Martyn C. Jones

Essential elements of questionnaire design and development

Aims.  The aims of this paper were (1) to raise awareness of the issues in questionnaire development and subsequent psychometric evaluation, and (2) to provide strategies to enable nurse researchers to design and develop their own measure and evaluate the quality of existing nursing measures. Background.  The number of questionnaires developed by nurses has increased in recent years. While the rigour applied to the questionnaire development process may be improving, we know that nurses are still not generally adept at the psychometric evaluation of new measures. This paper explores the process by which a reliable and valid questionnaire can be developed. Methods.  We critically evaluate the theoretical and methodological issues associated with questionnaire design and development and present a series of heuristic decision-making strategies at each stage of such development. The range of available scales is presented and we discuss strategies to enable item generation and development. The importance of stating a priori the number of factors expected in a prototypic measure is emphasized. Issues of reliability and validity are explored using item analysis and exploratory factor analysis and illustrated using examples from recent nursing research literature. Conclusion.  Questionnaire design and development must be supported by a logical, systematic and structured approach. To aid this process we present a framework that supports this and suggest strategies to demonstrate the reliability and validity of the new and developing measure. Relevance to clinical practice.  In developing the evidence base of nursing practice using this method of data collection, it is vital that questionnaire design incorporates preplanned methods to establish reliability and validity. Failure to develop a questionnaire sufficiently may lead to difficulty interpreting results, and this may impact upon clinical or educational practice. This paper presents a critical evaluation of the questionnaire design and development process and demonstrates good practice at each stage of this process.

Prevalence and time trends in obesity among adult West African populations: a meta-analysis

The objective of this study was to determine the distribution of and trends in obesity in adult West African populations.

A comparison of health behaviours in lonely and non-lonely populations.

Abstract Loneliness can be defined as perceived social isolation and appears to be a relatively common experience in adults. It carries a significant health risk and has been associated with heart disease, depression and poor recovery after coronary heart surgery. The mechanisms that link loneliness and morbidity are unclear but one of the mechanisms may be through poor health beliefs and behaviours. The aims of this cross-sectional survey of 1289 adults were to investigate differences in health behaviours (smoking, overweight, BMI, sedentary, attitudes towards physical activity) in lonely and non-lonely groups. Lonely individuals were more likely to be smokers and more likely to be overweight – obese. The lonely group had higher body mass index scores controlling for age, annual income, gender, employment and marital status. Logistic regression revealed no differences in sedentary lifestyles. Lonely individuals were significantly less likely to believe it was desirable for them to lose weight by walking for recreation, leisure or transportation. The findings provide support for an association between health behaviours, loneliness and excess morbidity reported in previous studies.

Prevalence and time trends in diabetes and physical inactivity among adult West African populations: The epidemic has arrived

OBJECTIVE To determine the prevalence and distribution of, and trends in, physical inactivity and diabetes in adult West African populations. DESIGN Systematic review and meta-analysis. METHODS Literature searches were conducted using four electronic databases. Journal hand searches and examination of citations of relevant articles were also undertaken. To be included, studies had to be population based, use clearly defined criteria for measuring diabetes and physical inactivity, present data that allowed calculation of the prevalence of diabetes or physical inactivity, and sample adult participants. Studies retrieved were appraised critically. Meta-analysis was performed using the DerSimonian-Laird random effect model. RESULTS Twenty-one reports were retrieved for diabetes and 15 reports were retrieved for physical in/activity. Most studies (10 for diabetes and six for physical activity) were conducted solely among urban populations. The prevalence of diabetes in West Africa was approximately 4.0% [95% confidence interval (CI) 2.0-9.0] in urban adults and 2.6% (95%CI 1.5-4.4) in rural adults, and was similar in men and women [prevalence ratio (PR) 1.36, 95%CI 0.96-1.92]. Cumulative time trend analyses suggested an increase in the prevalence of diabetes among adults in urban West Africa, from approximately 3.0% (95%CI 1.0-7.0) to 4.0% (95%CI 2.0-9.0) in the past 10 years. The prevalence of inactivity in West Africa was 13% (95%CI 9.0-18.0). An association was found between physical inactivity and being older (> or = 50 years) (PR 1.82, 95%CI 1.36-2.44), female gender (PR 1.62, 95%CI 1.41-1.87) and urban residence (PR 2.04, 95%CI 1.58-2.63). CONCLUSIONS Diabetes and physical inactivity are important public health issues in urban West Africa, with similar prevalences to wealthy industrialized countries. There is an urgent need for policy makers, politicians and health promotion experts to put measures in place to encourage active lifestyles and control diabetes in urban West Africa.

The derivation of a brief Student Nurse Stress Index.

The lack of an adequate measure of perceived sources of stress for student nurses led to the construction of the Student Nurse Stress Index (SNSI). Responses from 235 first-year student nurses to 35 items from the Beck and Srivastava Stress Inventory (Beck, and Srivastava, 1991), and 15 new items, were subjected to exploratory factor analysis using principal components analysis and oblimin rotation. A reliable 22-variable solution with a simple oblique structure including Academic load, Clinical sources, Interface worries, and Personal problems factors was obtained in this initial sample, and confirmed at an exploratory level in a further independent validation sample of 188 first-year students. Confirmatory factor analysis established the four-factor model in the first sample, but required that three variables load onto more than one factor. This more complex four-factor model was confirmed using independent data from the validation sample, and the total invariance of factor loadings and factor covarianc...

Evaluating the impact of a worksite stress management programme for distressed student nurses: A randomised controlled trial

Abstract The effectiveness of a stress management intervention designed to reduce affective distress in 79 student nurses who previously reported significant distress, was evaluated by comparing stress management with wait-list control. The intervention had reliable, positive effects on affective outcomes including General Health Questionnaire-30, State and Trait Anxiety Inventory, Beck Depression Inventory, and a measure of domestic satisfaction. The intervention also led to an increase in Direct Coping use. State Anxiety immediately preceding two important examinations, i.e. at 3 and 18 month follow-up, was lower for students receiving stress management. However, no effect was detected on sickness, absence and examination performance following this intervention. Stress management delivered in groups reduces affective distress and increases adaptive coping use in both clinical and academic settings.

Exploring the relationship between coping, social support and health-related quality of life for prostate cancer survivors: A review of the literature

OBJECTIVE Men affected by prostate cancer can experience profound physical and psychological sequalae; and unmet support needs are prevalent in men affected by this disease. Social support has been linked to improved health-related quality of life (HRQoL) and coping strategies, but little is known about the relationship between social support, coping and HRQoL for prostate cancer survivors. This review aims to identify the mechanism through which social support influences the relationship between coping and HRQoL for prostate cancer survivors. METHODS A literature review was conducted from the earliest date available to January 2013. Medline, CINAHL, PsycInfo, and ASSIA databases were searched using terms relevant to coping, social support and prostate cancer. Studies that explored the relationship between coping, social support and HRQoL were included. RESULTS 175 studies were assessed for potential inclusion with 11 publications included in this review. Studies predominately reported main effects of perceived social support on HRQoL, and few studies assessed moderation and mediation effects of coping and social support on HRQoL. Perceived social support was frequently assessed, but few studies evaluated the effects of received social support or satisfaction with social support on HRQoL. CONCLUSIONS The evidence base is under-developed at present. Future research should use a multidimensional inventory of the social support constructs to examine how each of the constructs influences the relationship between coping and HRQoL over time. This may facilitate the development of appropriately targeted social support interventions that are theoretically driven to address the unmet support needs of prostate cancer survivors.

Using computerized ambulatory diaries for the assessment of job characteristics and work-related stress in nurses

Abstract Much research into work-related stress is based on retrospective self-reports, whereas records made at the time could be more valuable. In this study the primary components of two models of work stress, Karaseks demand-control (DC) model and Siegrists effort-reward imbalance (ERI), were assessed in trained nurses using ambulatory diaries and traditional questionnaire methods. The diaries were entered on small hand-held computers and the method used has been termed ecological momentary assessment (EMA), in which recordings are made in real time in the working environment. The participants were 36 nurses who completed standardized questionnaires evaluating ERI, strain (from DC model), and, over three shifts, computerized behavioural diaries that measured effort-demand, control, reward, and stress every 90 minutes on average, enabling determination of strain and ERI repeatedly in the work situation. A total of 674 observations were recorded. Using multilevel linear modelling, it was found that the questionnaire and computerized diary derived measures of strain (DC) and ERI were reliably correlated. In addition, the ambulatory measures of both strain (DC) and ERI correlated with ratings of stress taken at the same time. From this study it would appear that ambulatory diaries could be a powerful and flexible way of assessing work related stress and its putative determinants in a real life work setting.

Work stress and well-being in oncology settings: a multidisciplinary study of health care professionals.

Staff working in oncology report high levels of work‐related stress. This arises partly from the nature of clinical work, including practitioner perceptions of high demand and low control or high effort and low reward. This comparative study investigated the correlates of work stress in a multidisciplinary group of staff and the associations between staff perceptions of the work environment, emotional distress, job satisfaction and work‐based social support.

What predicts the selection of nursing as a career choice in 5th and 6th year school students

Demand for nursing care, and nurses, is growing in the United Kingdom given an increasingly ageing patient population with long-term co-morbidities. An ageing nursing workforce and fewer school leavers entering nursing are key barriers to student nurse recruitment. This paper aims to identify the socio-demographic and correlates nursing as a career choice in 5th and 6th year school students. This cross-sectional descriptive study gathered self-administered questionnaires from a total cohort of 5th and 6th year school students (n=1059) in one educational authority in Scotland. A response rate of 100% was achieved, with 702 students expressing a career choice. Some 71.7% (n=503) of students providing a full data set would never consider nursing, even if they obtained poor grades. Only 28.3% (n=199) would ever consider nursing. Students cited nursing as a career choice if they were female, of average to below average academic ability/achievement, expressed a positive attitude to nursing as a degree subject which was shared by their career guidance teacher. Each additional higher reduced the likelihood of nursing as a career choice by 22%. Nursing is an unpopular career choice amongst school students. Strategies are required to improve the occupational image of nursing in secondary education.