Investigating gender-based differential item functioning on the Kansas City Cardiomyopathy Questionnaire (KCCQ) using qualitative content analysis

Abstract

Purpose The purpose of this study is to evaluate potential gender-based differences in interpreting the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) and to explore if there are aspects of health-related quality of life (HRQOL) not captured by the KCCQ-23 that are important to assess in men and/or women with heart failure (HF). Methods Patients ≥ 22 years of age with clinician-diagnosed HF and left ventricular ejection fraction ≤ 40% were recruited from two academic medical centers to participate in semi-structured concept elicitation and cognitive debriefing interviews. Enrollment was stratified by patient-identified gender (half women/half men). All interviews were conducted over the phone/web and audio recorded. Interviews were transcribed and descriptive qualitative content analysis was used to summarize findings overall and by gender. Results Twenty-five adults (56% women) diagnosed with HF participated. The average age was 67 years (range: 25–88). Women attributed a wider variety of symptoms to HF than men. Some participants had difficulty differentiating whether their experiences were due to HF, side effects of their medications, or age. We found very little evidence that participants interpreted KCCQ-23 items differently based on gender. Conclusions Overall, our findings indicate that interpretation of the KCCQ-23 items were similar in men and women. However, some modifications to items may improve clarity of interpretation for a wide range of patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03276-y.

Validation of the Kansas City Cardiomyopathy Questionnaire in Patients with Tricuspid Regurgitation: The Tri-QOL Study

“…As a result, there have been concerns that men and women may interpret questions about symptoms, function, and quality of life differently. Prior quantitative 47 and qualitative 48 studies in patients with heart failure have generally dispelled this concern, but this was also essential to investigate in the current study, given the predominance of women in TTVI trials. KCCQ as a Clinical Trial Endpoint.…”