Arabic translation, cross-cultural adaptation, and testing measurement properties of the European heart failure self-care behaviour (EHFScBS-12 and EHFScBS-9)

BACKGROUND: Enhanced self-care is the primary objective of many heart failure (HF) management programs. The European Heart Failure Self-care Behaviour Scale (EHFScBS), available in 12-item and 9-item versions, is widely used to assess self-care in patients with HF. However, the EHFScBS has not been translated or evaluated its measurement properties in Arabic-speaking populations with HF. OBJECTIVE: The objective of this study was to translate, culturally adapt and evaluate the measurement properties of the Arabic version of EHFScBS-12 and EHFScBS-9 followed the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines and to compare both versions regarding structural validity, reliability, and model fit among Arabic-speaking patients with HF. MATERIALS AND METHODS: A cross-sectional study conducted at a governmental hospital in Riyadh used purposive sampling to recruit participants who met the predefined inclusion criteria relevant to the study objectives:137 patients with HF (mean age = 59 years; 61.3% male). The researchers evaluated the comprehensive measurement properties of the 12- and 9-item (EHFScBS) included forward-backward translation, confirmatory factor analysis (CFA), and reliability testing. In addition, convergent and divergent validity were assessed using the Self-Care Heart Failure Index version 6.2 and the Perceived Stress Scale10-Item. RESULTS: The scale demonstrated excellent content validity as evidenced by I-CVI of .85 to 1 and S-CVI of .95, and the CFA of the 12-item scale yielded ambiguous fit indices: root mean square error of approximation (RMSEA) =0.084, (90% CI: .059-.108), comparative fit index (CFI) =0.824, and normed fit index (NFI) =0.706 which is low/suboptimal. The CFA of the 9-item scale showed good fit indices (RMSEA = 0.042, (90%CI: .000-.084), CFI = 0.969). The internal consistency was acceptable for both scales at 0.75 and 0.72, respectively. Both the versions demonstrated convergent and discriminant validity. CONCLUSIONS: The EHFScBS as unidimensional showed satisfactory measurement properties in Arabic-speaking HF patients. The 9-item one-factor has demonstrated better fit in the present sample compared to the 12-item version achieved after post-hoc modification, support its use in practice and research. However, future studies should conduct independent cross-validation in separate samples from Saudi Arabia and other Arabic-speaking countries to confirm the generalizability, and cross-cultural validity of the instrument.