Background: Patient evaluation of primary health care (PHC) as a recognised means of obtaining important information for quality improvement can be enhanced with the availability and use of acceptable, reliable and valid questionnaires. This research reports the development and validation of the patients' evaluation scale (PES) for assessment of the quality of primary health care in Nigeria. Methods: Mixed methods design was used to develop and validate items, response scale and domains in the Patients' Evaluation Scale. Items were derived from literature review and content analysis of interviews with patients. Face and content validity were established with primary health care experts and patients while quantitative pilots were conducted to determine questionnaire's acceptability across groups and appropriate response format. The conduct of a large multi-centre psychometric validation survey was used to determine the internal structure (exploratory factor analysis), reliability (internal consistency), construct, criterion and discriminative validities (Pearson's correlation coefficient, structural equation modelling using regression equation method) and acceptability (scale and item response pattern) of the questionnaire. The discriminatory properties were assessed by questionnaire's ability to differentiate population groups' scores in line with 'a priori' hypotheses. Results: The development resulted in the long and shortened forms of PES containing 27 and 18-items respectively. Both showed good indices for validity and acceptability among various population groups in Nigeria. PES-SF resulted from the deletion of items in PES that didn't meet recommended Eigen value < 1, factor loading < 0.5, item-total, item-domain correlation < 0.4 and item-item correlation within domains of < 0.2. PES-SF has Cronbach's alpha of 0.87 for entire questionnaire and 0.78, 0.79 and 0.81 respectively for the three domains (codenamed 'facility', 'organisation', and 'health care'). The three components solution from the Scree plot explained 56.6% of the total variance of perceived quality. Items correlated significantly higher with domain identified through factor analysis than with other domains. In line with 'a priori' hypothesis, scale and domains scores of PES-SF could differentiate population groups based on patients' clinical and socio-demographic characteristics. PES-SF scores also showed significant correlation with patient general satisfaction and likelihood of returning or recommending others to the PHC centres. Conclusion: The patient evaluation scale designed for exit assessment of patients' experiences with PHC in Nigeria shows good measurement properties. It will be useful to clinicians, researchers and policy makers for patient-focused quality improvement activities in Nigeria. Further research will involve translation to major Nigerian languages and to assess PES validity against observed quality criteria.

CHAPTER 1: Introduction: The most common craniofacial congenital anomaly is the cleft lip and/or palate (CLP). The CLEFT-Q is the first condition-specific comprehensive patient reported outcome instrument (PROM) for patients with CLP. Other measures used in assessment of patients with CLP are Child Oral Health Impact Profile (COHIP) and Cleft Hearing, Appearance and Speech Questionnaire (CHASQ). The development and validation of the CLEFT-Q have been completed in three phases. In phase I, 138 patients with CLP from six countries were interviewed, and data were used to form 13 scales measuring appearance, facial function and health-related quality of life (HR-QOL). In phase II, scales were field-tested internationally with 2434 patients to examine reliability and validity as well as develop a common scoring algorithm for international use. Phase III, the focus of this thesis, aimed to examine further construct validity and responsiveness of the CLEFT-Q scales. CHAPTER 2: Methods: Patients were recruited at six cleft centres in Canada, USA and UK between January 2018 and October 2019. The sample included patients aged 8-29 seeking rhinoplasty, orthognathic, cleft lip scar revision and alveolar bone graft (ABG) operations. Before and six months after surgery, participants were asked to complete the CLEFT-Q scales relevant to their operation and two other PROMs frequently used in cleft research, i.e., COHIP and CHASQ. Cross-sectional construct validity was examined by testing prespecified hypotheses about expected relationships between CLEFT-Q, CHASQ and COHIP instruments. Internal responsiveness was examined using the distribution-based method. Data were analysed using paired sample t-tests and calculation of effect sizes (ESs) and minimally important differences (MIDs). CHAPTER 3: Results: Examination of cross-sectional construct validity of the CLEFT-Q scales using the COHIP and CHASQ subscale resulted in 39/53 (74%) hypotheses having been supported by the results. The required sample size to examine responsiveness using the anchor-based approach was not reached. Assessment of internal responsiveness using the distribution-based approach demonstrated that the appearance scales were highly responsive to change following cleft-specific surgeries, with statistically significant results and ESs ranging from 0.4 (small) to 1.8 (large). Change on the CLEFT-Q HR-QOL scales was not statistically significant. As predicted, the ESs on scales measuring facial aspects most affected by rhinoplasty and orthognathic surgeries were larger than the ESs on scales measuring facial aspects least affected by these surgeries. MIDs for each scale in each operation were determined. CHAPTER 4: Discussion: Assessment of cross-sectional construct validity demonstrated that CLEFT-Q performs as it was intended when compared with other similar measures (i.e., CHASQ and COHIP). The CLEFT-Q appearance scales were responsive to change following rhinoplasty, orthognathic and cleft lip scar revision operations. As predicted, the CLEFT-Q appearance scales did not detect change following the ABG operation as this operation does not result in visible difference. As hypothesized, the CLEFT-Q HR-QOL scales were less responsive to change than appearance scales as HR-QOL is a more distal construct than appearance in relation to the cleft-related surgeries performed. The preliminary MIDs estimated by the distribution-based approach should be confirmed in studies with diverse CLP populations and larger sample sizes using the anchor-based approach. The findings of this phase III study build on the results of another CLEFT-Q validation study, which demonstrated the ability of the CLEFT-Q scales to detect differences between groups with varying surgical status, i.e., need surgery, have had surgery and never needed surgery. CHAPTER 5: Conclusion: Cross-sectional construct validity of the CLEFT-Q scales was supported by most prespecified hypotheses. The CLEFT-Q scales were found to be responsive to change. MIDs were determined. The results of this phase III study should be confirmed in a larger and more culturally diverse patient population. Future studies to examine reproducibility and measurement error as well as external responsiveness of the CLEFT-Q scales may be beneficial to add to the psychometric evaluation process. / Thesis / Master of Science (MSc)

(1) Surrender to God (STG), is a construct which quantifies the extent to which an individual willingly relinquishes control to God. (2) An STG scale has been developed, yet remains unvalidated, as it relates to psychological constructs. (3) Utilizing undergraduate participants (N=249), we conducted a psychometric validation of the STG scale, and examined its potential relation with depression, anxiety, stress, and suicide risk

Strategic consensus is a group process that can be described as the agreement among team members on strategic matters for success at work. The psychometric evidences of the validity of an assessment scale measuring strategic consensus in pedagogic teams are analyzed. Participants were 140 school teachers in Quito (Ecuador). Statistical analyses of the applied scale containing 14 items revealed a uni-dimensional factor structure explaining 49.7% of the variance. The internal consistency of the scale was satisfactory (α = .92; r item-total = .66). Results show that the scale is an useful tool for the diagnosis of the existence of consent among members of pedagogic teams and contributes to a full understanding of the phenomenon. / Se estudia las evidencias psicométricas de validez de una escala de evaluación del consenso estratégico en equipos pedagógicos. El consenso estratégico es un proceso grupal descrito como la concordancia entre los miembros sobre asuntos estratégicos para el éxito del trabajo. Los participantes fueron 140 profesores de escuelas de Quito (Ecuador). La escala aplicadacuenta con 14 ítems y los análisis estadísticos realizados revelaron una estructura unifactorial que explica 49.72% de la variancia. La confiabilidad interna fue satisfactoria (α = 0.92; r ítem-total = 0.66). Los resultados revelan que la escala constituye una herramienta útil para el diagnóstico del consenso existente entre miembros de equipos pedagógicos y contribuye para la mejor comprensión del fenómeno.

Avec près d'un million de cas de démence en France en 2010, la maladie d'Alzheimer (MA) et les syndromes apparentés constituent un enjeu majeur de santé publique. A l'heure actuelle, il n'existe aucun traitement médicamenteux permettant de guérir de la MA. Ces médicaments visent à ralentir la progression de la maladie en améliorant certains symptômes. De ce fait, il semblait utile et nécessaire de disposer d'indicateurs permettant d'évaluer les prises en charge mises en place pour ces patients. La qualité de vie liée à la santé (QDV) est donc devenue un critère d'évaluation indispensable tant pour les chercheurs que pour les cliniciens.Les outils de QDV génériques sont en général moins sensibles pour une maladie donnée. C'est pourquoi d'autres outils spécifiques à la MA se sont développés. Aucun parmi eux n'était validé en langue française. L'objectif de cette thèse était donc, après une revue de la littérature, de réaliser la validation transculturelle puis psychométrique du « Quality of Life in Alzheimer's Disease » (QoL-AD) et du « Dementia Quality of Life » (DQoL). Ces deux questionnaires étaient d'après la littérature les plus utilisés en langue anglaise dans cette maladie.Ce travail de thèse a été réalisé sur les données du PHRC National 2004 « Evaluation de la qualité de vie chez le sujet âgé dément : validation d'un instrument spécifique ». Cette étude a permis de recueillir des données d'un total de 155 couples patient-aidant recrutés au sein de sept centres hospitaliers français et d'un centre suisse francophone participant à l'étude. Les patients présentaient une MA au stade léger ou stade modéré (Mini Mental State Examination > ou = 10). Le QoL-AD et le DQoL ont été administrés par un enquêteur. Le QoL-AD aidants a été auto-administré. L'adaptation transculturelle puis la validation psychométrique ont donc été réalisées pour ces deux questionnaires.Nous disposons donc désormais d'une version française du QoL-AD et d'une version française du DQoL, ayant bénéficié d'une adaptation transculturelle effectuée selon les recommandations internationales, et qui présentent toutes deux de bonnes propriétés psychométriques. / With nearly one million cases of dementia in France in 2010, Alzheimer's disease (AD) and related syndromes are a major public health issue. Up to now, there is no drug for treatment or preventing for AD. The only available drugs aim to slow down the progression of the disease by improving some symptoms. Therefore, it seemed necessary to have indicators enabling assessment of treatment strategies for these patients. So, health related quality of life (HRQoL) became an essential criterion for evaluation for both researchers and clinicians.Generic HRQoL tools are generally less sensitive for a given disease. That is why other specific tools for AD have been developed. None of them was validated in French. The aim of this thesis was therefore, after a review of the literature, to achieve a cross-cultural adaptation and psychometric validation of the "Quality of Life in Alzheimer's Disease" (QoL-AD) and "Dementia Quality of Life" (DQoL). These two questionnaires were selected because they were the most popular in English-language literature for this disease.This thesis was conducted on data collected during the PHRC National 2004 "Evaluation of the quality of life in elderly demented people: validation of a specific instrument". This study concerned a total of 155 patient-caregiver pairs recruited from seven French hospitals and a Francophone Swiss center. Patients had a confirmed diagnosis of AD (mild to moderate stage: Mini Mental State Examination > ou = 10). QoL-AD and DQoL were administered by an interviewer. The caregiver sheet of QoL-AD was self-administered. Cross-cultural adaptation and psychometric validation have been carried out for these two questionnaires.We now have at disposal two HRQoL questionnaires specifics for AD in French language. They are issued from a cross-cultural adaptation performed according to international quidelines and both have good psychometric properties. So they can be used to evaluate quality of life in Alzheimer's disease on French speaking population.

La qualité de vie (QV) liée à la sclérose en plaques (SEP) a été très étudiée lors de ces dernières années et plusieurs échelles d'évaluation ont ainsi été élaborées. Cependant, peu d'échelles de QV liée à la SEP validées sont disponibles en version française, et aucune ne s'attache à évaluer spécifiquement les périodes de poussées ni les perspectives temporelles. C'est l'objet de ce travail. La première étape a permis d'élaborer une première version d'une échelle d'évaluation de la perception de la QV liée à la SEP et à ses poussées (PERSEPP) en se basant sur la réalisation d'entretiens semi-directifs auprès de patients atteints de formes rémittentes de SEP et de soignants. A partir d'une analyse de contenu thématique de l'ensemble des entretiens individuels et de groupes réalisés, des items spécifiques du concept de QV liée à la SEP et à ses poussées ont ainsi été sélectionnés afin d'élaborer l'échelle PERSEPP constituée d'un questionnaire principal et de modules complémentaires. Une étude pilote a ensuite été réalisée afin d'évaluer différents critères d'acceptabilité et de faisabilité de l'échelle PERSEPP auprès de 40 patients. A la suite de cette étape, une étude multicentrique a permis d'inclure des patients atteints de forme rémittente de SEP, en poussée ou hors poussée, et suivis à l'hôpital ou chez des neurologues libéraux. L'analyse des données recueillies auprès de 305 patients a permis de compléter plusieurs étapes nécessaires à la validation d'une échelle de QV liée à la santé et d'obtenir une version définitive de l'échelle PERSEPP. De par sa méthodologie d'élaboration, cette échelle est spécifique de la forme rémittente de SEP. / Quality of life (QoL) related to multiple sclerosis (MS) has been widely studied in recent years and several rating scales have been developed. However, few QoL scales validated in MS are available in French, and none specifically focuses on assessing periods of relapses or time perspective. This is the purpose of this work. The first step consisted in establishing a first version of a rating scale of QoL perceived in MS and its relapses (PERSEPP) based on semi-structured interviews with patients affected by relapsing-remitting forms of MS and with health care providers. From a thematic content analysis of ail individual interviews and focus groups conducted, specific items of the concept of QoL related to MS and its relapses were selected to develop the PERSEPP scale consisting of a main questionnaire and additional modules. A pilot study with 40 patients was then conducted to evaluate various criteria for acceptability and feasibility of the PERSEPP scale. Following this step, a multicenter study included patients with a relapsing-remitting form of MS, in relapse or not in relapse, and followed by hospital or private practice neurologists. Analysis of the data collected from 305 patients has enabled us to complete several steps necessary for the validation of a health­related QoL scale and obtain a final version of the PERSEPP scale. This scale is specific for relapsing­remitting form of MS due to the methodology used.

Today it seems as if each individual is responsible for choosing his/her mate. Historically, this process has been mainly regulated by culture, family and society, which make the rules and norms, and defines suitable behaviors in the mate selection process. This research aimed at constructing a scale to analyze if people consider themselves responsible for the choice of their partner and to what extent. A qualitative study using ATLAS.ti content analysis resulted in different theoretical factors. A second study sought to corroborate the theoretical factors using a principal component analysis, determining the following factors: Destiny-Predestination, Powerful Microcosm, and Internal Control factor, which explain 50.94% of the variance with 17 items. The instrument shows that the locus of control in mate choice is not a continuum that moves between internality and externality but, rather, it is multidimensional. / En la actualidad pareciera que cada individuo es responsable de la elección de pareja, sin embargo, históricamente ha sido regulado por la cultura, familia y sociedad, quienes marcan las reglas, normas y conductas adecuadas para dicha elección. Esta investigación tuvo como propósito la construcción de una escala que analiza si una persona se considera a sí misma como responsable de la elección de su pareja; para ello se cuestiona la globalidad del proceso de locus de control. Un primer estudio, cualitativo, obtuvo indicadores usando ATLAS.ti, para obtener factores teóricos. Un segundo estudio corroboró los factores teóricos mediante un análisis de componentes principales, mostrando la existencia de los factores de: DestinoPredestinación, Poderosos del Microcosmos, y Control Interno, explicando con sus 17 ítems el 50.94% de varianza. Se concluye que el locus de control en la elección de pareja no es un continuo que se mueva entre internalidad y externalidad, sino que es multidimensional. / Actuellement, il semble que chaque individu est responsable du choix d’un couple, mais, historiquement, il a été réglementé par la culture, la famille et la société, qui marquent les règles, les normes et les comportements appropriés pour cette élection. Le but de cette recherche était la construction d’une échelle qui analyse si une personne se considère comme responsable du choix de son partenaire; pour cela, la globalité du processus de locus de contrôle est mise en question. Une première étude qualitative a obtenu des indicateurs en utilisant ATLAS.ti, pour obtenir des facteurs théoriques. Une deuxième étude a corroboré les facteurs théoriques au moyen d’une analyse des composantes principales, montrant l’existence des facteurs: Fate-Pré- destination, Microcosme Puissant et Contrôle Interne, expliquant avec leurs 17 items les 50.94% de variance. Nous concluons que le locus de contrôle dans le choix du couple n’est pas un continuum qui se déplace entre l’internalité et l’externalité, mais qu’il est multidimensionnel. / Hoje, parece que cada indivíduo é responsável pela escolha de seu parceiro, no entanto, tem sido historicamente regulado pela cultura, família e sociedade, que estabelecem regras, normas e comportamentos adequados a essa escolha. Esta pesquisa teve como objetivo construir uma escala que analise se uma pessoa se considera responsável pela escolha de seu parceiro; para isso, a globalidade do processo de locus de controle é questionada. Um primeiro estudo qualitativo, obteve indicadores usando ATLAS.ti, para obter fatores teóricos. Um segundo estudo corroborou os fatores teóricos através de uma análise de componentes principais, mostrando a existência dos fatores de Destinação-Predestinação, Poderosa do Microcosmo e Controle Interno, explicando com seus 17 itens 50.94% de variância. Concluímos que o locus de controle na escolha do par não é um continuum que se move entre internidade e externalidade, mas é multidimensional.