Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA Project. International Quality of Life Assessment

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Cross-Cultural Comparison; Developed Countries; Discriminant Analysis; *Health Status Indicators; Humans; Psychometrics; *Quality of Life; Questionnaires


Biostatistics | Epidemiology | Health Services Research


Data from general population samples in 11 countries (n = 1483 to 9151) were used to assess data quality and test the assumptions underlying the construction and scoring of multi-item scales from the SF-36 Health Survey. Across all countries, the rate of item-level missing data generally was low, although slightly higher for items printed in the grid format. In each country, item means generally were clustered as hypothesized within scales. Correlations between items and hypothesized scales were greater than 0.40 with one exception, supporting item internal consistency. Items generally correlated significantly higher with their own scale than with competing scales, supporting item discriminant validity. Scales could be constructed for 93-100% of respondents. Internal consistency reliability of the eight SF-36 scales was above 0.70 for all scales, with two exceptions. Floor effects were low for all except the two role functioning scales; ceiling effects were high for both role functioning scales and also were noteworthy for the Physical Functioning, Bodily Pain, and Social Functioning scales in some countries. These results support the construction and scoring of the SF-36 translations in these 11 countries using the method of summated ratings.

DOI of Published Version



J Clin Epidemiol. 1998 Nov;51(11):1149-58. Link to article on publisher's site

Journal/Book/Conference Title

Journal of clinical epidemiology

PubMed ID


Related Resources

Link to Article in PubMed