Psychometric evaluation of the Chinese version of the Toronto Hospital Alertness Test

Abstract

Background: Alertness is an important part of attention which is different from the opposite of sleepiness. This study aimed to translate and assess the measurement properties of the Toronto Hospital Alertness Test (THAT) in Hong Kong Chinese population.

Methods: The standard forward-backward translation procedure and cognitive debriefing were conducted to obtain the Chinese THAT. One hundred Chinese adults completed the Chinese THAT, the Center for Epidemiological Studies Depression Scale (CES-D), the Pittsburgh Sleep Quality Index (PSQI), and the Athens Insomnia Scale (AIS) by telephone interviews.

Results: The factorial validity was assessed by confirmatory factor analysis, and the internal reliability was examined by coefficient omega. The two negatively worded items of the THAT had low factor loadings and were removed. One more item was removed based on the modification indices of the eight-item model. The remaining seven-item THAT showed satisfactory unidimensionality with root mean square error of approximation (RMSEA) = 0.06, standardized root mean square residual (SRMR) = 0.08, and comparative fit index (CFI) = 1.00. The coefficient omega of the seven-item Chinese THAT was 0.80 (95% CI: 0.74–0.86). Convergent validity was demonstrated with THAT moderately associated with CES-D (r = − 0.45, P < 0.01), PSQI (r = − 0.40, P < 0.01), and AIS (r = − 0.45, P < 0.01).

Conclusions: The Chinese version of THAT demonstrated acceptable reliability and validity in a Chinese population.