Introduction The Patient-Reported Outcomes Measurement Information System (PROMIS)® Sexual Function and Satisfaction measure (SexFS) version 1.0 was developed with cancer populations. There is a need to expand the SexFS and provide evidence of its validity in diverse populations. Aim The aim of this study was to describe the development of the SexFS v2.0 and present preliminary evidence for its validity. Methods Development built on version 1.0, plus additional review of extant items, discussions with 15 clinical experts, 11 patient focus groups (including individuals with diabetes, heart disease, anxiety, depression, and/or are lesbian, gay, bisexual, or aged 65 or older), 48 cognitive interviews, and psychometric evaluation in a random sample of U.S. adults plus an oversample for specific sexual problems (2281 men, 1686 women). We examined differential item functioning (DIF) by gender and sexual activity. We examined convergent and known-groups validity. Results The final set of domains includes 11 scored scales (interest in sexual activity, lubrication, vaginal discomfort, clitoral discomfort, labial discomfort, erectile function, orgasm ability, orgasm pleasure, oral dryness, oral discomfort, satisfaction), and six nonscored item pools (screeners, sexual activities, anal discomfort, therapeutic aids, factors interfering with sexual satisfaction, bother). Domains from version 1.0 were reevaluated and improved. Domains considered applicable across gender and sexual activity status, namely interest, orgasm, and satisfaction, were found to have significant DIF. We identified subsets of items in each domain that provided consistent measurement across these important respondent groups. Convergent and known-groups validity was supported. Conclusions The SexFS version 2.0 has several improvements and enhancements over version 1.0 and other extant measures, including expanded evidence for validity, scores centered around norms for sexually active U.S. adults, new domains, and a final set of items applicable for both men and women and those sexually active with a partner and without. The SexFS is customizable, allowing users to select relevant domains and items for their study.
Computerized testing has created new challenges for the production and administration of test forms. Many testing organizations engaged in or considering computerized testing may find themselves changing from well-established procedures for handcrafiing a small number of paper-and-pencil test forms to procedures for mass producing many computerized test forms. This paper describes an integrated approach to test development and administration called computer-adaptive sequential testing, or CAST. CAST is a structured approach to test construction which incorporates both adaptive testing methods with automated test assembly to allow test developers to maintain a greater degree of control over the production, quality assurance, and administration of different types of computerized tests. CAST retains much of the efficiency of traditional computer adaptive testing (CAT) and can be modified for computer mastery testing (CMT) applications. The CAST framework is described in detail and several applications are demonstrated using a medical licensure example.
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