Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
Department of Rheumatology and Immunology, Singapore General Hospital, SingHealth, Singapore, Singapore.
Health Qual Life Outcomes. 2021 Mar 10;19(1):80. doi: 10.1186/s12955-021-01709-9.
The Short Form Health Survey (SF-12v2) is an increasingly popular measure of health-related quality of life (HRQoL) in Singapore. In order to examine whether the SF-12v2 was appropriate for use in the population, the factor structure and validity of the English, Mandarin, and Malay versions were assessed in a representative sample of the general population of Singapore.
6126 respondents were recruited for the Singapore Mental Health Study 2016 (SMHS 2016), a cross-sectional and population-based survey. Confirmatory factor analyses (CFA) were conducted to examine the fit of a two-factor model for the SF-12v2 within a representative sample and amongst the different language (English, Mandarin, Malay) subgroups. Multiple-group CFAs (MGCFA) were conducted to test measurement invariance across the different languages, ethnicities, and chronic illnesses subgroups. CFA-generated latent factor scores (FSCORE command in MPlus) were also compared with the composite scores derived from the developer's scoring method via correlations. Sociodemographic correlates of the latent physical and mental health scores were explored.
CFA results within the full sample supported a two-factor model (RMSEA = 0.044; CFI = 0.991; TLI = 0.988; SRMR = 0.044) in which physical functioning, role physical, bodily pain and general health items loaded onto a latent physical health factor, while role emotional, mental health, social functioning, and vitality items loaded onto a latent mental health factor. Physical and mental health factors were allowed to correlate, unlike the developer's orthogonal scoring method. All standardized loadings were high and statistically significant. Both factors had high internal consistency. CFA within subsamples of English, Mandarin, and Malay languages indicated similar findings. MGCFA results indicate that measurement invariance held across the different languages, ethnicities, and those with and without chronic illnesses.
The present study identified a two-factor (physical and mental health) structure within the general population and amongst the three different languages and demonstrated the measurement invariance of SF-12v2 across different subgroups. Findings indicate that algorithm-derived PCS and MCS should be interpreted with caution as they may result in inaccurate conclusions regarding the relationships between HRQoL and its correlates. Future studies using the SF-12v2 within the general population of Singapore should consider utilizing the factor structure put forth in the present study to obtain more appropriate estimates of HRQoL.
简短形式健康调查（SF-12v2）是新加坡日益流行的健康相关生活质量（HRQoL）测量方法。为了检验 SF-12v2 是否适用于该人群，在新加坡普通人群的代表性样本中评估了英语、普通话和马来语版本的因子结构和有效性。
2016 年新加坡心理健康研究（SMHS 2016）共招募了 6126 名受访者，这是一项横断面和基于人群的调查。在代表性样本和不同语言（英语、普通话、马来语）亚组中，进行验证性因子分析（CFA）以检验 SF-12v2 的两因素模型拟合情况。进行多组验证性因子分析（MGCFA）以检验不同语言、族裔以及患有和不患有慢性病亚组的测量不变性。使用 CFA 生成的潜在因子分数（MPlus 中的 FSCOR 命令）与通过相关性得出的开发者评分方法的综合分数进行比较。还探讨了潜在生理和心理健康分数的社会人口统计学相关性。
全样本的 CFA 结果支持两因素模型（RMSEA=0.044；CFI=0.991；TLI=0.988；SRMR=0.044），其中生理功能、角色生理、躯体疼痛和一般健康项目加载到潜在的生理健康因素上，而角色情感、心理健康、社会功能和活力项目加载到潜在的心理健康因素上。物理和心理健康因素允许相关，而不是开发者的正交评分方法。所有标准化负荷均较高且具有统计学意义。两个因素的内部一致性都很高。英语、普通话和马来语亚组内的 CFA 得出了相似的结果。MGCFA 结果表明，测量在不同语言、族裔以及患有和不患有慢性病的人群中具有不变性。
本研究在普通人群和三种不同语言中确定了两因素（生理和心理健康）结构，并证明了 SF-12v2 在不同亚组中的测量不变性。研究结果表明，算法衍生的 PCS 和 MCS 应谨慎解释，因为它们可能导致对 HRQoL 与其相关性之间关系的不准确结论。未来在新加坡普通人群中使用 SF-12v2 的研究应考虑使用本研究提出的因子结构，以获得更合适的 HRQoL 估计值。
