***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background One economical way to inform patients about their illness and medical procedures is to provide written health information material . So far , a generic and psychometrically sound scale to evaluate cognitive , emotional , and behavioral aspects of the subjectively experienced usefulness of patient information material from the patient ’s perspective is lacking . The aim of our study was to develop and psychometrically test such a scale . Methods The Usefulness Scale for Patient Information Material ( USE ) was developed using a multistep approach . Ultimately , three items for each subscale ( cognitive , emotional , and behavioral ) were selected under consideration of face validity , discrimination , difficulty , and item content . The final version of the USE was subjected to reliability analysis . Structural validity was tested using confirmatory factor analysis , and convergent and divergent validity were tested using correlation analysis . The criterion validity of the USE was tested in an experimental design . To this aim , patients were r and omly allocated to one of two groups . One group received a full version of an information brochure on depression or chronic low back pain depending on the respective primary diagnosis . Patients in the second group received a reduced version with a lower design quality , smaller font size and less information .  Patients were recruited in six hospitals in Germany . After reading the brochure , they were asked to fill in a question naire . Results Analyzable data were obtained from 120 question naires . The confirmatory factor analysis supported the structural validity of the scale . Reliability analysis of the total scale and its subscales showed Cronbach ’s α values between .84 and .94 . Convergent and divergent validity were supported . Criterion validity was confirmed in the experimental condition . Significant differences between the groups receiving full and reduced information were found for the total score ( p<.001 ) and its three subscales ( cognitive p<.001 , emotional p=.001 , and behavioral p<.001 ) , supporting criterion validity . Conclusions We developed a generic scale to measure the subjective usefulness of written patient information material from a patient perspective . Our construct is defined in line with current theoretical models for the evaluation of written patient information material . The USE was shown to be a short , reliable and valid psychometric scale Background Implementation science in healthcare is an evolving discipline in German-speaking countries . In 2015 , the Medical Faculty of the University of Heidelberg , Germany , implemented a two-year full-time Master of Science program Health Services Research and Implementation Science . The curriculum introduces implementation science in the context of a broader program that also covers health services research , healthcare systems , research methods , and generic academic skills . Our aim was to assess the expectations of different stakeholder groups regarding the master ’s program . Methods An online survey listing desired competencies of prospect i ve graduates was developed and administered to four groups : national experts in the field ( including potential employers of graduates ) , teaching staff , enrolled students , and prospect i ve students ( N = 169 ) . Competencies were extracted from the curriculum ’s module h and book . A five-point Likert scale was used for the assessment of 42 specific items . Data were analyzed descriptively . Results A total of 83 people participated in the survey ( response rate 49 % ) . The online survey showed a strong agreement across the groups concerning the desired competencies of graduates . About two-thirds of the listed competencies ( 27 items ) were felt to be crucial or very important by 80 % or more of participants , with little difference between stakeholder groups . Of the eight items specifically related to implementation in practice , six were in this category . Knowledge of implementation strategies ( 90 % very important ) , knowledge of barriers and enablers of implementation ( 89 % ) , and knowledge of evidence -based practice ( 89 % ) were the top priorities . Conclusions The master ’s program is largely orientated towards the desired competencies of graduates according to students , teaching staff , and national experts Background Implementing clinical practice guidelines ( CPGs ) in healthcare setting s is a complex intervention involving both independent and interdependent components . Although the Consoli date d Framework for Implementation Research ( CFIR ) has never been evaluated in a practical context , it appeared to be a suitable theoretical framework to guide an implementation process . The aim of this study was to evaluate the comprehensiveness , applicability and usefulness of the CFIR in the implementation of a fall-prevention CPG in nursing practice to improve patient care in an Austrian university teaching hospital setting . Methods The evaluation of the CFIR was based on ( 1 ) team-meeting minutes , ( 2 ) the main investigator ’s research diary , containing a record of a before- and -after , mixed- methods study design embedded in a participatory action research ( PAR ) approach for guideline implementation , and ( 3 ) an analysis of qualitative and quantitative data collected from graduate and assistant nurses in two Austrian university teaching hospital departments . The CFIR was used to organise data per and across time point(s ) and assess their influence on the implementation process , result ing in implementation and service outcomes . Results Overall , the CFIR could be demonstrated to be a comprehensive framework for the implementation of a guideline into a hospital-based nursing practice . However , the CFIR did not account for some crucial factors during the planning phase of an implementation process , such as consideration of stakeholder aims and wishes/needs when implementing an innovation , pre-established measures related to the intended innovation and pre-established strategies for implementing an innovation . For the CFIR constructs reflecting & evaluating and engaging , a more specific definition is recommended . The framework and its supplements could easily be used by research ers , and their scope was appropriate for the complexity of a prospect i ve CPG-implementation project . The CFIR facilitated qualitative data analysis and provided a structure that allowed project results to be organised and viewed in a broader context to explain the main findings . Conclusions The CFIR was a valuable and helpful framework for ( 1 ) the assessment of the baseline , process and final state of the implementation process and influential factors , ( 2 ) the content analysis of qualitative data collected throughout the implementation process , and ( 3 ) explaining the main findings Background The Worksite Health Promotion Capacity Instrument ( WHPCI ) was developed to assess two key factors for effective worksite health promotion : collective willingness and the systematic implementation of health promotion activities in companies . This study evaluates the diagnostic qualities of the WHPCI based on its subscales Health Promotion Willingness and Health Promotion Management , which can be used to place companies into four different categories based on their level of health promotion capacity . Methods Psychometric evaluation was conducted using exploratory factor and reliability analyses with data taken from a r and om sample of managers from n = 522 German information and communication technology ( ICT ) companies . Receiver operating characteristic ( ROC ) analyses were conducted to determine further diagnostic qualities of the instrument and to establish the cut-off scores used to determine each company 's level of health promotion capacity . Results The instrument 's subscales , Health Promotion Willingness and Health Promotion Management , are based on one-dimensional constructs , each with very good reliability ( Cronbach 's alpha = 0.83/0.91 ) . ROC analyses demonstrated satisfactory diagnostic accuracy with an area under the curve ( AUC ) of 0.76 ( SE = 0.021 ; 95 % CI 0.72 - 0.80 ) for the Health Promotion Willingness scale and 0.81 ( SE = 0.021 ; 95 % CI 0.77 - 0.86 ) for the Health Promotion Management scale . A cut-off score with good sensitivity ( 71%/76 % ) and specificity ( 69%/75 % ) was determined for each scale . Both scales were found to have good predictive power and exhibited good efficiency . Conclusions Our findings indicate preliminary evidence for the validity and reliability of both subscales of the WHPCI . The goodness of each cut-off score suggests that the scales are appropriate for determining companies ' levels of health promotion capacity . Support in implementing ( systematic ) worksite health promotion can then be tailored to each company 's needs based on their current capacity level Background The perspective of users should be taken into account in the evaluation of  Web-based health interventions . Assessing the users ’ satisfaction with the intervention they receive could enhance the evidence for the intervention effects . Thus , there is a need for valid and reliable measures to assess satisfaction with Web-based health interventions . Objective The objective of this study was to analyze the reliability , factorial structure , and construct validity of the Client Satisfaction Question naire adapted to Internet-based interventions ( CSQ-I ) . Methods The psychometric quality of the CSQ-I was analyzed in user sample s from 2 separate r and omized controlled trials evaluating Web-based health interventions , one from a depression prevention intervention ( sample 1 , N=174 ) and the other from a stress management intervention ( sample 2 , N=111 ) . At first , the underlying measurement model of the CSQ-I was analyzed to determine the internal consistency . The factorial structure of the scale and the measurement invariance across groups were tested by multigroup confirmatory factor analyses . Additionally , the construct validity of the scale was examined by comparing satisfaction scores with the primary clinical outcome . Results Multigroup confirmatory analyses on the scale yielded a one-factorial structure with a good fit ( root-mean-square error of approximation = .09 , comparative fit index = .96 , st and ardized root-mean-square residual = .05 ) that showed partial strong invariance across the 2 sample s. The scale showed very good reliability , indicated by McDonald omegas of .95 in sample 1 and .93 in sample 2 . Significant correlations with change in depressive symptoms ( r=−.35 , P<.001 ) and perceived stress ( r=−.48 , P<.001 ) demonstrated the construct validity of the scale . Conclusions The proven internal consistency , factorial structure , and construct validity of the CSQ-I indicate a good overall psychometric quality of the measure to assess the user ’s general satisfaction with Web-based interventions for depression and stress management . Multigroup analyses indicate its robustness across different sample s. Thus , the CSQ-I seems to be a suitable measure to consider the user ’s perspective in the overall evaluation of Web-based health interventions BACKGROUND Depressive disorders place a significant disease burden on individuals as well as on societies . Several web-based interventions for depression have shown to be effective in reducing depressive symptoms . However , it is not known whether web-based interventions , when used as adjunctive treatment tools to regular psychotherapy , have an additional effect compared to regular psychotherapy for depression . METHODS Adults ( N = 98 ) with a unipolar affective disorder were recruited in routine outpatient psychotherapy practice s in Germany from therapists over the course of their initial sessions and r and omized within therapists to one of two active treatment conditions :  regular psychotherapy or psychotherapy plus a web-based depression program ( " deprexis " ) . Primary outcome was depressive symptoms measured with the Beck Depression Inventory ( BDI-II ) at 12 weeks . Secondary outcomes were anxiety symptoms , somatic symptoms and quality of life at 12 weeks and six months follow-up . The study also included an assessment of the working alliance after six and 12 weeks . RESULTS The combination of psychotherapy with the web-based program was more effective than psychotherapy alone at 12 weeks , with medium between-group effect sizes on primary depressive symptoms ( Cohen 's d = .51 ) and small to medium between-group effect sizes on secondary outcomes ( Cohen 's d = .07-.55 ) . Furthermore , we did not observe negative side effects in the blended format , e.g. , a lower working alliance than in psychotherapy alone . LIMITATIONS The study had a smaller than planned sample size and the dropout rate at follow-up was high . CONCLUSIONS This study provides first evidence that the use of a web-based program as an adjunctive tool in regular psychotherapy could be a promising option to consider in future treatment for depression OBJECTIVE Models for the structured delivery of care rely on organizational attributes of practice teams . The Survey of Organizational Attributes for Primary Care ( SOAPC ) is known to be a valid instrument to measure this aspect in the primary care setting . The aim of this study was to determine the validity of a translated and culturally adapted German version of the SOAPC . METHODS The SOAPC was translated and culturally adapted according to established st and ards . The external validity of the German SOAPC was assessed using the German version of the Warr-Cook-Wall scale .  A total of 200 practice s r and omly selected from a conference data base were asked to participate in the validation study . Practice , clinicians and staff characteristics were determined via short-form question naires . We used st and ardized statistical procedures to reveal the psychometric properties of the SOAPC . RESULTS A total of 54 practice teams participated by returning 297 completed question naires ( 297/425 , response rate 69.8 % ) . All four domains of the SOAPC  ( communication , decision making , stress/chaos , history of change ) could be approved by factor analysis . Internal consistency is underlined by a Cronbach 's alpha of 0.70 or higher in all categories . We show strong correlation with the Warr-Cook-Wall scale in all corresponding categories indexing high external validity . CONCLUSIONS The German SOAPC is a reliable and valid instrument for the assessment of organizational attributes of practice teams as the providers of quality of care . Moreover , the tool makes it possible to map the state of implementation of quality management and practice organization . The availability of the German SOAPC encourages further research on this topic in German-speaking countries We translated the  Canadian residential long term care versions of the Alberta Context Tool ( ACT ) and the Conceptual Research Utilization ( CRU ) Scale into German , to study the association between organizational context factors and research utilization in German nursing homes . The rigorous translation process was based on best practice guidelines for tool translation , and we previously published methods and results of this process in two papers . Both instruments are self-report question naires used with care providers working in nursing homes . The aim of this study was to assess the factor structure , reliability , and measurement invariance ( MI ) between care provider groups responding to these instruments . In a stratified r and om sample of 38 nursing homes in one German region ( Metropolregion Rhein-Neckar 
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In addition , we seldom detected instruments operationalizing the CFIR domains intervention characteristics , outer setting , and process , and the IOF constructs adoption , fidelity , penetration , and sustainability .