The Short Form Health Survey (SF-36): Translation and validation study of the Iranian version

This was a large population-based study to develop and validate the Iranian version of the Short Form Health Survey (SF-36) for use in health related quality of life assessment in Iran. A culturally comparable questionnaire was developed and pilot tested. Then, the Iranian version of the SF-36 was administered to a random sample of 4163 healthy individuals aged 15 years and over in Tehran. The mean age of the respondents was 35.1 (SD=16.0) years, 52% were female, mostly married (58%) and the mean years of their formal education was 10.0 (SD=4.5). Reliability was estimated using the internal consistency and validity was assessed using known groups comparison and convergent validity. In addition factor analysis was performed. The internal consistency (to test reliability) showed that all eight SF-36 scales met the minimum reliability standard, the Cronbachs coefficients ranging from 0.77 to 0.90 with the exception of the vitality scale (=0.65). Known groups comparison showed that in all scales the SF-36 discriminated between men and women, and old and the young respondents as anticipated (all p values less than 0.05). Convergent validity (to test scaling assumptions) using each item correlation with its hypothesized scale showed satisfactory results (all correlation above 0.40 ranging from 0.58 to 0.95). Factor analysis identified two principal components that jointly accounted for 65.9% of the variance. In general, the Iranian version of the SF-36 performed well and the findings suggest that it is a reliable and valid measure of health related quality of life among the general population.     

Development of a Vietnamese version of the Short form-36 Health Survey

We aimed to test the psychometric properties of a culturally relevant translation of the medical outcomes study short form-36 health survey (SF-36) with prospective Vietnamese migrants. The translated survey was interviewer-administered to 1610 Vietnamese aged over 15 years who had applied to migrate to Australia. All but two SF-36 items had good discriminant validity, and all eight scales of the Vietnamese version of the SFS-36 had good discriminant validity, which supports the use of SF-36 constructs to assess self-reported health status among Vietnamese migrants. However, the mental health, vitality and bodily pain scales demonstrated low internal consistency. This finding is likely to be a product of the increased diversity among scale items following modifications to improve cultural relevance. Further modifications to improve the internal consistency of these scales are required.     

The version 2.0 of the SF-36 Health Survey: results of a population-representative study

Zusammenfassung. Fragestellung: Der SF-36 ist ein international anerkanntes Verfahren zur Erfassung der subjektiven Gesundheit. In seiner zweiten Version beinhaltet der SF-36 gegenüber Version 1.0 Ver?nderungen in einigen Item-Formulierungen und Antwortkategorien. Version 2.0 liegt in deutscher übersetzung vor, eine psychometrische Prüfung und Normierung fehlt aber. Methoden: Der SF-36, Version 2.0, wurde in einer repr?sentativen bundesdeutschen Stichprobe eingesetzt, hinsichtlich seiner Skalenstruktur, Reliabilit?t, Verteilungscharakteristika sowie bezüglich Unterschieden in Populationsmerkmalen untersucht und verglichen mit Version 1.0 (Bundesgesundheitssurvey). Ergebnisse: Version 2.0 zeigt eine hohe Reliabilit?t der Subskalen und eine Skalenstruktur, die der Version 1.0 vergleichbar ist. Die Skalenwerte sind in der aktuellen bev?lkerungsrepr?sentativen Stichprobe eher schief verteilt, wobei regressionsanalytisch Effekte von Geschlecht, Alter und Wohnort (Ost/West) nachweisbar sind. Eine Gegenüberstellung der Kennwerte von Version 1.0 und 2.0, unter Konstanthaltung obiger Confounder, zeigt eine hohe Konkordanz. Schlussfolgerung: Die psychometrische Vergleichbarkeit der beiden Versionen ist gegeben, sollte inhaltlich wegen der unterschiedlichen Erhebungszeitr?ume aber vorsichtig interpretiert werden. Der erwartete Zugewinn an psychometrischer Qualit?t und Differenzierungsf?higkeit von Version 2.0 gegenüber Version 1.0 ist zwar vorhanden, rechtfertigt aber nicht eine Bevorzugung von Version 2.0.      

Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36)

OBJECTIVE: The characteristics of the 36 item Medical Outcome Short Form Health Study Survey (SF-36) questionnaire, designed as a generic indicator of health status for the general population, allow it to be self-administered or used in personal or telephone interviews. The main objective of the study was to compare the telephone and self-administered modes of SF-36 for a population from Girona (Spain). METHODS: A randomized crossover administration of the questionnaire design was used in a cardiovascular risk factor survey. Of 385 people invited to participate in the survey, 351 agreed to do so and were randomly assigned to two orders of administration (i.e., telephone-self and self-telephone); 261 completed both questionnaires. Scores were compared between administration modes using a paired t test. Internal consistency and agreement between modalities were analyzed by respectively applying Chronbach's alpha and intraclass correlation coefficients. The effect of the order of administration on the test-retest difference was analyzed by one-way ANOVA for repeated measurements. RESULTS: Physical function, physical role and social functioning received significantly lower scores when the self-administered questionnaire was used prior to the telephone survey. When the initial survey was conducted by telephone, all Chronbach's alpha coefficients (except social functioning) scored over 0.70 in the self-administered modality. The intraclass correlation coefficient ranged from 0.41 to 0.83 for the telephone-self order and from 0.32 to 0.73 for the self-telephone order. No clinically significant effect was observed for the order of application. CONCLUSIONS: The results of the present study suggest that the telephone-administration mode of SF-36 is equivalent to and as valid as the self-administered mode.     

Validity and Reliability of MOS Short Form Health Survey (SF-36) for Use in India

Background:

Health is defined as the state of complete physical, mental and social well-being than just the absence of disease or infirmity. In order to measure health in the community, a reliable and validated instrument is required.

Objectives:

To adapt and translate the Medical Outcomes Study Short-Form Health Survey (SF-36) for use in India, to study its validity and reliability and to explore its higher order factor structure.

Materials and Methods:

Face-to-face interviews were conducted in 184 adult subjects by two trained interviewers. Statistical analyses for establishing item-level validity, scale-level validity and reliability and tests of known group comparison were performed. The higher order factor structure was investigated using principal component analysis with varimax rotation.

Results:

The questionnaire was well understood by the respondents. Item-level validity was established using tests of item internal consistency, equality of item-scale correlations and item-discriminant validity. Tests of scale-level validity and reliability performed well as all the scales met the required internal consistency criteria. Tests of known group comparison discriminated well across groups differing in socio-demographic and clinical variables. The higher order factor structure was found to comprise of two factors, with factor loadings being similar to those observed in other Asian countries.

Conclusion:

The item-and scale-level statistical analyses supported the validity and reliability of SF-36 for use in India.     

A comparison of the Nottingham Health Profile and Short Form 36 Health Survey in patients with chronic lower limb ischaemia in a longitudinal perspective

Background

Different generic quality of life instruments such as the Nottingham Health Profile (NHP) and the Short Form 36 Health Survey (SF-36) have revealed conflicting results in patients with chronic lower limb ischaemia in psychometric attributes in short-term evaluations. The aim of this study was to compare the NHP and the SF-36 regarding internal consistency reliability, validity, responsiveness and suitability as outcome measures in patients with lower limb ischaemia in a longitudinal perspective.

Methods

48 patients with intermittent claudication and 42 with critical ischaemia were included. Assessment was made before and one year after revascularization using comparable domains of the NHP and the SF-36 questionnaires.

Results

The SF-36 was less skewed and more homogeneous than the NHP. There was an average convergent validity in three of the five comparable domains one year postoperatively. The SF-36 showed a higher internal consistency except for social functioning one-year postoperatively and was more responsive in detecting changes over time in patients with intermittent claudication. The NHP was more sensitive in discriminating among levels of ischaemia regarding pain and more able to detect changes in the critical ischaemia group.

Conclusion

Both SF-36 and NHP have acceptable degrees of reliability for group-level comparisons, convergent and construct validity one year postoperatively. Nevertheless, the SF-36 has superior psychometric properties and was more suitable in patients with intermittent claudication. The NHP however, discriminated better among severity of ischaemia and was more responsive in patients with critical ischaemia.

     

SF-36健康调查量表中文版的研制及其性能测试

目的 研制SF-36健康调查量表中文版并验证量表维度建立及记分假设、信度和效度。方法 采用多阶段混合型等概率抽样法,用SF-36健康调查量表中文版对1000户家庭的居民进行自评量表式调查;参照国际生命质量评价项目的标准程序,进行正式的心理测验学试验。结果 在收回的1985份问卷中,18岁以上的有效问卷1972份,其中应答者1688人(85．6％),1316人回答了所有条目,372人有1个或以上的缺失答案,无应答者中文盲、半文盲占65．5％。等距假设在活力(VT)和精神健康(MH)维度被打破了,按重编码后值计算维度分数;条目集群的分布接近源量表及其他2个中文译本;除了生理功能(PF)、躯体疼痛(BP)、社会功能(SF)维度,其余维度有相似的标准差;除了SF、VT维度,其余6个维度条目维度相关一致;除了SF维度,7个维度集合效度成功率范围为75％～100％,,区分效度成功率范围为87．5％～100％。一致性信度系数除了SF、VT维度,其余6维度变化范围为0．72～0．88,满足群组比较的要求。两周重测信度变化范围为0．66～0．94。因子分析产生了2个主成分,分别代表生理健康和心理健康,解释了56．3％的总方差。结论 为SF-36健康调查量表适用于中国提供了证据,已知群效度试验将为量表效度提供更有意义的证据。     

The Iranian version of 12-item Short Form Health Survey (SF-12): factor structure, internal consistency and construct validity

Background  

The 12-item Short Form Health Survey (SF-12) as a shorter alternative of the SF-36 is largely used in health outcomes surveys. The aim of this study was to validate the SF-12 in Iran.     

Translation and psychometric testing of the Basque version of the SF-36 Health Survey

Introduction: The primary goals of this study were to adapt the Short Form-36 (SF-36) questionnaire to the Basque language and to assess the translated questionnaires psychometric properties. Methods: Two pilot studies and a field study were conducted in 1999. The pathologies selected were hypertension, eating disorders, back pain, and HIV infection; blood donors were also included. The analyses conducted at item-level were: item internal consistency, item discriminant validity, equal item variance, and equal item-scale correlation. Internal consistency was measured at the scale level. Reproducibility, convergent validity and discriminant validity were also examined. Results: 285 individuals took part in the study; sufficient data were obtained for 265 (93%). All items correlated higher than 0.4 with their hypothesized scales. Within each scale, item standard deviations were similar. Item-scale correlations were also similar. Cronbachs alpha coefficients varied from 0.76 to 0.92. In the test-retest reliability study, which included 54 additional individuals, all scales were above 0.50. Regarding the inter-scale correlation, the majority exceeded the 0.40 coefficient. In the correlation of similar scales of the SF-36 and the Nottingham Health Profile, intraclass correlation coefficient results ranged from 0.29 to 0.62. Conclusions: These results confirm that this new version of the SF-36 has been translated and adapted correctly for the Basque language and that it fulfils, at least partially, the psychometric properties required for this instrument. Further studies, however, are needed to completely validate the Basque version of the SF-36.     

An assessment of factorial structure and health-related quality of life in problem drug users using the Short Form 36 Health Survey

AIMS: To confirm the factorial structure of the Short Form 36 Health Survey (SF-36) in problem drug users and to compare their health-related quality of life (HRQOL) with general Dutch population norms. METHOD: Data of 394 participants from the Amsterdam Cohort Study among drug users, who had completed once the SF-36 standard form (4 weeks recall) between February and August 2005, were analyzed. The factorial structure of the SF-36 was investigated by confirmatory factor analysis. Subsequently, sum scores of the eight SF-36 health dimensions were converted into z-scores by standardizing them with the mean and standard deviation of the corresponding general Dutch population age and gender group. RESULTS: The factor structure was acceptable and also comparable with previous findings. Compared with the general population, participants had significantly lower z-scores on all of the eight SF-36 dimensions, with largest deviations in social functioning (M = -1.13) and mental health (M = -1.01), and smallest deviations in bodily pain (M = -0.32). CONCLUSION: The results corroborate the factorial structure and reliability of the answers of problem drug users to the SF-36. Their HRQOL was low, even though it was assessed irrespective of substance abuse treatment settings.     

The Spanish version of the Nottingham Health Profile: a review of adaptation and instrument characteristics

The increased interest in measuring health status implies a need for instruments that are appropriate and valid. Adaptation of existing instruments may be a cost-effective strategy. In this paper we describe the adaptation into Spanish of the Nottingham Health Profile (NHP), a self-administered perceived health questionnaire developed in the UK. The characteristics of the adapted questionnaire (validity, reliability, and sensitivity to change), as well as current and purposed applications, are discussed. Some of the principles that were applied in the described adaptation process may be useful for similar future research: involving the investigators that developed the original instrument; using a panel of lay individuals in the translation process; testing the characteristics of the adapted instrument by replicating previous studies with the original instrument, and organizing an international group for the development and use of the European versions of the NHP. Adaptation of health status measures is an opportunity for gaining comparability when measuring health, and for learning about cross-cultural differences in health-related quality of life.A preliminary version of this paper was presented at the Satellite Symposium of the Inaugural Meeting of the International Health-related Quality of Life Society, Brussels, Belgium, 3–4 February 1994.     

SF-36量表在乙型肝炎患者生存质量测量中的可行性评价

目的评价SF-36量表在乙型肝炎患者生存质量测量中的可行性。方法对150例乙型肝炎患者的测量结果,考核量表应答率、Cronbach α系数、内容效度、结构效度和甄别力等进行评价。结果SF-36量表各维度的条目能被全部回答的比例范围是94.8%~97.8%,维度分数能被计算的比例范围是98.5%~100.0%;各维度Cronbach’sα系数范围是0.513~0.934;9I条目与VT维度的相关系数为0.334,其余大于0.4;VT维度与构想的生理健康强相关不一致;VT和MH维度不能表现出应该有的区别患者与正常人、疾病的严重程度上的差异。结论从总体上看SF-36量表用于测定乙型肝炎患者具有比较好的信度、效度,但不够全面。     

Spanish version of the Child Health and Illness Profile-Child Edition Parent Report Form [CHIP-CE/PRF]

OBJECTIVES: To analyze the reliability and validity of the domains of the Child Health and Illness Profile-Child Edition Parent Report Form (CHIP-CE/PRF) included in the Barcelona Health Survey conducted in 2000 and to obtain population-based reference values. METHODS: Data were obtained from proxy-respondent interviews of children aged 5-14 years old (n = 836) participating in the Barcelona Health Survey 2000. The 4 subdomains of the parent version of the CHIP-PRF included in the health survey were: satisfaction with health, and physical discomfort, emotional discomfort, and limitation of activities of the discomfort domain. Internal consistency was assessed using Cronbach's alpha coefficients. An exploratory factor analysis was carried out and analysis of covariance was performed to assess the construct validity of the subdomains. RESULTS: In all the subdomains assessed, Cronbach's alpha was above 0.70 (range, 0.76-0.98). In the factorial analysis, almost all the items (31/35) presented the highest load in their corresponding subdomain. Most of the expected mean differences among groups were confirmed. Girls aged 10-14 years old scored the lowest, both in satisfaction with health (48.93; 95% confidence interval [CI 95%], 47.40-50.47) and in discomfort (48.87; CI 95%, 47.51-50.22). No differences were found according to the social class of the head of the family. CONCLUSIONS: The present study provides a useful measure of perceived health status in a child health survey.     

Quality of Life Assessed with the Medical Outcomes Study Short Form 36-Item Health Survey of Patients on Renal Replacement Therapy: A Systematic Review and Meta-Analysis

OBJECTIVES: The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) is the most widely used generic instrument to estimate quality of life of patients on renal replacement therapy. Purpose of this study was to summarize and compare the published literature on quality of life of hemodialysis (HD), peritoneal dialysis (PD), and renal transplant (RTx) patients. METHODS: We used random-effects regression analyses to compare the SF-36 scores across treatment groups and adjusted this comparison for age and prevalence of diabetes using random-effects meta-regression analyses. RESULTS: We found 52 articles that met the inclusion criteria, reporting quality of life of 36,582 patients. The unadjusted scores of all SF-36 health dimensions were not significantly different between HD and PD patients, but the scores of RTx patients were higher than those of dialysis patients, except for the dimensions Mental Health and Bodily Pain. Point differences between dialysis and RTx patients varied from 2 to 32. With adjustment for age and diabetes, the differences became smaller (point difference 2-22). The significance of the differences of both dialysis groups compared with RTx recipients disappeared for the dimensions Vitality and Social Functioning. The significance of the differences between HD and RTx patients disappeared on the dimensions Physical Functioning, Role Physical, and Bodily Pain. CONCLUSION: We conclude that dialysis patients have a lower quality of life than RTx patients, but this difference can partly be explained by differences in age and prevalence of diabetes.     

The psychometric properties of the Spanish version of the Foot Health Status Questionnaire

Purpose

Clinical studies suggest that foot pain may be problematic in one-third of patients in early disease. The Foot Health Status Questionnaire (FHSQ) was developed and validated to evaluate the effectiveness of conservative (orthoses, taping, stretching) and surgery interventions. Despite this fact, there are few validated instruments that measure foot health status in Spanish. Thus, the primary aim of the current study was to translate and evaluate psychometrically a Spanish version of FHSQ.

Methods

A cross-sectional study was designed in a university community-based podiatric clinic located in south of Spain. All participants (n = 107) recruited consecutively completed a Spanish version of FHSQ and EuroQoL Health Questionnaire 5 dimensions, and 29 participants repeated these same measures 48 h later. Data analysis included test–retest reliability, construct and criterion-related validity and factor analyses.

Results

Construct validity was appropriate with moderate-to-high corrected item–subscale correlations (α = ≥0.739) for all subscales. Test–retest reliability was satisfactory (ICC > 0.932). Factor analysis revealed four dimensions with 86.6 % of the common variance explained. The confirmatory factor analysis findings demonstrated that the proposed structure was well supported (comparative fit index = 0.92, standardized root mean square = 0.09). The Spanish EuroQoL 5D score negatively correlated with the FHSQ pain (r = ?0.445) and positively with general foot health and function (r = 0.261 ? 0.579), confirming criterion-related validity.

Conclusion

The clinimetric properties of the Spanish version of FHSQ were satisfactory.     

A Kiswahili version of the SF-36 Health Survey for use in Tanzania: translation and tests of scaling assumptions

The objective of the study was to translate and adapt the SF-36 Health Survey for use in Tanzania and to test the psychometric properties of the Kiswahili SF-36. A cross-sectional study was conducted as part of a household survey of a representative sample of the adult population of Dar es Salaam, Tanzania. The IQOLA method of forward and backward translation was used to translate the SF-36 into Kiswahili. The translated questionnaire was administered by trained interviewers to 3,802 adults (50% women, mean (SD) age 31 (13) years, 50% married and 60% with primary education). Data quality and psychometric assumptions underlying the scoring of the eight SF-36 scales were evaluated for the entire sample and separately for the least educated subgroup (n=402), using multitrait scaling analysis. Forward and backward translation procedures resulted in a Kiswahili SF-36 that was considered conceptually equivalent to the US English SF-36. Data quality was excellent: only 1.2% of respondents were excluded because they answered less than half of the items for one or more scales; ninety percent of respondents answered mutually exclusive items consistently. Median item–scale correlations across the eight scales ranged from 0.47 to 0.81 for the entire sample. Median scaling success rates were 100% (range 87.5–100.0). The median internal consistency reliability of the eight scales for the entire sample was 0.81 (range 0.70–0.92). Floor effects were low and ceiling effects were high on five of the eight scales. Results for n=402 people without formal education did not differ substantially from those of the entire sample. The results of data quality and psychometric tests support the scoring of the eight scales using standard scoring algorithms. The Kiswahili translation of the SF-36 may be useful in estimating the health of people in Dar es Salaam. Evidence for the validity of the SF-36 for use in Tanzania needs to be accumulated.     

Spanish version of the Nottingham Health Profile: translation and preliminary validity.

We report the transfer into Spanish of a multi-dimensional measure of perceived health originally developed in Great Britain, the Nottingham Health Profile (NHP), and an assessment of the preliminary validity of the version is presented. Translation of the questionnaire was obtained from experts and from a Spanish monolingual lay group. Construct validity of the version was assessed in two studies: testing relationship of NHP scores to other self-reported measures of health in a general population survey; and comparing NHP scores for a group of frequent users and for a group of non-users of primary health services. Mean scores of NHP dimensions were higher for people with poorer self-reported health and higher for the frequent health services users than for the non-users. Findings suggest that the Spanish version of the NHP is culturally equivalent to the original questionnaire, and has a similar level of construct validity. Nevertheless, further research on reliability and on the weighting system is required to establish the equivalence of the Spanish version definitively.