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Development and psychometric validation of the 8-item Student Quality of Life Index (IQoL) using item response theory (IRT): a cross-sectional study among Brazilian higher education students

Por: Gobbo · M. · Silveira de Resende · M. · Santos · I. M. · Moura · E. C. d. · Pedro · R. d. A.
Objectives

To develop and validate the 8-item Student Quality of Life Index (IQoL), a concise, multidimensional instrument for assessing quality of life (QoL) among higher education students in Brazil, encompassing psychological well-being, vitality and perceived functional capacity.

Design

Cross-sectional psychometric validation study using a split-sample approach for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), followed by bifactor item response theory (IRT) modelling and measurement invariance testing.

Setting

A large-scale survey conducted across 32 private higher education institutions in 14 Brazilian states, covering diverse academic fields. To ensure representativeness, the medical student subgroup was calibrated using post-stratification weights to align sex and age distributions with national medical education demographics.

Participants

A total of 10 844 undergraduate students completed the survey. Psychometric model development used 10 793 respondents with complete data for the candidate item pool included in the EFA/CFA/IRT pipeline. Score distributions and subgroup comparisons used 10 838 respondents with complete information for sex, age group and course (3656 medical; 7182 other). The sample was predominantly female (69.0%) and white (47.3%) or mixed-race (41.2%), with an age range predominantly between 18 and 29 years. For medical-student comparisons, a stratified, calibrated analytic subset was created to match national sex and age margins, which led to a small reduction in the medical subgroup denominator in those analyses.

Primary outcome measures

Psychometric properties of the 8-item IQoL scale. Structural validity was assessed via CFA (weighted least squares mean and variance adjusted estimator) and internal consistency via Cronbach’s alpha and Omega coefficients. Item-level performance was evaluated using Samejima’s Graded Response Model. Scalar measurement invariance was tested across sex, age and course.

Results

The parsimonious 8-item, three-factor model demonstrated superior fit indices (comparative fit index=0.996; Tucker-Lewis index=0.993; root mean square error of approximation=0.058 (90% CI 0.052 to 0.064); standardised root mean square residual=0.031). Internal consistency was high (α=0.88; ). Bifactor IRT analysis supported a dominant general QoL factor, with item discrimination parameters () ranging from 1.37 to 3.48. Scalar measurement invariance was established for sex, age and academic field, supporting valid group comparisons. Medical students reported slightly higher psychological well-being than non-medical peers, though effect sizes were trivial (Hedges’ g=0.074). Within the medical subgroup, females scored higher in vitality and psychological well-being (g up to 0.225). Lower income and self-reported depression were significantly associated with lower global IQoL scores.

Conclusions

The Student Quality of Life Index (IQoL) is a psychometrically robust, invariant and efficient tool for large-scale monitoring of student well-being. The establishment of scalar invariance ensures that the observed differences across demographic and academic subgroups reflect true differences in the latent construct, reinforcing the instrument’s utility for institutional assessment and mental health policy-making in higher education.

Top 10 research priorities for adolescent and young adult cancer in Canada: a James Lind Alliance priority setting partnership

Por: Tutelman · P. R. · Thurston · C. · Ranger · T. · Rader · T. · Henry · B. · Abdelaal · M. · Blue · M. · Buckland · T. W. · Del Gobbo · S. · Dobson · L. · Gallant · E. · Heykoop · C. · Jansen · M. · Larsen · L. · Maseja · N. · Oberoi · S. · Ramasamy · V. · Smith · M. · Wendowsky · N. · Beattie
Objectives

Cancer in adolescents and young adults (AYAs; ages 15–39 years) is a rising global epidemic. Yet, AYAs remain an understudied population, and little is known about what research topics should be prioritised according to those with lived experience. The AYA Cancer Priority Setting Partnership (PSP) was established to identify the top 10 research priorities for AYA cancer in Canada according to patients, caregivers, and clinicians.

Design

This project followed the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology that included two national cross-sectional surveys and a final priority setting workshop following an adapted nominal group technique.

Setting

A national sample was recruited to participate from across Canada.

Participants

Participants were patients, caregivers, and clinicians with lived personal and/or professional experience of AYA cancer in Canada.

Outcome measures

In the first survey, open-ended responses were collected from participants about questions they would like answered by research. Responses were collated into overarching summary questions and a literature search was undertaken to verify if questions were true uncertainties and not fully answered by existing evidence. Unanswered questions were ranked by participants in a second survey. The top-ranked questions were prioritised through consensus at the final priority setting workshop. The final outcome was the top 10 priorities for AYA cancer research in Canada.

Results

In the initial survey, 1916 potential research questions were submitted by 275 patients, caregivers, and clinicians. Following data processing, summary question formation, and the evidence check, 58 questions were put forward for interim prioritisation in a second survey (n=285 patients, caregivers, and clinicians). The top 20 questions from the interim prioritisation were ranked at the final priority setting workshop attended by a diverse group of 23 patients, caregivers and clinicians from across Canada. The resulting top 10 priorities reflect topics across the cancer continuum including: diagnostic delays, screening and early detection, novel therapies, psychosocial impacts, end-of-life concerns, and survivorship issues.

Conclusions

This patient-directed research agenda will guide researchers, funding agencies, and policymakers to ensure that future research is aligned with what matters most to the AYA cancer community.

Development and psychometric validation of the 13-item physician health and quality of life (Afya MedQoL) index: a nationwide cross-sectional survey of Brazilian physicians

Por: Gobbo · M. · Silveira de Resende · M. · Santos · I. M. · Moura · E. C. d. · Pedro · R. d. A.
Objectives

To develop and validate a concise, physician-specific quality-of-life scale (Afya MedQol) Index, and to examine sociodemographic and occupational correlates of physician well-being in Brazil.

Design

Nation-wide, cross-sectional, web-based survey employing split-sample psychometric validation: exploratory factor analysis, confirmatory factor analysis (CFA), multidimensional graded-response item-response theory calibration and post-stratification weighting to the 2025 Brazilian medical demographic census.

Setting

Physicians practising in all five Brazilian macro-regions and 27 state medical councils (2 July 2024–6 August 2024).

Participants

A total of 2005 fully responding physicians (56% women; mean age 38.5±12.6 years).

Primary outcome measures

Domain scores—F1: Quality of Life, F2: Institutional Support, F3: Perceived Stress—and a Fisher-information-weighted global score. Convergent validity with WHOQOL-Bref; subgroup differences (Cohen’s d, partial ²).

Results

CFA supported a three-factor, 13-item solution (Comparative Fit Index=0.987; Root Mean Square Error of Approximation=0.050) with strict invariance across sex and graduation-year quartiles. Item-response modelling showed marginal reliability =0.82. Convergent validity with WHOQOL-Bref domains was strong (r=0.55–0.73). Weighted mean (95% CI) scores were: Global 67.2 (66.5–67.9), F1 69.5 (68.9–70.2), F2 64.1 (63.4–64.8) and F3 62.5 (61.8–63.2).Women scored higher on Perceived Stress (F3) than men by 5.6 points (weighted mean difference 5.6, 95% CI 4.0 to 7.2; Cohen’s d 0.28). Physicians working ≥60 hours/week scored higher on Perceived Stress than those working ≤44 hours/week by 8.8 points (weighted mean difference 8.8, 95% CI 6.7 to 10.9; Cohen’s d 0.40). Well-being increased with income up to ~BRL 25 000 per month and plateaued thereafter.

Conclusions

Afya MedQoL Index is a psychometrically robust, 13-item instrument capturing personal, organisational and stress dimensions of physician well-being. Perceived Stress—shaped by workload, institutional climate and gender—was the most discriminative domain, while additional income beyond an upper-middle-class threshold conferred negligible benefit. Findings support policies aimed at capping duty hours, fostering ‘just-culture’ environments and expanding flexible work models.

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