Validity Evidence and Normative Assessment of the Brief Adjustment Scale-6 in BrazilAbstract
Psychological adjustment (PA) reflects an individual’s capacity to adapt to environmental stressors by mobilizing responses that promote balance and well-being. This study evaluated the psychometric properties of the Brief Adjustment Scale-6 (BASE-6). The sample comprised 4,115 adults from all Brazilian states. Confirmatory factor analysis and measurement invariance testing were conducted, along with hierarchical linear and multinomial logistic regressions and correlations with external instruments (PHQ-9 and WHO-5) for validity testing. The results supported a unidimensional model with all fit indices exhibiting satisfactory values. The model remained invariant across sociodemographic variables at all assessment levels. Classification strata for PA (high, moderate, and low) were proposed based on score standardization. The results indicated lower levels of PA among women and younger participants. Overall, the findings support the use of BASE-6 as a brief and standardized screening measure of PA in Brazilian adults.
Keywords:
Psychological Adjustment; Psychometrics; Test standardization
Resumo
Ajustamento psicológico (AP) reflete a capacidade do indivíduo de se adaptar aos estressores ambientais, mobilizando respostas que favorecem o equilíbrio e o bem-estar. Este estudo avaliou as propriedades psicométricas da Brief Adjustment Scale-6 (BASE-6). A amostra foi composta por 4115 adultos. Conduziram-se análise fatorial confirmatória e de invariância da medida, regressões linear hierárquica e logística multinomial, além de correlações com instrumentos externos (PHQ-9 e WHO-5) para evidências de validade e normatização. Os resultados apoiaram um modelo unidimensional, com todos os índices de ajuste satisfatórios. O modelo permaneceu invariante em relação às variáveis sociodemográficas em todos os níveis de avaliação. Foram propostos estratos de classificação do AP (alto, moderado e baixo) com base na normatização dos escores. Os resultados indicaram piores níveis de AP entre mulheres e participantes mais jovens. Os achados apoiam o uso da BASE-6 como medida breve e padronizada de triagem do AP em adultos brasileiros.
Palavras-chave:
Ajustamento Psicológico; Psicometria; Padronização do teste
Resumen
El ajuste psicológico (AP) refleja la capacidad del individuo para adaptarse a los estresores ambientales, movilizando respuestas que favorecen el equilibrio y el bienestar. Este estudio evaluó las propiedades psicométricas de la Brief Adjustment Scale-6 (BASE-6) en una muestra de 4.115 adultos. Se realizaron análisis factorial confirmatorio y de invariancia de la medida, regresiones lineales jerárquicas y logísticas multinomiales, así como correlaciones con instrumentos externos (PHQ-9 y WHO-5) para obtener evidencias de validez y normativización. Los resultados respaldaron un modelo unidimensional, con índices de ajuste satisfactorios. El modelo se mantuvo invariante respecto a las variables sociodemográficas en todos los niveles de evaluación. Se propusieron estratos de clasificación del AP (alto, moderado y bajo) basados en la normalización de las puntuaciones. Los resultados indicaron niveles más bajos de AP entre mujeres y participantes más jóvenes. En conjunto, los hallazgos respaldan el uso de la BASE-6 como una medida breve y estandarizada de cribado del AP en adultos brasileños.
Palabras clave:
Ajuste Psicológico; Psicometría; Estandarización del test
Assessing psychological adjustment (PA) has become increasingly relevant in the field of health psychology, especially because this construct functions as an indicator of the presence or absence of psychological symptoms and the level of subjective well-being (Cruz et al., 2020). Studies indicate that reduced levels of PA are associated with an increase in psychopathology (Bender et al., 2019; Gurtovenko et al., 2021), emotional exhaustion (Lucas-Mangas et al., 2022), and lower levels of quality of life and life satisfaction (Chambers et al., 2017). Although the relevance of PA is widely recognized, important assessment gaps remain, largely because the concept is still treated in a diffuse manner, consequently resulting in the use of measures predominantly focused on well-being or general health to represent PA (Cruz et al., 2020).
PA reflects individuals’ capacity to adapt effectively to changes, stressors, and challenges present in their environment, mobilizing emotional, behavioral, and physiological responses that promote internal balance and well-being. PA therefore refers to how a person thinks, feels, and deals with adverse situations in everyday life (Heppner & Anderson, 1985; Heppner & Lee, 2002). By contrast, psychological maladjustment refers to persistent difficulties in the adaptive process, manifesting as the inability to manage stress, maintain healthy interpersonal relationships, and cultivate a lasting sense of satisfaction and well-being (McSweeney, 2023).
Given the complexity and breadth of this construct, the measurement of PA has been a challenge. Several measures have been developed to integrate indicators of symptoms, well-being, and functioning within a single instrument following a transtheoretical approach (Cruz et al., 2020; Kraus et al., 2005). Among them, the Outcome Questionnaire-45.2 (OQ-45.2; Lambert, 2005) is one of the most widely used tools for assessing PA both globally and across specific domains, such as symptomatic functioning, social role, and interpersonal well-being. Despite adequate evidence of validity and reliability, its considerable length, consisting of 45 items, and the complexity of the scoring system (the presence of reverse-scored items) have been highlighted as limitations for practical application (Cruz et al., 2020), thereby opening space for the development and use of shorter and easier-to-administer instruments.
The Brief Adjustment Scale-6 (BASE-6) (Cruz et al., 2020) was developed to address the need for a brief and valid measure of general PA, intended for use in measurement-based care. The development of this measure aimed to provide a viable alternative to longer instruments, such as the OQ-45.2, ultimately offering more detailed clinical information. The BASE-6 can be used independently or as a complement to disorder-specific measures. The measure was developed based on the understanding of PA as a broad construct that encompasses the subjective experience of psychological distress and the individual’s capacity to function in everyday life, thus integrating emotional symptoms and functional impairments into a global indicator (Cruz et al., 2020).
For measurement purposes, the BASE-6 assesses psychological distress through items that encompass emotional symptoms such as irritability, anxiety, and depressed mood (e.g., “To what extent did you feel tense, anxious, and/or afraid?”). The functional/behavioral dimension is operationalized through the assessment of the interference of this distress in self-esteem, interpersonal relationships, and performance in social roles (e.g., “To what extent did emotional distress interfere with your ability to perform your activities at work, at school, or in other roles?”).
In the initial examination of validity evidence, the BASE-6 displayed satisfactory internal consistency, with Cronbach’s alphas ranging from 0.86 to 0.92. Test-retest reliability was moderate, with a coefficient of 0.76 (95% confidence interval (CI)=0.68-0.83). In addition, the total score displayed a strong correlation with the total score of the OQ-45.2 (r=0.72) (Cruz et al., 2020). To date, only a few studies have examined the adaptation and validity of BASE-6 (Cruz et al., 2020; Ko et al., 2023; Rehman et al., 2024; Yildirim & Solmaz, 2021), which has been adapted into Turkish (Yildirim & Solmaz, 2021) and Urdu (Rehman et al., 2024). This may be explained by the fact that BASE-6 is still a relatively recent measure, which requires further adaptation studies.
To date, studies examining the psychometric properties of the BASE-6 have supported a unidimensional structure that adequately reflects the construct of global PA. The instrument has demonstrated good psychometric quality, with potential for comparisons of findings across countries. In addition, the scale has been used in research contexts to investigate PA and its relationship, for example, with loneliness and geriatric depression (Aman, 2024), patients who have experienced fractures (Kart & Akça, 2025), and smartphone use (Yildirim et al., 2024). This measure has also been widely used in the context of COVID-19 (Güder et al., 2024; Jones et al., 2024; Sanli et al., 2024).
The assessment of PA has proven especially relevant in clinical and research contexts, which require the use of instruments that are easy to administer and conceptually well defined. In this sense, the BASE-6 presents advantages that go beyond its brevity and ease of use, thus standing out for its conceptual coherence with the definition of PA as a global and transtheoretical construct that integrates emotional distress and functional impact in everyday life. In addition, the measure has presented adequate psychometric evidence, with high internal consistency and strong associations with widely established instruments such as the OQ-45.2, while also offering greater feasibility for use in different clinical and research contexts (Cruz et al., 2020; Ko et al., 2023).
Considering BASE-6’s administration time of approximately one minute, ability to assess emotional distress and interference in related areas, as well as free availability, the scale can be considered a brief measure with potential for easy adoption in professional practice in the Brazilian context. To the best of our knowledge, no studies to date have translated, culturally adapted, and systematic investigated of validity evidence for the BASE-6 in the Brazilian context. Accordingly, and considering the relevance of brief and standardized instruments for the assessment of general PA in adults, the present study is justified.
Through the evaluation of the internal structure of the measure (CFA) and analysis of measurement invariance (MI), this study applied the BASE-6 to the Brazilian population and presents validity evidence. The study also sought to establish normative data for the interpretation of the scores, subsequently providing a standardized reference for future studies, ensuring consistent use of the parameters, and facilitating informed decision-making in different contexts. In addition, validity evidence was obtained based on the relationship with external variables (depression and psychological well-being). Finally, a predictive validity analysis was performed to evaluate the ability of BASE-6 to identify individuals or groups at greater risk, considering sociodemographic variables (sex, age, and education).
Method
Study Design
Data were collected using a cross-sectional and non-probabilistic design, in which an electronic convenience-based method was employed. The sample included individuals aged 18 years or older, covering the entire national territory, in both rural and urban regions. The exclusion criterion was incomplete responses to the questionnaire.
Participants
The full sample consisted of 4,115 adults with a mean age of 48.5 years (SD=13.36). Most participants were female (88.7%, n=3,650) and had completed higher education (64.4%; n=2,650). Regarding age distribution, the largest proportion of participants was in the 50-59 years age group (27.6%; n=1,134), while the smallest those aged 18-29 years (10.1%; n=415). The mean score on the BASE-6 was 23.7 (SD=9.14; Minimum (Min.)=6.0; Maximum (Max.)=42.0).
Instruments
Developed both for independent use and as part of a measurement system for Routine Outcome Monitoring (ROM) (Barkham et al., 2023), the BASE-6 (Cruz et al., 2020) is a brief self-report measure of general PA. The measure has six items that assess individuals’ perceptions of emotional distress (3 items: depression, anxiety, and anger) and its interference in related areas (3 items: self-esteem, personal relationships, and occupational functioning). All BASE-6 items are rated on a seven-point response scale (1=not at all, 7=extremely), with higher scores indicating lower overall PA. The final score is obtained by summing the items (ranging from 6 to 42 points). In the original study, the instrument displayed good internal consistency, with Cronbach’s alpha ranging from 0.87 to 0.93 (Cruz et al., 2020). In the present study, the BASE-6 also exhibited satisfactory reliability (α=0.90).
Adapted for Brazilian Portuguese by Lima Osório et al. (2009) and validated by Nunes and Faro (2022) and Faro et al. (2025), the Patient Health Questionnaire-9 (PHQ-9; Kroenke et al., 2001) assesses the presence of each of the symptoms of major depression described in the Diagnostic and Statistical Manual of Mental Disorders. The questionnaire consists of nine items arranged on a Likert-type scale (0 “not at all” to 3 “nearly every day”). The final score ranges from 0 to 27 points. A score equal to or greater than 10 points indicates the presence of depressive symptomatology. In the study of validity evidence for the measure, the instrument obtained a Cronbach’s alpha of 0.93. In the present study, the instrument also displayed good internal consistency (α=0.90).
The World Health Organization-Five Well-Being Index (WHO-5) (WHO, 1998) was developed to assess the level of well-being, and is also effective for screening depressive and anxiety symptoms. This instrument consists of five items with a response scale ranging from 0 (at no time) to 3 (all the time). Higher scores indicate greater psychological well-being. The WHO-5 was adapted and validated in Brazil by Souza and Hidalgo (2012), and exhibited a satisfactory reliability index (α=0.83). In this study, the Cronbach’s alpha was 0.91.
A sociodemographic questionnaire was used to collect data on sample characteristics. Participants reported their age (in years, later categorized into age groups), sex/gender (male, female, or another option), and level of education (up to completed high school and higher education).
Procedures and Ethical Considerations
The process of translation and adaptation of the BASE-6 into Brazilian Portuguese followed the recommended technical guidelines (Borsa et al., 2012). The scale was translated by two independent translators and the versions were subsequently integrated into a single consensual translation. Theoretical and structural compatibility was evaluated by three expert judges, who considered the items and response scale to be appropriate, with no need for modifications in terms of content or wording.
This study was approved by the Research Ethics Committee for Human Subjects of Brazil (National Research Ethics Commission (CONEP) 30485420.6.0000.0008). Data collection was conducted in 2020 and 2022 through invitations to participants via digital media. The questionnaire was hosted on the SurveyMonkey platform, and available only to those who accepted the invitation, thereby indicating their agreement with the Registro de Consentimento Livre e Esclarecido (RCLE). The RCLE was presented on the first page of the questionnaire, and participation was allowed only after acceptance of this initial consent.
Data Analysis
CFA and MI analysis were conducted using the JASP software (version 0.17.0; lavaan package). Robust Diagonally Weighted Least Squares was adopted for estimation. The fit indices considered were the Comparative Fit Index (CFI; expected>0.95), Tucker-Lewis Index (TLI; expected>0.95), Root Mean Square Error of Approximation (RMSEA; expected≤0.050, 95% CI between 0 and 0.08; p-close>0.05), and Standardized Root Mean Residual (SRMR; expected≤0.080). MI analysis was conducted at four levels: configural, metric, scalar, and strict (Cheung & Rensvold, 2002). The criteria ΔCFI<0.010 and ΔRMSEA<0.015 were applied in the sequential comparison of the models (Chen, 2007). Reliability was analyzed using Cronbach’s alpha (expected>0.60) and McDonald’s omega (expected>0.70) (Hancock & Mueller, 2001). Normative procedures were conducted based on the general classification in percentiles (5% intervals) and calculation of the T score ((Z score of the raw score × 10)+50).
Hierarchical linear regression (LinR) and multinomial logistic regression (LogR) were conducted using JASP software (version 0.17.0) and Jamovi (version 2.3.28), respectively. The scale score was used as the dependent variable in two ways: raw score (LinR) and classification level (LogR), considering the results of the normative procedures. The following sociodemographic variables were included as independent variables: sex/gender (male and female), level of education (high school and higher education), and age group (18-29, 30-39, 40-49, 50-59, and 60 years or older). Model fit indicators included R2, adjusted R2, and ΔR2 (Nagelkerke’s R2 for LogR) to identify the individual contribution of the independent variables in the models. Tests were also performed to assess multicollinearity (variance inflation factor (VIF) and tolerance) in the LinR and LogR analyses. Finally, considering that the scores displayed a normal distribution, validity evidence based on the relationship with other variables was obtained through the association between BASE-6 scores and PHQ-9 and WHO-5 scores using Pearson correlations (JASP, version 0.17.0). The analysis materials are available from the corresponding author upon request via email.
Results
Confirmatory Factor Analysis
The CFA model revealed a unidimensional structure of the BASE-6, further showing good model fit (χ2=40.691; df=9; CFI=0.99; GFI=0.99; TLI=0.99; RMSEA=0.029, 95% CI=0.020-0.039). The explained variance (R2) by item ranged from 0.294 (item 4) to 0.714 (item 2). All items presented factor loadings above 0.500, with the lowest and highest factor loading in item 4 (λ=0.542) and item 2 (λ=0.845), respectively (Table 1). The model displayed adequate fit at all four levels of invariance (configural, metric, scalar, and strict; ΔCFI and ΔRMSEA criteria) in comparisons across sex/gender, educational level, and age group. No modification indices were suggested (Table 2). Both reliability indices (Cronbach’s alpha and McDonald’s omega) were satisfactory, at 0.90.
The mean scores obtained indicated that the BASE-6 had a mean of 23.7 (SD=9.14; Min.=6.0; Max.=42.0), PHQ-9 a mean of 12.1 (SD=7.57; Min.=0; Max.=27.0), and WHO-5 a mean of 11.6 (SD=5.99; Min.=1.0; Max.=30.0). A positive and negative correlation was observed between BASE-6 scores and PHQ-9 scores (r=0.730; p<0.001) and between BASE-6 scores and WHO-5 scores (r=-0.628; p<0.001), respectively.
BASE-6 Standardization
The mean total score of the sample on the BASE-6 was 23.7 (SD=9.14), with a minimum and maximum score of 6 and 42 points, respectively. Stratification was adopted to facilitate the interpretation of the findings obtained with the scale and to allow the use of strata corresponding to the level of severity related to adjustment (high, moderate, or low). No similar proposal was found in the literature; however, considering the possibility of stratification based on T scores, this was considered a valid initiative to diversify the ways in which the BASE-6 can be used. The scores were stratified into three strata (approx. 33.3% each), as follows: scores from 6 to 19, from 20 to 29, and 30 points or higher were classified as “high,” “moderate,” and “low,” respectively. Most participants presented a moderate level of PA (36.0%), followed by a high level (33.3%) and a low level (30.7%). The T scores for standardized comparisons, individual scores in the current sample, and cumulative frequency are presented in Table 3.
Multiple Linear Regression
In the final multiple LinR model, sex/gender and age were statistically significant predictors. Women presented lower levels of overall PA (M=22.1; SD=9.44; B=1.948; p<0.001) compared to men. Age group displayed overall statistical significance, with older age associated with better overall PA (M=25.5; SD=8.44; B=-1.032; p=.042 for ages 40-49; M=23.2; SD=9.23; B=-3.321; p<0.001 for ages 50-59; M=19.1; SD=8.72; B=-7.487; p<0.001 for ages 60 years or older; ages 18-29 used as the reference group).
The model accounted for 10.0% of the total variance explained by the final models (R2 converted to percentage). Among the individual predictors, age group was responsible for the largest proportion of explained variance (3.1%). By contrast, sex/gender was the least influential predictor, explaining.07%.
Multinomial Logistic Regression
The multinomial LogR considered the classification proposed in the normative analysis, in which the low and moderate level groups were compared with the high level of PA group (reference group). Sex and age group displayed statistical significance in the final model (p<0.001), with a total explained variance of 0.06. Women were almost 50% more likely to belong to the moderate level group (OR=1.48; 95% CI=1.17-1.86; p<0.001) and nearly 75% more likely to be in the PA group (OR=1.74; 95% CI=1.35-2.24; p<0.001) compared to men. Regarding age group, younger age was associated with higher odds ratios. Participants aged 30-39 years were almost four times more likely (OR=3.84; 95% CI=2.95-5.01; p<0.001) to present a moderate level and nearly nine times more likely (OR=8.80; 95% CI=6.60-11.68; p<0.001) to present a low level of PA compared to participants aged 60 years or older.
The results, including adjusted odds ratios (ORa) and other indices derived from the multinomial LogR analyses, are reported in Table 5.
Discussion
This study provides validity evidence for the BASE-6 through the analysis of its internal structure using CFA and MI. Social distribution parameters were examined to estimate the vulnerability of specific groups and individuals to PA difficulties. In addition, the study standardized the measure’s scores to establish cut-off points based on the obtained sample.
Psychometric evidence for the BASE-6 has revealed consistent results regarding its structure and measurement properties (Cruz et al., 2020; Ko et al., 2023; Rehman et al., 2024; Yildirim & Solmaz, 2021). The unidimensionality of the measure suggests that the PA assessed by the BASE-6 is organized globally, thus integrating emotional and behavioral responses to environmental demands. Furthermore, this finding is consistent with theoretical models that conceptualize the construct as a functional and comprehensive process (Heppner & Anderson, 1985; Heppner & Lee, 2002).
The results of the MI analyses suggest that the factor structure remains stable across different sociodemographic groups, which is consistent with other studies (Ko et al., 2023; Yildirim & Solmaz, 2021), thereby supporting comparisons across different groups and contexts. Although the number of adaptation and validation studies of BASE-6 is still relatively limited, due to its recent development, available evidence has exhibited methodological consistency, further reinforcing the robustness of the measure for use in population-based research and psychological monitoring contexts. However, the fact that the accumulation of research is still ongoing should be considered, and further investigations in different cultural contexts and clinical and population samples are needed to consolidate its applicability on a broader scale.
One of the main contributions of this study is the novel proposal to standardize BASE-6 scores in Brazil, subsequently establishing cut-off points based on the distribution observed in the sample. The fact that the suggested cut-off points were defined based on the social distribution of BASE-6 scores should be emphasized, which means that such analysis is not based on criterion validity evidence (see DeVellis & Thorpe, 2021). These parameters provide an initial reference for interpreting levels of PA, particularly in epidemiological, comparative, and longitudinal studies, in which the identification of profiles and variations over time is central. In this sense, normatization contributes to expanding the applicability of BASE-6 in other investigations and across different research contexts (Arias et al., 2022). This also enables, for example, the monitoring of variations in PA over time or across different populations.
Nevertheless, the limitations inherent in using normative criteria derived from a sample that is not representative of the Brazilian population must be acknowledged. Therefore, our proposed cut-off points should be interpreted with caution and understood as preliminary parameters, primarily valid for exploratory, comparative, and research purposes, and should not be used in isolation for diagnostic or classificatory decisions in clinical contexts. Future studies should seek to replicate these findings in more diverse samples.
Sex and age group were significant predictors, with poorer outcomes observed among women and younger individuals. These variables also influenced the likelihood of belonging to the moderate and low PA groups. Previous research has also reported similar findings (Dufner et al., 2019; Hoyle & Davisson, 2023; Kingery et al., 2023; Perry et al., 2023).
Difficulties in PA among women may be explained by psychological, social, and contextual factors that operate cumulatively throughout their lifecycle. Evidence suggests that women are more exposed to emotional overload, gender inequalities, and the double burden of work, in addition to having a higher likelihood of experiencing adverse events such as violence, discrimination, and relational instability, which tend to negatively affect PA (Stanton et al., 2007; Hoyle et al., 2023). Furthermore, differences in emotional socialization lead women to report negative emotions more frequently and seek psychological help more often, which may contribute to both greater detection of difficulties and higher scores on self-report instruments (Qiu et al., 2024). These findings reinforce the need for mental health interventions that are sensitive to gender-specific characteristics and consider not only individual aspects but also structural determinants that disproportionately affect this group.
The results indicated poorer PA among younger individuals, which may reflect challenges that are characteristic of developmental transitions during this stage of the life course. Entry into adulthood is often marked by uncertainties related to identity, occupational insertion, and financial stability, as well as intense social pressures and performance expectations, which may compromise psychological adaptation (Varma et al., 2021). In addition, younger individuals tend to display greater sensitivity to environmental stressors and a less consolidated repertoire of coping strategies, which may increase their vulnerability to adjustment difficulties in adverse contexts (Schaefer et al., 2022). These results highlight the importance of intervention strategies focused on strengthening psychological resources and providing support during critical transition periods.
Although these sociodemographic variables were statistically significant in the regression models, the explained variances were considered relatively modest. Evidence indicates that in large samples, statistical significance may occur even with small effects, which reinforces the importance of effect size for a more substantive interpretation of the results (Kelley & Preacher, 2012). Even when considered jointly, sex and age explained approximately one-tenth of the variability in PA levels, thus indicating that most of the variance is associated with other factors not included in the models. This finding reinforces that although relevant as contextual markers, sociodemographic variables have limited explanatory power for complex psychological phenomena. Therefore, future studies should incorporate psychological variables such as coping strategies, emotional regulation, and social support to expand the predictive capacity of the models and deepen the understanding of the determinants of PA.
Despite the contributions of this study, some limitations should be acknowledged. First, the sample included predominantly female participants, which may have affected the generalizability of the findings. Second, although large, the study sample is not representative. In addition, the use of convenience sampling, with exclusively online administration, may have introduced selection bias, potentially underrepresenting individuals with limited internet access or low digital proficiency, which limits the applicability of the results to the general population.
Furthermore, the study relied on basic sociodemographic variables such as sex, education level, and age group, without including other relevant socioeconomic indicators such as income or occupational status, which could broaden the understanding of disparities in PA. To increase the validity and replicability of the findings, future investigations should seek representative samples and adopt diversified data collection strategies. Importantly, future research should include clinical samples and achieve a more balanced distribution of sociodemographic variables, such as sex and age.
Finally, this study represents a significant advancement in the investigation of the BASE-6 regarding the production of validity evidence in Brazil. The psychometric analysis confirmed the unidimensional structure and internal consistency of the measure. One of the main contributions of this study is the novel proposal to standardize BASE-6 scores, consequently enabling the establishment of cut-off points based on the distribution observed in the Brazilian sample. This standardization provides support for future studies to use consistent parameters when interpreting results across different contexts. However, these cut-off points must be interpreted with caution, as additional studies are necessary to evaluate their diagnostic sensitivity and specificity, as well as to verify their adequacy in representative samples and in different application contexts. Based on our findings, the adoption of the proposed cut-off points is suggested as a reference for the assessment of PA in the Brazilian population. Thus, the applicability of the BASE-6 as a brief instrument that is easy to understand and administer reinforces its potential usefulness in large-scale studies and across diverse research contexts.
DATA AVAILABILITY STATEMENT
The research data are not available.
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