=Paper= {{Paper |id=Vol-3696/ELEARNING_paper_9 |storemode=property |title=Towards a Valid and Reliable Checklist to Evaluate Argumentative Essays Composed by ChatGPT |pdfUrl=https://ceur-ws.org/Vol-3696/article_9.pdf |volume=Vol-3696 |authors=Danijela Ljubojević,Djordje M. Kadijevich,Nikoleta Gutvajn |dblpUrl=https://dblp.org/rec/conf/elearning/LjubojevicKG23 }} ==Towards a Valid and Reliable Checklist to Evaluate Argumentative Essays Composed by ChatGPT== https://ceur-ws.org/Vol-3696/article_9.pdf
                         Towards a Valid and Reliable Checklist                                                                    to        Evaluate
                         Argumentative Essays Composed by ChatGPT
                         Danijela Ljubojević1, Djordje M. Kadijevich1 and Nikoleta Gutvajn1
                         1
                                Institute for Educational Research, 11/III Dobrinjska, 11000 Belgrade, Republic of Serbia


                                              Abstract
                                              Since its launch a year ago, ChatGPT has sparked many concerns in education, especially
                                              when it comes to writing. Many students enjoy the benefits of getting generated text for their
                                              homework assignments; however, this behaviour impacts profoundly the writing process and
                                              the development of critical thinking skills. Among these assignments that are particularly
                                              important to critical skills development are so-called argumentative essays, which require the
                                              student to investigate a topic, collect, generate, and evaluate evidence, and establish a
                                              position on the topic in a concise manner. To assess these essays in a thoughtful way, this
                                              paper presents a checklist whose indicators focus on main aspects of essay organisation and
                                              higher-order critical thinking skills. The checklist was developed for both machine and
                                              human responses by using relevant theoretical framework (the Classical model of
                                              Argumentation and Paul-Elder critical thinking framework), the five-paragraph approach,
                                              and Cambridge English Qualifications scales at level C1 of the CEFR. As this assessment
                                              tool was applied in evaluating ChatGPT-composed argumentative essays, apart from the
                                              validity of the tool, this paper also presents its inter-rater reliability. Suggestions for research
                                              and practice are included.

                                              Keywords1
                                              ELT, argumentative essay, writing, ChatGPT, checklist, critical thinking, reliability, validity

                         1. Introduction
                             Artificial intelligence (AI) has become an integral part of learning and teaching in many fields and
                         English language teaching (ELT) is not an exception. Recent studies have recognised the importance
                         of using chatbots, such as ChatGPT, in ELT [1] [2]. ChatGPT generates human-like text based on the
                         input it receives and up to now users have been very satisfied with it. However, essay writing in
                         English is about not only generating written content but also demonstrating good essay organization
                         and paragraph structuring.
                             This pilot study set out to analyse argumentative essays generated through ChatGPT and,
                         consequently, to come up with a reliable and valid instrument to assess students writing tasks in
                         English. Furthermore, it aims to determine what can ChatGPT generate in terms of developing critical
                         thinking skills. To assess the extent to which writing proficiency has been achieved, an appropriate
                         checklist with good validity and reliability needs to be applied. Hence, this study examined validity
                         and reliability of the developed checklist.
                             The findings of this research hold implications for teaching writing and the integration of AI in
                         English language classrooms. A positive answer to the question of validity and reliability could
                         contribute to the improvement concerning the missing instrument that assesses the promotion of
                         critical thinking skills and the use of AI-generated content.



                         Proceedings for the 14th International Conference on eLearning (eLearning-2023), September 28–29, 2023, Belgrade, Serbia
                         EMAIL: danijela.ljubojevic@ipi.ac.rs (A. 1); djkadijevic@ipi.ac.rs (A. 2); gutvajnnikoleta@gmail.com (A. 3)
                         ORCID: 0000-0002-4168-7107 (A. 1); 0000-0002-5628-3455 (A. 2); 0000-0002-4337-4884 (A. 3)
                                         ©️ 2023 Copyright for this paper by its authors.
                                         Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
                                         CEUR Workshop Proceedings (CEUR-WS.org)


CEUR
                  ceur-ws.org
Workshop      ISSN 1613-0073
Proceedings

                                                                                                               82
2. Theoretical Framework
    Argumentative essays are types of essays which require the student to investigate a topic, collect,
generate, and evaluate evidence, and establish a position on the topic in a concise manner. They are
very important for developing critical thinking skills. Providing sufficient and sound arguments in the
argumentative essays is essential to their success. It is not enough just to support the idea with enough
details and examples; there are some more aspect that should be covered.
    Developing good argumentation is vital to argumentative essays. There are different models of
argumentation that be used: the Classical Model of Argumentation, the Toulmin Model, Rogerian
Argumentation Model, etc. One of the most applied models in ELT is the Classical. It is also called
Aristotelian because it was first mentioned in Aristotle’s work Rhetoric. Aristotle’s central idea is that
persuasion comes about through arguments, i.e. by proving that something is the case. The classical
argument is made up of five components, which are commonly composed in the following order [3]:
introduction, narration, confirmation, refutation, and conclusion. When using this model, the writer
should start with a clear, concise, and defined thesis statement that occurs in the first paragraph of the
essay. Each paragraph should develop only one idea (paragraph unity) which must be supported by
sufficient supporting details. What is important for this model is the use of “opposing” point of view:
argumentative essays should also consider and explain differing points of view regarding the topic
and discuss conflicting opinions on the topic. It is also important to use clear and logical transitions
between the introduction, body, and conclusion, because without logical progression of thought, the
reader will be unable to follow the essay’s argument, and the structure will collapse.
    A common outline for writing an argumentative essay is the five-paragraph approach (also known
as the “hamburger essay,” the “one-three-one essay,” and the “three-tier essay.”). It consists of an
introductory paragraph, three body paragraphs with evidence that include discussion of opposing
views, and a conclusion.
    Writing argumentative essays is crucial for the development of critical thinking (CT) skills with
students. CT refers to the ability to analyse and evaluate arguments or evidence. The National Council
for Excellence in Critical Thinking defined it as ‘the intellectually disciplined process of actively and
skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered
from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to
belief and action” [4]. However, it is a skill that cannot be measured directly; instead, intellectual
standards are used to determine the quality of reasoning [5]. One of the critical thinking models that
can be adopted in improving argumentation skills is the Paul-Elder critical thinking framework [6]
[7]. The intellectual standards proposed by the framework are clarity, precision, accuracy, depth,
breadth, logic, significance, relevance, and fairness and they are used for the checklist in this study.
    When designing a checklist, the items addressed all five Aristotelian components and Paul-Edler’s
intellectual standards.

3. Methodology
   The aim of this study was to determine if a reliable and valid checklist can be applied in assessing
ChatGPT generated essays. It set out to explore inter-rater agreement between the two reviewers who
applied the checklist developed. Furthermore, it explored if ChatGPT offers some possibilities for
language teaching and learning.
   In order to do this a comprehensive checklist for assessing essay structure and intellectual
standards was designed. Two independent secondary school teachers graded the essays using the
proposed checklist. The reviewers were not aware of the fact that they were assessing computer-
generated essays.
   The following instructions were given as prompts to ChatGPT:
   Higher education increases the chances of employment. Agree or disagree with this statement.
Support your opinion with reasons and examples. Write an essay in around 240 - 280 words.
   The first researcher in this study generated the essays. The essays were then sent to the reviewers
for assessment.




                                                   83
    Essay organization was assessed using 14-item instrument, whose indicators were derived from the
five-paragraph approach, the Classical model, and Cambridge English Qualifications scales at level
C1 of the CEFR. The checklist was meticulously designed based on the previous research by the first
author [8]. Each item gets different marks. These indicators are listed in Table 1. Ranging from 0
(lowest) to 5 (highest) and precise instructions were given for the band in the right column.
Table 1
Checklist for Essay Structure
                                                                                              Max. no.
  Indicator Items for assessment
                                                                                              of points
  1           Does the essay have an introduction, a body, and a conclusion?                          3
  2           Is the response of appropriate length?                                                  1

             Introduction
 3           Do the general statements give background information?                                 1
 4           Is it a funnel introduction?                                                           1
 5           Does the thesis statement state a clearly focused main idea for the whole essay?       1

             Body
 6           Are there arguments expressing the writer's point of view?                             2
 7           Are there arguments expressing the opposing point of view?                             2
 8           Does each body paragraph have a clearly stated topic sentence with a main              3
             (controlling) idea?
 9           Does each body paragraph have good development with sufficient supporting              3
             details (facts, examples, and quotations)?
 10          Does each body paragraph have unity (one idea per paragraph, there are no              3
             sentences that are "off the topic")?
 11          Does each body paragraph have coherence (logical organization, transition              3
             words, and consistent pronouns)?

             Conclusion
 12          Does the conclusion restate your thesis or summarize your main points? What            1
             kind of conclusion does the essay have? Is it summary of the main points or
             restatement of the thesis?
 13          Does the conclusion give writer’s personal opinion about the topic?                    1

 14          Language (choose only one)                                                             5
             Uses a (wide) range of vocabulary, including less common lexis, effectively and        5
             precisely.
             Uses a wide range of simple and complex grammatical forms with full control,
             flexibility and sophistication.
             Errors, if present, are related to less common words and structures, or occur as
             slips.
             Performance shares features of Bands 3 and 5.                                          4
             Uses a range of vocabulary, including less common lexis, appropriately.                3
             Uses a range of simple and complex grammatical forms with control and
             flexibility.
             Occasional errors may be present but do not impede communication.
             Performance shares features of Bands 1 and 3.                                          2
             Uses a range of everyday vocabulary appropriately, with occasional                     1
             inappropriate use of less
             common lexis.
             Uses a range of simple and some complex grammatical forms with a good



                                                  84
              degree of control.
              Errors do not impede communication.

   The attainment of critical thinking skills was examined using a 9-item instrument (Table 2), whose
indicators were derived from the above-mentioned Paul-Elder CT Model [9] with clarification as
given by Inoshita et al. [10]. These indicators are listed in Table 2. Each item gets marks from 0
(lowest) to 3 (highest).
Table 2
Checklist for Intellectual Standards
           Intellectual Standards                                   Clarification [10]
          (Paul – Elder Model) [7]
  Indicator 15 Clarity
  Could you elaborate?                     An essay is clear, it’s understandable and communicates
  Could you illustrate what you mean?      information to readers with ease. None of the statements are
  Could you give me an example?            confusing or ambiguous. There aren’t areas within the essay
                                           where the meaning is lost due to exaggerated narrative or
                                           forced and unnatural word choice. When an essay is clear,
                                           readers can follow the path that the writer is communicating.
                                           They can read smoothly without stopping to ponder what a
                                           word or even an entire sentence means.
  Indicator 16 Accuracy
  How could we check on that?              Is it correct? Is it true? Accuracy, not only when it comes to
  How could we find out if that is true?   spelling, punctuation, and word usage, but also grammar,
  How could we verify or test that?        syntax, and conducting research within and outside of the
                                           respective disciplines.
  Indicator 17 Precision
  Could you be more specific?              Precision within writing demands that words are not only
  Could you give me more details?          spelled correctly but that their meanings are also clear and that
  Could you be more exact?                 the words are not overused. Punctuation needs to be used in a
                                           manner that follows standard rules, and ideas must be
                                           expressed in ways that are direct while still allowing for the
                                           writer to perform with skill and artistry.
  Indicator 18 Relevance
  How does that relate to the problem?     Is it essential to the main idea? If paragraphs in an essay are
  How does that bear on the question?      relevant, they are related to the main topic and help support
  How does that help us with the issue?    the main idea with additional, related, relevant details and
                                           evidence. If paragraphs are irrelevant, a reader might think,
                                           “Wait. What? How is this on topic?”
                                           Does this point help readers understand the main issue?
                                           Does this essay focus on the assignment question or prompt?
                                           Does it answer the main question?
                                           If this paragraph is slightly off-topic, what can be done to
                                           refocus it so that it does its job in supporting the main idea in
                                           the thesis statement?
                                           If a point is confusing readers who don’t understand how it’s
                                           related to the main idea, does it belong in this essay?
  Indicator 19 Depth
  What factors make this difficult?        Is it sufficiently complex? How deeply does this essay go into its
  What are some of the complexities of     topic?
  this question?                           Is it detailed enough?
  What are some of the difficulties we     Did it go far enough into the research and reviews of other
  need to deal with?                       texts to demonstrate a deep knowledge about the subject?
                                           How thoroughly have specific subtopics within a major been
                                           researched?




                                                     85
  Indicator 20 Breadth
  Do we need to look at this from            Are all views considered? - a writer must consider not only one
  another perspective?                       point of view, but all the multiple major perspectives about an
  Do we need to consider another point       issue.
  of view?                                   Is the content of an essay sufficiently comprehensive enough to
  Do we need to look at this in other        cover a wide range of perspectives and angles on a given topic?
  ways?                                      Is anything missing that should be included in the scope of the
                                             topic and which would help the essay achieve enough breadth?
                                             Has the opposing view (i.e., the “naysayer’s” perspective) been
                                             explored so as to strengthen the writer’s own argument? (This
                                             consideration is particularly key in the development of a fully
                                             supported and wisely composed persuasive or argumentative
                                             essay.)
                                             What has not yet been considered to make this idea or essay
                                             complete?
  Indicator 21 Logic
  Does all of this make sense together?      Does a sentence, paragraph, or argument make sense?
  Does your first paragraph fit in with      Does one point follow another point with reason and
  your last one?                             connected ideas and transitions, rather than jumping from
  Does what you say follow from the          point A to point Z without sufficient explanation of how they
  evidence?                                  are related?
                                             Are all assertions fortified by sufficient evidence?
                                             Does all data collected, whether determined as relevant or not,
                                             follow a logical approach?
  Indicator 22 Significance
  Is this the most important problem to      Is the information important enough to include?
  consider?                                  Does the information answer the question asked in an
  Is this the central idea to focus on?      assignment?
  Which of these facts are most              What key points are most important for writers to include and
  important?                                 for readers to consider?
                                             Is this topic important in relation to other topics in the same
                                             subject area?
                                             What’s the most important thing to focus on?
                                             Is this topic worth the writer’s time researching and the
                                             reader’s time reading?
                                             Would there be enough readers interested in this topic?
  Indicator 23 Fairness
  Is my thinking justifiable in context?     Does the writer of this essay exhibit the ability to fairly assess
  Am I taking into account the thinking of   the viewpoints of others, even opposing viewpoints?
  others?                                    Are there any fallacies, such as ad hominems that unfairly label
  Is my purpose fair given the situation?    opponents rather than speak directly and precisely about the
  Am I using my concepts in keeping with     opposing argument or point of view itself?
  educated usage, or am I distorting         Does the writer or speaker have a conflict of interest?
  them to get what I want?                   Does that conflict of interest appear as bias in the text?

    For each essay (there were 23 instances), the average Spearman correlations among the reviewers’
score was calculated. These values were 0.885, 0.733, 0.754, and 0.918, respectively. As being above
0.60, these figures evidence a good agreement among the four raters, especially for the first and the
last essay. Note that in many cases different measures of inter-rater reliability result in the same
conclusion [11], meaning that a standard reliability threshold (>0.60) used for the kappa measure [12]
could be applied.




                                                      86
4. Results
   When the prompts were given to ChatGPT, it generated the following two essays:
   Essay 1
    In today's rapidly evolving job market, the role of higher education in increasing employment prospects is a
topic of considerable debate. While some argue that a college degree significantly enhances one's chances of
securing a job, others contend that it is not always a guarantee of employment. In this essay, I will argue that
higher education does indeed increase the chances of employment, but its effectiveness depends on various
factors.
    To begin with, higher education equips individuals with valuable skills and knowledge that are often
required in the modern workforce. Many professions, such as engineering, medicine, and law, demand
specialized training and qualifications that can only be acquired through higher education. Without these
credentials, individuals may find it challenging to access certain career paths or secure well-paying jobs.
    Moreover, a college degree demonstrates to employers a candidate's commitment, discipline, and ability to
complete a long-term educational program. It serves as a signal of a person's willingness to invest time and
effort in self-improvement, qualities highly valued in the job market.
    However, it's essential to acknowledge that the relationship between higher education and employment is not
always straightforward. Factors such as the choice of major, the prestige of the institution, and the individual's
networking skills also play significant roles. For example, a degree in computer science from a top-tier
university may open doors to lucrative job opportunities, while a less specialized degree from a less-known
institution might not yield the same results.
    In conclusion, higher education undeniably enhances the chances of employment by providing essential
skills, demonstrating commitment, and opening doors to specialized professions. However, the extent of its
impact varies depending on the field of study, the institution, and the individual's networking abilities.
Therefore, while higher education is a valuable asset in the pursuit of employment, it should be considered as
part of a broader strategy that includes factors beyond academic qualifications.
                                                                                                  Word count: 312
    Essay 2
    I strongly agree that higher education increases the chances of employment. This belief is grounded in the
fact that higher education equips individuals with valuable skills, knowledge, and qualifications that are highly
sought after by employers.
    Firstly, higher education provides students with specialized skills and expertise that are often essential for
many professions. For example, a degree in engineering equips graduates with the technical knowledge required
for jobs in the engineering field. Similarly, a medical degree is necessary to become a doctor. Employers often
prioritize candidates with such specialized knowledge and skills, making higher education a key factor in
securing employment.
    Secondly, higher education institutions offer students opportunities for personal and professional growth.
Students learn critical thinking, problem-solving, communication, and teamwork skills that are transferable
across various industries. These skills not only make individuals more employable but also help them succeed
and advance in their chosen careers.
    Furthermore, statistics consistently show a strong correlation between higher education attainment and
employment rates. According to data from the U.S. Bureau of Labor Statistics, individuals with higher levels of
education tend to have lower unemployment rates and higher earning potential compared to those with only a
high school diploma.
    For instance, in the United States, the unemployment rate for individuals with a bachelor's degree is
significantly lower than for those with only a high school diploma. This demonstrates that higher education not
only increases the chances of finding employment but also provides better job security.
    In conclusion, higher education is a significant factor in increasing the chances of employment. It equips
individuals with specialized skills, fosters personal and professional growth, and is strongly correlated with
lower unemployment rates and higher earning potential. While there are exceptions, overall, pursuing higher
education is a wise investment in one's future career prospects.

                                                                                          Word count: 296 words




                                                       87
   These essays were marked in the following way by the reviewers (Table 3):
Table 3
Grading results for Essay 1 and Essay 2 by Reviewer 1 and Reviewer 2
    Indicator                E1 R1              E1 R2            E2 R1                   E2 R2
        1                      3                  3                 3                      3
        2                      1                  1                 1                      1
        3                      1                  1                 1                      1
        4                      1                  1                 0                      1
        5                      1                  1                 1                      1
        6                      2                  2                 2                      2
        7                      2                  1                 2                      0
        8                      3                  3                 2                      3
        9                      3                  3                 3                      3
        10                     3                  3                 3                      3
        11                     3                  3                 3                      3
        12                     1                  1                 1                      1
        13                     1                  0                 1                      0
        14                     5                  4                 4                      4
        15                     3                  3                 3                      3
        16                     3                  3                 3                      2
        17                     3                  3                 2                      3
        18                     3                  3                 3                      3
        19                     3                  2                 3                      2
        20                     3                  2                 2                      2
        21                     3                  3                 3                      3
        22                     3                  3                 3                      3
        23                     3                  2                 2                      3

    Reliability of this checklist was examined using inter-rater reliability based upon Spearman's
correlation. This correlation suitable for ordinal data was determined using an online calculator
available at https://www.socscistatistics.com/tests/spearman/default2.aspx). For the first essay, this
correlation was 0.90. For the second essay, the correlation was 0.78. These figures evidence a good
agreement between the two raters, especially for the first essay. Note that in many cases different
measures of inter-rater reliability result in the same conclusion [11], meaning that a standard
reliability threshold (>0.60) used for the kappa measure [12] could be applied.

5. Discussion
   The present study was designed to determine if a reliable and valid checklist can be applied in
assessing ChatGPT generated essays, to explore inter-rater agreement between the two reviewers who
applied the checklist developed and explore the potential of using ChatGPT generated essays in the
classroom.
   It was shown that ChatGPT can produce argumentative essays that are given high marks in almost
every aspect regarding the requirements set in the checklist. The results for reliability of the given
instrument clearly show that the applied checklist had good psychometric features, which answers the
applied research question in a positive way. It can be thus said that this checklist successfully
measures one underlying construct and thus it can confidently be used in further research. Hence, the
outcome of this study contributes to developing an instrument that assesses the promotion of critical
thinking with the use of ChatGPT, which has been a neglected research area so far, to the authors’
readings.
   The results for reliability of the given instrument were affirmative, meaning that it enables a
consistent, reliable assessment. Hence, the outcome of this study contributes to developing a valid and



                                                  88
reliable instrument that assesses the promotion of critical thinking in a broader context (both for a
human and machine generated responses), which has been a neglected research area so far, to the
authors’ readings.


6. Closing Remarks
    This study set out to determine if a reliable and valid instrument can be used to assess
argumentative essays in terms of essay organization and the elements of critical thinking. These
essays were ChatGPT generated. The checklist was designed for this purpose comprising the
requirements stemming from: the five-paragraph approach, the Classical model of argumentation, and
Paul-Elder critical thinking framework. The findings have shown that the checklist is both reliable
and valid so it can be used within ELT classrooms. Implications for ELT are numerous: teachers can
use this checklist not only to evaluate students’ argumentative essays but also to benefit from it by
analysing together with students ChatGPT generated essays and thus, focus on the promotion of
critical thinking skills.
    Limitations of this study can be regarded in terms of the sample of essays used and the number of
teachers who participated as reviewers. This limitation means that study findings need to be
interpreted cautiously.
    Up to now, no studies were undertaken longitudinally because ChatGPT is a new technology.
Further research should be undertaken to find good learning models with the help of ChatGPT and
how to implement them within educational settings.

7. Acknowledgements
    The authors of this paper would like to thank the following teachers for their participation in the
research as reviewers: Nana Shavishvili, Professional English Instructor, Georgian American
University, Georgia; and Biljana Pipović, English Language Teacher, Grammar School “Stevan
Jakovljević” Vlasotince, Serbia.
    This research was funded by the Ministry of Science, Technological Development and Innovation
of the Republic of Serbia (Contract No. 451-03-47/2023-01/ 200018).




                                                  89
8. References


[1]    W. C. H. Hong, “The impact of ChatGPT on foreign language teaching and learning: Opportunities in
       education and research,” Journal of Educational Technology and Innovation(JETI), vol. 5, no. 1, 2023.
[2]    W. Huang, K. F. Hew and L. K. Fryer, “Chatbots for language learning—Are they really useful? A
       systematic review of chatbot-supported language learning,” Journal of Computer Assisted Learning,
       vol. 38, no. 1, p. 237–257, 2022.
[3]    Aristotel, Retorika, Beograd: Štampar Makarije, 2017.
[4]    National Council for Excellence in Critical Thinking, “The Foundation for Critical Thinking,” 1987.
       [Online]. Available: https://www.criticalthinking.org/pages/defining-critical-thinking/766.
[5]    Z. S. Nakrowi, D. S. Ansori, Y. Mulyati and Y. Setyaningsih, “The use of intellectual standards to
       assess the quality of students’ argumentative writings,” LITERA, vol. 22, no. 2, pp. 200-212, 2023.
[6]    L. Elder and R. Paul, The Thinker’s Guide to Analytic Thinking: How to Take Thinking Apart and
       What to Look for When You Do, 2nd Edition, Tomales: Rowman & Littlefield Publishers / The
       Foundation for Critical Thinking, 2016, p. 9.
[7]    E. Linda and R. Paul, “Critical Thinking: Intellectual Standards essential to Reasoning Well Within
       Every Domain of Thought,” Journal of Developmental Education, vol. 36, no. 3, pp. 34-35, 2013.
[8]    D. Ljubojevic, Developing academic writing skills in English as L2 by means of collaborative e-
       learning tools, University of Belgrade, Faculty of Philology, 2017.
[9]    R. Paul and L. Elder, “Critical Thinking: Intellectual Standards Essential to Reasoning Well Within
       Every Domain of Human Thought, Part Two,” Journal of Developmental Education, vol. 37, no. 1, p.
       32–36, 2013.
[10]   A. Inoshita, Garland, K. K. Sims, T. Keuma, J. K. and T. Williams, English Composition - Connect,
       Collaborate, Communicate, Honolulu: University of Hawai, OER , 2019.
[11]   A. de Raadt, M. Warrens, R. Bosker and H. A. L. Kiers, “A Comparison of Reliability Coefficients for
       Ordinal Rating Scales,” Journal of Classification, vol. 38, p. 519–543 , 2021.
[12]   J. Flo, B. Landmark, O. E. Hatlevik and L. Fagerström, “Using a new interrater reliability method to
       test the modified Oulu Patient Classification instrument in home health care,” Nursing Open., vol. 5, p.
       167–175, 2018.




                                                     90