A Psychometric Review of Measures Assessing Discrimination Against Sexual Minorities

ABSTRACT

Discrimination against sexual minorities is widespread and has deleterious consequences on victims’ psychological and physical wellbeing. However, a review of the psychometric properties of instruments measuring lesbian, gay, and bisexual (LGB) discrimination has not been conducted. The results of this review, which involved evaluating 162 articles, reveal that most have suboptimal psychometric properties. Specifically, myriad scales possess questionable content validity as (1) items are not created in collaboration with sexual minorities; (2) measures possess a small number of items and, thus, may not sufficiently represent the domain of interest; and (3) scales are “adapted” from measures designed to examine race- and gender-based discrimination. Additional limitations include (1) summed scores are computed, often in the absence of scale score reliability metrics; (2) summed scores operate from the questionable assumption that diverse forms of discrimination are necessarily interrelated; (3) the dimensionality of instruments presumed to consist of subscales is seldom tested; (4) tests of criterion-related validity are routinely omitted; and (5) formal tests of measures’ construct validity are seldom provided, necessitating that one infer validity based on the results obtained. The absence of “gold standard” measures, the attendant difficulty in formulating a coherent picture of this body of research, and suggestions for psychometric improvements are noted.     

Empirical Comparison Between Capability and Two Health-Related Quality of Life Measures

The Investigating Choice Experiments Capability Measure (ICECAP) is a new preference-based measure of the extent to which a person is able to achieve attributes or capabilities related to the quality of life. Conceptually, it differs from health-related quality of life (HRQoL) as the focus is upon the ability or capacity to achieve as distinct from the current experience of the attributes. The objective of this study was to explore the empirical relationships between capability as assessed by the ICECAP for Adults (ICECAP-A) and HRQoL as assessed by the Assessment of Quality of Life (AQoL)-8D and the five-level EuroQol Five Dimensions questionnaire (EQ-5D). To compare these measures, the study employed self-reported survey data from the healthy public and from seven disease areas in five countries. Results indicate that, despite their conceptual origins, the ICECAP-A is strongly associated with the AQoL-8D and that the clear distinction between capabilities and HRQoL found in other studies is attributable to the use of the EQ-5D in the comparison and the weaker association between the EQ-5D and ICECAP-A. The suggestion that ICECAP-A should be included in evaluation studies along with a HRQoL instrument is more persuasive when the instrument is the EQ-5D. The case for its inclusion with other HRQoL instruments requires further research and evaluation.     

The Psychometric Properties of the Early Development Instrument: A Rasch Analysis Based on Swedish Pilot Data

The Early Development Instrument (EDI) is a population measure and an indicator of children’s developmental health before entering the school system. EDI-Sweden was translated and adapted from EDI-Canada. In 2011 a pilot study was conducted, as a first step of the preparations for nationwide implementation of EDI in Sweden. The purpose of the study is to analyse the psychometric properties of EDI-Sweden. Data about 116 5-year-old children were collected at ten preschools in two municipalities. EDI consists of 104 core items in five domains: physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge. Preschool teachers completed a web based questionnaire for each child. The data were analysed using the unidimensional Rasch model. With exception for the domain of physical health and well-being the Rasch analysis showed satisfying psychometric properties of EDI after removal of some misfitting items. In these four domains no items showed disordered thresholds and the reliability was good, indicated by person separation index values of 0.73 or higher. Tentative analyses of Differential Item Functioning (DIF) showed that some items didn’t work invariantly across genders, suggesting that the DIF-items should be split into gender specific items. Due to the relatively small sample size the results can’t provide definite answers but tentative indications of the psychometric properties of the EDI-Sweden. As a whole the Rasch analysis provides ground for cautious optimism for large scale assessment of EDI-Sweden enabling more thorough and finer level analysis of the instrument.     

Development of a tool to measure holistic reflection in midwifery students and midwives

BackgroundHolistic reflection encompasses reflection as a continuum, incorporating critical reflection, reflexivity, critical thinking and a whole-of-person approach. The development of holistic reflection in midwifery students and midwives is rarely measured in a standardised way.AimTo develop and test a tool to measure holistic reflection in midwifery students and midwives, for use in pre-registration and post-graduate education, and research.DesignThe eight-step approach to tool development by DeVellis was followed with psychometric testing of data from a cross-sectional survey.ParticipantsMidwifery students (pre-registration and postgraduate), and midwifery alumni of an Australian university.MethodsDraft items (n = 84) were generated from review of the literature, qualitative research, and a theoretical model. An expert panel (n = 19) reviewed draft items resulting in 39 items. The survey included demographic details, the draft Holistic Reflection Assessment Tool, emotional intelligence subscale, and a social desirability scale. Participants repeated the online survey at two weeks to confirm test-retest reliability.ResultsThe 187 responses were received. Exploratory factor analysis with varimax rotation revealed three factors accounting for 49% of variance. Internal consistency of the tool was high (α = .91) and test-retest reliability at two weeks (α = .93) demonstrated stability. There were low correlations between social desirability (r = .22, p < .001) and emotional intelligence (r = .21, p < .001) with the new holistic reflection scale.ConclusionsThe Holistic Reflection Assessment Tool is the first for midwifery. The tool was reliable, stable, and valid. Further research is warranted for criterion validity.     

Validation of the Orientation to Life Questionnaire in Norwegian Adolescents,Construct Validity Across Samples

In spite of the potential significance of sense of coherence (SOC) for adolescent health and well-being, the past decades have yielded limited progress in investigating the psychometric properties of the most used inventory measuring SOC, The Orientation of Life Questionnaire (OLQ) in adolescents. The present study aimed at investigating the factorial validity and reliability of the Norwegian version of the 13 item OLQ based on two adolescent samples 13–18 years from Norway. Concerning the dimensionality of the OLQ, two measurement models were tested using confirmatory factor analysis; a one-factor model and a three-factor-model. The results showed that a three-factor solution with correlated residual variances between item 2 and item 3 showed the best fit across the two adolescent samples, although five items revealed low factor loadings. The dimensions were highly correlated and showed adequate composite reliability. The present results indicate that the 13 item OLQ has potential as an instrument assessing SOC in adolescents. However, more psychometric testing of the instrument is required in reference to the modified factor structure and the low reliability found on some of the items in OLQ.     

Assessing the Psychometric Properties of Both a Global and a Domain-Specific Perceived Quality of Life Measure When Used with Youth Who Have Chronic Conditions

The purpose of this paper was to assess the psychometric properties of the Students’ Life Satisfaction Scale (SLSS) and the Brief Multidimensional Students’ Life Satisfaction Scale (BMSLSS) when used with youth who have chronic conditions. Baseline data from a longitudinal study examining predictors of changes in perceived quality of life (PQOL) for youth with chronic conditions were used. SLSS and BMSLSS data were collected on over 400 youth aged 11–17 using youth self-report and parent proxy-report versions. Internal consistency, convergent validity, and factor structure were examined for both versions. Extent of agreement and magnitude of differences between youth and parent report were evaluated. Finally, gender, age, and condition group differences in youth report scores were examined for the SLSS and BMSLSS. Strong internal consistency was demonstrated for the youth and parent reports of both measures. As with normative samples, a single factor structure was found for youth and parent reports of the BMSLSS. However, both youth and parent reports of the SLSS had a two-factor structure: one consisting of five positively worded items, and the other, two negatively worded items. Youth reported their PQOL to be significantly higher than did their parents. Significant differences in PQOL scores for the youth report were not found by age, gender, or conditions. Findings show that, from a psychometric standpoint, the BMSLSS (both youth and parent report) is a promising measure of PQOL for use in population-based research with youth who have chronic conditions. The SLSS may need to be revised to exclude negative items when used with this population of youth.     

The Performance of the World Health Organization’s WHOQOL-BREF in Assessing the Quality of Life of Thai College Students

The purpose of this study was to examine the performance of the Thai-version of WHOQOL-BREF in assessing the quality of life (QoL) among Thai college students. The psychometric properties of WHOQOL-BREF were assessed in this study. The self-administered WHOQOL-BREF questionnaire was applied. A total of 407 Thai college students (male age = 20.5 ± 1.2; female age = 20.5 ± 1.2) participated in this study. Item-response distributions, internal consistency reliability, discriminant validity, criterion-related validity and construct validity through confirmatory analysis were analyzed. The findings indicate that the WHOQOL-BREF had acceptable internal consistency (α = 0.73–0.83 across four domains), all items highly correlated with corresponding domain scores (r = 0.53–0.80), the indices of a two-order confirmatory factor analysis (CFA) demonstrate that the data fit the model well with allowing covary of error variances of some items, all items had good property of criterion-related validity and item discrimination and, all three domain scores except the social relationship domain had significant associations with overall QoL or general health. The results suggest that the WHOQOL-BREF was reliable and valid to health professionals in the assessment of the QoL of college-based Thai youth, but some unsuitable items may be deleted in future studies.     

Factorial Validity and Invariance of the Rosenberg Self-Esteem Scale Among Portuguese Youngsters

The purpose of the present study was to examine the reliability, factorial validity and measurement invariance (across gender, age and physical activity participation) of a Portuguese version of the Rosenberg Self-Esteem Scale (RSES). The sample consisted of 1,763 Portuguese youngsters (731 male and 1,032 female) with ages between 15 and 20 years. Reliability estimate for the one-factor solution was .845, although some proposed RSES’s underlying dimensions were lower than .70. Confirmatory factor analysis revealed that the best-fitting model was a single self-esteem factor, plus simultaneous correlated uniqueness for positively and negatively worded items. Multigroup analysis supported measurement invariance across age and physical activity participation, and partial metric invariance across gender, as three items failed to show metric equivalence. These results provide evidence that RSES has excellent psychometric properties and it is a valid self-esteem measure to be used among Portuguese youngsters.     

Development and validation of the attitudes toward same-sex marriage scale

This research details the development of a new instrument designed to measure attitudes toward same-sex marriage. Participants were 615 heterosexual women and men, drawn from both student and nonstudent adult populations. Four studies were conducted for the purpose of developing the scale and to establish its psychometric properties. The resulting Attitudes Toward Same-Sex Marriage Scale (ATSM) consists of 17 items, has a one-dimensional factor structure, and exhibits a high degree of reliability. Additional analyses established the construct validity of the ATSM where ATSM scores were highly correlated with scores on the Attitudes Toward Lesbians and Gay Men Scale (Herek, 1988). ATSM scores followed predicted correlational patterns with select demographics, including educational attainment, religiosity, and political conservatism. The usefulness of this new measure in survey research is discussed.     

Similarities and Differences Among the Taiwan,China, and Hong-Kong Versions of the WHOQOL Questionnaire

To facilitate comparison across cultures, the World Health Organization (WHO) has been developing a universal measure of quality of life (QOL) called the WHOQOL Questionnaire. This questionnaire contains 24 facets organized into six broad domains: physical, psychological, level of independence, social relationships, environment, and spirituality/religion/personal beliefs. The standard WHOQOL is designed for cross-cultural comparison. However, to obtain a valid QOL measure that can be applied in diverse populations, cultural adaptation of the WHOQOL has been encouraged. Each culture is permitted to add culture-specific questions, called national items, so that the questionnaire can also reflect cultural attributes. Three Chinese versions of the WHOQOL have been developed for China, Hong Kong, and Taiwan. National items were selected for each version according to the criteria proposed by the WHOQOL Group. The purpose of this paper is to compare the Taiwan version to the China and Hong Kong versions. The questionnaire development process, response scale generation, psychometric properties (reliability and validity), national items, and population means were all examined. Results indicated that not only is cultural adaptation of WHOQOL measures necessary for individual cultures, but also for sub-cultures, as these differences must be considered in order to provide effective health care and treatment.     

Reliability and Validity of the Personal Social Capital Scale 16 and Personal Social Capital Scale 8: Two Short Instruments for Survey Studies

Rapid developments in social capital and health research require short instruments for large-scale survey studies. The Personal Social Capital Scale (PSCS) is a theory-based and empirically tested instrument with reliability and validity established in the US and China, but it is too long for large-scale survey research. In this study, we described two short versions of the instrument: the PSCS-16 and PSCS-8. The two short scales were evaluated with survey data collected among an adult sample (N = 259) in China. The sample consisted of rural-to-urban migrants and non-migrant rural and urban residents. Cronbach’s alpha coefficients were .90 for the PSCS-18 and .83 for the PSCS-8. Both short instruments satisfactorily fit a two-factor model comprising the bonding capital and bridging capital subscales. The two short scales were highly correlated with the original PSCS (r = .95 for the PSCS-18 and .93 for the PSCS-8 respectively, p < .001 for both); significantly distinguished the migrant subsample from the two non-migrant subsamples; and significantly predicted social capital investment and stress level. In conclusion, the two short instruments PSCS-16 and PSCS-8 were reliable and valid, and can be used in large-scale survey studies to assess personally owned social capital. Further research is needed to replicate their reliability and validity in different cultural settings and to establish the test–retest reliability.     

Measuring women's experiences of maternity care: A systematic review of self-report survey instruments

BackgroundRecognition of the measurement of women's experiences of their maternity care as a critical component of care quality evaluation has led to a proliferation of instruments to measure this concept. However, the suboptimal methodological and psychometric quality of these instruments, or the lack of reporting of same, hinders the credibility and efficient use of the arising results, which often serve as an indicator for the direction of limited resources within maternity services.AimTo review systematically and critically appraise self-report survey instruments measuring women's experiences of their maternity care.MethodsA systematic review was conducted using comprehensive searches of the CINAHL, OVID MEDLINE and EMBASE citation databases. Inclusion and exclusion criteria were applied, and a stepped approach employed to facilitate evaluation of the methodological and psychometric quality of included instruments.Findings4905 records were obtained from database searches. Additional records were obtained via reference checking and by expert suggestion. Following stepped screening, 40 papers related to 20 instruments are included in this review. Findings indicate that evidence of the methodological and psychometric quality have not been reported for many included instruments.ConclusionsPublished evidence of the methodological and psychometric quality of self-report survey instruments to evaluate women's experiences of their maternity care is lacking. The conduct and reporting of future development processes of such instruments can be improved.Systematic review PROSPERO registration: CRD42018105325.     

Development and Validation of the Middle Years Development Instrument (MDI): Assessing Children’s Well-Being and Assets across Multiple Contexts

Few instruments provide reliable and valid data on child well-being and contextual assets during middle childhood, using children as informants. The authors developed a population-level, self-report measure of school-aged children’s well-being and assets—the Middle Years Development Instrument (MDI)—and examined its reliability and validity. The MDI was designed to assess child well-being inside and outside of school on five dimensions: (1) Social and emotional development, (2) Connectedness to peers and to adults at school, at home, and in the neighborhood, (3) School experiences, (4) Physical health and well-being, and (5) Constructive use of time after school. This paper describes the theoretical framework, selection of items and scales for the survey, and four studies that were conducted to revise the MDI and examine its psychometric properties. The findings indicate a theoretically predicted factor structure, high internal consistency, and document the convergent and discriminant validity of the MDI scales. The discussion delineates a plan for future validation studies that address further validity questions, such as predictive validity, measurement invariance, and fairness/bias, and provides a brief outlook of how the MDI may be used by practitioners, educators, and decision makers in schools and communities to motivate and inform action in support children’s well-being.     

Measuring Social Isolation in Older Adults: Development and Initial Validation of the Friendship Scale

Although there are many excellent published scales measuring social isolation, there is need for a short, user-friendly, stand alone scale measuring felt social isolation with good psychometric properties. This study reports the development and preliminary validation of a short, user-friendly scale, the Friendship Scale. The six items measure six of the seven important dimensions that contribute to social isolation and its opposite, social connection. The psychometric properties suggest that it has excellent internal structures as assessed by structural equation modelling (CFI = 0.99, RMSEA = 0.02), that it possesses reliability (Cronbach α = 0.83) and discrimination when assessed against two other short social relationship scales. Tests of concurrent discriminant validity suggest it is sensitive to the known correlates of social isolation. Although further work is needed to validate it in other populations, the results of this study suggest researchers may find the Friendship Scale particularly useful in epidemiology, population surveys or in health-related quality of life evaluation studies where a parsimonious measure of felt social support or social isolation is needed.     

Can the Web-Form WHOQOL-BREF be an Alternative to the Paper-Form?

The purpose of this study was to test whether the web version is an alternative to the paper version of the short version of the World Health Organization Quality of Life assessment (WHOQOL-BREF). Two studies were conducted. Study 1 used crossover self-controlled trials with 80 participants to compare the web and paper versions and to determine the test–retest reliability of the web version. Study 2 used data from 1,016 web participants to analyze the internal consistency and concurrent and construct validity of the web version. The correlations of domain scores between the web and paper versions ranged from 0.71 to 0.85. Dependent t tests showed no significant differences in domain scores between these two versions. The intra-class correlation coefficients (ICC) for test–retest reliability of web version ranged from 0.79 to 0.91. The Cronbach’s α for internal consistency reliability ranged from 0.60 to 0.83. Multiple regression models indicated that the web version has good concurrent validity. Confirmatory factor analysis (CFA) for the second-order hierarchical factor model also supported the construct validity of the web version. The web version of the WHOQOL-BREF can be the alternative to the paper version for health-related quality of life (HR-QOL) evaluation.     

Validation of the 12 Item Short form Health Survey in a Sample from Region Central Jutland

In 2010 the Danish regions started a new program of public health surveillance in collaboration with the national and local health authorities using the short form health survey (SF-12) for measuring and reporting on health related quality of life among the Danish adult population. The instrument has not, however, been validated in a Danish setting. The aim of this study was to assess the reliability and validity of the physical component summary (PCS) and the mental component summary (MCS) score of the 12-item short form health survey (SF-12) in a sample from Central Denmark Region. A total of 26,397 persons above the age of 25 were included in the analyses. Reliability was assessed by Cronbach’s α. The validity was assessed using known-groups comparisons and convergent validity. The factor structure was investigated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach’s α showed high reliability with a score of 0.90 and 0.85 for PCS and MCS respectively. The SF-12 discriminated well with respect to gender, age, educational status and long term illness. Individual items correlated higher with own hypothesized scales than with other scales and summary measures corroborating the convergent validity. The EFA gave a two-factor structure. Irrespective of the chosen rotation method (varimax and oblimin) the items related to PCS loaded on one factor and the items related to MCS loaded on another factor. The factor structure was validated with acceptable model-fit values in CFA. The SF-12 instrument is a reliable and valid measure of health related quality of life among the population of Central Denmark Region.     

A Validity and Reliability Study of the Multidimensional Trust in Health-Care Systems Scale in a Turkish Patient Population

The importance of trust within health care is widely acknowledged. Measuring patients’ trust in health care systems may contribute to plans for the financing, delivery, and outcomes of health services. Although many scales are available to measure patient trust, less attention has been paid to the multidimensional nature of trust in health care systems. The purpose of this methodological study was to adapt the Multidimensional Trust in Health-Care Systems Scale into Turkish and to evaluate its psychometric properties for a Turkish patient population. The scale was adapted into Turkish through a translation and back-translation process. The content validity of the scale was assessed using expert approval. The psychometric properties of the scale were investigated by collecting data from 232 hospitalised patients in Ankara during theperiod of 1 January–30 December 2010. An exploratory factor analysis identified that the eigenvalues for the three factors of the scale were 7.30, 2.61, and 1.21; these three factors explained 65 % of the variance. A confirmatory factor analysis indicated a sufficient model fit for the construct validity of the scale. Cronbach’s α for the total scale was 0.87, as well as 0.91, 0.82, and 0.61 for the three subscales; the Spearman-Brown split half reliability coefficient was 0.67. Despite the low internal consistency of the subscale 3, evidence from this study supports the validity and reliability of the Multidimensional Trust in Health-Care Systems Scale. This instrument can be used to measure multiple aspects of trust in the health care system; however, as trust is a contextual phenomenon, further work is needed to test the psychometric properties of this scale both in Turkish and different cultures.     

The Evaluation of a Self-enumerated Scale of Quality of Life (CASP-19) in the Context of Research on Ageing: A Combination of Exploratory and Confirmatory Approaches

This paper describes the conceptual development of a self-enumerated scale of quality of life (CASP-19) and presents an empirical evaluation of its structure using a combination of exploratory and confirmatory factor analytic approaches across three different survey settings for older people living in England and Wales in the new millennium. All evaluations are conducted using MPlus which allows the analyst to evaluate the properties of the scale for a set of multivariate categorical items which are subject to item non-response. CASP-19 is a subjective measure of well-being derived from an explicit theory of human need spanning four life domains: control, autonomy, self-realisation and pleasure. Put formally, CASP-19 is a self-reported summative index consisting of 19 Likert scale items. The three survey settings include a postal survey of 263 people in early old age followed up from childhood when the respondents were first interviewed in the 1930's, the first wave (2002) of the English Longitudinal Study of Ageing (ELSA_1) and the eleventh wave of the British Household Panel Survey (BHPS_11) also conducted in 2002. These nationally representative surveys consisted of 9300 and 6471 respondents aged 55 years and older. The Boyd-Orr sample provides an exploratory context for the evaluation and ELSA_1 together with BHPS_11 provide the opportunity for confirmatory analyses of three measurement models. There is some support for the use of CASP-19 as a stand alone summative index. However, the analysis reveals that a shortened 12-item scale which combines the life domains 'control and autonomy' in a second order measurement model is the recommended model for analysts. The work was funded under the UK's Economic and Social Research Council's Growing Older Programme and their Priority Network on Human Capability and Resilience. Grant Nos. L480254016 & L326253061.

Measure of internalized sexual stigma for lesbians and gay men: a new scale

The goal of this study is to propose a new Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) that assesses three dimensions of internalized homonegativity: identity, social discomfort, and sexuality. A convenience sample of 735 Italian lesbians and gay male participants was used to demonstrate the psychometric validity of the scale. Results of confirmatory factor analysis supported three identifiable factors reflecting theoretically based constructs of the MISS-LG. The correlations with other instruments demonstrate the convergent validity: lesbian and gay participants with high internalized sexual stigma describe lower levels of self-disclosure and wellbeing. Implications for research and practice are discussed.     

Validation of the Flourishing Scale and Scale of Positive and Negative Experience in Portugal

The Flourishing Scale (FS) and the Scale of Positive and Negative Experience (SPANE) created by Diener et al. (Soc Indic Res 97:143–156, 2010) are instruments that assess psychological flourishing and feelings (positive and negative, and the difference between the two). In this study, the psychometric properties of both scales were explored by using two Portuguese samples (I: n = 734; II: n = 194). Reliability analysis and a multi-group confirmatory factorial analysis (MCFA) of both scales were performed. To examine the validity of FS and SPANE we analyzed their correlations with other well-being and happiness measures. Results showed that the Portuguese versions of both scales have good psychometric properties, and they also showed convergent validity. Results also demonstrated the unidimensional structure of the FS and a two-factor solution for the SPANE. The multi-group CFA of both scales evidenced an invariant structure. Both Portuguese versions of the scales behave consistently with the original and may be used in future studies of well-being.