Linking genetic counseling communication skills to patient outcomes and experiences using a community-engagement and provider-engagement approach: research protocol for the GC-PRO mixed methods sequential explanatory study.

INTRODUCTION: In over 50 years since the genetic counseling (GC) profession began, a systematic study of GC communication skills and patient-reported outcomes in actual sessions across multiple clinical specialties has never been conducted. To optimize GC quality and improve efficiency of care, the field must first be able to comprehensively measure GC skills and determine which skills are most critical to achieving positive patient experiences and outcomes. This study aims to characterise GC communication skills using a novel and pragmatic measure and link variations in communication skills to patient-reported outcomes, across clinical specialties and with patients from diverse backgrounds in the USA. Our community-engagement and provider-engagement approach is crucial to develop recommendations for quality, culturally informed GC care, which are greatly needed to improve GC practice. METHODS AND ANALYSIS: A mixed methods, sequential explanatory design will be used to collect and analyze: audio-recorded GC sessions in cancer, cardiac, and prenatal/reproductive genetic indications; pre-visit and post-visit quantitative surveys capturing patient experiences and outcomes and post-visit qualitative interview data. A novel, practical checklist will measure GC communication skills. Coincidence analysis will identify patterns of GC skills that are consistent with high scores on patient-reported measures. Two-level, multilevel models will be used to evaluate how GC communication skills and other session/patient characteristics predict patient-reported outcomes. Four community advisory boards (CABs) and a genetic counselor advisory board will inform the study design and analysis. ETHICS AND DISSEMINATION: This study has been approved by the single Institutional Review Board of the University of Minnesota. This research poses no greater than minimal risk to participants. Results from this study will be shared through national and international conferences and through community-based dissemination as guided by the study's CABs. A lay summary will also be disseminated to all participants.

Exercise Prescription Practices Among Mental Health Professionals on College Campuses: Testing the Information-Motivation-Behavioral Skills Model.

BACKGROUND: The co-occurrence of physical inactivity and poor mental health in the college student population can lead to chronic health issues that have negative short-term effects (e.g., academic success). Poor mental health is associated with long-term conditions (e.g., obesity, serious mental illness) that are linked to premature mortality. The purpose of this study was to examine the information-motivation-behavioral (IMB) skills model and evaluate its ability to explain the variance in the use of exercise prescription in mental health treatment. METHOD: Mental health professionals (MHPs) (n = 255) were recruited from college counseling centers in the USA. Structural equation modeling was used to examine the relationship between the predictor variables of information (exercise knowledge and benefits of exercise), motivation (personal beliefs, perceived barriers, and organizational support), and behavioral skills (self-efficacy), and the outcome variable of exercise prescription (i.e., brief counseling and referral for exercise). RESULTS: The predictors accounted for 23% of the variance in exercise prescription (p = .001). Organizational support had a significant direct effect on exercise prescription (ß = 0.27, p = .05). Personal beliefs (ß = 0.96, p = .05) and organizational support (ß = 0.31, p = .04) had significant direct effects on self-efficacy for prescribing exercise. MHP personal exercise behavior was associated with exercise prescription. CONCLUSION: MHPs may be willing to support physical activity promotion and exercise prescription, but organizational structures are critical to enhance and sustain the delivery of this adjunctive therapy. The personal exercise history of MHPs may be an important consideration for behavior change interventions. The development and validation of scales are important considerations for future intervention study design.

The Functional External Memory Aid Tool Version 2.0: A How-To Clinical Guide.

PURPOSE: Although compensatory cognitive rehabilitation is a common treatment approach for adults with cognitive-communication disorders, there are few assessment tools available to support clinicians in developing person-centered treatment plans. In addition to understanding a client's cognitive and functional abilities, it is also important to understand how they compensate for their weaknesses, specifically with external aids (e.g., calendars, notes), in everyday life. The Functional External Memory Aid Tool (FEMAT) is a performance-based measure that quantifies and describes external aid use during task completion. METHOD: The purpose of this clinical focus article is to educate and equip clinicians to administer and interpretate the FEMAT with adult clients with cognitive-communication disorders. This clinical focus article describes the theoretical motivation for the FEMAT as well as the administration, scoring, and interpretation procedures for Version 2.0 of the measure. A hypothetical case example is included to illustrate how to use the FEMAT to develop person-centered goals and treatment plans. CONCLUSIONS: The FEMAT is psychometrically sound, clinically relevant, free, easily accessible, and quick to administer and provides data that are complementary to data obtained from traditional performance-based and/or patient-reported measures. This clinical focus article describes new resources that are available to help clinicians administer and interpret Version 2.0 of the FEMAT when serving adults with cognitive-communication disorders. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21651311.

Scheduling math practice: Students' underappreciation of spacing and interleaving.

Many randomized controlled experiments in the classroom have found that mathematics learning is improved dramatically when practice problems of one kind are distributed across multiple assignments (spaced) and mixed with other kinds of problems (interleaved). In two studies, we investigated students' knowledge of spacing and interleaving. In Study 1, 193 undergraduates designed learning schedules for a hypothetical math class. In Study 2, 175 undergraduates selected from among five hypothetical schedules in response to a variety of questions, provided reasons for their selections, and rated the utility of spacing and interleaving. In both studies, most participants incorrectly judged schedules with minimal degrees of spacing and interleaving to be most effective. Also, schedules with more spacing and interleaving were perceived as more difficult, less enjoyable, and less common. Participants' ratings of utility revealed mixed perspectives on spacing and an underappreciation of interleaving. Altogether, these findings demonstrate that most students fail to recognize the benefits of spaced and interleaved practice. Further, by identifying specific ways in which their beliefs about spacing and interleaving fall short, we reveal opportunities to reshape students' beliefs to foster these effective learning techniques. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Masked analysis for small-scale cluster randomized controlled trials.

Researchers conducting small-scale cluster randomized controlled trials (RCTs) during the pilot testing of an intervention often look for evidence of promise to justify an efficacy trial. We developed a method to test for intervention effects that is adaptive (i.e., responsive to data exploration), requires few assumptions, and is statistically valid (i.e., controls the type I error rate), by adapting masked visual analysis techniques to cluster RCTs. We illustrate the creation of masked graphs and their analysis using data from a pilot study in which 15 high school programs were randomly assigned to either business as usual or an intervention developed to promote psychological and academic well-being in 9th grade students in accelerated coursework. We conclude that in small-scale cluster RCTs there can be benefits of testing for effects without a priori specification of a statistical model or test statistic.

Associations Between Multiple Health-Promoting Behaviors and Subjective Well-Being in High School Age Youth.

BACKGROUND: Conceptualizations of health have expanded to include indicators of adolescents' physical and mental wellness, rather than solely the absence of diseases or disorders. Although extensive research has identified links between mental and physical wellness, few studies have investigated the relationship between health promotion and happiness, particularly in adolescent populations who may be at particular risk for engaging in health-compromising behaviors, such as alcohol consumption. METHODS: This cross-sectional study examined the relationship between 12 health-promoting behaviors and subjective well-being in a sample of 450 high school students from 2 states. Participants reported on their diet, physical activity, sleep hygiene habits, as well as abstinence from tobacco and alcohol products, and completed a multidimensional assessment of subjective well-being. RESULTS: Findings demonstrated that 7 of the 12 health-promoting behaviors were significantly correlated with adolescents' subjective well-being. A sizeable portion of the variance in adolescents' subjective well-being (39.8%) was accounted for by the linear combination of the 12 health-promoting behaviors of interest. Increased physical activity, sleep hygiene cognitive/emotional factors, and bedtime routine all were identified as unique predictors of subjective well-being. CONCLUSIONS: These findings bring attention to the salience of daily physical activity and sleep hygiene and their associations with adolescents' happiness.

Factor Structure and Measurement Invariance of the Irrational Beliefs Inventory for University Students in the United States and Iceland.

We used multigroup confirmatory factor analysis to evaluate the five-factor measurement model underlying the 50-item Irrational Beliefs Inventory (IBI) in samples of university students in the United States (n=827) and Iceland (n=720). Global model fit was marginally acceptable in each sample. Further analyses identified several sources of model misfit that included weak factor loadings, several item pairs with correlated errors, and items with loadings on more than one factor. Cronbach's alpha reliability estimates for the five factors were similar for the U.S. and Icelandic samples, and comparable to those reported by the developers of the IBI. Measurement invariance testing supported configural (same form) and metric invariance (equal loadings), but identified only 20 items that had invariant item intercepts across the U.S. and Icelandic groups. Given the finding of partial measurement invariance, we offer caution when using the IBI to make group comparisons for U.S. and Icelandic samples. Recommendations are proposed for ongoing psychometric evaluations of the IBI that would identify strengths of the IBI and items that, if revised or deleted, may improve the quality of the measure for research and clinical purposes.

Speech-Language Pathologist Involvement in Multi-Tiered System of Supports Questionnaire: Advances in Interprofessional Practice.

Purpose This article describes the development and initial validation of the Speech-Language Pathologist (SLP) Involvement in Multi-Tiered System of Supports (MTSS) Questionnaire. It was developed to measure the extent to which SLPs are involved in MTSS at their school site(s). Method A total of 567 SLPs practicing in the United States responded to up to 39 Likert-type items meant to reflect six domains: scope of practice, professional development, leadership, consulting/collaborating, assessment and analysis, and intervention. Measurement quality was evaluated in terms of score reliability and validity. An exploratory factor analysis was conducted to evaluate the internal structure of the questionnaire responses. A three-factor model with the following dimensions of Carrying out Roles and Responsibilities, Leading, and Planning and Providing Interventions was supported. Loadings for retained factors ranged from .35 to .87. Internal consistency estimates ranged from .87 to .92. Descriptive statistics summarized the overall involvement of SLPs in MTSS, and responses to questions to assess the feasibility and acceptability of this questionnaire were analyzed. Results Questionnaire responses indicated that SLPs infrequently engage in MTSS activities. The item with the highest mean was related to SLPs collaborating with teachers to help them address students' speech and language disorders in their classrooms. Most of the SLPs who took the questionnaire found it easy to complete, but only some found the information to be useful. Conclusions The infrequent involvement of SLPs in MTSS indicates a need to disseminate information on the potentially valuable roles SLPs can play in MTSS implementation. This tool may be used by SLPs to better understand contributions they can make within an MTSS framework and self-reflect on their current levels of involvement. Supplemental Material https://doi.org/10.23641/asha.13874516.

A Motivational Interviewing Intervention for Adolescents in Accelerated High School Curricula: Applicability and Acceptability in a Second Sample.

The paper describes the applicability and acceptability of a selective intervention-Motivation, Assessment, and Planning (MAP)-for high school students that was developed based on the principles of motivational interviewing (MI) and tailored to the unique needs and strengths of students taking accelerated coursework, specifically Advanced Placement (AP) and International Baccalaureate (IB) classes. In addition to detailing the intervention in terms of MI spirit, processes, and relational and technical skills, we report applicability and acceptability data from a second iteration of MAP implementation in eight AP/IB programs in a Southeastern state during spring 2018. We analyzed quantitative and qualitative acceptability data from 121 high school freshmen (97 from AP and 24 from IB courses), as well as the seven MAP coaches who were trained using the Motivational Interview Training and Assessment System (Frey et al. 2017). To gain perspectives from the intended end users of the refined MAP, 12 school counselors and school psychologists who were not trained in MAP evaluated the intervention and provided qualitative and quantitative data on applicability and acceptability. All three stakeholder groups (students, coaches, and school mental health staff) rated and described the intervention as highly acceptable and appropriate for addressing the social-emotional needs of adolescents in AP/IB classes.

Testing Measurement Invariance Across Unobserved Groups: The Role of Covariates in Factor Mixture Modeling.

Factor mixture modeling (FMM) has been increasingly used to investigate unobserved population heterogeneity. This study examined the issue of covariate effects with FMM in the context of measurement invariance testing. Specifically, the impact of excluding and misspecifying covariate effects on measurement invariance testing and class enumeration was investigated via Monte Carlo simulations. Data were generated based on FMM models with (1) a zero covariate effect, (2) a covariate effect on the latent class variable, and (3) covariate effects on both the latent class variable and the factor. For each population model, different analysis models that excluded or misspecified covariate effects were fitted. Results highlighted the importance of including proper covariates in measurement invariance testing and evidenced the utility of a model comparison approach in searching for the correct specification of covariate effects and the level of measurement invariance. This approach was demonstrated using an empirical data set. Implications for methodological and applied research are discussed.

Development and Initial Validation of the Functional External Memory Aid Tool.

Purpose The purpose of this study was to develop the item pool and investigate the structure and measurement properties of the Functional External Memory Aid Tool (FEMAT), a performance-based measure of everyday strategy use for persons with mild memory impairments. The FEMAT examines one's use of strategies to compensate for cognitive communication impairments that interfere with the completion of complex daily tasks. Method During Phase 1, six expert panel members reviewed the initial item pool and scoring rubric to assess item verification. Each item was developed to elicit strategy use and represent a complex daily task. During Phase 2, 99 participants with possible mild neurocognitive disorder (as determined by screening procedures) responded to 11 items. The factor structure of the data was analyzed using confirmatory factor analysis. Reliability and relationships between the FEMAT and additional factors were also examined. Results The process of development (Phase 1) resulted in 11 items distributed among three factors: (a) Medical Tasks, (b) Instrumental Daily Tasks, and (c) Retrieval-Based Tasks. Internal consistency (Phase 2), assessed with confirmatory factor analysis, confirmed the proposed three-factor model. Reliability analyses revealed at least 62%-84% of within-test score variance was due to true score variance. Correlation analyses indicated weak and strong relationships between the FEMAT and participant demographic variables and additional assessment measures. Conclusions The FEMAT provides reliable measurement of everyday external memory aid use in persons with possible mild neurocognitive disorder. The FEMAT was designed to be used in clinical settings and to provide better guidance to clinicians to design person-centered interventions than currently available cognitive communication measures.

Health Knowledge and Adherence as Predictors of Viral Burden and CD4+ T-Cell Count in Youth and Young Adults Living With HIV.

Health literacy influences HIV treatment for youth and, thus, is a research priority. We explored health knowledge and self-reported adherence, as indicators of health literacy, among youth living with HIV (YLWH) and the association between health literacy and health outcomes. A total of 102 YLWH ages 13-25 years participated in the study. Participants completed the Brief Estimate of Health Knowledge and Action-HIV Version; CD4 T-cell counts and viral loads were extracted from participant medical records. Participants had a moderate amount of HIV knowledge, and most reported taking their medications under most conditions. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. Health literacy is an important factor that should be addressed by practitioners working with YLWH. More research is needed to determine the best way to measure and improve health literacy.

Depression, anxiety, and posttraumatic stress as predictors of immune functioning: differences between youth with behaviorally and perinatally acquired HIV.

Youth living with HIV (YLWH) face significant mental health problems, namely depression, anxiety, and PTSD with rates of these disorders higher than in the general population. This study explored the relationship between symptoms of depression, anxiety, and PTSD and biological markers among a sample of 145 YLWH ages 13-25 years. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 Item Scale (GAD-7), and Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD). Biological markers included CD4 count and viral load (VL) abstracted from medical records. Findings revealed a relationship between depression and anxiety and CD4 count as well as anxiety and VL. The relationship between depression and anxiety and CD4 count and anxiety and VL was moderated by transmission mode (i.e., behavioral versus perinatal). For youth perinatally infected, greater psychological symptoms of depression and anxiety were associated with a decline in CD4 count and increase in VL, but this was not true for youth with behaviorally acquired HIV. These findings point to the need for individualized mental health prevention and intervention services for YLWH.

A Multilevel Bifactor Approach to Construct Validation of Mixed-Format Scales.

Wording effects associated with positively and negatively worded items have been found in many scales. Such effects may threaten construct validity and introduce systematic bias in the interpretation of results. A variety of models have been applied to address wording effects, such as the correlated uniqueness model and the correlated traits and correlated methods model. This study presents the multilevel bifactor approach to handling wording effects of mixed-format scales used in a multilevel context. The Students Confident in Mathematics scale is used to illustrate this approach. Results from comparing a series of models showed that positive and negative wording effects were present at both the within and the between levels. When the wording effects were ignored, the within-level predictive validity of the Students Confident in Mathematics scale was close to that under the multilevel bifactor model. However, at the between level, a lower validity coefficient was observed when ignoring the wording effects. Implications for applied researchers are discussed.

On the measurement of thin-ideal internalization: Implications for interpretation of risk factors and treatment outcome in eating disorders research.

OBJECTIVE: Although the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) and Ideal Body Stereotype Scale (IBSS) are used interchangeably to assess thin ideal internalization, limited work has examined the assumption that the two measures index the same construct. METHOD: The current study utilized confirmatory factor analysis to examine whether these measures capture a single construct (one-factor), two constructs (two-factor), or both shared and unique constructs (bifactor). The SATAQ-4R-Internalization: Thin/Low Body Fat subscale and IBSS-Revised were administered to 1,114 college females. RESULTS: A bifactor model provided the best fit to the data. Further, the SATAQ-4R was more strongly related to disordered eating and body satisfaction than the IBSS-R. DISCUSSION: Results indicate that the two most commonly used measures of internalization capture both shared and unique constructs. While both measures appear to contribute to the assessment of a global internalization factor, the SATAQ-4R may be better suited to assess personal acceptance of and desire to achieve a thin body, while the IBSS-R may be better suited to assess an awareness or acknowledgement of broader sociocultural ideals (e.g., toned, shapely bodies). Continued psychometric investigation of the scales is recommended in order to ensure targeted assessment of the intended constructs.

Use of Polynomial Regression to Investigate Biased Self-Perceptions and ADHD Symptoms in Young Adolescents.

OBJECTIVE: This study investigated biased self-perceptions of academic and social competence among young adolescents with a range of ADHD symptoms. The goal was to better understand how to measure agreement and disagreement between competence ratings from multiple informants. METHOD: The commonly used discrepancy methodology was used along with polynomial regression/response surface analyses to explore the relationship between biased self-perceptions and ADHD symptoms. Participants were 164 middle school students and their homeroom teachers. Students and teachers completed measures about academic and social competence, and teachers rated ADHD symptoms. RESULTS: Discrepancy score and polynomial regression/response surface analyses both supported the relationship between student overestimation of competence and ADHD symptoms. Response surface analyses also suggest that some students with ADHD symptoms accurately perceive their impairments, particularly in the academic domain. CONCLUSION: Findings demonstrate the importance of using more advanced methods to understand the relationship between both accurate and discrepant perceptions of competence and ADHD symptoms.

Multilevel Factor Analysis: Reporting Guidelines and a Review of Reporting Practices.

We provide reporting guidelines for multilevel factor analysis (MFA) and use these guidelines to systematically review 72 MFA applications in journals across a range of disciplines (e.g., education, health/nursing, management, and psychology) published between 1994 and 2014. Results are organized in terms of the (a) characteristics of the MFA application (e.g., construct measured), (b) purpose (e.g., measurement validation), (c) data source (e.g., number of cases at Level 1 and Level 2), (d) statistical approach (e.g., maximum likelihood), and (e) results reported (e.g., intraclass correlations for indicators and latent variables, standardized factor loadings, fit indices). Results from this review have implications for applied researchers interested in expanding their approaches to psychometric analyses and construct validation within a multilevel framework and for methodologists using Monte Carlo methods to explore technical and methodological issues grounded in realistic research design conditions.

Weight Bias Internalization Scale: Psychometric properties using alternative weight status classification approaches.

The Weight Bias Internalization Scale (WBIS) was developed to facilitate systematic investigation of internalized weight bias, but the English version has not undergone confirmatory factor analysis (CFA). Additionally, it is unclear whether the measure can be used when participants are grouped based on self-perceived versus body mass index (BMI)-based weight status. The present study evaluated the WBIS in a sample of 243 male and female undergraduate students who were overweight/obese as classified by self-perception or BMI. After exclusion of Item 1 due to poor item-to-total correlation, Cronbach's alphas were .92 and .94 for the perception-based and BMI-based groupings, respectively. CFAs using the reduced 10-item scale with addition of modifications for correlated errors resulted in acceptable model fit for the one-factor model in both groupings. Findings suggest psychometric properties of the modified WBIS are acceptable and are similar for overweight/obese participants grouped by either perceived weight status or BMI.

Psychometric properties of the Family Accommodation Scale for Obsessive-Compulsive Disorder-Patient Version.

In obsessive-compulsive disorder (OCD), family accommodation is a frequently occurring phenomenon that has been linked to attenuated treatment response, increased obsessive-compulsive symptom severity, and lower levels of functioning. No patient-report version of family accommodation exists, with available measures relying on relatives as informants. However, adult patients with OCD often present to clinical services alone, frequently making it impractical to obtain information from these informants. Consequently, a standardized patient-reported measure of family accommodation proves salient in clinical practice. The present study examined the psychometric properties of the Family Accommodation Scale for Obsessive-Compulsive Disorder-Patient Version (FAS-PV). Sixty-one adults with OCD were administered clinician-rated measures of OCD symptom severity and self-report questionnaires examining functional impairment, family functioning, and emotional/behavioral difficulties. Fifty-four relatives completed self-report measures assessing family accommodation and family functioning. The majority of the adult OCD participants (89%) endorsed at least 1 type of accommodating behavior in the previous week. The FAS-PV total score demonstrated good internal consistency and test-retest reliability. Convergent validity was evidenced by strong associations with scores on another measure of family accommodation, OCD symptom severity, OCD-related family functioning, anxiety, and functional impairment. Divergent validity was supported through nonsignificant correlations with depressive symptoms and impulsivity. The FAS-PV did not significantly differ from the relative-reported measure of family accommodation in terms of the internal consistency or mean of the total scores. Ultimately, the FAS-PV scores demonstrated sound psychometric properties and validity in assessing family accommodation from the patient's perspective, encouraging its use in research and clinical practice.

The Relationship Between Life Satisfaction and ADHD Symptoms in Middle School Students: Using a Bifactor Model.

OBJECTIVE: ADHD is associated with increased academic and social difficulties and comorbid psychopathology which may lead to decreased life satisfaction (LS). METHODS: The current study utilized a bifactor model of ADHD consisting of a general factor and two specific factors (inattention and hyperactivity-impulsivity) to determine if ADHD symptoms place middle school students (n= 183) at risk for diminished LS and if this relationship differed depending on whether teachers versus students reported ADHD symptoms. RESULTS: Confirmatory factor analyses indicated that the bifactor model provided very good fit to the ADHD symptoms reported by students (comparative fit index [CFI] = .995; root mean square error of approximation [RMSEA] = .028) and teachers (CFI = .997; RMSEA = .043). Results also demonstrated that when students rated ADHD symptoms, the general ADHD factor and inattention were negatively related to LS; however, when teachers rated ADHD symptoms, only inattention was negatively related to LS. CONCLUSIONS: Implications and future directions related to these results are discussed.