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Do the unlabeled response categories of the Minnesota Living with Heart Failure Questionnaire satisfy the monotonicity assumption of simple-summated scoring?

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Abstract

Purpose

Half of the 21-item Minnesota Living with Heart Failure Questionnaire (MLHFQ) response categories are labeled (0 = No, 1 = Very little, 5 = Very much) and half are not (2, 3, and 4). We hypothesized that the unlabeled response options would not be more likely to be chosen at some place along the scale continuum than other response options and, therefore, not satisfy the monotonicity assumption of simple-summated scoring.

Methods

We performed exploratory and confirmatory factor analyses of the MLHFQ items in a sample of 1437 adults in the Better Effectiveness After Transition—Heart Failure study. We evaluated the unlabeled response options using item characteristic curves from item response theory—graded response models for MLHFQ physical and emotional health scales. Then, we examined the impact of collapsing response options on correlations of scale scores with other variables.

Results

The sample was 46% female; 71% aged 65 or older; 11% Hispanic, 22% Black, 54% White, and 12% other. The unlabeled response options were rarely chosen. The standard approach to scoring and scores obtained by collapsing adjacent response categories yielded similar associations with other variables, indicating that the existing response options are problematic.

Conclusions

The unlabeled MLHFQ response options do not meet the assumptions of simple-summated scoring. Further assessment of the performance of the unlabeled response options and evaluation of alternative scoring approaches is recommended. Adding labels for response options in future administrations of the MLHFQ should be considered.

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Funding

This study was funded in part by the Agency for Healthcare Research and Quality (R01 HS019311), the National Heart Lung and Blood Institute (RC2 HL101811), the National Institute on Aging (P30 AG021684), the Robert Wood Johnson Foundation (66336), and the Sierra Health Foundation, and the participating institutions.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine & Health Services Research, UCLA Department of Medicine, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA

    Visith Uy, Ron D. Hays & Michael K. Ong

  2. Department of Health Policy & Management, University of California, Los Angeles, Los Angeles, CA, USA

    Ron D. Hays & Michael K. Ong

  3. RAND Health, RAND Corporation, Santa Monica, CA, USA

    Ron D. Hays

  4. UCLA Department of Biostatistics, 650 Charles E. Young Drive South, 51-254 CHS, Los Angeles, CA, 90024, USA

    Jay J. Xu

  5. Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Peter M. Fayers

  6. Emeritus Professor, Institute of Applied Health Sciences, King’s College, University of Aberdeen, Aberdeen, AB24 3FX, UK

    Peter M. Fayers

  7. Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, 533 Parnassus Avenue, Room 131, San Francisco, CA, 94117, USA

    Andrew D. Auerbach

  8. Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, 116 N. Robertson Blvd., Suite 800, Los Angeles, CA, 90048, USA

    Jeanne T. Black

  9. Sue & Bill Gross School of Nursing, University of California, Irvine, 284 Berk Hall, Irvine, CA, 92697, USA

    Lorraine S. Evangelista

  10. Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093, USA

    Theodore G. Ganiats

  11. Department of Internal Medicine, University of California, Davis, 4860 Y Street, Suites 0101 & 0400, Sacramento, CA, 95817, USA

    Patrick S. Romano

  12. Department of Pediatrics, University of California, Davis, Sacramento, CA, USA

    Patrick S. Romano

  13. Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Michael K. Ong

Authors
  1. Visith Uy
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  2. Ron D. Hays
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  3. Jay J. Xu
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  9. Patrick S. Romano
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Corresponding author

Correspondence to Ron D. Hays.

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The authors declare that they have no conflict of interest.

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UCLA Institutional Review Board approved the study.

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All study participants provided informed consent.

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Uy, V., Hays, R.D., Xu, J.J. et al. Do the unlabeled response categories of the Minnesota Living with Heart Failure Questionnaire satisfy the monotonicity assumption of simple-summated scoring?. Qual Life Res 29, 1349–1360 (2020). https://doi.org/10.1007/s11136-020-02422-8

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