Ensuring cross-cultural data comparability by means of anchoring vignettes in heterogeneous refugee samples.

BACKGROUND: Configural, metric, and scalar measurement invariance have been indicators of bias-free statistical cross-group comparisons, although they are difficult to verify in the data. Low comparability of translated questionnaires or the different understanding of response formats by respondents might lead to rejection of measurement invariance and point to comparability bias in multi-language surveys. Anchoring vignettes have been proposed as a method to control for the different understanding of response categories by respondents (the latter is referred to as differential item functioning related to response categories or rating scales: RC-DIF). We evaluate the question whether the cross-cultural comparability of data can be assured by means of anchoring vignettes or by considering socio-demographic heterogeneity as an alternative approach. METHODS: We used the Health System Responsiveness (HSR) questionnaire and collected survey data in English (n = 183) and Arabic (n = 121) in a random sample of refugees in the third largest German federal state. We conducted multiple-group Confirmatory Factor Analyses (MGCFA) to analyse measurement invariance and compared the results when 1) using rescaled data on the basis of anchoring vignettes (non-parametric approach), 2) including information on RC-DIF from the analyses with anchoring vignettes as covariates (parametric approach) and 3) including socio-demographic covariates. RESULTS: For the HSR, every level of measurement invariance between the Arabic and English languages was rejected. Implementing rescaling or modelling on the basis of anchoring vignettes provided superior results over the initial MGCFA analysis, since configural, metric and - for ordered categorical analyses-scalar invariance could not be rejected. A consideration of socio-demographic variables did not show such an improvement. CONCLUSIONS: Surveys may consider anchoring vignettes as a method to assess cross-cultural comparability of data, whereas socio-demographic variables cannot be used to improve data comparability as a standalone method. More research on the efficient implementation of anchoring vignettes and further development of methods to incorporate them when modelling measurement invariance is needed.

Measurement invariance in the social sciences: Historical development, methodological challenges, state of the art, and future perspectives.

This review summarizes the current state of the art of statistical and (survey) methodological research on measurement (non)invariance, which is considered a core challenge for the comparative social sciences. After outlining the historical roots, conceptual details, and standard procedures for measurement invariance testing, the paper focuses in particular on the statistical developments that have been achieved in the last 10 years. These include Bayesian approximate measurement invariance, the alignment method, measurement invariance testing within the multilevel modeling framework, mixture multigroup factor analysis, the measurement invariance explorer, and the response shift-true change decomposition approach. Furthermore, the contribution of survey methodological research to the construction of invariant measurement instruments is explicitly addressed and highlighted, including the issues of design decisions, pretesting, scale adoption, and translation. The paper ends with an outlook on future research perspectives.

[Barriers and Potential Improvements in the Diagnosis and Treatment of Asylum Seekers with Tuberculosis in Germany: A Qualitative Study]. / Hemmnisse und Verbesserungspotenziale bei der Diagnose und der Therapie asylsuchender Tuberkulosepatienten in Deutschland: Ergebnisse einer qualitativen Untersuchung.

Since 2014, the number of new cases of tuberculosis (TB) has risen in Germany by about 20%. This coincides with a large number of people applying for asylum in Germany. Some of them are from countries in which TB is much more prevalent than in Germany. The objectives of this contribution are to identify and explain barriers in the diagnosis and treatment of asylum seekers with TB and potential improvements in those fields. Data are derived from 14 problem-centred interviews that were carried out with doctors and staff from public health offices, representing the views of experts in the field of health care. On the one hand, the results suggest that structural factors are responsible for some of the barriers mentioned by the experts. For example, the restricted access to health care for asylum seekers leads to a delayed diagnosis since they visit the doctor too late (if at all). Accordingly, a nationwide implementation of an electronic health card for asylum seekers was proposed. On the other hand, individual and cultural factors play important roles as well. To those belong language barriers: they not only complicate history taking and diagnosis, but also educating patients about their disease and therapy. Moreover, the lack of knowledge concerning the German health care system increases the risk of treatment interruptions. To alleviate those problems, experts propose to carry out train-the-trainer-programmes and to install "guides" who pilot asylum seekers with TB through the German health care system.

Health monitoring among asylum seekers and refugees: a state-wide, cross-sectional, population-based study in Germany.

BACKGROUND: Health monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient and marginalized groups such as asylum seekers and refugees (ASR). We aim to advance current health monitoring approaches and obtain reliable estimates on health status and access to essential healthcare services among ASR in Germany's third largest federal state, Baden-Württemberg. METHODS: We conducted a state-wide, cross-sectional, population-based health monitoring survey in nine languages among ASR and their children in collective accommodation centres in 44 districts. Questionnaire items capturing health status, access to care, and sociodemographic variables were taken from established surveys and translated using a team approach. Random sampling on the level of 1938 accommodation centres with 70,634 ASR was employed to draw a balanced sample of 65 centres with a net sample of 1% of the state's ASR population. Multilingual field teams recruited eligible participants using a "door-to-door" approach. Parents completed an additional questionnaire on behalf of their children. RESULTS: The final sample comprised 58 centres with 1843 ASR. Of the total sample expected eligible (N = 987), 41.7% (n = 412) participated in the survey. Overall, 157 households had children and received a children's questionnaire; 61% (n = 95) of these were returned. Age, sex, and nationality of the included sample were comparable to the total population of asylum applicants in Germany. Adults reported longstanding limitations (16%), bad/very bad general health (19%), pain (25%), chronic illness (40%), depression (46%), and anxiety (45%). 52% utilised primary and 37% specialist care services in the previous 12 months, while reporting unmet needs for primary (31%) and specialist care (32%). Younger and male participants had above-average health status and below-average utilisation compared to older and female ASR. CONCLUSIONS: Our health monitoring survey yielded reliable estimates on health status and health care access among ASR, revealing relevant morbidities and patterns of care. Applying rigorous epidemiological methods in linguistically diverse, transient and marginalized populations is challenging, but feasible. Integration of this approach into state- and nation-wide health monitoring strategies is needed in order to sustain this approach as a health planning tool.

On the Importance of Coefficient Alpha for Measurement Research: Loading Equality Is Not Necessary for Alpha's Utility as a Scale Reliability Index.

The population relationship between coefficient alpha and scale reliability is studied in the widely used setting of unidimensional multicomponent measuring instruments. It is demonstrated that for any set of component loadings on the common factor, regardless of the extent of their inequality, the discrepancy between alpha and reliability can be arbitrarily small in any considered population and hence practically ignorable. In addition, the set of parameter values where this discrepancy is negligible is shown to possess the same dimensionality as that of the underlying model parameter space. The article contributes to the measurement and related literature by pointing out that (a) approximate or strict loading identity is not a necessary condition for the utility of alpha as a trustworthy index of scale reliability, and (b) coefficient alpha can be a dependable reliability measure with any extent of inequality in the component loadings.

On the Relationship Between Item Stem Formulation and Criterion Validity of Multiple-Component Measuring Instruments.

The possible dependency of criterion validity on item formulation in a multicomponent measuring instrument is examined. The discussion is concerned with evaluation of the differences in criterion validity between two or more groups (populations/subpopulations) that have been administered instruments with items having differently formulated item stems. The case of complex item stems involving two stimuli description sentences (double-barreled questions) is thereby compared with the setting where items contained a single sentence. Using empirical data, the latent criterion validity differences are evaluated across three groups that are randomly assigned to conditions characterized by item stems with differing number of stimuli. The results indicate that validity of an instrument can be influenced by the specific way item stem is formulated. Implications for empirical educational, behavioral, and social science research are discussed.

Evaluation of Second- and Third-Level Variance Proportions in Multilevel Designs With Completely Observed Populations: A Note on a Latent Variable Modeling Procedure.

Two- and three-level designs in educational and psychological research can involve entire populations of Level-3 and possibly Level-2 units, such as schools and educational districts nested within a given state, or neighborhoods and counties in a state. Such a design is of increasing relevance in empirical research owing to the growing popularity of large-scale studies in these and cognate disciplines. The present note discusses a readily applicable procedure for point-and-interval estimation of the proportions of second- and third-level variances in such multilevel settings, which may also be employed in model choice considerations regarding ensuing analyses for response variables of interest. The method is developed within the framework of the latent variable modeling methodology, is readily utilized with widely used software, and is illustrated with an example.

Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems.

Financial toxicity is a side effect of cancer that results from the perceived financial distress an individual may experience in the course of the disease. The purpose of this paper is to analyse underlying factors related to subjective financial distress in high-income countries with universal healthcare coverage. A systematic literature review was conducted to identify qualitative and quantitative studies of cancer patient-reported subjective financial distress by performing a search in the databases of PubMed, PsycINFO and CINAHL up to December 2020. A qualitative synthesis was performed linking the time-dependent occurrence of risk factors to derived categories of risk factors. Out of 4321 identified records, 30 quantitative and 16 qualitative studies were eligible. Classification of risk factors resulted in eight categories with a total of 34 subcategories. Subjective financial distress is primarily determined by pre-diagnosis sociodemographic- factors as well as financial and work factors that might change during the course of the disease. The design of healthcare and social security systems shapes the country-specific degree of subjective financial distress. Further research should focus on evolving multidisciplinary intervention schemes and multidimensional instruments for subjective financial distress to account for identified risk factors in universal healthcare systems more precisely.

Multiple-Component Measurement Instruments in Heterogeneous Populations: Is There a Single Coefficient Alpha?

This note confronts the common use of a single coefficient alpha as an index informing about reliability of a multicomponent measurement instrument in a heterogeneous population. Two or more alpha coefficients could instead be meaningfully associated with a given instrument in finite mixture settings, and this may be increasingly more likely the case in empirical educational and psychological research. It is argued that in such situations explicit examination of class-invariance in the alpha coefficient must precede any statements about its possible value in the studied population. The approach permits also the evaluation of between-class alpha differences as well as point and interval estimation of the within-class alpha coefficients. The method can similarly be used in situations with (a) known class membership when distinct (sub)populations are investigated while their number is known beforehand and membership in them is observed for studied persons, as well as (b) in settings where only the number of latent classes is known for a population under investigation. The outlined procedure is illustrated with numerical data.

Studying Latent Criterion Validity for Complex Structure Measuring Instruments Using Latent Variable Modeling.

Validity coefficients for multicomponent measuring instruments are known to be affected by measurement error that attenuates them, affects associated standard errors, and influences results of statistical tests with respect to population parameter values. To account for measurement error, a latent variable modeling approach is discussed that allows point and interval estimation of the relationship of an underlying latent factor to a criterion variable in a setting that is more general than the commonly considered homogeneous psychometric test case. The method is particularly helpful in validity studies for scales with a second-order factorial structure, by allowing evaluation of the relationship between the second-order factor and a criterion variable. The procedure is similarly useful in studies of discriminant, convergent, concurrent, and predictive validity of measuring instruments with complex latent structure, and is readily applicable when measuring interrelated traits that share a common variance source. The outlined approach is illustrated using data from an authoritarianism study.

Reliability of Scales With Second-Order Structure: Evaluation of Coefficient Alpha's Population Slippage Using Latent Variable Modeling.

A readily applicable procedure is discussed that allows evaluation of the discrepancy between the popular coefficient alpha and the reliability coefficient of a scale with second-order factorial structure that is frequently of relevance in empirical educational and psychological research. The approach is developed within the framework of the widely used latent variable modeling methodology and permits point and interval estimation of the slippage of alpha from scale reliability in a population under investigation. The method is useful when examining the consistency of complex structure measuring instruments assessing higher order latent constructs and, under its assumptions, represents a generally recommendable alternative to coefficient alpha. The outlined procedure is illustrated using data from an authoritarianism study.

Examining Measurement Invariance and Differential Item Functioning With Discrete Latent Construct Indicators: A Note on a Multiple Testing Procedure.

A latent variable modeling method for studying measurement invariance when evaluating latent constructs with multiple binary or binary scored items with no guessing is outlined. The approach extends the continuous indicator procedure described by Raykov and colleagues, utilizes similarly the false discovery rate approach to multiple testing, and permits one to locate violations of measurement invariance in loading or threshold parameters. The discussed method does not require selection of a reference observed variable and is directly applicable for studying differential item functioning with one- or two-parameter item response models. The extended procedure is illustrated on an empirical data set.

Can Reliability of Multiple Component Measuring Instruments Depend on Response Option Presentation Mode?

This article examines the possible dependency of composite reliability on presentation format of the elements of a multi-item measuring instrument. Using empirical data and a recent method for interval estimation of group differences in reliability, we demonstrate that the reliability of an instrument need not be the same when polarity of the response options for its individual components differs across administrations of the instrument. Implications for empirical educational, behavioral, and social research are discussed.

Methodological Aspects of Focus Groups in Health Research: Results of Qualitative Interviews With Focus Group Moderators.

Although focus groups are commonly used in health research to explore the perspectives of patients or health care professionals, few studies consider methodological aspects in this specific context. For this reason, we interviewed nine researchers who had conducted focus groups in the context of a project devoted to the development of an electronic personal health record. We performed qualitative content analysis on the interview data relating to recruitment, communication between the focus group participants, and appraisal of the focus group method. The interview data revealed aspects of the focus group method that are particularly relevant for health research and that should be considered in that context. They include, for example, the preferability of face-to-face recruitment, the necessity to allow participants in patient groups sufficient time to introduce themselves, and the use of methods such as participant-generated cards and prioritization.