A psychometric evaluation of a new social subscale for the Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire: toward the CM-TBI-II

Figures & data

Table 1. Overview of Common TBI Misconception Measures, Their Development Process and Psychometric Properties in Chronological Order.

Scale and first-named author	Domains	Item development	Item scale	Psychometrics
Untitled scale First author: Gouvier (24)	Use of seatbelts, nature of unconsciousness, nature of amnesia, characteristics associated with brain injury, recovery from brain injury.	Clinical based observations.	4-point scale (false, probably false, probably true, true).	Not known.
CM-TBI First author: Springer (25)	Seatbelts/prevention, brain damage, brain injury sequelae, unconsciousness, amnesia, recovery, rehabilitation.	Clinical observations and items from (24).	4-point scale (true, probably true, probably false, false).	None in original study. Cronbach’s α = 0.75(26).
BIMS First author: Hux (27)	General brain injury knowledge, coma and unconsciousness, memory deficits, brain injury recovery.	Items from (24) if at least 25% incorrect in original research.	2-point scale (true/false).	None in original study. Internal consistencyα = 0.14 (28).
RoCKAS-ST First author: Rosenbaum (29)	Concussion Knowledge Index (CKI) and Concussion Attitudes Index (CAI) in relation to youth athletes.	Items from (24,30,31).	2-point scale (true/false) or 5-point scale (strongly agree to strongly disagree) depending on the section.	Test-retest reliability = 0.79, overall Cronbach’s α = 0.76, subscales α = 0.59–0.72.
PBIS First author: Oyesanya (32)	Perceived knowledge, beliefs, learning preferences of nurses.	Adapted the BIMS for nurses caring for TBI survivors.	4-point scale, with different anchors for the subscales.^1	Overall α = 0.93, subscalesα = 0.73–0.93.

Note. CM-TBI = Common Misconceptions about Traumatic Brain Injury; BIMS = Brain Injury Misconception Scale; RoCKAS-ST = Rosenbaum Concussion Knowledge Survey – Student Version; PBIS = Perceptions of Brain Injury Survey. ¹For example, the beliefs subscale anchors = strongly agree, agree, disagree, strongly disagree; the knowledge subscale anchors = none, some, moderate, expert.

Table 2. Summary of the item development process showing use of the literature and expert feedback to form and refine new CM-TBI-II items.

Sources used for content and domain identification of new items		Item, versions
Empirical Literature	Experts	Phase one	Final
The public may perceive persons with TBI as ‘untrustworthy,’ ‘unproductive’ and ‘not hardworking’ (19,20,26,50)	Experts recommended coverage of ‘return to work.’	I would employ a person with a brain injury. I would not trust a person with a brain injury to take care of my finances.	Items retained unchanged.
The social experience post-TBI can include decreased social status, and increased social deprivation and isolation (4,53)	Experts recommended coverage of: ‘separation from peers due to injury;’ ‘impact on friendships and activities with friends’	People with a brain injury are generally negative and anti-social. I would be hesitant to befriend a person with a brain injury.	Items retained, with rewording for one item: ‘It is common for a person with a brain injury to show anti-social behaviors.’

Note. Experts also suggested further wording alterations for several phase one items to improve the match with existing CM-TBI items (replacing ‘individual’ with ‘people’ or ‘person’ with TBI). This change was implemented. The tabulated expert recommendations were elicited from an item about the key social considerations post TBI.

Figure 1. The selection of community participants across two data collection periods. Notes: T1 = time 1; T2 = time 2. All duplicate attempts were removed from the dataset. § Duplicate attempts screened first, with removal f all attempts by a duplicate responder.** Evaluated via Instructional Manipulation Checks (IMC)s. At T1, participants excluded for fail ure on two or more out of three IMCs. At T2, participants were excluded if the on e IMC was failed. † Unlinked codes included 12 novel T2 codes, and 6 codes that could not be linked after T1 screening.

Table 3. Characteristics of the main study sample.

Characteristic	Statistic
Age (years), m (SD), range	28.52 (14.51), 18–86
Gender, n (%)^1
Male	32 (20.3)
Female	124 (78.5)
Non-binary	2 (1.3)
Highest level of completed education^,*1 n (%)
Some post-primary school	9 (5.7)
Primary and secondary/high/senior school	68 (43.0)
Diploma	23 (14.6)
Bachelor’s degree	48 (30.4)
Master’s degree	9 (5.7)
PhD/Doctorate	1 (0.6)
Previous injury experience, n (%)
Yes, I have personally experienced a mild TBI	14 (8.9)
Yes, someone I know has had a mild TBI	50 (31.6)
No, I have no previous experience	94 (59.5)

Note. N = 158. * School- versus post-school education categories were used in some analyses. School = some post-primary plus primary and secondary/high/senior school. Post-school = all other education subcategories, excluding prefer not to say. 1 = prefer not to say, not endorsed; data not shown.

Table 4. Intercorrelations (Pearson’s R) for CM-TBI-II Block 1 (new) items, 10-item social subscale (lower diagonal), and between the CM-TBI-II social subscale and CAMI-TBI subscales (upper diagonal).

Item or subscale	1	2	3	4	5	6	7	8	9	10
1	-	−.458**	.316**	−.462**	.353**
2	.268**	-
3	.174*	.429**	-
4	.293**	.456**	.447**	-
5	.159*	.336**	.253**	.332**	-
6	.257**	.305**	.435**	.405**	.233**	-
7	.133	.261**	.459**	.289**	.203**	.549**	-
8	.172*	.343**	.481**	.369**	.176**	.471**	.436**	-
9	.293**	.294**	.392**	.48**	.202*	.310**	.319**	.278*	-
10	.298**	.247**	.282**	.247**	.171*	.340**	.337**	.257**	.306**	-

Note. CM-TBI = Common Misconceptions about Traumatic Brain Injury. CM-TBI-II = Extension of the CM-TBI that includes a 10-item social subscale. CAMI-TBI = Community Attitudes toward Mental Illness (TBI adaptation). CMI-TBI-II Social subscale items: 1: It is common for people with a brain injury to be easily identified from those without a brain injury^⸸; 2: It is usually best to avoid people with brain injuries^⸸; 3: People with a brain injury are usually unable to handle important responsibilities^⸸; 4: I would be hesitant to befriend a person with a brain injury^⸸; 5: People with a brain injury can be productive members of society; 6: It is usually difficult to hold a conversation with a person with a brain injury^⸸; 7: People with a brain injury are usually unable to properly think for themselves^⸸; 8: I would not trust a person with a brain injury to take care of my finances^⸸; 9 : I would employ a person with a brain injury; 10: It is common for a person with a brain injury to show anti-social behaviours^⸸. ⸸ = Reversed items. Subscales: 1: CM-TBI-II-Social; 2: CAMI-TBI-Authoritarian; 3: CAMI-TBI-Benevolence; 4: CAMI-TBI-Social restrictiveness; 5: CAMI-TBI Community mental health ideology. * p < 0.01 ** p < 0.001.

Table 5. Descriptive Statistics, Reliability (Internal Consistency), and Group Differences (School versus Post-School) for CM-TBI-II and CAMI-TBI Summary Scores.

					Subgroup analyses
Summary scores: subscales and totals	N (items)	Subscale total M (SD)	Alpha	Subscale Item M	School n = 77	Post-school n = 81	p, d^b
CM-TBI
Recovery	8	31.78 (4.00)	.76	3.97	31.48 (3.85)	32.06 (4.10)	n.s.
Sequalae	6	20.56 (2.93)	.69	3.43	20.56 (2.99)	20.56 (2.90)	n.s.
Insight	3	9.49 (1.82)	.44	3.17	9.30 (1.74)	9.68 (1.88)	n.s.
Hidden injury	3	12.51 (1.59)	.60	4.17	12.27 (1.66)	12.73 (1.49)	n.s.
Total	20	74.34 (6.34)	.72	3.72	73.61 (6.2)	75.02 (6.30)	n.s. (p = 0.164)
Social (T1)	10	38.54 (5.04)	.82	3.86	37.75 (5.32)	39.28 (4.67)	n.s. (p = 0.056)
Social (T2)^a	10	38.76 (5.20)	.87	3.88
CM-TBI-II Total	30	112.87 (7.95)	.71	3.76	111.36 (7.32)	114.31 (8.29)	.019, 7.83
CAMI-TBI
Authoritarianism	10	21.93 (4.03)	.53	2.19
Benevolence	10	41.45 (3.84)	.70	4.15
Social restrictiveness	10	17.12 (4.64)	.82	1.71
Community mental health ideology	10	41.09 (5.21)	.88	4.11
			-	-

Note. N = 158. ^an = 46. ^bSubgroup differences tested using independent-samples t-tests. *p < 0.05 n.s. = nonsignificant d = effect size (Cohen’s d). T1 = Time 1; T2 = Time 2 (i.e., one week after T1). CM-TBI = Common Misconceptions about Traumatic Brain Injury Questionnaire, 20-item version (26). CM-TBI-II = extended CM-TBI (30-items) with social subscale. CAMI-TBI = Community Attitudes Towards the Mentally Ill – TBI adaptation.

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