Search Results (2,264)

Background: Societal stigma toward eating disorders and obesity remains pervasive and is associated with psychological distress, maladaptive eating behaviors, reduced help-seeking, and barriers to care. Despite its documented impact, comprehensive and psychometrically robust instruments to assess stigma—particularly in Spanish-speaking populations—are scarce. This study aimed to develop and validate a multidimensional measure of societal stigma toward eating disorders and obesity in Spain, grounded in contemporary stigma frameworks. Methods: A cross-sectional observational study was conducted in a large community sample recruited online (N = 2121). An initial pool of stigma-related items was developed based on theoretical and empirical literature and refined through expert content validation. Psychometric evaluation included item screening, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), bifactor modeling, and reliability assessment. The sample was randomly split for EFA (n = 988) and CFA (n = 658). Associations between stigma scores and sociodemographic and experiential variables were examined. Results: The final 36-item instrument demonstrated excellent psychometric properties. Bifactor analyses supported an essentially unidimensional structure dominated by a strong general stigma factor, with secondary content-specific dimensions (e.g., legitimacy, personal responsibility, visibility, and treatment beliefs). The theory-driven bifactor model showed excellent fit (CFI = 0.991; TLI = 0.990; RMSEA = 0.024). The general factor exhibited high reliability (ωₕ = 0.87). Higher stigma was observed among men, older participants, and individuals without personal or familial experience of eating disorders or obesity. Conclusions: This study provides a reliable and theoretically grounded instrument for assessing societal stigma toward eating disorders and obesity in Spain. The scale enables systematic research on stigma and offers a valuable tool for public health surveillance, intervention development, and evaluation of anti-stigma initiatives aimed at promoting compassionate and equitable care. Full article

The effects of moral protective factors (e.g., moral cost) on aggression and the underlying mechanisms remain unclear. To address this issue, this study developed the Moral Cost of Aggression Questionnaire (MCAQ) and validated its psychometric properties in 516 college students (287 female; Mage = 19.77 years, SD = 1.61). Subsequently, the relationships among moral cost, positive outcome expectancies for aggression (POEA), and aggression were examined in 749 college students (330 females; Mage = 18.96 years, SD = 0.74). Mediation analysis indicated that POEA mediated the relationship between moral cost and aggression. This pattern of associations is consistent with the hypothesis that moral cost is negatively associated with aggression, in part through its link to lower subjective value of aggressive outcomes (i.e., lower POEA). This study provides a reliable and valid measure of the trait moral cost (MCAQ) and offers preliminary empirical support for a discounting mechanism in which moral cost is associated with reduced aggression via decreased POEA. These findings suggest that interventions targeting both moral cost and outcome valuation may be a useful direction for future research. Full article

Background: Population aging represents a major public health challenge, accompanied by an increasing prevalence of chronic diseases and age-related functional decline. Declines in lower-extremity physical function are particularly important, as they are strongly associated with mobility limitations, loss of independence, increased risk of falls, hospitalization, and mortality in older adults. Reliable and valid tools to assess physical performance are therefore essential in both clinical and research settings. The Short Physical Performance Battery (SPPB) is a widely used instrument for assessing lower-extremity physical performance in older adults and is recommended within the diagnostic algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP2) for evaluating physical performance severity. However, the SPPB has not yet been psychometrically validated in the Croatian older population. This study aimed to evaluate the reliability and validity of the SPPB in Croatian older adults. Methods: This study examined the metric properties of the SPPB in a sample of 153 older adults recruited from nursing homes and community settings. Results: The SPPB demonstrated acceptable internal consistency (Cronbach’s alpha = 0.74) and good test–retest reliability (ICC = 0.893) for the total score. Convergent and construct validity were supported by significant associations with established measures of functional mobility and muscle strength. Conclusions: The Croatian version of the SPPB is a reliable and valid instrument for assessing lower-extremity physical performance in older adults. Its use is supported in clinical practice and research settings in Croatia. Further studies should examine responsiveness and predictive validity in nationally representative samples. Full article

This study investigates how bio-inspired versus sustainability-focused framing influences lay evaluations of a specific bio-inspired building-technology scenario, testing the empirical validity of the so-called “biomimetic promise”. Employing a between-subjects experimental design ($N=582$), we examined assessments of a weather-responsive self-shading façade across bio-inspired, sustainable, and neutral framing conditions. We developed and validated the 12-item Perceived Bio-Inspiration Scale (PBS)—a novel standardized psychometric instrument designed to quantify lay recognition of biomimetic features across visual, intentional, and naturalistic dimensions. While results showed robust direct framing effects, we identified a significant negative spillover: emphasizing biological inspiration significantly reduced the technology’s perceived sustainability, while sustainability framing diminished its perceived bio-inspiration. These findings demonstrate, in this façade context, that laypersons evaluate bio-inspiration and sustainability as cognitively distinct and potentially competing constructs, indicating that “natural-is-better” bias is not universal across all technology domains. Consequently, merely invoking biological origins is insufficient to enhance a technology’s ecological appeal. To foster public trust, science communication should shift from abstract biological metaphors toward a performance-driven communication strategy that prioritizes the disclosure of verifiable life-cycle assessment and specific operational advantages over symbolic nature-based analogies. Full article

This study explores the effectiveness of Baskin—an inclusive sport discipline—as a pedagogical tool to promote school inclusion, social cohesion and motivation in secondary school students. The intervention, conducted on a sample of 600 students in four Italian institutions, adopted an experimental design with pre–post measurements and a mixed methods approach. The quantitative results, obtained by means of validated psychometric instruments (PIQ, Classroom Cohesion Scale, AMS), showed significant improvements in all variables investigated in the experimental group compared with the control (p < 0.001). The qualitative analysis, based on interviews, focus groups and reflexive diaries, highlighted five thematic areas: revaluation of diversity, improvement of the classroom climate, development of self-efficacy, restructuring of interpersonal relationships and request for project continuity. Baskin emerged as a comprehensive educational practice, capable of integrating corporeity, citizenship and critical thinking. The systematic inclusion of inclusive sport in the curriculum and initial teacher training is suggested, as well as the promotion of school networks and longitudinal studies. Baskin emerges as a pedagogy of participation that contributes to transforming school culture, making inclusion concrete. Full article

Online disinhibition is a fundamental construct for understanding adolescent behaviour in digital environments. However, in Chile, there are no psychometric studies that support its measurement. In this regard, having valid and reliable tools to assess this phenomenon is key to advancing research on the dynamics of digital interaction and its possible implications for the well-being and online coexistence of adolescents. This study aimed to evaluate the psychometric properties of the Measure of Online Disinhibition (MOD) in a sample of Chilean adolescents. A cross-sectional study was conducted involving 4646 students from 41 secondary education institutions. The sample consisted of 50.2% males, 48.5% females, and 1.4% who identified with another gender category, with an average age of 15.79 years (SD = 1.33). The factorial structure was examined using confirmatory factor analysis, which confirmed the theoretical unidimensional solution. Factorial invariance was examined across gender, internet use, social media use, and age. Scalar invariance was supported for internet use, social media use, and age, while partial scalar invariance was established across gender. Convergent validity was supported by positive, moderate, and statistically significant correlations with the Global Assessment of Internet Trolling (GAIT). Finally, the scale demonstrated adequate internal consistency, supporting its use in the Chilean adolescent population. Full article

The aim of this study is to develop a valid and reliable scale for measuring the self-efficacy of primary school and mathematics teachers regarding dyscalculia. Grounded in Bandura’s Social Cognitive Theory, the study followed established scale development procedures. In the initial phase, a pool of 42 items was generated to assess teachers’ self-efficacy regarding dyscalculia. The items were reviewed by a panel of seven experts in the fields of psychometrics, mathematics education, special education, and psychology to ensure content validity. Based on expert evaluations, four items were removed due to overly technical phrasing that could lead to misinterpretation, reducing the pool to 38 items. Subsequently, Exploratory Factor Analysis (EFA) conducted with 273 teachers indicated that four additional items exhibited inadequate factor loadings or problematic cross-loadings; these items were also excluded. The resulting Dyscalculia Self-Efficacy Scale (DSES) comprises 34 items organized into four factors: “Dyscalculia Symptoms”, “Providing Psychological Support to Children with Dyscalculia”, “Diagnosing Dyscalculia”, “Providing Support in the Teaching Process”. Confirmatory Factor Analysis conducted with a separate sample of 242 teachers yielded strong model fit indices, supporting the construct validity of the scale. The overall scale demonstrated high internal consistency (Cronbach’s α = 0.980, McDonald’s ω = 0.980). Correlation analyses with established instruments provided evidence of convergent and discriminant validity. The findings indicate that the DSES is a valid and reliable instrument for assessing teachers’ self-efficacy regarding dyscalculia. Full article

Background: The Strengths and Difficulties Questionnaire (SDQ) has largely been used in adolescents to screen for mental health difficulties and prosocial capabilities. The objective is to analyze the psychometric properties of the Spanish version of the SDQ in university students. Methods: This work included a large sample (N = 1256), 64.6% women with a mean age of 22.96 years (SD = 6.15). Results: The confirmatory factor analysis indicated that a six-factor solution was the most tenable. The study of measurement invariance (MI) revealed strong measurement invariance both by gender and age. The study of relations with other variables indicated that the SDQ subscales were statistically significantly correlated with indicators of self-esteem, emotional well-being, stress, and emotional regulation. Finally, the internal consistency of the scores for the Total Difficulties Score was 0.763. Conclusions: These results allow confirming the psychometric properties of the Spanish version of the SDQ for its use in university students. Full article

Background/Objectives: Strict adherence to a gluten-free diet (GFD) is the only effective treatment for celiac disease (CeD) but remains challenging due to structural and environmental barriers. Evidence on these determinants in Latin America is scarce. This study aimed to adapt and validate the Gluten-Free Perceived Nutrition Environment Measures Survey (NEMS-P-GF) for adults with CeD in Chile and examine its association with GFD adherence. Methods: A cross-sectional online survey (October 2023–January 2024) included adults (≥18 years) with biopsy- or serology-confirmed CeD (n = 233). The questionnaire collected sociodemographic and clinical data, assessed adherence using the Celiac Dietary Adherence Test (CDAT; good < 13, poor ≥ 13), and measured perceptions of home and supply food environments via the adapted NEMS-P-GF. Construct validity was tested using exploratory factor analysis and reliability with Cronbach’s α and McDonald’s ω. Associations with adherence were analyzed using Mann–Whitney U. Results: NEMS-P-GF domains showed adequate validity (KMO 0.71–0.81; Bartlett’s p < 0.001) and acceptable-to-excellent reliability (α/ω = 0.70–0.90). Participants with good vs. poor adherence perceived more supportive environments, particularly at home (median 4.79 vs. 1.29; p < 0.01) and globally (1.72 vs. −7.25; p < 0.01). Supply environments were perceived as less supportive due to limited availability and high prices (median −3.68 and −7.78), with smaller differences between adherence groups (p = 0.018). Conclusions: Supportive home environments were strongly associated with better GFD adherence, while supply environments remained broadly restrictive, showing modest but significant differences between adherence groups. The NEMS-P-GF demonstrated preliminary evidence of good psychometric properties and offers a valid, context-sensitive tool to assess GF food environments and inform public health strategies for CeD populations. Full article

Background/Objectives: Breast cancer awareness is essential for early detection and timely help-seeking among women and represents a key component of multidisciplinary breast cancer prevention. The Breast Cancer Awareness Measure (Breast-CAM) is widely used to assess awareness of breast cancer symptoms, risk factors, and screening behaviors. Its measurement quality across populations has not yet been comprehensively evaluated. As Breast-CAM is a population-reported measurement instrument, evaluation using a standardized framework for measurement properties is required. This systematic review and meta-analysis aimed to assess the psychometric properties of the Breast-CAM across diverse populations and cultural adaptations, in accordance with COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodological standards. Methods: Major bibliographic databases and trial registries were systematically searched for peer-reviewed English-language studies published between 2010 and 2025 that evaluated at least one psychometric property of the Breast-CAM in adult women. Methodological quality was assessed using the COSMIN Risk of Bias checklist. Measurement properties were evaluated according to COSMIN criteria, and the certainty of evidence was graded using a modified GRADE approach. Meta-analysis was performed when data were sufficiently comparable. Results: Seventeen studies met the inclusion criteria for narrative synthesis, of which eleven were included in a meta-analysis, representing fourteen cultural adaptations of the instrument. A descriptive random-effects meta-analysis of reported Cronbach’s α yielded a pooled estimate of 0.89 (95% confidence interval 0.85–0.92). This value should be interpreted cautiously, as structural validity was frequently insufficient across cultural adaptations, limiting interpretation of internal consistency according to COSMIN guidance. Other measurement properties, including reliability and measurement error, were frequently inadequately assessed or unreported. The certainty of evidence ranged from very low to moderate. Conclusions: Content validity was generally rated as sufficient, although certainty of evidence was low. Despite the high pooled α estimate, the reliability of Breast-CAM cannot be firmly established because structural validity was frequently insufficient across cultural adaptations. In accordance with the COSMIN ceiling rule, internal consistency was not considered sufficient in the absence of adequate structural validity. Key measurement properties, including test–retest reliability, measurement error, and responsiveness, were rarely evaluated. Further high-quality psychometric studies, particularly in culturally diverse populations, are needed to address these gaps and support appropriate use of the instrument in research and public health practice. Full article

Psychological comorbidity is increasingly recognized as a critical factor influencing outcomes in chronic illness management, particularly in patients with end-stage renal disease (ESRD). The present study examines the psychological burden associated with long-term hemodialysis in patients with ESRD, focusing on emotional distress and maladaptive personality traits. Specifically, it explores group differences between hemodialysis patients and matched healthy controls in levels of stress, anxiety, depression, and psychopathological tendencies, including neuroticism, paranoia, and psychopathy-related traits, as well as exploratory associations with treatment duration. A purposive sample of 60 participants (30 patients undergoing chronic hemodialysis and 30 age- and sex-matched healthy controls) was assessed using validated psychometric instruments: The Hospital Anxiety and Depression Scale, the Pichot Neuroticism and Psychopathy Questionnaire, and a 23-item stress measurement questionnaire adapted to the dialysis context. Both descriptive and inferential statistical analyses were conducted, including independent-samples t-tests and effect size calculations (Cohen’s d). Compared to healthy controls, hemodialysis patients exhibited significantly higher levels of psychological distress across multiple domains. Large between-group effect sizes were observed for depression (Cohen’s d = 1.26) and perceived stress (d = 1.51), while moderate effects were identified for anxiety (d = 0.70), neuroticism (d = 0.58), and psychopathy-related traits (d = 0.82). Exploratory analyses indicated that patients with less than 10 years of dialysis experience reported significantly higher stress levels than those with longer treatment duration, whereas differences in anxiety, depression, and personality traits by dialysis duration were not statistically significant. These findings highlight the substantial emotional burden associated with long-term hemodialysis and underscore the importance of routine psychological screening and early psychosocial interventions to support adaptation, treatment adherence, and quality of life in nephrology care. Full article

Background: The use of digital media in childhood offers both opportunities and risks. Digital stressors—such as excessive screen time, constant availability, information overload, and social media pressures—affect primary school children but have been rarely studied systematically. Despite growing research, no validated instruments adequately capture how younger children perceive and express digital stress. This study presents the development and validation of a three-dimensional instrument for children under 14: the “Digital Stress in Children” scale (DSS-CH). The DSS-CH is theory-driven and child-appropriate, with three interrelated but distinct dimensions: (1) excessive screen time, (2) compulsive media behavior, and (3) approval anxiety. Methods: In a cross-sectional survey of n = 907 Swiss primary school children (grades 5–6; ages 10–14), participants completed an online questionnaire in class. Latent variable modeling with cluster-robust inference accounted for classroom nesting. Competing models (1-, 2-, 3-factor CFA; ESEM; bifactor-ESEM) were evaluated. Results: The 1-factor CFA fit poorly (CFI ≈ 0.81; RMSEA ≈ 0.15), while the 3-factor CFA showed acceptable fit (CFI ≈ 0.96; RMSEA ≈ 0.07). Allowing cross-loadings improved fit substantially in the 3-factor ESEM and bifactor-ESEM (CFI ≈ 0.999; RMSEA ≈ 0.01), supporting a general digital stress factor alongside facet-specific variance. Subscales showed good reliability (ordinal α ≈ 0.81 − 0.89) and moderate intercorrelations (r ≈ 0.28 − 0.47). Scalar invariance across gender and age was supported (ΔCFI ≤ 0.003; ΔRMSEA ≤ 0.012). Conclusions: The DSS-CH demonstrates good reliability, model fit, and measurement invariance. It provides valid evidence for interpreting children’s digital stress as three related facets and can help identify elevated stress profiles to inform preventive efforts. Full article

Introduction: Major depressive disorder (MDD) is a leading cause of disability worldwide and contributes significantly to the global burden of disease. Recent data show an increasing prevalence of treatment-resistant depression (TRD). Patients with autism spectrum disorder (ASD) often exhibit MDD as a comorbidity and it is often resistant to conventional treatments. ASD determines emotional dysregulation and a reduced ability to understand mental states (mentalization). These features can lead to suicidal ideation and/or behavior. Intranasal esketamine may offer a novel therapeutic option for this population. Methods: This case series focuses on the clinical response to intranasal esketamine in patients with autism and TRD; esketamine is approved in Italy as an add-on therapy in TRD, so our case study is based on an in-label treatment. Three young patients (n = 3, F/M 2:1, age range 20–25 y) with light to moderate autism (Level 1 or 2) were treated. Esketamine was administered in augmentation with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in accordance with EMA/AIFA guidelines. A structured follow-up protocol was set to monitor depressive symptoms, social cognition, and mentalization. Follow-up during treatment was maintained for six months, and psychometric evaluations were performed at six time points: baseline (T0), 1 week (T1), 1 month (T2), 2 months (T3), 3 months (T4), and 6 months (T5). Also, subjective quality of life was investigated before and after the observation period. Results: Despite differences in clinical profile, all patients showed good efficacy of esketamine in reducing depressive symptoms: two patients experienced clinical remission at T5 (MADRS < 10), one patient showed partial response (dMADRS = 43.24%). No major side effects were reported. Significant improvements were observed after the first week of treatment (P1: MADRS_T0 = 37, MADRS_T1 = 12; P2: MADRS_T0 = 32, MADRS_T1 = 21; P3: MADRS_T0 = 25, MADRS_T1 = 12). Depressive relapses occurred (e.g., P1, T3–T4), but they were not associated with hospitalizations and/or suicidal attempts. Suicidal ideation, when present, decreased by the end of the follow-up period. Lack of mentalization and in social cognition was noted, with just mild improvements during therapy. Subjective quality of life improved significantly for all patients (P1: 28% at T0, 73% at T5. P2: 25% at T0, 71% at T5. P3: 35% at T0, 80% at T5). Conclusions: Intranasal esketamine showed a favorable efficacy and safety in these three cases of TRD in comorbidity with ASD (at six months: total remission = 66.66%, partial remission = 33.33%, inefficacy = 0%, drop-out = 0, severe adverse events = 0). Besides improvements in depressive symptoms, esketamine was associated with a constant decrease in suicidal thoughts. A case series is unfit to form statistical conclusions; preliminary data warrant further investigation in randomized controlled studies to validate the therapeutic potential of esketamine in this population. Full article

Background: Sustainable dietary transitions are increasingly emphasized in public health policy; however, validated psychometric instruments assessing knowledge, attitudes, and practices (KAP) in Asian contexts remain limited. Objectives: This study aimed to develop and evaluate a KAP questionnaire on sustainable diets and examine sociodemographic variations and behavioral correlates among Taiwanese adults. Methods: A two-phase mixed-methods design was used, including expert validation and a cross-sectional online survey (n = 587). Construct validity was examined using exploratory factor analysis, and reliability was evaluated through internal consistency and test–retest assessments. Multivariable logistic regression models were fitted to identify factors associated with low adherence to a low-carbon diet. Model diagnostics included variance inflation factors (VIF), Hosmer–Lemeshow tests, Nagelkerke pseudo-R², and ROC analysis. Results: Content validity was high (S-CVI/Ave = 0.95–0.98). The attitude and practice domains demonstrated satisfactory internal consistency, whereas the knowledge domain showed comparatively lower reliability. In multivariable logistic regression analyses, higher attitude scores were independently associated with lower odds of low adherence to a low-carbon diet. Eating-out frequency and clear awareness of sustainability in Taiwan’s Dietary Guidelines were also significantly associated with adherence. The fully adjusted model demonstrated adequate calibration and excellent discrimination (AUC = 0.778). Conclusions: The instrument provides preliminary psychometric evidence supporting the assessment of sustainable diet-related KAP among Taiwanese adults. Attitudes appear more strongly associated with dietary practices than knowledge alone. The questionnaire may support future monitoring and research. Full article

Organizations face increasing pressure to reduce their environmental impact while preserving worker health, well-being, and performance. While sustainability research increasingly emphasizes organizational and human dimensions, validated tools assessing how environmental sustainability is integrated into ergonomic practice remain limited. Green ergonomics provides a systemic framework linking human factors and environmental objectives in sustainable work system design. This study aimed to develop and validate the Green Ergonomics Questionnaire (GEQ), a psychometric instrument designed to assess employees’ perceptions of organizational readiness to integrate sustainability into ergonomic practice. The GEQ was developed through a structured literature review, expert evaluation, and empirical validation using data from 412 employees across multiple occupational sectors. Exploratory and confirmatory factor analyses supported a seven-factor structure including knowledge, training and organizational learning, organizational practices, perceived impacts, obstacles, organizational culture, and employee involvement. Reliability indices indicated satisfactory internal consistency (α = 0.78–0.86; CR = 0.80–0.88), and convergent and discriminant validity were supported. Overall, the GEQ provides a structured framework to assess employees’ perceptions of how environmental sustainability is embedded within ergonomic and participatory work system design processes, contributing to research at the intersection of ergonomics, sustainability management, and organizational change. Full article