A new model of health indentified through qualitative and quantitative analysis of the Chinese Arthritis Impact Measurement Scales 2. Cultural issues in the translation and validation of health status measures

Abstract

OBJECTIVE: Individuals with different cultural background tends to have their own conceptualization of health and disease. The purpose of this study is to examine the underlying concepts of health identified from factor analysis of a recently validated Chinese Arthritis Impact Measurement Scales 2 (CAIMS2) and qualitative data collected by Delphi technique. METHOD: Delphi technique was employed with 1 panel of bilingual experts (including 19 rheumatologist, 4 physicians and 7 allied health professionals) and 1 panel of Chinese patients (14) to derive the constructs of the culturally relevant health model. 158 subjects with arthritis (RA581, OA577) and 82 healthy subjects were asked to complete the CAIMS2. A principal-component analysis was performed on these responses to identify the major components of health. RESULTS: The expert panel had identified the following components of health: physical, psychological/mental, spiritual, free from disease, free from pain, well-being, no restriction on activities of one’s choice, social capabilities and enjoy work. The patients panel identified similar components including physical, psychological, free from disease, free from pain, no restriction in function, work ability and well-being. The patients additionally identified sleep and positive thinking as health components. 4 components were derived from factor analysis accounting for 68.4% of the variance: 1) physical (mobility, walking and bending, social activities, arthritis pain and work), 2) upper limb function (hand and finger function, arm function and household tasks), 3) psychological (support from family and friends, tension and mood) and 4) self-care. This model was different from the 5 factor model (physical, symptom, affect, social interaction, role) of the original AIMS2. CONCLUSION: The results of this study reveals the existence of different perceptions of health among different ethnic groups. Cautions should be taken to ensure construct and content validity in cross cultural health status studies.