Search Results (46)

Oral health during pregnancy is a critical factor in preventing caries in both mothers and children. Croatia currently lacks validated psychometric instruments for reliably assessing knowledge, attitudes, and oral hygiene practices in the general population. This study aimed to develop and provide initial psychometric evidence for a comprehensive instrument for this purpose in Croatia, with potential relevance for future cross-cultural adaptation. Following Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines, an initial item pool was generated through literature review and expert consultation. The study was conducted from May 2024 to February 2025 in primary healthcare settings across Primorje-Gorski Kotar County (PGC). The validation study included 319 pregnant women. Exploratory factor analysis (EFA) revealed a six-factor structure with acceptable to strong factor loadings (ranging from 0.423 to 0.984). The instrument showed acceptable to good internal consistency (Cronbach’s α = 0.61–0.87) and excellent test–retest reliability (Pearson r = 0.993). Results indicated that knowledge about oral health was independent of attitudes and practices during pregnancy. Regression analyses were exploratory and did not provide evidence of predictive validity at this stage, suggesting that additional contextual and psychosocial factors should be considered in future modelling. The present study provides initial psychometric evidence supporting the proposed structure and reliability of the instrument; however, further confirmatory and longitudinal validation studies are required before broader implementation and generalization can be fully justified. Full article

The well-being of healthcare professionals (HCPs) is widely recognised as a critical construct related to workforce sustainability, patient safety, and healthcare system performance; however, research in this area remains conceptually fragmented. This systematic review identifies and critically analyses conceptual models, assessment instruments, and factors associated with HCPs’ subjective well-being. A comprehensive literature search was conducted across six databases covering 2014 to 2024, focusing on quantitative empirical studies published in English in peer-reviewed journals. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using the Joanna Briggs Institute criteria, and the methodological quality of measurement instruments was evaluated with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist in validation-focused studies. Of the 7838 records initially identified, 48 studies met the inclusion criteria. Three primary thematic areas emerged: (1) conceptual models framing subjective well-being, (2) measurement instruments assessing subjective well-being, and (3) factors associated with subjective well-being among HCPs. Frequently applied conceptual frameworks included the job demands–resources model, Maslach burnout theory, and WHOQOL-related approaches. Commonly used instruments comprised the WHO-5, Maslach Burnout Inventory, and Mini-Z. In validation-focused studies assessed using COSMIN criteria, internal consistency and aspects of construct validity were generally reported as acceptable; however, reporting across measurement property domains was variable. Factors examined in relation to subjective well-being included workload, emotional exhaustion, social support, autonomy, and work–life balance. Overall, the reviewed literature demonstrates substantial variability in conceptual and methodological approaches and frequently focuses on single dimensions of well-being. These findings highlight the potential value of developing integrated, sector-specific frameworks to inform future measurement development and research in this field. Full article

Background: Diabetes in youth, specifically type 1 diabetes (T1D), is an increasing global health concern. As prevalence rises, a growing number of adolescents are required to transition from pediatric to adult healthcare services. This phase is recognized as a particularly critical and high-risk period, during which emerging adults with T1D must exhibit advanced self-management skills to maintain optimal outcomes. When transition support is inadequate, the process is frequently associated with deterioration in glycemic control, higher rates of hospitalization, and significant psychological distress. Methods: A systematic review was conducted in accordance with PRISMA guidelines to identify and evaluate instruments that assess transition readiness in adolescents with diabetes, focusing on their psychometric properties. Five electronic databases (PubMed, CINAHL, Embase, APA PsycInfo, and Web of Science) were searched. Methodological quality and measurement properties were appraised using the updated 2024 COSMIN Guidelines. Results: Eleven studies were included, examining 10 distinct instruments. Overall, psychometric evidence was promising but limited. Only the “On TRAck” instrument demonstrated moderate-quality evidence with acceptable feasibility and reliability. Other tools showed partial support for validity, reliability, and responsiveness, but presented methodological limitations. Conclusions: Interest in diabetes-specific tools to assess transition readiness is growing, yet their psychometric robustness remains limited. Further research is needed to develop and validate instruments with stronger methodological rigor. Future efforts should focus on longitudinal performance and predictive validity to enhance their applicability in clinical practice and ultimately improve outcomes during transition. Full article

Background: Safety climate is widely used to explain and prevent occupational accidents in industrial settings; however, the field remains conceptually fragmented, with multiple measurement instruments coexisting without consensus on the core dimensions that define the construct, limiting the comparability of findings and the effectiveness of organizational interventions. Objectives: This study aims to identify, organize, and synthesize the determinants of safety climate reported in validated instruments applied in industrial settings through a systematic literature review. Methods: The review was conducted in accordance with the PRISMA 2020 guidelines, with searches performed in the Scopus and Web of Science databases, resulting in the inclusion of 27 empirical studies published between 2015 and 2025. Dimensions reported in the instruments were extracted, grouped by conceptual similarity, and integrated into a common structure. The synthesis examined determinant recurrence across instruments and interpreted the findings in light of the psychometric quality of the measures, as assessed using the COSMIN framework. Results: The results indicate that despite the diversity of scales, safety climate determinants derived from measurement instruments consistently converge into four domains: Health and Safety Management, Organizational Safety Resources, Worker Involvement, and Working Conditions. The convergence of these domains across independent instruments, considered alongside the methodological robustness of their validation procedures, indicates a conceptually coherent structural core predominantly supported by instruments with confirmatory structural validation. Conclusions: By integrating conceptual structure and measurement quality, this study contributes to reducing fragmentation in the literature and provides an empirical basis for the development, adaptation, and selection of safety climate instruments, with direct implications for research and safety management in industrial environments. Full article

Background/Objectives: The use of physical restraints in adult and pediatric intensive care units (ICUs) is common yet controversial. While restraints are intended to prevent treatment interference or self-harm, they pose significant physical, psychological, and ethical risks. Nurses in intensive care units play a key role in decisions about restraint application, but there is a global lack of validated tools to assess their knowledge, attitudes, and practices, particularly in non-English-speaking contexts. Aim of this study was to develop and validate a questionnaire for assessing knowledge, attitudes, and practices (KAP) of ICU nurses regarding restraint use in adult and pediatric settings. Materials and Methods: A multi-method psychometric validation study was conducted across both adult and pediatric ICU settings at two hospitals in northern Italy. Questionnaire development included literature review, expert consultation, and iterative content and face validity assessments. Reliability was tested using test–retest methods, and construct validity was explored through exploratory factor analysis. The study followed COSMIN guidelines. Results: The final CON-Ti-IT questionnaire comprised 29 items across three subscales: Practices, Attitudes, and Knowledge. It demonstrated strong content validity (CVI = 0.96) and good internal consistency for the Practices subscale (Cronbach’s α = 0.89). Internal consistency for the Attitudes (α = 0.51) and Knowledge (α = 0.47) subscales was lower, reflecting the broader conceptual variability of these domains. Exploratory factor analysis confirmed the structural validity of the tool and led to the removal of three items with low factor loadings. Conclusions: This study presents the first validated tool specifically designed to evaluate ICU nurses’ KAP on restraint in adult and pediatric settings. While developed and validated in Italy, it could undergo cross-cultural adaptation and translation for use in other languages and healthcare systems. Its strong psychometric properties support its application in future research, and the data collected through its use can serve both to improve patient care and to provide a foundation for targeted educational initiatives. Full article

Introduction. The proliferation of immersive virtual reality (VR) technologies has transformed the way individuals interact with digital environments, offering unprecedented opportunities in fields ranging from entertainment and education to healthcare and mental health interventions. Immersive VR is increasingly being implemented in motor and cognitive programs in neurorehabilitation, where patient safety and treatment adherence are critical. Despite its relevance, the conceptualization and measurement of cybersickness (CS) remain fragmented across disciplines, with various assessment tools developed in isolation, targeting different symptom domains, populations, and use contexts. Aim. The aim of this systematic review is to identify, categorize, and critically appraise all existing instruments and scales developed to measure CS associated with immersive VR use. The secondary objectives involve examining the psychometric properties of the identified instruments to provide robust evidence for clinicians in assessing CS associated with VR, thereby supporting future scale development and standardization. Additionally, a further objective is to evaluate the specific applicability of these instruments and scales for measuring CS within neurorehabilitation settings, given the growing use of immersive VR in clinical practice with neurological populations. Methods. This systematic review was conducted in accordance with the Guideline for reporting systematic reviews of outcome measurement instruments (PRISMACOSMIN). The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Data extraction was performed independently by the two reviewers, and discrepancies were resolved by consensus or consultation with a third reviewer. To assess the psychometric robustness of existing CS assessment instruments used in virtual reality settings, we applied the methodology proposed by the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) initiative for systematic reviews of patient-reported outcome measures (PROMs). The evaluation was structured across three steps: Assessment of risk of bias; Quality of measurement properties and Summary of evidence; and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Results. Nine assessment instruments were included in this review. Following our analysis, the CSQ-VR and VRNQ received a Grade A recommendation, as they met sufficient criteria for both internal consistency and structural validity with high methodological quality. Few instruments have reported validations in specific clinical populations related to neurorehabilitation, including individuals with neurological conditions such as brain injury, multiple sclerosis (MS), migraine-associated vestibulopathy, vestibular disorders or cognitive impairment, indicating a critical gap in scale generalizability across clinical contexts. Conclusions. Despite the increasing use of immersive VR, few CS assessment tools have been designed and validated, reaching the CSQ-VR and VRNQ a Grade A recommendation. Among the nine identified assessment instruments, only the SSQ, MSAQ, CSQ-VR, VRNQ MSSQ and SEQ have been employed in samples with neurological disorders. There is a critical need for standardized CS VR-specific tools with robust psychometric properties to ensure safe and effective implementation in neurorehabilitation settings. Full article

Background/Objectives: Muscle strength is a vital indicator of the development and health-related fitness in children and adolescents, and it also plays a crucial role in clinical assessments across pediatric rehabilitation. The aim of this review was to evaluate the available literature on handheld dynamometry (HHD) assessments of the overall muscle strength in the pediatric population, focusing on measurement protocols, validity and reliability, and the availability of reference and normative data. Methods: Following PRISMA 2020 guidelines, a systematic review was conducted across PubMed, Scopus, Cochrane CENTRAL, CINAHL, and Web of Science. The protocol was registered in PROSPERO (CRD42024537557). Eligible studies (2005–2023) included healthy participants under the age of 18 reporting on isometric muscle strength using HHDs. Studies reporting handgrip strength or alternative methods (e.g., isokinetic and 1RM) of assessment were excluded. Due to the heterogeneity of the studies, the JBI and COSMIN risk of bias checklists were used to assess risk of bias. A narrative synthesis approach was used to summarize the findings. Results: Twelve studies were included, with a total of 1683 participants aged 4–17 years (764 girls and 919 boys). Test re-test reliability and low measurement error were established in measuring the toe strength, while the concurrent validity of lower limb torque was determined as poor. Conclusions: When standardized protocols and fixed stabilization are implemented, studies confirm good intra- and inter-rater reliability. Substantial heterogeneity in measurement protocols highlights the need for standardized procedures. It is essential to establish normative or reference values by age and sex to enhance clinical decision making and the utility of HHDs in pediatric overall strength assessments. Full article

Contemporary transformations in the world of work, together with the growing emotional and physical demands in nursing, have led to the emergence of new labor phenomena such as quiet quitting, which reflects changes in professional engagement and in the management of nurses’ well-being. Objective: To translate, culturally adapt, and validate the Quiet Quitting Scale for European Portuguese, evaluating its psychometric properties among the nursing population. Methods: A cross-sectional validation study was conducted following COSMIN guidelines. The process included forward and back translation, expert panel review, and pretesting with 30 nurses. The psychometric evaluation was carried out with 347 nurses from Northern Portugal. Data were analyzed using descriptive and inferential statistics, internal consistency measures (Cronbach’s α and McDonald’s ω), and confirmatory factor analysis (CFA) with maximum likelihood estimation to assess construct validity. Results: The Portuguese version (QQS-PT) maintained the original three-factor structure (Detachment/Disinterest, Lack of Initiative, and Lack of Motivation). The model showed satisfactory fit indices (CFI = 0.936; GFI = 0.901; AGFI = 0.814; TLI = 0.905; RMSEA = 0.133). The overall internal consistency was excellent (α = 0.918; ω = 0.922), with subscale α ranging from 0.788 to 0.924. Composite reliability (CR) ranged from 0.815 to 0.924, and average variance extracted (AVE) from 0.606 to 0.859, confirming convergent and discriminant validity. Conclusions: The QQS-PT demonstrated a stable factorial structure, strong reliability, and solid validity evidence. It is a brief and psychometrically sound instrument for assessing quiet quitting among nurses, providing valuable insights for research and management of professional engagement and well-being in healthcare contexts. Full article

(1) Background: Planetary empathy includes deep reflection on one’s relationship with nature, curiosity about other worldviews, and an assumption of responsibility for creating a healthier and more equitable world for current and future generations. (2) Purpose: This paper presents a study that aimed to develop and conduct preliminary validation of the Planetary Empathy Scale for healthcare professionals. (3) Methods: The Planetary Empathy Scale was developed based on a concept analysis and preliminary validation was conducted in accordance with COSMIN guidelines. Data from 231 healthcare students and professionals informed item analysis. Cronbach’s alpha, known-groups comparisons, and exploratory factor analysis were used to assess reliability and validity. (4) Results: Initial psychometric testing supported a six-factor structure representing distinct yet interrelated dimensions of planetary empathy. The Scale demonstrated adequate structural validity, internal consistency, and construct validity. (5) Conclusions: The Planetary Empathy Scale proved to be a valid and reliable instrument. Participants had generally high levels of planetary empathy. Further psychometric testing with diverse cohorts is recommended. Full article

Background/Objectives: The Adolescent and Adult Coordination Questionnaire (AAC-Q) is a brief self-report tool developed to assess daily performance difficulties related to Criterion B of Developmental Coordination Disorder (DCD) across adolescence and adulthood. Despite the AAC-Q’s clinical and research relevance, its psychometric properties have not yet been comprehensively evaluated. This study aimed to examine the structural, construct, and criterion validity, internal consistency, and test–retest reliability of the AAC-Q and to establish normative percentile bands for Spanish adolescents and young adults (AAC-Q-ES). Methods: A cross-sectional psychometric study was conducted in 800 typically developing participants (200 adolescents, 600 young adults). Measurement properties—including factor structure, internal consistency, test–retest reliability, construct validity, and criterion validity—were assessed following COSMIN guidelines. Percentile cut-offs were calculated for adolescents and young adults. Results: The AAC-Q-ES revealed a three-factor structure with excellent fit indices (CFI = 0.95–0.98; RMSEA = 0.060–0.067). Internal consistency was good (α = 0.76–0.83), and test–retest reliability was excellent (ICC = 0.90, p < 0.001). Criterion validity with the Adult DCD/Dyspraxia Checklist was very high in adults (r = 0.972, p < 0.001), and construct validity in adolescents was confirmed through moderate correlations with the Flamingo Balance Test (r = −0.352, p < 0.01). Age- and sex-specific percentile bands were established. Conclusions: The AAC-Q-ES is a psychometrically robust, culturally adapted, and efficient tool for assessing functional difficulties related to DCD in Spanish adolescents and young adults, facilitating both clinical and research applications. Full article

Background/Objectives: The Italian version of the Feeding/Swallowing Impact Survey (FS-IS-IT) is an 18-item caregiver self-report questionnaire assessing the impact of paediatric feeding disorders (PFDs) on health-related quality of life (HR-QoL). The present study sought to evaluate its psychometric properties using Classical Test Theory (CTT), following COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines and criteria. Methods: A total of 145 caregivers of children with PFD of various etiologies were recruited (median age: 60.0 months; IQR: 35.8–108.0), of whom 134 provided sufficiently complete data for psychometric analysis. Structural validity was determined using exploratory factor analysis. Internal consistency was assessed using Cronbach’s alpha coefficient, McDonald’s ω, and inter-item correlations. Hypothesis testing was conducted using Mann–Whitney U-tests and correlation analysis, while interpretability was examined by assessing floor and ceiling effects. Results: Factor analysis indicated that the FS-IS-IT is a unidimensional measure, with an adequate total variance explained of 60.1%. The FS-IS-IT has moderate structural validity, good internal consistency with some evidence of item redundancy, strong construct validity as supported by hypothesis testing, and no floor and ceiling effects. Conclusions: These findings suggest that the FS-IS-IT is a promising caregiver self-report measure for evaluating HR-QoL in PFD. Further validation is recommended to assess potential item redundancy and to examine the dimensionality of the FS-IS-IT using item response theory. Conversely, although the Italian version of the FS-IS demonstrated encouraging psychometric properties, it could be further strengthened in future studies by revising ambiguous items, refining response formats, and removing misfitting items. Full article

Background: Mobility assessment is a crucial aspect of rehabilitation for individuals with lower limb amputation, as it directly influences their independence and quality of life. The objective of this study was to translate and cross-culturally adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility grades questionnaire in the Persian language and to investigate its psychometric properties. Methods: The SIGAM mobility scale was translated into Persian according to international guidelines for cross-cultural adaptation of self-reported measures and was administered to forty Persian-speaking people with lower limb amputations. Measurement properties were evaluated following COSMIN (COnsensus-based Standards for the Selection of Health Measurement INstruments) recommendations and included internal consistency, test–retest reliability, and hypotheses testing for construct validity by comparing SIGAM mobility grades to the Locomotor Capabilities Index-5 (LCI-5), Houghton scale, Activities-specific Balance Confidence (ABC) scale, the 2-Minute Walk Test (2-MWT), and the Timed Up and Go (TUG). Results: SIGAM mobility scale demonstrated acceptable internal consistency (Kuder-Richardson 20 coefficient = 0.72) and excellent test–retest reliability (Cohen Kappa coefficient = 0.85). Hypothesis testing for construct validity confirmed the good to very good correlations of the Persian SIGAM mobility scale with the LCI-5 (r = 0.63, 0.55, and 0.63 for the general, basic, and advanced activities components, respectively), Houghton scale (r = 0.63), ABC scale (r = 0.73), 2-MWT (r = 0.50), and TUG test (r = −0.51). Conclusion: The Persian version of the SIGAM mobility scale demonstrated preliminary evidence of acceptable psychometric properties, supporting its clinical applicability. Full article

Background: Fear of cancer recurrence (FCR) is a common, distressing concern among cancer survivors, with implications for psychological well-being and quality of life. Despite the proliferation of patient-reported outcome measures (PROMs) to assess FCR, consensus on the most valid and reliable instruments remains limited. Objective: To conduct a comprehensive psychometric evaluation of FCR PROMs developed or validated between 2011 and 2023, using the full COSMIN methodology. This review builds on earlier work by systematically appraising both newly developed and adapted instruments to inform evidence-based PROM selection for clinical and research use. Methods: This review followed the COSMIN 10-step procedure and PRISMA 2020 guidelines. Six databases were searched from January 2011 to December 2023. A search cut-off of 31 December 2023 was applied to align with COSMIN feasibility recommendations and ensure sufficient time and resources for full psychometric evaluation across all included PROMs. Eligible studies included adults diagnosed with cancer and reported on the psychometric evaluation of a self-reported, Likert-scale-based FCR PROM. PROMs were appraised across eight psychometric properties using COSMIN’s Risk of Bias checklist, criteria for good measurement properties, and modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for evidence quality. Instruments were categorized as A, B, or C according to COSMIN’s recommendations. Results: Of the 34 PROMs evaluated across 32 studies, 28 achieved COSMIN Category A status, indicating sufficient psychometric quality for clinical or research use. Among the 19 FCRI and FoP-Q instruments validated in new cultural or population contexts, 15 received a Category A rating, reflecting strong cross-cultural performance. Short forms such as the FCRI-SF and FoP-Q-SF demonstrated consistent psychometric strength across French, English, Portuguese, and Asian-language versions. Of the 14 newly developed PROMs—including the CWS-6, FCR4/7, CARQ-4, and FCR-1—12 achieved Category A. The FCR-1 was the only single-item PROM to demonstrate responsiveness, supporting its use in both screening and longitudinal monitoring. For practical guidance, five PROMs (FCR-1, FCRI-SF, FoP-Q-SF, FCR-7, and CWS) emerged as the most strongly supported for clinical use. Conclusions: This review provides a comprehensive evaluation of contemporary FCR PROMs and highlights substantial progress in the development of valid, reliable, and culturally adaptable tools. The FCRI, FoP-Q-SF, and several newly developed short forms, such as FCR7, CWS, and particularly, the FCR-1, emerge as strong candidates for use in clinical screening and longitudinal assessment. These findings offer clear evidence-based guidance for instrument selection in research and survivorship care. PROSPERO registration: CRD42023453783. Full article

Objectives: The objective of this manuscript is to translate, adapt, and validate an Arabic version of the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire to assess disordered eating behaviors (DEBs) in adolescents with T1D in Saudi Arabia. Additionally, the study sought to estimate the prevalence of DEBs and analyze its associations with glycemic control and diabetes-related complications. Methods: A cross-cultural validation study was conducted following the COSMIN guidelines. The DEPS-R questionnaire was translated into Arabic through forward and backward translation involving expert panels, including psychiatrists, diabetologists, and linguists. A sample of 409 people with type 1 diabetes (PwT1D) (58.4% females) aged 12–20 years was recruited from outpatient diabetes clinics in the five main regions of Saudi Arabia. Participants completed the Arabic DEPS-R and the validated Arabic version of the SCOFF questionnaire. Sociodemographic, anthropometric, and biochemical data were collected, and statistical analyses, including confirmatory factor analysis (CFA) and internal consistency tests, were conducted. Results: The Arabic DEPS-R exhibits strong internal consistency (Cronbach’s alpha = 0.829) and high test–retest reliability (ICC = 0.861), with a CFA supporting a three-factor structure, namely body weight perception, disordered eating behaviors (DEBs), and bulimic tendencies. Notably, higher DEPS-R scores are significantly linked to elevated HbA1c levels, increased BMI, and more frequent insulin use. Alarmingly, 52.8% of participants show high-risk DEB, which is directly associated with poor glycemic control (HbA1c ≥ 8.1%) and a heightened risk of diabetic ketoacidosis (DKA). Conclusions: The Arabic DEPS-R is a valid and reliable tool for screening DEBs among Saudi adolescents with T1D. Findings underscore the necessity for early identification and intervention to mitigate the impact of EDs on diabetes management and overall health outcomes. Full article

Background/Objectives: Psychological safety is essential for effective learning in high-fidelity simulation (HFS); however, no validated Japanese instrument currently exists to measure psychological safety among nursing students. This study aimed to translate the Psychological Safety in High-Fidelity Simulation (PS-HFS) scale into Japanese (PS-HFS-J) and evaluate its psychometric properties. Methods: Following COSMIN guidelines, the PS-HFS was translated through forward and back translation, reviewed by an expert panel, and tested for face validity via pilot testing. The scale’s reliability and validity were subsequently examined in 263 undergraduate nursing students using confirmatory factor analysis (CFA), Cronbach’s alpha, and intraclass correlation coefficients (ICC). Results: CFA confirmed a good fit of the original four-factor model (CFI = 0.990, TLI = 0.988, RMSEA = 0.026). The scale demonstrated excellent internal consistency (Cronbach’s α = 0.906 overall) and strong test-retest reliability (ICC range: 0.859–0.914). Content validity indices were also high (I-CVI = 0.80–1.00, S-CVI/Ave = 0.94). Conclusions: The PS-HFS-J is a reliable, valid, and culturally adapted instrument for assessing psychological safety in Japanese nursing education. It can support educational research, curriculum development, and faculty training, contributing to safer and more effective simulation-based education. Future studies should examine its applicability across diverse educational levels and clinical contexts. Full article