Which dimensions of disability does the HIV Disability Questionnaire (HDQ) measure? A factor analysis

O’Brien, Kelly K; Bayoumi, Ahmed M.; Stratford, Paul W.; Solomon, Patricia

doi:10.3109/09638288.2014.949358

Cited by 16 publications

(21 citation statements)

References 35 publications

(36 reference statements)

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“…The HIV Disability Questionnaire (HDQ) is a 69 item self-administered patient-reported outcome measure developed to describe the presence, severity and episodic nature of disability experienced by adults living with HIV. Comprised of six domains, the HDQ describes: physical symptoms and impairments (20 items), cognitive symptoms and impairments (3 items), mental-emotional symptoms and impairments (11 items), uncertainty and worrying about the future (14 items), difficulties carrying out day-to-day activities (9 items), and challenges to social inclusion (12 items) [20]. HDQ items were derived from categories in the Episodic Disability Framework, developed from perspectives of adults living with HIV [19, 20].…”

Section: Methodsmentioning

confidence: 99%

“…Comprised of six domains, the HDQ describes: physical symptoms and impairments (20 items), cognitive symptoms and impairments (3 items), mental-emotional symptoms and impairments (11 items), uncertainty and worrying about the future (14 items), difficulties carrying out day-to-day activities (9 items), and challenges to social inclusion (12 items) [20]. HDQ items were derived from categories in the Episodic Disability Framework, developed from perspectives of adults living with HIV [19, 20]. The HDQ possesses an ordinal response scale that ranges from ‘not at all’ ('0' response) having a challenge to ‘extreme challenge’ ('4' response).…”

Section: Methodsmentioning

confidence: 99%

“…The HIV Disability Questionnaire (HDQ) is an HIV-specific patient-reported outcome measure of disability that was derived from the Episodic Disability Framework to assess disability presence, severity and episodic nature among adults living with HIV [19, 20]. The HDQ demonstrated sensibility, validity and reliability with people living with HIV in Canada, Ireland and the United States [21–24].…”

Section: Introductionmentioning

confidence: 99%

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Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

et al. 2019

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Background People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as ‘disability’. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV. Methods We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2–0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis. Results Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001). Conclusions Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions. Electronic supplementary material The online version of this article (10.1186/s12879-019-4203-0) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

et al. 2019

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“…HIV Disability Questionnaire: The HDQ includes 69-items grouped into six domains: i) physical symptoms and impairments (20 items), ii) cognitive symptoms and impairments (3 items), ii) mental-emotional symptoms and impairments (11 items), iv) uncertainty about future health (14 items), v) di culties with day-to-day activities (9 items), and vi) challenges to social inclusion (12 items) [32,33]. The questionnaire describes a range of health challenges a person might experience so that clinicians may better understand and address the disability needs of people aging with HIV.…”

Section: Methodsmentioning

confidence: 99%

“…This study is the rst to establish a PROM to assess the multi-dimensional nature of disability among adults aging with HIV. By retaining the six domain structure of the SF-HDQ, the PROM builds on the previously validated Episodic Disability Framework and HDQ with adults living with HIV [17,19,24,25,32]. Results will help to advance instrumentation and methods for PROM implementation to enhance feasibility, relevance and ease of use in clinical practice.…”

Section: Implications For Practice and Researchmentioning

confidence: 99%

Developing a Short-Form Version of the HIV Disability Questionnaire (SF-HDQ) for Use in Clinical Practice: A Rasch Analysis

O’Brien

Dzingina

Harding

et al. 2020

Preprint

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Background: Disability is an increasingly important health-related outcome to consider as more individuals are now aging with HIV and multimorbidity. The HIV Disability Questionnaire (HDQ) is a patient-reported outcome measure (PROM), developed to measure the presence, severity and episodic nature of disability among adults living with HIV. The 69-item HDQ includes six domains: physical, cognitive, mental-emotional symptoms and impairments, uncertainty and worrying about the future, difficulties with day-to-day activities, and challenges to social inclusion. Our aim was to develop a Short-Form version of the HIV Disability Questionnaire (SF-HDQ) to facilitate use in clinical and community-based practice among adults living with HIV.Methods: We used Rasch analysis to inform item reduction using an existing dataset of adults living with HIV in Canada (n=941) and Ireland (n=96) who completed the HDQ (n=1037). We evaluated overall model fit with Cronbach’s alpha and Person Separation Indices (PSIs) (≥ 0.70 acceptable). Individual items were evaluated for item threshold ordering, fit residuals, differential item functioning (DIF) and unidimensionality. For item threshold ordering, we examined item characteristic curves and threshold maps merging response options of items with disordered thresholds to obtain order. Items with fit residuals >2.5 or less than -2.5 and statistically significant after Bonferroni-adjustment were considered for removal. For DIF, we considered removing items with response patterns that varied according to country, age group (≥50 years versus <50 years), and gender. Subscales were considered unidimensional if ≤5% of t-tests comparing possible patterns in residuals were significant. Results: We removed 34 items, resulting in a 35-item SF-HDQ with domain structure: physical (10 items); cognitive (3 items); mental-emotional (5 items); uncertainty (5 items); difficulties with day-to-day activities (5 items) and challenges to social inclusion (7 items). Overall models’ fit: Cronbach’s alphas ranged from 0.78 (cognitive) to 0.85 (physical and mental-emotional) and PSIs from 0.69 (day-to-day activities) to 0.79 (physical and mental-emotional). Three items were rescored to achieve ordered thresholds. All domains demonstrated unidimensionality. Three items with DIF were retained because of their clinical importance.Conclusion: The 35-item SF-HDQ offers a brief, comprehensive disability PROM for use in clinical and community-based practice with adults living with HIV.

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Measuring disability experienced by adults living with HIV: assessing construct validity of the HIV Disability Questionnaire using confirmatory factor analysis

2014

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ObjectivesTo assess the construct validity of the HIV Disability Questionnaire (HDQ), a self-administered questionnaire that describes the presence, severity and episodic nature of disability experienced by people living with HIV.DesignWe conducted a confirmatory factor analysis. We hypothesised that domains in the HDQ characterised six dimensions of disability, each represented by HDQ items: physical symptoms and impairments (20 items); cognitive symptoms and impairments (3 items); mental and emotional health symptoms and impairments (11 items); uncertainty (14 items); difficulties with day-to-day activities (9 items) and challenges to social inclusion (12 items). We developed a measurement model to test these hypotheses. We used maximum likelihood methods of estimation to determine model fit. We considered a threshold for the Root Mean Square Error of Approximation (RMSEA) of <0.05 as an indication of overall goodness of model fit. We considered variables with factor loadings of >0.30 as representing a given domain of disability.SettingWe recruited adults with HIV from hospital clinics, AIDS service organisations and a specialty hospital in Ontario.ParticipantsOf the 361 adults with HIV who completed the HDQ, 80% were men, 36% were 50 or older and 77% reported living with at least two concurrent health conditions in addition to HIV.Outcome MeasuresWe administered the HDQ followed by a demographic questionnaire.ResultsThe model achieved good overall fit as indicated by a RMSEA of 0.030 (90% CI 0.028 to 0.033). All HDQ items represented our hypothesised dimensions of disability (factor loadings >0.30). Factor loadings ranged from 0.34 to 0.90. Domains of disability correlated with each other ranging from r=0.47 (between difficulties with day-to-day activities and uncertainty) to r=0.88 (between mental-emotional health challenges and challenges to social inclusion).ConclusionsThe six domain structure of the HDQ demonstrated construct validity when administered to adults living with HIV.

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Which dimensions of disability does the HIV Disability Questionnaire (HDQ) measure? A factor analysis

Cited by 16 publications

References 35 publications

Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

Developing a Short-Form Version of the HIV Disability Questionnaire (SF-HDQ) for Use in Clinical Practice: A Rasch Analysis

Measuring disability experienced by adults living with HIV: assessing construct validity of the HIV Disability Questionnaire using confirmatory factor analysis

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Which dimensions of disability does the HIV Disability Questionnaire (HDQ) measure? A factor analysis

Cited by 16 publications

References 35 publications

Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

Developing a Short-Form Version of the HIV Disability Questionnaire (SF-HDQ) for Use in Clinical Practice:&nbsp;A Rasch Analysis

Measuring disability experienced by adults living with HIV: assessing construct validity of the HIV Disability Questionnaire using confirmatory factor analysis

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Developing a Short-Form Version of the HIV Disability Questionnaire (SF-HDQ) for Use in Clinical Practice: A Rasch Analysis