Original Article
Results from the IQOLA Project
Susan D. Keller1,
, John E. WareJr. 1, Peter M. Bentler2, Neil K. Aaronson3, Jordi Alonso4, Giovanni Apolone5, Jakob B. Bjorner6, John Brazier7, Monika Bullinger8, Stein Kaasa9, Alain Leplège10, Marianne Sullivan11 and Barbara Gandek1 1 Health Assessment Lab at the Health Institute, New England Medical Center, Boston, Massachusetts USA 2 University of California, Los Angeles, California USA 3 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands 4 Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain 5 Dipartimento di Oncologia, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy 6 Institute of Public Health, University of Copenhagen, Copenhagen, Denmark 7 Sheffield Health Economics Group, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom 8 Abteilung Für Medizinische Psychologie, Universitätskrankenhaus Eppendorf, Hamburg, Germany 9 Unit for Applied Clinical Research, The Norwegian University for Science and Technology, Trondheim, Norway 10 Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France 11 The Health Care Research Unit, Institute of Internal Medicine, Sahlgrenska University Hospital and Göteborg University, Göteborg, Sweden Accepted 7 July 1998. Available online 30 March 1999.
Abstract
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.
Author Keywords: Structural equation modeling; confirmatory factor analysis; cross-cultural comparison; health status indicators; SF-36 Health Survey; IQOLA
Index Terms: health survey; quality of life
9592.rar
(288.07 KB)
本附件包括: