Development and Validation Analysis of Redeemer’s University Alexithymia Scale (RUNAS)

Background: In Nigeria, alexithymia, “no words for feelings” is understudied and under-assessed despite its significance in physical and psychological health outcomes. This study attempts the development of a standardised alexithymia scale. Methodology: The development of this scale is in two phases: the first phase is the development and refinement of screening tool items and the second phase establishes the scale’s psychometric properties. Results: The observed KMO measure of sampling adequacy is .59 with a significant Bartlett’s test of sphericity (X 2 = 1022.608, df = 561, p = .000). The test of the principal components indicated twelve components extracted. Based on Principal Component Analysis, only 12 items in one component were found significant and retained as part of the final scale. The item-total statistics and Cronbach coefficient (α) of .79, a Spearman-Brown coefficient of .80, and Guttman Split-Half coefficient of .79 of the tool indicate that all items have good discrimination and should be retained. The internal consistency of RUN-PDST among the Nigerian sample revealed that the screening tool is re-liable. Paired with TAS-20, RUNAS has good concurrent validity. Conclusion: RUNAS has appropriate psychometric properties for assessing alexithymia in Nigeria and similar cultural contexts.

Alexithymia was first researched in the context of traditional psychosomatic or somatic diseases, but it is now recognised as a personality trait normally distributed in the general population; a high degree of alexithymia is a risk factor for several mental diseases and medical conditions (Luminet et al., 1999;Taylor et al., 1997).
There is extensive literature on the prevalence of alexithymia in Nigeria. According to Moussa and Senol (2019), there is a high prevalence rate of alexithymia in female (68.58%) and male (66.39%) Nigerian undergraduates. Also, a high prevalence of alexithymia, 55.02%, was uncovered among people with essential hypertension in South-East Nigeria (Onyedibe & Onyekwelu, 2015).
There currently exists no indigenous screening tool for assessing and managing alexithymia in Nigeria. Hence, alexithymia is under-assessed, underdiagnosed, as an indigenous measure of alexithymia.

Methods
The study adopted a mixed-method design to develop and validate the scale comprising two broad phases 1) development and refinement of screening tool items 2) establishment of psychometric properties. To develop scale items, extensive literature findings on research outputs from previous alexithymia studies and scale development articles were conducted to generate original items for the RUNAS scale. Authors agree on the definition of the construct and development of relatable items based on a range of scenarios based on the definition of alexithymia. Item response ranged from "1 = Never" to "5 = Very Often" in response to items that measure how in-tune the respondents are with your emotions.
Thirty-four items were initially generated from this process.
After generating original items for the scale, items were statistically refined using exploratory factor analysis (EFA) to uncover the Principal Components Analysis (PCA), Bartlett's Test of Sphericity (BTS), and the Kaiser-Meyer-Olkin (KMO) data. The first phase of data collection from 89 female undergraduates of Redeemer's University was conducted in November 2020.
In establishing psychometric properties, item-total statistics, concurrent validity, norms and scoring guide were estimated. The second phase of data collection from 454 female undergraduates of Osun State University took place in May 2021. The sample size for the study's second phase is justified using the Araoye sample size determination formula for a population above 10,000 (Araoye, 2003 Results reveal a KMO measure of sampling adequacy of .59, which falls within the statistically significant range of 0 to 1. The Bartlett's test of sphericity was also significant (X 2 = 1022.608, df = 561, p = .000). These results support the factorability of the correlation matrix, signifying that the factor analysis is considered appropriate. Hence the Principal Components Analysis (PCA) was conducted.
The Principal Components Analysis indicated that the items on the scale had twelve components, and the analysis of the components revealed all items that loaded based on the presence of 12 components exceeding an eigenvalue of 1.
The eigenvalues of the twelve components range between 5.969 to 1.025, with a percentage ranging from 17.557 to 3.016, as presented in Table 1.  A summary of the reliability details of the instrument is presented in Table 3. Using data derived from the initial sample, values of the corrected item/total correlations were used to indicate discriminations in the items in the scale. All items had values ranging between .331 -.506, indicating that all items have good discrimination and should be retained.
Furthermore, the internal consistency of RUNAS among the Nigerian sample revealed a Cronbach coefficient (α) of .79, a Spearman-Brown coefficient of .80, and Guttman Split-Half coefficient of .79, all indicating that the scale is reliable.

Concurrent Validity for RUNAS
For this phase of the study, four hundred and fifty-four (454) undergraduates selected from Osun State University, Osogbo, Osun State, were sampled using Redeemer's University Alexithymia Scale (RUNAS) and Toronto Alexithymia Scale (TAS-20). The Toronto Alexithymia Scale (TAS-20) developed by Bagby, Parker and Taylor (1994) is a 20-item instrument that is one of the most commonly used measures of alexithymia. TAS-20 demonstrates good internal consistency (Cronbach's alpha = .81) and test-retest reliability (.77, p < .01). Research using the TAS-20 demonstrates adequate levels of convergent and concurrent validity. The 3-factor structure was theoretically congruent with the alexithymia construct. In addition, it is stable and replicable across clinical and non-clinical populations. Table 4

Calculation of Norms for the Redeemer's University Alexithymia Scale (RUNAS)
This study employed the 95% Confidence Interval method in estimating the cut-off point for RUNAS. As summarised in Table 5 with 95% confidence, the population mean is between 32.3 and 33.5 based on 454 samples [32.87 (95% CI 32.3 to 33.5)]. The lower limit of the interval (i.e., mean score minus one margin of error) of ≥ 32.3 is considered the cut-off point for the sample.

Redeemer's University Alexithymia Scale (RUNAS): Final Draft
Below is a Redeemer's University Alexithymia Scale (RUNAS) sample and its scoring guide. Responses are presented on a 5-point Likert scale ranging from Never to Very Often. The highest possible score on the scale is 60, while the lowest possible score of 12. The scale adopts a direct scoring pattern. Hence, the total alexithymia score is derived by summing up all responses on the scale (See Table 6 and Table 7).

Discussion
This research aimed to develop a tool to measure alexithymia, the inability to recognise or describe one's emotion. The study was conducted in two phases.  A positive relationship was found between RUNAS and the overall score obtained in TAS-20. In addition, it was observed that the relationship between RUNAS and the three dimensions of TAS-20 were also positively significant.
This implied that RUNAS reflected alexithymia as a construct and indicated the identified possible sub-sections found in literature.
Also, norms were established for RUNAS, and it was indicated that scores from individuals below the score of 10 are perceived as normal, those that scored between 11 and 32 had mild forms of alexithymia, those that scored between 33 and 53 are described as having moderate form of alexithymia, while scores 54 and above are regarded as severe.
RUNAS is a promising brief measure for the assessment of alexithymia in research and clinical practice. Despite the novelty that this study presents in the development of a standardised scale for the assessment of alexithymia, there are some limitations to the study due to requiring further research. First, only female undergraduates were used as sample for the test development and further studies is required for more inclusive sampling of general population including males, adults and clinical populations. Hence, RUNAS needs to be validated among larger and more diverse samples so as to further ascertain the viability of the scale. Also, a test-retest analysis could be incorporated in further research to determine the consistency of the scale in its measurement of the construct.

Conclusion and Recommendations
The study was two-phase research conducted to create an indigenous measure for alexithymia in Nigerian society. It also established the psychometric properties of the construct. The development of RUNAS serves as a more appropriate tool to measure alexithymia among Nigerian samples since it is an indigenous developed scale with items structured based on the cultural and social perception of sensations and feelings in the society. By implication, the scale could be utilised for both health management and research purposes.
However, there is still a need to undertake other studies utilising samples selected across the country (Nigeria) to establish a more generalised norm and indicate the prevalence of alexithymia within the multicultural Nigerian society. In addition, alexithymia is not a concept that could be associated with adolescents and youths alone; thus, the samples should include other categories of individu-