# Dimensionality of the Swahili version of the General Health Questionnaire (GHQ-12) in a Kenyan population: A confirmatory factor analysis

## TL;DR

This study confirms the Swahili version of a health questionnaire works well in Kenya, even among women with low literacy.

## Contribution

The study validates a bifactor model for the GHQ-12 in a low-literacy Kenyan population exposed to gender-based violence.

## Key findings

- A bifactor model with a general distress factor and two wording-related factors best fits the GHQ-12 data.
- The GHQ-12 shows consistent results in low-literacy Kenyan women, similar to other low- and middle-income countries.
- Positive and negative item wording significantly influences the questionnaire's dimensionality.

## Abstract

The current study evaluated the Kiswahili version of General Health Questionnaire (GHQ-12) in a Kenyan context comprising of women exposed to gender-based violence. Participants were randomly drawn from community sampling using household screening methods in peri-urban areas in Nairobi. A total of 1,394 participants with varying levels of literacy (years of education: mean [M] = 9.42; standard deviation [SD] = 3.73) and aged between 18 and 89 years were recruited for the study. The observed factor structure of the GHQ-12 was evaluated using six most tested models querying the dimensionality of the instrument insofar as the impacts of positive and negative wording effects in driving multidimensionality. Results from the confirmatory factor analysis supported a bifactor model, consisting of a general distress factor and two separate factors representing common variance due to the positive and negative wording of items. Overall, the findings support the use of the Kiswahili version of the GHQ-12 as a unidimensional construct with method-specific variance owing to wording effects. Importantly, GHQ-12 responses from a sample of Kenyan women with relatively low levels of literacy are congruent with the factor structure observed in other cross-cultural settings in low- and-middle-income countries.