Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients

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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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