Key result
The 9-item European Heart Failure Self-Care Behavior scale demonstrated sound psychometric properties, with only item 3 showing substantial differential item functioning across NYHA classes (-0.69).
Cross-Sectional (n=380)
The EHFScB-9 demonstrates sound psychometric properties and a valid 2-factor structure for assessing self-care behavior in Iranian patients with heart failure.
Supports EHFScB-9 use in Iranian HF patients; extends validation to this population but leaves broader applicability open.
BACKGROUND: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF). OBJECTIVE: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran. METHODS: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA). RESULTS: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47). CONCLUSIONS: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.
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Lin et al. (2017) conducted a cross-sectional in Heart failure (n=380). 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) was evaluated on Factorial structure, categorical functioning, and differential item functioning (DIF). The 9-item European Heart Failure Self-Care Behavior scale demonstrated sound psychometric properties, with only item 3 showing substantial differential item functioning across NYHA classes (-0.69).
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