Psychometric evaluation of an interview-administered version of the WHOQOL-BREF questionnaire for use in a cross-sectional study of a rural district in Bangladesh: an application of Rasch analysis

Examine a factor structure for the World Health Organization quality of life measure among adults with ADL limitations in underserved neighborhoods in the United States

BACKGROUND

The extent of the impact of Activity of daily living (ADL) limitations on Quality of Life is well documented. However, the validity of the World Health Organization's Quality of Life-BREF (WHOQOL-BREF) rarely focuses of residents living in underserved settings and on minority inclusion.

OBJECTIVE

to examine the structural validity of WHOQOL-BREF among adults with long-term ADL limitations residing in underserved communities.

METHODS

A cross-sectional survey of patients from underserved communities in the Midwestern United States was conducted between March 2019 and February 2021. Inclusion criteria included a minimum age of 19 years, ADL limitations for more than 5 years, English proficiency, and residence in the targeted zip code areas. A confirmatory factor analysis was conducted to determine the factor structure of the WHOQOL-BREF. The International Statistical Classification of Diseases and Related Health Problems 10 was used to identify individuals with ADL limitations.

RESULTS

A total of 290 people met the criteria. Four latent factors were extracted. However, compared to the original conceptual relationships between variables and latent factors, Physical health to leisure activities, social relationships to self-satisfaction, and environmental health to acceptance of body appearance were additional leadings beyond their conceptual group. This CFA final model fit the data well (ꭓ2 (df = 228) = 320.30, p < 0.001; RMSEA = 0.06; CFI = 0.95; TLI = 0.94).

CONCLUSIONS

These findings underscored the need for accessible environments in their communities. In addition, supportive intra- and interpersonal relationships are needed to improve the QOL for adults with long-term ADL limitations.

Gender difference in domain-specific quality of life measured by modified WHOQoL-BREF questionnaire and their associated factors among older adults in a rural district in Bangladesh

BACKGROUND

The global population of older adults has steadily increased in recent decades. Little is known about the gender difference in the quality of life (QoL) of older adults in the general population. This study aimed to identify factors associated with QoL among older adults by gender.

METHOD

Data on QoL using the World Health Organization Quality of Life (WHOQoL-BREF) questionnaire and socio-demographic characteristics, including living status and sources of income, were collected from 1147 older adults. The WHOQoL-BREF has four domains: physical, psychological, social and environmental. Rasch analysis was used to compute a combined score from Likert-type data to a continuous scale ranging from 0% satisfaction to 100% satisfaction in terms of QoL for each domain. We used a generalized linear model to compare the mean rate of QoL for different factors, and logistic regression analysis was used to quantify the associations of factors with below-average QoL measured as 50% or less in QoL.

RESULTS

The domain-specific QoL mean (standard error), minimum-maximum values were physical 48.9 (0.41), 7-86, psychological 38.9 (0.51), 4-71, social 50.5 (0.49), 8-92, and environmental domains 47.8 (0.37), 6-91 in the total sample with significant gender difference in all but social domain. The proportion of below average QoL for females vs. males was physical 47.6% vs. 42.6%, psychological 74.4% vs.66.7%; social 34.8% vs. 30.1% and environmental domains 56.1% vs. 49.0%. In females, participants living alone were associated with a higher proportion of below average QoL in physical OR 30.2, 95% CI 2.47, 370, psychological OR 9.54, 95% CI1.09,83.27 and social domains OR 5.94, 95% CI 1.25,28.34. In males, participants' sources of income from relatives were associated with a higher proportion of below average QoL in physical OR 3.6, 95% CI 2.01,6.44, psychological 30.2, 95% CI 2.47, 370, psychological OR 4.63 95% CI 2.56, 8.38, social domains OR 1.81, 95% CI 1.04, 3.16 and environmental domains OR 2.53 95% CI 1.44, 4.43 than those who had own income. Females engaged in income generation activities had better QoL in social and environmental domains than those with house duties, irrespective of their education or socioeconomic status. Males in retired life had the highest QoL in the social and environmental domains if they had better SES.

CONCLUSIONS

The study's findings reveal that more than 50% of people had below-average QoL in each domain, which is significant. The study also highlighted that females living alone and males without their own income had the poorest QoL. On a positive note, it was found that females engaged in any income generation activities had better QoL in social and environmental domains. These results provide valuable insights for policymakers and healthcare professionals. They underscore the importance of implementing appropriate intervention programs to enhance the QoL of older adults, reiterating the urgency and necessity of their work to improve the health and well-being of older adults.

Grandparenting and life satisfaction of the aged in rural areas: A study in Kalia Upazila of Narail District

In rural Bangladesh, older adults generally enjoy their role as grandparents and spend their leisure and inactive periods (non-involvement in income-generating activities) with their grandchildren. The life satisfaction of the older adults partly lies in their role-playing as grandparents. The aim of this study was to examine the impact of caring for grandchildren on the life satisfaction of the older adults in rural areas. A survey method was used to conduct the study, and the age of the participants was 60 years and above. Four Mohollas of Kalia Upazilla of Narail district were selected purposively, and 253 older adults (123 male & 130 female) were chosen by using a purposive sampling technique. An interview schedule (containing both open and close-ended questions) was used to collect data in the months of November and December 2018. The findings showed that activities with grandchildren and caregiving roles depended on the age structure, and families with more household income were found to enhance the life satisfaction with grandparenting. There was a significant association between the life satisfaction of older adults and their grandparenting role. By identifying some dimensions of family involvement and socio-demographic conditions, this research aims to provide a deeper understanding of the dynamics of how grandparenting impacts the life satisfaction of older adults in rural areas of Bangladesh. The results might help to minimize the shortfalls of policy regarding the well-being of the older adults by focusing on their social and psychological needs. This will ensure aging is in place for everyone.

Modern psychometric evaluation of Thai WHOQOL-BREF and its shorter versions in patients undergoing warfarin in Thailand: Rasch analysis

Rasch analysis was employed to investigate the psychometric properties of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and its shorter versions (EUROHIS-QOL-8 and WHOQOL-5) within the context of patients undergoing warfarin in Thailand. A group of 260 patients were recruited from three public hospitals and tasked with completing the WHOQOL-BREF questionnaire. Rasch analysis showed that the WHOQOL-BREF, structured into four-domain subtests, achieved a commendable fit to the Rasch model (χ2[16] = 12.26, p = 0.73), met the criterion of unidimensionality (7.31% significant t-tests; lower bound confidence interval, 4.66), and demonstrated satisfactory reliability (PSI = 0.87). The adoption of a subtest approach facilitated an acceptable fit to the Rasch model for each domain of the WHOQOL-BREF, except for the social domain. However, the presence of local dependency of the three-item social domain was detected, so the reliability was not reported. The WHOQOL-5 proved to be unidimensional, fitting the Rasch model acceptably, and had satisfactory reliability. Conversely, the EUROHIS-QOL-8 presented local dependency; thus, reliability was not reported. Consequently, the WHOQOL-BREF in its four-domain subtests is recommended for pre- and post-HRQoL measurements, whereas the WHOQOL-5 can effectively measure HRQoL levels in between-group analyses.

Psychometric evaluation of the WHOQOL-BREF and its shorter versions for general Thai population: confirmatory factor analysis and Rasch analysis

PURPOSE

Rasch analysis was employed to validate the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and its existing shorter versions in the general Thai population.

METHODS

1200 respondents were randomly selected to complete the questionnaire. Confirmatory factor analysis (CFA) was employed to test the structure of the WHOQOL-BREF and its shorter versions with the random sub-sample of 900 respondents, while Rasch analysis was performed with a random sub-sample of 300 respondents.

RESULTS

The CFA confirmed the factor structure of WHOQOL-BREF and its shorter versions. The Rasch analysis revealed that the WHOQOL-BREF, when a four-domain structure was tested using a subtest approach, achieved acceptable model fit to the Rasch model and met the expectations of unidimensionality with high reliability (PSI = 0.87). Individual domain models were also unidimensional, but reliability of the 3-item social domain was inadequate. While the 8-item EUROHIS-QOL-8 and 5-item WHOQOL-5 achieved an overall acceptable fit and met the expectations of unidimensionality, the reliability of the WHOQOL-5 was below the acceptable threshold (PSI = 0.66). Reliability of the EUROHIS-QOL-8 was satisfactory (PSI = 0.79).

CONCLUSIONS

The WHOQOL-BREF is a valid instrument for use in the Thai general population, both as a total score as well as individual subscales. Rasch analysis also supports the use of EUROHIS-QOL-8, but the WHOQOL-5 lacks good reliability. While the reliability of the EUROHIS-QOL-8 is sufficiently high for between-group analysis, the Thai WHOQOL-BREF total score can also be used for within-participant analyses. Rasch investigation with a more varied health conditions of general Thai samples or patient groups is encouraged for future studies.

Rasch validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in community-dwelling adults

BACKGROUND

With the ongoing global COVID-19 pandemic and the recent political divide in the United States (US), there is an urgent need to address the soaring mental well-being problems and promote positive well-being. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) measures the positive aspects of mental health. Previous studies confirmed its construct validity, reliability, and unidimensionality with confirmatory factor analysis. Six studies have performed a Rasch analysis on the WEMWBS, and only one evaluated young adults in the US. The goal of our study is to use Rasch analysis to validate the WEMBS in a wider age group of community-dwelling adults in the US.

METHODS

We used the Rasch unidimensional measurement model 2030 software to evaluate item and person fit, targeting, person separation reliability (PSR), and differential item functioning (DIF) for sample sizes of at least 200 persons in each subgroup.

RESULTS

After deleting two items, the WEMBS analyzed in our 553 community-dwelling adults (average age 51.22 ± 17.18 years; 358 women) showed an excellent PSR = 0.91 as well as person and item fit, but the items are too easy for this population (person mean location = 2.17 ± 2.00). There was no DIF for sex, mental health, or practicing breathing exercises.

CONCLUSIONS

The WEMWBS had good item and person fit but the targeting is off when used in community-dwelling adults in the US. Adding more difficult items might improve the targeting and capture a broader range of positive mental well-being.

Assessing the dimensionality of scores derived from the Revised Formal Thought Disorder Self-Report Scale in schizotypy

The current work explored the dimensionality and convergent validity of responses to Barrera et al.'s (2015) 29-item Formal Thought Disorder-Self Scale (FTD-SS) obtained in two non-clinical samples. Exploratory factor analyses were conducted in Sample 1 (n = 324), yielding evidence of three correlated factors, although simple structure was not achieved until nine items were removed. Support for the correlated three factors model of responses to the revised 20-item scale (FTD-SS-R) was replicated when a confirmatory factor analysis was conducted in Sample 2 (n = 610). Finally, convergent associations were found between FTD-SS-R scores and scores from other schizotypy measures across both samples, though these measures only explained half of the variance in FTD-SS-R scores. Additional research is needed to evaluate the appropriateness of the items and incremental validity of the scale in non-clinical samples.

Variáveis clínicas consideradas fatores de risco para a síndrome metabólica: um estudo transversal

RESUMO Objetivo Identificar os principais fatores de risco para a síndrome metabólica e sua relação com a percepção da qualidade de vida em colônias pesqueiras brasileiras. Métodos Incluímos 77 participantes com idade > 18 anos. Síndrome metabólica e qualidade de vida foram os principais desfechos do estudo. Consideramos nível de significância < 0,05 e todos os procedimentos foram aprovados pelo comitê de ética. Resultados A maioria dos participantes é do sexo masculino, solteiros, classe econômica D-E, carga horária trabalhada de 6 a 8 horas, tempo de serviço de 1 a 5 anos e dedicados exclusivamente à pesca. Conclusão: Perímetro abdominal e pressão arterial foram os critérios mais frequentes e de maior contribuição para a síndrome metabólica. Apesar de a qualidade de vida apresentar maior escore para o domínio relações sociais, neste estudo, o domínio físico foi o único associado a outra observação, na qual observamos correlação significativa com a pressão arterial sistólica.

Clinical variables considered risk factors for the metabolic syndrome: a cross-sectional study

ABSTRACT Objective To identify the main risk factors for metabolic syndrome and its relationship with the perception of quality of life in Brazilian fishing colonies. Methods We included 77 participants aged > 18 years. Metabolic syndrome and quality of life were the main study outcomes. We considered a significance level < 0.05 and all procedures were approved by the ethics committee. Results Most participants are male, single, economic class D-E, working hours of 6 to 8 hours, length of service from 1 to 5 years, and dedicated exclusively to fishing. Conclusion Abdominal perimeter and blood pressures were the most frequent criteria and the greatest contribution to metabolic syndrome. Although quality of life had a higher score for the social relationship domain, in this study, the physical domain was the only one associated with another observation, in which we observed a significant correlation with systolic blood pressure.

Quality of life in Brazilian martial arts and combat sports practitioners

Study aim: Martial arts and combat sports have been an alternative for individuals seeking the health benefits of physical activity and exercise, but little is known about its practitioners’ quality of life. Therefore, this study aimed to investigate the quality of life of practitioners of five of the most common modalities in Brazil.

Material and methods: A total of 922 young men, competitive and recreational practitioners of Brazilian jiu-jitsu, judo, karate, kung-fu, and taekwondo, answered the Brazilian version of the WHOQOL-BREF questionnaire.

Results: The results for each domain – physical, psychological, social, and environmental – are, respectively, as follow (mean ± standard deviation): Brazilian jiu-jitsu: 74 ± 11, 75 ± 12, 77 ± 17, 67 ± 14; judo: 74 ± 13, 75 ± 12, 77 ± 15, 64 ± 12; karate: 76 ± 13, 75 ± 12, 78 ± 15, 64 ± 13; kung-fu: 77 ± 13, 75 ± 13, 74 ± 17, 65 ± 13; taekwondo: 76 ± 12, 76 ± 11, 78 ± 16, 64 ± 13; total: 75 ± 13, 75 ± 12, 77 ± 16, 65 ± 13. There was no difference between modalities and no interaction between modalities and experience level. All groups and the total sample presented higher values than the normative national data in the physical and psychological domains. This was also the case for the judo, karate, and taekwondo groups, as well as the total sample in the social domain, and for the Brazilian jiu-jitsu and the whole sample in the environmental domain. Additionally, in the whole sample competitors scored higher than recreational practitioners in the psychological domain.

Conclusion: These findings reveal that the practice of these modalities is associated with higher quality of life than the normative values. Longitudinal studies are warranted for a better understanding of this association.

Psychometric evaluation of the modified 19-item Bengali version of WHOQOL scale using Rasch analysis: a cross-sectional study of a rural district in Bangladesh

BACKGROUND

This investigation aims to validate the psychometric properties of the modified 19-item Bengali version World Health Organization Quality of Life (WHOQOL) instrument in a typical healthy rural population in Bangladesh.

METHOD

The cross-sectional investigation collected 300 adults aged 18-85 years from Narail, a rural district of Bangladesh using a multi-stage cluster random sampling technique. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application CommCare. SPSS version 25; IBM. and a Rasch analysis software RUMM2030 were used for analyses.

RESULTS

Results showed good overall fit, as indicated by a significant item-trait interaction with Bonferroni corrected p values, for physical ([Formula: see text] =32.13, p = 0.041), psychological ([Formula: see text] =14.93, p = 0.529), social ([Formula: see text] =12.62, p = 0.397), and environmental ([Formula: see text] =22.01, p = 0.339) domains. Item fit residual (IFR) values for all domains were within the desired limits, indicating no deviation from the expected relationship between the individual items and the rest of the items of the scale. Person fit residual (PFR) values also showed no person misfit among the samples, indicating item threshold are suitable for Rasch analysis. Reliability of the three domains of the 19-item WHOQOL scale was very good as indicated by a person separation index (PSI) = 0.873 and Cronbach's Alpha (CA) = 0.881 for physical domain, PSI = 0.739 and CA = 0.746 for psychological domain, and PSI = 0.753 and CA = 0.781 for environmental domain. The social domain (PSI = 0.650 and CA = 0.669) had below acceptable reliability. All items in each domain had ordered thresholds except one item of the environmental domain. All four domains of the 19-item WHOQOL scale showed unidimensionality and was free from local dependency. Each domain also showed similar functioning for adults and older adults, males and females, no education and at least primary level of education, low and high socio-economic conditions.

CONCLUSION

The 19-item modified WHOQOL scale is confirmed as an efficient screening tool for measuring QoL among healthy rural Bangladeshi people. The scale could be implemented more widely. In particular, validations are required for diseases-specific population in Bangladesh to measure the Health Related Quality of life (HR-QoL) assessments for people suffering from chronic or other diseases.

Psychometric evaluation of the modified Kessler seven-item version (K7) for measuring psychological distress using Rasch analysis: a cross-sectional study in a rural district of Bangladesh

OBJECTIVES

This investigation expected to validate the psychometric properties of the modified seven-item Kessler psychological distress scale (K7) for measuring psychological distress in healthy rural population of Bangladesh.

DESIGN

Cross-sectional study.

SETTING

Narail district, Bangladesh.

PARTICIPANTS

A random sample of 300 adults of age 18-90 years were recruited. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application known as CommCare.

OUTCOME MEASURE

Validation of the K7 was the major outcome. Sociodemographic factors were measured to assess for Differential Item Functioning to check if the tool functions equally in different factors. Rasch analysis was carried out for the validation of the K7 scale in the healthy rural population of Bangladesh. RUMM2030 was used for the analyses.

RESULTS

Results showed good overall fit, as indicated by a non-significant item-trait interaction (χ²=44.54, df=28, p=0.0245) compared with a Bonferroni adjusted p value of 0.007. Both item fit (mean=0.30, SD 1.22) and person fit residuals (mean=-0.18, SD 0.85) showed perfect fit. Reliability was very good as indicated by a Person Separation Index=0.85 and Cronbach's alpha=0.89. All individual items were ordered thresholds. The K7 scale showed adequate reliability, unidimensionality and was free from local dependency. The K7 scale also showed similar functioning for adults and older adults, males and females, no education and any level of education, and at least some financial instability versus no financial instability.

CONCLUSIONS

Validation of K7 scale confirmed that the tool is suitable for measuring psychological distress among the rural Bangladeshi population. Further research should validate the K7 scale in different rural settings in Bangladesh to determine a valid cut-off score for assessment of severity levels of psychological distress. The K7 scale should also be tested in other developing countries where sociodemographic characteristics are similar to those of Bangladesh.

An assessment of awareness of mental health conditions and its association with socio-demographic characteristics: a cross-sectional study in a rural district in Bangladesh

BACKGROUND

To assess the level of awareness, knowledge and help-seeking attitudes and behaviours in relation to mental health conditions (MHCs) and associations with socio-demographic characteristics of a rural district of Bangladesh.

METHODS

We recruited 2425 adult samples (18-90 years) from a Cross-sectional study in Narial district of Bangladesh. Data on awareness, knowledge, help-seeking attitudes and practice in relation to six MHCs were collected. The MHCs were classified as common (depression, anxiety and drug addiction), and severe (psychosis, dementia and bipolar disorder). Associations of MHCs with socio-demographic characteristics were assessed using Chi-square tests. Rasch analysis was performed to transform the latent attribute (awareness) of MHCs from ordinal to interval scale. Multiple regression analysis was performed to determine how the socio-demographic characteristics contribute to the combined awareness score of MHCs.

RESULTS

Of 2425 participants, 17 (0.7%) were cognizant of all the awareness construct of MHCs, and 1365 (56.28%) were not aware of any of MHCs. The prevalence of awareness of MHCs such as depression (8.5%), anxiety (6.2%), psychosis (3.5%), and bipolar disorder (3.3%), was found to be very low. Awareness was significantly lower in older adults, and in women. Higher levels of education (β 1.77, 95% confidence interval (CI): 1.58-1.97) associated with common MHCs and (β 0.81, 95% CI: 0.67-0.95) those associated with severe MHCs contributed significantly to increased awareness as opposed to having no or primary level of education. Availability of sufficient funds when applied to common MHCs (β 0.43, 95% CI: 0.26-0.61) and severe MHCs (β 0.25, 95% CI: 0.13-0.38) appeared to be more effective in boosting awareness compared to unstable financial situations. Almost 100% of the participants who were aware of the MHCs demonstrated positive attitudes towards seeking medical or psychological counselling.

CONCLUSIONS

Awareness of MHCs appeared to be very limited. However, knowledgeable participants were found to be very receptive to medical or psychological counselling. For improving awareness of MHCs need to conduct various intervention programs in particular those campaigns that focus on women, older adults, low SES and people up to the primary levels of education.