Arabic translation, cross-cultural adaptation, and testing measurement properties of the European heart failure self-care behaviour (EHFScBS-12 and EHFScBS-9)

Background Enhanced self-care is the primary objective of many heart failure (HF) management programs. The European Heart Failure Self-care Behaviour Scale (EHFScBS), available in 12-item and 9-item versions, is widely used to assess self-care in patients with HF. However, the EHFScBS has not been translated or evaluated its measurement properties in Arabic-speaking populations with HF. Objective The objective of this study was to translate, culturally adapt and evaluate the measurement properties of the Arabic version of EHFScBS-12 and EHFScBS-9 followed the COSMIN (CO nsensus-based Standards for the selection of health Measurement Instruments) guidelines and to compare both versions regarding structural validity, reliability, and model fit among Arabic-speaking patients with HF. Materials and methods A cross-sectional study conducted at a governmental hospital in Riyadh used purposive sampling to recruit participants who met the predefined inclusion criteria relevant to the study objectives:137 patients with HF (mean age = 59 years; 61.3% male). The researchers evaluated the comprehensive measurement properties of the 12- and 9-item (EHFScBS) included forward-backward translation, confirmatory factor analysis (CFA), and reliability testing. In addition, convergent and divergent validity were assessed using the Self-Care Heart Failure Index version 6.2 and the Perceived Stress Scale10-Item. Results The scale demonstrated excellent content validity as evidenced by I-CVI of .85 to 1 and S-CVI of .95, and the CFA of the 12-item scale yielded ambiguous fit indices: root mean square error of approximation (RMSEA) =0.084, (90% CI: .059−.108), comparative fit index (CFI) =0.824, and normed fit index (NFI) =0.706 which is low/suboptimal. The CFA of the 9-item scale showed good fit indices (RMSEA = 0.042, (90%CI: .000−.084), CFI = 0.969). The internal consistency was acceptable for both scales at 0.75 and 0.72, respectively. Both the versions demonstrated convergent and discriminant validity. Conclusions The EHFScBS as unidimensional showed satisfactory measurement properties in Arabic-speaking HF patients. The 9-item one-factor has demonstrated better fit in the present sample compared to the 12-item version achieved after post-hoc modification, support its use in practice and research. However, future studies should conduct independent cross-validation in separate samples from Saudi Arabia and other Arabic-speaking countries to confirm the generalizability, and cross-cultural validity of the instrument.