Use of structural equation modeling to test the construct validity of the SF-36 Health Survey in ten countries: results from the IQOLA Project. International Quality of Life Assessment
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Authors
Keller, Susan D.Ware, John E. Jr.
Bentler, Peter M.
Aaronson, Neil K.
Alonso, Jordi
Apolone, Giovanni
Bjorner, Jakob B.
Brazier, John E.
Bullinger, Monika
Kaasa, Stein
Leplege, Alain
Sullivan, Marianne
Gandek, Barbara
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
1998-11-17Keywords
Cross-Cultural ComparisonEurope
Factor Analysis, Statistical
*Health Status Indicators
Humans
*Psychometrics
*Quality of Life
Questionnaires
Translations
United States
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
A crucial prerequisite to the use of the SF-36 Health Survey in multinational studies is the reproduction of the conceptual model underlying its scoring and interpretation. Structural equation modeling (SEM) was used to test these aspects of the construct validity of the SF-36 in ten IQOLA countries: Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, the United Kingdom, and the United States. Data came from general population surveys fielded to gather normative data. Measurement and structural models developed in the United States were cross-validated in random halves of the sample in each country. SEM analyses supported the eight first-order factor model of health that underlies the scoring of SF-36 scales and two second-order factors that are the basis for summary physical and mental health measures. A single third-order factor was also observed in support of the hypothesis that all responses to the SF-36 are generated by a single, underlying construct--health. In addition, a third second-order factors, interpreted as general well-being, was shown to improve the fit of the model. This model (including eight first-order factors, three second-order factors, and one third-order factor) was cross-validated using a holdout sample within the United States and in each of the nine other countries. These results confirm the hypothesized relationships between SF-36 items and scales and justify their scoring in each country using standard algorithms. Results also suggest that SF-36 scales and summary physical and mental health measures will have similar interpretations across countries. The practical implications of a third second-order SF-36 factor (general well-being) warrant further study.Source
J Clin Epidemiol. 1998 Nov;51(11):1179-88. Link to article on publisher's siteDOI
10.1016/S0895-4356(98)00110-3Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47411PubMed ID
9817136Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/S0895-4356(98)00110-3