Ramji Rathi, Rämgård Margareta, Kottorp Anders
Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
Front Psychol. 2023 Apr 11;14:1118575. doi: 10.3389/fpsyg.2023.1118575. eCollection 2023.
Citizens living in disadvantaged neighborhoods experience poorer health than the majority, and this inequality is a public health problem even in a welfare state such as Sweden. Numerous initiatives aimed at improving health and quality of life in these populations are being implemented and evaluated. Given that these populations are predominantly multicultural and multilingual, an instrument such as the WHOQOL-BREF, which is cross-culturally validated and available in multiple languages, may be appropriate. However, this cannot be ascertained since the psychometric properties of WHOQOL-BREF have never been assessed in the Swedish context. Thus, the current study aimed at assessing the psychometric properties of the WHOQOL-BREF questionnaire in citizens from a disadvantaged neighborhood in Southern Sweden.
The respondents in this study were 103 citizens who participated in the health promotional activities of a Health promotional program and also responded to the 26-item, WHOQOL-BREF questionnaire as a part of an evaluation to assess the impact of the activities on the health-related quality of life of citizens. A Rasch model using WINSTEP 4.5.1 was used to assess the psychometric properties in this study.
Five of the 26 items, including pain and discomfort, dependence on medical substances, physical environment, social support, and negative feelings did not display acceptable goodness-of-fit to the Rasch model. On removing these items, the 21-item WHOQOL-BREF scale had an improved internal scale validity and person-separation reliability than the original 26-item version for this group of citizens from the neighborhood. When assessing the individual domains, three of the five items that were misfits on analyzing the full model also showed misfits in relation to two respective domains. When these items were removed, the internal scale validity of the domains also improved.
WHOQOL-BREF seemed to be psychometrically inadequate when used in the original form due to internal scale validity problems, while the modified 21-item scale seemed better at measuring the health-related quality of life of citizens living in socially disadvantaged neighborhoods in Sweden. Omission of items shall be done but with caution. Alternatively, future studies may also consider rephrasing the items with misfits and further testing the instrument with larger samples exploring the associations between subsamples and specific item misfit responses.
生活在弱势社区的居民健康状况比大多数人差，即使在瑞典这样的福利国家，这种不平等也是一个公共卫生问题。目前正在实施和评估许多旨在改善这些人群健康和生活质量的举措。鉴于这些人群主要是多元文化和多语言的，像世界卫生组织生活质量简表（WHOQOL-BREF）这样经过跨文化验证且有多种语言版本的工具可能适用。然而，由于从未在瑞典背景下评估过WHOQOL-BREF的心理测量特性，所以无法确定这一点。因此，本研究旨在评估WHOQOL-BREF问卷在瑞典南部一个弱势社区居民中的心理测量特性。
本研究的受访者为103名参与健康促进项目健康促进活动的居民，他们还回答了26项的WHOQOL-BREF问卷，作为评估活动对居民健康相关生活质量影响的一部分。本研究使用WINSTEP 4.5.1的拉施模型来评估心理测量特性。
26个条目中的5个，包括疼痛与不适、对药物的依赖、物理环境、社会支持和负面情绪，对拉施模型的拟合优度不可接受。去除这些条目后，对于该社区的这群居民，21项的WHOQOL-BREF量表比原始的26项版本具有更好的内部量表效度和人员区分可靠性。在评估各个领域时，在分析完整模型时不拟合的5个条目中有3个在各自的两个领域中也显示不拟合。去除这些条目后，各领域的内部量表效度也有所提高。
由于内部量表效度问题，以原始形式使用时，WHOQOL-BREF在心理测量方面似乎存在不足，而修改后的21项量表在测量瑞典社会弱势社区居民的健康相关生活质量方面似乎更好。应谨慎地进行条目删除。或者，未来的研究也可以考虑重新表述不拟合的条目，并使用更大的样本进一步测试该工具，探索子样本与特定条目不拟合反应之间的关联。
