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Understanding Moral Conceptualization through Community Health Activities

Explore the moral concepts and dimensions of community-based health organizations through response theory models. Analyze activities and survey data for insights into patient activation measures and construct validity.

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Understanding Moral Conceptualization through Community Health Activities

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  1. Things I’ve Tried to Measure Remo Ostini Healthy Communities Research Centre University of Queensland Australia

  2. Overview • Community Based Health Organisation Activities • Moral concepts • Using Polytomous Item Response Theory models MEASURED PROGRESS – Jan. 2009: 2 of 18

  3. Community Based Health Organisations • “Self-help” organisations for people with chronic illnesses • Diabetes Australia • Arthritis Queensland • Prospective survey, two time periods, 4 months apart • PS1 N=323; PS2 N=306 respondents surveyed again MEASURED PROGRESS – Jan. 2009: 3 of 18

  4. CBO Activities Asked nine questions at both surveys: • Member of CBO? • Estimate times phoned CBO • Estimate times read newsletter or printed info • Estimate times in seminar, workshop, info session • Estimate times talked with other CBO members • Estimate times attend CBO support group or social outing • Estimate times volunteer with CBO • Estimate times counselling, exercise, discount products • Estimate times used CBO info raise others' awareness • Dimensionality? MEASURED PROGRESS – Jan. 2009: 4 of 18

  5. CBO Activities • Factor analysis suggested 1 or two factors • Theory supported 2-factor structure • Factor I: High intensity activities • Factor II: Low intensity activities • Qualitatively different, stage-like relationship MEASURED PROGRESS – Jan. 2009: 5 of 18

  6. Rotated Factor Matrix Factor 1: High Intensity Activities; Factor 2: Low Intensity Activities MEASURED PROGRESS – Jan. 2009: 6 of 18

  7. IRT Results – Scaled together • Model • Partial Credit model • Results • All items together (assume one dimension); both time periods (9 + 10 items) -- 5 items with poor fit (< 0.001) MEASURED PROGRESS – Jan. 2009: 7 of 18

  8. IRT Results – Scaled separately • Results • Low Intensity Activity items both time periods - 2 items with poor fit • Low Intensity Activity items PS1 - 2 items with poor fit • No High Intensity Activity items with poor fit (at both times or PS1) • Really just want q for further analyses MEASURED PROGRESS – Jan. 2009: 8 of 18

  9. Comparing Organisations • Mean q across activities and time periods • Diabetes Aus and Arthritis QLD significantly different on low intensity activities MEASURED PROGRESS – Jan. 2009: 9 of 18

  10. Predicting PAM PAM = Patient Activation Measure; a self-report measure of patient confidence in managing their own health MEASURED PROGRESS – Jan. 2009: 10 of 18

  11. Moral Conceptualization • Initial question: What is morality? • Lots of answers. Who knows? Everyone! • So ask them… MEASURED PROGRESS – Jan. 2009: 11 of 18

  12. Moral Conceptualization - Background • 20 Interviews – talkative people • 1269 statements – some (~ half) redundant • 4 × 150 item questionnaires - MCS • 5-point Likert scale (1 – Nothing like what you think; 5 – Exactly what you think) MEASURED PROGRESS – Jan. 2009: 12 of 18

  13. Moral Conceptualization - Background • Example statements: • Caring about others is the dominant feature of a good person • Everyone is born good • Evil does exist and people can do it • The boundaries between right and wrong are defined by social custom • What aspects of morality does the questionnaires cover? MEASURED PROGRESS – Jan. 2009: 13 of 18

  14. Moral Conceptualization Structural Analysis • Data Screening – bound to be noise • Four linear analyses: • Principal Components Analysis • Factor Analysis • Multidimensional Scaling • Cluster Analysis • One non-linear analysis • Mokken scaling analysis – nonparametric IRT with h test for dimensionality assessment • 10-14 factors MEASURED PROGRESS – Jan. 2009: 14 of 18

  15. Moral Conceptualization Structural Analysis • Types of Factors • Life definition • Relativism • Responsibility • Socially defined morality • Conscience • Tolerance MEASURED PROGRESS – Jan. 2009: 15 of 18

  16. Moral Conceptualization Item Analysis • Item-total correlations < 0.20 • Serious skew (some items still useful?) IRT for Item analysis • Partial Credit Model • Reversed boundaries • Evidence of a problem? • Item model fit • p <0.001 • Too soon for information? MEASURED PROGRESS – Jan. 2009: 16 of 18

  17. Moral Conceptualization Construct Validity • Concurrent validity • Personality (Agreeableness & Conscientiousness related to Relativism) • Internal State Awareness – multiple MCS • Liberalism & Conservatism – some MCS • Multiple Social Values – multiple MCS • Not Emotional Intelligence; Empathy; Guilt; Religion • Predictive validity • Predicting moral judgements? MEASURED PROGRESS – Jan. 2009: 17 of 18

  18. Moral Conceptualization Construct Validity • Next? • Reduced number of questionnaires with best items from first four • More sophisticated test development, scoring and validation… MEASURED PROGRESS – Jan. 2009: 18 of 18

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