Chung-Ying Lin1, Amir H Pakpour, Anders Broström, Bengt Fridlund, Kristofer Årestedt, Anna Strömberg, Tiny Jaarsma, Jan Mårtensson. 1. Chung-Ying Lin, PhD Assitant Professor, Faculty of Health and Social Sciences, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom. Amir H. Pakpour, PhD Associate Professor, Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Iran, and Department of Nursing, School of Health and Welfare, Jönköping University, Sweden. Anders Broström, PhD Professor, Department of Nursing, School of Health and Welfare, Jönköping University, Sweden. Bengt Fridlund, PhD Professor, School of Health and Welfare, Jönköping University, Sweden. Kristofer Årestedt, PhD Professor, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, and Department of Medical and Health Sciences, Linköping University, Sweden. Anna Strömberg, PhD Professor, Department of Medical and Health Sciences, Linköping University, Sweden. Tiny Jaarsma, PhD Professor, Department of Social and Welfare Studies, Linköping University, Sweden; and Mary MacKillop Institute of Health Research, ACU, Melbourne, Australia. Jan Mårtensson, PhD Professor, Department of Nursing, School of Health and Welfare, Jönköping University, Sweden.
Abstract
BACKGROUND: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF). OBJECTIVE: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran. METHODS: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA). RESULTS: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47). CONCLUSIONS: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.
BACKGROUND: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF). OBJECTIVE: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran. METHODS:Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA). RESULTS: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47). CONCLUSIONS: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.