Variations in Pre-exposure Prophylaxis (PrEP) Awareness and Healthcare Provider Interactions in a Nationally Representative Sample of American Men Aged 15-49 Years: A Cross-Sectional Study.

Awareness of and discussions with a healthcare provider (HCP) around pre-exposure prophylaxis (PrEP), an effective HIV prevention method, are associated with PrEP uptake, yet few studies utilize representative samples or report on these outcomes using distinct behavioral risk subgroups. This cross-sectional study utilized responses given by men on the 2017-2019 National Survey of Family Growth, a nationally representative survey of Americans aged 15-49 years. Multiple logistic regression models were used to determine how respondents' sociodemographic characteristics and HIV risk behaviors were related to PrEP awareness and HCP discussions. PrEP awareness was low (29.40%) as was the proportion who reported ever discussing PrEP with an HCP (4.48%). Odds of being PrEP aware and discussing PrEP with an HCP varied significantly within sexual behavior subgroups based on sociodemographic and behavioral characteristics highlighting the differential risks within distinct behavioral subgroupings of men. Sexual behavior subgroupings should be considered when promoting PrEP awareness and discussions as HIV risk behaviors vary considerably and sexual identity alone may not sufficiently capture one's HIV risk.

Multistage Testing in Heterogeneous Populations: Some Design and Implementation Considerations.

A central challenge in international large-scale assessments is adequately measuring dozens of highly heterogeneous populations, many of which are low performers. To that end, multistage adaptive testing offers one possibility for better assessing across the achievement continuum. This study examines the way that several multistage test design and implementation choices can impact measurement performance in this setting. To attend to gaps in the knowledge base, we extended previous research to include multiple, linked panels, more appropriate estimates of achievement, and multiple populations of varied proficiency. Including achievement distributions from varied populations and associated item parameters, we design and execute a simulation study that mimics an established international assessment. We compare several routing schemes and varied module lengths in terms of item and person parameter recovery. Our findings suggest that, particularly for low performing populations, multistage testing offers precision advantages. Further, findings indicate that equal module lengths-desirable for controlling position effects-and classical routing methods, which lower the technological burden of implementing such a design, produce good results. Finally, probabilistic misrouting offers advantages over merit routing for controlling bias in item and person parameters. Overall, multistage testing shows promise for extending the scope of international assessments. We discuss the importance of our findings for operational work in the international assessment domain.

Examining the Impact of Differential Item Functioning on Classification Accuracy in Cognitive Diagnostic Models.

Cognitive diagnostic models (CDMs) are of growing interest in educational research because of the models' ability to provide diagnostic information regarding examinees' strengths and weaknesses suited to a variety of content areas. An important step to ensure appropriate uses and interpretations from CDMs is to understand the impact of differential item functioning (DIF). While methods of detecting DIF in CDMs have been identified, there is a limited understanding of the extent to which DIF affects classification accuracy. This simulation study provides a reference to practitioners to understand how different magnitudes and types of DIF interact with CDM item types and group distributions and sample sizes to influence attribute- and profile-level classification accuracy. The results suggest that attribute-level classification accuracy is robust to DIF of large magnitudes in most conditions, while profile-level classification accuracy is negatively influenced by the inclusion of DIF. Conditions of unequal group distributions and DIF located on simple structure items had the greatest effect in decreasing classification accuracy. The article closes by considering implications of the results and future directions.

Developing a Barriers Scale in the Context of Travel: TRIP.

OBJECTIVE: To develop an environmental-barriers scale, Travel Restrictions Influencing Participation (TRIP), in the context of travel for people living with spinal cord injury (SCI). DESIGN: A mixed-method approach where, in the qualitative phase, items were developed and written based on results of interviewers with different stakeholder groups and, in the quantitative phase, survey data were collected to examine the psychometric properties of the scale. SETTING: Home, work, and community settings. PARTICIPANTS: People living with SCI, caregivers/family members, therapists, and travel professionals (N=333). INTERVENTIONS: None. MAIN OUTCOME MEASURES: A 19-item TRIP scale that measures the travel barriers encountered by people with SCI. RESULTS: Results from 83 semi-structured in-depth interviews with 4 stakeholder groups guided the writing of items in the TRIP scale. Seven cognitive interviews and an expert panel conducted reviews for content validity of the scale, and 19 items were included in the quantitative assessment of the scale. A total of 250 patients enrolled in the Rocky Mountain Regional Spinal Injury System was systematically selected to report their experience with each travel barrier. Item-response theory-based Rasch analysis revealed that TRIP has acceptable psychometric properties. CONCLUSIONS: The 19-item TRIP scale demonstrates promising psychometric properties for the scale to be used in clinical settings to quickly identify environmental barriers individuals with SCI encounter when traveling. It has the potential to assist with developing interventions that will improve the travel experience of individuals with SCI or to assist with strategies to overcome travel barriers.

Investigation of Missing Responses in Q-Matrix Validation.

Missing data can be a serious issue for practitioners and researchers who are tasked with Q-matrix validation analysis in implementation of cognitive diagnostic models. The article investigates the impact of missing responses, and four common approaches (treat as incorrect, logistic regression, listwise deletion, and expectation-maximization [EM] imputation) for dealing with them, on the performance of two major Q-matrix validation methods (the EM-based δ-method and the nonparametric Q-matrix refinement method) across multiple factors. Results of the simulation study show that both validation methods perform better when missing responses are imputed using EM imputation or logistic regression instead of being treated as incorrect and using listwise deletion. The nonparametric Q-matrix validation method outperforms the EM-based δ-method in most conditions. Higher missing rates yield poorer performance of both methods. Number of attributes and items have an impact on performance of both methods as well. Results of a real data example are also discussed in the study.

Examining DIF in the Context of CDMs When the Q-Matrix Is Misspecified.

The rise in popularity and use of cognitive diagnostic models (CDMs) in educational research are partly motivated by the models' ability to provide diagnostic information regarding students' strengths and weaknesses in a variety of content areas. An important step to ensure appropriate interpretations from CDMs is to investigate differential item functioning (DIF). To this end, the current simulation study examined the performance of three methods to detect DIF in CDMs, with particular emphasis on the impact of Q-matrix misspecification on methods' performance. Results illustrated that logistic regression and Mantel-Haenszel had better control of Type I error than the Wald test; however, high power rates were found using logistic regression and Wald methods, only. In addition to the tradeoff between Type I error control and acceptable power, our results suggested that Q-matrix complexity and item structures yield different results for different methods, presenting a more complex picture of the methods' performance. Finally, implications and future directions are discussed.

Parameter Recovery in Multidimensional Item Response Theory Models Under Complexity and Nonnormality.

Information about the psychometric properties of items can be highly useful in assessment development, for example, in item response theory (IRT) applications and computerized adaptive testing. Although literature on parameter recovery in unidimensional IRT abounds, less is known about parameter recovery in multidimensional IRT (MIRT), notably when tests exhibit complex structures or when latent traits are nonnormal. The current simulation study focuses on investigation of the effects of complex item structures and the shape of examinees' latent trait distributions on item parameter recovery in compensatory MIRT models for dichotomous items. Outcome variables included bias and root mean square error. Results indicated that when latent traits were skewed, item parameter recovery was generally adversely impacted. In addition, the presence of complexity contributed to decreases in the precision of parameter recovery, particularly for discrimination parameters along one dimension when at least one latent trait was generated as skewed.

Examining similarities and differences among parent-teacher reports of Spanish-English productive vocabulary.

PURPOSE: The purposes of the present study were to (a) explore the relationship between parent and teacher reports of children's bilingual (Spanish-English) productive vocabulary and (b) examine similarities and differences among parent-teacher reports. Word categories were examined to determine the nature of similarities and differences. METHOD: Parents and teachers of eleven Spanish-English bilinguals ( Mage = 44.5 months) completed the MacArthur-Bates Communicative Development Inventory upper extension and an experimental version of a congruent Spanish form at 2 time points. Percent agreement, kappa coefficient, and Spearman's rho were employed to estimate overall interrater agreement and agreement on specific word categories. RESULTS: Results indicated inconsistent levels of overall agreement across measures and forms. Higher levels of parent-teacher agreement were observed on Spanish forms at either time point using Spearman's rho coefficient and kappa, whereas percent agreement was higher on English forms. Limited overlap of high agreement between parents and teachers was found on word categories across indices. Unique contributions of reporters were observed. CONCLUSION: This work underscores the utility of multiple informants of bilingual children's productive vocabulary. Combined and unique contributions of parent and teacher reporters may inform the language development of preschool-age bilingual children as productive vocabulary skills develop and change.

Word learning by preschoolers with SLI: effect of phonotactic probability and object familiarity.

PURPOSE: In this study, the authors investigated whether previous findings of a low phonotactic probability/unfamiliar object word-learning advantage in preschoolers could be replicated, whether this advantage would be apparent at different "stages" of word learning, and whether findings would differ for preschoolers with specific language impairment (SLI) and typical development (TD). METHOD: Participants included 114 children: 40 with SLI, 39 with TD matched for age and gender, and 35 with TD matched for expressive vocabulary and gender. Comprehension and production were assessed during word learning and at post-test for words that varied in phonotactic probability and object familiarity. RESULTS: Across groups, comprehension performance increased significantly from day 1 to day 2 and from day 2 to day 3, but there was no significant word/object type effect. Production performance increased significantly from day 1 to day 2, from day 2 to day 3, and from day 3 to day 4 for all groups, and there was a clear low phonotactic probability/unfamiliar object advantage during word learning but not at post-test. CONCLUSION: Results help to establish that preschoolers with TD and SLI show a low phonotactic probability/unfamiliar object production advantage during word learning that is not restricted to the first few exposures to words, but continues over time. This study illustrates how the interaction of phonological characteristics in nascent and extant words can affect word learning.

A generalized dimensionality discrepancy measure for dimensionality assessment in multidimensional item response theory.

A generalized dimensionality discrepancy measure is introduced to facilitate a critique of dimensionality assumptions in multidimensional item response models. Connections between dimensionality and local independence motivate the development of the discrepancy measure from a conditional covariance theory perspective. A simulation study and a real-data analysis demonstrate the utility of the discrepancy measure's application at multiple levels of analysis in a posterior predictive model checking framework.