static-content.springer.com10.1007/s104… · Web viewSupplementary Material for Online Publication Only. Appendix S1: Elluam Tungiinun/Yupiucimta Asvairtuumallerkaa Measurement

Running Head: APPENDIX S1: MEASUREMENT DEVELOPMENT PROCEDURES 1

Supplementary Material for Online Publication Only

Appendix S1: Elluam Tungiinun/Yupiucimta Asvairtuumallerkaa Measurement Development

Procedures

James Allen

University of Minnesota Medical School, Duluth Campus and University of Alaska Fairbanks

David Henry

University of Illinois at Chicago

People Awakening Team

University of Alaska Fairbanks

Author Note

James Allen, Department of Biobehavioral Health & Population Sciences, University of

Minnesota Medical School, Duluth Campus and Center for Alaska Native Health Research,

University of Alaska Fairbanks. This research was funded by the National Institute of Alcohol

Abuse and Alcoholism and the National Center for Minority Health Disparities [R21 AA016098-

01, RO1AA11446; R21AA016098; R24 MD001626]. We also want to thank all of the People

Awakening Team including participants, community co-researchers, our Coordinating Council

and our project staff for their assistance in completing this research. The People Awakening (PA)

Team includes the Yupiucimta Asvairtuumallerkaa Councils, the Ellangneq Councils, the Yup’ik

Regional Coordinating Council, the Ellangneq Advisory Group, and the Ellangneq, Yupiucimta

Asvairtuumallerkaa, and Cuqyun Project Staff. The Yupiucimta Asvairtuumallerkaa Councils

included Sophie Agimuk, Harry Asuluk, Thomas Asuluk, T.J. Bentley, John Carl, Mary Carl,

Emily Chagluk, James Charlie, Sr., Lizzie Chimiugak, Ruth Jimmie, Jolene John, Paul John,

APPENDIX S1: MEASUREMENT DEVELOPMENT PROCEDURES 2

Simeon John, Aaron Moses, Phillip Moses, Harry Tulik, and Cecelia White. The Ellangneq

Councils includes Catherine Agayar, Fred Augustine, Mary Augustine, Paula Ayunerak, Theresa

Damian, Lawrence Edmund, Sr., Barbara Joe, Lucy Joseph, Joe Joseph, Placide Joseph, Zacheus

Paul, Charlotte Phillp, Henry Phillip, Joe Phillip, Penny Alstrom, Fred Augustine, Mary

Augustine, Paula Ayunerak, Theresa Damian, Shelby Edmund, Flora Patrick, Dennis Sheldon,

Isidore Shelton, Catherine Agayar, Theresa Damian, Freddie Edmund, Shelby Edmund, Josie

Edmund, and Flora Patrick. The Yup’ik Regional Coordinating Council includes Martha Simon,

Moses Tulim, Ed Adams, Tammy Aguchak, Paula Ayunerak, Sebastian Cowboy, Lawrence

Edmunds, Margaret Harpak, Charles Moses, Raymond Oney. The Ellangneq Advisory Group

includes Walkie Charles, Richard Katz, Mary Sexton, Lisa Rey Thomas, Beti Thompson, and

Edison Trickett. The Ellangneq Project Staff includes Debbie Alstrom, Carl Blackhurst, Rebekah

Burkett, Diana Campbell, Arthur Chikigak, Gunnar Ebbesson, Aaron Fortner, John Gonzalez,

Scarlett Hopkins, Nick Hubalik, Joseph Klejka, Charles Moses, Dora Nicholai, Eliza Orr, Marvin

Paul, Michelle Dondanville, Jonghan Kim, Rebecca Koskela, Johanna Herron, and Stacy

Rasmus. Cuqyun also acknowledges the invaluable contributions of James A. Walsh.

Correspondence concerning this article should be addressed to James Allen, Department

of Biobehavioral Health and Population Sciences, University of Minnesota Medical

School, Duluth Campus, 231 SMed, 1035 University Drive, Duluth, MN 55812-3031.

Email: [email protected].


Abstract

Measurement development procedures for the Elluam Tungiinun and the Yupiucimta

Asvairtuumallerkaa projects are described. An engaged approach in collaborative measurement

development was an integral part of this Project, which was a prevention research program that

sought to promote protective factors against alcohol abuse and suicide in Yup’ik Alaska Native

youth and families. The goals of measurement development were to identify culturally and

contextually relevant constructs, then develop, adapt, and refine culturally and contextually

appropriate measurement strategies and measures. Broader goals included construct elaboration

and enhanced community engagement and ownership in the research process through the

collaborative process. We found the process of culturally appropriate measurement development

in a community based participatory research (CBPR) paradigm should include the communities

in the selection of measurement constructs, methods of measurement, and development of

measures.

Keywords: American Indian and Alaska Native; community based participatory research;

measurement development; suicide, suicide prevention; alcohol; alcohol abuse prevention


Appendix S1: Elluam Tungiinun/Yupiucimta Asvairtuumallerkaa Measurement Development

Procedures

We report here on the measurement development procedures for the Elluam Tungiinun

(ET) and Yupiucimta Asvairtuumallerkaa (YA) projects. Our goal is to describe procedures

within a community engaged perspective on measurement development for intervention

research. We believe the approach is valuable as part of all community intervention work, and

particularly important to work in culturally distinct contexts. The ET and YA projects are

multilevel cultural interventions directed towards the prevention of suicide and alcohol abuse

among rural Yup’ik Alaska Native youth (Allen, Mohatt, Beehler, and Rowe, this issue; Rasmus

et al. this issue). The measures that are the focus of the development activity described here

were developed to serve as outcome measures as part of the Cuqyun (measuring) project. Cuqyun

was a measurement development project that ultimately provided initial validity evidence for

these outcome measures and tested the theoretical model for intervention (Allen, Mohatt, Fok,

Henry, and Burkett, this issue). Gonzalez and Trickett (this issue) provide more detailed

description on these process issues in collaborative measurement development with communities

as partners, including some of the ethical, scientific, and process issues that emerge when doing

this work, difficulties and dilemmas that can emerge in this process, and how partners can

respond to them. The focus of the current paper is detailed description of more technical aspects

associated with the process and content issues described in Gonzalez and Trickett that arose in

the collaborative adaptation and development of culturally relevant measures.

The procedures we will describe respond to issues that arise in cross-cultural

measurement development work (Allen & Walsh, 2000). These include such topics as construct

equivalence, the functional equivalence of behavior expressed in items, the contextual relevance


of item content, the indeterminacy of meaning arising with certain concepts, words, and even

semantic constructions, such as within negative wording among reverse keyed items, and subtle

issues in linguistic equivalence, including local variations in English language dialect and usage.

They also include a number of additional culture specific issues arising in work with the Yup’ik

cultural group. Some of these Yup’ik culture specific considerations include nuances in the

features and styles of categorical thinking within the culture and important cultural rules that

govern description and evaluation of experience, and in particular, the description and evaluation

of the personal experience of others. Other culture specific issues include response style

characteristics within the culture, where local interpretations of the semantic meaning of ratings

interact with the proportional significances of anchor points in scaling created through response

alternatives for items. A final overriding issue includes questions about the cultural

inappropriateness of asking direct questions, numerous questions, repeated questioning.

We also seek to convey detailed information describing some aspects of the process of

this work as these issues unfolded. In many ways, this process can be understood as involving a

negotiation that occurred within a mode of discourse that was culturally patterned. We wish to

convey the importance of our efforts in molding our work to these Yup’ik patterns of discourse,

and their implications for work with other cultural groups. We also wish to convey that through

this process of negotiation about measurement and measures, researcher and community partners

navigated deeper waters to achieve some element of shared understanding, and underlying issues

surfaced of important significance to the larger project. Through our experience, we came to

appreciate how measurement development in an intervention project with indigenous, and by

extension, with other culturally distinct groups, can serve as a flashpoint, where different values,

worldviews, and meaning systems associated with two cultural knowledge systems converge.


One knowledge system is embedded in the culture of the community. In the current case, this

involved the cultures of two Yup’ik communities, which both possessed a deep and rich local

indigenous knowledge system, along with additional more local knowledge and customs that

were unique to each community. The other system is based in the culture of intervention science,

and embraces the cannons of Western science. Much of the work we describe here involves a

negotiation between these knowledge systems.

We believe cross-cultural measurement issues inevitably arise in community intervention

research with nonwestern cultural groups. The resulting dilemmas provide a nexus wherein two

at times discordant worldviews and epistemologies can converge through negotiated solutions.

What becomes critical is the manner in which this negotiation occurs, and that these negotiations

are open, transparent, and honest. For this reason, CBPR approaches applied to the measurement

development process introduce a potential for new voices and perspectives that were formerly

excluded to engage in this process. Inclusion of voice that is aligned with community knowledge

and concerns can lessen the extent to which the research process can become colonizing.

Context and Measurement Development

Context largely determined our measurement development procedures, which can be

understood through three phases of community engagement and measurement development. On

reflection, both the quality and local responsiveness of the measures developed in parallel to the

quality and responsiveness of the co-researcher relationship between the university and

communities.

Typical to rural and much of ethnic minority assessment research (Okazaki & Sue, 1995),

our research context is characterized by small populations. Further, in our review of the

literature, no direct validity studies of measures of our variables of interest exist for the culturally


distinct group with whom we work. Accordingly, our community intervention work involves

small sample research requiring either development of new measures from the ground up or use

of existing measures with unknown psychometric properties in the population of Yup’ik. Our

efforts in measurement development within this context were guided by a single crucial rubric

guiding one key principle. Our rubric was to listen to our community co-researchers and the local

people doing the intervention work and to involve them in each key decision regarding measures.

The key principal guiding us was to consistently implement procedures whenever they reduced

error variance in the measures at whatever time we could empirically identify their source, and

confirm our response reduced measurement error. Through doing this we sought to maximize the

sensitivity of the measures by accounting for as much variation in our models as possible. This

was particularly crucial in the use of statistical testing procedures for the assessment of our

program outcomes, given their limited statistical power due to the small sample sizes we

anticipated in our research in rural, remote, small communities where we faced significant

logistical challenges to data collection.

One important implication of this rubric and principle led to the principled decision we

made to continue to refine item content of the measures at baseline, as part of the methodology

of using two baseline assessments in our two feasibility studies. The use of two baselines was

initially selected to increase statistical power of our analyses with small samples. Though we

made intensive efforts to devise measures with strong psychometric properties prior to baseline

administration in these two feasibility studies, through years of cultural expert consultation,

focus group work, and repeated pilot testing with follow-up interviewing, we continued to

identify poorly functioning items at Time 1 of our feasibility studies. In response, we tested

refinements of these poorly functioning items at Time 2.


Typically, changing item content in measures during any outcome study, even a study of

feasibility, is methodologically questionable because of potential loss of measurement

equivalence across the time points of the study. As a result, the meaning of any significant

difference identified in the outcomes can become uncertain. However, we made any decision to

revise an item empirically, rigorously basing it in the data, by making use of item response

theory (IRT) analyses (Muraki, 1990; Rasch, 1966; Wilson, 2005) to guide decisions to revise

any suboptimally functioning items. In most instances, this resulted in modifications to less than

5% of the baseline item pool. Only one measure, a scale of family functioning (the adapted

Family Environment Scale, described below), required modification of approximately 15% of

the baseline item pool at Time 1. Though the item response theory (IRT) literature has

historically advised a the need for large samples to effectively use the approach (e.g., Embretson

& Reise, 2000, p. 124), other authors (Wright & Tennant, 1996), and our experience with the

technique here, found IRT approaches a useful diagnostic and decision tool even with small

samples (n < 50) to determine if a revision or elimination of items in fact reduced measurement

error. The approach allowed us to retain items with adequate discrimination indices and category

thresholds suggesting reasonable coverage of the theoretical latent trait being measured. The

consistent procedural use of this rigorous empirical approach to ongoing item refinement allowed

us to revise select items after the first Time 1 baseline assessment, then examine these same

characteristics at the two week re-testing at Time 2, with the knowledge that later time point

assessments possessed less measurement error, and increased sensitivity in their assessment of

the same underlying construct, and that any statistically significant difference that emerged

would be meaningful. In a few cases, revising an item did not improve the fit of the item to the

latent trait. In such instances we deleted the item.


Our approach also led to the development of two parallel sets of measures. One set were

measures designed for theoretical model testing, the outcome of which is described in Allen,

Mohatt, Fok, Henry, Burkett, and People Awakening Team (this issue), the second set was

designed to maximize sensitivity to change, and was used in Mohatt, Allen, Fok, Henry, and

People Awakening Team (this issue). The first set of measures designed to provide a test of the

People Awakening (PA) protective factors model, which was the model guiding the intervention,

aimed to comprehensively map the constructs defining the model using instruments with stable,

internally consistent properties. This first set of measures was devised to provide a test of

hypothesized causal relations between variables in the model; thereby providing empirical

support for our emically derived cultural theory regarding protection from alcohol and suicide. In

contrast, our measures of change were designed instead to be maximally sensitive to intervention

effects as measures of outcome. This second parallel set of instruments tapped these same

constructs from the protective factors model, and was a subset of the larger item pool. These

were constructed as brief measures that were highly sensitive to change, and intended for

repeated administration at baseline and at time points during and following intervention in a

format minimizing the burden from lengthy assessments.

Phase I: Initial Proposed Measurement Model

The research group began the process of measurement development by identifying

candidate measures and constructing a proposed measurement strategy for the intervention. The

goal of this phase was to develop a measurement model to assess growth in protective factors as

outcomes from the intervention we were simultaneously developing. Given the burden such a

lengthy set of measures would impose on youth, we would be unable to individually assess all

protective factors the intervention intended to address. In addition, the intervention was in


development through a community directed process. Community members were directing the

selection cultural activities and devising them as intervention activity modules and they believed

would work. Measurement development needed to occur for pretest, while the development of

the intervention was still occurring in this intervention development grant project. Through the

year, after the activity was delivered to youth, university researchers would evaluate each

activity for the specific protective factors from the People Awakening model (Allen, Mohatt,

Howe, & Beehler, this issue) that were delivered in the module activity. Given the twin realities

of intervention development work and participant burden of long questionnaires, we focused on

development of key indicator measures as proximal variables at the level of family, individual

and community of selected protective factors that were feasible to briefly measure, over

exhaustive measurement of all the protective factors in the model. For ultimate variables, we

attempted to measure consequences of alcohol use tailored to adolescents, who unlike adults,

experience somewhat different consequences than adults (for example, limited alcohol related

chronic disease health consequences emerge in adolescent alcohol abuse), and suicidal ideation,

given suicide attempts are rare and have a low base rate, despite the divesting consequences

when one single event occurs in a community. The aims of Phase I were to (1) adapt existing

youth measures from the mainstream psychological literature for cultural appropriateness for use

with Yup’ik youth, (2) adapt adult measures from the mainstream psychological literature for

cultural and developmental appropriateness for use with Yup’ik youth (3) adapt adult measures

developed for Yup’ik adults in previous research for use with Yup’ik youth. The approach

began with identification of variables derived from our previous retrospective protective factors

work with Alaska Native adults (Mohatt, et al., 2004; Allen et al., 2006). This measurement


approach was guided by theory and a decade of discovery based and measurement development

research described in Allen, Mohatt, Howe, & Beehler, this issue.

Table 1 describes our initial approach to a measurement model, as proposed at project

start up. For each variable in the model, we identified its level of analysis (individual, family, or

community) and a candidate measure or set of measurement scales tapping this variable. On the

basis of our previous research, we also identified each variable as a proximal (change) variables

or ultimate intervention (outcome) variable. We also identified the informant (youth, parent, or

community member). For measures, we selected instruments to adapt from the literature. Some

measures had been used previously with American Indian tribal groups, and some were

developed for use with Yup’ik as part of our previous research with adults. Most, but not all of

the proposed measures, and none of the Yup’ik instruments were adapted for use with

adolescents. Table 1 also identifies this development status for each measure. The university

co-researcher group began this process by proposing to our consultant, local researcher staff, and

co-researcher community planning group members the following measures of proximal and

ultimate variables.

Proximal outcome measures

Individual Characteristics (IC)

Efficacy. The Communal Mastery (CM) scale (Jackson, McKenzie, & Hobfol, 2000) is a

measure of adult collective or communal mastery: a sense an individual can overcome life

challenges through joining with others in an interwoven, close, social network. Hobfoll, Jackson,

This perspective on mastery may be more operative among individuals from collectivist cultural

orientations. The respondent answers to this 10-item measure on a 4-point likert-type scale.


Hobfoll, Pierce, and Young (2002) used the CM scale successfully in research with Northern

Plains American Indian women, where it displayed adequate internal consistency ( = .74).

The seven-item Self Mastery (SM) scale (Pearlin, Lieberman, Menaghan, & Mullan,

1981) is designed to measure a personal sense of control over goal achievement and a sense an

individual can overcome life challenges though their own effort. The respondent provides

answers to this 7-item using a 4-point likert scale. Hobfoll et al. (2002) used the SM scale

successfully in research with Northern Plains American Indians, obtaining = .72. We had used

both SM and CM with a sample of 471 adults and youth (14 to 18) in previous work with

Yup’ik.

Learned Optimism. The measurement of explanatory style has received considerable

attention in the study of depression and suicide. We adopted the perspective of positive

psychology in response to sustained expressions of community participant preferences in our

research. Within the framework of positive psychology, the construct of learned optimism has

received considerable recent attention (Reivich & Gillham, 2003). The explanatory style

construct of optimism is grounded in two theories of explanatory style, representing a

reformulation of learned helplessness and hopelessness theories, and the most widely used brief

measure of learned optimism for youth is the Children's Attributional Style Questionnaire-

Revised (CASQ-R; Thompson, Kaslow, Weiss, & Nolen-Hocksema, 1998). It contains 24

forced-choice items (12 related to positive events and 12 for negative events). Internal

consistency in a sample age 12-14 was = .64. The measure has been most recently used in

study of the recovery from depression among youth from 7-17 years (Voelz, Haeffel, Joiner, &

Wagner, 2003).

Family Characteristics (FC)


Family Environment. The Family Environment Scale (FES; Moos, 1974; Moos & Moos,

1994) is a widely used 90 dichotomous item measure of family functioning. Four FES subscales

were originally identified as potentially mapping well to the PA Protective Factors Model for

Family Characteristics. These subscales were Cohesion, Conflict, Parent Moral Focus, and

Religious Behavior.

Family Social Network: The Alaska Native Social Network-Family Subscale (SN-F) is a

component of the Ilaliuryaraq/Yup’ik Social Network (YSN) measure developed by PA. The

YSN assesses network size as it pertains to immediate family, defined as parents, siblings, and

grandparents. The YSN is a card sort task; each card displays a member of the immediate family

and allows the respondent to map the quality of their relationship with family members in terms

of 13 important culturally grounded developmental variables in childhood suggested by the PA

Phase I Yup’ik life history transcripts. The card sort task was developed into the SN-F, a

computer administered task. We selected from the YSN the three best item predictors of adult

nonproblem drinking. The resulting SN-F assesses social network size as it pertains to immediate

family, defined as parents, siblings, and grandparents. We will adapt the card sort task for

computer administration. The total score is sum of the network size for immediate family

members for the three items.

Family Protective Factors. Alaska Native Protective Factors-Family Characteristics

Scale (PF-F) is derived from the item pool used in development of the Yup’ik Protective Factors

from alcohol abuse scales (Allen et al, 2006) and is intended to tap family-level role modeling

and behavior protective from alcohol abuse. The Yup’ik Protective Factors scale was developed

for adults by PA. Items were derived from statements in the life history transcripts of abstainers

and non-problem drinkers that exemplified important components of the Protective Factors


model, including the Yup’ik indigenous concept of ellangneq, an awareness of the reciprocal

consequences of one’s behavior across people and time. The resulting scale displayed a complex

structure, tapping individual reflective processes, including from adolescence, along with family

and community characteristics from childhood, that were protective from alcohol abuse. The

respondent answers on a 4-point likert scale. The measure displayed a clear four factor structure,

and the resulting factor analytically derived subscales displayed low intercorrelations (r

= .09-.50). Full scale internal consistency reliability was = .81, and subscale reliabilities ranged

= .59-.71 in a stratified community sample of 51 Yup’ik adult nonproblem drinkers (Allen at

al., in press). Because items generally describe experiences from adolescence and childhood,

adaptation for adolescents will be possible. We adapted the existing scale item pool to compose

an adolescent PF-F subscale that retrospectively taps family-level protective factors from alcohol

experienced in childhood.

Community Characteristics (CC)

Community Readiness. Community Readiness Assessment (CRA) is a key informant-

based assessment of a community’s awareness and readiness to confront a social problem

(Oetting, Donnermeyer, Plested, Edwards, Kelly, & Beauvais, 1995). CRA has been used in

many Alaska Native communities. CRA interviews of key informants are coded and produce a

score placing the community on a developmental continuum from denial of problem to active

engagement. We proposed to interview the same five key informants using CRA throughout the

duration of the project to evaluate change over time as one indicator of the effectiveness of

intervention components such as tribal courts and social marketing. CRA has been extensively

used in Alaska Native communities, including on a recent series of Community Substance Abuse

Prevention projects. We proposed to ask key informants about the general issue, e.g. “how much


of a concern is suicide (alcohol abuse) in your community?” in order to assess the following:

community efforts directed toward the issue, community knowledge of efforts, community

leadership, support, and involvement around this issue, community climate (e.g., attitudes,

support, and obstacles), community knowledge of the problem including its effects on the

community and causes of the problem, and community resources available directed toward

dealing with the issue. Questions are rated on 10-point rating scales. There are a total of 34

questions in the CRA procedure; we proposed to use a subset of 20 items that fit the village

context.

Ultimate Outcome Measures

Alcohol

Alcohol Consequences. The PA project adapted the Drinker Inventory of Consequences

(Miller & Tonigan, 1995) for use with Alaska Natives. The resulting 50-item Drinker Inventory

of Consequences for Alaska Natives (DrInC-AN) was administered as part of 101 life history

interviews conducted in Phase I of PA. The instrument taps lifetime alcohol consequences, using

a true-false response format, and recent consequences, using likert-type scale responses for each

item scored 0-3. Analysis of data from 55 self-identified non-problem drinkers and recovering

alcoholics with five or more years of sobriety showed the instrument possessed excellent internal

consistency reliability for the DrInC-AN lifetime consequences total score ( = .95), and good to

excellent reliability for the six DrInC-AN lifetime subscales ( = .80-.93). A score of 15

discriminated problem drinkers from a sample of nonproblem drinkers. The project will adapt

this measure for adolescents. Based on our success in creation of a 15 item brief version of the

DrInC-AN for the second phase of PA, we anticipate construction of a briefer adolescent

measure is possible. We planned on approximately 30 true / false items in this adaptation based


upon the better discriminating items from the DrInC-AN. In addition, some existing DrInC-AN

items (e.g. loss of a spouse/custody of child) are not relevant to adolescents.

Alcohol Use. We proposed to develop and validate a self-report Alcohol Quantity/

Frequency/Binge Episode (Q-F-BE) measure for use with youth and adults in rural Alaska

settings in which importation and consumption of alcohol is illegal. This measure would be

adapted an instrument used by May, Gossage, & Tonigan (2000) in their study of alcohol

consumption patterns with 4 AI groups. The Q-F-BE was adapted for use in rural Alaska. The

measure assesses for quantity and frequency of drinking, including binge drinking episodes,

defined as a consumption pattern of greater than 4 drinks of alcohol on one occasion. The

adaptation specifically queries about types of alcohol used in rural, ‘dry’ communities in Alaska

(e.g., home brew) over the last month. The measure will require 2 minutes to administer.

Suicide

Reasons for Living: The Brief Reasons for Living Inventory for Adolescents (BRFL-A;

Osman, Kopper, Barrios, & Osman, Besett, & Linehan, 1996) is a modification of the Reasons

for Living Inventory (RSL; Linehan, Goodstein, Nielsen, & Chiles, 1983), a widely used adult

measure that correlates with suicidal ideation. However, the measures tap an individual’s self-

assessment of positive aspects of their life and reasons for living in response to an urge to

commit suicide, rather than ideation regarding ending one’s life. The BRFL-A has demonstrated

good reliability and a clear factor structure with adolescents (Osman, Kopper, Barrios, & Osman,

1996) and has been used successfully in recent research with children aged 11-15 (Merwin &

Ellis, 2004). We anticipate greater community acceptance with this measurement approach to

ideation. A negative correlation between suicidality and reasons for living has been repeatedly

demonstrated through numerous studies that show individuals who possess few reasons for living


are likely to be suicide ideators (Connell & Meyer, 1991; Hirsch & Ellis, 1996; Linehan,

Goodstein, Nielsen, & Chiles, 1983; Osman, Gifford, & Jones, 1993). A college student version

(Scheel, 1999) displayed good psychometric properties with AN college students (Simmons,

2003). The 14 item BRFL-A has demonstrated adequate reliability ( = .75) and a clear five

factor structure with adolescents (Osman et al., 1996), has been used successfully in recent

research with children aged 11-15 (Merwin & Ellis, 2004),

Phase 1 Procedures

Phase 1 of the measurement development work began with item review by the research

team, followed by pilot testing with Yup’ik Alaska Native youth with follow-up interviewing of

these youth participants. The process between research team review and pilot testing was

iterative, and included successive waves of item revision, pilot testing, then item revision. The

research team included Yup’ik and nonnative researchers, along with Yup’ik cultural expert

consultants, School of Education faculty who had teaching experience with youth in rural and

Southwest Alaska, and external research consultants. The core research team was composed of

the paid Yup’ik community co-researcher staff and the University based faculty and staff, some

of whom were also Yup’ik or members of other Alaska Native and other American Indian tribal

groups. The core research team meetings generally consisted of about half community and half

university co-researcher staff and faculty. The meetings were conducted through mixed face-to-

face, audio, and video conferencing hosted at the University of Alaska Fairbanks with

community staff in the communities they lived and the project worked and frequently, some of

the university based research team who travelled extensively to these communities in the remote

community locations in southwest Alaska. Smaller measurement development work groups were

scheduled at times outside of the regular weekly research team meetings. These work group


meetings would focus on a particular question or problem in the measurement development, and

different groups of experts were invited, depending on the mixture of expertise needed to address

the questions at had. Because we knew the backgrounds of our consultants and local cultural

consultants, we made best possible use of their schedules by tailoring their attendance to

meetings within their area of expertise. In addition to cultural and linguistic experts, relevant

consultants included educational experts and teachers, external expert research consultants,

behavioral health providers, and Alaska Native studies and Alaska Native languages faculty. A

subset of the university research team, the measurement development group, would meet

frequently through the week in order to divide up, monitor, and complete tasks that included

statistical analyses, revising and formatting item revisions from previous work groups, preparing

for the next work group, and preparing technical presentations and updates to work groups.

Often our expert pool’s schedules were quite busy. Because of this, the measurement

development group would also meet individually with cultural experts in conjunction with an

expert’s schedule, in order to obtain key feedback within their area of expertise. This might

involve linguistics or word usage, or the meaning of a cultural concept, or simply one-on-one

assistance in the working of a particular item. In this way, within a typical two week period

during our period of intensive scale development work, we might (1) have two regular research

team meetings which might include an hour of measurement development work along with other

research business, (2) five or more independently scheduled smaller measurement development

work group meetings in which one or several cultural experts were invited, (3) daily meetings of

measurement development group that were check ins with each other or with a single or a very

small group of expert consultants, and (4) one formal expert consultant meeting with a group of

several consultants. From time to time, we would also have larger meetings with, to the greatest


extent possible, our entire community co-researcher team and community consultants, in order to

review progress. These were every expensive meetings, since they involved flying people in to

one location at significant distance from remote communities, and paying a group of 10-20

people for their time. However, they provided a number of important and distinguishing features.

First, they allowed all the different community co-researchers to interact face-to-face; typically

they met each other only through audio or sometimes video. Second, at these meetings the

university based research team members were in the minority in contrast to the numbers of

community co-researchers. We found a change in critical mass in these meetings that in contrast

to our regular meetings, appeared to allow for freer discussion among community members. As

we shall see, one such large face-to-face meeting at the end of Phase 2 led us into different

directions, and stimulated a key turning point in the measurement development process, and the

research. The research team reviewed item content for all the proposed scales, and in

consultation with our cultural expert team members we identified items difficult to understand in

terms of second language and local English dialect usages. Sometimes called village dialect,

English language usage in the communities in which we work is in many ways is embedded in

Yup’ik grammatical construction, word choice, and sociolinguistic conventions. Instruments

underwent linguistic equivalence procedures for use with Yup’ik. Each was adapted to local

English dialects, rural remote Alaska village contexts, and fourth grade reading level. Items were

evaluated for cultural appropriateness and understandability. This process identified most reverse

keyed and negatively worded items, as well as items using locally unfamiliar vocabulary, as

difficult to understand or confusing English language usages, e.g., “in our family, we hardly

every get mad at each other” (yes/no). Other items were identified as contextual irrelevant (e.g.,

“driving in a car,” “shopping in the community” in roadless communities without stores), or


cultural inappropriate. For example, “In our family, we try to outdo each other,” led to confusion

about the item meaning within out cultural expert team. When some of the other research team

members explained their understanding of the question, this led to general agreement among our

local cultural experts that their confusion stemmed from the extent to which this behavior in a

family would be culturally inappropriate, so much so that the question was culturally

inappropriate to ask of people.

For revision work, cultural experts proposed and worked with the entire team on rewrites,

at times asynchronously in subgroup work groups. We sought to maintain the original meaning

of the item, rewriting it to be understandable to local youth, or if this was not possible, so it

described a locally contextually relevant and culturally appropriate behavior that was

functionally equivalent to the original item content. We deleted items when such a rewrite was

not possible.

We initially evaluated item pools and scales by piloting them with Yup’ik 18 year old

university freshman recently arrived at the University from rural Southwest Alaska communities.

These students completed the survey items individually or in small groups, and then participated

in debriefing interviews to provide feedback on readability, understandability, and cultural

appropriateness.

In the case of our adaptation of the FES, the potential of low internal consistency in some

of the subscales became a substantive concern, due to deletion of inappropriate or difficult to

understand items for which our attempts at rewriting were unsuccessful. Here we authored new

FES items then at baseline, using IRT approaches, we tested item fit to the latent trait tapped by

the remaining items of the parent FES subscale. Generally, we found most newly written items


did not function adequately, and in the end, we kept only four newly written items in our

adaptation of the FES, though the majority of FES items required at least minor revision.

We also developed adult measures for outcome assessment, but not theory testing. These

measures consisted of a subset of the youth measures, along with a measure of social support and

drinking behavior. Due to space constraints, we will focus here only on development of the

youth measures. The adult measures proved secondary in the concerns of community members

regarding potential negative consequences of assessment in our collaborative work (c.f., Allen,

Mohatt, Fok, Henry, & People Awakening Team, 2009 for a report on outcomes with several of

these adult measures). In later sections of this article, we will describe in detail the nature of

some of these concerns, and how the research group responded to these concerns.

Phase 2: Elaboration, Pilot Testing, and Cultural Review

Consultation with cultural experts, external consultants, and the pilot work testing the

performance of the measures led to several far-reaching recommendations for cultural and

linguistic revision of the measures, and of the measurement model itself. Through these

recommendations, the measurement development work advanced to become construct

elaboration. Beyond revision of measures, these efforts increasingly encompassed both

measurement model refinement and extension of the underlying theoretical model. Among

youth, at the individual level, important differences in the CM experience were conjectured to

emerge for adolescents, in contrast to adults, when it occurred through enlisting the networks of

their friends, in comparison to enlisting the networks of their families. Therefore, we authored

parallel Family and Friends subscales with the same item content to explore possible differences

and potentially to more fully describe the construct. The SM scale appeared useful to our

cultural consultants and co-researchers. Through our construct elaboration work, we came to


understand mastery as the higher order construct, functioning through the levels of the self,

family, and friends as three constituent second order constructs (Fok, Allen, Henry, Mohatt, &

People Awakening Team, 2012). On the individual level, our cultural consultants all expressed

significant reservations about the CASQ scale. They questioned whether numerous items would

be understandable to youth within the culture, and we attempted a major revision, rewriting the

items. The research team questioned its alignment with mastery, and instead began to view it as a

mediator variable, through which mastery impacts alcohol use/suicidal ideation.

On the family level, we added the FES Emotional Expressivity subscale to the original

four subscales, to more fully tap different dimension of family relationships. In response to

concerns about length and participant burden in the social network measure, we created a briefer

four question YSN-F based in the best functioning items most relevant from our theory of

change out of the 13-item version used in PA. For family protective factors, we adapted

questions from the original adult measure, in order to create an initial PF-F item pool for youth,

derived from the adult Protective Factors scale in our previous PA work.

On the community level, CRA data obtained through just five adult key informant data

informants was assessed by our external consultants to possess significant limitations. It

possessed obvious limitations in statistical power related to sample size and equally importantly,

limitations in its ability to directly assess protective community characteristics impacted by

intervention. CRA did not provide direct assessment of changes in youth perceptions of specific

community level protective factors important to the theory of change and intervention model of

the project, such as support, safety, alcohol behavior limits and norms, and opportunities. In

response, the team devised a new youth self-report measure whose subscales taped these

community protective factors, as evaluated by youth. We also added an YSN-Community (SN-


C) scale using the SN-F items in order to identify important non-family community members in

the social network.

To tap the alcohol use and consequences variables, we developed alcohol measures for

Alaska Native youth. We spent considerable effort developing a brief measure of youth alcohol

consequences, adapted from the adult DrINC-AN item pool. Based on our success in creation of

a 15 item brief version of the DrInC-AN for the second phase of PA, we constructed a more

detailed 30-item measure. Our intent was to develop a measure appropriate to the types of

negative consequences rural Alaska Native adolescents, in contrast to rural Alaska Native adults,

might experience from drinking, while also allowing more accurate classification of the episodic

binge drinking styles found in the region. We also developed a Q-F-BE measure that

distinguished episodic binge use from frequency of daily or typical use through an item

vocabulary appropriate to measuring home brew and bootleg alcohol usage, with locally tailored

methods for tracking amount consumed and drinking styles, through count of number of times

drinking in past month, and amount drank in (1) their usual drinking situation, and (2) in what

the youth considers to be a binge drinking situation.

The BRFL-A was evaluated by the team as a reasonable alternative to direct measure of

suicidal ideation, given our community consultants repeated cautions regarding the limits of

community acceptability for direct questioning about past suicidal behavior, suicidality, or

ideation. Given our preference as researchers to use well-researched ultimate (outcome)

measures with minimal revision, in order to use the validity evidence for scores on the measure,

we elected to use this adolescent measure without revisions, as consultants assessed existing item

content was understandable to local Yup’ik youth.

Phase 2 Revised Proposed Measurement Model: Youth Measures


Our measurement development work, including pilot work, and exploratory analyses of

our initial pilot data, led the team to engage in elaboration of the PA protective factors model.

Accordingly, the goal of this phase was construct elaboration. This led to extensive revision to

our measurement strategy, and would prove crucial to development of the final, working

measurement model. Relations between proximal and ultimate variables suggested mediating

mechanisms, and with this, mediating variables and candidate measures of these variables from

the literature with youth and American Indians were identified by the researchers.

Table 2 describes the measurement model during this second phase in our collaborative

development of a measurement system for the project. During this phase, we came to situate our

measurement model deeper into the PA Protective Factors Model. Through this work, we came

to recognize specific variable groupings as latent variables that were tapping important elements

of the PA model. With our cultural consultants, we began to identify the narrower components

of the broader emic, indigenous model from the previous PA qualitative work, described in

Allen, Mohatt, Howe, & Beehler (this issue), assessed by this evolving measurement model of

outcomes. We provided bilingual labels, using Yup’ik terms that we would continually refine

throughout our remaining work, to more accurately describe local understandings of each latent

variable component of the indigenous model that we were measuring. In Phase 2, we achieved

five aims. First, we completed our initial cultural adaptation or development of measures for

proximal variables to map Individual Characteristics (IC) and Family Characteristics (FC) as

latent variables. Community Characteristics (CC) in particular underwent significant revisions,

given difficulties in devising a new measure with items that composed functioning scales that

provided youth assessments of community level attributes. Second, Significant revisions were

made on ultimate variable measures of the latent variables of Sobriety (S), understood as both


abstinence or limited problematic drinking consequences, and Reasons for Living, in order to

improve their functioning in pilot testing. Third, we added three new important Intermediate

latent variables, also conceived as change agents. We labeled these new mediating latent

variables social environment (SE) thinking over alcohol use (TO), and explanatory style (ES).

TO involved development work on a new scale. For ES, our understanding of its role changed

from that of a proximal to an intervening variable with mediation effects in the event chain of

developmental maturation. Fourth, we devised a more culturally congruent response format,

described below. Fifth, we devised and implemented a secure web based adaptive testing format

that both pushed to the limits yet worked within the limitations of rural Alaska satellite internet

connectivity. Below we describe only those new measures added to the Phase I model in Phase

2.

Proximal Variables

Family Characteristics

FC3: Family Environment Scale (FES). The Emotional Expressiveness subscale was

added to the item pool for adaptation for the FES.

Community Characteristics

Community Protective Factors: CC1: Alaska Native Protective Factors-Community

Characteristics Scale (PF-C). We adapted items from the existing Yup’ik Protective Factors

scale. We adapted the existing scale item pool to compose an adolescent PF-F subscale that

retrospectively taps community-level protective factors from alcohol experienced in childhood.

Community Protective Factors: CC2: Alaska Native Social Network-Community Scale

(SN-C). SN-C) is adapted from the Ilaliuryaraq/Yup’ik Social Network measure described

above. The SN-C uses the same three items as the SN-F, and consists of a list of non-immediate


family members, including aunts, uncles, other relatives, friends, and other community figures

from childhood. This list appears at the same time with the list of immediate family members, so

is rated in the same time period as the SN-F. Total score is the number of extended family

members and community members selected. The measures provides an estimate of one

important community characteristic in childhood that surfaced in the PA life history data as

important to sobriety, a community with a large number of adults who took active interest in the

welfare of the child.

Intermediate Variables

Social Environment

Peer Effects: SE1: Peer Discouragement of Alcohol, Tobacco, and Other Drugs (ATOD)

Use Scale (PDU); SE2: Disapproval of Peers’ ATOD Use Scale (DPU); SE3: Peer

Encouragement of ATOD Use Scale (PEU); SE4: Friends’ School Adjustment Scale (FSU).

Four scales from the American Drug and Alcohol Survey and the Prevention Planning Survey

(Oetting & Beauvais, 1990) measure peer influences during adolescence. The scales have been

used extensively with American Indian tribal communities (Beauvais, 1992). These four

measures form separate clusters, providing evidence for discriminant validity. When used

together, three of the four are indicators for an underlying factor labeled Peer Drug Associations.

In previous research, this factor, or latent variable, has the highest relationship of any risk factor

to adolescent drug use, accounting for as much as half the variance (Oetting & Lynch, 2003).

The fourth cluster taps friends’ school adjustment and peer/school connections, another

important factor in the adolescent social environment linked to alcohol abuse. The four Peer

Influences measures included: SE1: The Peer Discouragement of Alcohol, tobacco, and Other

Drugs (ATOD) Use Scale (PDU), comprised of 8 items with an internal consistency of = .92 in


previous research with various American Indian tribal groups; SE2: The Disapproval of Peers’

ATOD Use Scale (DPU) has 7 items with = .94; SE3: The Peer Encouragement of ATOD Use

Scale (PEU), with 16 items and = .93; SE4: The Friends’ School Adjustment Scale (FSU) with

5 items and = .82.

Thinking Over Alcohol Use

Alcohol Attributions: TO1: The Substance Use Self-Efficacy Scale (SSE). The SSE (St.

Mary & Russo, 1990-1991) is a 20-item scale that assesses self-efficacy in situations substances

might be used. Taylor (2000) rewrote items to allow completion by nonusers of substances,

focused items only on alcohol, and added questions on beliefs regarding the ability to control

one’s drinking and the ability of significant others to control their own drinking. Using a five

point likert scale, Taylor obtained = .93 with an AI/AN sample.

Alcohol Attributions: TO2: Decision Balance Inventory and Stages of Change Algorithm

(DBI). The DBI (Migneault, Pallonen, & Velicer, 1997) is a 16-item measure that assesses

positive and negative aspects of drinking, to which respondents answer using a 5-point likert-

type scale and a 7-item algorithm to assess the individual through the Transtheoretical Model

Stages of Change. The two subscales displayed good internal consistency ( = .86, .77) among a

multi-ethnic high school sample (Hudmon, Prokhorov, Koehly, DiClemente, & Gritz, 1997).

Life Goals Reflection: TO3: The Alaska Native Protective Factors-Reflective Process

Scale (PF-RP). The RF-RP is developed from the adult Yup’ik Protective Factors scale,

described above. We adapted items for adolescents, to tap current reflective processes of the

young person as part of their thinking over the decision about alcohol use. In general, these

items tap a combination of consideration of immediate negative consequences of drinking, along


with impact upon the future regarding life goal reflection and affirmation of responsibilities to

family and community.

Ultimate Variables

Alcohol Consequences: S1: Drinker Inventory of Consequences for Alaska Natives-

Adolescents (DrInC-AN-A). The team committed to work to cut the length of the DrInC-AN-A

by half to 15 items.

Suicidal Ideation: SI: Suicide ideation Questionnaire (SIQ-Jr). Midway though the

Phase 2 adaptation process, as part of their review of our work, several of our external

consultants encouraged the team to include a measure of suicidality, in addition to the BRFL-A,

to more directly evaluate change on one of the primary outcomes from this community

prevention program. In response, we conducted an extensive and careful review of standard

measures of suicide. The SIQ-Jr (Reynolds, 1988), a widely used measure of suicidal ideation,

with previous use in American Indian communities (Dick, Beals, Manson, & Bechtold, 1994;

Novins, Beals, Roberts, & Manson, 1999), was selected. In response to this development, our

cultural consultants and community co-researchers again expressed strong reservations about the

community acceptability of suicide attempt or even ideation measures. Their concerns centered

around the level of trauma in most communities from both recent suicides and suicide waves

over the past 30 years, and important cultural beliefs regarding the power of words and the

perceived risks and dangers to discussion of topic. In response to these concerns, the team

elected to discuss use of the SIQ-Jr with community representatives with the measures described

in Table 2 as a computerized outcomes assessment package for their review.

Phase 2 Procedures: Further Adaptation Work–Development of a Computerized

Web-Based Interface and Community Review


The group continued adaptation work with both the original and the newly introduced

measures. The Peer Effects measures required adaptation focusing on rewording for relevance to

the local rural Alaska context. Changes included local drugs of use (e.g., inhalants, igmik-a local

smokeless tobacco/punk ash mixture) and some differences in structure and nature of the school

activities available within these communities. Our team and consultants concluded that despite

initial efforts at adaptation, three measures would not work locally. Both the DBI and CASQ-R

were described as lengthy and difficult to understand in our consultant consultant’s assessment.

As we explored this issue further, their concerns emerged most centrally around the issue of

cross-cultural construct equivalence, and broader cultural-philosophical concerns inherent in how

change occurs and the meaning of events. For example, the attributions describe din the

measures as value-laden judgments of the meanings of certain events and their outcomes,

differed from a Yup’ik more culturally normative acceptance of events and their outcomes that

trended toward adoption of a more nonjudgmental stance. It quickly became apparent it was

unclear, and a major research question in itself, whether the constructs of stages of change and

learned optimism as an explanatory style were in fact cross-culturally transportable to Yup’ik

contexts. After significant discussion within our group, we decided this was beyond the scope of

feasibility in our measurement development work, and to stop adaptation work on these

measures.

At this point, the team concluded we had a final set of measures adapted into working

form. We possessed psychometric data from our pilot testing that showed clear promise that

these were adequately functioning measures with Yup’ik youth. We also put considerable work

into develop of a computer testing interface for use in rural Alaska. Through significant efforts,

state and local school districts had secured Internet access for every school in rural Alaska.


However, this access in the communities where we were working was via satellite link, which is

slower and often interrupted by weather, including sunspot activity. This lead us to design a lean

interface that was graphics rich with local artwork as background, but used limited bandwidth in

its page refresh requirements, and possessed robust packet checking in transmissions. In

addition to the reduction of error related to data entry, this assessment technology addressed

important local concerns in these small, tight knit communities where everyone knew everyone

regarding confidentiality of sensitive data, including engagement in the locally illegal activity of

drinking. The web interface survey meant no data was stored in the community, responses

immediately moved out of the community to data storage at servers at the University. Computer

testing also allowed for customization of the response format. This was in response to years of

cultural consultant feedback regarding their level of discomfort with conventional likert scaling.

Reasons for this discomfort were many and varied, and included its segmentation, linearity, the

requirement to choose one number in a way that imposed lack of choice on the individual, and

general discomfort about rating people and behavior using a number. In response, we developed

a variation of an analog scale, with markings similar to a 5-point likert scale, that also included a

salmon, a local cultural icon, with its dorsal fin as a pointer to indicate place on the scaling (see

Figure 1). This change from conventional likert scaling led generally to positive responses.

Typically, measurement development work in conventional research might end here in

terms of local community involvement in decision processes, if included at all. At this point,

more wide scale pilot testing of measures might occur, or the measures might be immediately

used as outcomes in an actual study. We were confident in our work, and anticipated a generally

positive response to it when we requested a community review of the recently completed

computer based assessment instrument. The research group now had invested considerable


effort in consultation with out cultural experts and promising pilot work on each scale, and had

some pride in its accomplishment. We anticipated community members would recognize how

these measures differed in contrast to the standard questionnaires they had experience with in

terms of wording, briefness, and graphical look and feel and in terms of community input in their

development process. We looked forward to community feedback when we invited a large

group of our community-based staff and community members to a weeklong meeting to initiate

the project through face-to-face planning work on the intervention, concluding with their review

of the new measures. Our timeline was for use of these measures in about one month for

baseline assessments in the communities.

What happened next was unexpected, and highlights how the community engagement

drove our process in ways we could not predict and alerted us to issues we did not fully

comprehend. The measurement development work moved beyond efforts to improve the

psychometric functioning of an existing instrument set, or the broader goals of construct

elaboration. What happened was critical for enhanced community acceptability of the measures,

and more importantly, of the idea of research in general, with increased community ownership

over the research process.

Community Review Meeting. Community co-researchers were convened from the two

intervention communities to review the completed computer assessment instrument at the end of

a two-day interventions development meeting. We now view the events and process of the

meeting, ensuing discussions that came out of the meeting, and the university co-researchers

response to events, as a crucial stage in the development of the project and the CBPR work. This

process will be described as a detailed case study in the final section of this article. Here we will


describe the primary outcomes and actions we took as part of a shared decision making process,

along with some summary reflections on basic parameters of the process.

Yup’ik community co-researcher feedback included extensive discussion on the cultural

appropriateness and length of the instruments. The entire survey was seen as too long, too

burdensome, and inappropriately intrusive for both youth and adults. The Yup’ik co-researchers

provided very thoughtful critiques, which we will explore in greater detail in the final section of

this report, on such topics as the nature of repeated questioning and the act of direct questioning

in particular, and what was an appropriate and respectful way to ask a question. They also

considered one measure, the BFRL, as overly focused on suicide ideation and not on actual

reasons for living, and were unwilling to consider using a direct measure of ideation such as the

SIQ-Jr. Yup’ik co-researchers were very concerned about asking youth direct questions on

alcohol and drug use. Their concerns focused on the impact of asking questions on substance

use as encouraging experimenting with drugs and alcohol. Finally, our co-researchers observed

many questions were repetitious in that they asked similarly worded questions repeatedly. In

addition, items were identified that did not fit the context of the community. The extent of the

negative reaction to the measures made it uncertain if the representatives of at least one of the

communities were willing to allow this type of youth self-report approach to be used in their

community. After the review of measures, discussion ranged to other approaches to evaluation,

such as non-obtrusive social indicators, key informant approaches, and qualitative approaches.

We discussed how social indicator data was lacking and often inaccessible, and limitations in use

of key informant approaches and qualitative approaches, given current conventions within the

review process for biomedical research and what constitutes evidence base for practice. At the

end of the first day of meetings on the measures, which were held the last two days of a


weeklong training and working session at the University on development of the intervention, it

was unclear if community representatives would give their permission to use outcomes

measures. We resolved to return the next day with fresh perspectives, and to continue

negotiations.

After reviewing available options and alternatives to self-report instruments, university

co-researcher group offered to incorporate this feedback, taking the assessment software package

completely back to the drawing board. The university co-researcher group offered to rework all

the existing instruments in order to delete measures that were particularly objectionable, delete

items that were objectionable from measures we retained, and to shorten remaining instrument

length substantially, which would result in significantly revised set of briefer measures that were

responsive to many of their strongest concerns. Community co-researchers confronted a

dilemma. Representatives from one community were willing to proceed given their recent very

painful history of repeated waves of suicide, and a strong desire to do something in response.

They liked the promise of the approach of the project enough to live with the measures. The

representatives from other the community, which in contrast did not have the history of suicide

and whose community also possessed a greater proportion of Yup’ik first language speakers, had

greater reservations, but also made the decision the program itself was desirable for their

community, despite enduring concerns about the approach of the measures with their youth.

Shortly after this meeting, the university group received a separate NIH grant award for

Cuqyun (measuring), a measurement development project, the outcome of which is described in

Allen et al. (this issue). The aims of this new grant funded the testing we had planned of the

theoretical model guiding the intervention program, and would provide large sample

psychometric testing of the measures. However, the timing of the Cuqyun award was late in


terms of the timelines for the two grants funding intervention development and feasibility testing.

The results of Cuqyun could inform the measures item composition, but baseline assessments for

the intervention would need to be completed before start up of Cuqyun. Therefore, university

co-researchers could tell community co-researchers that out of this work in their communities,

combined with the Cuqyun study, we could develop shorter measures for use in future

communities after the work in their own communities.

The University co-researcher group and our programmer, who redesigned the measures,

largely from the ground up, in response to the community co-researcher feedback, presented a

revised, briefer set of instruments to the community co-researchers after a very intensive month

of work. Additional discussions were held, leading to additional directions for revision. We also

described to the co-researcher group our procedures to shorten these measures further in the

future, based on the findings from the future Cuqyun measurement development study. The

University co-researcher group again revised based on continued concerns about length and

intrusive questioning, and presented this revision to the two local community planning groups,

incorporated their feedback into the next revision of the measures, which was the version of

measures we used for the first baseline, or Time 1 assessment (T1).

Emergent Processes in this Measurement Development Work. Underlying the process of

meetings and consultations with community members was an ongoing set of negotiations. These

occurred on the level of negotiation between university and community co-researchers, and

negotiations between university co-researchers and the peer community of Western biomedical

science. The negotiations involved a discourse that at its root, went deeper than developing

psychometrically valid instruments, or testing the cultural equivalency of constructs, or even the

process of construct elaboration, and instead, moved the research group into a dialogue about


values. This involved a collision between the values of the cultures of Yup’ik communities and

the values of the cultures of Western science. Within these deeper dimensions and structures of

culture, value structures were at times in conflict. We believe this is not unique to our work,

though Yup’ik cultural distinctiveness highlights some of these contrasts; we instead see these

types of values negotiation inherent in virtually all community based research, with measurement

development and development of measurement strategies as one particular flashpoint area where

this negotiation can often occur.

We began to see the process of this work as multifaceted. Instead of two simple poles of

community and scientist, we came to understand it through the idea of an acculturation

continuum. By this we mean the poles of cultural contact involved links in a chain, stretching

from two local Yup’ik communities comprised of their own sets of shared and at times diverging

values, beliefs, and worldviews, to their community representatives. These community

representatives now had a history of working with Western science community researchers who

possessed elements of a community psychology value orientation and several years of experience

working in rural Alaska with the cultural group. The chain continued with these community

researchers, extending to the interactional space of these community representatives joining with

these community researchers as co-researchers, to the community psychology researchers. The

community psychology researchers were in turn interacting with representatives at the National

Institutes of Health (NIH) and the values, beliefs, worldviews, and methodological expectations

of Western biomedical research science. This continuum provides a more nuanced understanding

of the multiple viewpoints that belie a complexity far beyond a monolithic “Western science”

versus “Yup’ik culture” understanding of these events. Instead, multiple viewpoints, even within

local communities, were situated somewhere in a chain of people representing levels of cultural


contact and values, represented a cultural viewpoint that was local and contextualized, with each

point of contact often working on the edge of their comfort zone regarding values and beliefs.

It was important to keep in awareness that at all times this process of negotiation was also

asymmetrical. In terms of power relationships, university co-researchers had a significant

knowledge base and technical background in measurement development, statistics, and the

community intervention literature. Much of this was unfamiliar to community co-researchers.

University co-researchers typically wanted longer more detailed measures using procedures that

would surmount the scrutiny of peer review to provide sufficient validity argument for evidence

based practice. The university co-researchers were also the awardees of the grant, do the

university held the funding and hired the staff. Though we collaborated on hiring decisions,

requiring the university co-researchers to develop new policies with their Human Resources

department, the decisions about where and when to share power were always unidirectional, and

coming from the university. It was important to acknowledge that university researchers were

constrained by expectations from NIH, the broader peer science community, and their own

values based intervention science perspective. Certain decisions, such as a decision to dispense

with outcome measures entirely would have responded directly to many or our co--researchers’

local community values and preferences, was off the table, at least at that historical juncture, for

the development of this cultural intervention as an evidence based practice.

Phase 3: Final Measurement Model

At the end of Phase 2, our collaborative measurement development work led us to discard

entire measures into which our research team had by now invested significant time. This required

the university co-researchers to significantly reduce in scope their outcome measurement

strategy in terms of the number and breadth of constructs assessed. The team recognized the risk


this entailed. In dropping some of the constructs, we recognized some of the constructs we chose

to reject might have proven critical outcomes for demonstrating program efficacy through the

effect sizes they could have produced in response to the intervention. The university co-

researcher team also devoted considerable efforts attempting to make the measures we retained

even briefer. This also involved risk. With fewer items, the assessments would no longer be

tapping the remaining constructs at the originally proposed level of depth and coverage. The

assessments might become insufficiently sensitive to critical change processes most responsive

to intervention. At this time, the research team also did not have sufficient pilot data on which to

base these decisions. We had information from very small pilot samples on general

psychometric characteristics but limited data on individual item functioning and no data on scale

or item responsiveness to intervention. This required us to combine the limited existing data with

our experiences in working with these communities over the years and our past work on the

protective factors theory. This was combined with critical input during our ongoing consultations

with community co-researchers, many of whom, by virtue of their ongoing work on the measures

to this point, had now developed increasingly sophisticated understandings of the measures and

their objectives.

At this point, the university co-researchers felt they confronted a dilemma based within

two value systems, which were in conflict, and to varying degrees, were both now internalized.

The perspective of measurement science was clear in terms of what constituted the most

defensible decision from this value system; a significant body of literature called for among

several things, a thorough mapping of the constructs using lengthy scales composed of related,

direct questions. At the same time, the University co-researchers were also clear about their

responsibility to communities to live up to their commitment to a participatory structure for the


research. At its more core level, this involves honoring the rights of communities to reject

research procedures unacceptable to local standards, when presented through key community

members.

What constitutes the community is an important question in CBPR. In this controversy

about the use of self-report measures using direct questions about personal and sensitive topics,

the reluctance and concerns about use of the self-report measures was not universal. The

majority of the representatives for one community did not have the same, strong negative

reactions to the measures that several of the key co-researchers from the second community

experienced. This other group would have found the existing measures acceptable given the

benefit of the intervention. The co-researchers differed in the immediacy of the problem of

suicide in their communities. One community had experienced a history of numerous suicides,

while the co-researchers most vocal in their concern were from the other community that had

not. This second community had experienced less cultural contact, enjoyed more widespread use

of tribal language among youth, and was more focused on concerns regarding youth alcohol

abuse, and not suicide. While we will discuss this in more detail as part of the case study in the

third section of this report, we want to emphasize here the co-researcher response was complex,

multifaceted, and contained diverse perspectives, including some perspectives without concerns

regarding the measures. However, we were clear the CBPR perspective dictated research be

responsive to community needs and decisions, and the cultural values of the community. This

issue activated strong reactions within at least one segment of the community. The university co-

researchers also had some understanding of the difficult dilemma the community co-researchers

similarly faced.


The community co-researchers faced a similar level of dilemma in that even those most

opposed to use of any self-report measures of youth sincerely desired for their communities the

potential benefits of the prevention program and its resources. Moreover, they were genuinely

interested in research about types of activates and experience that would benefit their youth, and

more broadly, about solutions that might help address the pressing community needs associated

with the devastating problems created by alcohol and suicide. They were instead asking for

different research method, and frustrated by responses from the university co-researchers about

the range of options they understood as acceptable to establishing an evidence base from the

perspective of funders and peer review. In contrast to this university co-researcher perspective,

from one traditional cultural perspective, one could question why one would even go talk to

youth, instead of those who from a cultural perspective should know answers to these types of

questions–which might instead involve interviewing elders as the credible information source

regarding changes in the community that they observed following intervention. The community

co-researchers also had to return home to these small close-knit communities and their

neighbors, and live for the next several years with the fall out from assessments that would be

understood locally as their work. Many of our co-researchers had thoughtful perspectives, a

personal level of discomfort, and concerns as to how their neighbors and extended families in

their community would be affected by these measures.

Negotiating Across Perspectives and Value Systems

This event in our research process was a clear flashpoint in the values conflict that can

emerge between the values of science as practiced in our current intervention research, and the

values of the communities with which we work. The dilemma needed to be negotiated before the

project could proceed. In addition, given our timeline, we had only one month to do this. This


surfaced yet another conflict, one rooted in values regarding time: the NIH grant had an

inflexible timeline. If the specific aims were not completed by the next competitive renewal

application deadline, further funding for this project was jeopardized.

The university co-researchers explored alternative assessment strategies in consultation

with our group of external research consultants. This included exploration of several alternatives

that included options from exclusive use of qualitative assessment to working within the severe

limitations of the existing social indicator or potentially feasible nonreactive or unobtrusive

measurement strategies. This consultation yielded generally pessimistic assessments, in that

these approaches would provide inadequate outcome assessments to establish an evidence based

practice. In the face of this feedback and the time demands, the university co-researchers best

efforts to devise briefer measures and to drop direct questions about suicide, suicide ideation, and

follow up questions about alcohol use to those who claimed nondrinking status, were evaluated

as still too lengthy and intrusive by many of our community co-researchers. However, together

we negotiated a strategy to move forward. This strategy was based in our evolving relationship

and developing trust. Essentially the proposal was to revise the measures further using the

comparatively large data set collected from the Cuqyun project, our measurement development

study. Unfortunately, due to the vagrancies of grant funding, the award date for this

measurement development project for the intervention was not until after the first wave of data

collection in the two intervention projects.

As part of this strategy, community co-researchers were asked to request community

participants complete measures perceived by many of them as lengthy and intrusive. This would

allow our research team to work to collect a large enough data set to use multivariate statistical

techniques, in particular IRT, to construct working, very brief measures of change for future


prevention programs in other communities. University co-researchers committed to use the

Cuqyun data to develop these briefer measures, and to use these briefer measures in the future

envisioned prevention trial with other communities, which could occur if we demonstrated the

intervention’s feasibility in the two community feasibility study projects. In this way,

communities currently engaged in the research would be giving to future intervention

communities.

Following this agreement, the goal of this final phase of measurement development was

to revise the working measurement model from Phase 2 into a set of measures that would be

acceptable to communities. This involved work to construct new briefer measures of constructs

acceptable to communities led us to two interrelated specific aims, which where to minimize

measurement error produced by the items on these briefer scales and to select the best

functioning items in terms of their information value. This was conducted through three

interrelated processes.

First, because we were now using even fewer items than in our pilot work, we resolved to

use the baseline data from the Elluam Tungiinun (ET) and Yupiucimta Asvairtuumallerkaa (YA)

projects, our two community intervention feasibility studies, to minimize measurement error on

the item level, using small sample IRT estimates of item functioning. We monitored item level

functioning and scale functioning during baseline administration of outcomes measures in the ET

and YA projects. Making careful use of extremely small sample (n > 50) IRT testing, we sought

to identify individually poorly functioning items at Time 1. We rewrote and revised these items,

and explored improvement in fit following item revision at Time 2, one month following Time 1

administration. An item was dropped if fit to the underlying latent trait did not improve.

Second, following baseline administrations, we tested this Time 2 item set using a large


sample (n = 452) in the Cuqyun measurement development project. We used the Cuqyun data in

two ways. One approach made use classical test theory. We sought to develop scales in ways that

maximized their internal consistency alpha values to acceptable ( = .80-95) levels. We were

also finally able to use IRT analyses with sample sizes described in the conventional IRT

literature (e.g., Forero & Maydeu-Olivares, 2009) as sufficient to provide precision in estimates

of individual item fit, item discriminability indices, and item location on an item difficulty

continuum for each homogenous item scale. This allowed us to rigorously construct final item

sets for measures of several constructs within the protective factors model with good to excellent

psychometric properties for an SEQ test of the theory.

Third, the Cuqyun work with IRT techniques also allowed for the construction of brief

outcome measures of change using graded response models. Because of the small sample sizes

in our outcome work, and the resultant limited power afforded analyses of these outcomes, we

did not preserve multiple subscales in the measures of change for outcome analyses. Instead, we

selected a very small set comprised of the best functioning items from all the subscales in each

measurement variable along a continuum of item difficulty in a graded response model. This

resulted in a single measure of change for each of the latent variables we established through the

SEQ modeling work, for testing of intervention impact.

A report on the resulting measurement properties of the long version of the scales

intended for protective factors research and of the outcome of the path analytic test of the model

based in the protective factors theory is described in Allen, Mohatt, Fok et al. (this issue).

Measurement properties of the measures of change and their use in the intervention feasibility

studies are described in Mohatt, Allen et al. (this issue). Fok, Allen, Henry and PA Team (2011;

2012) and Allen, Fok, Henry, Skewes, and People Awakening Team (2012) provide detailed


reporting of the confirmatory factor analytic and item response theory analyses on the

psychometric functioning of several of the resulting brief scales.

Measurement Model and Measures

Table 3 describes the resulting measurement model consisting of the six final latent

variables, the six associated measurement variables, and the final two sets of measures. Only

adequately functioning subscales were retrained in the model, and within subscales, poor

functioning items were dropped. The actual content measured by these brief subscales had

changed and in some cases narrowed, so these scales were re-evaluated by the YRCC, who

revised the Yup’ik terms descriptive of their latent constructs. The Latent Constructs column is

presented in two ways. It first provides the Yup’ik term and its literal translation, which are

presented to provide the reader something of their understanding from the perspective of

Indigenous theory. Following this is the term assigned by the university co-researchers, more

rooted in the perspective of Western intervention theory. Next is listed the more restricted

measurement defining the latent variable. The next two columns describe the subscales and items

for the theoretical model testing measures, while the final three columns describe the outcome

measures of change through their scale names, items, and variable type (proximal or ultimate).

These change measures constructed using graded response models combined the theory testing

measures subscales defining a measurement variable into a single briefer outcome measure

responsive to community requests for shorter measures.

Comparing Tables 2 and 3 shows the extent of changes in response to co-researcher and

community input. The Table 3 Yup’ik language descriptors and their translations describe our

co-researchers’ current understanding of each construct, developed during a two-day workshop

on measurement with our regional Yup’ik co-researcher group, the Yukon Regional


Coordinating Council. Several alterations were made in each of the final three proximal, the

intermediate, and the two ultimate latent variables, as described below. An entire latent variable

(Explanatory Style) was dropped, and with this the entire group of subscales from the CASQ-R

measure. Entire measures and measurement variables were also dropped from the remaining

latent variables. The social network questions on family (SN-F) and community (SN-C) proved

too complex for younger adolescents, and the Alaska Native Protective Factors-Family

Characteristics Scale (PF-F) was too lengthy and had marginal reliability. In response to

community concerns about repeated, similar direct questions about drinking,

Significant changes occurred in the ultimate variables. The entire Alcohol Attributions

measurement variable, comprised of the SSE and the DBI, was dropped. For the measurement

variable Alcohol Consequences, the longer 15-item adapted Drinkers Inventory of Consequences

for Alaska Natives (DrInC-AN) adolescent measure was replaced by a five item brief measure of

past month consequences, and this was administered with the Quantity-Frequency Binge Episode

(Q-F-BE). To address the community concerns about asking these question of nondrinking

youth, these alcohol measures were administered using an adaptive testing approach. The

software only administered these two alcohol scales to those youth who responded affirmatively

to a screening question that asked if they had ever drank alcohol. In the end, only a limited

number of youth endorsed drinking at baseline. This was not completely surprising as these

communities voted through the local option law to make alcohol use is illegal for adults as well

as youth. More youth acknowledged alcohol use only after a year of establishing relationships of

trust with our team through the intervention program. They later told us during dissemination

activities, that at that time in the first assessment, they were not being honest about their use. In

addition, a significant number of the youngest participants were actually entering the program


before they had experimented with alcohol, or had only experimented with alcohol a few times.

This led our group to determine what we had originally conceived as an intermediate variable,

Reflective Processes (RP), was instead a better, more developmentally and contextually

appropriate outcome measure for intervention as an ultimate variable. The Reflective Processes

on the Consequences of Alcohol Use (RP) scale (Allen, Fok, Henry, Skewes, & People

Awakening Team, 2012), which measures reflective process about culturally salient reasons for

not drinking, is described below.

The other ultimate variable underwent significant revision. We dropped the SIQ-Jr

measure of ideation in response to strong community concerns about its use, and replaced the

ultimate latent variable construct in response to community concerns about any direct

questioning on suicide. These concerns extended to the direct types of questions about why one

would not end one’s life if they felt suicidal found on the Brief Reasons for Living Inventory for

Adolescents (BRFL-A). This new construct, termed Reasons for Life (RL) is also described

below in the description of scales. Psychometric values for each of these scales is reported for

the theoretical model testing measures in Allen, Mohatt et al. (this issue) and the outcome

measures of change in Mohatt, Allen et al. (this issue).

Intermediate Variables

Elluarrluni Piyugngariluni: “Learning in the Mind of Doing Things in a Masterful

Way”—Individual Characteristics (IC)

The measurement variable of Mastery in this model testing version of the scale retained

15 items to which the youth responds using a 5-point likert scale (Fok, Allen, Henry, Mohatt, G.

& People Awakening Team, 2012). Five of the original 7 items were retained from the Self

Mastery scale, with a few minor vocabulary revisions. A representative item from the 5-item


Mastery-Self subscale includes, “I can solve many of the problems I have on my own.” Only 5 of

the best functioning items form the Communal Mastery scale were retained. The Mastery-

Family, and Mastery-Friends subscales used an identical wording of the item stem for these 5

items with the sole difference interchanging of the word “family” and “friends.” A representative

item stem is “Working together with [family / friends] I can solve many of my problems.”

We found self mastery both predicted limited variance in data when testing the protective

factors model (Allen et al., this issue), and did not change in response to the ET/YA intervention

(Mohatt, et al; this issue). For this reason, outcomes measure of change we dropped Mastery-Self

and retained only the 10 items assessing mastery through family and friends.

Elluarrluteng Ilakelriit: “Nurturing Family” —Family Characteristics (FC)

The measurement variable of Family Environment retained three significantly adapted

FES subscales (Fok, Allen, Henry, & People Awakening Team, 2011); the Parent Moral Focus,

and Religious Behavior FES subscales, despite repeated adaptation efforts, never produced

acceptable internal consistency reliabilities and most items produce poor item characteristics

curves. Nineteen adaptations of the original items provided adequate item characteristics curves

tapping family cohesion, emotional expressiveness, and conflict. Representative items from this

scale include “We spend time doing things together at home,” and “We put down each other

down” (reverse keyed) to which the youth responds true or false. The three subscales in theory

testing measure are combined into a single outcome measure variable.

Nunamta: “Our Community”—Community Characteristics (CC)

The Community Support and Opportunities measurement variable resulted from dropping

the simplified Social Network measure, and the Safety and Community Attitudes Regarding

Alcohol scales, which all functioned inadequately. In the end, through careful IRT and SEQ


modeling work, we discovered 7 very high functioning items accounted for virtually all of the

variance in the entire set of community items in the protective factors model (Allen, Mohatt et al.

(this issue). Representative items include “People are available to me for advice,” and “There are

things that keep me busy,” to which the youth responds using a 5-point likert scale.

Maryarta: “One Who Leads” —Peer Influences (PI)

Peer Influences (PI) is the single Intermediate measurement variable, and is comprised of

two of the four Peer Influences scales adapted from the American Drug and Alcohol Survey

(Oetting & Beauvais, 1990) Peer Discouragement of Alcohol, Tobacco, and Other Drug (ATOD)

Use Scale (Discourage) and Disapproval of Peers’ ATOD Use Scale (Disapproval). We selected

5 adequately functioning adapted items from each scale; our adaptation work focused on

understandability and relevance to rural Alaska Native youth. Representative items include “In

the last week, how often would your friends try to stop you from: Drinking alcohol,” and “In the

last week, how often would you try to stop your friends from: Drinking alcohol,” to which the

youth responds using a 4 point likert scale. For the outcomes measure, a 10-item total scale is

used.

Ultimate Variables

Umyuangcaryaraq: “Reflecting”—Reflective Processes (RP)

We selected the measurement variable of Reflective Processes on the Consequences

Alcohol Use (Allen, Fok, Henry, Skewes, & People Awakening Team, 2012) to replace the

Alcohol Use and Alcohol Consequences measurement variables as one ultimate of the two

variables. All youth could provide data for this was a variable, which was not the case for

alcohol use, and our theory and retrospective research with adults (Allen at al, 2006) indicated it

was an important determinant of problem and nonproblem drinking and the decision not to drink


that was predicted by individual, family, and community characteristics protective factors. Three

4-item subscales tap reflective process on the potential impact of alcohol abuse on Wangnun

Piyumiutenka, or “Things I Want for Myself” (Self), Ilamnun Piyumiutenka, “Things I Want for

My Family” (Family), and Ilamnun Piyumiutenka, “Things I Want for Our Way of Life (Way of

Life). To answer items, the youth is instructed “Below is a list of reasons people have told us

helped them stay away from alcohol. Think of how each reason applies to you,” then asked to

respond to the following stem “If someone asks you to drink alcohol and you say no, it is

because…” Representative items include “You do not want to lose control of yourself,” “You

would feel embarrassed to have drinking in your family,” and “You want to be the kind of

person that your parents want you to be.” The youth responds using a 5-point likert scale. The

theory testing measures uses the 3 subscales, while the outcome measure of change using the

total score.

Yuuyaraqegtaar: “A Way to Live a Very Good, Beautiful Life”–Reasons for Life (RL)

The second ultimate measurement variable involved a major adaptation of the Brief Reasons for

Living Inventory for Adolescents (BRFL-A; (Osman, Kopper, Barrios, Osman, Besett, &

Linehan, 1996), itself a modification for youth of an adult measure, the Reasons for Living

Inventory (Linehan, Goodstein, Nielsen, & Chiles, 1983). The Reasons for life measure included

significant changes in the instructional set for the items, and the item wording and meaning in

order to make the measure more acceptable to community co-researchers. While the RL retains

similar subscale dimensions to the BRFL-A, this adaptation work also appears to have altered the

construct in important ways. Whereas the BRFL taps reasons why a person would not end life

when they feel suicidal, the RL scale instead taps beliefs and experiences that make life for

Yup’ik youth enjoyable, meaningful, and worthwhile, regardless of the presence or absence of


suicidal feelings and without asking about suicide. The instructional set is “Below are listed

some things that make life enjoyable and worthwhile for some people. Please indicate how

important each reason is to you.” Fourteen items are organized into 4 subscales tapping reasons

associated with others’ assessment of me (Others’ Assessment), cultural and spiritual beliefs

(Beliefs), sense of efficacy (Efficacy), and Family Responsibility. Representative items include

“Other people say I live my life in a good way, My Elders teach me that life is valuable, I have

the courage to face life, “ and “My family depends upon me and needs me.” The youth responds

using a 5-point likert scale, and the theory testing scale includes the 4 subscale scores, while the

outcome measure of change combines items into one total score.

Engaging Anew: CBPR Shaping Research and Researcher

Over the past decade, we have engaged several Alaska Native communities in

collaborative relationships to tackle serious health concerns in the areas of obesity and diabetes

(Boyer et al., 2006) and alcohol and substance abuse (Allen, Mohatt, Hazel, Rasmus, Thomas, &

Lindley, 2006; Mohatt, Hazel, Allen, Stachelrodt, Hensel, & Fath, 2004; Mohatt, Rasmus,

Thomas, Allen, Hazel & Hensel, 2004). While the lessons learned from these collaborations

were particularly useful for preparing the contextual soil to engage the communities in CBPR,

several cultural and community issues surfaced in this project, namely instrument content

meaning and response styles and the population-community distinction which played out in the

community differences we observed. These two stories will be discusses shortly with an

interrelating backdrop provided first.

As mentioned in the procedures section above, we did not begin with a blank slate in

which all assessment instruments needed to be developed or adapted to the Yup’ik cultural

context. Many of the measures, particularly those assessing substance use protective factors,


were formulated and constructed by selecting items from the PA project life histories (Allen et

al., 2006). However, those measures were developed with the broad goal of assessing sobriety

constructs in Alaska Native populations. Here, we wanted to engage specific communities in

assessing a substance abuse and suicide prevention program for youth, families, and

communities built on the People Awakening model. We therefore had to consider whether these

more general instruments were appropriate for the specific communities involved in the project.

Because of our experiential knowledge of community differences a new iterative process of

measurement adaptation was demanded as a result of our commitment to engaging community

members as co-researchers. While this was challenging at times to say the least, the richness of

these experiences for our research team and the additional lessons learned are recounted here.

The first story shared involves broad issues in cross-cultural measurement relating to item

meaning to those whom the instrument was intended for and cultural response patterns.

In the beginning stages of the CBPR project UAF and community co-research team

members attended a four-day workshop and training. During this initial meeting we discussed in

detail the proposed measurement instruments and assessment procedures. Gonzalez and Trickett

(this issue) describe in detail one key event during this meeting regarding community co-

researcher team concerns the cultural appropriateness and acceptability of the measurement

approach. The current paper will describe an additional issue that arose during this meeting and

our technical work to resolve it that was not discussed, because of page limitations, in Gonzalez

and Trickett. In addition, the current paper will also describe technical aspects of the solution

arrived at through the negotiation described in Gonzalez and Trickett regarding direct questions

about alcohol and suicide.


The first additional issue was related to the cultural meaning of items, and more

particularly the response options for items using a likert scale format. Previous work by research

team members (Mohatt, Hazel et al., 2004; Allen, Mohatt et al., in press) with Alaska Native

participants also observed this confusion created by the standard response formats used in survey

research. More specifically, when working with Yup’ik participants, we found there is a

reluctance to commit to one definitive answer to a question; very often there was the desire to

qualify the response with an “it depends” addendum to the response choice. In other words, it

often didn’t make sense cross-culturally that we would be asking the participant to answer an

item like “Are there safe places to go in your community” with choices ranging from “not at all”

to “always/all the time”. For many Yup’ik, and many other Indigenous persons, there is usually

more than one “correct” or right answer to a problem or situation. Culturally, this relates to

communication patterns in small, close, collectivistic communities where one adaptively

negotiates social situations using noncommittal terms.

Interestingly, we learned the larger the range of response choices, the more reluctance

there was to commit to an answer and the more confusion there was about the item; those

additional anchor points within the range (such as “hardly”, “nearly all the time”, etc.) made very

little sense in the Yup’ik cultural context. This came out of attempting to translate response

choices and finding no linguistic equivalence beyond a 3-point set of anchors that was based on

previous work with Yup’ik communities (Mohatt, Hazel, et al., 2004). After considerable

discussions and consultations with our current community co-investigators and cultural experts, a

3-point response option was again determined most appropriate for Yup’ik participants.

In the People Awakening Project, Mohatt, Hazel et al. (2004) reported how a slider tool

was created that allowed participants to represent their answer by placing the bar along the


continuum. In relation to the current project, the assessment protocol was being developed as a

web-based procedure for youth. Rather than simply “clicking” on one of the three response

choices, participants were asked to slide a salmon icon somewhere on the continuous 3-point

scale that best fit their response. This allowed the participant to avoid being “tied” to one

particular choice that may not have had the same cultural meaning; thus allowing for “nearly” or

“sometimes” option without the additional confusing language within the scale (Mohatt, Hazel et

al. 2004).

Another area of discussion centered on item wording and meaning – particularly the idea

of interdependent cultural perspectives – or cultural response patterns. This issue was explored

in considerable detail in Gonzalez and Trickett (this issue); here we describe additional

perspectives and the technical aspects of the negotiated solution. This concern seemed to involve

two interrelated layers: individualistic-collectivistic issues and speaking for self versus others.

On the one hand, in Western individualistic cultures, such as the U.S., questionnaires are written

in a first person format with the assumption the respondent will provide their independent

perspective (i.e. I don’t like the taste of it). Yup’ik culture, like many Indigenous cultures, is

more collectivistic which translates into an avoidance of using many first person markers in

speaking and language. However, there is also a Yupik cultural value not to speak for another

person or group, and to only speak for oneself. Ultimately, the community co-researchers

warned the team that the idea of asking many first person questions to Yup’ik individuals could

be too intrusive and in some cases lead a reluctance to respond. One of the tasks of the four-day

meeting was for all the research team members to complete the proposed measures and reflect on

the process and items. Gonzalez and Trickett describe the debate that ensued after one of the

community co-researchers first expressed concern about the first-person nature of many of the


items, and how certain topics were more of a concern than others regarding asking first person

questions. For example, as noted in Table 3, there were measures of self and communal mastery

as well as specific measures assessing individual and community protective factors against

alcohol use. Community members seemed to agree that when asking about self and communal

mastery, first person type of questions were appropriate because many of the questions were

linked to others and conveyed a collectivistic tone (i.e., “Working together with family I can

solve many of my problems”). It made cultural sense to ask if a youth’s success/difficulty was

tied to their family or community. As Gonzalez and Trickett described, the topic of most

concern for some members of the community co-investigators regarding first person type of

questions was related to substance use and suicide, and was focused on issues of suggestibility

interwoven with cultural values and concerns regarding historical trauma.

The concern about assessing substance use and suicide seemed to have several layers

based on cultural influences and community differences. Here is where the interrelated and

interwoven story of community differences began to take shape. The general Alaska Native

Leadership (Alaska Federation of Natives, 1994) and many communities recognize the need to

address the alcohol and substance abuse issues facing their people. However, it remains a

sensitive and stigmatized area - where communities vary on the relevance of the issue and their

readiness to address the issue and make changes. This is not to say that communities don’t want

to change or address the issue, but rather how direct or indirect they want to be is the concern.

Furthermore, this ambiguity interacts with cultural beliefs and affects how communities want to

talk about and discuss substance use with their youth.

In our process, there was a discussion led by community co-investigators regarding

asking alcohol use questions to youth, particularly at such a young age, and how that could


influence their (the youth) life choices and decisions to use alcohol. This discussion did not

reflect a denial that youth do not “see” or are not aware of alcohol use in their communities, but

reflected a cultural, and more specifically, community concern about just how direct we are with

youth and the role of this prevention program. For example, community co-investigators from

one community viewed substance use and suicide as paramount, and wanted to be very direct in

asking youth and family members about. In contrast, co-investigators from the other community

were very reluctant to do so – they were not in denial of the youth being exposed to substance

use (and suicide) – but were concerned about the influence that actual direct questioning might

have and about “inviting” this influence into the community.

More importantly, this was an opportunity for the community co-investigator to educate

the rest of the research team on the intricacies of community and culture; to share the needs and

desires of community members for his village; and to share in the decision making process

regarding the assessment protocol. The community co-investigator was not saying we should not

assess alcohol use, but rather was saying we need to be aware of the consequences of assessing

alcohol use in his particular community context. For example, the community co-investigator

pointed that all youth would be exposed to questions about the “taste of alcohol” and the “way

alcohol makes me feel” without knowing if the youth has even experimented with alcohol. This

was viewed as too intrusive and potential too influential by this community member.

The end result of that particular discussion was an adaptation of the alcohol use

instrument item sequencing with the addition of a “conditional” set of items. For youth, the

assessment procedure was being developed as a web-based method where youth participants

used the computer to complete the questionnaires. This allowed us to control when and what

questions could be viewed and answered by the participants. Instead of exposing all youth to


questions that asked about the use of alcohol and its effects on a person, youth were asked a few

questions about if they ever used alcohol in the past – and then being “exposed” or presented

with the remainder of the items about alcohol was conditional on whether they affirmed those

initial alcohol use statements.

The trust and confidence gained from the process also facilitated the discussions on

suicide assessment that was and continued to be a difficult topic and further highlights the

population-to-community differences and construct relevance across communities within the

same cultural group. As discussed in Trickett and Gonzalez (this issue), the two Yupik

communities in our initial prevention projects differed on a number of characteristics,

particularly their respective histories with suicide.

During our intensive discussions on suicide measures historical and cultural factors were

voiced that allowed us all to learn and appreciate the concerns. In Yupik culture, as in many

other Indigenous cultures, suicide is considered a spirit that “visits” a community or individual to

bring harm. In addition, there is a strong cultural belief that if one talks or thinks too much about

these spirits, they are in essence inviting those spirits to “visit” them or their community. Co-

investigators from the second community believed that their village has not been visited by this

spirit and by exposing their youth to the thoughts of suicide could constitute an invitation. These

concerns and statements, in fact, actually validate the awareness these community members have

about the serious impact of suicide. For the outsider, it is a mistake to interpret these thoughts

and concerns as irrational fears.

In the end, this effort led to the creation of innovative measures for two new ultimate

variables, tapping Reasons for Life and Reflective Processes on the Consequences of Alcohol

Use, as described above in Phase 3. Furthermore, the measurement development and the


feasibility study data provided support that these measures, in addition to being acceptable to

communities, displayed good psychometric operating characteristics and identified measurable

outcomes (Allen, Mohatt, Fok, Henry, and Burkett, this issue; Mohatt, Allen, Fok, Henry, and

People Awakening Team, this issue). This solution was an important learning process in our

work – we were able to both engage and increase community commitment, and honor the rigors

of scientific inquiry.


References

Alaska Federation of Natives (1994). A call to action: Taking community responsibility.

Anchorage, AK.

Allen, J., & Walsh, J. R. (2000). A construct-based approach to equivalence: Methodologies for

cross-cultural and multicultural personality assessment research. In R. H. Dana, (ed.),

Handbook of multicultural/cross-cultural personality assessment (pp. 63-85). Mahwah,

NJ: Erlbaum.

Allen, J., Mohatt, G.W., Hazel, K., Rasmus, M., Thomas, L. & Lindley, S., & People Awakening

Team (2006). The tools to understand: Community as co-researcher on culture specific

protective factors for Alaska Natives. Journal of Prevention and Intervention in the

Community, 32, 41-59.

Allen, J., Mohatt, G. V., Fok, C. C. T., Henry, D., & People Awakening Team. (2009). Suicide

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Allen, J., Mohatt, G.V., Rasmus, S. M., Two Dogs, R., Ford, T., Iron Cloud Two Dogs, E.,

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Indian and Alaska Native Youth: The Elluam Tungiinun and Nagi Kicopi Programs. In P.

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Allen, J., Fok, C.C.T., Henry, D., Skewes, M., & People Awakening Team. (2012).

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COLLABORATIVE MEASUREMENT DEVELOPMENT PROCEDURES 67

Table 1 Phase 1: Initial Proposed Measurement Model: Variables, Levels of Variables, Instruments, Types of Variables, and Informant

Variable Level of Variable Instrument Type of

Variable Informant Development Status at Start of Measurement Development

Efficacy IndividualCommunal Mastery Scale (CM) Proximal Youth Existing Measure: Used with Adult AI,

No Adolescent; No AN

Self Mastery Scale (SM) Proximal Youth Existing Measure: Adapted for and Used with Adult Yup’ik, No Y Adolescent

Learned Optimism Individual Children's Attributional Style

Questionnaire (CASQ) Proximal Youth Existing Measure: Adolescent, No AI/AN

Family Environment Family Family Environment Scale (FES) Proximal Youth Existing Measure: Adolescent and

Parents, No AI/AN

Family Social Network Family Alaska Native Social Network-Family

Subcale (SN-F) Proximal YouthPlanned Adapation of Existing Measure:

Developed for Adult Yup’ik, No Adolescent

Family Protective

FactorsFamily Alaska Native Protective Factors-Family

Characteristics Scale (PF-F) Proximal YouthPlanned Adapation of Existing Measure:

Developed for Adult Yup’ik, No Adolescent

Community Readiness Community Community Readiness Assessment

(CRA) ProximalAdult

Community Informants

Existing Measure: Adapted for Used with Yup’ik

Alcohol Consequences Individual

Drinker Inventory of Consequences for Alaska Native Adolescents (DrInC-AN-

A)Ultimate Youth

Planned Adapation of Existing Measure: Developed for Adult Yup’ik, No

Adolescent

Alcohol Use Individual Quantity/Frequency (Q-F-BE) Ultimate Youth Planned Adapation of Existing Measure: No Yup’ik, No Youth

Suicidal Ideation Individual Brief Reasons for Living Inventory for

Adolescents (BRFL-A) Ultimate Youth Existing Measure: Adolescent, No AN

Note: Development Status at Start of Measurement Development indicates if the measure is an existing measure, a planned adaptation of an existing measure, or new measure to be developed, and the extent of previous use of the instrument with adolescents and Yup’ik, Alaska Native, and American Indian samples; Existing Measure indicates measure used in previous research; Planned Adaptation of Existing Measure indicates the project planned to adapt for Yup’ik youth a measure used in previous research with non-Yup’ik samples, Non-Yup’ik adolescents, or Yup’ik adults; Developed for Yup’ik Adults indicates measure was developed for Yup’ik adults and used in previous research with Yup’ik; Used with Adult AI indicates used in previous research with American Indian adults; No Adolescent indicates not used in previous research with adolescents; No AI indicates not used in previous research with American Indian samples, No AN indicates not used in previous research with Alaska Native samples.


Table 2. Phase 2; Revised Proposed Youth Measurement Model: Latent Variables, Measurement Variables, Instruments, Adaptation Status, and Type of Variable

Latent Variable Measurement Variable Instrument

Culturally Adapted for Yup’ik/ AN

Adapted for Adolescents/Adolescent

Measure

Type of Variable

Yuum Qaillun Ayuqucia: Individual Characteristics (IC)

EfficacyIC1: Self Mastery Scale (SM) Yes Yes Proximal

IC2: Communal Mastery Scale (CM) Yes Yes Proximal

Ilakellriit Qaillun Ayuquciit:

Family Characteristics (FC)

Family Protective Factors

FC1: Alaska Native Protective Factors-Family Characteristics Scale (PF-F) Yes Yes Proximal

FC2: Alaska Native Social Network-Family Scale (SN-F) Yes Yes Proximal

FC3: Family Environment Scale (FES) No Yes Proximal

Nunam Qaillun Ayuqucia: Community Characteristics (CC)

Community Protective Factors

CC1: Alaska Native Protective Factors-Community Characteristics Scale (PF-C) Yes Yes Proximal

CC2: Alaska Native Social Network-Community Scale (SN-C) Yes Yes Proximal

Yuut Nunami Uitallrata Ayuquciat: Social Environment (SE)

Peer Effects

SE1: Peer Discouragement of ATOD Use (PDU) No Yes IntermediateSE2: Disapproval of Peers’ ATOD Use (DPU) No Yes IntermediateSE3: Peer Encouragement of ATOD Use (PEU) No Yes IntermediateSE4: Friends’ School Adjustment (FSU) No Yes Intermediate

Umyuangcaarane: Thinking Over Alcohol

Use

Alcohol Attributions

TO1: Substance Use Self-Efficacy Scale (SSE) Yes No IntermediateTO2: Decision Balance Inventory and Stages of Change Algorithm (DBI) Yes No Intermediate

Life Goals Reflection

TO3: Alaska Native Protective Factors-Reflective Process Scale (PF-RP) Yes No Intermediate

Explanatory Style Learned Optimism

ES1: Children's Attributional Style Questionnaire-Revised (CASQ-R) No Yes Intermediate

SobrietyAlcohol

ConsequencesS1: Drinker Inventory of Consequences for Alaska Natives-Adolescents (DrInC-AN-A) Yes No Ultimate

Alcohol Use S2: Quantity/Frequency/Binge Episode Measure (Q-F-BE) Yes No Ultimate

Yuuguryuumiuci: Reasons For Living

Reasons for Living

RFL: Brief Reasons for Living Inventory for Adolescents (BRFL-A) No Yes Ultimate

Suicidal Ideation SI: Suicide ideation Questionnaire (SIQ-Jr) No Yes UltimateNote: Culturally Adapted for Yup’ik/AN indicates culturally adapted for Yupik or Alaska Natives at start of Phase 2; Adapted for Adolescents/Adolescent measure is at start of Phase 2.


Table 3. Phase 3: Final Protective Factors Measurement System for Theoretical Model Testing and for Outcome Measures of Change: Latent Variables, Measurement Variables, Model Testing Scales and Scale Items, Outcome Assessment Scales and Scale Items, and Outcome Variable Types

Theoretical Model Testing Measures Outcome Measures of Change

Latent Variable Measurement Variable Model Testing Scales Model Testing

Scale ItemsOutcome Assessment

ScalesOutcome

Scale ItemsOutcome

Variable TypeElluarrluni piyugngariluni: “Learning in the Mind of Doing Things in a Masterful Way”–Individual Characteristics (IC)

Mastery

IC1 Mastery-Self 5 (5-pt likert)Individual

Characteristics: Communal Mastery- Family and Friends

10(5-pt likert) Proximal

IC2 Communal Mastery-Family 5 (5-pt likert)

IC3 Communal Mastery-Friend 5 (5-pt likert)

Elluarrluteng ilakelriit: “Nurturing Family”–Family Characteristics (FC)

Family Environment

FC1 Cohesion 9 (true/false) Family Characteristics: Cohesion,

Expressiveness, and Conflict

19 (true/false) ProximalFC2 Expressiveness 7 (true/false)

FC3 Conflict 9 (true/false)Nunamta:“Our Community”–Community Characteristics (CC)

Community Support and

Opportunities

CC1 Support 3 (5-pt likert) Community Characteristics:

Support and Opportunities

7(5-pt likert) Proximal

CC2 Opportunities 4 (5-pt likert)

Maryarta:“One who Leads”–Peer Influences (PI)

Peer Influences

PI1 Peer Discouragement of Drug Use

5 (4-pt likert) Peer Influences: Discourage and

Disapprove

10(4-pt likert) Intermediate

PI2 Disapproval of Peer Drug Use 5 (4-pt likert)

Umyuangcaryaraq: “Reflecting”–Reflective Processes (RP)

Reflective Processes on Alcohol Use

RP1 Self 4 (5-pt likert) Brief Reflective Processes

5(5-pt likert) UltimateRP2 Family 4 (5-pt likert)

PR3 Way of Life 4 (5-pt likert)

Yuuyaraqegtaar:“A Way to Live a Very Good, Beautiful Life”–Reasons for Life (RL)

Reasons for Life

RL1 Others’ Assessment 4 (5-pt likert)

Brief Reasons for Life 5(5-pt likert) UltimateRL2 Beliefs 4 (5-pt likert)

RL3 Efficacy 3 (5-pt likert)RL4 Family Responsibility 3 (5-pt likert)

COLLABORATIVE MEASUREMENT DEVELOPMENT PROCEDURES

70

Figure 1. Mixed likert-analog response format

Documents

static-content.springer.com10.1007/s104… · Web viewSupplementary Material for Online Publication Only. Appendix S1: Elluam Tungiinun/Yupiucimta Asvairtuumallerkaa Measurement