AIM: To present a systematic review of nursing research that uses SEM.

DISCUSSION: The review revealed poor reporting of information about the determination of sample size, missing data, normality and outliers. Most studies neither computed composite reliability nor assessed convergent and discriminant validity. There was a lack of consistency in performing the analysis. Some of the studies conducted exploratory factor analysis before performing confirmatory factor analysis, without discussing its necessity. Although most studies declared the estimation method and software used, there were many that did not.

CONCLUSION: Little information about the different steps of conducting SEM analysis was provided in the studies. Weaknesses and areas of improvement for future empirical SEM studies were identified.

METHODS: The development of the MUAPHQ C-19 was conducted in two stages. Stage I resulted in the generation of the instrument's items (development), and stage II resulted in the performance of the instrument's items (judgement and quantification). Six-panel experts related to the study field and ten general public participated to evaluate the validity of the MUAPHQ C-19. The content validity index (CVI), content validity ratio (CVR) and face validity index (FVI) were analysed using Microsoft Excel.

RESULTS: There were 54 items and four domains, namely the understanding, attitude, practice and health literacy towards COVID-19, identified in the MUAPHQ C-19 (Version 1.0). The scale-level CVI (S-CVI/Ave) for every domain was above 0.9, which is considered acceptable. The CVR for all items was above 0.7, except for one item in the health literacy domain. Ten items were revised to improve the item's clarity, and two items were deleted due to the low CVR value and redundancy, respectively. The I-FVI exceeded the cut-off value of 0.83 except for five items from the attitude domain and four from the practice domains. Thus, seven of these items were revised to increase the clarity of items, while another two were deleted due to low I-FVI scores. Otherwise, the S-FVI/Ave for every domain exceeded the cut-off point of 0.9, which is considered acceptable. Thus, 50-item MUAPHQ C-19 (Version 3.0) was generated following the content and face validity analysis.

METHODS: A total of 603 participants from the United States completed the IES-2, alongside measures of body appreciation, body acceptance from others, and self-esteem. Our analyses compared the fit of various hypothesised models of IES-2 scores.

RESULTS: Models of IES-2 scores based on confirmatory factor analysis (CFA) uniformly showed poor fit. ESEM models showed superior fit to CFA representations and a B-ESEM model showed improved fit over higher-order CFA and B-CFA representations of IES-2 scores. The optimal model was a B-ESEM model that accounted for, through correlated uniqueness (CU), the methodological artefact introduced by negatively-worded IES-2 items. This B-ESEM-CU model was fully invariant across gender and showed adequate construct validity.

CONCLUSION: The B-ESEM-CU framework appears well-suited to understand the multidimensionality of IES-2 scores. A model of IES-2 scores that yields a reliable latent indicator of global intuitive eating while allowing for simultaneous consideration of additional specific factors will likely provide more accurate accounting of the nature and outcomes of intuitive eating.