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      Bifactor and Item Response Theory Analyses of Health Care Workers’ Attitudes Toward HIV-Infected People


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          Abstract. Health care workers’ attitudes toward people living with HIV/AIDS (PLWHA) can play an important role in the quality of life of PLWHA as well as in public health efforts in HIV prevention and treatment. The main aim of this study was to develop and evaluate the psychometric properties of an instrument to measure health care workers’ attitudes toward PLWHA using bifactor and IRT analyses. We applied bifactor and Item Response Theory (IRT) analyses to questionnaire development, evaluation, and refinement. A sample of 836 Italian health care workers was recruited in 2013, including medical practitioners, nurses, health care assistants, social workers, and psychologists. We tested a hierarchical item response model (bifactor model) with model fit comparisons with one-dimensional and five-dimensional models. The bifactor model was found to provide the best fit to the observed data. The results were used to construct a 15-item short form. The test information function showed that the scale was slightly more precise at higher levels of negative attitudes. Finally, the differential item functioning (DIF) analysis revealed that the items did not function differently across gender or professional groups. The instrument was found to have good criterion validity with regard to discriminatory practices toward HIV-infected patients.

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          mirt: A Multidimensional Item Response Theory Package for theREnvironment

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            Forming attitudes that predict future behavior: a meta-analysis of the attitude-behavior relation.

            A meta-analysis (k of conditions = 128; N = 4,598) examined the influence of factors present at the time an attitude is formed on the degree to which this attitude guides future behavior. The findings indicated that attitudes correlated with a future behavior more strongly when they were easy to recall (accessible) and stable over time. Because of increased accessibility, attitudes more strongly predicted future behavior when participants had direct experience with the attitude object and reported their attitudes frequently. Because of the resulting attitude stability, the attitude-behavior association was strongest when attitudes were confident, when participants formed their attitude on the basis of behavior-relevant information, and when they received or were induced to think about one- rather than two-sided information about the attitude object.
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              Measuring health-related stigma--a literature review.

              Stigma related to chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, mental illness and epilepsy is a global phenomenon with a severe impact on individuals and their families, and on the effectiveness of public health programmes. To compare stigma measurement in different disciplines, a literature review was conducted. References were obtained through a search of literature databases and through examining relevant bibliographies. Sixty-three papers were selected that addressed the issue of measurement of stigma or related constructs and that contained a sample of the instrument or items used. Five unpublished studies were also included in the review. The aspects of health-related stigma used for assessment can be grouped in five categories. First, the experience of actual discrimination and/or participation restrictions on the part of the person affected; second, attitudes towards the people affected; third, perceived or felt stigma; fourth, self or internalized stigma; and fifth, discriminatory and stigmatizing practices in (health) services, legislation, media and educational materials. Within each of these areas, different research methods have been used, including questionnaires, qualitative methods, indicators and scales. The characteristics of the instruments considered most promising are described and compared. The purpose of stigma assessment is to increase our understanding of stigma and its determinants and dynamics, to determine its extent or severity in a given setting or target group and to monitor changes in stigma over time. The conclusions from this review are that (a) the consequences of stigma are remarkably similar in different health conditions, cultures and public health programmes; (b) many instruments have been developed to assess the intensity and qualities of stigma, but often these have been condition-specific; and (c) development of generic instruments to assess health-related stigma may be possible. To achieve this aim, existing instruments should be further validated, developed or adapted for generic use, where possible.

                Author and article information

                European Journal of Psychological Assessment
                Hogrefe Publishing
                December 29, 2016
                : 35
                : 2
                : 156-163
                [ 1 ]Department of Psychology, University of Bologna, Italy
                Author notes
                Gabriele Prati, Dipartimento di Psicologia, Università di Bologna, Viale Europa 115, 47521 Cesena (FC), Italy, gabriele.prati@ 123456unibo.it
                : December 19, 2014
                : March 8, 2016
                : May 18, 2016
                Self URI (journal-page): https://econtent.hogrefe.com/loi/jpa
                Original Article

                Assessment, Evaluation & Research methods,Psychology,General behavioral science
                HIV/AIDS,stigma,measurement,health care workers,item response theory,bifactor model


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