Job analysis of vaccination health workers at public health centers and sub-centers.

OBJECTIVE: To analyze duties, tasks, and task elements of health workers in charge of vaccination at public health centers in South Korea. DESIGN: Descriptive study using a survey. SAMPLE: Health workers in charge of vaccination for more than 1 year at 254 public health centers in South Korea. Of 631 health workers, 401 responded to the questionnaire, and 379 responses were included in the analysis after excluding 22 incomplete responses. MEASUREMENTS: The Developing A Curriculum (DACUM) workshop was conducted to identify the frequency, importance, and difficulty of duties, tasks, and task elements. RESULTS: Four duties (vaccination promotion, vaccination administration and symptom management, execution of vaccination, and vaccination education), 18 tasks, and 81 task elements were identified. "Execution of vaccination" exhibited the highest determinant coefficient. "Implementing the budget" exhibited the highest determinant coefficient among tasks, and "dealing with an emergency in the case of adverse events" exhibited the highest determinant coefficient among task elements. CONCLUSIONS: Duty, task, and task elements with high determinant coefficients have high educational needs. Education demands was higher for administrative work than for direct vaccination. Developing an educational curriculum based on DACUM results could contribute to the professional education of vaccine workers.

Development and psychometric evaluation of a new brief scale to measure eHealth literacy in people with type 2 diabetes.

BACKGROUND: The internet has become a major source of health information, and obtaining appropriate information requires various abilities and skills, labeled as electronic health literacy (eHealth literacy). The existing instruments for measuring eHealth literacy are outdated because they were developed during the Web 1.0 era, or not sufficiently sensitive for people with a specific condition or disease because they were designed to assess eHealth literacy over a broad range for a general population. Approximately one in ten adults worldwide live with diabetes. Health professionals have a responsibility to identify patients with low eHealth literacy to prevent them from obtaining misleading internet diabetes information. AIMS: The aims were to develop a condition-specific eHealth literacy scale for diabetes and to evaluate its psychometric properties among people with type 2 diabetes. METHODS: An instrument development design was used. This study recruited 453 people diagnosed with type 2 diabetes at the outpatient clinics of hospitals in 2021. Psychometric properties (internal consistency, measurement invariance, and content, structural, convergent, and known-groups validities) were analyzed. RESULTS: An expert panel assessed content validity. Exploratory factor analysis, exploratory graph analysis, and confirmatory factor analysis (CFA) for structural validity yielded a two-factor solution (CFI = 0.977, SRMR = 0.029, RMSEA = 0.077). Cronbach's alpha and omega values were excellent for each factor (0.87-0.94). Multigroup CFA yielded configural and metric measurement invariance across the gender, age, and glycemic control status groups. Convergent validity with a comparator instrument to measure health literacy was supported by a moderate correlation, and known-groups validity determined using groups with different internet-use frequencies was satisfied with a high effect size. CONCLUSION: A new condition-specific eHealth literacy scale for people with type 2 diabetes was developed, comprising 10 items. The scale exhibited good psychometric properties; however, test-retest reliability must be determined for the stability of the scale and cross-cultural validity is required among different languages. The brief scale has the merits of being feasible to use in busy clinical practice and being less burdensome to respondents. The scale can be applied in clinical trials of internet-based diabetes interventions for assessing the eHealth literacy of respondents.

eHealth Literacy Instruments: Systematic Review of Measurement Properties.

BACKGROUND: The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies. OBJECTIVE: This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument. METHODS: We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology. RESULTS: This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated. CONCLUSIONS: The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence.

Self-efficacy instruments for type 2 diabetes self-care: A systematic review of measurement properties.

AIMS: To identify currently available self-efficacy instruments for type 2 diabetes self-care and to evaluate the evidence for their measurement properties. DESIGN: Systematic review of measurement properties. DATA SOURCES: The PubMed, Embase and CINAHL databases were searched from their inception to 27 May 2019. REVIEW METHODS: The updated COnsensus-based Standards for the selection of health Measurement INstruments methodology were applied. RESULTS: Twelve instruments were identified from 3,665 records. Eight instruments were related to self-efficacy in performing a comprehensive set of the tasks/behaviours for diabetes self-care and the other four addressed specific behaviours related to diabetes self-care, such as insulin management. Most of the 12 instruments were developed based on Bandura's self-efficacy theory as their theoretical background. Overall, sufficient high-quality evidence for measurement properties was seldom identified. The Diabetes Management Self-Efficacy Scale is currently the best instrument, with particularly the 4-factor, 16-item version being demonstrated to have sufficient high-quality evidence for structural and internal consistency and sufficient moderate-quality evidence for reliability and convergent validity. CONCLUSIONS: None of the instruments evaluated all of the relevant measurement properties. The Diabetes Management Self-Efficacy Scale is currently the most suitable instrument for potential use in practice and research. The measurement invariance across languages, measurement error and responsiveness of this instrument still need be evaluated. IMPACT: This systematic review provides clinicians and researchers with a comprehensive list of available instruments for measuring self-efficacy in diabetes self-care, as well as evidence for helping them to select the most appropriate instrument. Using a psychometrically sound instrument will accurately inform practitioners about the levels of self-efficacy in self-care among patients with type 2 diabetes in practice and avoid threatening the credibility of research studies on self-efficacy in diabetes self-care.

Systematic review of the measurement properties of the Depression Anxiety Stress Scales-21 by applying updated COSMIN methodology.

PURPOSE: The Depression Anxiety Stress Scales (DASS)-21 measures emotional symptoms of depression, anxiety, and stress, is relatively short, and is freely available in the public domain, which has resulted in it being applied to various clinical and non-clinical populations in many countries. The aim of this study was to systematically review the measurement properties of the DASS-21. METHODS: The MEDLINE, Embase, and CINAHL databases were searched. The methodological quality of each identified study was assessed using the updated COSMIN Risk of Bias checklist. The quality of the measurement properties of the studies was rated using the updated criteria for good measurement properties. The quality of evidence was rated using a modified version of the GRADE approach. RESULTS: This study included 48 studies in its review. The content validity of the DASS-21 demonstrated sufficient moderate-quality evidence. The instrument exhibited sufficient high-quality evidence for bifactor structural validity and internal consistency. The instrument also showed sufficient high-quality evidence for hypothesis testing of construct validity. Regarding criterion validity, only the DASS-21 Depression subscale demonstrated sufficient high-quality evidence. The measurement invariance across gender demonstrated inconsistent moderate-quality evidence. There was insufficient low-quality evidence for the reliability of each subscale. For responsiveness there was sufficient low-quality evidence for depression and stress subscales, and insufficient very-low-quality evidence for anxiety subscale. CONCLUSIONS: The DASS-21 demonstrated sufficient high-quality evidence for bifactor structural validity, internal consistency (bifactor), criterion validity (Depression subscale), and hypothesis testing for construct validity. Further studies are required to assess the other measurement properties of the DASS-21.

The mediating and moderating effects of meaning in life on the relationship between depression and quality of life in patients with dysphagia.

AIMS AND OBJECTIVES: To identify whether meaning in life has moderating and mediating effects on the relationship between depression and quality of life in patients with dysphagia. BACKGROUND: Dysphagic patients typically have multidimensional problems, such as depression, which can negatively influence their quality of life. Meaning in life, therefore, can be used as a psychological resource that may enhance quality of life for these patients. DESIGN: A descriptive cross-sectional research design was used. METHODS: Ninety patients with dysphagia were recruited for a survey from eight general and rehabilitation hospitals in Korea. The questionnaires, which included the Korean version of the Swallowing Quality of Life scale developed by Cha, the Center for Epidemiological Studies-Depression Scale developed by Radloff, and the Purpose in Life test developed by Crumbaugh and Maholick, were used for data collection. Descriptive statistics, Hayes' PROCESS macro and Cronbach's alpha were used for data analyses. RESULTS: Meaning in life was found to mediate the relationship between depression and quality of life in patients with dysphagia. However, the index of moderation was not statistically significant, which mean that meaning in life did not moderate the relationship between the patients' depression and quality of life. CONCLUSIONS: Meaning in life had a mediating effect on the relationship between depression and quality of life in patients with dysphagia. Thus, to improve the quality of life of patients with dysphagia, nurses should apply interventions to help them find meaning in life. RELEVANCE TO CLINICAL PRACTICE: Meaning in life can be used as a nursing intervention strategy to improve the quality of life for patients living with dysphagia and depression.

Relationships of health literacy to self-care behaviors in people with diabetes aged 60 and above: Empowerment as a mediator.

AIM: To examine the relationships of health literacy to diabetes self-care behaviors (diet, physical exercise, foot care and blood glucose monitoring) through empowerment controlling for diabetes education. BACKGROUND: Potential mechanisms of how health literacy links to health outcomes have not clearly elucidated. DESIGN: A cross-sectional study design was used. METHODS: Participants were recruited from three community health centers in South Korea from September 2016 to April 2017 using a convenience sampling method. A total of 136 people with diabetes aged 60 and above were participated in this study. The main study variables of health literacy, empowerment and diabetes self-care activities were assessed using self-reported questionnaires. This study applied a simple mediation analysis with a single covariate using the PROCESS macro, with health literacy entered as an antecedent variable, empowerment as a mediator, diabetes self-care behaviors as outcome variables and diabetes education as a covariate. RESULTS: After controlling for diabetes education, the indirect effects of health literacy to self-care behaviors through empowerment were significant when the self-care behaviors were particularly diet and physical exercise. Whereas, the indirect effects were not significant when the self-care behaviors were foot care and blood glucose monitoring. CONCLUSIONS: This study indicates that the people with higher health literacy were more empowered and those with higher empowerment were more likely to eat healthy foods and exercise. In the light of these findings, a health literacy-tailored empowerment enhancing program may be important targets for interventions promoting diabetes self-care behaviors of diet and physical exercise.

First-order vs. second-order structural validity of the Health Literacy Scale in patients with diabetes.

OBJECTIVE: The purpose of this study was to determine the structural validity of the Health Literacy Scale (HLS) in Korean patients with diabetes based on the previously reported first-order three-factor and two-factor models and a newly proposed second-order model, to identify which model best represents the structure of the Korean version of the HLS (HLS-K). METHODS: The HLS was translated from Japanese into Korean using a translation and back-translation technique. A secondary data analysis was used to validate the structure of the HLS. Data were obtained from a cross-sectional survey involving 459 adults with diabetes recruited from outpatient clinics at two university hospitals in South Korea. The structural validity was examined using confirmatory factor analysis. Additionally, the known-groups validity by education level and internal consistency validity were assessed. RESULTS: The second-order three-factor model of the HLS-K exhibited a good fit to the data, as indicated by χ2 /df = 3.891, SRMR = 0.042, GFI = 0.924, RMSEA = 0.079 (90% CI = 0.069-0.090), and CFI = 0.962. The second-order three-factor model empirically demonstrated that both communicative and critical factors explained the variance in the overall health literacy better than did the functional factor. The HLS-K mean score was significantly lower for patients with only elementary school education than for those with higher education levels, implying the presence of known-groups validity. Cronbach's alpha for the total scale was 0.90. CONCLUSIONS: This study found that the second-order three-factor model of the HLS-K is better than that the original first-order three-factor and first-order two-factor models. Further validation studies are needed to generalise the underlying structure of the instrument in diabetes populations across various cultures.

Mental Health of Nurses Working at a Government-designated Hospital During a MERS-CoV Outbreak: A Cross-sectional Study.

BACKGROUND: During an epidemic of a novel infectious disease, many healthcare workers suffer from mental health problems. OBJECTIVES: The aims of this study were to test the following hypotheses: stigma and hardiness exert both direct effects on mental health and also indirect (mediated) effects on mental health through stress in nurses working at a government-designated hospital during a Middle East Respiratory Syndrome coronavirus (MERS-CoV) epidemic. METHODS: A total of 187 participants were recruited using a convenience sampling method. The direct and indirect effects related to the study hypotheses were computed using a series of ordinary least-squares regressions and 95% bootstrap confidence intervals with 10,000 bootstrap resamples from the data. DISCUSSIONS: The influences of stigma and hardiness on mental health were partially mediated through stress in nurses working at a hospital during a MERS-CoV epidemic. Their mental health was influenced more by direct effects than by indirect effects.

A double blind, placebo-controlled, randomized clinical trial that breast milk derived-Lactobacillus gasseri BNR17 mitigated diarrhea-dominant irritable bowel syndrome.

The exact pathogenesis of diarrhea-dominant irritable bowel syndrome (IBS) is not known, but the abnormal microbiota of the gastrointestinal tract is considered to be one of the important contributing factors as in other gastrointestinal diseases such as inflammatory bowel disease, antibiotic-associated diarrhea, and colorectal cancer as well as systemic diseases. Though diverse trials of probiotics had been continued in the treatment of diarrhea-IBS, only a few proved by randomized clinical trial. To prove the efficacy of Lactobacillus gasseri BNR17 isolated from breast milk in patients with diarrhea-IBS, prospective, randomized, placebo controlled clinical trial was done including health related-quality of life analysis, colon transit time, and the changes of fecal microbiota. BNR17 significantly improved the symptoms of diarrhea compared to control group. Health related-QOL analysis showed significant improvement of abdominal pain, distension, disturbed daily life, and mean defecation frequency with BNR17. On comparative CTT before and after BNR17, 6 out of 24 subjects showed significant correction of rapid colon transit pattern, while only 2 out of 24 in placebo (p<0.01). Upon fecal microbiota analysis, BNR17 significantly increased B. fecalis, E. rectale, C. aerofaciens, F. prausnitzil and B. steroris. Conclusively, Lactobacillus gasseri BNR17 can be a potential probiotics to ameliorate diarrhea-IBS.

Self-administered health literacy instruments for people with diabetes: systematic review of measurement properties.

AIMS: The aims of this study were to identify all available self-administered instruments measuring health literacy in people with diabetes and to determine the current instrument that is the most appropriate for applying to this population in both practice and research. DESIGN: A systematic review of measurement properties. DATA SOURCES: MEDLINE, EMBASE and CINAHL electronic databases from their inception up to 28 March 2016. REVIEW METHOD: The methodological quality of each included study was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The reported results for measurement properties in the studies were assessed according to Terwee's quality criteria. RESULTS: Thirteen self-administered instruments measuring health literacy in people with diabetes were identified, of which six (44%) were diabetes-specific instruments. The instruments that covered the broadest contents of health literacy were the Health Literacy Scale and Health Literacy Questionnaire. The (test-retest) reliability, measurement error and responsiveness were not evaluated for any instrument, while internal consistency and hypothesis testing validity were the most frequently assessed measurement properties. CONCLUSIONS: With the current evidence, the Health Literacy Scale may be the most appropriate instrument for patients with diabetes in practice and research. However, the structural validity of this scale needs to be further established, particularly in other language versions. It is also recommended to use the Diabetes Numeracy Test-15 along with the Health Literacy Scale to complement the lack of numeracy measures in the Health Literacy Scale.

Psychometric evaluation of the Korean version of the Suicidal Ideation Scale in mentally ill patients living in the community.

OBJECTIVE: The purpose of this study was to translate the Suicidal Ideation Scale (SIS) into Korean (SIS-K) and then evaluate its psychometric properties in mentally ill Korean patients living in the community. METHODS: The SIS-K was translated into Korean using a translation and back-translation technique. A sample of 396 patients with mental disorders was recruited from regional mental health centres in Korea. Factorial-construct validity was tested using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The data were randomly split into two subsamples: one used for EFA to identify the underlying structure of the items, and the other used for CFA to test whether the underlying structure was supported by actual data. Convergent validity, known-groups validity and internal-consistency reliability were tested. RESULTS: Exploratory factor analysis extracted nine items clustered into two subscales that accounted for 68.59% of the variance. One item ('I feel there is no solution to my problems other than taking my own life') was deleted. The structure of the two subscales was supported by CFA. The SIS-K score was moderately correlated with depression, and the scale demonstrated convergent validity. The SIS-K scores were significantly higher in patients who had attempted suicide, implying the presence of satisfactory known-groups validity. Cronbach's alpha of the total SIS-K was 0.91. CONCLUSIONS: The study has demonstrated the excellent psychometric properties of the SIS-K. The SIS-K is brief and easy to complete, and so it can be applied in both practice and research to patients with mental disorders. This cultural validation of the SIS-K will promote both domestic and international studies of suicidal ideation.

Irritable bowel syndrome-specific health-related quality of life instrument: development and psychometric evaluation.

BACKGROUND: Health-related quality of life (HRQOL) is an important outcome indicator for chronic disease, and particularly in the absence of biological markers for illness, such as with irritable bowel syndrome (IBS). The aims of this study were to develop and evaluate a new IBS-specific HRQOL instrument (IBS-HR-QOL). METHODS: This methodological study comprised three steps: conceptualization of the IBS-HR-QOL, item extraction and establishment of content validity, and psychometric evaluation of the instrument with 267 IBS patients recruited from four university hospitals. RESULTS: The content validity of the developed IBS-HR-QOL was assessed by 11 experts. Exploratory and confirmatory factor analyses yielded four factors. The criterion and convergent validities of the IBS-HR-QOL were demonstrated using the Short Form-36 and the Hospital Anxiety and Depression Scale, respectively. Known-groups validity was demonstrated using a symptom-severity scale. The internal consistency reliability and test-retest reliability were satisfactory, with a Cronbach's alpha and intraclass correlation coefficient of 0.93 and 0.88, respectively. CONCLUSIONS: The IBS-HR-QOL comprises a total of 16 items. The IBS-HR-QOL demonstrated good psychometric properties. This instrument is easily comprehensible and short, rendering it feasible for use in clinical practice and research.

A systematic review of measurement properties of the instruments measuring health-related quality of life in patients with irritable bowel syndrome.

PURPOSE: The systematic review of patient-reported outcome instruments can allow the selection of the most appropriate instrument for use in research and clinical practice. There has been no systematic review of the measurement properties of irritable bowel syndrome (IBS)-specific health-related quality-of-life (HRQOL) instruments. The purposes of this study were to identify all available instruments for measuring the IBS-specific HRQOL and to determine which is the most appropriate instrument to apply in clinical practice. METHODS: A systematic review study was conducted. The MEDLINE, EMBASE, and CINAHL databases were searched. The methodological quality of the included studies was assessed using the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist. The measurement property results of each study were assessed using Terwee's quality criteria. RESULTS: Seven instruments were identified: The Irritable Bowel Syndrome-Quality of Life (IBS-QOL) instrument was the only one that had been analyzed in multiple studies, with each of the remaining six instruments only being analyzed in a single psychometric study. The IBS-QOL demonstrated moderate positive evidence for internal consistency and reliability and is the best instrument based on the currently available evidence. CONCLUSIONS: Even though the IBS-QOL is currently the best instrument, there is conflicting evidence for its underlying structural validity. The factor structure or dimensionality of the IBS-QOL needs to be elucidated further.

Korean versions of the Perceived Stress Scale (PSS-14, 10 and 4): psychometric evaluation in patients with chronic disease.

BACKGROUND: The Perceived Stress Scale (PSS) is a representative instrument used to measure stress. The original PSS comprises 14 items (PSS-14) in two subscales, but 10- and 4-item versions are also available (PSS-10 and 4, respectively). The target populations of psychometric studies using the PSS have far mainly comprised college students, and the underlying constructs of the PSS versions are controversial: one factor vs. two factors and first order vs. second order. OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the Korean versions of the PSS-14, 10 and 4 (designated KPSS-14, 10 and -4, respectively) in patients with chronic disease. METHODS: The PSS-14, 10 and 4 were translated into Korean using forward and backward translation. Factorial construct validity was tested using both exploratory and confirmatory factor analyses. Item convergent validity and item discriminant validity were tested. Concurrent validity was examined using the Center for Epidemiologic Studies-Depression scale. Known-groups validity was analysed using t-test and effect size. Reliability was tested using Cronbach's alpha and the intraclass correlation coefficient. RESULTS: Exploratory factor analysis supported a two-factor model for all Korean versions of the PSS, and confirmatory factor analysis indicated that the model fit the KPSS-10 well and the KPSS-4 only marginally. The testing of item convergent and discriminant validity revealed a 100% scaling success. As expected, all scores in the KPSS-14, 10 and 4 were moderately correlated with depression scores and differed significantly according to gender. The Cronbach's alpha for the KPSS-14 and 10 exceeded the criterion of 0.70. The intraclass correlation coefficient values of all three Korean versions were satisfied. CONCLUSIONS: The KPSS-10 exhibited a first-order, two-factor construct, and excellent reliability and validity were established for Korean patients with chronic disease. The psychometric properties of the shortest version, KPSS-4, were only marginally acceptable.

Measurement of diabetes-related emotional distress using the Problem Areas in Diabetes scale: psychometric evaluations show that the short form is better than the full form.

BACKGROUND: The Problem Areas in Diabetes (PAID) scale is widely used for measuring diabetes-related emotional distress. There has been debate over the last 2 decades about the underlying factorial-construct validity of the PAID, with one- to four-factor structures being reported. A short form of the PAID, which comprises five items (PAID-5), was recently developed using Western patients with type 2 diabetes. This study measured the psychometric properties of the full and short forms of the PAID in Korean patients with type 2 diabetes, with the aim of determining which form is preferable. METHODS: The PAID and PAID-5 were translated into Korean (K-PAID and K-PAID-5, respectively) using a forward-and-backward translation technique. The study participants were recruited from university hospitals. The factorial-construct, convergent, and known-groups validity, and internal-consistency and test-retest reliability of both the K-PAID and K-PAID-5 were evaluated. RESULTS: For the K-PAID, confirmatory factor analysis revealed a marginal fit to the one-, two-, three-, and four-factor models. The three- and four-factor models of the K-PAID partially satisfied the internal-consistency and test-retest reliability, and convergent and known-groups validity. For the K-PAID-5, confirmatory factor analysis demonstrated an excellent fit to the one-factor model, with a Cronbach's alpha of 0.87 and an intraclass correlation coefficient of 0.89. The K-PAID-5 satisfied the convergent validity, as evaluated using the Center for Epidemiologic Studies Depression Scale and hemoglobin A1c. Known-groups validity by gender was also satisfied. CONCLUSIONS: The K-PAID-5 demonstrated excellent psychometric properties as a one-factor scale. The brevity of the K-PAID-5 represents a major advantage in a practical context in that it may impose a minimum burden upon patients with diabetes.

Psychometric evaluation of the Korean version of the Diabetes Symptom Checklist-Revised (DSC-R) for patients with type 2 diabetes.

BACKGROUND: This study was to elucidate the psychometric properties of the Korean version of the Diabetes Symptom Checklist-Revised (K-DSC-R), which is a patient-reported outcome measure of diabetes symptom burden. METHODS: A sample of 432 Korean patients with diabetes was recruited from university hospitals. The data were analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), multitrait/multi-item correlation, Pearson's correlation, t-test, ANOVA, and Cronbach's alpha for construct, item-convergent/discriminant, concurrent, and known-groups validity, and internal consistency reliability. RESULTS: EFA extracted a total of 29 items clustered into 7 subscales from the K-DSC-R. The construct of the seven-subscales was supported by CFA. The scaling success rates of item-convergent validity were 100% for all subscales, and those of item-discriminant validity ranged from 83.3% to 100%. Patients in more-depressed groups and in the HbA1c-uncontrolled group had higher K-DSC-R scores, satisfying the known-groups validity. The subscales of the K-DSC-R were moderately correlated with health-related quality of life, indicative of the established concurrent validity. The Cronbach's alpha of the K-DSC-R was 0.92. CONCLUSIONS: The psychometric properties of the K-DSC-R have been established. It is thus appropriate for use with respect to reliability and validity in practice and clinical trials for Korean patients with type 2 diabetes.

Measurement properties of rheumatoid arthritis-specific quality-of-life questionnaires: systematic review of the literature.

PURPOSE: This study conducted a systematic review of the methodological quality of the psychometric evaluation process and the quality of measurement properties of rheumatoid arthritis (RA)-specific health-related quality-of-life (HRQOL) questionnaires with the purpose of obtaining the best evidence to help in the selection of the most appropriate instrument for measuring HRQOL in RA patients. METHODS: A systematic literature search was performed to identify RA-specific HRQOL questionnaires in databases. The methodological quality of the studies was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The quality of the measurement properties was assessed using quality criteria. The evidence regarding the measurement properties was pooled using best-evidence synthesis, with considerations of the number and methodological quality of the studies, and the consistency of their findings in terms of the quality of the measurement properties. RESULTS: The search identified 37 studies describing 9 instruments. Best-evidence synthesis suggested that the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire had the strongest positive evidence, especially with respect to reliability, measurement error, and content validity, and moderate positive evidence with respect to hypothesis testing and responsiveness. CONCLUSIONS: The current evidence suggests that the best-validated instrument among the RA-specific HRQOL measures is the RAQoL questionnaire in terms of both methodological quality in the process of psychometric evaluation and the quality of the measurement properties. However, there is limited evidence regarding internal consistency and structural validity of the RAQoL. Further efforts are warranted to establish the psychometric quality of this questionnaire.

Measurement equivalence of touch-screen computerized and paper-based diabetes-specific quality-of-life questionnaires.

Current advances in technology have enabled the development of a computer-based questionnaire that provides advantages over the paper-based mode of administration, such as automatic data entry, storage and calculations. However, before implementing a computer-based questionnaire, its equivalence with the original paper-based questionnaire must first be demonstrated. The purpose of this study was to evaluate the measurement equivalence of the computerized Diabetes-Specific Quality-of-Life questionnaire (cD-QOL) with its original paper-based counterpart. A two-period crossover design was used in this study. The measurement equivalence was evaluated using quadratic weighted kappa coefficients, intraclass correlations and Cronbach's alpha comparisons. The cD-QOL was equivalent to its original paper-based counterpart. Participants preferred the cD-QOL over the paper-based questionnaire and reported that it was easy to use.

Relationship Between Electronic Health Literacy and Self-Management in People With Type 2 Diabetes Using a Structural Equation Modeling Approach.

BACKGROUND: Electronic health (eHealth) literacy is a relatively new concept used to determine health outcomes. However, it is not well known how eHealth literacy relates to health outcomes such as diabetes self-management. PURPOSE: This study was designed to examine the relationships among eHealth literacy, self-efficacy, social support, and self-management in people with Type 2 diabetes. METHODS: A cross-sectional design was used to examine secondary data from a field survey of people with Type 2 diabetes recruited from outpatient clinics from August to December 2021 ( N = 453). A structural equation model was used that first analyzed the measurement model using confirmatory factor analysis and then tested the hypothesized structural model to estimate the expected relationships among the study variables. The significance of the statistical estimates for the model was assessed based on the 95% bias-corrected bootstrap confidence interval from 5,000 bootstrap resamples. RESULTS: Significant, indirect relationships were found between eHealth literacy and self-management via self-efficacy (ß = 0.26, B = 0.17, 95% CI [0.10, 0.24]) and via social support and, in turn, self-efficacy (ß = 0.08, B = 0.05, 95% CI [0.04, 0.08]). eHealth literacy, social support, and self-efficacy together explained 58.1% of the variance in self-management. CONCLUSION/IMPLICATIONS FOR PRACTICE: This study provides new evidence regarding how eHealth literacy relates to self-management in people with Type 2 diabetes via two indirect pathways, including self-efficacy alone and social support and self-efficacy in series. An eHealth literacy program for self-management should be developed in clinical practice that includes strategies for inducing synergistic effects from self-efficacy and social support on self-management in people with Type 2 diabetes.