TY - JOUR
T1 - Developing a short-form version of the HIV Disability Questionnaire (SF-HDQ) for use in clinical practice
T2 - a Rasch analysis
AU - O'Brien, Kelly K
AU - Dzingina, Mendwas
AU - Harding, Richard
AU - Gao, Wei
AU - Namisango, Eve
AU - Avery, Lisa
AU - Davis, Aileen M
N1 - Funding Information:
We acknowledge Veronica Murrey (Cicely Saunders Institute, King?s College London) and Rachel Aubry (University of Toronto) for their contributions to this study. The authors also acknowledge members of the HIV Health and Rehabilitation Survey (HHRS) Study and Ireland HDQ Validation Study from which the original data for this study were derived. We thank participants from the HIV Health and Rehabilitation Survey (HHRS) study and Ireland HDQ Validation Study. We thank collaborators who were involved in the original studies from which these data were collected including the GUIDE Clinic, St. James?s Hospital, Dublin, Ireland; Open Doors, Dublin, Ireland; Realize , Canada; Toronto People With AIDS (PWA) Foundation; Dr. Peter AIDS Foundation (Vancouver), Nine Circles Community Health Centre (Winnipeg); AIDS Niagara; AIDS Committee of Durham Region; and AIDS Committee of Toronto.
Funding Information:
This research was supported by a Fellowship from the British Academy for Humanities and Social Sciences and the National Institute On Aging of the National Institutes of Health (NIH) (Award Number R21AG062380). Kelly K. O’Brien (KKO) is supported by a Canada Research Chair in Episodic Disability and Rehabilitation. The British Academy, NIH, and Canada Research Chairs program did not have a role in the development of the study design, data collection or analysis, interpretation of results, or in writing this manuscript.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Background: Disability is an increasingly important health-related outcome to consider as more individuals are now aging with Human Immunodeficiency Virus (HIV) and multimorbidity. The HIV Disability Questionnaire (HDQ) is a patient-reported outcome measure (PROM), developed to measure the presence, severity and episodic nature of disability among adults living with HIV. The 69-item HDQ includes six domains: physical, cognitive, mental-emotional symptoms and impairments, uncertainty and worrying about the future, difficulties with day-to-day activities, and challenges to social inclusion. Our aim was to develop a short-form version of the HIV Disability Questionnaire (SF-HDQ) to facilitate use in clinical and community-based practice among adults living with HIV. Methods: We used Rasch analysis to inform item reduction using an existing dataset of adults living with HIV in Canada (n = 941) and Ireland (n = 96) who completed the HDQ (n = 1037). We evaluated overall model fit with Cronbach’s alpha and Person Separation Indices (PSIs) (≥ 0.70 acceptable). Individual items were evaluated for item threshold ordering, fit residuals, differential item functioning (DIF) and unidimensionality. For item threshold ordering, we examined item characteristic curves and threshold maps merging response options of items with disordered thresholds to obtain order. Items with fit residuals > 2.5 or less than − 2.5 and statistically significant after Bonferroni-adjustment were considered for removal. For DIF, we considered removing items with response patterns that varied according to country, age group (≥ 50 years versus < 50 years), and gender. Subscales were considered unidimensional if ≤ 5% of t-tests comparing possible patterns in residuals were significant. Results: We removed 34 items, resulting in a 35-item SF-HDQ with domain structure: physical (10 items); cognitive (3 items); mental-emotional (5 items); uncertainty (5 items); difficulties with day-to-day activities (5 items) and challenges to social inclusion (7 items). Overall models’ fit: Cronbach’s alphas ranged from 0.78 (cognitive) to 0.85 (physical and mental-emotional) and PSIs from 0.69 (day-to-day activities) to 0.79 (physical and mental-emotional). Three items were rescored to achieve ordered thresholds. All domains demonstrated unidimensionality. Three items with DIF were retained because of their clinical importance. Conclusion: The 35-item SF-HDQ offers a brief, comprehensive disability PROM for use in clinical and community-based practice with adults living with HIV.
AB - Background: Disability is an increasingly important health-related outcome to consider as more individuals are now aging with Human Immunodeficiency Virus (HIV) and multimorbidity. The HIV Disability Questionnaire (HDQ) is a patient-reported outcome measure (PROM), developed to measure the presence, severity and episodic nature of disability among adults living with HIV. The 69-item HDQ includes six domains: physical, cognitive, mental-emotional symptoms and impairments, uncertainty and worrying about the future, difficulties with day-to-day activities, and challenges to social inclusion. Our aim was to develop a short-form version of the HIV Disability Questionnaire (SF-HDQ) to facilitate use in clinical and community-based practice among adults living with HIV. Methods: We used Rasch analysis to inform item reduction using an existing dataset of adults living with HIV in Canada (n = 941) and Ireland (n = 96) who completed the HDQ (n = 1037). We evaluated overall model fit with Cronbach’s alpha and Person Separation Indices (PSIs) (≥ 0.70 acceptable). Individual items were evaluated for item threshold ordering, fit residuals, differential item functioning (DIF) and unidimensionality. For item threshold ordering, we examined item characteristic curves and threshold maps merging response options of items with disordered thresholds to obtain order. Items with fit residuals > 2.5 or less than − 2.5 and statistically significant after Bonferroni-adjustment were considered for removal. For DIF, we considered removing items with response patterns that varied according to country, age group (≥ 50 years versus < 50 years), and gender. Subscales were considered unidimensional if ≤ 5% of t-tests comparing possible patterns in residuals were significant. Results: We removed 34 items, resulting in a 35-item SF-HDQ with domain structure: physical (10 items); cognitive (3 items); mental-emotional (5 items); uncertainty (5 items); difficulties with day-to-day activities (5 items) and challenges to social inclusion (7 items). Overall models’ fit: Cronbach’s alphas ranged from 0.78 (cognitive) to 0.85 (physical and mental-emotional) and PSIs from 0.69 (day-to-day activities) to 0.79 (physical and mental-emotional). Three items were rescored to achieve ordered thresholds. All domains demonstrated unidimensionality. Three items with DIF were retained because of their clinical importance. Conclusion: The 35-item SF-HDQ offers a brief, comprehensive disability PROM for use in clinical and community-based practice with adults living with HIV.
UR - http://www.scopus.com/inward/record.url?scp=85098789047&partnerID=8YFLogxK
U2 - 10.1186/s12955-020-01643-2
DO - 10.1186/s12955-020-01643-2
M3 - Article
C2 - 33407538
SN - 1477-7525
VL - 19
SP - 6
JO - Health and Quality of Life Outcomes
JF - Health and Quality of Life Outcomes
IS - 1
M1 - 6
ER -