The global agenda to move societies towards a more sustainable course of development also affects the lives of older people in our ageing populations. Therefore, it is important to understand the drivers, intentions and behaviours concerning sustainability among older adults. The aim of this study is to translate and cross-culturally validate an existing instrument (SustainABLE-16 Questionnaire), developed in the Netherlands, which measures how older people view the theme of environmental sustainability in their daily lives, for use in Romania, Poland, North Macedonia and Israel. The SustainABLE-16 covers three domains: 1) Pro-environmental behaviours; 2) Financial position; and 3) Beliefs. The scale was translated in Romanian, Polish, Macedonian, Albanian and Hebrew. Its 16 items were appraised for relevance by older people and experts in the field. A total of 2299 older people, including the original Dutch respondents, were included for the assessment of the level of measurement invariance across six languages, spoken in five countries. As the initial validation of the SustainABLE-16 did not meet internationally-recognised fit requirements, the shorter SustainABLE-8 was validated instead. This instrument proved valid for use in all participating countries (configural validity). Subsequently, increasingly constrained structural equation models were applied to test their fit with the data, ensuring that the fit did not deteriorate. The test results of measurement invariance across the countries indicated that items were stable, achieving partial scalar invariance, with five items demonstrating full scalar invariance. The shorter SustainABLE-8 functions uniformly across all language groups and can, therefore, be used to evaluate sustainable practices among older people. A better understanding of the drivers and practices among older citizens across Europe could, in turn, feed into more fitting public policies on sustainability in the built environment.
MULTIFILE
Background: Accurate measurement of health literacy is essential to improve accessibility and effectiveness of health care and prevention. One measure frequently applied in international research is the Short Assessment of Health Literacy (SAHL). While the Dutch SAHL (SAHL-D) has proven to be valid and reliable, its administration is time consuming and burdensome for participants. Our aim was to further validate, strengthen and shorten the SAHL-D using Rasch analysis. Methods: Available cross-sectional SAHL-D data was used from adult samples (N = 1231) to assess unidimensionality, local independence, item fit, person fit, item hierarchy, scale targeting, precision (person reliability and person separation), and presence of differential item functioning (DIF) depending on age, gender, education and study sample. Results: Thirteen items for a short form were selected based on item fit and DIF, and scale properties were compared between the two forms. The long form had several items with DIF for age, gender, educational level and study sample. Both forms showed lower measurement precision at higher health literacy levels. Conclusions: The findings support the validity and reliability of the SAHL-D for the long form and the short form, which can be used for a rapid assessment of health literacy in research and clinical practice.
Background: In clinical practice, nurses’ attitudes regarding older patients are important in relation to quality of care. The Older People in Acute Care Survey (OPACS) is an instrument measuring hospital nurses attitudes regarding older patients and is validated in Australia and the USA. The OPACS is translated in Dutch language and content validity of this translation is previously assessed, presenting questionable results. Measurement instruments, however, cannot be “validated” based on content validity evidence alone. Judgmental evidence and statistical analysis should be combined to fully evaluate content domain definition and representation and guide further development. Objective: Assess structural validity and reliability to fully evaluate the OPACS for use in the Netherlands, complementing previous conducted content validity results. Design: Cross-sectional. Setting: Three general hospitals in the Netherlands. Participants: 201 registered nurses. Methods: Confirmatory factor analysis was used to assess the structural validity. Reliability was assessed with Cronbach’s alpha. Results: OPACS Section A (measuring practice experiences) demonstrated to have acceptable structural validity- and good reliability outcomes after exclusion of two items (model fit: x² [df=537]=8475.40, p <0.001, CFI=0.96, TLI=0.96, RMSEA=0.21; Cronbach’s alpha=0.82). Section B (measuring general opinion) demonstrated to have inadequate structural validity outcomes (model fit: x² [df=1127]=9200.29, p<0.001, CFI=0.68, TLI=0.67, RMSEA=0.15). None of the items contributed significant to the factor and therefore no further analysis could be performed (range p(>|z|)= 0.551 -0 .788). Conclusion: Even though structural validity for section A was acceptable, content validity scores of a majority of items in this subscale were low, resulting in questionable use of this subscale for the Dutch context. The findings of this study, in relation to the earlier findings regarding content validity, justify the conclusion that use of the Dutch OPACS in clinical practice and research is not recommended. Given these findings, future research should pursue the development or (cross-cultural) validation of other instruments measuring hospital nurses attitudes towards older patients for the Dutch cultural context. Furthermore, this study demonstrated the influence of cultural differences on measurement instruments and the need for rigorous research before using a measurement instrument in a new culture or context.
