Frans J. Oort

The Influence of Affective Teacher–Student Relationships on Students’ School Engagement and Achievement A Meta-Analytic Approach

A meta-analytic approach was used to investigate the associations between affective qualities of teacher–student relationships (TSRs) and students’ school engagement and achievement. Results were based on 99 studies, including students from preschool to high school. Separate analyses were conducted for positive relationships and engagement (k = 61 studies, N = 88,417 students), negative relationships and engagement (k = 18, N = 5,847), positive relationships and achievement (k = 61, N = 52,718), and negative relationships and achievement (k = 28, N = 18,944). Overall, associations of both positive and negative relationships with engagement were medium to large, whereas associations with achievement were small to medium. Some of these associations were weaker, but still statistically significant, after correction for methodological biases. Overall, stronger effects were found in the higher grades. Nevertheless, the effects of negative relationships were stronger in primary than in secondary school.

Predicting and preventing physician burnout: results from the United States and the Netherlands.

Burnout is a long-term stress reaction seen primarily in the human service professions. It is a “psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment” (1). Over the past 20 years, many aspects of medical practice have changed: autonomy is declining, the status of physicians has diminished, and work pressures are increasing. Burnout is an unintended and adverse result of such changes. Burnout has been described among physicians in several countries and practice settings; in the Netherlands, physician disability insurance premiums have recently risen 20% to 30% owing to an increasing incidence of burnout and stress-related complaints (2). Paraphrasing Maslach, Wilters (3) describes burned out physicians as being angry, irritable, and impatient; “there is also an increase in absenteeism and job turnover. Decreasing productivity and practice revenue are byproducts of physician turnover.” Thus burnout can be associated with a deterioration in the physician-patient relationship and a decrease in both the quantity and quality of care. In a recent survey of health maintenance organization (HMO) physicians (4), burned out physicians were less satisfied, more likely to want to reduce their time seeing patients, more likely to order tests or procedures, and more interested in early retirement than other physicians. To better understand the interplay of the predictors of physician burnout and to develop strategies for prevention, we compared data from two large physician surveys, one in the United States (the Physician Worklife Study) and another in the Netherlands (the Dutch Study of Motivation among Medical Consultants). These data were used to construct and test a predictive model of physician burnout.

How to Improve Teaching Practices The Role of Teacher Motivation, Organizational Factors, and Leadership Practices

Purpose: Although it is expected that building schoolwide capacity for teacher learning will improve teaching practices, there is little systematic evidence to support this claim. This study aimed to examine the relative impact of transformational leadership practices, school organizational conditions, teacher motivational factors, and teacher learning on teaching practices. Research Design: Data were collected from a survey of 502 teachers from 32 elementary schools in the Netherlands. A structural model was tested on the within-school covariance matrix and a chi-square test taking into account nonindependence of observations. Findings: Results suggest that teachers’ engagement in professional learning activities, in particular experimenting and reflection, is a powerful predictor for teaching practices. Teachers’ sense of self-efficacy appeared to be the most important motivational factor for explaining teacher learning and teaching practices. Motivational factors also mediate the effects of school organizational conditions and leadership practices on teacher learning and teaching practices. Finally, transformational leadership practices stimulate teachers’ professional learning and motivation and improve school organizational conditions. Conclusions: For school leaders, to foster teacher learning and improve teaching practices a combination of transformational leadership behaviors is required. Further research is needed to examine the relative effects of transformational leadership dimensions on school organizational conditions, teacher motivation, and professional learning in schools. Finally, conditions for school improvement were examined at one point in time. Longitudinal studies to school improvement are required to model changes in schools’ capacities and growth and their subsequent effects on teaching practices.

Using structural equation modeling to detect response shifts and true change

The assessment of change in patient-reported outcomes is hindered by the fact that there are different types of change. Besides ‘true’ change, different types of response shift, such as recalibration, reprioritization, and reconceptualization, may occur. We describe how structural equation modeling can be used to detect response shifts and to measure true change.

Methods to detect response shift in quality of life data: a convergent validity study

When measuring changes in quality of life (QL) with a pretest-posttest design, response shift can affect results. We investigated the convergent validity of three approaches to detect response shift. (1) In the thentest approach, response shift is measured using a retrospective judgment of pretest QL-levels (thentest). (2) In the anchor–recalibration approach response shift is measured, assessing shifts in patients’ individual definitions of the scale-anchors (worst and best imaginable QL) over time. (3) In the Structural Equation Modeling (SEM) approach response shift is indicated by mathematically defined changes in factor solutions and variance–covariance matrices over time. Prior to and three months after invasive surgery, 170 cancer patients completed the SF-36, the Multidimensional Fatigue Inventory (as pre-, post-, and thentest), and the anchor–recalibration task (as pre-, and posttest). Results showed agreement between the thentest and SEM approach on the absence (6 scales) and presence (2 scales) of response shift in 8 of the 9 scales. For the ninth scale both methods detected response shift, but in opposite directions. Possible explanations for this discrepancy are discussed. The anchor–recalibration task agreed with the other approaches on only the absence of response shift in 4 of the 7 scales. The convergent results of thentest and SEM support their validity, especially because they use statistically independent operationalizations of response shift. In this study, recall bias did not invalidate thentest results.

An application of structural equation modeling to detect response shifts and true change in quality of life data from cancer patients undergoing invasive surgery

The objective is to show how structural equation modeling can be used to detect reconceptualization, reprioritization, and recalibration response shifts in quality of life data from cancer patients undergoing invasive surgery. A consecutive series of 170 newly diagnosed cancer patients, heterogeneous to cancer site, were included. Patients were administered the SF-36 and a short version of the multidimensional fatigue inventory prior to surgery, and 3 months following surgery. Indications of response shift effects were found for five SF-36 scales: reconceptualization of ‘general health’, reprioritization of ‘social functioning’, and recalibration of ‘role-physical’, ‘bodily pain’, and ‘vitality’. Accounting for these response shifts, we found deteriorated physical health, deteriorated general fitness, and improved mental health. The sizes of the response shift effects on observed change were only small. Yet, accounting for the recalibration response shifts did change the estimate of true change in physical health from medium to large. The structural equation modeling approach was found to be useful in detecting response shift effects. The extent to which the procedure is guided by subjective decisions is discussed.

Satisfaction with the outpatient encounter: a comparison of patients' and physicians' views.

AbstractOBJECTIVE: To compare patients’ and physicians’ visit-specific satisfaction in an internal medicine outpatient setting, and to explain their respective views. DESIGN: Patients’ and physicians’ background characteristics were assessed prior to outpatient encounters. Immediately after the encounter, both patients and physicians completed a questionnaire assessing satisfaction with the visit. SETTING: The outpatient division of an academic teaching hospital. PARTICIPANTS: Thirty residents and specialists in general internal medicine, rheumatology, and gastroenterology, and 330 patients having a follow-up appointment with one of these physicians. MEASUREMENTS AND MAIN RESULTS: Patients’ and physicians’ visit-specific satisfaction was assessed using 5 Visual Analogue Scales (0 to 100). Patients’ overall satisfaction was higher than physicians’ satisfaction (mean 81 vs. 66), and correlation of patients’ and physicians’ overall satisfaction with the specific visit was medium sized (r=.28, P<.001). Patients’ satisfaction ratings were associated with their previsit self-efficacy in communicating with their physician (P<.001) and with visiting a female physician (P<.01). Physicians’ satisfaction was associated with patients’ higher educational level (P<.05), primary language being Dutch (P<.001), better mental health (P<.05), and preference for receiving less than full information (P<.05). CONCLUSIONS: In an outpatient setting, patients’ visit-specific satisfaction ratings were substantially higher than, and only moderately associated with, physicians’ ratings of the same visit. The dissimilar predictors explaining patients’ and physicians’ satisfaction suggest that patients and physicians form their opinion about a consultation in different ways. Hence, when evaluating outpatient encounters, physicians’ satisfaction has additional value to patients’ satisfaction in establishing quality of care.

The value of the hospital anxiety and depression scale (HADS) for comparing women with early onset breast cancer with population-based reference women

Background: The Hospital Anxiety and Depression Scale (HADS) is frequently used in cancer studies, yet its utility for comparing people with cancer with people in the community is uncertain. Methods: HADS scores were obtained from population-based samples of women with (n = 731) and without (n = 158) early-onset breast cancer. Psychometric properties were examined using differential item functioning (DIF) which is the presence of systematic group differences in certain response items independent of the trait being measured. Results: Women with breast cancer scored lower than reference women on anxiety (mean (SD) 7.5 (4.3) vs. 8.2 (4.0); p = 0.06) and depression (3.3 (3.2) vs. 4.2 (3.0); p = 0.003). Group differences remained following adjustment for demographics. Time since diagnosis was not related to anxiety or depression scores. DIF was present in two anxiety and five depression items. Adjustment for DIF did not substantially change the anxiety or depression group differences. Conclusion: Specific sampling or DIF effects do not explain the observation that women with breast cancer have lower levels of anxiety and depression than population controls. The psychometric properties of the HADS appear to be acceptable in these groups.

Simulation study of item bias detection with restricted factor analysis

Restricted factor analysis (RFA) can be used to detect item bias (also called differential item functioning). In the RFA method of item bias detection, the common factor model serves as an item response model, but group membership is also included in the model. Two simulation studies are reported, both showing that the RFA method detects bias in 7‐point scale items very well, especially when the sample size is large, the mean trait difference between groups is small, the group sizes are equal, and the amount of bias is large. The first study further shows that the RFA method detects bias in dichotomous items at least as well as an established method based on the one‐parameter logistic item response model. The second study concerns various procedures to evaluate the significance of two‐item bias indices provided by the RFA method. The results indicate that the RFA method performs best when it is used in an iterative procedure.

Formal definitions of measurement bias and explanation bias clarify measurement and conceptual perspectives on response shift

OBJECTIVE Response shift is generally associated with a change in the meaning of test scores, impeding the comparison of repeated measurements. Still, different researchers have different views of response shift. From a measurement perspective, response shift can be considered as bias in the measurement of change, whereas from a more conceptual perspective, it can be considered as bias in the explanation of change. We propose definitions to accommodate both interpretations of response shift. STUDY DESIGN AND SETTING Formal definitions of measurement bias and explanation bias serve to define response shift in measurement and conceptual perspectives. Examples from the field of health-related quality of life research illustrate the definitions. RESULTS Definitions of response shifts as special cases of either measurement bias or explanation bias clarify different interpretations of response shift and lead to different research methods. Different structural equation models are suggested to investigate biases and response shifts in each of the two perspectives. CONCLUSION It is important to distinguish between measurement and conceptual perspectives as they involve different ideas about response shift. Definitions from both perspectives help to resolve conceptual and methodological confusion around response shift and to further its research.