The IPSBQ can be used by researchers and practitioners working in areas of healthcare improvement, implementation, and patient safety. Further research should be undertaken to fully understand the uses and limitations of the measure, but initial results suggest that it demonstrates reliable and valid properties for assessing the psychosocial factors affecting practitioner behavior change. These findings provide sufficient support to suggest that this measure can be used to identify barriers to behavior change among healthcare staff; the next stage should be to discover if this measure can be used as a tool for informing the development of theoretically informed tailored interventions. It is recommended that the IPSBQ be used in future research to understand whether targeting key domains with matched interventions can change practitioner behaviors for patient safety.
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Research on student acceptance of distance learning or online studies point out the importance of carefully studying and analysing the factors of student motivation, attitudes toward learning, attitudes toward technology, self-confidence, anxiety, beliefs and values (Bender et al., 2004; Conrad, 2002). This study examines the perceptions of secondary-school students regarding the factors that contribute to the success of online instruction and their intention to use this mode of learning.
Several measurement models are used in this study. Before full structural equation analysis is carried out, a test of each measurement model is required. The tests are intended to identify the significant items in each measurement model to use in further analysis. The measurement models are related to several constructs in the study. The constructs in the model include:
For those constructs with more than three items, a full confirmatory factor analysis was be applied and fit statistics were checked. LISREL output was used to suggest which indicators should be retained and which ones should be separated from other indicators to form other factors (or constructs).
The validity of the model was assessed by LISREL, which generates various measures in order to evaluate the goodness of fit of the research model. The most popular index is perhaps the chi-square statistic, which tests the proposed model against the general alternative in which all observed variables are correlated (in LISREL terms, unconstrained). With this index, significant values indicate poor model fit while insignificant values indicate good fit. Other measures of fit include degrees of freedom, Non-Normed Fit Index (NNFI), Comparative Fit Index (CFI), Average Absolute Standardized Residual (AASR), Goodness-of-Fit Index (GFI), Adjusted Goodness-of-Fit Index (AGFI) and Root Mean Square Residual. There are many writings on the acceptance threshold with regard to each fit statistic. Poor goodness of model fit indicates possible model misspecifications. Two parts of the LISREL output, standardized residuals and modification indices, can be used to help in determining possible sources of the lack of fit. Generally, LISREL consists of two distinct parts: the confirmatory factor model and the structural equation model (Segars & Grover, 1993). The confirmatory factor model specifies the relations of the observed factors to their posited underlying constructs. The structural equation model specifies the relationships of the constructs to one another as posited by research models.
In developing the ACT, items selected to measure each of the 10 concepts were designed to tap similar yet explicitly non-redundant features. This intentional non-redundancy of the items renders the usual alpha criterion marginally-inappropriate. The items are supposed to be similar within sets (which makes alpha style information somewhat relevant) but the items are not created to be strictly redundant (which makes traditional alpha criteria unlikely to be fully satisfied). Internal consistency reliability of the ACT (Cronbach's alpha coefficients)was at or above the standard (0.80) for established scales administered at the individual level for 9 of 10 concepts. One concept was below this standard: formal interactions (alpha = 0.59). This is consistent with previous assessments with pediatric nurses and healthcare aides in nursing homes [14,20]. The low alpha results partially from the four items within this concept, which were purposefully selected to be non-redundant. Other ACT concepts designed in this manner include informal interactions and structural/electronic resources; the fact that these concepts have acceptable alpha levels may be explained by their larger item sets.
The majority of implications arising from this study and analysis by its nature of being a measurement study focused on reliability and validity relate to future research (as identified above). However, there are also implications for nursing practice. Concepts in the ACT were purposefully selected for inclusion in the tool because they are potentially modifiable. Thus, a measurably reliable and valid ACT holds potential to identify targets for future tailored implementation efforts if, through robust measurement, they can be shown to consistently and positively influence research use and/or improve outcomes.
Traditional cognitive assessment in neurological conditions involving physical disability is often prevented by the presence of verbal-motor impairment; to date, an extensive motor-verbal-free neuropsychological battery is not available for such purposes. We adapted a set of neuropsychological tests, assessing language, attentional abilities, executive functions and social cognition, for eye-tracking (ET) control, and explored its feasibility in a sample of healthy participants. Thirty healthy subjects performed a neuropsychological assessment, using an ET-based neuropsychological battery, together with standard "paper and pencil" cognitive measures for frontal (Frontal Assessment Battery-FAB) and working memory abilities (Digit Sequencing Task) and for global cognitive efficiency (Montreal Cognitive Assessment-MoCA). Psychological measures of anxiety (State-Trait Anxiety Inventory-Y-STAI-Y) and depression (Beck Depression Inventory-BDI) were also collected, and a usability questionnaire was administered. Significant correlations were observed between the "paper and pencil" screening of working memory abilities and the ET-based neuropsychological measures. The ET-based battery also correlated with the MoCA, while poor correlations were observed with the FAB. Usability aspects were found to be influenced by both working memory abilities and psychological components. The ET-based neuropsychological battery developed could provide an extensive assessment of cognitive functions, allowing participants to perform tasks independently from the integrity of motor or verbal channels. Further studies will be aimed at investigating validity and usability components in neurological populations with motor-verbal impairments.
Cognitive dysfunction is prevalent in multiple sclerosis. As self-reported cognitive functioning is unreliable, brief objective screening measures are needed. Utilizing widely used full-length neuropsychological tests, this study aimed to establish the criterion validity of highly abbreviated versions of the Brief Visuospatial Memory Test - Revised (BVMT-R), Symbol Digit Modalities Test (SDMT), Delis-Kaplan Executive Function System (D-KEFS) Sorting Test, and Controlled Oral Word Association Test (COWAT) in order to begin developing an MS-specific screening battery. Participants from Holy Name Medical Center and the Kessler Foundation were administered one or more of these four measures. Using test-specific criterion to identify impairment at both -1.5 and -2.0 SD, receiver-operating-characteristic (ROC) analyses of BVMT-R Trial 1, Trial 2, and Trial 1 + 2 raw data (N = 286) were run to calculate the classification accuracy of the abbreviated version, as well as the sensitivity and specificity. The same methods were used for SDMT 30-s and 60-s (N = 321), D-KEFS Sorting Free Card Sort 1 (N = 120), and COWAT letters F and A (N = 298). Using these definitions of impairment, each analysis yielded high classification accuracy (89.3 to 94.3%). BVMT-R Trial 1, SDMT 30-s, D-KEFS Free Card Sort 1, and COWAT F possess good criterion validity in detecting impairment on their respective overall measure, capturing much of the same information as the full version. Along with the first two trials of the California Verbal Learning Test - Second Edition (CVLT-II), these five highly abbreviated measures may be used to develop a brief screening battery.
Assessment of executive functions in the adult is best captured at the stage where full maturation of brain development occurs. Assessment of executive functions of children, however, is considerably more complicated. First, assessment of executive functioning in children represents a snapshot of these developing functions at a particular time linked stage, which may have implications for further development. Second, neuropsychological measures available to assess executive functions in children are limited in number and scope and may not be sensitive to the gradual developmental changes. The present article provides an overview of the salient neurodevelopmental stages of executive functioning and discusses the utilization of recently developed neuropsychological measures to assess these stages. Comments on clinical implications of these findings regarding Traumatic Brain Injury will be provided.
The recognition of attention deficit/hyperactivity disorder (ADHD) in adults is a well documented, but relatively new development. Investigations of the disorder have indicated that disturbances in behavior and adjustment are common. These disturbances may be linked to poorly developed executive functions. This paper reviews the neuropsychological studies that have compared persons with ADHD to normal controls and to psychiatric controls. The review indicates that persons with ADHD share many neuropsychological characteristics with other persons with serious psychiatric conditions, although those with ADHD may have a particular profile of slowed performance in tasks of sustained attention and set shifting, and their use of working memory may be particularly impaired. The implications of research for clinical assessment are discussed. We contend that a neuropsychological orientation is necessary for making the diagnosis and gaining a full understanding of adult ADHD. A model for clinical assessment is proposed which utilizes a neuropsychological orientation and the targeted administration of neuropsychological instruments. The careful use of neuropsychological measures is warranted in providing an elaborate picture of a person's functioning, although the use of neuropsychological tests is not necessary to make the diagnosis. 2ff7e9595c
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