The Application of Exploratory and Confirmatory Factor Analysis for Assessing the Construct Validity of SF-36 Thai version in Chronic Renal Disease Patients

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Areewan Cheawchanwattana
On-anong Waleekhachonloet
Supon Limwattananon


Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the construct validity of SF-36 Thai version in chronic renal disease patients. The patients (n=466) were interviewed at Srinagarind Hospital during March-May 2005. Data were randomly divided into two datasets for cross-validation. The first dataset was analyzed using EFA to reveal alternative models (AMs), while the second dataset was analyzed using CFA to compare the AMs and the original model assigned by SF-36 developers (Ware model). The construct validity of SF-36 Thai version in chronic renal disease patients was confirmed in this study. Results from CFA indicated that the Ware model was more parsimony than two AMs. The constructs of two AMs that resulted from the EFA differed from that was assigned by Ware et at. The results replicated the previous study in a Taiwanese general population, and these results confirmed the suggestion of using CFA to assess the construct validity of known construct measure.


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Areewan Cheawchanwattana, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 4002

Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 4002


Bowling A. 2005. Measuring health: A review of quality of life measurement scales. 3rd ed., Bell & Bain, Glasgow.

Byrne BM. 2001. structural equation modeling with AMOS: Basic concepts, applications, and programming. Lawrence Erlbaum Associates, Mahwah.

de Vet HCW, Ader HJ, Terwee CB, et al. 2005. Are factor analytical techniques used appropriately in the validation of health status questionnaires? A systematic review on the quality of factor analysis of the SF-36. Qual Life Res 14: 1203-1218.

Fayers PM, Machin D. 2000. Quality of life: Assessment, analysis, and interpretation. John Wiley & Sons, West Sussex.

Garratt A, Schmidt L, Mackintosh A, et al. 2002. Quality of life measurement: Bibliographic study of patient assessed health outcome measures. BMJ 324: 1417-1421.

Hann M, Reeves D. 2008. The SF-36 scales are not accurately summarised by independent physical and mental component scores. Qual Life Ren 17: 413-123.

Kline RB. 2005. Principles and practice of structural equation modeling. 2nd ed., The Guilford Press, New York.

Knight EL, Ofsthun N, Teng M, et al. 2003. The association between mental health, physical function, and hemodialysis mortality. Kidney Int 63: 1843-1851.

Lowrie EG, Curtin RB, Le Pain N, et al. 2003. Medical Outcomes Study Short Form-36: A consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis 41(6): 1286-1292.

Mapes DL, Lopes AA, Satayathum s, et al. 2003. Health-related quality of life as a predictor of mortality and hospitalization: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int 64: 339-349.

Mapi Research Trust. PROQOLID patient-reported outcome and quality of life instruments database. Accessed May 30, 2008.

Schumacker RE, Lomax RG. 2004. A beginner’s guide to structural equation modeling. 2nd ed., Lawrence Erlbaum Associates, Mahwah.

Sprangers MAG, de Regt EB, Andries F, et al. 2000. Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol 53: 895-907.
Strainer DL, Norman GR. 2000. Biostatistics: the bare essentials. 2nd. B.c. Decker. Ontario.

Streiner DL, Norman GR. 2003. Health measurement scales: A practical guide to their development and use. 3rd ed., Oxford University Press, New York.

Unruh ML, Weisbord SD, Kimmel PL. 2005. Health-related quality of life in nephrology research and clinical practice. Semin Dial 18(2): 82-90.

Ware JE, Kosinski M, Keller SD, editors. 1994. SF-36 Physical & mental health summary scales: A user's manual. The Health Institute New England Medical Center, Boston.

Ware JE, Snow KK, Kosinski M, et al. 1993. SF-36 health survey manual and interpretation guide. The Health Institute New England Medical Center, Boston.

Wood-Dauphinee S. 1999. Assessing quality of life in clinical research: from where have we come and where are we going? J Clin Epidemiol 52(4): 355-363.

World Health Organization. 1948. Constitution of the World Health Organization. In; World Health
Organization. Handbook of basic documents. 5th ed., Geneva, Palias des Nations, 1952; 3-20. cited in Testa MA, Simonson DC. 1996. Assessment of quality-of-life outcomes. A/EJM 334(13): 835-840.

Wu c, Lee K, Yao G. 2007. Examining the hierarchical factor structure of the SF-36 Taiwan version by exploratory and confirmatory factor analysis. J Eval Clin Pract 13: 889-900.