need to develop an appropriate self-efficacy scale before conducting the study. Other examples of theory-based constructs that require behavior-specific instruments include outcome expectations (social cognitive theory); stages of change (transtheoretical model); and perceived susceptibility, barriers, and benefits (health belief model).
A second possible reason for developing a new measure is that the existing mea- sure of the concept is inappropriate for the intended population. For example, several measures of social support for adults exist. However, if a researcher wanted to measure social support among children and no scale existed, he or she would have to modify one developed for adults or create a new one.
Researchers need to be aware that some theoretical concepts are not amenable to measurement. A common example of a nonmeasurable concept comes from Freud’s psychoanalytic theory. Because of their psychodynamic nature, the ego, id, and super- ego are not amenable to self-report measures. Likewise, though death might be a vari- able in some situations (for example, resuscitated, brain-dead), the afterlife is not amenable to measurement.
A researcher who accepts the challenge of developing a new measure must first select the concept and then conduct a concept analysis. The concept analysis allows the researcher to develop a solid understanding of the concept and the ways in which people use and interpret the concept. Only after the completion of the concept analy- sis, the clarification of the theoretical definition, and the statement of the variable should the researcher begin to write items. Because of the importance of concept analysis to the scale development process, we will devote the remainder of this chap- ter to a discussion of concept analysis. In Chapter Seven, we will discuss item writing.
interviews with people familiar with the concept, and personal experience. As we conduct the analysis, we record definitions, uses, measurements, contexts, and case examples.
The analysis usually begins with a literature review that identifies both theory and research that incorporate the concept. If the concept is embedded within a theory, the researcher conducts a careful examination of the theorist’s writings, the defini- tion, the use of the concept, and the context in which it is used. If more than one the- ory includes the concept, the researcher compares the theories, examining the meanings of the concept and its use by the theorists. The investigator also searches for studies in which the concept has been investigated. Here, it is important to learn how researchers have defined and measured the concept and how they have interpreted the results of the study. For example, more than one theory and definition exist to explain the con- cept of social support. Weiss (1974), for example, identified six provisions in his the- ory of social relationships. According to that theory, these six provisions—guidance, reliable alliance, reassurance of worth, attachment, social integration, and opportunity for nurturance—reflect what people receive from relationships with others. The six pro- visions were used to guide the development of the Personal Resource Questionnaire, a measure of social support (Weinert, 2003). Tilden, Nelson, and May (1990), on the other hand, have developed the Interpersonal Relationship Inventory (IPR Inventory), basing their definition of social support on social exchange and equity theories. The premise of these theories is that interactions among people are influenced by power re- lationships and efforts to achieve balance in relationships (Emerson, 1976).
Identify definitions and uses of the
concept
Identify antecedents and consequences of
the concept Identify similar and
different concepts
Identify critical attributes
Identify dimensions of the concept
Write a model case
FIGURE 6.5. STEPS IN CONDUCTING A CONCEPT ANALYSIS.
The review can also include other literature and media in which the concept appears. For example, we can use a dictionary to determine the common usage of terms, and media such as poetry, stories, art, and song to examine the portrayal of a concept.
Another approach to gathering information about a concept and its use is con- ducting interviews with individuals who are familiar with the concept. Investigators may conduct these interviews with individuals (that is, in unstructured or semistructured in- terviews) or with groups (that is, in focus groups). The purpose of the interview is to ob- tain information about how respondents define or understand the concept, how people use the concept, what terms they use in reference to the concept, and the context of the concept’s use. Moreover, interviews help identify a greater number of contexts or sit- uations in which the concept is used and verify or refute the use of the concept as presented in the literature and media. In addition, the researcher can call on personal experience with the concept to augment the literature review and the interviews.
Researchers might be in a position to observe the concept in research, teaching, or clin- ical venues, and their experience can be brought to bear on the concept analysis.
Matt, as we mentioned at the beginning of this chapter, is interested in developing a scale to measure the degree to which one expects positive outcomes associated with eating a healthy diet (OE for healthy eating). We can use his example to demonstrate the concept analysis process. In reviewing the literature, Matt finds that Bandura (1997, p. 21) coined the term outcome expectations to refer to a person’s judgment about the likely consequences of performing a specific behavior. Bandura also observed that researchers generally measure OE by first creating a set of outcomes associated with a particular behavior and then asking individuals to rate the degree to which they agree (or disagree) that a given outcome would occur if they performed the behavior. Behaviors for which OE scales have been developed include mathematical ability, career planning, chronic disease management, and sports performance. In a review of general media, including magazines, Web sites, and newspaper articles, Matt discovered that people tend to talk about outcomes associated with behaviors in everyday conversation, though they are unlikely to use the term outcome expectations.
Identify Critical Attributes of the Concept
To further refine the understanding of the concept, the next step in the concept analy- sis process is to identify the critical attributes of the concept. We scrutinize informa- tion gained from literature and media reviews, interviews with people familiar with the concept, and personal experience to isolate critical attributes. The review of the uses and definitions of the concept is likely to generate a list of characteristics that de- fine the concept and help differentiate it from others. For example, critical attributes for the concept of OE might be anticipatory, probabilistic, and behavior-specific.
Identify Dimensions of the Concept
In the exploration of the meaning of the concept and its use in the scientific literature, the researcher also identifies any dimension of the concept and labels it important. If the concept is embedded within a theory, the theorist often identifies dimensions of the con- cept. Some concepts are unidimensional (having only one dimension), whereas others are multidimensional (including more than one aspect). Although all aspects, or di- mensions, refer to the overarching concept, each aspect is slightly different. For exam- ple, Fitts (1965), in his discussion of self-concept, noted five dimensions: physical, moral, personal, family, and social. An instrument developed to measure self-concept using his definition would likely include items to measure these five different aspects.
Matt has observed that Bandura (1997) identified three dimensions of OE: (1) self- evaluative, (2) social, and (3) physical OE. If we talk about OE related to running a marathon, self-evaluative OE might include feeling proud of one’s accomplishment;
social OE might include accolades from friends and family; and physical OE might include the prospect of dehydration, sore muscles, and a leaner body. In regard to OE for healthy eating, people might expect that they would feel that they were doing the right thing for their health, that their doctors would approve of their diet, and that their cholesterol levels would remain low.
Identify Similar and Different Concepts
One of the goals of the concept analysis process is to identify concepts that are simi- lar in meaning to the chosen concept and those that are different from it. An evalua- tion of the attributes that make the concepts similar but slightly different advances the researcher’s understanding of the concept and helps him or her clarify the meaning of the concept before writing items to measure it. Similar concepts are those that pos- sess some but not all of the attributes of the chosen concept; different concepts are those that possess none of its attributes. Comparing and contrasting the meanings of similar, related, and different concepts help the researcher to further understand how the chosen concepts fit within a group of concepts.
A concept similar to that of OE is subjective norms, a concept within the theory of planned behavior. Fishbein and Ajzen (1975) define subjective norms as people’s per- ceptions of the social pressure related to performing or not performing a behavior. As we have learned, OE has a social component, defined as the outcomes one would expect for others if the behavior were performed. An item such as “If I ate a healthy diet, my doctor would approve” could function as an OE item because it reflects the critical attributes of OE. It is behavior-specific, anticipatory, and probabilistic. The item
“My doctor thinks I should eat a healthy diet” can be classified as a subjective-norm item, but not as an OE item. This latter statement is a perception of the opinion of
another, but not a perceived outcome of a behavior. Benefits and barriers—concepts within the health belief model—are also similar to the concept of OE. Both are behavior-specific. However, though some benefits and barriers might be outcomes of performing a behavior, there is no requirement that all benefits and barriers be related to outcomes, a condition of OE.
Concepts that possess none of the critical attributes associated with OE might in- clude depression, fame, and stigma.
Identify Antecedents and Consequences of the Concept
We can identify the antecedents and consequences of the selected concept by review- ing the literature and through discussions with others. Antecedents are events, actions, processes, cognitions, or feelings that occur before the expression of the concept. In the case of OE, Bandura (1997) notes that there are four primary sources of efficacy information, which in turn influence one’s expectations of outcomes associated with a behavior. The four sources of efficacy information are enactment of the behavior, vicarious learning, verbal persuasion, and physical or affective states related to the per- formance. For example, surrounding oneself with others who eat well can increase one’s chances of developing positive expectations about healthy eating. Consequences are those events, actions, processes, cognitions, or feelings that follow the expression of the concept. A person who expects positive outcomes to be associated with main- taining a healthy diet is likely to be successful in altering his or her eating habits to achieve this goal despite previous failed attempts. These positive feelings about a healthy diet are likely to motivate the person to eat well and perhaps to spark an in- terest in looking for low-fat recipes. In contrast, a person who expects that it will be difficult to maintain a diet low in fat and high in fruits and vegetables might struggle to change his or her eating habits, give up quickly, and fail to achieve the goal.
Write a Model Case
The final step in the concept analysis process is to write an exemplar that demonstrates the critical attributes of the concept. Below is a model case that Matt wrote for the concept of OE for healthy eating.
Mary is a seventy-eight-year-old woman who is in reasonably good health. She has hypertension, controlled by daily medications, and arthritis in her knees and hips.
She has no other health problems, but is about 20 pounds overweight. She walks every day and goes to the gym three or four times per week. Here she uses the treadmill, lifts weights, and uses the weight machines for upper-body strength. She lives alone and does not always eat as well as she should. Some of her dinners consist of snacking on high-fat foods. She believes that if she changed her diet by lowering her fat intake
and increasing the number of fruits and vegetables that she eats every day, she would lose some weight and her knees would not hurt as much when she walks. She also thinks that she could lower her blood pressure and not have to take an extra water pill every three days. Her children have encouraged her to eat better, and she knows that they would approve of her changing her diet. She also believes that a diet change is what she needs to do for her health. In making changes in her diet, Mary is aware that her expectations of these positive outcomes will keep her motivated to continue de- spite the fact that it will take some extra effort to prepare wholesome meals.
State the Variables
Following the concept analysis, it is important to state a concept in the form of a vari- able before beginning the item-writing process. Although we all know that a variable is a concept or construct that takes on different values for different people under the same conditions (that is, it varies), a more precise definition that is useful in making relational statements is, “A variable is a set of values, only to one of which can an object ever be assigned at any one time” (Mulaik, 2004, page 428). For example, the values of a marital status variable might be never married, married, divorced, separated, and widowed. A person can be assigned to only one of these values at any one time.
Mulaik (2004) notes that constructs such as self-efficacy, locus of control, self- concept, patient satisfaction, and quality of life as stated are not variables because it is not evident from these terms what varies. To create variables from these and similar constructs, a researcher must understand what quantity is being measured. A precisely defined variable is stated in terms of quantities such as “degrees to which,” “frequency with which,” and “amount to which” (Mulaik, 2004). Moreover, variables are unidi- mensional in that they vary on only one attribute.
For example, as stated, the concept patient satisfaction does not give us a clue as to what precisely is being measured. Is the researcher interested in how much the patient is satisfied with his or her care? How often patients are satisfied with care? The degree to which the patient is satisfied with access to care, communication with the doctor, nursing care, or cost of care? The concept analysis process helps the researcher un- derstand the meaning of the concept, and the statement of the concept in terms of a variable clarifies precisely what is being measured.
Summary
As can be seen from the discussion in this chapter, a carefully conducted concept analy- sis will provide health educators and behavioral scientists with a thorough understand- ing of concepts that they seek to measure. The task of writing items for scales becomes
much easier when the scale developer, before attempting to write items, thoroughly un- derstands the concept and how it is the same as and different from other concepts.
Knowing the subtle differences that distinguish concepts facilitates more efficient item writing and will save the researcher considerable work in the assessment of reliability and validity, which we will discuss in Chapters Nine, Ten, and Eleven. In this chapter, we have presented only a summary of the concept analysis process. Readers who are developing scales may desire more information. They are encouraged to read Chinn and Kramer (1995), Walker and Avant (1988), and Wilson (1970).
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LEARNING OBJECTIVES
At the end of this chapter, the student should be able to 1. Identify the steps in the item development process.
2. Create a matrix for writing scale items.
3. List three ways to obtain information for writing items.
4. Identify three issues associated with item writing for summated rating scales.