Development and Psychometric Testing of the Hemophilia Well-being Index



Hemophilia experts have recommended that screening tools should be introduced into clinical practice to assess patients’ needs and perceptions.


The present work aims to describe the development of a brief instrument for the assessment of subjective well-being of men with hemophilia within an international study involving participants from 10 countries.


Several steps were implemented toward achieving this objective: (1) literature review; (2) semistructured interviews in different Ibero-American countries; (3) exploratory qualitative content analysis of the interviews; (4) definition of the construct being evaluated; (5) generation of preliminary items; (6) interjudgment ratings of the items, by both patients and experts, to assess comprehension and review items; and (7) psychometric testing of an international sample of 342 patients with hemophilia.


Exploratory qualitative study allowed the development of an initial pool of items which adress salient life domains related to well-being. Interjudment ratings led to improvents in the wording and comprehensibilty of the preliminary pool of questions. Psychometric testing allowed items to be reviewed according to empirical criteria. The assessment of the underlying structure of the questionnaire by exploratory factor analysis (generalized least squares) showed a unidimensional model explaining 59.7 % of variance. Adequate internal consistency (0.91) and test–retest reliability (0.82) were observed for the instrument. Associations with other outcome measures and clinical indicators also provided a range of evidence for the instrument’s validity.


This study presents a new disease-specific tool which is able to assess subjective well-being in hemophilia patients.The instrument is available in Spanish, Portuguese (Brazilian), and English language versions for use in future research.

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The author wishes to thank the experts, health professionals, and voluntary patients from the Ibero-American countries who took part in the study and carried out data collection as part of this work. The present study was partially supported by grants to the author from “Centro de Estudios para América Latina (UAM),” reference PD 02-541A-Q-640 (during the period 2002–2004), and “Consejería de Educación, Comunidad de Madrid/UAM,” reference CCG08-UAM/HUM-4462 (during the period 2009–2010).

Conflict of Interest

The author has no interests that might be perceived as posing a conflict or bias.

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Corresponding author

Correspondence to Eduardo Remor.

Appendix: Hemophilia Well-being Index (HWBI)

Appendix: Hemophilia Well-being Index (HWBI)

Researchers interested in the HWBI and scoring instructions should contact the author for proper authorization before its use.

English version

During the last month, to what extent have the following areas of your life been negatively affected by hemophilia?

1. Family

2. Health/well-being

3. Work or school

4. Friends and relationships

5. Love life and partnership

6. Economic status

7. Leisure time

8. Social activities

Response format: 4 = Strongly affected, 3 = Quite affected, 2 = Somewhat affected, 1 = A little affected, 0 = Not affected

International Spanish version

Durante el último mes ¿hasta qué punto las siguientes áreas de tu vida han sido afectadas negativamente por la hemofilia?

1. Familia

2. Bienestar/Salud

3. Trabajo o Escuela

4. Amigos y Relaciones afectivas

5. Vida sentimental y Relación de Pareja

6. Situación económica

7. Actividades recreativas u ocio

8. Actividad social

Formato de respuesta: 4 = Muy afectada, 3 = Bastante afectada, 2 = Algo afectada, 1 = Poco afectada, 0 = Ninguna afectación

Brazilian Portuguese version

Durante o ultimo mês, em que medida as seguintes áreas de sua vida foram afetadas negativamente pela hemofilia?

1. Família

2. Bem-estar/Saúde

3. Trabalho ou Escola

4. Amigos e Relações afetivas

5. Vida sentimental e Relação de casal

6. Situação econômica

7. Atividades recreativas ou lazer

8. Atividade social

Formato de resposta: 4 = Muito afetada, 3 = Bastante afetada, 2 = Algo afetada, 1 = Pouco afetada, 0 = Nenhuma afetação

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Remor, E. Development and Psychometric Testing of the Hemophilia Well-being Index. Int.J. Behav. Med. 20, 609–617 (2013).

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  • Well-being
  • Mental health
  • Measurement
  • Hemophilia
  • HWBI
  • Adults