Quality of Life Research

, Volume 26, Issue 6, pp 1463–1472 | Cite as

Minimal impact of response shift for SF-12 mental and physical health status in homeless and vulnerably housed individuals: an item-level multi-group analysis

  • Anne M. GadermannEmail author
  • Richard Sawatzky
  • Anita Palepu
  • Anita M. Hubley
  • Bruno D. Zumbo
  • Tim Aubry
  • Susan Farrell
  • Stephen W. Hwang



The purpose of this study was to examine whether homeless or vulnerably housed individuals experienced response shift over a 12-month time period in their self-reported physical and mental health status.


Data were obtained from the Health and Housing in Transition study, a longitudinal multi-site cohort study in Canada (N = 1190 at baseline). Multi-group confirmatory factor analysis (MG-CFA) and methods for response shift detection at the item level, based on the approach by Oort, were used to test for reconceptualization, reprioritization, and recalibration response shift on the SF-12 in four groups of individuals who were homeless (n = 170), housed (n = 437), or who reported a change in their housing status [from homeless to housed (n = 285) or housed to homeless (n = 73)] over a 12-month time period. Mean and variance adjusted weighted-least squares estimation was used to accommodate the ordinal and binary distributions of the SF-12 items.


Using MG-CFA, a strict invariance model showed that the measurement model was equivalent for the four groups at baseline. Although we found small but statistically significant response shift for several measurement model parameters, the impact on the predicted average mental and physical health scores within each of the groups was small.


Response shift does not appear to be a significant concern when using the SF-12 to obtain change scores over a 12-month period in this population.


Homeless persons Vulnerable populations Response shift Health Mental health SF-12 



This project was supported by an Operating Grant (MOP-86765) from the Canadian Institutes of Health Research. Dr. Gadermann also acknowledges support from the Michael Smith Foundation for Health Research and Canadian Institutes of Health Research. We would like to acknowledge the following individuals from our community partner organizations: Laura Cowan, Liz Evans, Sarah Evans, Stephanie Gee, Clare Haskel, Erika Khandor, and Wendy Muckle. The authors also thank the study coordinators and interviewers in each of the three cities as well as the shelter, drop-in, municipal and provincial staff for their assistance with participant recruitment and follow-up.


This project was supported by an Operating Grant (MOP-86765) from the Canadian Institutes of Health Research. Dr. Gadermann also acknowledges support from the Michael Smith Foundation for Health Research and Canadian Institutes of Health Research.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Anne M. Gadermann
    • 1
    • 2
    Email author
  • Richard Sawatzky
    • 1
    • 3
  • Anita Palepu
    • 1
  • Anita M. Hubley
    • 4
  • Bruno D. Zumbo
    • 4
  • Tim Aubry
    • 5
  • Susan Farrell
    • 5
  • Stephen W. Hwang
    • 6
    • 7
  1. 1.Centre for Health Evaluation and Outcome SciencesProvidence Health Care Research InstituteVancouverCanada
  2. 2.Human Early Learning Partnership, School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  3. 3.School of NursingTrinity Western UniversityLangleyCanada
  4. 4.Measurement, Evaluation, and Research Methodology Program, Department of Educational and Counselling Psychology and Special EducationUniversity of British ColumbiaVancouverCanada
  5. 5.School of PsychologyUniversity of OttawaOttawaCanada
  6. 6.Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  7. 7.Department of MedicineUniversity of TorontoTorontoCanada

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