Curt Hagquist

KIDSCREEN-52 quality-of-life measure for children and adolescents

This study describes the development and reports the first psychometric results of the European KIDSCREEN-52 generic health-related quality-of-life questionnaire for children and adolescents. The KIDSCREEN-52, including ten dimensions, was applied in a European survey involving 12 countries (i.e., Austria, Switzerland, Czech Republic, Germany, Greece, Spain, France, Hungary, The Netherlands, Poland, Sweden and the UK) and 22,110 children and adolescents aged between 8 and 18 years of age. Questionnaire development included a literature search, expert consultation, and focus group discussions with children and adolescents. After definition of dimensions and collection of items, a translation process following international translation guidelines, cognitive interviews and a pilot test were performed. Analysis regarding psychometric properties showed Cronbach-α ranged from 0.77 to 0.89. Correlation coefficients between KINDLR and KIDSCREEN-52 dimensions were high for those assessing similar constructs (r = 0.51–0.68). All KIDSCREEN-52 dimensions showed a gradient according to socioeconomic status and most dimensions showed a gradient according to psychosomatic health complaints. The first results demonstrate that the KIDSCREEN-52 questionnaire is a promising cross-cultural measure of health-related quality-of-life assessment for children and adolescents in Europe.

THE KIDSCREEN-52 QUALITY OF LIFE MEASURE FOR CHILDREN AND ADOLESCENTS: PSYCHOMETRIC RESULTS FROM A CROSS-CULTURAL SURVEY IN 13 EUROPEAN COUNTRIES

OBJECTIVE This study assesses the reliability and validity of the European KIDSCREEN-52 generic health-related quality of life (HRQoL) questionnaire for children and adolescents. RESEARCH DESIGN The KIDSCREEN-52, which measures HRQoL in 10 dimensions, was administered to a representative sample of 22,827 children and adolescents (8 to 18 years) in 13 European countries. Psychometric properties were assessed using the Classical Test Theory approach, Rasch analysis, and structural equation modeling (SEM). A priori expected associations between KIDSCREEN scales and sociodemographic and health-related factors were examined. Test-retest reliability was assessed in 10 countries. RESULTS For the overall sample, Cronbachs alpha values ranged from 0.77 to 0.89. Scaling success (Multitrait Analysis Program) was >97.8% for all dimensions and Rasch analysis item fit (INFITmsq) ranged from 0.80 to 1.27. The intraclass correlation coefficients ranged from 0.56 to 0.77. No sizeable differential item functioning (DIF) was found by age, sex or health status. Four items showed DIF across countries. The specified SEM fitted the data well (root mean square error of approximation: 0.06, comparative fit index: 0.98). Correlation coefficients between Pediatric Quality of Life Inventory, Child Health and Illness Profile-Adolescent Edition, and Youth Quality of Life Instrument scales and KIDSCREEN dimensions assessing similar constructs were moderate for those (r = 0.44 to 0.61). Statistically significant differences between children with and without physical and mental health problems (Children with Special Health Care Needs screener: d = 0.17 to 0.42, Strengths and Difficulties Questionnaire: d = 0.32 to 0.72) were found in all dimensions. All dimensions showed a gradient according to socioeconomic status. CONCLUSIONS The KIDSCREEN-52 questionnaire has acceptable levels of reliability and validity. Further work is needed to assess longitudinal validity and sensitivity to change.

Using the Rasch model in nursing research: An introduction and illustrative example

OBJECTIVE The purpose was to introduce the Rasch model by showing an application in nursing research. METHODS The Rasch model was used to examine the psychometric properties of the nursing self-efficacy (NSE) scale. Data were collected among nursing students in Sweden. Two sets of items were analysed more thoroughly: an original set of nine items with eleven response categories and a revised set of seven items with seven response categories. Invariance of the item functioning and the categorisation of the items were analysed. Targeting was examined by comparisons of the items and persons locations. Differential Item Functioning across sample groups such as gender was examined using analysis of variance. The final set of seven items was also analysed more closely with respect to possible multidimensionality and response dependence. RESULTS The Rasch analysis of the original set of nine items showed high reliability measured by a person separation index, but it also indicated severe problems with the targeting, the categorisation of the items as well as lack of invariance. Although the revised set comprising seven items with seven categories performed better than the original item set some items showed misfit according to formal test statistics. Graphical examination showed, however, that the items operated in the right direction. The formal test of local independence of the items indicated minor signs of multidimensionality, alternatively response dependence. CONCLUSIONS The Rasch model is useful for rigorous examination and development of measurement instruments in nursing research. The Rasch model facilitates disclosure of lack of invariance and other measurement problems that may not be easily detected by traditional analyses. Hence, the NSE-scale would probably have performed much better if the developmental work had been guided by Rasch analyses. In future work on the scale, priority should be given to improving the targeting and the categorisation of the items.

Is the Sense of coherence-instrument applicable on adolescents? A latent trait analysis using Rasch-modelling

This study examines the construct validity of the 13-items Sense of Coherence (SOC) -instrument applied to a sample of 868 eighteen-year-old adolescents from a city in Sweden by using the Rasch model. All items showed relative invariance across the continuum, and although three items showed statistically significant lack of perfect invariance across genders, it was considered that they nevertheless worked sufficiently well to be retained. One item did show a response format that was incompatible with the correct operation of the categories. The questionnaire could separate the adolescents from this general population and it was concluded that the results were consistent with Antonovskys view that the SOC-scale should be dealt with as a measure of one global factor.

Discrepant Trends in Mental Health Complaints Among Younger and Older Adolescents in Sweden: An Analysis of WHO Data 1985–2005

PURPOSE To elucidate the time trends in self-reported mental health complaints (internalizing problems) among school children in Sweden during a time characterized by economic downturns and upturns, with a focus on possible differences across grades and genders. METHODS The study uses nationwide and repeated cross-sectional data collected five times during 1985-2005 among students in Sweden in grades 5, 7, and 9. The number of participating students each year varied between 2,933 and 4,421. The attrition rates varied between 10% and 15% in the participating schools. Data were subjected to descriptive analysis and multinomial logistic regression using a composite measure of self-reported mental health complaints. RESULTS The study results show significantly higher rates of mental health complaints in 2005/2006 compared with 1985/1986 among older adolescents, in particular girls, whereas the rates are almost unchanged among younger boys and girls. Only among girls in grade 9 has there been a successively (linear) increase of mental health complaints across years of investigations. CONCLUSIONS The increasing rates of mental health complaints among older adolescents, in particular girls, are a cause for concern and a challenge for public health work. By showing discrepant time trends among younger and older adolescents, the results of the study nuance the predominant and unambiguous notions about continuously deteriorating mental health among children and adolescents in Sweden. To address hypotheses concerning the causes of the discrepant time trends, suggestions are made for comparative cross-country analyses based on data from Sweden and other European countries.

Psychosomatic health problems among adolescents in Sweden—are the time trends gender related?

BACKGROUND Since the economic recession in Sweden in the 1990s alarming reports about deteriorating mental and psychosomatic health among young people have repeatedly been published but reliable survey data are rare. The purpose of the study is to describe the trends in psychosomatic health problems among adolescents, focusing on gender differences. METHODS The analysis is based on repeated cross-sectional data collected 1988-2005 among about 15,000 adolescents (15- to 16-years old) within a county in Sweden. The data were collected in schools using a questionnaire that was completed anonymously. A composite measure of psychosomatic health problems based on eight items was used. RESULTS Psychosomatic health complaints among boys increased mainly during the in-recession time period, while the health problems among girls increased only slightly during the crisis, but increased dramatically in the post-recession time period. Only among boys did the variance in psychosomatic health increase successively across years of investigation, implying that the psychosomatic health among boys on average did not change over time. CONCLUSIONS In showing different trend patterns across genders, the present study nuances and qualifies previous reports on deteriorating mental and psychosomatic health among adolescents. Whether the gender-related trend patterns are due to differences in the relative influence of economic and social stress factors or if they reflect other factors such as changes in the educational systems should be addressed in future studies.

Does the association with psychosomatic health problems differ between cyberbullying and traditional bullying

The association between mental health problems and traditional bullying is well known, whereas the strength of the association in cyberbullying is less known. This study aimed to compare the association between mutually exclusive groups of bullying involvement and psychosomatic problems as measured by the PsychoSomatic Problems scale. The sample comprised 3820 students (13–16 years old) in Sweden. The results indicate an association between bullying and psychosomatic problems, regardless of type of bullying involvement. No statistically significant differences in psychosomatic problems were found between cyberbullying and traditional bullying, either for victims or for bullies. The results do not confirm the hypothesis that the association between bullying and mental health is stronger for cyberbullying than for traditional bullying. Another important finding is that cyberbullies seem as likely as cybervictims to be at risk for mental health problems.

Discrepant gender patterns for cyberbullying and traditional bullying – An analysis of Swedish adolescent data

In the wake of the rapid development of modern IT technology, cyberspace bullying has emerged among adolescents. The aim of the present study was to examine gender differences among adolescents inv ...

Real and Artificial Differential Item Functioning.

The literature in modern test theory on procedures for identifying items with differential item functioning (DIF) among two groups of persons includes the Mantel–Haenszel (MH) procedure. Generally, it is not recognized explicitly that if there is real DIF in some items which favor one group, then as an artifact of this procedure, artificial DIF that favors the other group is induced in the other items. Using the Rasch model for dichotomous responses as a theoretical basis, this article proves that the source of artificial DIF in the MH procedure is that estimates of the person locations are substituted for their unknown values. The article then demonstrates that the formalization of artificial DIF implies mathematically (a) a particular sequential, iterative procedure for detecting items with real DIF and for identifying a set of items that may have no DIF and (b) a resolution of the items with real DIF for quantifying the DIF on the same metric as the items showing no DIF and provides expected value curves and tests of fit for the item for each of the groups. Finally, because the source of artificial DIF in the MH procedure is the substitution of a parameter with its estimate, it is suggested that all procedures that use the substitution of an estimate for a parameter are likely to induce artificial DIF.

Real and Artificial Differential Item Functioning in Polytomous Items

Differential item functioning (DIF) for an item between two groups is present if, for the same person location on a variable, persons from different groups have different expected values for their responses. Applying only to dichotomously scored items in the popular Mantel–Haenszel (MH) method for detecting DIF in which persons are classified by their total scores on an instrument, Andrich and Hagquist articulated the concept of artificial DIF and showed that as an artifact of the MH method, real DIF in one item favoring one group inevitably induces artificial DIF favoring the other group in all other items. Using the dichotomous Rasch model in which the total score for a person is a sufficient statistic, and therefore justifies classifying persons by their total scores, Andrich and Hagquist showed that to distinguish between real and artificial DIF in an item identified by the MH method, a sequential procedure for resolving items is implied. Using the polytomous Rasch model, this article generalizes the concept of artificial DIF to polytomous items, in which multiple item parameters play a role. The article shows that the same principle of resolving items sequentially as with dichotomous items applies also to distinguishing between real and artificial DIF with polytomous items. A real example and a small simulated example that parallels the real example are used illustratively.