The Self‐Care of Heart Failure Index version 7.2: Further psychometric testing

Abstract

Clinicians and researchers need valid and reliable instruments to evaluate heart failure (HF) self-care. The Self-Care of Heart Failure Index (SCHFI) is a theoretically driven instrument developed for this purpose. The SCHFI measures self-care with three scales: self-care maintenance, measuring behaviors to maintain HF stability; symptom perception, measuring monitoring behaviors; and self-care management, assessing the response to symptoms. After the theory underpinning the SCHFI was updated, the instrument was updated to version 7.2 but it was only tested in the United States. In this study we tested the psychometric characteristics (structural and construct validity, internal consistency, and test-retest reliability) of the SCHFI v.7.2 in an Italian population of HF patients. We used a cross-sectional design to study 280 HF patients with additional data collected after 2 weeks for test-retest reliability. Adults with HF (mean age 75.6 (±10.8); 70.8% in New York Heart Association [NYHA] classes II and III) were enrolled from six centers across Italy. Confirmatory factor analysis showed supportive structural validity in the three SCHFI v.7.2 scales (CFI from 0.94 to 0.95; RMSEA from 0.05 to 0.07). Internal consistency reliability estimated with Cronbach's α and composite reliability ranged between .73 and .88; test-retest reliability ranged between 0.73 and 0.92. Construct validity was supported with significant correlations between the SCHFI v.7.2 scale scores and quality of life, brain natriuretic peptide levels and NYHA class. This study further supports the psychometric characteristics of the SCHFI v.7.2, illustrating that it can be used in clinical practice and research also in an Italian population.

The Revised Self-Care of Heart Failure Index — a new tool for assessing the self-care of Polish patients with heart failure

“…The Cronbach's α values for the self-care maintenance and symptom perception subscales here were similar to those found in the original and Italian version (respectively: self-care maintenance -0.790 vs 0.710 vs 0.733; symptom perception -0.790 vs 0.810 vs 0.830) [13,15]. The greatest difference in Cronbach's α was found for the self-care management domain, where the original version of the questionnaire had a considerably lower value of this reliability index (0.660), compared to the Polish (0.705) and Italian versions (0.802) [13,15]. The results of confirmatory factor analysis confirmed the three-factor structure of the questionnaire.…”

“…Similarly, in the study by Vellone et al, all loadings except for item 2 ("Get some exercise") were statistically significant [15]. Polish patients obtained the highest scores in self-care confidence, and the lowest in symptom perception, while the overall self-care level measured using the EHFSc-9 was similar to that obtained in the study by Uchmanowicz and Wleklik on a group of Polish patients with heart failure [23].…”

“…Polish patients obtained the highest scores in self-care confidence, and the lowest in symptom perception, while the overall self-care level measured using the EHFSc-9 was similar to that obtained in the study by Uchmanowicz and Wleklik on a group of Polish patients with heart failure [23]. Notably, though, self-care capabilities may be affected by differences between the health care systems of each country, as well as socio-economic conditions [13,15]. Our analysis demonstrated that patients with higher self-care scores on the self-care maintenance and symptom perception subscales had a higher LVEF and lower NYHA class.…”

“…In the study, its score was inverted and standardized. As interpreted by the questionnaire's authors, a patient can score between 0 and 100 points, with higher scores indicating better self-care [15]. The mean (SD) EHFSc-9 score was 51.92 (22.0) points out of 100.…”

“…As such, the new version comprises self-care maintenance, self-care management, and the new component of symptom perception. To date, the questionnaire has been validated in an Italian patient population [13,15].…”