showed satisfactory reliability in terms of both internal consistency and stability; showed satisfactory validity in terms of convergent and discriminant validity; provided a very preliminary cut-off value and quite low sensibility and sensitivity and showed results which indicated that this scale is sensitive to changes. One gender difference was identified in that women without a cohabitant had a higher well-being than men without a cohabitant (as measured by GP-CORE). CONCLUSIONS: The GP-CORE showed satisfactory psychometric properties to be used to measure and monitor subjective well-being in older adults (> 65 years) in the general population of community dwelling. Future studies should establish a cut-off value in relation to another well-being measure relevant for mental health in older adults.

Empathy levels among nursing students: A comparative cross-sectional study.

AIM: Empathy is a crucial component of the nurse-patient relationship, but knowledge is lacking as to when empathy develops during nursing education. The aim of the present study was to compare empathy levels at different stages of undergraduate nursing education and different master's nursing programmes. DESIGN: The design was a comparative cross-sectional study. METHODS: A total of 329 participants in Sweden, comprised of nursing students in their second and sixth semesters in an undergraduate nursing programme as well as master's nursing students, rated their own empathy using the Jefferson Scale of Physician Empathy. RESULTS: Students in their sixth semester in an undergraduate nursing programme expressed more empathy than did students in their second semester and master's nursing students. Among the five master's programmes, public-health nursing students expressed the most empathy and intensive-care nursing students the least.

Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students.

BACKGROUND: Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. OBJECTIVE: This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-à-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. DESIGN: This study used an exploratory cross-sectional design. METHODS: The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. RESULTS: All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R2 = 0.04; SBC change in R2 = 0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. LIMITATIONS: The limitations of this study are that it was cross-sectional. CONCLUSIONS: Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.

Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'.

Background and aim: 'Reasoning 4 Change' (R4C) is a newly developed instrument, including four domains (D1-D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1-D4); inter-rater reliability (D2-D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (α range: 0.67-0.91), satisfactory test-retest reliability (ICC range: 0.46-0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94-1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06-0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.

Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change.

BACKGROUND AND AIM: A systematically developed and evaluated instrument is needed to support investigations of physiotherapists' clinical reasoning integrated with the process of clients' behavior change. This study's aim was to develop an instrument to assess physiotherapy students' and physiotherapists' clinical reasoning focused on clients' activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. METHODS: The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. RESULTS: Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument's content relevance. CONCLUSIONS: This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students' and physiotherapists' clinical reasoning, however continued development and testing are needed.

The relation between sense of coherence and daily hassles among university students.

Based on Antonovsky's salutogenic model, it was hypothesized that persons with a high sense of coherence (SOC), compared to persons with a low SOC, (1) experience fewer hassles and (2) experience hassles as less stressful. In addition to each of the two main hypotheses, gender differences and interaction between SOC and gender were also explored. Two hundred and fifty-eight female students (Mage = 23.77 years) and 136 male students (Mage = 24.02 years) participated in a survey where they responded to a questionnaire that was designed to measure some demographic variables, SOC and daily hassles. The data were analysed by two 3 (SOC-groups) × 2 (Gender) ANOVAs for independent measures, with frequency and intensity as dependent variables, followed up with Tukey's HSD post-hoc tests. The results confirmed both main hypotheses. In addition, the results showed no interaction between SOC and gender, no differences between female and male students with regard to the number of experienced hassles but that female students experienced the hassles more intensively. These findings further corroborated the two fundamental parts of Antonovsky's salutogenic model concerned with avoidance and appraisal of stressors.

Psychometric evaluation of the Swedish translation of the revised Cystic Fibrosis Questionnaire in adults.

AIM: The CFQ-R is one of the most established disease-specific, health-related quality of life (HRQOL) measurements for patients with cystic fibrosis (CF). The aim was to evaluate the psychometric properties of the Swedish translation of CFQ-R in adults. METHOD: A total of 173 CF patients answered the CFQ-R. The CFQ-R was evaluated with regard to: (1) distributional properties; (2) reliability; and (3) construct validity. RESULTS: The majority of scales were negatively skewed with ceiling effects. Eight of the 12 scales had satisfactory homogeneity; 10 of the 12 scales had satisfactory test-retest reliability. On many of the CFQ-R scales expected differences were observed when patients were divided regarding disease severity, nutritional status, age, and gender. CONCLUSION: Some weaknesses were detected, but overall the instrument has satisfactory psychometric properties.

Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand.

The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand's aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors.

Test of Antonovsky's postulate: high sense of coherence helps people avoid negative life events.

This study tested Antonovsky's postulate that a high sense of coherence (SOC) helps people avoid negative life events. It was assumed that negative life events that were uncontrollable would not show this effect, while those events that potentially could be controlled would show a significant relationship with SOC. 1,012 female nurses (M age=46.9 yr.; SD=8.9) participated in this longitudinal study and were divided into groups with low, moderate, and high SOC. Sixteen negative life events were categorized into uncontrollable and controllable events, with the controllable events divided into three sub-categories. Five one-way analyses of variance (ANOVAs) for independent measures followed up with post hoc tests were performed, with the number of experienced events in a given category by each participant (at Time 2) as the dependent variable and the three SOC groups (formed at Time 1) as the independent variable. The results indicated that the high SOC group reported fewer controllable negative life events, while there was no significant relationship between the SOC level and uncontrollable negative life events. The findings support the postulate in Antonovsky's model, with the distinction between controllable and uncontrollable negative life events.

A clinical reasoning model focused on clients' behaviour change with reference to physiotherapists: its multiphase development and validation.

BACKGROUND AND PURPOSE: A biopsychosocial approach and behaviour change strategies have long been proposed to serve as a basis for addressing current multifaceted health problems. This emphasis has implications for clinical reasoning of health professionals. This study's aim was to develop and validate a conceptual model to guide physiotherapists' clinical reasoning focused on clients' behaviour change. METHODS: Phase 1 consisted of the exploration of existing research and the research team's experiences and knowledge. Phases 2a and 2b consisted of validation and refinement of the model based on input from physiotherapy students in two focus groups (n = 5 per group) and from experts in behavioural medicine (n = 9). RESULTS: Phase 1 generated theoretical and evidence bases for the first version of a model. Phases 2a and 2b established the validity and value of the model. The final model described clinical reasoning focused on clients' behaviour change as a cognitive, reflective, collaborative and iterative process with multiple interrelated levels that included input from the client and physiotherapist, a functional behavioural analysis of the activity-related target behaviour and the selection of strategies for behaviour change. CONCLUSIONS: This unique model, theory- and evidence-informed, has been developed to help physiotherapists to apply clinical reasoning systematically in the process of behaviour change with their clients.

Psychometric evaluation of the Danish and Swedish Satisfaction with Life Scale in first episode psychosis patients.

PURPOSE: To psychometrically evaluate the Satisfaction with Life Scale in two cohorts of first-episode psychosis patients in the Danish National Schizophrenia Project and in the Swedish Parachute Project. METHOD: Four properties of the Satisfaction with Life Scale were examined in the Danish cohort (explorative investigation) and then confirmed in the Swedish cohort: (1) the factor structure; (2) correlations between subscales; (3) internal consistencies of subscales; and (4) main tendencies (arithmetic means) and variations (standard deviations) of subscales. The relations between the Satisfaction with Life Scale and various life conditions were investigated in the Swedish cohort. RESULTS: For both samples, the analysis indicated that the obtained four-dimensional 11-item scale had satisfactory properties. Moderately high scores were obtained in the four subscales: "living," "social relationships," "self and present life" and "work." They correlated positively with each other, the internal consistencies of the subscales were acceptable and the means for the subscales indicated no apparent floor or ceiling effects. The four dimensions obtained seem relevant and presented good face validity. The dimensions were confirmed in the Swedish sample. CONCLUSION: The Satisfaction with Life Scale shows satisfactory psychometric properties and seems valid and useful among first-episode psychosis patients.

Changes in hope and health-related quality of life in couples following acute myocardial infarction: a quantitative longitudinal study.

BACKGROUND: Acute myocardial infarction (AMI) is a life-changing event that affects both the patient and the family and can have an influence on hope as well as HRQoL during the recovery period. AIMS: To compare self-rated scores of hope and health-related quality of life (HRQoL) 1, 7, 13 and 25 months, after an AMI with regard to (i) differences across time, and (ii) differences between patients and their partners. DESIGN: Explorative and longitudinal study. METHODS: In this nonrandomized study, Short Form 36 Health Questionnaire (SF-36) and Herth Hope Index-Swedish (HHI-S) questionnaires were completed by thirteen post-AMI patients and their partners. Data were collected on four occasions. RESULTS: In general, hope as well as HRQoL scores increased over time. A 2 (groups) × 4 (times) anova for mixed design showed significant changes in mental as well as in physical health over time but no significant effect of group on mental or physical health. Calculation of the minimum detectable change (MDC-index) for HHI-S and SF-36 revealed that scores between data collection points were not stable. conclusion: Our results show that although hope and HRQoL scores increased, only a few of the changes were statistically significant. Neither HHI-S nor SF-36 seems to measure stable states. Changes in hope and HRQoL levels may be due to participants striving to adapt to the current situation. RELEVANCE TO CLINICAL PRACTICE: These results can be used in the training of nursing staff to enhance their understanding of the significance of a family-centred approach after an AMI.

Health outcomes among Swedish children: the role of social capital in the family, school and neighbourhood.

AIM: The aim of the study was to explore the extent to which Swedish children's perceptions of social capital in the family, school and neighbourhood predicted health complaints and well-being. METHODS: The study used data from the Swedish Health Behaviour in School-aged Children survey. The sample consisted of 3926 children aged 11-15 years. Correlations and hierarchical multiple linear regression were performed. RESULTS: Higher degrees of family, school and neighbourhood social capital corresponded to lower levels of health complaints and higher levels of well-being. Social capital in these three spheres had a cumulative effect on children's health and well-being. CONCLUSIONS: Social capital in the family, school and neighbourhood matters for children's health and well-being and the contributions from each context seem to be additive. Besides the family context, investments for improving child health should primarily be in the school, focusing on social relations and on creating safe and cohesive school environments. Neighbourhood social capital is also of importance and so must be taken into consideration when planning child health promotion interventions.

Perceptions of community trust and safety - consequences for children's well-being in rural and urban contexts.

AIM: To explore the associations between subjective well-being and perceptions of community trust and safety amongst children in rural and urban areas. METHODS: The study used self-reported data from the 2001/2002 Swedish cross-national WHO study Health Behaviour in School-aged Children. The sample consisted of 3852 children aged 11-15 years, living in different residential areas. Bivariate analyses and multivariate logistic regression were performed. RESULTS: The results indicated that a greater proportion of children in urban areas perceived low community trust and safety, compared with children in rural areas. Further, the multivariate analysis revealed that perceived community trust and safety significantly impacts upon children's subjective well-being in both rural and urban contexts. CONCLUSION: Children's perceptions of trust and safety have different magnitudes in urban and rural areas. The associations of perceptions of community trust and safety for children's subjective well-being are relevant in both urban and rural areas. As perceptions of low trust and safety in the community seem to be related to low subjective well-being, efforts to encourage community trust and safety should be included amongst the key priorities in community health promotion.

Mental health and sense of coherence among Swedish adults with cystic fibrosis.

The purpose of this study was to describe mental health among adult Swedish patients with cystic fibrosis (CF) and to study if mental health and the salutogene factor sense of coherence (SOC) intercorrelate with good medical status. Women and men were compared. The patient group (n=59) attended the Stockholm CF Center. Mental health was measured with the General Health Questionnaire (GHQ-28) and the salutogenesis by SOC-3. Medical status included forced vital capacity and forced expiratory volume in 1 second in per cent of predicted as well as Body Mass Index. The differences within and between groups were tested with t-tests and the relations between the variables were described by Spearman's correlation coefficient. The patients had on the whole good mental health, but the group with a risk of mental ill-health (n=19) experienced life as difficult to manage, meaningless and hard to understand compared to the group with a small risk of mental ill-health (n=40). Women at risk of mental ill-health (n=10) experienced difficulties in managing life to a greater extent than women with a small risk of mental ill-health (n=16). Men at risk of mental ill-health (n=9) found life hard to understand. Mental health and SOC did not correlate significantly with the medical status of the CF patients. The conclusion was that there were comparably few problems of mental health among the patients with CF. The problems that were found were not related to the seriousness of their CF. Women had a more complex pattern of problems in mental health and SOC than men had.

A longitudinal study of the relationship between empowerment and burnout among registered and assistant nurses.

The relation between empowerment and burnout was investigated using a two-wave and two-variable panel model. A questionnaire was completed on two occasions, one year apart, by 1,356 nurses. The paths in the model were estimated using regression analyses and the following results were obtained: (a) empowerment is a stable state; (b) higher levels of empowerment are related to lower levels of burnout, when empowerment and burnout are studied at the same point in time; (c) higher prior levels of empowerment can be associated with higher later levels of burnout, when empowerment and burnout are studied at different points in time; (d) for assistant nurses, but not for registered nurses, prior higher levels of burnout resulted in lower later levels of empowerment, indicating a reciprocal relation between the two concepts. The results imply that what is a protective factor from a cross-sectional perspective may be a risk factor from a longitudinal perspective.

A scale for measuring specific job demands within the health care sector: development and psychometric assessment.

BACKGROUND: Earlier research has indicated that the psychological demand dimension in one of the most commonly used occupational stress models, the job-demand-control-support model, can be too generic and does not capture the multidimensionality of different job demands within health care work. OBJECTIVE: The main objective of the study was to develop and psychometrically evaluate a new job demand scale, which captures specific job demands within health care work. Further, to analyse whether a congruent component structure could be obtained in two different occupational groups, namely registered and assistant nurses. The final objective was to analyse the relationship between the new job demand scale and the dimensions in the job-demand-control-support model. PARTICIPANTS: Seven hundred and ninety five registered nurses and 527 assistant nurses from three hospitals and two primary health care centres in Stockholm, Sweden participated voluntarily in the study DATA AND METHOD: A questionnaire, which collected information on demographics, various job demands, job control and social support, was used in both occupational groups. Descriptive statistics, correlation analyses, principal component analyses and independent samples t-test were used in the study RESULTS: A congruent component structure was obtained in both occupational samples, consisting of four demand indices "pain and death", "patient and relative needs", "threats and violence" and "professional worries". The four-component solution explained 69.6% and 72.1% of the variance for registered nurses and assistant nurses, respectively. The new job demand indices also showed satisfactory internal consistencies, which ranged from .62 to .91 and had inter-item correlations, which varied from .33 to .84 in both occupational groups. The strongest relationship was shown with the psychological job demand dimension in the job-demand-control-support-model. CONCLUSION: The scale is short and could be used to obtain information concerning different job demands that are related to the interaction with, and care of patients and their relatives as an addition to the more generic psychological demand dimension that is specified in the job-demand-control-support model.

The psychosocial work environment and burnout among Swedish registered and assistant nurses: the main, mediating, and moderating role of empowerment.

The aim of the present study was to explore: the main effect of empowerment on burnout; empowerment as a mediator between the work environment and burnout; and empowerment as a moderator of the association between the work environment and burnout. In order to explore these effects, multiple regression analyses were performed on questionnaire data from 838 registered nurses and 518 assistant nurses in Sweden. The analyses showed that: empowerment has a negative association to burnout; empowerment has a mediating effect between the work environment (especially for control and social support) and burnout; and the moderating effect of empowerment on the association between the work environment and burnout was weak. The results suggest that: empowerment explains variation with regard to burnout over and above what can be explained by established work situation dimensions; the improvement of the work environment is associated with a higher sense of empowerment which, in turn, is related to lower degrees of burnout; and individual and group differences should be considered in workplace health promotion.

The relationship between different work-related sources of social support and burnout among registered and assistant nurses in Sweden: a questionnaire survey.

BACKGROUND: This cross-sectional study addresses the relationship between organisational and social factors and burnout in a group of registered and assistant nurses in Sweden. OBJECTIVE: The main objective of the study was to analyse the relationship (and the specific relationship patterns) between three different work-related sources of social support and Maslach's three burnout dimensions, while taking the dimensions in the Karasek job-demand-control model, emotional demands, workload outside the work situation and demographic factors into account. DATA AND METHOD: Data was collected using a questionnaire which was based on validated instruments, in accordance with the job-demand-control model and Maslach's Burnout Inventory. Descriptive statistics, correlation analysis and three hierarchical regression analyses were conducted using a sample of 1561 registered and assistant nurses in Sweden. RESULTS: The results showed statistically significant correlations between the three support indicators and all three burnout dimensions. In the regression analyses, co-worker and patient support were statistically significantly related to all three burnout dimensions, whereas supervisor support was only statistically significantly related to emotional exhaustion. In accordance with prior findings, high levels of psychological demands were most strongly related to high emotional exhaustion. Further, high levels of emotional demands showed the strongest correlations with high personal accomplishment.

A psychometric assessment of a Swedish translation of Shafer's personality scale.

The psychometric properties of a Swedish translation of Shafer's (1999a) Big Five Marker (BFM) scale were assessed. The assessment was based on self-ratings on the BFM scale obtained from 694 subjects (82% women and 18% men) residing in Sweden. The following main results were obtained: (a) The factor structure was clear and simple. (b) The factor reliabilities were satisfactory. (c) The heterotrait-heteromethod coefficients indicated construct validity for the scale. (d) The BFM scale showed similar psychometric properties for the older, employed, Swedish sample of the present study to those obtained for the younger, psychology undergraduate, USA sample in Shafer's study (1999a). The conclusion is that the BFM scale has satisfactory and stable psychometric properties and that due to its brevity and documented psychometric evaluation will facilitate research within the Big-Five factor domain, not least in Sweden.