Published in:
Open Access 01-12-2021 | Hypertension | Research
Detecting response shift in health-related quality of life measurement among patients with hypertension using structural equation modeling
Published in: Health and Quality of Life Outcomes | Issue 1/2021
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Background
Outcomes derived from longitudinal self-reported health-related quality of life measures can be confounded by response shift. This study was aimed to detect response shift among patients with hypertension attending a community-based disease management program.
Methods
240 consecutive consulting or follow-up patients with diagnosed hypertension were recruited. The Short Form 36-item Health Survey was self-administered at 12 community health service stations at baseline and four weeks after attending the program. The 4-step structural equation modeling approach assessed response shift.
Results
Data from 203 (84.6%) patients were eligible for analyses (mean age 65.9 ± 10.8 years, 46.3% female). The results showed uniform recalibration of social functioning (\({\upchi}_{\mathrm{SBdiff}}^{2}\)(1) = 22.98, P < 0.001), and non-uniform recalibration of role limitations due to physical problems (\({\upchi}_{\mathrm{SBdiff}}^{2}\)(1) = 8.84, P = 0.003), and bodily pain (\({\upchi}_{\mathrm{SBdiff}}^{2}\)(1) = 17.41, P < 0.001). The effects of response shift on social functioning were calculated as “small” (effect-size = 0.35), but changed the observed changes from improvement (effect-size = 0.25) to slight deterioration (effect-size = -0.10). After accounting for the response shift effect, the general physical health of participants was improved (effect-size = 0.37), while deterioration (effect-size = -0.21) in the general mental health was also found.
Conclusions
Recalibration existed among patients with hypertension attending the disease management program. The interventions in the program might act as a catalyst that induced the response shift. We conclude that response shift should be considered in hypertension research with longitudinal health-related quality of life data.