The population targeted by this study was French adolescents, i.e. subjects between 13 and 18.
Study design
An expert committee was constituted for this study, comprising four confirmed French-speaking child psychiatrists and a medical epidemiologist specialized in questionnaire adaptation. Three of the five committee members were fluent in English. The whole expert committee analyzed original version, a reduce committee, comprising two of the four confirmed French-speaking child psychiatrists and the medical epidemiologist, developed the IPR short version.
Content Validity. Good content validity is an essential property of a measurement scale, as it is an evaluation of the degree to which the content of the scale is relevant with respect to the construct it wants to measure [24]. One of the components of the content validity is the face validity, which is how people perceive and comprehend the items.
The expert committee reviewed the French translation of each of the 62 items (box 1, Fig. 1). If any doubt was raised about the face validity of an item, it was discussed with adolescents (box 2, Fig. 1), and then considered by the expert committee. An English-speaking psychiatrist was contacted if the exact meaning of some items was unclear.
Ten adolescent volunteers were individually interviewed on the face validity of the questionnaire. The written consent of parents was obtained. All 62 items were discussed and specific questions raised by the expert committee were put to them. A qualitative analysis of the responses was carried out. If at least two of the ten adolescents interviewed mentioned a problem of comprehension for an item, it was discussed again by the expert committee (box 3, Fig. 1).
Based on these analyses and the attachment theory, the expert committee proposed a French cross-cultural adaptation of the IPR, used for the remainder of the study (box 4, Fig. 1).
Study of the metric properties of the French version of the IPR. Two independent groups were constituted: one for exploratory approach, further named development group, constituted from voluntary adolescents from schools and colleges; one for confirmatory approach further named validation group, constituted from school enrolled adolescents and adopted adolescents.
All adolescents responded to the 62 items of the IPR. Socio-demographic data were collected from parents. Consent was deemed to have been given when the adolescent and his/her parents completed all of the questionnaires distributed.
All questionnaires in the study were addressed to the parents and not to the adolescent. Consent was obtained by the parents if they responded to the questionnaires. The same was true for the adolescents. The inclusion of adolescents was only effective if all the questionnaires intended for the parents were returned. Indeed, the study was completely anonymous and it had been agreed with the ethics committee had requested that the people carrying out the study not have access to any data that could allow identification of the participants, in relation to the adoption data. The ethics committee validated this method of collecting consent.
Each group had to have a minimum number of four subjects by item, i.e. 62x4 = 248 responses for each parent to perform the analyses according to the recommendations of the COSMIN group [24].
As the items did not have the same valence, positive or negative, the scores of certain items were inverted so that all of the items followed the same direction in the analyses.
Based on the classical test theory, confirmatory factor analyses (CFA) were carried out in the development group on the structures proposed by the developers to explore construct validity (Appendix 1). Several fit indices were used to judge the CFA fit: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) and Root Mean Square Error of Approximation (RMSEA). A CFA was considered to have a reasonable fit with the model if CFI and TLI values were > 0.90 and if RMSEA was < 0.08; the fit with the model was deemed good if CFI and TLI ranged from 0.97 to 1.00 and if RMSEA was ≤ 0.05 [25, 26].
Compiling a short version of the IPR. In case of mediocre results in the CFA of the existing structures, the development of a new, stable, content-based, IPR structure was planned according to the following steps in the development group. It was considered that the same structure might not be appropriate for the mother and the father.
Step 1
New dimensions were identified from qualitative work carried out by the reduced committee. The 62 items were grouped into new dimensions consistent with the theory.
Items or group of items deemed to be irrelevant for measuring attachment were removed and items which posed significant problems in terms of comprehension were also removed.
Step 2
The floor and ceiling effects of responses to the items were taken into consideration in order to select discriminating items. If at least 80% of the sample size had the maximum or minimum response level for an item, it was discussed by the reduced committee and removed if it was not essential for measuring attachment styles.
Step 3
Psychometric properties were analyzed using the development group data based on the structure proposed on step 1.
In order to preserve the structure proposed on step 1, CFA were used iteratively in an exploratory approach. Between each CFA, the model was changed according to the modification indices of the model, which reflect the potential improvement of the model in the event of a change in the structure of the questionnaire, and according to the consistency of the new structure with the content.
The aim was to establish a structure with good fit indices and factor loadings > 0.4. If the presence of an item or a group of items was unnecessary in terms of content, it was removed. If some items did not fit into a dimension or did not present properties acceptable in CFA but were important for assessing attachment in qualitative terms, the reduced committee could decide to retain them.
A single-parameter Rasch analysis was carried out. As the items were polytomous, a Rating Scale Model was used for the analysis [27]. Item response theory was used to check that latent trait was well covered by the items, particularly insecure attachment, and that the sequence of item response modalities was respected. Model fit was evaluated via the infit and outfit mean square (MNSQ). Significant MNSQ values smaller than 0.6 or larger than 1.4 were considered to misfit the model [28, 29].
The Person Separation Reliability index, which assesses internal consistency by measuring the discrimination capacity of the different response levels, was considered good if ≥ 0.80 [30].
If the Rasch analyses yielded unsatisfactory results, the dimension was discussed and modified again by the reduced committee. This process involved going back and forth between several CFA and Rasch analyses combined with an ongoing discussion focusing on content. The Short-IPR obtained at the end of this process was used in the remainder of the study.
Confirmatory analyses of the Short-IPR. The confirmatory analyses were performed on the validation group data. Based on the Short-IPR structure, a CFA and Rasch analysis were carried out using the same criteria.
This study was approved by the relevant ethics committees. All of the analyses were carried out using R software version 3.5.1.