No abstract

Latent variable modeling is a popular and flexible statistical framework. Concomitant with fitting latent variable models is assessment of how well the theoretical model fits the observed data. Although firm cutoffs for these fit indexes are often cited, recent statistical proofs and simulations have shown that these fit indexes are highly susceptible to measurement quality. For instance, a root mean square error of approximation (RMSEA) value of 0.06 (conventionally thought to indicate good fit) can actually indicate poor fit with poor measurement quality (e.g., standardized factors loadings of around 0.40). Conversely, an RMSEA value of 0.20 (conventionally thought to indicate very poor fit) can indicate acceptable fit with very high measurement quality (standardized factor loadings around 0.90). Despite the wide-ranging effect on applications of latent variable models, the high level of technical detail involved with this phenomenon has curtailed the exposure of these important findings to empirical researchers who are employing these methods. This article briefly reviews these methodological studies in minimal technical detail and provides a demonstration to easily quantify the large influence measurement quality has on fit index values and how greatly the cutoffs would change if they were derived under an alternative level of measurement quality. Recommendations for best practice are also discussed.

Introduction Racial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors. Methods We contracted with GfK to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior. Results There were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge. Conclusions Racial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications.

Trust is thought to be a major factor in vaccine decisions, but few studies have empirically tested the role of trust in adult immunization. Utilizing a 2015 national survey of African American and White adults (n=1,630), we explore multiple dimensions of trust related to influenza immunization, including generalized trust, trust in the flu vaccine, and trust in the vaccine production process. We find African Americans report lower trust than Whites across all trust measures. When considering demographic, racial, and ideological predictors, generalized trust shows statistically significant effects on both trust in the flu vaccine and trust in the vaccine process. When controlling for demographic, racial, and ideological variables, higher generalized trust was significantly associated with higher trust in the flu vaccine and the vaccine process. When controlling for generalized trust, in addition to the baseline covariates, psychosocial predictors (i.e. risk perception, social norms, knowledge) are significant predictors of trust in flu vaccine and trust in the vaccine process, with significant differences by race. These findings suggest that trust in vaccination is complex, and that significant differences in trust between White and African American adults may be contributing to disparities in influenza immunization.

This study aimed to evaluate the reliability and validity of a patient safety competency self-evaluation (PSCSE) tool. An exploratory factor analysis (EFA) was used to investigate the compositions of the PSCSE. The internal structure of the PSCSE was schematized using a confirmatory factor analysis (CFA). Three hundred fifty-four students attending six schools of nursing participated in the study. On the basis of the results of the CFA, the PSCSE consisted of 12 factors (four for attitude, six for skill, and two for knowledge) with a good model fit. It was confirmed that the structures of the PSCSE were identical between EFA and CFA. The PSCSE consisted of multidimensional structures of the 12 factors and hierarchical models of three categories. The PSCSE can be used to assess nursing students' perception of their own competency regarding patient safety and to develop educational strategies integrating patient safety competency into nursing curricula.