Understanding the impact of racial self-identification on perceptions of health-related quality of life: a multi-group analysis
Multiple group analysis is used to determine whether the health-related quality of life (HRQoL) model developed by Wilson and Cleary (1995) is equivalent across racial categories. Using data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System, this study compares racial groups (African American vs. White; Hispanic vs. White) to determine whether they perceive HRQoL similarly.
This secondary data analysis of 2007 New York State Behavioral Risk Factor Surveillance System data (n = 6,103 cases) uses the multi-group analysis function in structural equation modeling to test for equivalency across the named ethnic/racial groups.
The White subsample achieved good fit indices and produced significant estimates for all structural components of the hypothesized model. Noteworthy differences, however, were found for the African American and Hispanic samples. In both cases, the data failed to support the Wilson and Cleary model as operationalized. This was most pronounced in the Hispanic versus White comparison, where the findings suggest fundamental differences between the two groups at the basic concept measurement level.
The substantial discrepancies that the findings suggest for the subsamples call into question not only the structural integrity of the Wilson and Cleary model for minorities but also suggest that racial groups, particularly Hispanics, may perceive concepts of health-related quality of life differently than Whites.
KeywordsHealth-related quality of life (HRQoL) Wilson and Cleary Model Behavioral Risk Factor Surveillance System Health disparities and HRQoL Racial self-identification and HRQoL Perceptions of HRQoL
This study was reviewed by the Institutional Review Boards (IRBs) at the University at Albany, State University of New York (Protocol # L90079) and Columbia University, Morningside Campus (IRB-AAAF3998). Both IRBs classified the study as exempt.
- 1.Bryne, B. (2001). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Mahwah: Lawrence Erlbaum Associates.Google Scholar
- 3.Rizzo V., & Kintner, E. (2012). The utility of the Behavioral Risk Factor Surveillance System (BRFSS) in testing quality of life research. Quality of Life Research. doi: 10.10071/s11136-012-0228-1.
- 4.Centers for Disease Control & Prevention. (2008). Racial/ethnic disparities in self-rated health status among adults with and without disabilities—United States. MMWR. Morbidity and Mortality Weekly Report, 57(39), 1069–1073.Google Scholar
- 5.Agency for Healthcare Quality and Research, U.S. Department of Health and Human Services. Key themes and highlights from the National Healthcare Disparities Report. http://www.ahrq.gov/qual/nhdr06/highlights/nhdr06high.htm. Accessed April 17, 2012.
- 7.Centers for Disease Control and Prevention. (2007). BRFSS overview. http://www.cdc.gov/brfss/technical_infodata/surveydata/2007.htm. Accessed April 17, 2012.
- 17.Nelson, D. E., Holtzman, D., Bolen, J., Stanwyck, C. A., & Mack, K. A. (2001). Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Social and Prevent Medicine, 46(Suppl 1), S03–S42.Google Scholar
- 19.Centers for Disease Control. (2008). BRFSS data quality, validity, and reliability. Resource document. Centers for Disease Control: Behavioral Risk Factor Surveillance System. http://www.cdc.gov/brfss/pubs/quality.htm Accessed August 29, 2008.
- 22.Kline, R. (2005). Principles and practice of structural equation modeling (2nd ed.). New York, NY: Guilford Press.Google Scholar
- 23.Ullman, J. B. (1996). Structural equation modeling. In B. G. Tabachnick & B. G. Fidell (Eds.), Using multivariate statistics (3rd ed., pp. 709–811). New York, NY: HarperCollins Publishers.Google Scholar
- 24.Keith, T. (2005). Multiple regression and beyond. Boston, MA: Pearson.Google Scholar
- 26.North Carolina State University. Structural equation modeling: Statnotes. http://faculty.chass.ncsu.edu/garson/PA765/strur.htm. Accessed September 21, 2009.