Aldridge Luke R, Kemp Christopher G, Bass Judith K, Danforth Kristen, Kane Jeremy C, Hamdani Syed U, Marsch Lisa A, Uribe-Restrepo José M, Nguyen Amanda J, Bolton Paul A, Murray Laura K, Haroz Emily E
Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.
University of Washington Department of Global Health, Seattle, USA.
Implement Sci Commun. 2022 May 19;3(1):54. doi: 10.1186/s43058-022-00301-6.
Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants and outcomes across four key stakeholder groups-consumers, providers, organization leaders, and policy makers-with dedicated versions of scales for each group. These were field tested and refined in several contexts, and criterion validity was established in Ukraine. The Consumer and Provider mhIST have since grown in popularity in mental health research, outpacing psychometric evaluation. Our objective was to establish the cross-context psychometric properties of these versions and inform future revisions.
We compiled secondary data from seven studies across six LMIC-Colombia, Myanmar, Pakistan, Thailand, Ukraine, and Zambia-to evaluate the psychometric performance of the Consumer and Provider mhIST. We used exploratory factor analysis to identify dimensionality, factor structure, and item loadings for each scale within each stakeholder version. We also used alignment analysis (i.e., multi-group confirmatory factor analysis) to estimate measurement invariance and differential item functioning of the Consumer scales across the six countries.
All but one scale within the Provider and Consumer versions had Cronbach's alpha greater than 0.8. Exploratory factor analysis indicated most scales were multidimensional, with factors generally aligning with a priori subscales for the Provider version; the Consumer version has no predefined subscales. Alignment analysis of the Consumer mhIST indicated a range of measurement invariance for scales across settings (R 0.46 to 0.77). Several items were identified for potential revision due to participant nonresponse or low or cross- factor loadings. We found only one item, which asked consumers whether their intervention provider was available when needed, to have differential item functioning in both intercept and loading.
We provide evidence that the Consumer and Provider versions of the mhIST are internally valid and reliable across diverse contexts and stakeholder groups for mental health research in LMIC. We recommend the instrument be revised based on these analyses and future research examine instrument utility by linking measurement to other outcomes of interest.
高收入国家制定的现有实施措施在低收入和中等收入国家（LMIC）的适用性可能有限。作为回应，约翰霍普金斯大学的研究人员于2013年开始开发心理健康实施科学工具（mhIST），以评估四个关键利益相关者群体（消费者、提供者、组织领导者和政策制定者）的优先实施决定因素和结果，并为每个群体提供专门的量表版本。这些量表在多个环境中进行了实地测试和完善，并在乌克兰建立了效标效度。此后，消费者版和提供者版mhIST在心理健康研究中越来越受欢迎，超过了心理测量学评估。我们的目标是确定这些版本的跨环境心理测量特性，并为未来的修订提供参考。
我们汇总了来自六个低收入和中等收入国家（哥伦比亚、缅甸、巴基斯坦、泰国、乌克兰和赞比亚）的七项研究的二手数据，以评估消费者版和提供者版mhIST的心理测量性能。我们使用探索性因素分析来确定每个利益相关者版本中每个量表的维度、因素结构和项目负荷。我们还使用一致性分析（即多组验证性因素分析）来估计六个国家消费者量表的测量不变性和项目功能差异。
提供者版和消费者版中除一个量表外，所有量表的克朗巴哈系数均大于0.8。探索性因素分析表明，大多数量表是多维的，提供者版的因素通常与先验子量表一致；消费者版没有预定义的子量表。消费者版mhIST的一致性分析表明，不同环境下量表的测量不变性范围为R 0.46至0.77。由于参与者无回应或负荷低或跨因素负荷，确定了几个项目需要潜在修订。我们发现只有一个项目，即询问消费者在需要时其干预提供者是否可用，在截距和负荷方面都存在项目功能差异。
我们提供的证据表明，mhIST的消费者版和提供者版在低收入和中等收入国家心理健康研究的不同环境和利益相关者群体中具有内部效度和可靠性。我们建议根据这些分析对该工具进行修订，未来的研究通过将测量与其他感兴趣的结果联系起来，检验该工具的效用。
