Part 1:
1.Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
Paradies YC, Cunningham J. Development and validation of the Measure of Indigenous Racism Experiences (MIRE). International Journal for Equity in Health. 2008;7:9. doi:10.1186/1475-9276-7-9.
2.What was the definition of the construct?
The Measure of Indigenous Racism Experiences (MIRE) is a 31-item questionnaire to assess self-reported racism across a range of dimensions for Indigenous people (Australian Aboriginal and/or Torres Strait Islander people).
3.How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
The draft instrument was developed based on a review of existing measures, the input from an initial focus group, and review from experts in the field and a range of Indigenous researchers. The content validity was then assessed in two focus groups with Indigenous people (different from the initial focus group) made up of working professionals and undergraduate students living in Darwin, Australia.
The authors assessed construct validity through cross-tabs and chi-squared tests to assess inter-item and inter-scale associations.
It is interesting to note that in the conclusion sections, the authors state “it should be noted that this research was not specifically designed to assess the validity of this instrument and hence the findings are opportunistic in nature.” And then a few paragraphs later, refer to this as a “validity study [that] has shown that each component of the MIRE has its own internal validity.”
Given that this construct was developed building off of other existing instruments, it seems as though the validity would be as strong as the similarities between the experiences of racism in different groups. However, in order to customize this for Indigenous people more broadly, it may have been useful to conduct validation with a broader set of people, for example: working class people, those not living in a major city, and those living in primarily Indigenous communities.
4.How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
There is no mention of testing the reliability of the MIRE in this paper as it describes only a single use of the measure. However, the authors assessed convergent validity by comparing responses to an item about experiencing discrimination asked in a different part of the larger study questionnaire in which the MIRE was implemented. This seems like it measures a degree of internal consistency.
It would be important to do some test-re-testing in order to see if individuals answer the questions consistently over time. As this construct isn’t meant to measure experiences in a set timeframe, the responses at two time periods should be very similar.
5.Describe the implications of a lack of measurement validity or reliability for future research applications.
It is important to increase measurement validity and reliability in order to decrease non-random measurement error and ensure the integrity of a study. Given the lack of evidence of reliability and limited evidence around validity, the MIRE requires more investigation before it can be considered a sound construct for assessing self-reported racism for Indigenous people.
Part 2:
1.Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
Fotso, J. C., Ezeh, A., & Oronje, R. (2008). Provision and use of maternal health services among urban poor women in Kenya: what do we know and what can we do?. Journal of Urban Health, 85(3), 428-442.
2.Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
The two outcomes measured were the frequency (1, 2 to 3, or 4 or more visits) and timing (initiating in the 1st, 2nd or 3rd trimester of pregnancy) of antenatal care among women residing in Korogocho and Viwandani (two Nairobi slums) to other Kenya population sub-groups: Nairobi as a whole, urban Kenya and rural Kenya. Data for the slum areas was collected through a demographic surveillance system (DSS) survey, which included a questionnaire administered to 1,927 women and a health facility survey of the 25 facilities within and outside the slum areas where women from Korogocho and Viwandani go to delivery their children.
This was compared to data from the Kenya DHS survey results for other population sub-groups. It was further broken down to look at differences by household wealth, education and parity.
3.What is the evidence for the validity and reliability of the measures?
None is provided.
4.What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
No measures of association were calculated using a reference category. Only descriptive statistics were used. Given that the purpose of the paper is to provide evidence that the urban poor are as or worse off than the rural poor, it may not have been of interest to do more, however, it might be interesting to use urban wealthy as the reference group. One thing that might be challenging is that the urban wealthy often also have rural residences and the most wealthy don’t get health care in Kenya at all.
5.How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
The disparity is not quantified, but presented in the % of respondents in each stratum. Given that the size of the sub-populations are changing as people move from rural to urban areas, I would prefer to see absolute measures and the changing size of the sub-populations.
Part 3:
1. Read someone else's response to part 1 above (identifying a construct) and comment, specifically noting whether you can see any additional implications of measurement quality for future research or whether you agree with those noted by your classmate.
TBD