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Development and validation of a 21-item challenges to stopping smoking (CSS-21) scale.

ABSTRACT: Identification of challenges associated with quitting and overcoming them may improve cessation outcomes. This study describes the development and initial validation of a scale for measuring challenges to stopping smoking.The item pool was generated from empirical and theoretical literature and existing scales, expert opinion and interviews with smokers and ex-smokers. The questionnaire was administered to smokers and recent quitters who participated in a hospital-based smoking cessation trial. Exploratory factor analysis was performed to identify subscales in the questionnaire. Internal consistency, validity and robustness of the subscales were evaluated.Of a total of 182 participants with a mean age of 55 years (SD 12.8), 128 (70.3%) were current smokers and 54 (29.7%) ex-smokers. Factor analysis of the 21-item questionnaire resulted in a 2-factor solution representing items measuring intrinsic (9 items) and extrinsic (12 items) challenges. This structure was stable in various analyses and the 2 factors accounted for 50.7% of the total variance of the polychoric correlations between the items. Internal consistency (Cronbach's α) coefficients for the intrinsic and extrinsic subscales were 0.86 and 0.82, respectively. Compared with ex-smokers, current smokers had a higher mean score (± SD) for intrinsic (24.0 ± 6.4 vs 20.5 ± 7.4, p=0.002) and extrinsic subscales (22.3 ± 7.5 vs 18.6 ± 6.0, p=0.001).Initial evaluation suggests that the 21-item challenges to stopping smoking scale is a valid and reliable instrument that can be used in research and clinical settings to assess challenges to stopping smoking.

SUBMITTER: Thomas D

PROVIDER: S-EPMC4823391 | biostudies-other | 2016 Mar

REPOSITORIES: biostudies-other

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Project description:BackgroundPreterm birth (PTB) is a complex and significant challenge in obstetrics. Thus, clinicians and researchers have paid a keen interest in the identification of women at a high risk for PTB. This study aimed to develop a PTB risk assessment scale based on the preliminary 32-item Preterm Birth Risk Assessment Scale-Korean version (PBRAS-K).MethodsWe enrolled 298 participants (167 in the exploratory factor analysis group from March 3, 2021 to August 31, 2021 and 131 in the confirmatory factor analysis group from December 3, 2021 to February 14, 2022) who delivered before 37+0 weeks after experiencing preterm symptoms and were admitted to high-risk pregnancy maternal-fetal intensive care units (MFICUs). After an item-reduction process in the exploratory factor analysis, the psychometric property scales were assessed using SPSS Statistics version 27.0, and the confirmatory factor analysis was conducted using AMOS version 27.0.ResultsThe Kaiser-Meyer-Olkin (KMO) test and Bartlett's χ2 test of sphericity confirmed the adequacy of the sample for factor analysis (KMO = .81 (> .80), χ2 = 1841.38, p < .001). The final version of the PBRAS-K comprised 23 items within seven dimensions. Factor analysis identified items explaining 65.9% of the total variance. The PBRAS-K achieved a mean score of 35.58 (± 10.35) and showed high internal consistency and satisfactory reliability (Cronbach's alpha = .85). Regarding concurrent validity, the PBRAS-K exhibited a low-to-moderate correlation with the PTB risk (r = .45, p < .001). As for criterion validity and convergent validity, the PBRAS-K showed a positive and high correlation with the Somatic Awareness Scale with Spontaneous Preterm Labor (SPL-SAS) (r = .65, p < .001) and pregnancy-related stress (r = .57, p < .001), respectively. Risk scoring for preterm delivery and SPL-SAS were moderately correlated (r = .53, p < .001).ConclusionsPBRAS-23-K is a valid and reliable instrument for assessing the risk for PTB in pregnant women. Clinical nurses are encouraged to apply and obtain information regarding effective interventions in MFICUs. This scale provides meaningful results and reflects the opinions of women who had experienced PTB. The PBRAS-23-K should be evaluated for standardization and cut-off scores using larger sample sizes in the future.

Project description:Despite extensive investigations of the Depression Anxiety Stress Scales-21 (DASS-21) since its development in 1995, its factor structure and other psychometric properties still need to be firmly established, with several calls for revising its item structure. Employing confirmatory factor analysis (CFA), this study examined the factor structure of the DASS-21 and five shortened versions of the DASS-21 among psychiatric patients (N = 168) and the general public (N = 992) during the COVID-19 confinement period in Saudi Arabia. Multigroup CFA, Mann Whitney W test, Spearman's correlation, and coefficient alpha were used to examine the shortened versions of the DASS-21 (DASS-13, DASS-12, DASS-9 (two versions), and DASS-8) for invariance across age and gender groups, discriminant validity, predictive validity, item coverage, and internal consistency, respectively. Compared with the DASS-21, all three-factor structures of the shortened versions expressed good fit, with the DASS-8 demonstrating the best fit and highest item loadings on the corresponding factors in both samples (χ2(16, 15) = 16.5, 67.0; p = 0.420, 0.001; CFI = 1.000, 0.998; TLI = 0.999, 0.997; RMSEA = 0.013, 0.059, SRMR = 0.0186, 0.0203). The DASS-8 expressed configural, metric, and scalar invariance across age and gender groups. Its internal consistency was comparable to other versions (α = 0.94). Strong positive correlations of the DASS-8 and its subscales with the DASS-21 and its subscales (r = 0.97 to 0.81) suggest adequate item coverage and good predictive validity of this version. The DASS-8 and its subscales distinguished the clinical sample from the general public at the same level of significance expressed by the DASS-21 and other shortened versions, supporting its discriminant validity. Neither the DASS-21 nor the shortened versions distinguished patients diagnosed with depression and anxiety from each other or from other psychiatric conditions. The DASS-8 represents a valid short version of the DASS-21, which may be useful in research and clinical practice for quick identification of individuals with potential psychopathologies. Diagnosing depression/anxiety disorders may be further confirmed in a next step by clinician-facilitated examinations. Brevity of the DASS-21 would save time and effort used for filling the questionnaire and support comprehensive assessments by allowing the inclusion of more measures on test batteries.

Project description:Depression, anxiety, and stress continue to be among the largest burdens of disease, globally. The Depression, Anxiety, and Stress Scale-21 Items (DASS-21) is a shortened version of DASS-41 developed to measure these mental health conditions. The DASS-41 has strong evidence of validity and reliability in multiple contexts. However, the DASS-21, and the resulting item properties, has been explored less in terms of modern test theories. One such theory is Item Response Theory (IRT), and we use IRT models to explore latent item and person traits of each DASS-21 sub-scale among people living in Malaysia. Specifically, we aimed to assess Classical Test Theory and IRT properties including dimensionality, internal consistency (reliability), and item-level properties. We conducted a web-based cross-sectional study and sent link-based questionnaires to people aged 18 and above in a private university and requested to roll out the link. Overall and individual sub-scales' Cronbach's alpha of the DASS-21 indicates an excellent internal consistency. The average inter-item correlation and corrected inter-item correlations for each of the sub-scales indicated acceptable discrimination. On average, DASS-21 total scores and sub-scale scores were significantly higher among female participants than males. The Graded Response Model had better empirical fit to sub-scale response data. Raw summated and latent (IRT estimated) scores of the Depression, Anxiety, and Stress sub-scales, and overall DASS-21 were strongly correlated. Thus, this study provides evidence of validity supporting the use of the DASS-21 as a mental health screening tool among Malaysians. Specifically, standard error of measurement was minimized to provide robust evidence of potential utility in identifying participants who are and are not experiencing these mental health issues. Additional research is warranted to ensure that test content culturally appropriate and accurately measuring cultural norms of depression, anxiety, and stress.

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Development and validation of a 21-item challenges to stopping smoking (CSS-21) scale.

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