The psychometric properties of the Physical Resilience Instrument for Older Adults (PRIFOR): a Rasch analysis.

BACKGROUND: Prior psychometric evidence of the Physical Resilience Instrument for Older Adults (PRIFOR) showed good criterion-related validity, concurrent validity, known-group validity, predictive validity, and internal consistency. However, it is unclear whether older patients with different treatment diagnoses interpret the PRIFOR similarly. AIMS: This study aimed to test the psychometric properties of the PRIFOR scores among different treatment diagnoses of older patients. METHODS: We recruited 413 hospitalized older patients with a medical diagnosis and 207 with a surgical diagnosis in a 1343-bed tertiary-care medical center in Taiwan. Data analyses included Rasch models, Principal Components Analysis (PCA), and Pearson correlations. RESULTS: The Rasch analyses showed that all PRIFOR items were embedded within their belonged constructs, reflecting good construct validity and unidimensionality. Person and item separation reliability support the internal consistency of the studied samples and PRIFOR items. However, six PRIFOR items were found to have meaningful differential item functioning (DIF) problems among treatment diagnoses. CONCLUSIONS: The PRIFOR is a solid measurement and can be used for monitoring the status of older adults' physical resilience. However, because six items were found to have meaningful DIF among treatment diagnosis groups, future studies should consider designing specific items for different patient populations to assess their needs in physical resilience.

Examining Patient Outcomes at a Faculty-Led Clinic for Uninsured and Underserved Clients.

IMPORTANCE: Routine measurements used in clinical settings can foster evidence-based interventions and show the treatment effectiveness. OBJECTIVE: To examine the efficacy of occupational therapy services for health outcomes, as determined by modified self-care and mobility items of the Continuity Assessment Record and Evaluation Tool, also known as Section GG. DESIGN: Retrospective and longitudinal. Data were obtained from medical records at four time points over 1 yr. SETTING: The study took place at a pro bono, faculty-led clinic. PARTICIPANTS: Ninety-one client charts were reviewed; 64 (70%) clients met the inclusion criteria and were enrolled. INTERVENTIONS: Interventions were provided by registered occupational therapists and entry-level occupational therapy students under supervision. OUTCOMES AND MEASURES: Self-care and mobility function were measured using modified GG0130 and GG0170 items from the Centers for Medicare & Medicaid Services Quality Reporting Program; three additional functional items were added. The 36-Item Short Form Health Survey, Version 2® (SF-36v2) was used to evaluate clients' quality of life at intake. RESULTS: Self-care and mobility composites significantly improved throughout the 1-yr intervention period. The additional functional composite significantly improved during the first 6 mo. Clients' scores on the physical function subdomain of the SF-36v2 were significantly related to their self-care, mobility, and additional functional items. CONCLUSIONS AND RELEVANCE: Faculty-led clinics can improve the occupational performance of clients in need of occupational therapy services, particularly in the areas of self-care and mobility, which have previously been identified as top priorities for clients. What This Article Adds: This study addressed health disparities in unique and effective ways. By using objective measures of functional mobility and self-care, the study provides robust evidence of the faculty-led clinic's impact in providing underserved and uninsured communities with effective client-centered occupational therapy services.

Burdens on caregivers of patients with stroke during a pandemic: relationships with support satisfaction, psychological distress, and fear of COVID-19.

BACKGROUND: Caregivers have faced unprecedented circumstances throughout the COVID-19 pandemic, but previous research only minimally addresses the caregivers' burden. Therefore, this study aimed to investigate the relationship between caregiver burden, psychological stress, satisfaction with support, and fear of COVID-19 in caregivers of patients with stroke during the pandemic. METHODS: A cross-sectional survey study with total of 171 caregivers of patients with stroke in a community hospital in Taiwan. All participants completed the Zarit Burden Interview, Depression, Anxiety, Stress Scale (DASS-21), satisfaction of support survey, and Fear of COVID-19 Scale. Pearson correlations were used to examine the bivariate correlations between study variables. Then, with the control of demographic confounders, a multiple linear regression model was applied with significant variables to construct and explain caregiver burden. RESULTS: The proposed model significantly explained the caregiver burden of caregivers of patients with stroke. Specifically, the caregiver burden was negatively correlated with satisfaction with family support, but positively with psychological distress and the fear of COVID-19. CONCLUSIONS: Caregivers of patients with stroke will suffer a greater burden if they have lower satisfaction with family support, experienced higher psychological distress, and perceived more fear of the COVID-19 pandemic. Health professionals must address these concerns, support caregivers, and enhance available resources.

Perceiving Therapeutic Communication: Client-Therapist Discrepancies.

IMPORTANCE: Few studies have examined differences in clients' and therapists' perspectives on therapeutic communication; this article contributes to the knowledge base. OBJECTIVE: To examine clients' and therapists' real-time perceptions of therapeutic communication. DESIGN: Observational, quantitative, cross-sectional study. SETTING: Inpatient and outpatient units of a large urban teaching hospital. PARTICIPANTS: Clients (n = 110) and rehabilitation therapists (n = 38; occupational, physical, and speech). OUTCOMES AND MEASURES: Demographic characteristics, Clinical Assessment of Modes (CAM). RESULTS: Clients perceived that therapists communicated by instructing more, and therapists reported empathizing more. CONCLUSIONS AND RELEVANCE: The findings suggest that clients and therapists may perceive therapeutic communication differently. What This Article Adds: This article supports therapists' use of the CAM to examine multiple perspectives on their communication mode use, as described in the Intentional Relationship Model.

Exploring Culture and Therapeutic Communication: Therapeutic Mode Use by Occupational Therapists in the United States and Singapore.

IMPORTANCE: According to the Intentional Relationship Model, six therapeutic modes characterize client-therapist interactions in occupational therapy: advocating, collaborating, empathizing, encouraging, instructing, and problem solving. However, whether these modes hold across cultural contexts is not clear. OBJECTIVE: To compare therapeutic mode use in occupational therapy interactions in the United States and Singapore. DESIGN: Cross-sectional observational study; questionnaires were collected and compared from two convenience samples of occupational therapists from the United States and Singapore, and results were analyzed using t tests and general linear modeling. SETTING: Large tertiary hospitals. PARTICIPANTS: Occupational therapists were recruited if they had at least 6 mo experience in their clinical specialty. Adult client participants were recruited if they had or planned to have at least three occupational therapy sessions. OUTCOMES AND MEASURES: The therapist version of the Clinical Assessment of Modes (CAM-T) was used to assess occupational therapists' therapeutic mode use in interactions with specific clients. RESULTS: A total of 74 U.S. and 39 Singaporean client-therapist interactions were assessed. U.S. therapists were more likely to use the upper end of the response scale; after we corrected for this, the pattern of mode use was similar in both cultural contexts, with instructing mode used the most. In absolute terms, U.S. therapists used the instructing mode more frequently than Singaporean therapists. CONCLUSION AND RELEVANCE: Further research should be done to examine the sociocultural factors that affect responses on the CAM-T and mode use. WHAT THIS ARTICLE ADDS: This study is the first to compare therapeutic mode use in different cultural settings. With the globalization of occupational therapy practice, it is important to consider the generalizability of occupational therapy concepts across cultures.

Online Module for Carrier Screening in Ashkenazi Jewish Individuals Compared with In-Person Genetics Education: A Randomized Controlled Trial.

To increase accessibility to genetics services for low-urgency patients seeking Ashkenazi Jewish (AJ) carrier screening, we designed an interactive computer (IC) module that provides pre-test genetics education and allows genetics professionals to order the test without meeting the patients beforehand. We compared this module with in-person genetic counseling (GC) using a randomized trial. AJ individuals were randomized to undergo genetics education via the IC module (n = 26) or GC (n = 28). We compared post-interventional genetics knowledge, perceived genetic risk, and anxiety between the two groups, after accounting for pre-interventional scores, using ANCOVA. Wilcoxon Rank-Sum test was used to compare post-interventional satisfaction. Post-interventional genetics knowledge, risk perception, or anxiety were not significantly different between the two groups after accounting for baseline scores (p = 0.50-0.54), although the data are inconclusive regarding the module's non-inferiority at a 5% margin. Post-intervention satisfaction scores were generally higher in the GC group than the IC module group. Our IC module has the potential to improve access to clinical genetics services for patients and staff, but it is not suitable for all AJ patients and cannot completely replace the benefits of in-person consultations.

The test-retest reliability and the minimal detectable change of the Purdue pegboard test in schizophrenia.

BACKGROUND/PURPOSE: The Purdue pegboard test is widely used in measuring the hand dexterity of patients with schizophrenia. In patients with schizophrenia, the test-retest reliability and minimal detectable change (MDC) of this test remain largely unknown, limiting the interpretability of this popular measure. The purpose of this study was to estimate the test-retest reliability and the MDC of the Purdue pegboard test for patients with schizophrenia. METHODS: A total of 147 patients with schizophrenia participated in this study. The participants were administrated the five subtests of the Purdue pegboard test, three trials in a row at both of the two sessions 1 week apart. The intraclass correlation coefficient (ICC) was used to examine the test-retest reliability and the MDC was calculated on the basis of standard error of measurement. RESULTS: The test-retest reliabilities of the five subtests were moderate to good (ICC = 0.73-0.88). The MDC (MDC%) was 3.0 (22.9%) for the dominant hand subtest, 3.1 (26.1%) for the nondominant hand subtest, 3.0 (31.7%) for the both hands subtest, 6.1 (17.7%) for the dominant + nondominant + both hands subtest, and 8.5 (35.3%) for the assembly subtest. CONCLUSION: Our results reveal that the Purdue pegboard test has moderate-to-good test-retest reliability but substantial random measurement error. These findings should enable clinicians and researchers to monitor and interpret the changes in the hand dexterity of patients with schizophrenia more accurately and confidently.

Evaluating the Psychometric Properties of a Clinical Vocational Rehabilitation Outcome Measurement: The Assessment of Work Performance (AWP).

This study examined the validity and reliability of the Assessment of Work Performance (AWP) using Rasch analysis. The AWP was administered to 365 clients with a variety of work-related problems. Rasch analysis and principal component analysis were used to examine the appropriateness of the rating scales and unidimensionality of AWP items. The person-response validity, internal consistency, targeting appropriateness, and differential item function were also analyzed. The Rasch analysis confirmed the 4-point rating scale, and the item set met the criteria of unidimensionality. The AWP exhibited satisfactory person-response validity and internal consistency. Among the three subdomains, the targeting of item-difficulty was sufficient in the motor skills and process skills subdomains. Differential item functioning was found across gender and diagnoses. This study presented evidence to support that the AWP functioned as a reliable and valid assessment in assessing work performance. [OTJR: Occupation, Participation and Health 2013;33(3):125-133.].

Differential item functioning for the Tendency of Avoiding Physical Activity and Sport Scale across two subculture samples: Taiwanese and mainland Chinese university students.

Aims: The aims of the study were to examine the differential item functioning (DIF) of the Tendency of Avoiding Physical Activity and Sport Scale (TAPAS) among three subgroups (gender, weight status, and region) and to test the construct and concurrent validities of the scale. Methods: Using an online survey, university students (608 Taiwanese and 2319 mainland Chinese) completed the TAPAS. Rasch analysis examined if all the 10 TAPAS items fitted the same construct and displayed no substantial DIF across three subgroups: gender (male vs. female), weight status (overweight vs. non-overweight), and region (Taiwan vs. China). Concurrent validity was examined using the scores on the Weight Self-Stigma Questionnaire (WSSQ) and Weight Bias Internalization Scale (WBIS). Results: All TAPAS items, except for Item 10 ("Prefer to participate in physical activity in a more private setting"), fitted the same construct. None of the TAPAS items displayed DIF in any of the subgroups except for Item 10 across participants from Taiwan and China (DIF contrast = -1.41). Conclusion: The TAPAS can appropriately assess the tendency to avoid physical activity and sport among both Taiwanese and mainland Chinese university students. However, Item 10 may need to be further examined.

The tendency to avoid physical activity and sport scale (TAPAS): Rasch analysis with differential item functioning testing among a Chinese sample.

BACKGROUND: The benefits of physical activity are well-known to prevent multiple long-term health conditions. Physical appearance and weight-related stigma may influence individuals' decision to engage in physical activity and sport. Therefore, the present study examined the psychometric properties of a newly developed instrument, the Tendency to Avoid Physical Activity and Sport Scale (TAPAS), using modern test theory. METHODS: A total of 2319 university students were recruited from mainland China and they completed the TAPAS. Rasch analysis was used to examine the TAPAS' rating scaling functioning, test unidimensionality, item hierarchy, ceiling and floor effects, and differential item functioning (DIF). Moreover, the concurrent validity of the TAPAS was examined using the Weight Self-Stigma Questionnaire (WSSQ), Weight Bias Internalization Scale (WBIS), and body mass index (BMI). RESULTS: Unidimensionality was confirmed except for one item. Items corresponding to attitude toward physical activity were more easily adopted compared to items corresponding to actual behavioral aspects. No ceiling and floor effects were found. No DIF existed in the TAPAS items. The TAPAS was strongly correlated with both the WSSQ and WBIS, but not BMI. CONCLUSION: The study showed that overall, the TAPAS has robust psychometric properties. However, future research needs to address the misfit item and explore the feasibility of applying the TAPAS to other populations including wider ethnic groups, age ranges, and life stages.

(Lack of) genetic diversity in immune genes predates glacial isolation in the North American mountain goat (Oreamnos americanus).

The major histocompatibility complex (MHC) plays an important role in an organism's ability to respond to pathogens. Immunogenetic diversity is advantageous as it permits the recognition of more external antigens. For this reason, MHC and immune gene variation are considered a barometer for the genetic health of wild populations. Mountain goats (Oreamnos americanus) were previously shown to have little variation at the MHC Class II Oram-DRB locus, which was attributed to population bottlenecks during the last glacial maximum (LGM). In this paper, we extended the analysis of immunogenetic variability in mountain goats to 5 genes representing the 3 classes of MHC gene (Class I OLA, Class II DRA and DRB, and Class III TNF-α) and the natural resistance-associated macrophage protein. We sequenced approximately 3000 bp from 31 individuals sampled across the range of mountain goats and found very low levels of diversity (1-3 polymorphic sites per gene) with the exception of the Class I Oram-OLA gene. Oram-OLA was nearly 30 times more diverse than the other immune genes and appears to represent a source of increased immunogenetic diversity. This diversity may be attributed to multiple loci, mediated by pathogen exposure, or potentially influenced by social factors. The distribution of SNPs was not associated with refugial history, suggesting that the current distribution of immunogenetic diversity was present prior to the LGM. These data suggest that although they have low levels of diversity at the 4 of 5 immune loci, mountain goats may be better equipped for future climate oscillations and pathogen exposure than previously thought.

Unprecedented times and uncertain connections: A systematic review examining sleep problems and screentime during the COVID-19 pandemic.

Objective: Sleep has been impacted by the COVID-19 pandemic around the world. Furthermore, screen time has been reported to influence sleep and has increased during pandemic quarantines. This systematic review searched databases to determine if screen time affected sleep during the COVID-19 pandemic. Methods: PubMed, Nursing and Allied Health Proquest, and Science Direct Health and Lifescience college edition were searched for articles that fit the inclusion criteria. There were 2750 articles initially screened. Then, 119 articles were further assessed to determine eligibility, creating a final sample of 18 articles that explored whether screen time affected sleep. Results: After reviewing the included articles (n = 18), the main theme revealed that screen time negatively affected sleep during the COVID-19 pandemic, specifically aspects such as sleep duration, sleep quality, sleep onset latency, and wake time. However, several articles countered this implication. Therefore, it is important to consider other factors that may influence the relationship between screen time and sleep. Conclusions: Although the number of articles included is limited, the overall synthesis suggests that COVID-19-related lifestyle changes, such as increased screen time, may negatively affect sleep health. However, other unidentified factors may have contributed to these findings and warrant further research. Nonetheless, community leaders must consider the long-term consequences of the pandemic and implement initiatives to address sleep challenges due to the intricate connection between sleep and well-being.

Psychometric evaluation of the Relative Mastery Scale: An Occupational Adaptation instrument.

This study evaluated the psychometric properties of the Relative Mastery Scale (RMS). Valid and reliable client-centered instruments support practice in value-based health care and community-based settings. Participants were 368 community-dwelling adults aged 18 to 95 years. Researchers conducted validity and reliability examinations of the RMS using classical test theory and Rasch measurement model. A partial credit model allowed exploration of individual scale properties. Spearman's correlation coefficients between items were statistically significant at the .01 level. Cronbach's alpha coefficient was .94 showing strong internal consistency. In exploratory factor analysis, Factor 1 accounted for 71% of variance with an eigenvalue of 4.26. In Rasch analysis, the 5-point rating scale demonstrated adequate functioning, confirmed unidimensionality, and person/item separation. The RMS instrument demonstrates sound psychometric characteristics. A valid and reliable measure of internal occupational adaptation supports application to monitor progress of internal occupational adaptation across a variety of individuals.

Gay Community Stress Scale with Its Cultural Translation and Adaptions in Taiwan.

The present study aimed to adapt the Gay Community Stress Scale (GCSS) into the traditional Chinese version for measuring gay community stress experienced. Additionally, we examined its psychometric propensities among gay and bisexual men (GBM) in Taiwan. In total, 736 GBM participated in this study and completed the 35-item traditional Chinese version of the GCSS (29 items from the original GCSS and six items from the results of the focus group interviews among GBM in Taiwan); the Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG); the State-Trait Anxiety Inventory (STAI); and the Center for Epidemiological Studies Depression Scale (CES-D). Exploratory factor analysis results suggest a five-factor structure (i.e., Sex, Status, Competition, Exclusion, and Externals) for the 32-item traditional Chinese version of the GCSS among Taiwanese GBM; three items were deleted due to low factor loadings (i.e., <0.3). The five-factor "Externals" were not observed in the original GCSS. Moreover, the concurrent validity of the traditional Chinese version was supported by the positive correlations with MISS-LG, STAI, and CES-D. In conclusion, the traditional Chinese version of the GCSS showed relatively satisfactory psychometric properties. However, further research is needed to investigate the reasons for the possible etiology account for the different factor structures between the traditional Chinese version and the original GCSS.

Immunoglobulin VDJ repertoires reveal hallmarks of germinal centers in unique cell clusters isolated from zebrafish (Danio rerio) lymphoid tissues.

DNA mutagenesis during antibody affinity maturation has potentially oncogenic or autoimmune outcomes if not tightly controlled as it is in mammalian germinal centers. Cold blooded vertebrates lack germinal centers, yet have a functional Ig gene mutator enzyme, Aicda. In fish there are clusters of Aicda+ cells encircled by pigmented 'melano-macrophages' and we test the hypothesis that these clusters are functionally analogous to germinal centers. Sequenced IgH VDJ repertoire libraries from individual isolated clusters showed evidence of B-cell clonal expansion and VDJ somatic hypermutation. Construction of Ig clonal lineage trees revealed that unlike surrounding lymphoid tissue, each cluster is dominated by a few B-cell VDJ clonotypes having hundreds of mutated variants. Recruitment of B-cells to the clusters appears to be ongoing, as there are additional Ig clones having smaller lineages. Finally, we show evidence for positive selection for replacement mutations in regions encoding the antigen contact loops, but not in the framework regions, consistent with functional antibody modification. Melano-macrophages appear to trap the Ag used for post-mutation B-cell selection, performing a role analogous to the follicular dendritic cells of mammalian germinal centers. These findings provide insights into the evolution of the affinity maturation process, the improvement of fish vaccines and possibly also the workings of atypical ectopic germinal centers generated in several human diseases.

Associations between vaccination and quality of life among Taiwan general population: A comparison between COVID-19 vaccines and flu vaccines.

The COVID-19 pandemic has profoundly impacted lives worldwide and has led to global vaccination against COVID-19. However, there are concerns about the adverse effects of such vaccines on individuals' health. Therefore, it is important to investigate the association between vaccination and holistic health outcome (i.e., quality of life [QoL]). The present study analyzed data from the Taiwan Social Change Survey (TSCS), a survey conducted utilizing stratified random sampling. More specifically, data (N = 1425; 47.44% males; mean age = 50.58 y) on their vaccinations (including COVID-19 and flu vaccines) and QoL (using the Short-Form 12) were used. Participants were separated into two age subgroups for analyses (those aged below 50 y, and those 50 y or above). For participants aged below 50 y, those who received COVID-19 vaccine and those who received both COVID-19 and flu vaccines had significantly better physical QoL than those who did not receive any vaccination. Mental QoL was not significantly associated with vaccinations for participants aged below 50 y. Moreover, neither mental nor physical QoL was significantly associated with vaccinations for those aged 50 y or above. The present study showed that not having COVID-19 and flu vaccinations is associated with poor QoL. This finding should be disseminated to the public to help aid vaccination promotion.

Effects of sleep quality on the association between problematic internet use and quality of life in people with substance use disorder.

BACKGROUND: Problematic internet use, especially in people with substance use disorder, may negatively affect their quality of life (QoL). However, it is unclear whether sleep quality is a key mediator in the association between problematic internet use and QoL among people with substance use disorder. AIMS: This study aimed to investigate the relationship between problematic internet use and QoL and how sleep quality may mediate the association between these two variables. METHOD: Overall, 319 people (85% male) with substance use disorder (mean age 42.2 years, s.d. 8.9) participated in a cross-sectional study in Taiwan. The Smartphone Application-Based Addiction Scale, Bergan Social Media Addiction Scale, Internet Gaming Disorder-Short Form, Pittsburgh Sleep Quality Index and World Health Organization Quality of Life Questionnaire Brief Version were used. RESULTS: The prevalence of sleep problems was 56%. There were significant and direct associations between sleep quality and two types of problematic internet use, and between sleep quality and different dimensions of QoL. All types of problematic internet use were significantly and negatively correlated with QoL. Mediated effects of sleep quality in relationships between the different types of problematic internet use and all dimensions of QoL were significant, except for problematic use of social media. CONCLUSIONS: Different types of problematic internet use in people with substance use disorder may be directly associated with reduced QoL. Sleep quality as a significant mediator in this association may be an underlying mechanism to explain pathways between problematic internet use and QoL in this population.

Psychometric Evaluation of Three Versions of the UCLA Loneliness Scale (Full, Eight-Item, and Three-Item Versions) among Sexual Minority Men in Taiwan.

The UCLA Loneliness Scale, with different short versions, is widely used to assess levels of loneliness. However, whether the scale is valid in assessing loneliness among sexual-minority men is unknown. Additionally, it is unclear whether the 8-item and 3-item short versions are comparable to the full 20-item version. The present study compared the validity of the three versions of the UCLA Loneliness Scale (i.e., 20-item, 8-item, and 3-item versions) among gay and bisexual men in Taiwan. The participants comprised 400 gay and bisexual men in Taiwan who completed a cross-sectional online survey, which included the UCLA Loneliness Scale, Center for Epidemiological Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI). Confirmatory factor analysis was used to evaluate factorial validity. Convergent validity was examined between the three versions of the UCLA Loneliness Scale and the CES-D and STAI. Known-group validity was investigated with participants' sexual orientation and educational levels. The unidimensional construct was supported in all three versions of the UCLA Loneliness Scale tested in the present study. Convergent validity was supported as the level of loneliness was correlated with the level of depression and anxiety for all three versions. There were no significant differences between gay and bisexual men, although significant differences were found across different educational levels. The study confirmed that all three versions of the UCLA Loneliness Scale were comparable with satisfactory reliability and validity in Taiwanese sexual-minority men.

Rasch Modeling and Differential Item Functioning of the Self-Stigma Scale-Short Version among People with Three Different Psychiatric Disorders.

Self-stigma is prevalent in individuals with psychiatric disorders and can profoundly affect people. A unified assessment with sound psychometric properties is needed for evaluating self-stigma across psychiatric conditions. The aim of this study was to examine the psychometric properties of the Self-Stigma Scale-Short version (SSS-S) using Rasch modeling. Six-hundred and twelve participants with substance use disorders (n = 319), attention-deficit/hyperactivity disorder (n = 100), and schizophrenia (n = 193) completed the SSS-S. Rasch results confirmed the unidimensionality of the nine items of the SSS-S. The four-point Likert scale of the SSS-S reflected monotonical increases along the self-stigma continuum. No ceiling or floor effects were detected. Among the three subdomains of the SSS-S, cognitive items appeared to be the most robustly endorsed, and behavioral items were the least endorsed. Two items in the SSS-S displayed differential item functioning across the three diagnoses. Additionally, SSS-S scores showed weak to moderate correlation with depression, anxiety, and stress scale scores. The SSS-S had overall satisfactory psychometric properties. Healthcare professionals may use this assessment to assess self-stigma in multiple psychiatric groups, and information gained may facilitate improved care.

Yale Food Addiction Scale 2.0 (YFAS 2.0) and modified YFAS 2.0 (mYFAS 2.0): Rasch analysis and differential item functioning.

BACKGROUND: Food addiction (FA) is a prevalent concern that may manifest as poorly controlled food consumption and promote overweight/obesity. Thus, having a well-established instrument for assessment may facilitate better prevention and treatment. The current study investigated the psychometric properties of two common measures of FA (i.e., the Yale Food Addiction Scale [YFAS] 2.0 and its modified version, mYFAS 2.0) using a robust statistical analysis (Rasch model). METHODS: In this cross-sectional study, the scales were sent to 974 students studying in higher education (60% females) in Taiwan through online media including email and social networks. Rasch modeling was used to assess dimensionality, difficulty level, and item misfit and hierarchy. Differential item functioning (DIF) was performed to examine consistency of the items across gender and weight status. RESULTS: Rasch analysis indicated 3 items of the 35 items belonging to the YFAS 2.0 (8.6%) and none belonging to the mYFAS 2.0 were misfit. Unidimensionality and construct validity of both scales were supported by appropriate goodness-of-fit for diagnostic criteria. The person separation was 3.14 (reliability = 0.91) for the YFAS 2.0 and 2.17 (reliability = 0.82) for mYFAS 2.0, indicating the scales could distinguish participants into more than 3 strata. Only one substantial DIF was found for diagnostic criteria of "Failure to fulfill major role obligation" in the YFAS 2.0 across gender. CONCLUSION: According to Rasch modeling, both the YFAS 2.0 and mYFAS 2.0 have acceptable construct validity in Chinese-speaking youth. Scoring methods using either diagnostic criteria or symptom counts for both the YFAS 2.0 and mYFAS 2.0 are supported by the present Rasch findings.

Food addiction is related to eating disorders and may overlap with a variety of disorders, including binge-eating disorder, night-eating syndrome, bulimia nervosa or other conditions. Therefore, it is important for healthcare providers to assess food addiction and one commonly used method is using the Yale Food Addiction Scale (YFAS) developed by Gearhardt and her colleagues. The YFAS has been updated and revised into two versions: the YFAS 2.0 and modified YFAS 2.0 (i.e., mYFAS 2.0). Psychometric testing studies have reported the feasibility and adequate properties for both the YFAS 2.0 and mYFAS 2.0. However, prior studies' findings were based on classical test theory (CTT) findings. The present study thus used a modern test theory (i.e., Rasch models) to examine if both the YFAS 2.0 and mYFAS 2.0 have similarly satisfactory psychometric properties shown in the CTT findings. The present findings using Rasch models support the use of both the YFAS 2.0 and mYFAS 2.0 to assess food addiction among youth. Therefore, healthcare providers may use either the YFAS 2.0 or mYFAS 2.0 to assess levels of food addiction.