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.     

Assessing the validity of the SF-36 General Health Survey

Our objective was to assess the validity of the SF-36 General Health Survey against the Social Maladjustment Schedule (SMS) and two questionnaire measures, the Social Problem Questionnaire and the Nottingham Health Profile (NHP) in a random subsample of 206 men and women from the Whitehall II study, a longitudinal survey of health and disease amongst 10,308 London-based civil servants. We found that social functioning on the SF-36 correlated significantly with social contacts, total satisfaction and total management scores on the SMS, and social isolation and emotional reactions on the NHP. General mental health on the SF-36 was associated with marriage, social contacts, leisure scores, total satisfaction and total management scores on the SMS, and emotional reactions, energy level and social isolation on the NHP. Conversely, physical functioning and physical role limitations were generally not associated with the SMS but were associated with physical abilities and pain on the NHP. In conclusion, this study offers evidence of the discriminant validity of the general mental health and physical functioning scales of the SF-36. We also found moderate construct and criterion validity for the social functioning scale of the SF-36 and considerable overlap between the general mental health and social functioning scales.     

Measuring health-related quality of life for persons with mobility impairments: an enabled version of the short-form 36 (SF-36E)

OBJECTIVE: Examine psychometric properties of the SF-36 and SF-36E for mobility-impaired individuals and assess whether the SF-36E yields higher health-related quality-of-life scores. METHODS: We altered the SF-36 Physical Function scale by substituting the word "go" for "walk" and "climb" and changed the stem to reflect function using assistive devices. We compared responses between versions for 201 individuals with disabilities (n = 95 wheelchair users, n = 48 other device users, 58 = no device users). RESULTS: Both surveys yielded reliable scores, but floor and ceiling effects occurred with both versions. Confirmatory factor analyses demonstrate good fit for the SF-36 and SF36E, but were compromised by low sample size. Respondents demonstrated significantly better Role Physical, Bodily Pain, and Vitality on the SF-36E, but worse General Health. CONCLUSIONS: The World Health Organization framework, the International Classification of Functioning, Disability, and Health (ICF) suggests that it is important to know both what one can do without assistance (capacity) and what one can do with assistance (performance). Results suggest that the SF-36E successfully measures performance among mobility-impaired individuals, including wheelchair users. However, further validation studies of the SF-36 and SF-36E are warranted with samples of individuals with disabilities.     

Equivalence of Chinese and US–English Versions of the SF-36 Health Survey

This study evaluated the equivalence of Chinese and US–English versions of the SF-36 Health Survey in a convenience sample of 309 Chinese nationals bilingual in Chinese and English living in a US city. Snowball sampling was used to generate sufficient sample size. Internal consistency, test–retest, and equivalent-forms reliability were estimated. Patients were randomized to one of four groups: (1) English version completed first, followed by Chinese version (same occasion); (2) Chinese version completed first, followed by English version (same occasion); (3) English version completed once and then again 1-week later; (4) Chinese version completed once and then again 1-week later. Internal consistency reliability estimates for the Chinese and US–English versions of the SF-36 scales ranged from 0.60 to 0.88; test–retest reliability estimates (1 week time interval) ranged from 0.67 to 0.90. Reliability estimates for corresponding Chinese and US–English SF-36 scales tended to be similar and not significantly different. Equivalent-forms reliability estimates (product–moment correlations) ranged from 0.81 to 0.98. Mean SF-36 scale scores were comparable for both versions of the instrument. This study provides support for the equivalence of the Chinese and US–English versions of the SF-36.     

SF-36量表应用于外来勤杂人员健康调查的信度和效度

目的评价SF-36量表在高校外来勤杂人员的信度和效度。方法采用SF-36生存质量量表，由经过统一培训的调查员对广州市某高校133名外来勤杂人员进行面对面现场测试，计算8项内容的评分，分析信度和效度。结果量表中除社会功能（0．69）外，其余各项维度Cronbach，a系数大于0．70；集合效度和区分效度较好；因子分析产生2个公共因子，解释65．13％的方差。结论SF-36量表具有较好的信度与效度，适于评价高校外来勤杂人员的生存质量。     

Do the SF-36 and WHOQOL-BREF Measure the Same Constructs? Evidence from the Taiwan Population*

Background: The SF-36 and WHOQOL-BREF are available for international use, but it is not clear if they measure the same constructs. We compared the psychometric properties and factor structures of these two instruments. Methods: Data were collected from a national representative sample (n=11,440) in the 2001 Taiwan National Health Interview Survey, which included Taiwan versions of the SF-36 and WHOQOL-BREF. We used Cronbach’s alpha coefficient to estimate scale reliability. We conducted exploratory factor analysis to determine factor structure of the scales, and applied multitrait analysis to evaluate convergent and discriminant validity. We used standardized effect size to compare known-groups validity for health-related variables (including chronic conditions and health care utilization) and self-reported overall quality of life. Structural equation modeling was used to analyze relationships among the two SF-36 component scales (PCS and MCS) and the four WHOQOL subscales (physical, psychological, social relations, and environmental). Results: Cronbach’s alpha coefficients were acceptable (⩾0.7) for all subscales of both instruments. The factor analysis yielded two unique factors: one for the 8 SF-36 subscales and a second for the 4 WHOQOL subscales. Pearson correlations were weak (<0.3) among subscales of both instruments. Correlations for subscales hypothesized to measure similar constructs differed little from those measuring heterogeneous subscales. Effect sizes suggested greater discrimination by the SF-36 for health status and services utilization known groups, but greater discrimination by the WHOQOL for QOL-defined groups. Structural equation modeling suggested that the SF-36 PCS and MCS were weakly associated with WHOQOL. Conclusions: In this Taiwan population sample, the SF-36 and WHOQOL-BREF appear to measure different constructs: the SF-36 measures health-related QOL, while the WHOQOL-BREF measures global QOL. Clinicians and researchers should carefully define their research questions related to patient-reported outcomes before selecting which instrument to use. * Presented in part at (1) 11th Annual Conference of the International Society for Quality of Life Research. Hong Kong, China, 2004. (2) 2004 Quality of Life Symposium – Conceptualization and Measurement issues in QOL. Tai-Chuan, Taiwan, 2004     

Performance of the Swedish SF-36 version 2.0

OBJECTIVES: To evaluate the performance of the first non-English (Swedish) SF-36 version 2.0 (V2) regarding scaling assumptions, reliability and validity, with special emphasis on the effects of extending the response scales of the two role functioning scales, role physical (RP) and role emotional (RE), from a dichotomous to a five-step format. METHODS: Questionnaires were mailed to a non-stratified, random national sample of 3000 18-75 year old Swedish residents in 1998-1999. Methods traditionally used in evaluating the original US SF-36 version 1.0 (V1) and other international versions were applied. RESULTS: A total of 73% of the questionnaires were returned. Scaling assumptions were satisfactorily met and generally enhanced compared with V1, particularly regarding the role functioning scales. Floor/ceiling effects were reduced and reliability estimates increased for the role scales. The factor structure was replicated and the relative validity of the role scales as measures of their components increased. Overall, the tests of the criterion-based validity using known groups comparisons produced results supporting hypotheses: scales from the physical domain distinguished best between groups expected to differ in physical health; and scales comprising the mental domain distinguished best between groups expected to differ in mental health. Furthermore, hypothesized differences in mean scale scores as a function of age and social risk factors were confirmed. CONCLUSIONS: The changes to the response formats of the role functioning scales have improved their precision, reliability and validity without jeopardizing the underlying structure of the original SF-36. These changes will likely further enhance the responsiveness of the SF-36.     

The EORTC breast cancer-specific quality of life questionnaire (EORTC QLQ-BR23): Translation and validation study of the Iranian version

The objective of this study was to test the reliability and validity of the Iranian version of the European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23). The English-language version of the questionnaire was translated into Persian (Iranian language) and its final form was approved by the EORTC Study Group on Quality of Life and then it was used in this study. The questionnaire was administered at two points in time to a consecutive sample of 168 newly diagnosed breast cancer patients and almost all of them (99%) found the questions easy to understand and acceptable. Cronbach's coefficient for multi-item scales (to test reliability) ranged from 0.63 to 0.95 at baseline and from 0.75 to 0.92 at follow-up administration of the questionnaire. Validity analysis was performed using known-groups' comparison analysis. The results showed that all functional and symptom scales discriminated between sub-groups of patients differing in clinical status as defined by their performance status and disease stage. In addition, all functional and symptoms scales detected change over time, as a function of changes in patients' performance status. In general, the findings of this study indicated that the Iranian version of the EORTC QLQ-BR23 is a reliable and valid supplementary measure of the quality of life in breast cancer patients and can be used in clinical trials and studies of outcome research in oncology.     

Health Status Assessed by the SF-36 Along the Diabetes Continuum in an Australian Population

Objective: To examine the association of health status with stage along the diabetes continuum. Design, setting and participants: Self-reported health status (SF-36) was assessed in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Impaired fasting glucose (IFG), undiagnosed diabetes, diagnosed diabetes, glycaemic control and cardiovascular disease were determined from fasting blood and self-reported data. Results: The prevalence of diagnosed diabetes was 5.6% (95% CI: 4.9–6.3), with an additional 1.0% (95% CI: 0.7–1.4) previously undiagnosed. When compared to those with normal glucose, those with diabetes were significantly impaired on all SF-36 dimensions except Mental Health, and those with IFG (4.3%) were significantly impaired in terms of Physical Functioning and Bodily Pain when controlling for the effects of age, sex and cardiovascular disease. Poor glycaemic control (HbA1c ≥ 7.0%) was also associated with impaired health status. Conclusions: Health status is impaired not only among those with diagnosed diabetes but also those with IFG and undiagnosed diabetes.     

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。     

Validation of the Kiswahili version of the SF-36 Health Survey in a representative sample of an urban population in Tanzania

The objective of this study was to assess the validity of a Kiswahili translation of the SF-36 Health Survey (SF-36) among an urban population in Tanzania, using the method of known-groups validation. People were randomly selected from a demographic surveillance system in Dar es Salaam. The representative sample consisted of 3,802 adults (15 years and older). Health status differences were hypothesized among groups, who differed in sex, age, socio-economic status and self-reported morbidity. Mean SF-36 scale scores were calculated and compared using t-test and ANOVA. Women had significantly lower mean SF-36 scale scores (indicating worse health status) than men on all scales and scores were lower for older people than younger on all domains, as hypothesized. On five of the eight SF-36 scales, means were higher for people of higher socio-economic status compared to those of lower socio-economic status. People who reported an illness within the previous 2 weeks scored significantly lower on all scales compared to those who were healthy, as did people who said they had a disability or a chronic condition.     

Assessment of Differential Item Functioning for Demographic Comparisons in the MOS SF-36 Health Survey

Objective: To investigate whether items of the Medical Outcomes Study (MOS) 36-Item Short-Form Health Status Survey (SF-36) exhibited differential item functioning (DIF) with respect to age, education, race, and gender. Methods: The data for this study come from two large national datasets, the MOS and the 1990 National Survey of Functional Health Status (NSFHS). We used logistic regression to identify items exhibiting DIF. Results: We found DIF to be most problematic for age comparisons. Items flagged for age DIF were vigorous activities, bend/kneel/stoop, bathing or dressing, limited in kind of work, health in general, get sick easier than others, expect health to get worse, felt calm and peaceful, and all four vitality items. Items flagged for education DIF include vigorous activities, health in general, health is excellent, felt calm and peaceful, and been a happy person. Vigorous activities, walk more than a mile, health in general, and expect health to get worse were identified as DIF when comparing African-Americans with whites. No items were identified for gender DIF. Conclusions: We found several consistent patterns of DIF using two national datasets with different population characteristics. In the current study, the effect of DIF rarely transferred to the scale level. Further research is needed to corroborate these results and determine qualitatively why DIF may occur for these specific items. This work was completed while Dr. McHorney was at Indiana University. Dr. McHorney is now with Outcomes Research & Management, Merck & Co., Inc.     

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.      

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.     

Estimating Utility Values for Health States of Overweight and Obese Individuals Using the SF-36

Objective: To use health-related quality-of-life (HRQoL) data from the Australian 1995 National Health Survey to estimate the impact of obesity (as measured by body mass index or BMI) on utility and quality-adjusted life expectancy (QALE).Method: SF-36 responses from 12,661 individuals in the general population were transformed into utility values using the SF-6D algorithm developed by Brazier and colleagues. Separate regression analyses for males and females were used to examine the impact of BMI and five obesity-related medical conditions (diabetes, coronary heart disease, depression, musculoskeletal disorders, and cancer) on utility. The utility estimates were used to provide indicative estimates of the decrease in QALE associated with being overweight or obese.Results: There was a statistically significant negative relationship between BMI and utility for males and females. For males (females), the marginal effect of a one-unit increase in BMI was associated with a −0.0024 (−0.0034) decrement in utility. Based on these estimates, a non-smoking male (female) aged 40 years who is obese can expect 7.2 (8.7) years less of QALE over their remaining lifetime.Conclusions : Results suggest that BMI is negatively associated with utility. Evaluation of policies designed to prevent or treat obesity should capture HRQoL as an outcome.     

The SF-36 questionnaire and its usefulness in population studies: results of the German Health Interview and Examination Survey 1998

SummaryObjectives To describe the distribution and the relationships of the SF-36 scales in a representative sample of the German population.Methods The German National Health Interview and Examination Survey 1998 comprised 7 124 participants aged 18 to 79 years and included the Short Form 36 Questionnaire (SF-36). The 1998 findings are compared to those of the first normative German SF-36 sample from 1994.Results Older people ( 65 years) in particular have increased the mean scale values for quality-of-life assessment during the four years. The average of all SF-36 scales increases with the social status of the individual in all age categories. The representative sample shows a more positive subjective assessment of their quality-of-life by East Germans in nearly all scales of SF-36, although they do not have a correspondingly better health status. The intensity of pain and the number of diseases during the preceding year are shown to decrease the life quality scales. Furthermore the General Health scale of SF-36 is correlated with the physicians' consultation.Conclusion The instrument to assess quality-of-life can generate useful information for a wide variety of variables. However, future health-related quality-of-life measurements in healthy population should be more sensitive and more differentiating than the SF-36 instruments.

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ZusammenfassungFragestellung Die Beschreibung der Verteilung der Skalen des SF-36-Fragebogens in einer repräsentativen Bevölkerungserhebung.Methoden Beim deutschen Bundes-Gesundheitssurvey 1998 nahmen 7 124 Probanden im Alter zwischen 18 und 79 Jahren teil. Erstmals wurde der SF-36 (Short Form 36)-Fragebogen eingesetzt. Die Ergebnisse von 1998 werden mit der SF-36-Normstichprobe von 1994 verglichen.Ergebnisse Insbesondere für ältere Menschen (65 Jahre) sind die mittleren Werte der Lebensqualitätsskalen in den letzten vier Jahren gestiegen. Die Mittelwerte der SF-36-Skalen erhöhen sich ausserdem mit dem Sozialstatus in allen Altersgruppen. Die repräsentative Stichprobe zeigt zudem für fast alle Skalen eine bessere subjektive Einschätzung der gesundheitsbezogenen Lebensqualität bei den Ostdeutschen, obwohl sie objektiv gesehen keinen besseren Gesundheitszustand aufzuweisen haben. Die Intensität von Schmerz und die Zahl von Krankheiten im vorangegangenen Jahr verringern die Werte der Lebensqualitätsskalen. Ausserdem besteht ein Zusammenhang zwischen der Inanspruchnahme von ärztlichen Leistungen und der subjektiven Einschätzung der allgemeinen Gesundheit.Schlussfolgerung Durch Untersuchung sehr unterschiedlicher Fragestellungen werden die Sinnhaftigkeit und der Informationswert dieses Lebensqualitätsinstruments klar demonstriert. Dennoch müssen die Instrumente zur Messung der gesundheitsbezogenen Lebensqualität für die gesunde Bevölkerung künftig sensitiver und differenzierter werden als es der SF-36 gegenwärtig zu sein vermag.

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RésuméObjectifs Décrire la distribution des échelles du questionnaire SF-36 dans une enquête représentatif de la population allemande.Méthodes En Allemagne, 7 124 personnes entre 18 et 79 ans ont participé à l'enquête Nationale de Santé 1998 qui incluait pour la première fois le questionnaire SF-36 (Short Form 36). Les résultats de 1998 sont comparés à ceux du premier échantillon standardisé de 1994.Résultats Il est démontré que les moyennes des valeurs d'échelles de la qualité de vie ont augmenté en particulier chez les vieilles personnes pendant les quatre années précédentes. De plus les moyennes de toutes les échelles SF-36 augmentent avec le statut social des individus dans toutes les catégories d'âge. Le tirage représentatif montre en outre une estimation subjective de la qualité de vie plus positive pour les Allemands de l'Est en comparaison avec les Allemands de l'Ouest, bien qu'objectivement ils n'aient pas un état de santé supérieur. Il est démontré que l'intensité de la douleur et le nombre de maladies durant l'année précédente diminuent les valeurs des échelles de qualité de vie. De plus, l'estimation générale subjective de la santé est corrélée avec le nombre de visites chez des médecins.Conclusions L'nstrument d'évaluation de la qualité de vie peut générer des informations utiles pour toute une série de variables. Cependant les instruments de mesure de la qualité de vie relative à la santé utilisés pour la population en bonne santé devraient à l'avenir devenir plus sensibles et plus pointus que les instruments SF-36.

     

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.     

A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore

Scaling assumptions and validity of the English (UK) and Chinese (HK) short form 36 health survey (SF-36) were assessed in a community-based survey of 5503 Chinese, Malays and Indians in Singapore using the international quality of life assessment project approach of item and scale level validation. Missing data for SF-36 items and scales occurred in less than 1.0% of subjects. Item level validation of both versions generally supported assumptions underlying Likert scoring and hypothesised item-order clustering. Item level factor analysis supported the eight-scale structure of the SF-36. In scale level validation, SF-36 scale scores showed wide variability and acceptable internal-consistency reliability (Cronbach's α > 0.70 for six English and seven Chinese scales), conformed to hypothesised patterns and generally varied according to hypotheses in subjects known to differ in quality of life. Scale level factor analysis of both versions yielded very similar patterns of factor correlation, comparable to that found in Japan, but differing from that seen in Western populations. Taken together, these results support the validity of the English (UK) and Chinese (HK) SF-36 versions in the multi-ethnic Asian socio-cultural context of Singapore. This revised version was published online in June 2006 with corrections to the Cover Date.     

Construct validation of the USA-Spanish version of the SF-36 health survey in a Cuban-American population with benign prostatic hyperplasia

This study examined the USA-Spanish version of the SF-36 health survey (validated in Mexican- Americans) and tested its construct validity in Cuban-Americans with benign prostatic hyperplasia (BPH). The study evaluated the SF-36 and American Urological Association (AUA) Symptom Index scores of 264 individuals with BPH. Individuals were assigned to one of the following groups: non-Hispanics who received the English version, Cubans who received the English version and Cubans who received the Spanish version. The objective was to determine the correlation between the individuals' SF-36 and AUA Symptom Index scores. It was expected that patients in the severe category would have the lowest quality of life (QoL) scores. The analysis was conducted using a MANOVA with a planned comparisons procedure. For all eight scales, the English and Spanish versions of the SF-36 were able to classify individuals with mild/moderate symptoms of BPH as having statistically higher QoL scores than those with severe symptoms of BPH. We concluded that the USA-Spanish version of the SF-36 can differentiate between levels of symptom severity in individuals with BPH. More importantly the construct validity of the English and Spanish versions of the SF-36 was demonstrated through significant correlation with the theorized constructs.