This article advances a simple conception of test validity: A test is valid for measuring an attribute if (a) the attribute exists and (b) variations in the attribute causally produce variation in the measurement outcomes. This conception is shown to diverge from current validity theory in several respects. In particular, the emphasis in the proposed conception is on ontology, reference, and causality, whereas current validity theory focuses on epistemology, meaning, and correlation. It is argued that the proposed conception is not only simpler but also theoretically superior to the position taken in the existing literature. Further, it has clear theoretical and practical implications for validation research. Most important, validation research must not be directed at the relation between the measured attribute and other attributes but at the processes that convey the effect of the measured attribute on the test scores.

This article examines the theoretical status of latent variables as used in modern test theory models. First, it is argued that a consistent interpretation of such models requires a realist ontology for latent variables. Second, the relation between latent variables and their indicators is discussed. It is maintained that this relation can be interpreted as a causal one but that in measurement models for interindividual differences the relation does not apply to the level of the individual person. To substantiate intraindividual causal conclusions, one must explicitly represent individual level processes in the measurement model. Several research strategies that may be useful in this respect are discussed, and a typology of constructs is proposed on the basis of this analysis. The need to link individual processes to latent variable models for interindividual differences is emphasized.

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The QUALIDEM is an easy to administer and sufficiently reliable rating scale that provides a QOL profile of persons with dementia in residential settings. The QUALIDEM can be used for evaluation as well as for research and practice innovation.

The results of this validation study together with the obtained content validity through the method of construction provide sufficient support for validity of the QUALIDEM to be used for care evaluation and research in residential settings.