Original Article

Checking the Validity and Reliability of the Delirium-O-Meter Questionnaire in the Persian Language

Abstract

Objective: Compiling and designing short and practical psychometric tools are among the benefits and strengths of a good standard test. The Delirium-O-Meter questionnaire measures patients' delirium status. Accordingly, the main aim of this research was to check the reliability and validity of the Persian version of this questionnaire.

Method: This exploratory psychometric study was conducted from 2021 to 2022 at the therapeutic research training centers of Tabriz University of Medical Sciences. The study population included patients diagnosed with delirium. Content and construct validity were assessed using exploratory factor analysis and confirmatory factor analysis. Exploratory factor analysis was performed using SPSS 18, which helped identify the underlying factor structure, while confirmatory factor analysis in Smart PLS was employed to confirm the structure's fit. Pearson correlation was used to evaluate the consistency between different raters, and Cronbach's alpha was calculated to assess internal consistency. These methods were selected for their robustness in evaluating the instrument's psychometric properties, ensuring the reliability and validity of the Persian version of the Delirium-O-Meter questionnaire.

Results: The Persian version of the Delirium-O-Meter questionnaire, consisting of 11 items, demonstrated strong psychometric properties. The average impact factor was 3.24, indicating a high relevance of the items. The content validity ratio was 0.78, and the content validity index was 0.87, both above the acceptable thresholds, confirming the content validity of the questionnaire. Cronbach's alpha coefficient for the entire questionnaire was 0.77, reflecting good internal consistency. The Kaiser-Meyer-Olkin index was 0.88, and Bartlett's sphericity test was significant (χ² = 278.45, P < 0.001), indicating the appropriateness of the data for factor analysis. Exploratory factor analysis revealed two factors that explained 76.09% of the total variance, supporting the questionnaire's construct validity. Additionally, Pearson’s correlation coefficient between the assessments of two nurses was 0.91, signifying inter-rater solid reliability.

Conclusion: The Persian version of the Delirium-O-Meter questionnaire demonstrates acceptable reliability and validity, as confirmed by the comprehensive psychometric evaluation conducted in this study. The strong internal consistency, significant content and construct validity, and high inter-rater reliability underscore its effectiveness in assessing delirium in Persian-speaking patients. These findings highlight the questionnaire's suitability for clinical use, providing a reliable and valid instrument for accurately diagnosing and managing delirium in diverse healthcare settings.

1. Guenther U, Weykam J, Andorfer U, Theuerkauf N, Popp J, Ely EW, et al. Implications of objective vs subjective delirium assessment in surgical intensive care patients. Am J Crit Care. 2012;21(1):e12-20.
2. Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, et al. Delirium. Nat Rev Dis Primers. 2020;6(1):90.
3. Bryczkowski SB, Lopreiato MC, Yonclas PP, Sacca JJ, Mosenthal AC. Risk factors for delirium in older trauma patients admitted to the surgical intensive care unit. J Trauma Acute Care Surg. 2014;77(6):944-51.
4. Maldonado JR. Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatry. 2018;33(11):1428-57.
5. Ginty AT. Psychometric properties. Encyclopedia of behavioral medicine: Springer; 2020. p. 1770-1.
6. Glynn K, McKenna F, Lally K, O'Donnell M, Grover S, Chakrabarti S, et al. How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients. BMJ Open. 2021;11(4):e041214.
7. Kim H, Chung S, Joo YH, Lee JS. The major risk factors for delirium in a clinical setting. Neuropsychiatr Dis Treat. 2016;12:1787-93.
8. Nallusamy S. Organ donation–current indian scenario. Journal of the Practice of Cardiovascular Sciences. 2018;4(3):177-9.
9. Jannati Y, Sohrabi M, Bagheri-Nesami M. Delirium and its diagnostic tools: a new approach to nursing. Clinical Excellence. 2013;1(2):85-96.
10. Camus V, Burtin B, Simeone I, Schwed P, Gonthier R, Dubos G. Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium. Int J Geriatr Psychiatry. 2000;15(4):313-6.
11. Hasemann W, Tolson D, Godwin J, Spirig R, Frei IA, Kressig RW. Nurses' Recognition of Hospitalized Older Patients With Delirium and Cognitive Impairment Using the Delirium Observation Screening Scale: A Prospective Comparison Study. J Gerontol Nurs. 2018;44(12):35-43.
12. Andrew MK, Freter SH, Rockwood K. Prevalence and outcomes of delirium in community and non-acute care settings in people without dementia: a report from the Canadian Study of Health and Aging. BMC Med. 2006;4:15.
13. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-22.
14. Torshizi M, Hekmatpou D, Sharbafchi MR, Afshar H, Ayati MM. Reliability and validity of the persian version of intensive care delirium screening checklist in detection of delirium in intensive care units. Journal of Isfahan Medical School. 2016;34(383):536-46.
15. Gibb K, Seeley A, Quinn T, Siddiqi N, Shenkin S, Rockwood K, et al. The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study. Age Ageing. 2020;49(3):352-60.
16. Greaves D, Psaltis PJ, Ross TJ, Davis D, Smith AE, Boord MS, et al. Cognitive outcomes following coronary artery bypass grafting: A systematic review and meta-analysis of 91,829 patients. Int J Cardiol. 2019;289:43-9.
17. Watt CL, Momoli F, Ansari MT, Sikora L, Bush SH, Hosie A, et al. The incidence and prevalence of delirium across palliative care settings: A systematic review. Palliat Med. 2019;33(8):865-77.
18. Asadollahi A, Saberi M, Entezari M, Hoseini Z, Hasani SA, Saberi LF, et al. Iranian version of 4AT, an instrument for rapid delirium screening for later life. Int J Adv Appl Sci. 2016;3:33-8.
19. Navaeifar MR, Abbaskhanian A, Shahbaznejad L, Khoshkam M. Translation, adaptation and validity assessment of the Cornell assessment of pediatric delirium scale in Persian language. Journal of Mazandaran University of Medical Sciences. 2019;29(178):75-84.
20. de Jonghe JF, Kalisvaart KJ, Timmers JF, Kat MG, Jackson JC. Delirium-O-Meter: a nurses' rating scale for monitoring delirium severity in geriatric patients. Int J Geriatr Psychiatry. 2005;20(12):1158-66.
21. Kotfis K, Szylińska A, Listewnik M, Brykczyński M, Ely EW, Rotter I. Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study. Neuropsychiatr Dis Treat. 2019;15:511-21.
22. Vreeswijk R, Timmers JF, De Jonghe JF, Kalisvaart KJ. Assessment scales for delirium. Aging Health. 2009;5(3):409-25.
23. van Velthuijsen EL, Zwakhalen SM, Warnier RM, Mulder WJ, Verhey FR, Kempen GI. Psychometric properties and feasibility of instruments for the detection of delirium in older hospitalized patients: a systematic review. Int J Geriatr Psychiatry. 2016;31(9):974-89.
24. DeVellis RF, Thorpe CT. Scale development: Theory and applications: Sage publications; 2021.
25. Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics: pearson Boston, MA; 2013.
26. Adamis D, Meagher D, Rooney S, Mulligan O, McCarthy G. A comparison of outcomes according to different diagnostic systems for delirium (DSM-5, DSM-IV, CAM, and DRS-R98). Int Psychogeriatr. 2018;30(4):591-6.
27. Lawshe C. A Quantitative Approach to Content Validity. Personnel psychology/Berrett-Koehler Publishers. 1975.
28. Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological assessment. 1994;6(4):284.
29. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. The impact of different diagnostic criteria on prevalence rates for delirium. Dement Geriatr Cogn Disord. 2003;16(3):156-62.
30. Whitby J, Nitchingham A, Caplan G, Davis D, Tsui A. Persistent delirium in older hospital patients: an updated systematic review and meta-analysis. Delirium (Bielef). 2022;1:36822.
31. Tsui A, Searle SD, Bowden H, Hoffmann K, Hornby J, Goslett A, et al. The effect of baseline cognition and delirium on long-term cognitive impairment and mortality: a prospective population-based study. Lancet Healthy Longev. 2022;3(4):e232-e41.
32. Pisani MA, D'Ambrosio C. Sleep and Delirium in Adults Who Are Critically Ill: A Contemporary Review. Chest. 2020;157(4):977-84.
Files
IssueVol 19 No 4 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v19i4.16554
Keywords
Delirium Diagnosis Factor Analysis Questionnaire Validity and Reliability
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Naghdi Sadeh R, Ghafarifar S, Ghaemmaghami M, Parchehbaf Mohseni MH. Checking the Validity and Reliability of the Delirium-O-Meter Questionnaire in the Persian Language. Iran J Psychiatry. 2024;19(4):412-423.