The "UNAV-experience of living with chronic heart failure scale": a psychometric validation study
Authors: Olano-Lizarraga M , Martin-Martin J , Zaragoza-Salcedo A , Simon-Ricart Cenizo A , Ara-Lucea P , Jimeno-San Martin L , Perez-Garcia S , De La Torre-Lomas N , Cobo-Sanchez J L , Perez-Herreros J , Cambra-Vidart L , Salinas-Urra S , Moro-Tejedor N , Guerra L , Saracibar-Razquin M 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Plan Estatal de I+D+I 2013-2016 (2013-2016 State Plan for Scientific and Technical Research and Innovation) of the Spanish Government and co-financed by the Subdirectorate-General for the Evaluation and Promotion of Research of the Carlos III Health Institute (Instituto de Salud Carlos III - ISCIII) and the European Regional Development Fund (Fondos Europeos de Desarrollo Regional - FEDER)

Introduction
No validated patient-reported scale has been identified focused on exploring the life experience of people with chronic heart failure. Its development is necessary to address the person's view as a unitary being, and understand the illness as a health experience embedded in the person's life history.

Purpose
This study aimed to analyse the psychometric properties of the "UNAV-Experience of Living with Chronic Heart Failure Scale" in a large Spanish population.

Methods
A test-retest validation study was conducted between June 2020 and May 2022. The study was performed in five Spanish hospitals' outpatient heart failure units. The sample consisted of 300 adult patients with chronic heart failure with functional class II-IV. The test-retest was performed with 50 of these patients. Sociodemographic data, clinical data, the Minnesota Living With Heart Failure Questionnaire, the Kansas City Cardiomyopathy Questionnaire and the UNAV-Experience of Living with Chronic Heart Failure Scale were collected. The adjustment of the data to the Rasch model was analysed, as well as psychometric analyses according to classical test theory: data quality and acceptability, reliability and construct validity.

Results
The initial version of 53 items (developed based on the results of a qualitative study, a systematic literature review, the opinion of a panel of experts and a pilot study) was finally reduced to 30 items. Through Rasch's analysis, five dimensions were identified that made up this scale: 1) Living with CHF involves profound personal changes (7 items); 2) People living with CHF have to accept their situation (5 items); 3) People with CHF need to feel that their life is normal (7 items); 4) People with CHF need to live with hope (5 items); 5) People with CHF feel that their situation negatively influences their close environment (6 items).
No subscales showed asymmetry or floor effect. All items had a corrected total item correlation &gt;0.30. The homogeneity index of the items ranged from 0.31 to 0.57, and Cronbach's alpha ranged from 0.73 to 0.87. The intraclass correlation coefficient was between 0.79 and 0.89. All subscales showed significant differences by gender (p&lt;0.001), except for the Acceptance subscale. The subscales on Profound Change, Acceptance and Hope showed significant differences by educational level (p&lt;0.05). Regarding functional class, subscale scores significantly differed between class II and III-IV (p&lt;0.01).

Conclusions
The UNAV-Experience of Living with Chronic Heart Failure Scale is an original and valid tool to measure the experience of living with chronic heart failure from the person's perspective.