Keller S D, Ware J E, Bentler P M, Aaronson N K, Alonso J, Apolone G, Bjorner J B, Brazier J, Bullinger M, Kaasa S, Leplège A, Sullivan M, Gandek B
Health Assessment Lab at the Health Institute, New England Medical Center, Boston, Massachusetts, USA.
J Clin Epidemiol. 1998 Nov;51(11):1179-88. doi: 10.1016/s0895-4356(98)00110-3.
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.
在跨国研究中使用SF-36健康调查的一个关键前提是再现其评分和解释所依据的概念模型。采用结构方程模型（SEM）对SF-36在十个IQOLA国家（丹麦、法国、德国、意大利、荷兰、挪威、西班牙、瑞典、英国和美国）的结构效度的这些方面进行了测试。数据来自为收集规范数据而进行的一般人群调查。在美国开发的测量模型和结构模型在每个国家样本的随机两半中进行了交叉验证。SEM分析支持了作为SF-36量表评分基础的八个一阶健康因子模型以及作为总体身心健康测量基础的两个二阶因子。还观察到一个单一的三阶因子，支持了关于对SF-36的所有回答都由一个单一的潜在结构——健康产生的假设。此外，一个被解释为总体幸福感的第三个二阶因子被证明可以改善模型的拟合度。这个模型（包括八个一阶因子、三个二阶因子和一个三阶因子）在美国以及其他九个国家中的每一个国家都使用留存样本进行了交叉验证。这些结果证实了SF-36项目与量表之间的假设关系，并证明了在每个国家使用标准算法进行评分的合理性。结果还表明，SF-36量表以及总体身心健康测量在各国将具有相似的解释。SF-36第三个二阶因子（总体幸福感）的实际意义值得进一步研究。
