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14-05-2018 | Uitgave 10/2018

Quality of Life Research 10/2018

Negligible impact of differential item functioning between Black and White dialysis patients on the Kidney Disease Quality of Life 36-item short form survey (KDQOLTM-36)

Tijdschrift:
Quality of Life Research > Uitgave 10/2018
Auteurs:
John D. Peipert, Peter Bentler, Kristi Klicko, Ron D. Hays

Abstract

Purpose

Black dialysis patients report better health-related quality of life (HRQOL) than White patients, which may be explained if Black and White patients respond systematically differently to HRQOL survey items.

Methods

We examined differential item functioning (DIF) of the Kidney Disease Quality of Life 36-item (KDQOLTM-36) Burden of Kidney Disease, Symptoms and Problems with Kidney Disease, and Effects of Kidney Disease scales between Black (n = 18,404) and White (n = 21,439) dialysis patients. We fit multiple group confirmatory factor analysis models with increasing invariance: a Configural model (invariant factor structure), a Metric model (invariant factor loadings), and a Scalar model (invariant intercepts). Criteria for invariance included non-significant χ2 tests, > 0.002 difference in the models’ CFI, and > 0.015 difference in RMSEA and SRMR. Next, starting with a fully invariant model, we freed loadings and intercepts item-by-item to determine if DIF impacted estimated KDQOLTM-36 scale means.

Results

ΔCFI was 0.006 between the metric and scalar models but was reduced to 0.001 when we freed intercepts for the burdens and symptoms and problems of kidney disease scales. In comparison to standardized means of 0 in the White group, those for the Black group on the Burdens, Symptoms and Problems, and Effects of Kidney Disease scales were 0.218, 0.061, and 0.161, respectively. When loadings and thresholds were released sequentially, differences in means between models ranged between 0.001 and 0.048.

Conclusion

Despite some DIF, impacts on KDQOLTM-36 responses appear to be minimal. We conclude that the KDQOLTM-36 is appropriate to make substantive comparisons of HRQOL between Black and White dialysis patients.

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