The latent growth curve modeling (LGM) and random effects modeling (REM) frameworks are analytically and empirically equivalent for intrinsically linear models and used interchangeably for ...intrinsically nonlinear models. However, while LGM provides overall model fit indices, REM does not. Overall model fit indices are useful because they evaluate how well a specified model fits data. This paper proposes to translate model fit concepts from LGM to REM to help researchers compute overall model fit indices, including the model chi-square (
), comparative fit index (CFI), root mean squared error of approximation (RMSEA), and standardized root mean squared residual (SRMR). Three empirical examples were used as illustrations.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
Nonlinear mixed-effects models (NLMEMs) allow researchers to model curvilinear patterns of growth, but there is ambiguity as to what functional form the data follow. Often, researchers fit multiple ...nonlinear functions to data and use model selection criteria to decide which functional form fits the data "best." Frequently used model selection criteria only account for the number of parameters in a model but overlook the complexity of intrinsically nonlinear functional forms. This can lead to overfitting and hinder the generalizability and reproducibility of results. The primary goal of this study was to evaluate the performance of eight model selection criteria via a Monte Carlo simulation study and assess under what conditions these criteria are sensitive to model overfitting as it relates to functional form complexity. Results highlighted criteria with the potential to capture overfitting for intrinsically nonlinear functional forms for NLMEMs. Information criteria and the stochastic information complexity criterion recovered the true model more often than the average or conditional concordance correlation. Results also suggest that the amount of residual variance and sample size have an impact on model selection for NLMEMs. Implications for future research and recommendations for application are also provided.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
Crossed random effects models (CREMs) are particularly useful in longitudinal data applications because they allow researchers to account for the impact of dynamic group membership on individual ...outcomes. However, no research has determined what data conditions need to be met to sufficiently identify these models, especially the group effects, in a longitudinal context. This is a significant gap in the current literature as future applications to real data may need to consider these conditions to yield accurate and precise model parameter estimates, specifically for the group effects on individual outcomes. Furthermore, there are no existing CREMs that can model intrinsically nonlinear growth. The goals of this study are to develop a Bayesian piecewise CREM to model intrinsically nonlinear growth and evaluate what data conditions are necessary to empirically identify both intrinsically linear and nonlinear longitudinal CREMs. This study includes an applied example that utilizes the piecewise CREM with real data and three simulation studies to assess the data conditions necessary to estimate linear, quadratic, and piecewise CREMs. Results show that the number of repeated measurements collected on groups impacts the ability to recover the group effects. Additionally, functional form complexity impacted data collection requirements for estimating longitudinal CREMs.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To model growth over time, statistical techniques are available in both structural equation modeling (SEM) and random effects modeling frameworks. Liu et al. proposed a transformation and an inverse ...transformation for the linear–linear piecewise growth model with an unknown random knot, an intrinsically nonlinear function, in the SEM framework. This method allowed for the incorporation of time-invariant covariates. While the proposed method made novel contributions in this area of research, the use of transformations introduces some challenges to model estimation and dissemination. This commentary aims to illustrate the significant contributions of the authors’ proposed method in the SEM framework, along with presenting the challenges involved in implementing this method and opportunities available in an alternative framework.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Abstract Background Low- and middle-income countries face a disproportionate impact of sexual health problems compared to high-income countries. To address this situation proper interpersonal ...communication skills are essential for clinician to gather necessary information during medical history-taking related to sexual health. This study aimed to evaluate the interrater reliability of ratings on sexual health-related interpersonal communication and medical history-taking between SPs and trained HCP faculty for health care professional students. Methods We conducted a cross-sectional comparative study to evaluate the interrater reliability of ratings for sexual health-related interpersonal communication and medical history-taking. The data were collected from medical and nursing students at Muhimbili University of Health and Allied Sciences, who interviewed 12 Standardized Patients (SPs) presenting with sexual health issues. The video-recorded interviews rated by SPs, were compared to the one rated by 5 trained Health Care Professional (HCP) faculty members. Inter-rater reliability was evaluated using percent agreement (PA) and kappa statistics (κ). Results A total of 412 students (mean age 24) were enrolled in the study to conduct interviews with two SPs presenting with sexual health concerns. For interpersonal communication (IC), the overall median agreement between raters was slight (κ 2 0.0095; PA 48.9%) while the overall median agreement for medical sexual history-taking was deemed fair (κ 2 0.139; PA 75.02%). Conclusion The use of SPs for training and evaluating medical and nursing students in Tanzania is feasible only if they undergo proper training and have sufficient time for practice sessions, along with providing feedback to the students.
Abstract Background The cancer burden in Africa is on the rise. A Cancer Training Course on screening, prevention, care, and community education is crucial for addressing a wide range of cancer ...health issues. When appropriately educated healthcare providers on cancer provide care, patient care improves, and healthcare costs decrease. However, in Tanzania, doctors and nurses receive little or no training in primary cancer care in their bachelor’s program. Aim This study assessed the need and acceptability of a cancer training course for nursing and medical doctor students at the Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania. Methods This study was a cross-sectional parallel mixed method study during the 3-month follow-up within the larger study on sexual health training for health professionals. The study was a randomized controlled (RCT), single-blind, parallel trial of sexual health training versus a waitlist control among health students at MUHAS in Tanzania. Descriptive analysis was performed to analyze the participants’ demographic information, need, and acceptability of the cancer training courseto determine the frequencies and percentages of their distribution between disciplines. In addition, inductive thematic analysis was performed for the qualitative data. The RCT study was registered at Clinical Trial.gov (NCT03923582; 01/05/2021). Results Data were collected from 408 students (272 medical doctors and 136 nursing students). The median age of the participants was 23 years. Most (86.0%) medical and 78.1% of nursing students reported receiving little to no cancer training. On the other hand, most (92.3%) medical and nursing (92.0%) students were interested in receiving cancer training. Furthermore, 94.1% of medical and 92.0% of nursing students needed a cancer training course in their undergraduate program. In addition, participants said a cancer training course would be important because it would help them improve the quality of cancer care and enhance the quality of life for patients by ensuring early diagnosis and treatment. Conclusion A cancer training course is both highly needed and acceptable to medical and nursing students. Implementation of this cancer training course will improve students’ knowledge and skills and eventually improve the quality of cancer care and patients’ quality of life by ensuring early diagnosis and management.
Men who have sex with men (MSM) are at increased risk for human papillomavirus-associated oropharyngeal cancer (HPV-OPC). The objective of this analysis was to create a psychometrically validated ...scale to measure perception of risk for HPV-OPC.
We conducted an exploratory and a confirmatory factor analysis to determine and confirm the latent factor structure. We used a path diagram to evaluate the relationship between the validated scale and perceived risk for HPV-OPC. The model was determined to be a good fit if it met all criteria: root mean square error of approximation ≤0.06, standardized root mean residual ≤0.08, Comparative Fit Index ≥0.90, and Tucker-Lewis Index ≥0.90. We report standardized estimates and 95% confidence intervals.
This cross-sectional study recruited 1315 MSM. A majority (73.33%) of MSM had performed fellatio on ≥20 partners, 36.98% had rimmed ≥20 partners, and 5.31% had performed cunnilingus on ≥10 partners in their lifetime.Six sexual history survey items loaded onto 2 latent factors: sexual risk behaviors: class 1 and sexual risk behaviors: class 2. The final model statistics indicated good fit: root mean square error of approximation = 0.064, standardized root mean residual = 0.059, Comparative Fit Index = 0.996, and Tucker-Lewis Index = 0.993. Sexual risk behaviors: class 1 was associated with greater perceived risk for HPV-OPC (0.217; 95% confidence interval, 0.138-0.295). Age, HIV status, HPV vaccination status, and sexual risk behaviors: class 2 were not associated with perceived risk for HPV-OPC.
Men who have sex with men assessed risk for HPV-OPC based on their lifetime number of cisgender male sexual partners, rimming partners, and fellatio partners but not other sexual behaviors. Men who have sex with men may be responsive to future HPV-OPC educational interventions and opportunities for screening.
Female genital mutilation/cutting (FGM/C) is tied to one of the most conservative cultures in the Mediterranean and Sub-Saharan Africa. More than 200 million girls and women in 30 African, Asian and ...the middle Eastern countries have undergone FGM/C. However, healthcare professionals are not adequately trained to prevent and manage FGM/C-related complications including sexual health problems. This study aimed to assess the need and acceptability of a curriculum to train nursing and medical students in the sexual healthcare of clients with FGM/C in Tanzania.
We used a descriptive and cross sectional study design to collect and analyse information from 271 medical and 137 nursing students in Tanzania. A Qualtrics online survey was used to obtain quantitative data on training interest, previous training received, and the curriculum delivery method. Open-ended questions were used to explore their insights on significance to obtain the necessary competencies to treat and prevent FGM/C. Descriptive statistics were used to analyze quantitative data while qualitative data were analyzed using a thematic approach.
Almost half of the participants reported they had little to no training in sexual healthcare for women with FGM/C (47%). In all, 82.4% reported the training to be acceptable. Following thematic analysis of open-ended questions, participants expressed a desire to improve their competencies to meet the current and future sexual and psychological health needs of women and girls who have undergone FGM/C.
It is a necessary and acceptable to develop a curriculum to train healthcare students to diagnose, treat and prevent sexual health complications related to FGM/C. In our study, designing a culturally sensitive curriculum and its delivery method, that includes practical sessions with simulated patients, was considered the most beneficial and favorable.
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IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
Background Tanzania is a country experiencing multiple sexual health challenges, but providers receive no formal training in sexual health.Aim This study aimed to assess (1) what sexual health ...challenges are commonly seen in clinics in Tanzania, (2) which are raised by patients, (3) which are not addressed and (4) which topics to prioritise for a sexual health curriculum.Setting Healthcare settings in Tanzania.Methods Participants were 60 experienced and 61 student doctors, nurses and midwives working in Dar es Salaam. The authors conducted 18 focus groups stratified by profession (midwifery, nursing or medicine) and experience (practitioners vs. students).Results Providers identified six common sexual health concerns: (1) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and sexually transmissible infection (STI) (especially syphilis and gonorrhoea), (2) sexual violence (including intimate partner violence and female genital mutilation), (3) early and unwanted pregnancy (including early sexual debut and complications from abortion), (4) sexual dysfunctions, (5) key population concerns (e.g. lesbian, gay, bisexual, transgender (LGBT); sex work) and (6) non-procreative sexual behaviour (including pornography and masturbation in males and oral and anal sex practices in heterosexual couples). Across professions, few differences were observed. Homosexuality, sex work, masturbation and pornography were identified as taboo topics rarely discussed. Most participants (81%) wanted one comprehensive sexual health curriculum delivered across disciplines.Conclusion A sexual health curriculum for health students in Tanzania needs to address the most common sexual health concerns of patients. In addition to teaching sexual science and clinical care, skills training in how to address taboo topics is recommended. Students endorsed almost all sexual health topics, which suggests that a comprehensive curriculum is appropriate.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
