Quality of Life Research

, Volume 22, Issue 2, pp 295–308 | Cite as

A cross-cultural validation of patient-reported outcomes measures: a study of breast cancers survivors




Psychometric inadequacy interferes with the assessment of patient-reported health outcomes. This study examined the psychometric properties of several standardized measures in health research.


Participants completed health outcomes measures including the FACT-G, SF-36, MOS Social Support Survey, and CES-D. Psychometric properties examined include reliability, and construct and concurrent validity.


320 BCS including 88 African-, 95 English-proficient Latina-, and 137 Limited English-proficient Latina-Americans participated. The findings demonstrate acceptable reliability (α > 0.70) and consistent factor structures for most measures with the variance ranging from 56 to 84%. The FACT-G physical well-being and SF-36 role limitations subscales had the best fitting structures. Concurrent validity showed the FACT-G subscales correlated with their appropriate counterparts.


Despite being commonly used instruments in HRQOL (e.g., FACT-G, SF-36) and QOL (e.g., CES-D, MOS) research, few studies reported the psychometric properties of these and when applied cross-culturally. However, evaluating the psychometric properties of measures in health outcomes research should be done routinely.


Measurement Reliability Validity Breast cancer survivors Ethnic minority Linguistic minority 


  1. 1.
    American Cancer Society. (2011). Cancer facts & figures 2011. Atlanta: American Cancer Society.Google Scholar
  2. 2.
    American Cancer Society. (2011). Cancer facts & figures for African-Americans 2011–2012. Atlanta: American Cancer Society.Google Scholar
  3. 3.
    American Cancer Society. (2009). Cancer facts & figures for hispanics/latinos 2009–2011. Atlanta: American Cancer Society.Google Scholar
  4. 4.
    Anderson, B. L., et al. (2008). Psychologic intervention improves survival for breast cancer patients: A randomized clinical trial. Cancer, 113, 3450–3458.CrossRefGoogle Scholar
  5. 5.
    Institute of Medicine. (2006). From cancer patient to cancer survivor: Lost in transition. Washington, DC: The National Academies Press.Google Scholar
  6. 6.
    Ashing-Giwa, K., et al. (2007). Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma. Quality of Life Research, 16(3), 413–428.CrossRefPubMedGoogle Scholar
  7. 7.
    Ashing-Giwa, K., & Lim, J. (2008). Predicting health-related quality of life: Testing the Contextual Model using structural equation modeling. Applied Research in Quality of Life, 3(3), 215–230.CrossRefGoogle Scholar
  8. 8.
    Bowen, D. J., et al. (2007). Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Research and Treatment, 106(1), 85–95.CrossRefPubMedGoogle Scholar
  9. 9.
    Paskett, E. D., et al. (2008). Breast cancer survivors’ health-related quality of life: Racial differences and comparisons to non-cancer controls. Cancer, 113(11), 3222–3230.CrossRefPubMedGoogle Scholar
  10. 10.
    Ashing-Giwa, K., & Lim, J. (2010). Exploring the association between functional strain and emotional well-being among a population-based sample of breast cancer survivors. Psycho-Oncology, 19, 150–159.CrossRefPubMedGoogle Scholar
  11. 11.
    Ashing-Giwa, K., et al. (2009). Cervical cancer survivorship in a population-based sample. Gynecologic Oncology, 112, 358–364.CrossRefPubMedGoogle Scholar
  12. 12.
    Fitzsimmons, D. (2004). What are we trying to measure? Rethinking approaches to health outcome assessment for the older person with cancer. European Journal of Cancer Care, 13, 416–423.CrossRefPubMedGoogle Scholar
  13. 13.
    Lawrence, W. F., & Clancy, C. M. (2003). Health outcomes assessment in cancer: Current measurement strategies and recommendations for improvement. Disease Management & Health Outcomes, 11(11), 709–721.CrossRefGoogle Scholar
  14. 14.
    Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  15. 15.
    Sherbourne, C. D., & Stewart, A. L. (1991). The MOS Social Support Survey. Social Science and Medicine, 32(6), 705–714.CrossRefPubMedGoogle Scholar
  16. 16.
    Ware, J. E., et al. (1993). SF-36 health survey: I. Manual and interpretation guide. Boston: Health Institute, New England Medical Center.Google Scholar
  17. 17.
    Cella, D., et al. (1993). The Functional Assessment of Cancer Therapy Scale: Development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570–579.PubMedGoogle Scholar
  18. 18.
    Ashing-Giwa, K., & Kagawa-Singer, M. (2006). Infusing culture into oncology research on quality of life. Oncology Nursing Forum, 33(1, Suppl), 31–36.CrossRefPubMedGoogle Scholar
  19. 19.
    Ramirez, M., et al. (2005). Measurement issues in health disparities research. Health Services Research, 40(5), 1640–1657.CrossRefPubMedGoogle Scholar
  20. 20.
    Stewart, A. L. & Napoles-Springer, A. (2000). Health-related quality of life assessments in diverse population groups in the United States. Medical Care 38(9), II-102–II-124.Google Scholar
  21. 21.
    De Walt, D. A., et al. (2004). Literacy and health outcomes: A systematic review of the literature. Journal of General Internal Medicine, 19, 1228–1239.CrossRefGoogle Scholar
  22. 22.
    Ashing-Giwa, K. (2005). Can a culturally responsive model for research design bring us closer to addressing participation disparities? Lessons learned from cancer survivorship studies. Ethnicity and Disease, 15, 130–137.PubMedGoogle Scholar
  23. 23.
    Hahn, E. A., & Cella, D. (2003). Health outcomes assessment in vulnerable populations: Measurement challenges and recommendations. Archives of Physical Medicine and Rehabilitation, 84(Suppl 2), S35–S42.CrossRefPubMedGoogle Scholar
  24. 24.
    Hahn, E. A., et al. (2010). Literacy-fair measurement of health-related quality of life will facilitate comparative effectiveness research in Spanish-speaking cancer outpatients. Medical Care, 48(6 Suppl 1), S75–S82.CrossRefPubMedGoogle Scholar
  25. 25.
    Kagawa-Singer, M. (2000). Improving the validity and generalizability of studies with underserved US populations expanding the research paradigm. Annals of Epidemiology, 10, S92–S103.CrossRefPubMedGoogle Scholar
  26. 26.
    Ashing-Giwa, K., et al. (2004). Breast cancer survivorship in a multiethnic sample: Challenges in recruitment and measurement. Cancer, 101(3), 460–465.CrossRefGoogle Scholar
  27. 27.
    Cella, D., et al. (1998). Spanish language translation and initial validation of the Functional Assessment of Cancer Therapy (FACT) quality of life instrument. Medical Care, 36(9), 1407–1418.CrossRefPubMedGoogle Scholar
  28. 28.
    Ashing-Giwa, K., Kim, J., & Tejero, J. (2008). Measuring quality of life among cervical cancer survivors: Preliminary assessment of instrumentation validity in a cross-cultural study. Quality of Life Research, 17, 147–157.CrossRefPubMedGoogle Scholar
  29. 29.
    Oh, S., et al. (2004). Quality of life of breast cancer survivors after a recurrence: A follow-up study. Breast Cancer Research and Treatment, 87, 45–57.CrossRefPubMedGoogle Scholar
  30. 30.
    Dapueto, J. J., et al. (2003). Evaluation of the Functional Assessment of Cancer Therapy-General (FACT-G) Spanish version 4 in South America: Classic psychometric and item response theory analyses. Health and Quality of Life Outcomes 1(32), p. Article available online from http://www.hqlo.com/content/1/1/32.
  31. 31.
    Hann, D., Winter, K., & Jacobsen, P. (1999). Measurement of depressive symptoms in cancer patients: Evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). Journal of Psychosomatic Research, 46(5), 437–443.CrossRefPubMedGoogle Scholar
  32. 32.
    Nunnally, J. (1978). Psychometric theory. New York: McGraw Hill.Google Scholar
  33. 33.
    SPPS. (2006). SPSS 15.0 command syntax reference 2006. Chicago, IL: SPSS, Inc.Google Scholar
  34. 34.
    Dapueto, J. J., et al. (2001). Evaluation of the Functional Assessment of Cancer Therapy-General questionnaire (FACT-G) in a South American Spanish speaking population. Psycho-Oncology, 10, 88–92.CrossRefPubMedGoogle Scholar
  35. 35.
    Sanchez, R., Ballesteros, M., & Arnold, B. J. (2011). Validation of the FACT-G scale for evaluating quality of life in cancer patients in Colombia. Quality of Life Research, 20, 19–29.CrossRefPubMedGoogle Scholar
  36. 36.
    Conerly, R. C., Baker, F., & Dye, J. (2002). Measuring depression in African-American cancer survivors: The reliability and validity of the Center for Epidemiologic Study-Depression (CES-D) Scale. Journal of Health Psychology, 7(1), 107–114.CrossRefPubMedGoogle Scholar
  37. 37.
    Eversley, R., et al. (2005). Post-treatment symptoms among ethnic minority breast cancer survivors. Oncology Nursing Forum, 32(2), 250–255.CrossRefPubMedGoogle Scholar
  38. 38.
    Northouse, L. L., et al. (2002). Quality of life of women with recurrent breast cancer and their family members. Journal of Clinical Oncology, 20, 4050–4064.CrossRefPubMedGoogle Scholar
  39. 39.
    Haase, J. E., & Braden, C. J. (2012). Conceptualization and measurement of quality of life and related concepts: Progress to date on guidelines for clarity. In C. R. King & P. S. Hinds (Eds.), Quality of life: From nursing and patient perspectives (pp. 59–81). Sudbury, MA: Jones & Bartlett Learning.Google Scholar
  40. 40.
    Kagawa-Singer, M., Padilla, G. V., & Ashing-Giwa, K. (2010). Health-related quality of life and culture. Seminars in Oncology Nursing, 26(1), 59–67.CrossRefPubMedGoogle Scholar
  41. 41.
    Stewart, A. L., & Napoles-Springer, A. (2003). Advancing health disparities research: Can we afford to ignore measurement issues? Medical Care, 41(11), 1207–1220.CrossRefPubMedGoogle Scholar
  42. 42.
    Wan, G., Counte, M., & Cella, D. (1997). The influence of personal expectations on cancer patients’ reports health related quality of life. Psycho-Oncology, 6, 1–11.CrossRefPubMedGoogle Scholar
  43. 43.
    Ganz, P. A., Guadagnoli, E., Landrum, M. B., Lash, T. L., Rakowski, W., Silliman, R. A. (2003). Breast cancer in older women: Quality of life and psychosocial adjustment in the 15 months after diagnosis. Journal of Clinical Oncology, 21, 4027–4033.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Center of Community Alliance for Research and Education (CCARE), Department of Population SciencesCity of Hope National Medical CenterDuarteUSA

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