Background:

There is evidence that both personality traits and personal beliefs about medications affect adherence behavior. However, limited research exists on how personality and beliefs about asthma medication interact in influencing adherence behavior in people with asthma. To extend our knowledge in this area of adherence research, we aimed to determine the mediating effects of beliefs about asthma medication between personality traits and adherence behavior.

Methods:

Asthmatics (n=516) selected from a population-based study called West Sweden Asthma Study completed the Neuroticism, Extraversion and Openness to Experience Five-Factor Inventory, the Medication Adherence Report Scale, and the Beliefs about Medicines Questionnaire. Data were analyzed using confirmatory factor analysis and structural equation modeling.

Results:

Three of the five investigated personality traits – agreeableness, conscientiousness, and neuroticism – were associated with both concerns about asthma medication and adherence behavior. Concerns functioned as a partial mediator for the influencing effects of agreeableness, conscientiousness, and neuroticism on adherence behavior.

Conclusion:

The findings suggest that personality traits could be used to identify individuals with asthma who need support with their adherence behavior. Additionally, targeting concerns about asthma medication in asthmatics with low levels of agreeableness or conscientiousness or high levels of neuroticism could have a favorable effect on their adherence behavior.

Purpose Personality traits are rather stable dispositions inadulthood, while self-efficacy and adherence may bemodified through targeted interventions. Health-relatedquality of life (HRQL) serves as a vital outcome measure.The present aim was to explore the function of self-efficacyand adherence as mediators for the influencing effect ofpersonality traits on HRQL in people with chronic disease.Methods An epidemiological sample of 786 personscompleted questionnaires on personality, general self-efficacy,adherence behaviour and HRQL. Data were statisticallyanalysed using descriptive statistics, correlationanalyses and path models.Results Self-efficacy mediated the effect of Extraversionand Conscientiousness on mental HRQL. Neuroticism hada direct effect on both physical and mental HRQL.Adherence partially mediated the effect of both Agreeablenessand Conscientiousness on mental HRQL.Conclusions The mental HRQL in people scoring low onExtraversion or low on Conscientiousness could beimproved by strengthening general self-efficacy. Increasingadherence in people scoring low on Agreeableness orConscientiousness could improve their mental HRQL, butthe improvement was small and may be of lesser clinicalrelevance. These results argue for personalized interventionsintended to positively affect health outcomes inpeople with chronic disease.

Widening Participation in Higher Education: Casting the Net Wide? offers an authoritative up-to-date commentary on the challenges facing higher education today, through the perspectives of experts representing universities across the UK, Europe, Africa and the USA. Contributors draw on recent empirical research as well as analysis of historical developments and emerging policy to provide an understanding of these issues of widening participation to educational practitioners, policy makers and academics alike. Up-to-date insights chart the impact of global economic trends and recent policy developments for students, academics, providers and changing course provision. Contributions from emerging and established experts address a broad range of relevant issues, from the question of grade inflation through to the effectiveness of peer outreach programmes. The book provides insight into how the effects of trends including marketization and globalization will continue to impact pivotally on the extent to which higher education is able to act as a force for social equalization or exclusion of opportunities.

When people’s health is threatened, they generally develop illness perceptions to make sense of their illness. The Illness Perception Questionnaire (IPQ-R), developed by Moss-Morris et al (2002), has been widely used in many countries to measure such representations. However, since studies in this crucial research area are lacking in Sweden a Swedish version of IPQ-R was validated with a focus on the seven subscales: timeline acute/chronic, timeline cyclical, consequences, personal control, treatment control, illness coherence and emotional representations. Using confirmatory factor analysis, the aim of the present study was to validate the internal structure of the Swedish version in a sample of 202 persons (144 men and 58 women) who had been diagnosed with myocardial infarction four months earlier. Additionally, inter-correlations among the seven subscales and external concurrent validity were also investigated. The results of confirmatory factor analysis revealed that, in line with the English version of the IPQ-R, the specified seven-factor model had a satisfactory fit. One item was however not considered reliable and was therefore excluded from the instrument. The internal consistency (Cronbach’s alpha coefficients) and the inter-factor correlations were relatively similar to those reported in the validation study of the original English IPQ-R. In tests of concurrent validity, the seven IPQ-R subscales were, as hypothesized, mainly associated with external variables. To conclude, the Swedish version of the IPQ-R’s seven dimensions, with one item removed, (total 37 items) was found to be a reliable and valid measure of illness perception.

Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.

Introduction: After treatment for myocardial infarction (MI) quite a few persons will experience different symptoms, including fatigue, during the recovery phase. The aim of the present study was to construct the multidimensional Post-Myocardial Infarction Fatigue (PMIF) scale, based on empirical data gathered in coronary heart disease contexts. Methods: The construction of the post-MI fatigue scale was conducted in seven steps, ending in a psychometric evaluation of the internal structure of the scale, using confirmatory factor analysis, as well as testing of convergent and discriminant validity, using correlational analysis, in a sample of 141 persons treated for MI. Results: The results showed that the PMIF scale represents three dimensions: physical, cognitive and emotional fatigue. It was also found that the scale is suitable for summing the items to obtain a total score representing a post-MI global fatigue dimension. Conclusion: The PMIF is a brief and easily completed scale for identifying persons experiencing post-MI fatigue. Early identification of fatigue, together with health behavior support, might prevent progression toward a more severe state of fatigue.

Att tveksamheter framförts angående mål- och kunskapsrelate-rade betyg liksom till möjligheten att betygskomplettera är väl känt. Likaså att betygsmedelvärdet har ökat sedan införandet av det nya målrelaterade betygssyste-met. Däremot har det varit oklart vad dessa höjningar av betygen representerar; mer kunskaper eller betygsinflation. Då betygen ska signalera kunskaper, och de kunska-per som eleverna tillägnar sig i gymnasieskolan ska ligga till grund för fortsatt utbildning, är det rimligt att förvänta att ju bättre gymnasiebetyg desto bättre studie-resultat vid fortsatt utbildning. Syftet med föreliggande studie är att undersöka gymnasiebetygens egenskaper och innebörden av betygskomplettering genom att relatera betygens jämförelsetal till studieframgång på civilingenjörs- och läkarpro-grammen. Resultaten visar att gymnasieskolans betygssättning är utsatt för en betydande inflation och att detsamma gäller för betygsförändringar som resultat av komplettering. Hela den genomsnittliga betygsökningen, oavsett om det gäller betygsutveckling eller komplettering, utgörs av »tomma» betygsenheter som inte svarar mot bättre resultat inom högskoleutbildningarna. 

The purpose of the study is to examine effects of repeated test taking over several sessions on the Swedish Scholastic Aptitude Test (SweSAT). Self-selection effects on test performance due to background variables that must be taken into consideration are also investigated. All test repeaters with two and three test scores from three cohorts are included in the study. By using different regression models a distinction can be made between the effects of practice as a function of test-taking experience, and the effects of growth as a function of time. The results show self-selection effects due to age and grades, such that students with higher grades tend to be younger when taking the first test. Furthermore, this phenomenon tends to be more accentuated with repeated test takings. It is also shown that there are score gains as a function of practice at the first testing session, and that there are also effects of growth on the SweSAT performance. The magnitude of score gains associated with growth is equal over the two intervals measured, but different between the three cohorts. There are reasons to assume that effects of schooling may explain these differences. An additional explanation may be that the younger students have a greater potential for growth. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The purpose of the study is to examine effects on study efficiency of specially designed

admission procedures, Step-wise admission, used for selection to medical education. In Step-wise procedures, written tests and interviews are used to assess personality traits such as motivation, social competence, patience, empathy and devotion. The selection of variables is based on assumptions about the influence of personal characteristics on success both academically and in the profession. By using data from a large-scale longitudinal project (VALUTA), the students admitted via Step-wise admission are compared to those admitted through regular admission, grades from upper secondary school and scores from the Swedish Scholastic Aptitude Test (SweSAT). Efficiency in studies is measured by achieved credit points, interruptions in studies, drop-outs and obtained degrees. The results indicate that admissions based on the Step-wise procedures had the highest point production, in spite of lower grades, and lower SweSAT scores than the SweSAT group. Previous research has emonstrated that upper secondary grades and SweSAT scores provide good measures for predicting study success in higher education. However, in this study those admitted through grades obtain somewhat fewer points, and those admitted via SweSAT scores produce by far the lowest average number of credit points. Thus, it does seem quite interesting to investigate why the Step-wise procedure results in the selection of more successful students, and to look more closely into the relative importance of cognitive factors and other personal characteristics for achievement in medical education.

The primary purpose of the study was to examine methodological issues in investigations of the relative effects of schooling and age on school performance. One means of separating these 2 effects involves the use of a between-grade regression discontinuity approach. However, amongst other things, this approach is based on assumptions concerning the mechanism for allocating students to grades. Using the Swedish sample of the Third International Mathematics and Science Study (TIMSS) 1995, which comprised 3 grades (Grades 6, 7, and 8), the study investigates the robustness of the regression discontinuity approach in terms of deviations from underlying assumptions. The main finding is that the technique is robust vis-à-vis deviations from a strictly age-based grade allocation present in the data. The pattern of substantive results also corresponds with those obtained in previous research, with the grade effect being about twice as strong as the age effect. © 2010 Taylor & Francis.

A sample of 221 11th grade students and their parents were asked to complete the Interpersonal Reactivity Index (IRI; M. H. Davis, 1980), which is comprised of 4 subscales: empathic concern, perspective taking, fantasy, and personal distress; and a global-item measure containing 4 items, 1 for each subscale. The factorial structure that emerged in a previous study (C. Cliffordson, 2000) involving the students was tested on ratings provided by their parents. The results from the IRI scale were also compared to results from the global-item measure. Structural equation modeling was used to examine the structure of empathy and the agreement of self/other judgments. The results support the conclusions from the previous study that the concept of empathy can be considered to be identical to empathic concern, which also explains a great deal of perspective taking and fantasy. The agreement between the students' and their parents' judgments was substantial, and there are several reasons to believe that the interjudge agreement obtained is accurate.

The purpose of this study is to examine step‐wise admission to two medical programs with regard to selection effects. By using data from a large‐scale longitudinal project, the influence of background variables on regular and step‐wise admission is estimated. Characteristics of both applicants and those admitted are investigated using descriptive statistics and the probabilities of admission and application are examined using logistic regression analysis. The results indicate that self‐selections were generally greater for the step‐wise groups compared to the regular groups. However, the selections resulting from the procedure were generally lower for the step‐wise groups. The results vary between different step‐wise designs, indicating self‐selections to be dependent upon the type of instrument used in the first step, and selections resulting from the procedure to be dependent on the number of steps and/or, more probably, the type of instruments used and the number of those selected in each step.

The purpose of the present study was to examine the structure of empathy using a hierarchical approach, and to compare the dimensions of empathy with measures of social functioning, in order to contribute to the understanding of the nature of empathy. The dimensionality of the Interpersonal Reactivity Index, which comprises four subscales (empathic concern, perspective taking, fantasy and personal distress) was examined using confirmatory factor analysis. Relations with the Social Skills Inventory were also investigated. A sample of 127 applicants for places on nursing and social work undergraduate programs participated in the study. The study findings indicate that empathy is hierarchi-cally organized, with one general dimension at the apex. The general factor is identical to empathic concern and this dimension overlaps to a great extent with perspective taking and fantasy. The findings also indicate that the general dimension constitutes an integrated entirety, with its main emphasis on emotional reactivity by also involving cognitive processes.

The purpose of this study is to examine effects of the admission system to higher education on background diversity of students and study efficiency. By using data from a longitudinal project, the students admitted to medical education on different admission grounds are compared. The results indicate that admissions based on upper secondary grades best promote the goal of diversity. In addition, those students perform nearly as well as those admitted via step-wise procedures. The step-wise procedures promote study efficiency, but tend to favour applicants with upper-middle-class and Swedish backgrounds compared to those admitted via grades. Those admitted on the basis of SweSAT scores perform more poorly than those admitted via grades and step-wise procedures. Furthermore, the results indicate that admission via SweSAT scores contradict rather than promote the goals of increasing social, educational, and national diversity in higher education. © 2006 Scandinavian Journal of Educational Research.

BACKGROUND:Cardiac self-efficacy is a person's belief in his/her ability to manage the challenges posed by a coronary disease, and its role has been evaluated in several coronary populations using the Cardiac Self-Efficacy Scale (CSE Scale). Self-efficacy has an important role in person-centred care, however there is a lack of appropriate instruments that evaluate person-centred interventions.AIM:The purpose of this study was to validate the CSE Scale by examining its psychometric properties as a first step in evaluating a person-centred care intervention in persons with acute coronary syndrome (ACS).METHODS:The study sample consisted of 288 persons (72 women, 216 men) who completed the Swedish version of the CSE Scale two months after hospitalisation for an ACS event. Construct validity was psychometrically evaluated using confirmatory factor analysis. Additionally, convergent and discriminant validity were tested using correlation analyses.RESULTS:The results revealed that the CSE Scale was represented by three dimensions (control symptoms, control illness and maintain functioning). The analyses also showed that the CSE Scale is suitable for providing a total summary score that represents a global cardiac self-efficacy dimension. Evaluation of convergent and discriminant validity showed the expected correlations.CONCLUSION:The CSE Scale is a valid and reliable measure when evaluating self-efficacy in patients with ACS. It also seems to be a useful tool to promote person-centred care in clinical practice since it may offer useful guidance in the dialogue with the patient in the common creation of a personal health plan.

Objective: The purpose of this study was to translate and test the psychometric properties of the Norwegian language version of the Risk Assessment Pressure Sore (RAPS) scale.

Background: Risk assessment scales for pressure ulcer (PU) prevention have become an aspect of quality improvement in healthcare, but their effectiveness depends on the reliability and validity of the scale.

Methods: A convenience sample of 481 residents in 15 nursing homes in rural Norway was included between January and June 2007. The English-language version of the RAPS scale was translated into Norwegian, and this scale was used to collect the data, including a skin  examination. The number of PUs and grades were documented. Reliability was assessed in a small group of 26 residents and construct validity in the total study group.

Results: Equivalence between two assessments regarding total scores of the RAPS scale was reflected in an intraclass correlation coefficient (ICC) of 0.95. Construct validity was supported, and the RAPS scale could define groups with expected low and high scores. Further evidence of construct validity was shown in a confirmatory factor analysis.

Conclusion: The Norwegian version of the RAPS scale has shown sufficient psychometric properties to be considered a reliable and valid scale for identifying risk of PUs among nursing home residents. However, further testing is needed.

AIMS AND OBJECTIVES: To translate the Self-care Ability Scale for the Elderly into Simplified Chinese, and to test the Chinese version of the scale regarding its reliability and validity among older people.

BACKGROUND: Self-care is an important topic in nursing. When assessing older people's self-care ability, it is essential that a reliable and valid instrument is used.

DESIGN: This study employed across-sectional design.

METHODS: We translated the English version of the Self-care Ability Scale for the Elderly into Simplified Chinese according to Brislin's translation guidelines, and carried out a questionnaire survey among 610 older people, including both community-dwelling people and hospital patients, in Jinzhou City, People's Republic of China. Eighty participants completed the instrument twice for test-retest reliability. Data analyses were performed using SPSS 17.0 and Mplus, version 5 to assess reliability and validity.

RESULTS: A Cronbach's alpha coefficient of 0.89 and statistically significant item-to-total correlations showed evidence of homogeneity. An intra-class correlation coefficient of 0.99 for the test-retest between total scores and intra-class correlation coefficients between 0.87 and 0.99 for the test-retest scores of each item explained the almost perfect test-retest reliability noted in this study. Content validity was found to be good, and a three-factor model was obtained in an exploratory factor analysis, (explaining a variance of 57%), and modified in a confirmatory factor analysis (χ(2) =261.559, df=98, RMSEA=0.074; SRMR=0.059), which reflected an acceptable construct validity.

CONCLUSIONS: This study shows that the Chinese version of the Self-care Ability Scale for the Elderly has sufficient psychometric properties for assessing self-care ability among older people in China.

RELEVANCE FOR PRACTICE: A reliable and valid instrument is available to assess the self-care ability of older Chinese people. This article is protected by copyright. All rights reserved.

Det huvudsakliga syftet med föreliggande rapport är att redogöra för urval, genomförande och instrumentegenskaper för insamlingen av enkätuppgifter inhämtade från eleverna i åk 9 för det åttonde stickprovet, varav flertalet är födda 1992. Den första enkätundersökningen för denna kohort gjordes i grundskolans åk 6. Det totala antalet elever i stickprovet uppgick  ursprungligen till 10 153. Från åk 3 då urvalet gjordes och till tidpunkten för enkätundersökningen i åk 9 har antalet elever reducerats till 9 890. Den främsta orsaken till detta bortfall är att de aktuella eleverna har flyttat från Sverige. Datainsamlingen har diskuterats i UGU-projektets referensgrupp bestående av representanter för Skolverket, Högskoleverket, SCB samt några forskningsinstitutioner. Elevenkätens mer precisa innehåll och formuleringar har sedan fortlöpande diskuterats med representanter från framförallt SCB. De uppgifter som insamlats omfattar delvis modifierade och delvis samma frågeställningar som insamlats för tidigare stickprov i grundskolans åk 6 och åk 9 samt från den enkät som erbjudits efter avslutad grundskola. Dessutom tillkom ett antal frågor rörande nya områden som inte behandlats i tidigare enkäter. Den slutgiltiga enkäten kom att omfatta 25 frågor av vilka 17 frågor rör grundskolan, 5 frågor handlar om elevens fortsatta skolgång efter grundskolan, 2 frågor rör elevers motivation för lärandet och uppfattning om kognitiv förmåga och 1 fråga berör elevens fritidssysselsättningar. Enkät och följebrev distribuerades som en postenkät adresserad hem till eleverna. Enkäten skickades ut i vecka 10 år 2008. Ett tack- och påminnelsekort samt ytterligare två påminnelser med ny enkät skickades därefter med någon veckas mellanrum. Svarsfrekvensen var 59 procent och bortfallet bestod nästan uteslutande av ej avhörda personer. Det interna bortfallet varierade mellan olika frågor och var överlag lågt. Det förefaller som om enkätens frågor har fungerat väl. För de skalkonstruktioner som motsvarar tidigare använda skalor gäller att delfrågornas antal i de allra flesta fall har utökats, vilket har inneburit att de mättekniska egenskaperna har förbättrats. De skalor som är nya för datainsamlingen i åk 9 avser att mäta olika typer av motivation för lärandet samt skalor för elevernas uppfattning om kognitiv förmåga. Den nu, för fjärde gången, använda modellen med huvudfrågor och underlydande delfrågor, utifrån vilka skalor kan bildas, bedöms alltså även denna gång ha fungerat väl. I och med att samma frågor och alternativ har används vid två olika tillfällen (åk6 och åk 9) för samma kohort ökar möjligheten att studera förändringar hos samma elever över tid. Att konstruera skalor genom att summera delfrågornas poäng och att använda sig av viktade data är två metoder/tekniker, bland andra, som kan användas för att öka resultatens reliabilitet och validitet. Ambitionen med föreliggande rapport har dock inte varit att ställa olika metoder mot varandra och diskutera dess styrkor och svagheter, utan att ge exempel på hur frågorna i elevenkäten kan användas.

Despite the consistency with which gender differences have been found in second language motivation, little systematic research has taken place on motivation and gender to date. Permeating self-concept development, gender impacts not only current selves but also future-oriented possible selves. In construing possible selves, females tend to emphasize interdependence, meaning they invest more in interpersonal relationships and self-other interaction. Based on instruments measuring ideal language-speaking/using selves and an interdependent self-construal in a sample of 140 female and 129 male adolescents enrolled in the final year of secondary education in Sweden, and using confirmatory factor analysis, support was found for the hypothesis that gender-related variance on a measure of the ideal language-speaking/using self could be accounted for by an interdependent self-construal. In discussing the results, further avenues for exploring the impact of gender on possible selves using more contextually sensitive research designs are presented. © 2013 Language Learning Research Club, University of Michigan.

English is today learnt in multitudes of settings worldwide, making it difficult to characterize relationships between motivation and context in generalized terms (Ushioda 2013). In settings where students have extensive encounters with English outside school, a reluctance to invest effort in formal learning has been observed. To investigate ways in which out-of-school encounters impact on motivation, questionnaire data was obtained from 116 upper secondary students in Sweden. Structural equation modelling was used to test a series of hypotheses generated from emerging research into language learners identities, beliefs and self-authenticity appraisals. Results revealed that, compared to reference studies from settings where English lacks similar prominence, the Ideal L2 Self accounted for substantially less of the explained variance on a criterion measure. This can be accounted for by the limited discrepancy between current and ideal L2 selves. Results also indicate that beliefs about the efficacy of learning in natural environments have a negative impact on motivation in school, and that appraisals of self-authenticity may have a similar effect, although methodological challenges make this contention difficult to substantiate.

AIMS AND OBJECTIVES: The aim of the present study was twofold: 1) to measure changes in health-related quality of life (HRQoL), two dimensions of illness perceptions (i.e., consequences and emotional representations), fatigue and self-efficacy in persons treated for CRC during the first year after surgical treatment, and 2) to study how fatigue, illness perceptions and self-efficacy measured at 3 months affect HRQoL at 12 months post-surgery.

BACKGROUND: There are fluctuations in HRQoL during the first year after treatment for colorectal cancer (CRC), and fatigue may negatively influence HRQoL. Illness perceptions (consequences and emotional representations) and self-efficacy have been shown to be associated with HRQoL in other cancer diagnoses. Concerning CRC, there is a lack of knowledge concerning how illness perceptions and self-efficacy change during recovery, and how these variables and fatigue at 3 months relate to HRQoL at 12 months.

DESIGN: A prospective longitudinal design.

METHODS: Thirty-nine persons surgically treated for colorectal cancer, of whom 17 had a colostoma, participated. HRQoL, fatigue, illness perceptions and self-efficacy were assessed using QLQ-C30, the Revised Illness Perception Questionnaire and the Maintain Function Scale. Descriptive and analytical statistics were used.

RESULTS: No changes were reported in levels of HRQoL, fatigue, or illness perceptions. Self-efficacy was lower at 12 months compared to 3 months. Fatigue and one dimension of illness perceptions mediated the effect of self-efficacy at 3 months on HRQoL at 12 months.

CONCLUSION: Persons treated for CRC who have lower self-efficacy 3 months post-surgery are inclined to have more negative illness perceptions concerning emotions and to experience more fatigue.

RELEVANCE TO CLINICAL PRACTICE: Nurses need to support persons with fatigue and negative illness perceptions concerning emotions and to bolster their self-efficacy, i.e., carry out follow-up consultations focusing on illness management, symptoms, emotions and information on ways to increase self-efficacy. This article is protected by copyright. All rights reserved.

The purpose of the study was to investigate how grading of students in primary school affected achievement measured by grades one year later, and how the effect varied as a function of cognitive ability, gender and socio-economic status. The data derive from The Evaluation Through Follow Up longitudinal project. Through a national curriculum change one group of students received grades and one group of students did not receive grades in the 6th Grade, while both groups of students received grades in the 7th Grade. A quasi-experimental design was thus created, with two comparable groups of students. The subjects were 8558 students born in 1967. Several multiple regression models were fitted to the data. The results showed no main effects of grading on subsequent achievement, but there were important differential effects: graded students with low cognitive ability received lower subsequent grades. The results also showed interaction effects between gender and grading and between gender and cognitive ability.

The aim of this study was to investigate the construct validity of the Moral Development Scale for Professionals (MDSP) using structural equation modeling. The instrument is a 12-item self-report instrument, developed in the Scandinavian cultural context and based on Kohlberg's theory. A hypothesized simplex structure model underlying the MDSP was tested through structural equation modeling. Validity was also tested as the proportion of respondents older than 20 years that reached the highest moral level, which according to the theory should be small. A convenience sample of 339 nursing students with a mean age of 25.3 years participated. Results confirmed the simplex model structure, indicating that MDSP reflects a moral construct empirically organized from low to high. A minority of respondents >20 years of age (13.5%) scored more than 80% on the highest moral level. The findings support the construct validity of the MDSP and the stages and levels in Kohlberg's theory

According to Orem's self-care deficit theory of nursing, the structure of self-care consists of self-care agency balanced by therapeutic self-care demand. Different conditioning factors constitute these two constructs. The aim of this study was to investigate through secondary analysis the structure of self-care in a group of elderly. Data were originally collected from a total of 125 randomly chosen elderly individuals (65+ years of age) in Sweden by means of a mailed questionnaire. Confirmatory factor analysis was used to show that self-care agency was totally and significantly balanced against therapeutic self-care demand and explained by five conditioning factors.

AIM: The aim of this study was to test the homogeneity and construct validity of the Sense of Coherence 29-item scale (SOC-29) among older home-dwelling Norwegians.

METHODS: A postal questionnaire, consisting of background variables, five health-related questions, the SOC-29, and three other instruments measuring mental health, self-care ability, and risk for undernutrition, was sent to 6033 home-dwelling older people (65+ years) in southern Norway. A total of 2069 participants were included. Homogeneity was assessed with Cronbach's alpha coefficient and item-to-total correlations. The construct validity was assessed with "the known-groups technique," a linear stepwise regression analysis with SOC score serving as the dependent variable and with confirmatory factor analysis.

RESULTS: With a Cronbach's alpha coefficient of 0.91 and statistically significant item-to-total correlations, the SOC-29 was found to be homogeneous. Construct validity was supported because the SOC-29 could separate known groups with expected high and low scores. The factors that could predict SOC were mental health, self-care ability, feeling lonely, being active, and chronic disease or handicap. Evidence of construct validity was displayed in a confirmatory factor analysis that confirmed SOC-29 as one theoretical construct with the three dimensions, comprehensibility, manageability, and meaningfulness.

CONCLUSIONS: The Norwegian version of the SOC-29 is a reliable and valid instrument for use in research among older people. The results confirm that SOC has a particularly strong relationship with mental health and self-care ability.

Purpose: Healthcare professionals' conscious or unconscious norms, values and attitudes have been identified as partial explanations of healthcare inequity. Norm criticism is an approach that questions what is generally accepted as "normal" in society, and it enables professionals to identify norms that might cause prejudice, discrimination and marginalisation. In order to assess norm-critical awareness, a measurement scale is needed. The purpose of this paper is to develop a scale for measuring norm-critical awareness. Design/methodology/approach: The scale-development process comprised a qualitative item-generating phase and a statistical reduction phase. The item pool was generated from key literature on norm criticism and was revised according to an expert panel, pilot studies and one "think aloud" session. To investigate the dimensionality and to reduce the number of items of the scale, confirmatory factor analysis was performed. Findings: The item-generation phase resulted in a 46-item scale comprising five theoretically derived dimensions revolving around function, consequences, identity, resistance and learning related to norms. The item-reduction phase resulted in an instrument consisting of five dimensions and 20 items. The analyses indicated that a summary score on the scale could be used to reflect the broad dimension of norm-critical awareness. Originality/value: The Norm-critical awareness scale comprises five theoretically derived dimensions and can be used as a summary score to indicate the level of norm-critical awareness in educational contexts. This knowledge is valuable for identifying areas in greater need of attention. © 2019, Emerald Publishing Limited.