Developing Turkish-Sign-Language Self-Efficacy Scale for Learners based on various test theories

Abstract

Turkish-Sign-Language (TSL) is a natural visuospatial language that the Deaf and hard of hearing use to communicate both with each other and with hearing people. It is important to determine the self-efficacy of individuals learning TSL in order to enhance their effective use of the TSL when their learning process. In this study, we aimed to develop a scale that measures TSL self-efficacy for TSL learners and provide valid and reliable results with different test theories. The study was designed in a quantitative research design, and the participants consisted of 430 university students who were identified through a purposive sampling technique. Automated item selection procedure in the context of Mokken Homogeneity Model-one of the nonparametric item response theory models, and principal axis factoring, convergent and discriminant validity in the context of classical test theory were investigated to present evidence for construct validity. According to the analysis, a measurement tool consisting of 22 items and a three-factor structure was reached. The reliability coefficients of the scores were investigated via Cronbach's Alpha (α), Guttman's lambda 2 (λ), latent class reliability coefficient (LCRC), composite reliability coefficients (CR), and McDonald's omega (ω). The reliability values obtained from these coefficients indicated that the scores obtained from the scale were reliable. As a result, the TSL-Self-Efficacy Scale for TSL learners, which provided valid and reliable results, was successfully developed.

Keywords

• Turkish-Sign-Language
• Self-efficacy
• Scale development
• Mokken scale analysis
• Principal axis factoring

References

1. Alfano, A.R., Radlinski, S., & del Corro-Helbig, M.G. (2022). Challenges and opportunities with deaf multilingual learners. (Eds. Musyoka, M.M.) Deaf education and challenges for bilingual/multilingual students, 1-39. IGI Global Scientific Publishing.
2. Almayez, M.A., Al-Khresheh, M.H., Al-Qadri, A.H., Alkhateeb, I.A., & Alomaim, T.I.M. (2025). Motivation and English self-efficacy in online learning applications among Saudi EFL learners: Exploring the mediating role of self-regulated learning strategies. Acta Psychologica, 254, 104796. https://doi.org/10.1016/j.actpsy.2025.104796
3. Anastasia, A. (1976). Psychological testing (6th ed.). Macmillan Publishing.
4. Artino, A.R. (2012). Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ, 1, 76–85. https://doi.org/10.1007/s40037-012-0012-5
5. Avşar, V., & Sevim, S.A. (2022). The effectiveness of cognitive behavioral therapy including updating the early life experiences and images with the empty chair technique on social anxiety. International Journal of Assessment Tools in Education, 9(1), 181-202. https://doi.org/10.21449/ijate.1062613
6. Ballenger, S. (2025). Effective communication for deaf and hard of hearing people. Center for inclusive design and innovation. Georgia Tech College of Design. https://accessga.gatech.edu/sites/default/files/2025 04/Effective%20Communication%20for%20Deaf%20and%20Hard%20of%20Hearing%20People_Final.pdf
7. Bandura, A. (1997). Self-efficacy: The exercise of control. W.H. Freeman.
8. Baumeister, R.F., & Vohs, K.D. (2007). Self-efficacy. In Encyclopedia of Social Psychology (pp. 815-817). SAGE Publications, Inc. https://doi.org/10.4135/9781412956253

9. Beal, J.S., Dostal, H.M., & Easterbrooks, S.R. (2024). Literacy instruction for students who are deaf and hard of hearing: (2nd ed.) (Perspectives on Deafness). Oxford University Press.
10. Bilgiç, H.C., Aslan, C., Özdemir Kılıç, C., & Kan, A. (2021). Developing an attitude scale for Turkish-Sign-Language (TSL-AS). Participatory Educational Research, 8(1), 200-218. http://dx.doi.org/10.17275/per.21.11.8.1
11. Bintoro, T., Fahrurrozi, Kusmawati, A.P., & Dewi, R.S. (2023). The teacher strategies in teaching sign language for deaf students in special schools Jakarta. Cogent Education, 10(2). https://doi.org/10.1080/2331186X.2023.2258294
12. Blackwell, C.K., Sherlock, P., Jackson, K.L., Hofheimer, J.A., Cella, D., Algermissen, M.A., Alshawabkeh, A.N., Avalos, L.A., Bastain, T., Blair, C., Bosquet Enlow, M., Brennan, P. A., Breton, C., Bush, N.R., Chandran, A., Collazo, S., Conradt, E., Crowell, S.E., Deoni, S., . . . & Margolis, A.E. (2023). Development and psychometric validation of the Pandemic-Related Traumatic Stress Scale for children and adults. Psychological Assessment, 35(11), 1054-1067. https://doi.org/10.1037/pas0001211
13. Bryne, B. (2016). Structural equation modeling with amos basic concepts, applications, and programming. (3rd ed.). Routledge.
14. Chen, Y., Watson, R., & Hilton, A. (2016). An exploration of the structure of mentors' behavior in nursing education using exploratory factor analysis and Mokken scale analysis. Nurse Education Today, 40, 161-167. https://doi.org/10.1016/j.nedt.2016.03.001
15. Chou, Y.H., Lee, C.P., Liu, C.Y., & Hung, C.I. (2017). Construct validity of the Depression and Somatic Symptoms Scale: evaluation by Mokken scale analysis. Neuropsychiatric Disease and Treatment, 13, 205-211. https://doi.org/10.2147/NDT.S118825
16. Cohen, R.J., Swerdlik, M., & Sturman, E.D. (2013). Psychological testing and assessment: An introduction to tests and measurement (8th ed.). McGraw-Hill Companies.
17. Council of Higher Education (2018). Özel eğitim öğretmenliği lisans programı [Special education teaching undergraduate program]. https://eski.yok.gov.tr/Documents/Kurumsal/egitim_ogretim_dairesi/Yeni Ogretmen Yetistirme Lisans Programlari/Ozel_Egitim_Ogretmenligi_Lisans_Programi.pdf
18. Crișan, D.R., Tendeiro, J.N., & Meijer, R.R. (2022). The Crit coefficient in Mokken scale analysis: A simulation study and an application in quality-of-life research. Quality of Life Research, 31(1), 49-59. https://doi.org/10.1007/s11136-021-02924-z
19. Crocker, L., & Algina, J. (1986). Introduction to classical and modern test theory. Cengage Learning.
20. Dagsdóttir, B.E., Kristjánsdóttir, H., Vésteinsdóttir, V., & Thorsdottir, F. (2023). Task and ego orientation in sport questionnaire: A Mokken scale analysis. Sage Open, 13(3). https://doi.org/10.1177/21582440231195200
21. Danermark, B., Antonson, S., & Lundström, I. (2001). Social inclusion and career development-transition from upper secondary school to work or post-secondary education among hard of hearing students. Scandinavian Audiology, 30(2), 120 128. https://doi.org/10.1080/010503901750166880
22. Darıca, N., & Şipal, F. (2011). İşitme engelli çocuklarda gelişim ve eğitsel müdahale [Development and educational intervention in hearing impaired children]. Hacettepe University Press.
23. de Cock, E.S., Emons, W.H., Nefs, G., Pop, V.J., & Pouwer, F. (2011). Dimensionality and scale properties of the Edinburgh Depression Scale (EDS) in patients with type 2 diabetes mellitus: the DiaDDzoB study. BMC Psychiatry, 11(1), 141. https://doi.org/10.1186/1471-244X-11-141
24. De Picker, M. (2020). Rethinking inclusion and disability activism at academic conferences: Strategies proposed by a PhD student with a physical disability. Disability & Society, 35(1), 163-167. https://doi.org/10.1080/09687599.2019.1619234
25. DeVellis, R.F. (2017). Scale development: Theory and applications (4th ed.). Sage publications.
26. Dikyuva, H., Makaroğlu, B., & Arık, E. (2015). Türk İşaret Dili dilbilgisi kitabı [Turkish-Sign-Language grammar book]. Ministry of Family and Social Policies Publications.
27. DiStefano, C., & Hess, B. (2005). Using confirmatory factor analysis for construct validation: An empirical review. Journal of Psychoeducational Assessment, 23(3), 225-241. https://doi.org/10. 1177/073428290502300303
28. Embretson, S.E., & Reise, S.P. (2000). Item response theory for psychologists. Lawrence Erlbaum Associates.
29. Emons, W.H., Sijtsma, K., & Pedersen, S.S. (2012). Dimensionality of the Hospital Anxiety and Depression Scale (HADS) in cardiac patients: comparison of Mokken scale analysis and factor analysis. Assessment, 19(3), https://doi.org/10.1177/1073191110384951
30. Erickson, G., & Noonan, P.M. (2025). Selfefficacy assessment suite: Technical report. College & Career Competency Framework. https://www.cccframework.org/wp content/uploads/Self-EfficacyAssessSuiteTech.pdf
31. Eryiğit, C. (2017). Yazılı Türkçe dilinden Türk İşaret Diline (TİD) makine çevirisi sistemi [Text to sign language machine translation system for Turkish] [Unpublished doctoral dissertation]. İstanbul Teknik Üniversitesi Fen Bilimleri Enstitüsü.
32. European Centre for Modern Languages (ECML). (2024, May 18). Promoting excellence in sign language instruction Instructions for learners-Assessment. Retrieved June 25, 2025, from www.ecml.at/prosign
33. Fitriyani, F., Ainii, L.Q., Jannah, R., & Maryam, S. (2024). Analysis of sign language skills in improving communication and learning for deaf children. Continuous Education: Journal of Science and Research, 5(1), 30-39. https://doi.org/10.51178/ce.v5i1.1757
34. Fornell, C., & Larcker, D.F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39-50. https://doi.org/10.2307/3151312
35. Fraenkel, J.R., Wallen, N.E., & Hyun, H.H. (2012). How to design and evaluate research in education. (8th ed.). McGraw-Hill.
36. Franke, G., & Sarstedt, M. (2019). Heuristics versus statistics in discriminant validity testing: a comparison of four procedures. Internet Research, 29(3), 430 447. https://doi.org/10.1108/IntR-12-2017-0515
37. Galindo-Garre, F., Hendriks, S.A., Volicer, L., Smalbrugge, M., Hertogh, C.M., & van der Steen, J.T. (2014). The Bedford Alzheimer nursing-severity scale to assess dementia severity in advanced dementia: a nonparametric item response analysis and a study of its psychometric characteristics. American Journal of Alzheimer's Disease & Other Dementias®, 29(1), 84-89. https://doi.org/10.1177/1533317513506777
38. Gao, S., Ma, X., Tsui, H., Wang, J., & Zhang, X. (2024). Item response theory analysis of the Chinese version compulsive shopping scale. Comprehensive Psychiatry, 135, 152535. https://doi.org/10.1016/j.comppsych.2024.152535
39. Garberoglio, C.L., Gobble, M.E., & Cawthon, S.W. (2012). A national perspective on teachers' efficacy beliefs in deaf education. The Journal of Deaf Studies and Deaf Education, 17(3), 367-383. https://doi.org/10.1093/deafed/ens014
40. Graham, S., Wolbers, K., Dostal, H., & Holcomb, L. (2021). Does teacher self-efficacy predict writing practices of teachers of deaf and hard of hearing students? Journal of Deaf Studies and Deaf Education, 26(3), 438-450. https://doi.org/10.1093/deafed/enab012
41. Guardino, C. (2015). Evaluating teachers' preparedness to work with students who are deaf and hard of hearing with disabilities. American Annals of the Deaf, 160(4), 415-426. https://www.jstor.org/stable/26235231
42. Gürboğa, C., & Kargın T. (2003). İşitme engelli yetişkinlerin farklı ortamlarda kullandıkları iletişim yöntemlerinin/becerilerinin incelenmesi [Examining the communication methods/skills used by hearing impaired adults in different environments]. Ankara University Journal of Faculty of Educational Sciences (JFES), 36(1), 51-64. https://doi.org/10.1501/Egifak_0000000074
43. Hair, J.F., Black, W.C., Babin, B.J., & Anderson, R.E. (2019). Multivariate data analysis (8th ed.). Annabel Ainscow.
44. Hambleton, R.K., Swaminathan, H., & Rogers, H.J. (1991). Fundamentals of item response theory. Sage Publications.
45. Hammer, S.G. (1998). The cost of treating deaf and hard-of-hearing patients. American Family Physician, 58(3), 659.
46. Henseler, J., Ringle, C.M., & Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43, 115-135. https://doi.org/10.1007/s11747-014-0403-8
47. Humphries, T., Mathur, G., Napoli, D.J., Padden, C., & Rathmann, C. (2022). Deaf children need rich language input from the start: Support in advising parents. Children, 9(11):1609. https://doi.org/10.3390/children9111609
48. Jones, B.E., Clark, G.M., & Soltz, D.F. (1997). Characteristics and practices of sign language ınterpreters in ınclusive education programs. Exceptional Children, 63(2), 257-268. https://doi.org/10.1177/001440299706300209
49. Jorgensen, T.D., Pornprasertmanit, S., Schoemann, A.M., Rosseel, Y., Miller, P., Quick, C., Garnier-Villarreal, M., Selig, J., Boulton, A., Preacher, K., Coffman, D., Rhemtulla, M., Robitzsch, A., Enders, C., Arslan, R., Bell, C., Panko, P., Merkle, E., Chesnut, S., … Vanbrabant, L. (2023). semTools: Useful tools for structural equation modeling (Version 0.5 7) [R package]. Comprehensive R Archive Network. https://doi.org/10.32614/CRAN.package.semTools
50. Kaiser, H.F. (1960). The application of electronic computers to factor analysis. Educational and Psychological Measurement, 20(1), 141 151. https://doi.org/10.1177/001316446002000116
51. Kelly, J.F., McKinney, E.L., & Swift, O. (2020). Strengthening teacher education to support deaf learners. International Journal of Inclusive Education, 26(13), 1289–1307. https://doi.org/10.1080/13603116.2020.1806366
52. Kim, H.Y. (2013). Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restorative Dentistry & Endodontics, 38(1), 52 54. https://doi.org/10.5395/rde.2013.38.1.52
53. Kim, H. (2024). Exploring the interplay of language mindsets, self-efficacy, engagement, and perceived proficiency in L2 learning. Humanit Soc Sci Commun 11, 1295. https://doi.org/10.1057/s41599-024-03783-y
54. Kim, S.J., Kwon, M.S., & Han, W. (2015). Development of a school adaptation program for elementary school students with hearing impairment. Journal of Audiology & Otology, 19(1), 26. http://dx.doi.org/10.7874/jao.2015.19.1.26
55. Kline, R.B. (2011). Principles and practice of structural equation modeling. Guilford Publications.
56. Koch, K.E. (2023). Increasing students' self-efficacy in American sign language using timely and specific instructional feedback. (Unpublished master's thesis). Wilmington University.
57. Koopman, L., Zijlstra, B.J., & Van der Ark, L.A. (2023). Evaluating model fit in two-level mokken scale analysis. Psych, 5(3), 847-865. https://doi.org/10.3390/psych5030056
58. Kubuş, O., İlkbaşaran, D., & Gilchrist, S. (2016). Türkiye'de işaret dili planlaması ve Türk İşaret Dili'nin yasal durumu [Sign language planning in Türkiye and the legal situation of Turkish-Sign-Language]. In E. Arık (Ed.), Ellerle konuşmak: Türk İşaret Dili araştırmaları [Talking with Hands: Turkish-Sign-Language Research] (pp. 23–50). Koç University.
59. Liu, T., Sun, Y., Li, Z., & Xin, T. (2019). The impact of aberrant response on reliability and validity. Measurement: Interdisciplinary Research and Perspectives, 17(3), 133-142. https://doi.org/10.1080/15366367.2019.1584848
60. Ma, Y. (2022). The effect of teachers’ self-efficacy and creativity on English as a foreign language learners’ academic achievement. Frontiers in Psychology, 13, 872147. https://doi.org/10.3389/fpsyg.2022.872147
61. Maldonado-Murciano, L., Pontes, H.M., Barrios, M., Gómez-Benito, J., & Guilera, G. (2024). Mokken scale analysis of the Internet Gaming Disorder Scale–Short-Form and the Gaming Disorder Test. Addictive Behaviors Reports, 100567. https://doi.org/10.1016/j.abrep.2024.100567
62. Marriage, J., Brown, T.H., & Austin, N. (2017). Hearing impairment in children. Paediatrics and Child Health, 27(10), 441-446. https://doi.org/10.1016/j.paed.2017.06.003
63. McDermid, C. (2020). Educational interpreters, deaf students and inclusive education? Turkish Journal of Special Education Research and Practice, 2(1), 27 46. https://doi.org/10.37233/TRSPED.2020.0107
64. Meijer, R.R., & Nering, M.L. (1997). Trait level estimation for nonfitting response vectors. Applied Psychological Measurement, 21(4), 321 336. https://doi.org/10.1177/01466216970214003.
65. Miles, M.B., & Huberman, A.M. (1994). Qualitative data analysis: an expanded source book. SAGE Publications.
66. MoNE (Milli Eğitim Bakanlığı) (2018). Özel Eğitim Hizmetleri Yönetmeliği [Special Education Services Regulation]. https://orgm.meb.gov.tr/meb_iys_dosyalar/2018_07/09101900_ozel_egitim_hizmetleri_yonetmeligi_07072018.pdf
67. Murray, J.J., Hall, W.C., & Snoddon, K. (2019). Education and health of children with hearing loss: the necessity of signed languages. Bulletin of the World Health Organization, 97(10), 711.
68. Musyoka, M.M. (2022). Deaf education and challenges for bilingual/multilingual students. IGI Global Scientific Publishing.
69. NDC (National Deaf Center) (2019). Importance of effective communication between deaf and hearing individuals. Retrieved June 18, 2024, from https://nationaldeafcenter.org/wp-content/uploads/2022/11/Importance-of-Effective-Communication-Between-Deaf-and-Hearing-Individuals.pdf
70. Nikolaraizi, M., & Argyropoulos, V. (2015). The learning and communication barriers of deaf and hard of hearing students in higher education. In EDULEARN15 Proceedings (pp. 4130-4134). IATED.
71. Ommundsen, R., van der Veer, K., Van Le, H., Krumov, K., & Larsen, K.S. (2007). Developing attitude statements toward illegal immigration: Transcultural reliability and utility. Psychological Reports, 100(3), 901-914. https://doi.org/10.2466/pr0.100.3.901-914
72. Özberk, E.H., Ünsal Özberk, E.B., Uluç, S., & Öktem, F. (2021). Investigating invariant ıtem ordering in intelligence tests: Mokken scale analysis of KBIT-2. International Journal of Assessment Tools in Education, 8(3), 714-728. https://doi.org/10.21449/ijate.858183
73. Palm, K.M., & Strong, D.R. (2007). Using item response theory to examine the white bear suppression inventory. Personality and Individual Differences, 42(1), 87 98. https://doi.org/10.1016/j.paid.2006.06.023
74. Panjie, D., & Velarde, J. (2025). A Study on the correlation between language self-efficacy and language learning strategies of non-english majors. International Journal of Academic Research in Progressive Education and Development, 14(2), 635 646. http://dx.doi.org/10.6007/IJARPED/v14-i2/24961
75. Pfitzner-Eden, F. (2016). Why do I feel more confident? Bandura's sources predict preservice teachers' latent changes in teacher self-efficacy. Frontiers in Psychology, 7, 1486. https://doi.org/10.3389/fpsyg.2016.01486
76. Piştav Akmeşe, P. (2019). Eğitimde Türk İşaret Dili [Turkish-Sign-Language in education]. Nobel Yayıncılık.
77. Piştav Akmeşe, P., Kayhan, N., Kirazlı, G., Öğüt, F., & Kirazlı, T. (2018). Odyoloji ve konuşma bozuklukları alanında lisansüstü eğitim öğrencilerinin işitme kayıplı çocukların dil, konuşma ve iletişim becerilerinin desteklenmesi ve eğitimleri hakkındaki görüşleri. Türkiye Sağlık Bilimleri ve Araştırmaları Dergisi, 1(1), 13-23.
78. Pretorius, T.B., & Padmanabhanunni, A.A. (2024). Unidimensional short form of the Beck Hopelessness Scale (BHS-7) derived using item response theory. Scientific Reports, 14, Article number: 6021. https://doi.org/10.1038/s41598-024-56792-x
79. Reddy, M.Z. (2011). The development of an American sign language general self-efficacy scale for use with deaf individuals [Unpublished doctoral dissertation]. Alliant International University.
80. Revelle, W. (2023). psych: Procedures for Psychological, Psychometric, and Personality Research (Version 2.3.3) [R package]. Comprehensive R Archive Network. https://cran.r-project.org/web/packages/psych/index.html
81. Rosseel, Y., Jorgensen, T.D., De Wilde, L., Oberski, D., Byrnes, J., Vanbrabant, L., Savalei, V., Merkle, E., Hallquist, M., Rhemtulla, M., Katsikatsou, M., Barendse, M., Rockwood, N., Scharf, F., Du, H., Jamil, H., & Classe, F. (2023). lavaan: Latent variable analysis (Version 0.6 15) [R package]. Comprehensive R Archive Network. https://cran.r project.org/package=lavaan
82. Rupp, A.A. (2013). A systematic review of the methodology for person fit research in item response theory: Lessons about generalizability of inferences from the design of simulation studies. Psychological Test and Assessment Modeling, 55(1), 3.
83. Salehomoum, M. (2020). Inclusion of signing deaf or hard-of-hearing students: factors that facilitate versus challenge access and participation. Perspectives of the ASHA Special Interest Groups, 5(4), 971-983. https://doi.org/10.1044/2020_PERSP-19-00124
84. Scott, J.A., & Hoffmeister, R.J. (2017). American Sign Language and academic English: Factors influencing the reading of bilingual secondary school deaf and hard of hearing students. The Journal of Deaf Studies and Deaf Education, 22(1). 59 71. https://doi.org/10.1093/deafed/enw065
85. Shenkin, S.D., Watson, R., Laidlaw, K., Starr, J.M., & Deary, I.J. (2014). The attitudes to ageing questionnaire: Mokken scaling analysis. PLOS ONE 9(9), e108766. https://doi.org/10.1371/journal.pone.0099100
86. Sijtsma, K., & Molenaar, I.W. (2002). Introduction to nonparametric item response theory. Sage Publications.
87. Sun, Z., & Mu, B. (2023). Motivating online language learning: exploring ideal L2 self, grit, and self-efficacy in relation to student satisfaction. Frontiers in Psychology, 14, 1293242. https://doi.org/10.3389/fpsyg.2023.1293242
88. Stochl, J. (2007). Nonparametric extension of item response theory models and its usefulness for assessment of dimensionality of motor tests. Acta Universitatis Carolinae, 42(1), 75-94.
89. Stochl, J., Jones, P.B., & Croudace, T.J. (2012). Mokken scale analysis of mental health and well-being questionnaire item responses: A non-parametric IRT method in empirical research for applied health researchers. BMC Medical Research Methodology, 12(1), 1-16. https://doi.org/10.1186/1471-2288-12-74
90. Szarkowski, A., Moeller, M.P., Gale, E., Smith, T., Birdsey, B.C., Moodie, S.T., ... & Zheng, X. (2024). Family-centered early intervention deaf/hard of hearing (FCEI-DHH): Cultural & Global Implications. The Journal of Deaf Studies and Deaf Education, 29(SI), SI27-SI39. https://doi.org/10.1093/deafed/enad036
91. Şengül Avşar, A. (2022). Comparing the automatic ıtem selection procedure and exploratory factor analysis in determining factor structure. Participatory Educational Research, 9(2), 416-436. https://doi.org/10.17275/per.22.47.9.2
92. Şengül Avşar, A. (2023). Aberrant individuals' effects on fit indices both of confirmatory factor analysis and polytomous IRT models. Current Psychology, 42(3), 2157-2166. https://doi.org/10.1007/s12144-021-01563-4
93. Şengül Avşar, A., & Barış Pekmezci, F. (2022). Examination of motivation scales: Is the purpose academic promotion or the need to measure psychological constructs? Psycho-Educational Research Reviews, 11(3), 774 791. https://doi.org/10.52963/PERR_Biruni_V11.N3.19
94. Tang, G. (2024). Sign language and inclusive deaf education: An Asian perspective. Deafness & Education International, 26(1), 1–5. https://doi.org/10.1080/14643154.2024.2302702
95. Tendeiro, J.N. (2023). PerFit: Person Fit (Version 1.3.0) [R package]. Comprehensive R Archive Network. https://cran.r-project.org/web/packages/PerFit/PerFit.pdf
96. Tran, U.S., Stieger, S., & Voracek, M. (2012). Psychometric analysis of Stöber's Social Desirability Scale (SDS-17): An item response theory perspective. Psychological Reports, 111(3), 870-884. https://doi.org/10.2466/03.09.PR0.111.6.870-884
97. Tuohimaa, K., Loukusa, S., Löppönen, H., Välimaa, T., & Kunnari, S. (2022). Communication abilities in children with hearing loss–views of parents and daycare professionals. Journal of Communication Disorders, 99, 106256. https://doi.org/10.1016/j.jcomdis.2022.106256
98. Ubido, J., Huntington, J., & Warburton, D. (2002). Inequalities in access to healthcare faced by women who are deaf. Health & Social Care in the Community, 10(4), 247-253. https://doi.org/10.1046/j.1365-2524.2002.00365.x
99. Usher, E.L., & Pajares, F. (2008). Sources of self-efficacy in school: Critical review of the literature and future directions. Review of Educational Research, 78(4), 751-796. https://doi.org/10.3102/0034654308321456
100. Van der Ark, L.A., Koopman L., Straat, H., & Van Den B. (2023). Mokken: Mokken Scale Analysis in R (Version 3.0.6). [R package]. https://cran.r project.org/web/packages/mokken/mokken.pdf
101. Wilson-Menzfeld, G., Gates, J.R., Jackson-Corbett, C., & Erfani, G. (2025). Communication experiences of deaf/hard‐of‐hearing patients during healthcare access and consultation: a systematic narrative review. Health & Social Care in the Community, 2025(1), 8867224. https://doi.org/10.1155/hsc/8867224