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[Intermittent claudication and quality of life. Psychometric validation of the French version of the CLAU-S questionnaire].

CLAU-S is a disease-specific quality of life (QoL) scale for patients with intermittent claudication due to peripheral arterial disease of the lower limbs. Initially developed in Germany, the scale has been translated into French according to classical forward/backward methodology. The objective of this study was to test the validity of the French version of CLAU-S. In its current format, the CLAU-S scale evaluates 5 dimensions: "Daily Living"; "Pain"; "Social Life"; "Disease-specific anxiety"; and "Mood", for a total of 47 items. The QoL scores and clinical findings in 157 patients with intermittent claudication were analysed. Validation of the convergence and discriminatory power of the scale were confirmed. Analysis of structural validity showed grouping of items in accordance with initial scale construction and a clear separation between the different dimensions. Analysis of the internal reliability of the questionnaire confirmed the good internal coherence of these dimensions. Reproducibility of the scores over time was confirmed by test-retest analysis. In addition to the actual validation of CLAU-S, a new, innovative mathematical technique called Structural Modelling Equations was used on this QoL instrument. It related the causal structure of the QoL components in peripheral arterial disease of the lower limbs (stage 2). An indisputable causal relationship was demonstrated between clinical parameters, particularly walking distance, and the QoL components. The classical symptom-deficit-disability causal structure of disease- specific QoL questionnaires was also studied. In particular, we found an essential relationship between the Daily Living dimension and, to a lesser extent, the Social Life activities and Disease- specific anxiety dimension, and QoL. The Pain dimension proved to be an explanatory variable of the other QoL components without being directly related to QoL. Finally, the Mood dimension was a resultant variable of QoL and not an explanatory variable of QoL. This study therefore enabled validation of the psychometric properties of the French version of CLAU-S and also demonstrated the complementary roles of walking distance and QoL in the management of patients with intermittent claudication.

Activities of Daily Living↗

Worldview and health promoting behavior: a causal model.

The present study investigated the manner in which Pepper's (1942) worldview theory relates to health promoting behavior. A sample of 259 subjects completed a battery of inventories measuring worldview, health promoting behavior (HPB), social class, and sex. The data were analyzed by means of structural equation modeling using the statistical program for the social sciences (SPSS) and the analysis of moment and structure (AMOS) computer programs. The results support the idea that a modest relationship exists between worldview and HPB, with organismic thinkers more likely than mechanistic thinkers to engage in HPB. There was also a slight indirect effect of sex on worldview and HPB, with women more likely to endorse an organismic worldview and therefore more likely to engage in HPB than men. No relationship was found between socioeconomic status and HPB.

Adolescent↗

Modeling age using cognitive, psychosocial and physiological variables: the Boston Normative Aging Study.

A structural equation model is computed for 36 variables from eight domains of data using 100 healthy male subjects whose age varies between 30 and 80 years. Chronological age is required to be an exogenous variable while cognitive function variables are required to be an ultimate endogenous or outcome set. The model suggests that the direct effect of age on cognition is substantially reduced when social, life style, physiological, and brain state variables are allowed to become intervening variables. The study also finds that there is an association between cognitive function and psychosocial measures relating to general psychiatric symptomatology and social support systems.

Adult↗

Predictors of functional ability in geriatric rehabilitation patients.

This study explored the impact that motivation, cognitive status, depression, age, and physical status have on the functional ability of older adults in a rehabilitation program. The study was based on a hypothesized model and was conducted with 200 patients on a geriatric rehabilitation unit. Structural equation modeling was done to test the hypothesized model. The average age of participants was 78 years, and the majority were female, Caucasian, unmarried, and had been admitted for rehabilitation after an orthopedic event. The data fit the hypothesized model; however, only five paths were significant. Mental status was a significant predictor of function on admission and a direct and indirect predictor of function at discharge, and diagnosis and age directly predicted function at discharge.

Activities of Daily Living↗

On the factorial and construct validity of the Intrinsic Motivation Inventory: conceptual and operational concerns.

The Intrinsic Motivation Inventory (IMI) has been gaining acceptance in the sport and exercise domain since the publication of research by McAuley, Duncan, and Tammen (1989) and McAuley, Wraith, and Duncan (1991), which reported confirmatory support for the factorial validity of a hierarchical model of intrinsic motivation. Authors of the present study argue that the results of these studies did not conclusively support the hierarchical model and that the model did not accurately reflect the tenets of cognitive evaluation theory (Deci & Ryan, 1985) from which the IMI is drawn. It is also argued that a measure of perceived locus of causality is required to model intrinsic motivation properly. The development of a perceived locus of causality for exercise scale is described, and alternative models, in which perceived competence and perceived locus of causality are held to have causal influences on intrinsic motivation, are compared with an oblique confirmatory factor analytic model in which the constructs are held at the same conceptual level. Structural equation modeling showed support for a causal model in which perceived locus of causality mediates the effects of perceived competence on pressure-tension, interest-enjoyment, and effort-importance. It is argued that conceptual and operational problems with the IMI, as currently used, should be addressed before it becomes established as the instrument of choice for assessing levels of intrinsic motivation.

Adult↗

Development of a scale to measure adherence to self-monitoring of blood glucose with latent variable measurement.

OBJECTIVE: Adherence to self-monitoring of blood glucose (SMBG) is problematic for many people with diabetes. Self-reports of adherence have been found to be unreliable, and existing paper-and-pencil measures have limitations. This study developed a brief measure of SMBG adherence with good psychometric properties and a useful factor structure that can be used in research and in practice. RESEARCH DESIGN AND METHODS: A total of 216 adults with diabetes responded to 30 items rated on a 9-point Likert scale that asked about blood monitoring habits. In part I of the study, items were evaluated and retained based on their psychometric properties. The sample was divided into exploratory and confirmatory halves. Using the exploratory half, items with acceptable psychometric properties were subjected to a principal components analysis. In part II of the study, structural equation modeling was used to confirm the component solution with the entire sample. Structural modeling was also used to test the relationship between these components. It was hypothesized that the scale would produce four correlated factors. RESULTS: Principal components analysis suggested a two-component solution, and confirmatory factor analysis confirmed this solution. The first factor measures the degree to which patients rely on others to help them test and thus was named "social influence." The second component measures the degree to which patients use physical symptoms of blood glucose levels to help them test and thus was named "physical influence." Results of the structural model show that the components are correlated and make up the higher-order latent variable adherence. CONCLUSIONS: The resulting 15-item scale provides a short, reliable way to assess patient adherence to SMBG. Despite the existence of several aspects of adherence, this study indicates that the construct consists of only two components. This scale is an improvement on previous measures of adherence because of its good psychometric properties, its interpretable factor structure, and its rigorous empirical development.

Adult↗

Elderly mothers caring at home for offspring with mental retardation: a model of permanency planning.

A theoretical model of permanency planning based on the double ABCX model of family stress and adaptation (McCubbin & Patterson, 1982) was tested using structural equation modeling. We interviewed 235 mothers, ages 58 to 96, who cared for adult offspring with mental retardation at home. Four variables were confirmed to directly influence their stage of planning: use of services for offspring, non-use of avoidance coping, the self-perception of being adversely affected by age-related changes, and help from offspring without mental retardation. Variables found to affect planning indirectly were perceived need for services, mothers' subjective burden, extent of caregiving tasks, offsprings' disability, and mothers' disability.

Adaptation, Psychological↗

Robustness of a model of exercise.

A recent longitudinal study of exercise behavior was published in this journal. A structural equation model derived from the theory of reasoned action was evaluated and found to fit the data well. This paper presents further analysis of the data to determine the robustness of the results to modifications of the original model.

Computer Simulation↗

Likelihood of undergoing genetic testing for cancer risk: a population-based study.

BACKGROUND: Studies on public perceptions of genetic susceptibility testing for cancer risks are few and tend to focus on specific cancer risks of higher-risk populations, ignoring the general population and their perceived risk of getting any cancers. This study develops and tests a psychosocial model of the proximal and distal influences on likelihood of undergoing genetic susceptibility testing for cancer risk among a population-based sample. METHODS: The sample consisted of 622 adults aged 18-75 interviewed by telephone. The survey instrument included measures derived from the Health Belief Model and adaptations of existing measures from the literature. Data were analyzed using structural equation modeling techniques. RESULTS: The model suggested independent main effects for perceived benefits, perceived barriers, perceived susceptibility, and pessimism while simultaneously accounting for the effects of age, socioeconomic status, family history of cancer, and awareness of the existence of genetic susceptibility testing for cancer risk. The model explained 34% of the variance in likelihood. CONCLUSIONS: While perceived benefits, perceived barriers, perceived susceptibility, and pessimism may directly impact likelihood, they may also mediate the effects of age, socioeconomic status, family history of cancer, and awareness of cancer genetic susceptibility testing, on likelihood.

Adolescent↗

A covariance structure analysis of flicker sensitivity.

We tested whether linear structural models of the mechanisms underlying flicker sensitivity could reproduce the variance-covariance matrix of temporal contrast sensitivity data. Monocular sensitivities to frequencies between 2.5 and 45 Hz were measured for 124 subjects, ages 18-88 yr. Exploratory factor analyses revealed that both a two-mechanism and a three-mechanism model could adequately account for the data. Furthermore, confirmatory factor analyses and full structural equation models, using age as an explanatory variable, supported both models, with the three-factor model giving a somewhat better representation of the data. Parsimony favors the two-mechanism model. But patterns of loss associated with pre-exudative age-related maculopathy are more easily understood in terms of three underlying mechanisms.

Adolescent↗

Age differences in the effects of network composition on psychological distress.

The main goal of this research is to better understand age differences in the effects of social networks on mental health. Using a social network approach to revise the convoy of social support model (Kahn and Antonucci, 1980), we examine specifically how two aspects of social support networks (kin composition and convoy dimensions) influence psychological distress for older and younger samples (18-59 and 60+). We hypothesize that kin composition will influence distress in general but especially for the younger sample, while two competing hypotheses for the convoy of social support model are tested. Using data from a three-wave panel health study, structural equation models (LISREL 8.20) indicate that a greater proportion of kin in the perceived support network and the presence of family members in the inner circle of the convoy significantly reduce distress, primarily for the younger sample. Implications for the convoy model are discussed.

Adolescent↗

Does psychomotor sensitivity to alcohol predict subsequent alcohol use?

Data from 42 male and 58 female subjects who participated in the Colorado Alcohol Research on Twins and Adoptees (CARTA) project were subjected to model-fitting analyses. The aim of the present study was to use linear structural equation models to determine whether differences in previously measured psychomotor sensitivity to alcohol predict differences in self-reported alcohol consumption over a 4-year period. LISREL model-fitting results indicate that, for male subjects, only rail walking insensitivity is predictive of alcohol use reported 2 years after their initial CARTA testing. For females, only hand steadiness sensitivity is predictive of alcohol use reported 2 years after their initial CARTA testing. The results for males support a hypothesis that would consider alcohol insensitive individuals at greater risk for alcohol abuse. The female results, however, would argue against such a hypothesis. With only one measure of sensitivity predicting alcohol use at only one out of four time points, in both men and women, the overall results suggest that our three measures of psychomotor sensitivity to alcohol are, in general, poor predictors of alcohol consumption in this sample.

Adult↗

A structural model for predicting mathematics achievement: its relation with anxiety and self-concept in mathematics.

This study proposed and tested a model of mathematics achievement and its relations to antecedent and subsequent factors using structural equations modeling. A sample of elementary school students in Al-Ain school district (n = 394) completed an Arabic version of the Self-description Questionnaire as well as a questionnaire measuring their perception of the importance of mathematics, anxiety about it, and the amount of effort they exerted in studying. Mathematics grades were obtained from the official school records. Importance and effort were positively related to achievement which in turn had a positive path coefficient to self-concept and a negative path to anxiety. The hypothesized model explained 40%, 64%, and 73% of the variance in achievement, self-concept, and anxiety, respectively. The results can be interpreted as indicating that achievement is an important outcome and antecedent construct within the proposed model.

Achievement↗

Health downturns and predictors of suicidal ideation: an application of the Baumeister model.

Suicidal thoughts and attempts have been studied from a number of perspectives, but only recently has an attempt been made to incorporate many different psychological perspectives into one framework. Baumeister (1990) has integrated personality and social psychological perspectives into one sequential model, moving from instigating events to a final stage of suicidal thoughts. Employing a sample of older adult subjects undergoing the stresses of a recent health downturn, this study tested a four-stage model of suicidal ideation based on many of the components proposed by Baumeister. Structural equation modeling achieved a good fit to the data. Results are discussed in terms of the importance of including life events, particularly poor health, and cognitive variables such as confusions in thinking, in understanding suicidal ideation.

Aged↗

A structural modeling analysis of anxiety and depression in patients undergoing coronary artery bypass graft surgery: a model generating approach.

The present study is a longitudinal study designed to explore structural relationships between anxiety, depression, personality, and background factors (e.g., gender, age, and complicated medical characteristics) in patients undergoing coronary artery bypass graft (CABG) surgery. At two timepoints before and two after CABG, 217 patients completed self-report questionnaires. To explore structural relationships, the structural equation modeling (SEM) method was applied. Using the model-generating approach, a model was developed, providing a good fit. The structural relationships revealed, in particular, the key position of neuroticism, which was related to both pre- and postoperative anxiety and depression. Relationships between anxiety and depression over time, both intra- and interrelationships, were relatively weak. Relationships between anxiety and depression at the same points in time were relatively strong, with preoperative depression leading to preoperative anxiety, and postoperative anxiety leading to postoperative depression. To provide a useful framework for development of intervention strategies, further research is needed to evaluate the plausibility of the final structural model.

Adult↗

Structural modeling of mixed longitudinal and cross-sectional data.

In this paper we describe some mathematical and statistical models for dealing with changes over age. We concentrate specifically on the use of a structural equation modeling (SEM) approach (using computer programs like LISREL) to deal with issues of: (1) group differences in regression parameters, (2) differences in longitudinal and cross-sectional results, (3) differences due to longitudinal attrition, and (4) mixtures of these problems. To illustrate these ideas we use data from a previous study of hypertension and intellectual abilities (from Schultz, Elias, Robbins, Streeten, and Blakeman, 1986).

Adult↗

Neural modeling, functional brain imaging, and cognition.

The richness and complexity of data sets acquired from PET or fMRI studies of human cognition have not been exploited until recently by computational neural-modeling methods. In this article, two neural-modeling approaches for use with functional brain imaging data are described. One, which uses structural equation modeling, estimates the functional strengths of the anatomical connections between various brain regions during specific cognitive tasks. The second employs large-scale neural modeling to relate functional neuroimaging signals in multiple, interconnected brain regions to the underlying neurobiological time-varying activities in each region. Delayed match-to-sample (visual working memory for form) tasks are used to illustrate these models.

Journal Article↗

The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients.

The effect of 12-step mutual help groups (e.g., Narcotics Anonymous) on members' friendship networks has received little attention. This 1-year longitudinal study examined such effects in a sample of 2,337 male substance abuse inpatients, 57.7% of whom became significantly involved in 12-step activities (e.g., reading program literature, attending meetings) after treatment. An a priori model of the interplay of 12-step involvement) and friendship networks was tested using structural equation modeling, and found to have excellent fit to the data. Twelve-step group involvement after treatment predicted better general friendship characteristics (e.g., number of close friends) and substance abuse-specific friendship characteristics (e.g., proportion of friends who abstain from drugs and alcohol) at follow-up. Results are discussed in terms of how mutual help group involvement benefits patients and how the self-help group evaluation paradigm should be broadened.

Adult↗