Cardiac Depression Scale: Mokken scaling in heart failure patients

Background: There is a high prevalence of depression in patients with heart failure (HF) that is associated with worsening prognosis. The value of using a reliable and valid instrument to measure depression in this population is therefore essential. We validated the Cardiac Depression Scale (CDS) in heart failure patients using a model of ordinal unidimensional measurement known as Mokken scaling. Findings: We administered in face-to-face interviews the CDS to 603 patients with HF. Data were analysed using Mokken scale analysis. Items of the CDS formed a statistically significant unidimensional Mokken scale of low strength (H<0.40) and high reliability (Rho>0.8). Conclusions: The CDS has a hierarchy of items which can be interpreted in terms of the increasingly serious effects of depression occurring as a result of HF. Identifying an appropriate instrument to measure depression in patients with HF allows for early identification and better medical management. Keywords: Cardiac Depression Scale, Heart failure, Depression, Mokken scalin

Mokken Scale Analysis in R

Mokken scale analysis (MSA) is a scaling procedure for both dichotomous and polytomous items. It consists of an item selection algorithm to partition a set of items into Mokken scales and several methods to check the assumptions of two nonparametric item response theory models: the monotone homogeneity model and the double monotonicity model. First, we present an R package mokken for MSA and explain the procedures. Second, we show how to perform MSA in R using test data obtained with the Adjective Checklist.

Preliminary testing using Mokken scaling of an Italian translation of the Edinburgh Feeding Evaluation in Dementia (EdFED-I) scale

© 2015 Elsevier Inc. Purpose: To study the psychometric properties of an Italian version of the Edinburgh Feeding Evaluation in Dementia (EdFED-I) Scale. Background: The EdFED Scale is the only validated instrument that measures difficulty with feeding in older people with dementia. The original English version of the EdFED had three factors measuring: behavioral aspects of feeding difficulty (obstinacy/passivity); indicators of feeding difficulty; and nursing interventions. Methods: Participants affected by dementia and living in nursing homes (n = 210) were selected. Data collectors were trained to observe the residents' eating problems and their food intake. The data were analyzed using Mokken scaling and Pearson's correlation. Results: The Italian version of the EdFED Scale formed a Mokken scale which correlated in the expected direction with measures of residents' weight, Body Mass Index, time taken to eat, Mini Mental State Examination score and Barthel Index according to the unmet needs model of Cohen-Mansfield. Conclusions: The EdFED-I shows reasonable psychometric properties and can be used for the assessment of feeding difficulty in Italian samples of older people with dementia. However, further work with larger samples is required to test the utility of the whole range of items and the necessity of their inclusion in the EdFED-I

Investigating invariant item ordering in the Mental Health Inventory : an illustration of the use of different methods

Invariant item ordering is a property of scales whereby the items are scored in the same order across a wide range of the latent trait and across a wide range of respondents. In the package ‘mokken’ in the statistical software R, the ability to analyse Mokken scales for invariant item ordering has recently been available and techniques for inspecting visually the item response curves of item pairs, have also been included. While methods to assess invariant item ordering are available, there have been indications that items representing extremes of distress in mental well-being scales, such as suicidal ideation, may lead to claiming invariant item ordering where it does not exist. We used the Mental Health Inventory to see if invariant item ordering was indicated in any Mokken scales derived and to see if this was being influenced by extreme items. A Mokken scale was derived indicating invariant item ordering. Visual inspection of the item pairs indicated that the most difficult item (suicidal ideation) was located far from the remaining cluster of items. Removing this item lowered invariant item ordering to an unacceptable level

Investigating the structure of the autism-spectrum quotient using Mokken scaling

Traits similar to those shown in autism spectrum condition (ASC) are apparent in relatives of individuals with ASC, and in the general population without necessarily meeting diagnostic criteria for an ASC. We assess whether the Autism-Spectrum Quotient (AQ), a self-report measure, has hierarchical properties using Mokken scaling. Hierarchical scales allow the presence of a latent trait to be identified by discovering whether and how many specific items form an ordered array along it. Data were collected from 2 groups: (1) people with ASC (n = 449: 240 males, 209 females, M age 35.4 years, SD = 12.8) and (2) university students (n = 943: 465 males, 475 females, M age = 23.0 years, SD = 8.4). A single Mokken scale was obtained in the data from university students and 3 scales were obtained in the data from people with ASC. The scales all showed moderate Mokken scaling properties with the single scale obtained from university students showing weak invariant item ordering and 2 of the scales from people with ASC showing weak invariant item ordering. The AQ formed reliable Mokken scales. There was a large overlap between the scale from the university student sample and the sample with ASC, with the first scale, relating to social interaction, being almost identical. The present study confirms the utility of the AQ as a single instrument that can dimensionalize autistic traits in both university student and clinical samples of ASC, and confirms that items of the AQ are consistently ordered relative to one another

Nature of behaviours that challenge in residents living in aged care homes: implications for psychosocial interventions and service development

Background/Aims: Competing theories exist regarding the causes and nature of behaviours that challenge (BC). The present study attempted to provide better insight into these behaviours and determine whether there were any underlying relationships for people living in care homes with and without dementia. Methods: Cross sectional data for 2185 residents living in 63 UK care homes using the Challenging Behaviour Scale were collected. The incidence (i.e. presence/absence) of 25 commonly reported behaviours that challenge staff were determined using dichotomous scoring. Cluster analysis and Mokken scaling were used to examine underlying relationships. Mokken is a method of analysing data to determine whether there is a ‘latent’ structure within a data set. Results: The prevalence of reported BC was 87.5%. Cluster analysis revealed three main clusters: apathy, agitation with internal focus, agitation with active external focus. For seven of the 25 items a hierarchical model emerged, where behaviours at the bottom of the hierarchy tended to occur in the presence of those higher up. Behaviours at the bottom of the hierarchy (dangerous behaviour) were less frequently observed than the items at the top (lack of self-care, verbal aggression). Conclusion: Some common BC may occur in groups and themed clusters. This study has shown that a hierarchical structure of BC in residents may be present. The findings testify to the complexity in the aetiology and treatment of BC and hence the need for focussed high intensity bio-psychosocial interventions to be targeted towards those with high levels of ‘unmet need’. Implications for future research and practice are discussed

Does cognitive ability influence responses to the Warwick-Edinburgh Mental Well-Being Scale?

It has been suggested that how individuals respond to self-report items relies on cognitive processing. We hypothesized that an individual's level of cognitive ability may influence these processes such that, if there is a hierarchy of items within a particular questionnaire, as demonstrated by Mokken scaling, the strength of that hierarchy will vary according to cognitive ability. Using data on 8,643 men and women from the National Child Development Survey (1958 birth cohort; Power, & Elliott, 2006), we investigated, using Mokken scaling, whether the 14 items that make up the Warwick-Edinburgh Mental Well-Being Scale (Tennant et al., 2007)-completed when the participants were 50 years of age-form a hierarchy and whether that hierarchy varied according to cognitive ability at age 11 years. Among the sample as a whole, we found a moderately strong unidimensional hierarchy of items (Loevinger's coefficient [H] = 0.48). We split participants into 3 groups according to cognitive ability and analyzed the Mokken scaling properties of each group. Only the medium and high cognitive ability groups had acceptable (?0.3) invariant item ordering (assessed using the HT statistic). This pattern was also found when the 3 cognitive ability groups were assessed within men and women separately. Greater attention should be paid to the content validity of questionnaires to ensure they are applicable across the spectrum of mental ability

Identifying longitudinal sustainable hierarchies in activities of daily living

© 2017 Elsevier B.V. Activities of daily living serve as an indicator of progression in disability and rehabilitation. It is know that some of the measurement scales used show hierarchical properties indicating that activities of daily living are lost and gained in a consistent pattern. Few studies have investigated the extent to which these patterns are sustained across time and across a range of disability. The study aimed to investigate the hierarchical properties of the activity of daily living items in the ValGraf functional ability scale, to establish if there is a hierarchy of items in the scale and to study the sustainability of the hierarchy over time. Secondary analysis of a retrospective database from 13,113 people over 65 years in 105 nursing homes in northern Italy, between 2008 and 2013 was conducted. Data were gathered 6-monthly and analysed using Mokken scaling to identify a hierarchy of items in the scale and if this was sustainable over time. A sustainable hierarchy of items was observed running in difficulty from urinary incontinence to feeding. The hierarchical structure of the activities of daily living observed in the present study is stable over time meaning that changes in total score for these items can be compared meaningfully across time

Short communication: a hierarchy of items within Eysenck’s EPI

Based on the recent finding of a hierarchical scale for Neuroticism in the NEO-Five Factor Inventory, two further personality inventories: the Eysenck Personality Inventory and Goldberg’s International Personality Item Pool were analysed using the Mokken Scaling Procedure for hierarchical scales. Items from two dimensions of the Eysenck Personality Inventory: Neuroticism and Extraversion produced hierarchical scales of 12 and five items, respectively. The Neuroticism items ran from items expressing mild to more extreme worry and the Extraversion items ran from mild sociability to more extreme ‘showing off’. The utility of hierarchical scales in personality measurement is discussed in terms of furthering theoretical understanding of personality and also practical application. In addition, the reasons why only one of these scales should produce hierarchical sets of items is discussed

A hierarchy of happiness? Mokken scaling analysis of the Oxford Happiness Inventory

The items of the Oxford Happiness Inventory (OHI, a self-report assessment of happiness, are subjected to an analysis for hierarchy among its items. By using Mokken scaling analyses we can assess whether items can reliably be ordered between persons as severity indicators on a latent trait; in this case, a latent trait of Happiness. OHI item-level data from 1024 participants were entered into the Mokken Scaling Procedure (MSP) seeking reliable scales with H > 0.30. 12 OHI items formed a reliable and statistically significant hierarchy. However, the MSP values indicate a 'weak' scale. The 'most difficult' (happiest) item on the scale is 'feeling energetic' and the 'least difficult' (least happy) is 'I have fun'. Items in the scale are consistent with what is already known about both happiness and low mood. The reduction in the OHI's items from 29 to 12 in the Mokken scale may have utility making it more accessible to participants as well as identifying items with reliably different levels of 'difficulty'. (C) 2010 Elsevier Ltd. All rights reserved