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Evaluating the Properties of the Evidence-Based Practice Attitude Scale (EBPAS) in Health Care

Authors:
Christos D Melas at Hellenic Mediterranean University
Christos D Melas
Leonidas A Zampetakis at University of Crete
Leonidas A Zampetakis
Anastasia Dimopoulou at Attikon University Hospital
Anastasia Dimopoulou
Vassilis S. Moustakis at Hellenic Open University
Vassilis S. Moustakis
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The Evidence-Based Practice Attitude Scale (EBPAS; Aarons, 2004) is a relatively new construct for the study of attitudes toward the adoption of innovation and evidence-based practices (EBPs) in mental health service settings. Despite widespread interest in measuring the attitudes of health care providers in conjunction with the adoption of EBPs, no prior research has used the EBPAS with medical doctors, a different population than that with which the scale was originally developed. In the present study, the factor structure, reliability, and validity of EBPAS scores were tested with a sample of 534 medical doctors working in 14 Greek hospitals. In addition, associations of health care provider characteristics (age, gender, medical specialty, information and communication technology use and knowledge) with EBPAS total scores are examined. Confirmatory factor analyses support the 4-factor structure of the EBPAS and provide convincing evidence for the validity of the scale. Implications and future directions are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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... The four subscales combine into a higher-order scale representing global attitudes toward adopting the evidence-based practice. The EBPAS-15 has been validated in over 26 states in the United States of America as well as in the Netherlands and Norway and among 100 different community-based organizations involving over 1,000 mental health providers, medical professionals, and child welfare workers (Aarons et al., 2010;Egeland et al., 2016;Keyser et al., 2016;Melas et al., 2012;Rye et al., 2017). ...
... Through the use of factor analysis, a 9-item, 3-factor structure emerged that deviated from the original EBPAS-15, developed by Aarons (2004). As found in similar measurement studies of the EBPAS-15, the Openness and Appeal subscales demonstrated the strongest relationships with the overall unitary construct of attitudes toward adopting EBPs (Aarons et al., 2011;Cook et al., 2018;Melas et al., 2012;Suhrheinrich et al., 2020), and the Divergence subscale had a weaker relationship (Cook et al., 2018;Suhrheinrich et al., 2020). In fact, our final measure only includes one item from the Divergence scale and is loaded onto the revised Openness subscale. ...
Teacher attitudes toward evidence-based practices: Exploratory and confirmatory analyses of the school-adapted evidence-based practice attitude scale
Article
Full-text available
  • Jan 2023
Background The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral health services. Method School-based stakeholders and a research team comprised of experts in the implementation of evidence-based practices in schools adapted the EBPAS for teachers (the S-EBPAS). The adapted instrument was administered to a representative sample ( n = 441) of general education teachers (grades K—5) to assess the reliability and internal consistency via factor analyses. The S-EBPAS included two forms (i.e., EBP-agnostic and EBP-specific item referents), therefore, a multiple-group confirmatory factor analysis (CFA) was also performed to establish measurement invariance between the two forms. Results After adaptation and refinement, a 9-item, 3-factor structure was confirmed, with the final model supporting three first-order factors that load onto a second-order factor capturing attitudes toward adopting evidence-based practices. Multiple-group CFA analyses of measurement invariance indicated there were no significant differences between the two forms. Conclusions Overall, this study provides a brief, flexible instrument capturing attitudes toward adopting EBPs that has high reliability and internal consistency, which support its use among general education teachers in school settings implementing evidence-based practices.
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... Implementer attitudes toward EBPs reflect their favorable or unfavorable evaluative judgments regarding the adoption and use of EBPs, which is established in the literature as a prominent motivational implementation factor (Aarons & Sawitzky, 2006;Fishman et al., 2021). The most widely used measure for implementer attitudes toward EBPs in the field of implementation science is the Evidence-Based Practice Attitude Scale (EBPAS; Aarons & Sawitzky, 2006), and a collection of existing research has established that implementer attitudes toward EBPs (measured by EBPAS) are associated with various implementation outcomes (e.g., intention to implement, adoption, fidelity, knowledge and use of EBPs, Aarons et al., 2012aAarons et al., , 2012bGregory et al., 2005;Melas et al., 2012). For instance, educational research indicates that teachers' attitudes toward certain EBPs influence their fidelity of implementation (Bowden et al., 2003). ...
... For instance, educational research indicates that teachers' attitudes toward certain EBPs influence their fidelity of implementation (Bowden et al., 2003). In the fields of healthcare, higher scores on EBPAS have been associated with clinicians' higher levels of knowledge about EBPs (Melas et al., 2012), as well as increased adoption and delivery of EBPs (Nelson et al., 2012;Smith & Manfredo, 2011). Moreover, based on the theory of planned behavior, attitudes are one of the main mechanisms that influence clinicians' intentions to implement EBPs, which is a proximal predictor of the actual implementation (e.g., adoption of EBPs; Godin & Kok, 1996). ...
The Interaction Between General and Strategic Leadership and Climate on Their Cross-Level Associations with Implementer Attitudes Toward Universal Prevention Programs for Youth Mental Health: A Multilevel Cross-Sectional Study
Article
Full-text available
  • Dec 2022
  • ADM POLICY MENT HLTH
Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership and climate (general and strategic) are associated with implementer attitudes toward EBPs across the individual and organizational levels and their interaction effect in schools. A series of multilevel models (MLMs) were fitted on a diverse sample of schools actively implementing universal prevention programs for youth mental health (441 implementers from 52 schools). The organization-level aggregates and individual educators' perceptions of general and strategic leadership and climate, and their interaction terms, were entered as level-2 and level-1 predictors of four attitudinal dimensions (Requirement, Openness, Appeal, and Divergence) based on their level of measurement. At the organizational level, higher levels of strategic leadership and climate, but not their general counterparts, were consistently associated with more favorable attitudes in all four dimensions. At the individual level, higher levels of perceived general and strategic leadership and climate were associated with more favorable attitudes of Requirement and Openness. At the organizational level, general climate moderated the positive effect of strategic climate on implementers' perception of appeal and divergence of EBPs. Our findings indicate that leaders need to make data-based decisions to allocate resources on strategic and/or general leadership and climate to foster favorable staff attitudes toward EBPs based on the level of measurement, implementation-specificity, and attitudinal dimensions. Keywords: general and strategic organizational factors, leadership, organizational climate, organizational context, attitudes toward EBPs
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... The EBPAS-15 has since been revalidated in both U.S. samples 17,[23][24][25] and international samples. [26][27][28][29] Aarons et al. (2012) created a more comprehensive 50-item version of the EBPAS that taps into 12 domains while considering individual and contextual in uences on provider attitudes. 21 In addition to the four domains captured by the EPBAS-15, the EBPAS-50 measures eight new domains: (1) perceived limitations of EBPs, (2) concerns about whether EBPs t with a clinician's circumstances, (3) negative beliefs regarding supervisor monitoring, (4) extent to which therapy involves a balance between art and science, (5) burden associated with learning EBPs, (6) extent to which EBPs increase job security, (7) organizational support of EBPs, and (8) positive perceptions of receiving feedback on performance. ...
Reexamining the Evidence-Based Practices Attitude Scale-36 (EBPAS-36) in a U.S. Sample of Trauma-Focused Treatment Providers
Preprint
Full-text available
  • Mar 2024
Background Mental health providers’ attitudes toward evidence-based practice are likely to influence what interventions they learn, implement, and sustain over time. Extending research on the 15-item Evidence-Based Practice Attitude Scale (EBPAS), a 36-item version of the EBPAS was recently developed to assess provider attitudes more comprehensively. Research suggests the EBPAS-36 is a promising tool, though inconsistencies across studies suggest there is a need to reexamine its validity and reliability. Methods This study assessed the factorial structure of the EBPAS-36, the intercorrelations and reliabilities of its subscales, and correlates of practice attitudes in a U.S. sample of 445 practitioners who received training in trauma-focused cognitive behavioral therapy. Results A confirmatory factor analysis verified that the EBPAS-36 fits a 12-factor model representing each of its subscales. Reinforcing prior results, the subscales of the EBPAS-36 were weakly to moderately correlated, suggesting that the 12 domains are related yet distinct. A hypothesized second-order model with three overarching latent factors was not validated, but an alternative two-factor model fit the data adequately. Most subscales demonstrated good-to-excellent internal consistency, though values for the appeal, divergence, and balance subscales ranged from marginally acceptable to poor. Provider attitudes varied by gender, professional experience, and discipline. Practitioners who more frequently assessed client trauma symptoms reported more positive EBP attitudes, and those who expressed greater concerns that trauma assessments may cause harm reported more negative attitudes. Conclusions Taken together with previous findings, the results suggest the EBPAS-36 performs well overall, though some subscales may benefit from refinement. Further validation tests of the EBPAS-36 in diverse samples are warranted.
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... 1999). Thus, investigating attitudes towards EBPs is key to improve service delivery, outcomes, and support their successful implementation of these practices in settings where they are needed the most (Aarons, 2004;Melas, et al., 2012;Rousseau & Gunia, 2016;Rye, et al., 2019). However, attitudes toward EBPs have been examined mostly in white, female, and U.S. professional samples (Parrish & Rubin, 2012;Locke, et al., 2019). ...
Needs and Attitudes Related to the Adoption of Evidence-Based Practices Among Latinx Mental Health Professionals
Article
Full-text available
  • Jun 2023
  • ADM POLICY MENT HLTH
This study investigated the needs and attitudes toward EBPs among an interdisciplinary sample of mental health professionals in Puerto Rico. An anonymous survey was distributed to social workers, psychologists, and professional counselors (N=237). Using structural equation modeling, four dimensions of attitudes towards EBPs (openness, divergence, appeal, and requirement) were regressed on various individual and organizational factors. Some socio-demographic characteristics, educational opportunities, and organizational factors significantly contributed to specific attitudes related to the adoption of EBPs. Female participants and those working in rural settings scored higher in the openness to innovation dimension. Greater organizational support and graduating from a private institution were associated with more divergence from research, while married individuals and those trained on EBPs scored lower on this dimension. The lack of exposure to EBPs in college and younger age predicted greater interest in the appeal of adopting an EBP intervention (i.e., would adopt an EBP if it made sense). No differences in attitudes toward EBPs were found by professional discipline or work setting (i.e., clinical, community, and schools). Recommendations to increase openness and interest in the appeal of EBPs among Spanish-speaking professional communities in Latin America are highlighted.
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... Although all constructs related to EBP are important, attitudes towards EBP play a key role in one's inclination to adopt EBP. Indeed, attitudes are strongly associated with practitioners' behaviors [74] and are a known precursor to practitioners' decision to adopt and apply evidence to their practice [75]. Our study shows that among all EBP constructs, only a high level of positive attitudes towards EBP can help practitioners sustain a high use of EBP over time. ...
Exploring if and how evidence-based practice of occupational and physical therapists evolves over time: A longitudinal mixed methods national study
Article
Full-text available
Background: Occupational therapists (OTs) and physiotherapists (PTs) are expected to provide evidence-based services to individuals living with disabilities. Despite the emphasis on evidence-based practice (EBP) by professional entry-level programs and professional bodies, little is known about their EBP competencies upon entry to practice and over time or what factors impact EBP use. The aim of the study was to measure and understand how EBP evolves over the first three years after graduation among Canadian OTs and PTs, and how individual and organizational factors impact the continuous use of EBP. Methods: A longitudinal, mixed methods sequential explanatory study. We administered a survey questionnaire measuring six EBP constructs (knowledge, attitudes, confidence, resources, use of EBP and evidence-based activities) annually, followed by focus group discussions with a subset of survey participants. We performed group-based trajectory modeling to identify trajectories of EBP over time, and a content analysis of qualitative data guided by the Theoretical Domains Framework. Results: Of 1700 graduates in 2016-2017, 257 (response rate = 15%) responded at baseline (T0) (i.e., at graduation), and 83 (retention rate = 32%), 75 (retention rate = 29%), and 74 (retention rate = 29%) participated at time point 1 (T1: one year into practice), time point 2 (T2: two years into practice, and time point 3 (T3: three years into practice) respectively. Group-based trajectory modeling showed four unique group trajectories for the use of EBP. Over 64% of participants (two trajectories) showed a decline in the use of EBP over time. Fifteen practitioners (7 OTs and 8 PTs) participated in the focus group discussions. Personal and peer experiences, client needs and expectations, and availability of resources were perceived to influence EBP the most. Conclusions: Though a decline in EBP may be concerning, it is unclear if this decline is clinically meaningful and whether professional expertise can offset such declines. Stakeholder-concerted efforts towards the common goal of promoting EBP in education, practice and policy are needed.
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... A more supportive response could be associated with more active participation in training and involvement in the design process as well as being more informed about the implemented concept (see Table 1). This is consistent with other studies assessing the impact of participation (Bartunek et al., 2006) and knowledge (Melas et al., 2012) on responses to change. Seemingly at odds with this finding is that those best informed and most supportive are also critical. ...
Taking open answers seriously: gaining insights into the perilous undercurrent of organizational change
Article
  • Jul 2022
  • J ORGAN CHANGE MANAG
Purpose This study aims to discuss the usefulness of free-text comments to gain insights into participants' opinions about an organizational change project. Design/methodology/approach A secondary analysis of 152 free-text answers to an open question in a questionnaire evaluating the implementation of lean facility design was conducted. Findings The authors identified three categories of responses to change: (1) dismissive – lean unrelated, (2) dismissive – lean related and (3) supporting – lean related. Notably, the large majority of the comments were dismissive by nature and unrelated to lean. Furthermore, critical responses also emanate from the most supportive group (critical friends). Practical implications Quintessential to change management is understanding how those involved perceive the changes. Free-text comments offer an opportunity to gain a view on these perceptions, particularly perceptions that often stay covert whilst having the potential to undermine change initiatives. At the same time, the comments may also be used to capitalize on constructive criticisms. Originality/value This study delivers a unique view on how free comments allow developing a broader understanding of hospital staff's responses to an organizational change initiative and particularly its “undercurrent” that may potentially have significant implications to change processes.
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Instruments measuring evidence-based practice behavior, attitudes, and self-efficacy among healthcare professionals: a systematic review of measurement properties
Article
Full-text available
  • Sep 2023
  • IMPLEMENT SCI
Background Evidence-based practice (EBP) is well known to most healthcare professionals. Implementing EBP in clinical practice is a complex process that can be challenging and slow. Lack of EBP knowledge, skills, attitudes, self-efficacy, and behavior can be essential barriers that should be measured using valid and reliable instruments for the population in question. Results from previous systematic reviews show that information regarding high-quality instruments that measure EBP attitudes, behavior, and self-efficacy in various healthcare disciplines need to be improved. This systematic review aimed to summarize the measurement properties of existing instruments that measure healthcare professionals’ EBP attitudes, behaviors, and self-efficacy. Methods We included studies that reported measurement properties of instruments that measure healthcare professionals’ EBP attitudes, behaviors, and self-efficacy. Medline, Embase, PsycINFO, HaPI, AMED via Ovid, and Cinahl via Ebscohost were searched in October 2020. The search was updated in December 2022. The measurement properties extracted included data on the item development process, content validity, structural validity, internal consistency, reliability, and measurement error. The quality assessment, rating of measurement properties, synthesis, and modified grading of the evidence were conducted in accordance with the COSMIN methodology for systematic reviews. Results Thirty-four instruments that measure healthcare professionals’ EBP attitudes, behaviors or self-efficacy were identified. Seventeen of the 34 were validated in two or more healthcare disciplines. Nurses were most frequently represented ( n = 53). Despite the varying quality of instrument development and content validity studies, most instruments received sufficient ( +) ratings on content validity, with the quality of evidence graded as “very low” in most cases. Structural validity and internal consistency were the measurement properties most often assessed, and reliability and measurement error were most rarely assessed. The quality assessment results and overall rating of these measurement properties varied, but the quality of evidence was generally graded higher for these properties than for content validity. Conclusions Based on the summarized results, the constructs, and the population of interest, several instruments can be recommended for use in various healthcare disciplines. However, future studies should strive to use qualitative methods to further develop existing EBP instruments and involve the target population. Trial registration This review is registered in PROSPERO. CRD42020196009. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020196009
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Evaluation of the New England Office Based Addiction Treatment ECHO: A Tool for Strengthening the Addiction Workforce
Article
  • Jun 2023
  • Subst Abuse
Introduction: Reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. We sought to characterize the program's impact on the knowledge and attitudes of NE OBAT ECHO participants. Methods: We conducted an 18-month prospective evaluation of the NE OBAT ECHO. Participants registered for 1 of 2 successive ECHO clinics. Each 5-month clinic included ten 1.5-hour sessions involving brief didactic lectures and de-identified patient case presentations. Participants completed surveys at Month-0, -6, -12, and -18 to assess attitudes about working with patients who use drugs and evidence based practices (EBPs), stigma toward people who use drugs, and addiction treatment knowledge. We compared outcomes using 2 approaches: (i) between-groups, which involved comparing the first intervention group to the delayed intervention (comparison) group, and (ii) within-groups, which involved comparing outcomes at different time points for all participants. In the within-group approach, each participant acted as their own control. Results: Seventy-six health professionals participated in the NE OBAT ECHO, representing various roles in addiction care teams. Approximately half (47% [36/76]) practiced primary care, internal, or family medicine. The first intervention group reported improved job satisfaction and openness toward EBPs compared to the delayed intervention group. Within-group analyses revealed that ECHO participation was associated with increased positive perceptions of role adequacy, support, legitimacy, and satisfaction 6 months following program completion. No changes were identified in willingness to adopt EBPs or treatment knowledge. Stigma toward people who use drugs was persistent in both groups across time points. Conclusions: NE OBAT ECHO may have improved participants' confidence and satisfaction providing addiction care. ECHO is likely an effective educational tool for expanding the capacity of the addiction workforce.
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Attitudes of Neurologists Toward the Use of Biomarkers in the Diagnosis of Early Alzheimer’s Disease
Article
Full-text available
  • Mar 2023
  • J ALZHEIMERS DIS
Background: Alzheimer's disease (AD) biomarkers reflect key elements of pathophysiology and improve the diagnostic process. However, their use in routine clinical practice is still limited. Objective: We aimed to assess neurologists' barriers and enablers to early AD diagnosis using core AD biomarkers. Methods: We conducted an online study in collaboration with the Spanish Society of Neurology. Neurologists answered a survey exploring their attitudes towards AD diagnosis using biomarkers in mild cognitive impairment (MCI) or mild AD dementia. Multivariate logistic regression analyses were conducted to determine the association between neurologists' characteristics and diagnostic attitudes. Results: We included 188 neurologists with a mean age (SD) of 40.6 (11.3) years, 52.7% male. Most participants had access to AD biomarkers, mainly in cerebrospinal fluid (CSF) (89.9%,#x0025;, n = 169). The majority of participants (95.2%,#x0025;, n = 179) considered CSF biomarkers useful for an etiological diagnosis in MCI. However, 85.6% of respondents (n = 161) used them in less than 60% of their MCI patients in routine clinical practice. Facilitating patients and their families to plan for the future was the most frequent enabler for the use of biomarkers. Short consultation time and practicalities associated with the programming of a lumbar puncture were the most common barriers. A younger neurologist age (p = 0.010) and a higher number of patients managed weekly (p = 0.036) were positively associated with the use of biomarkers. Conclusion: Most neurologists had a favorable attitude to the use of biomarkers, especially in MCI patients. Improvements in resources and consultation time may increase their use in routine clinical practice.
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Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement
Article
Full-text available
  • Apr 1999
Context: Despite wide promulgation, clinical practice guidelines have had limited effect on changing physician behavior. Little is known about the process and factors involved in changing physician practices in response to guidelines. Objective: To review barriers to physician adherence to clinical practice guidelines. Data sources: We searched the MEDLINE, Educational Resources Information Center (ERIC), and HealthSTAR databases (January 1966 to January 1998); bibliographies; textbooks on health behavior or public health; and references supplied by experts to find English-language article titles that describe barriers to guideline adherence. Study selection: Of 5658 articles initially identified, we selected 76 published studies describing at least 1 barrier to adherence to clinical practice guidelines, practice parameters, clinical policies, or national consensus statements. One investigator screened titles to identify candidate articles, then 2 investigators independently reviewed the texts to exclude articles that did not match the criteria. Differences were resolved by consensus with a third investigator. Data extraction: Two investigators organized barriers to adherence into a framework according to their effect on physician knowledge, attitudes, or behavior. This organization was validated by 3 additional investigators. Data synthesis: The 76 articles included 120 different surveys investigating 293 potential barriers to physician guideline adherence, including awareness (n = 46), familiarity(n = 31), agreement (n = 33), self-efficacy (n = 19), outcome expectancy (n = 8), ability to overcome the inertia of previous practice (n = 14), and absence of external barriers to perform recommendations (n = 34). The majority of surveys (70 [58%] of 120) examined only 1 type of barrier. Conclusions: Studies on improving physician guideline adherence may not be generalizable, since barriers in one setting may not be present in another. Our review offers a differential diagnosis for why physicians do not follow practice guidelines, as well as a rational approach toward improving guideline adherence and a framework for future research.
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The Theory of Planned Behavior
Article
Full-text available
  • Dec 1991
Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985, 1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is found to be well supported by empirical evidence. Intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control; and these intentions, together with perceptions of behavioral control, account for considerable variance in actual behavior. Attitudes, subjective norms, and perceived behavioral control are shown to be related to appropriate sets of salient behavioral, normative, and control beliefs about the behavior, but the exact nature of these relations is still uncertain. Expectancy— value formulations are found to be only partly successful in dealing with these relations. Optimal rescaling of expectancy and value measures is offered as a means of dealing with measurement limitations. Finally, inclusion of past behavior in the prediction equation is shown to provide a means of testing the theory*s sufficiency, another issue that remains unresolved. The limited available evidence concerning this question shows that the theory is predicting behavior quite well in comparison to the ceiling imposed by behavioral reliability.
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The Robustness of Test Statistics to Nonnormality and Specification Error in Confirmatory Factor Analysis
Article
  • Mar 1996
  • PSYCHOL METHODS
Monte Carlo computer simulations were used to investigate the performance of three χ2 test statistics in confirmatory factor analysis (CFA). Normal theory maximum likelihood χ2 (ML), Browne's asymptotic distribution free χ2 (ADF), and the Satorra-Bentler rescaled χ2 (SB) were examined under varying conditions of sample size, model specification, and multivariate distribution. For properly specified models, ML and SB showed no evidence of bias under normal distributions across all sample sizes, whereas ADF was biased at all but the largest sample sizes. ML was increasingly overestimated with increasing nonnormality, but both SB (at all sample sizes) and ADF (only at large sample sizes) showed no evidence of bias. For misspecified models, ML was again inflated with increasing nonnormality, but both SB and ADF were underestimated with increasing nonnormality. It appears that the power of the SB and ADF test statistics to detect a model misspecification is attenuated given nonnormally distributed data.
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Common Method Biases in Behavioral Research: A Critical Review of the Literature and Recommended Remedies
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Interest in the problem of method biases has a long history in the behavioral sciences. Despite this, a comprehensive summary of the potential sources of method biases and how to control for them does not exist. Therefore, the purpose of this article is to examine the extent to which method biases influence behavioral research results, identify potential sources of method biases, discuss the cognitive processes through which method biases influence responses to measures, evaluate the many different procedural and statistical techniques that can be used to control method biases, and provide recommendations for how to select appropriate procedural and statistical remedies for different types of research settings.
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David Sackett and the birth of Evidence Based Medicine: How to Practice and Teach EBM
Article
  • Jun 2015
  • Br Med J
Smith has written a most interesting obituary of Dave Sackett, whom I first met in 1995 at his office at the John Radcliffe Hospital in Oxford.1 I was publishing director for Churchill Livingstone and had made the appointment directly with him by email, of which he was a prolific and early user. Sackett sat at a very large screen, talking to …
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Complex Sample Data in Structural Equation Modeling
Article
  • Jan 1995
Large-scale surveys using complex sample designs are frequently carried out by government agencies. The statistical analysis technology available for such data is, however, limited in scope. This study investigates and further develops statistical methods that could be used in software for the analysis of data collected under complex sample designs. First, it identifies several recent methodological lines of inquiry which taken together provide a powerful and general statistical basis for a complex sample, structural equation modeling analysis. Second, it extends some of this research to new situations of interest. A Monte Carlo study that empirically evaluates these techniques on simulated data comparable to those in largescale complex surveys demonstrates that they work well in practice. Due to the generality of the approaches, the methods cover not only continuous normal variables but also continuous non-normal variables and dichotomous variables. Two methods designed to take into account the complex sample structure were investigated in the Monte Carlo study. One method, termed aggregated analysis, computes the usual parameter estimates but adjusts standard errors and goodness-of-fit model testing. The other method, termed disaggregated analysis, includes a new set of parameters reflecting the complex sample structure. Both of the methods worked very well. The conventional method that ignores complex sampling worked poorly, supporting the need for development of special methods for complex survey data.
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