# Validation and adaptation of the Arabic version of health-related quality of life with six domains (HRQ-6D): A factor and Rasch analyses study

## TL;DR

This study validates the Arabic version of a health-related quality of life tool, showing it is reliable and suitable for use in Jordan.

## Contribution

The study provides a validated Arabic version of the HRQ-6D tool using factor and Rasch analyses.

## Key findings

- The three-factor model of the Ar-HRQ-6D showed acceptable fit indices and high reliability.
- Rasch analysis confirmed the tool's item and person separation reliability.
- The Ar-HRQ-6D effectively distinguished between different health status categories.

## Abstract

Health-related quality of life (HRQOL) provides a complete picture of patients’ overall health status and should be evaluated in all patients encountered. To accurately assess patients’ HRQOL a comprehensive validated tool is necessary. Therefore, the present study aimed to validate the Arabic version of the Health-Related Quality of Life with Six Domains (Ar-HRQ-6D) scale.

This cross-sectional study utilized an online questionnaire targeting adult Jordanians and implemented several validation steps to ensure the adequacy of the Ar-HRQ-6D. These steps included the application of the forward-backward translation technique, assessment of the content and face validity of the questionnaire, evaluation of internal consistency, validation of the construct through confirmatory factor analysis (CFA) and Rasch analysis, and assessment of the questionnaire’s predictive capabilities.

A total of 808 participants (63% female) completed the Ar-HRQ-6D. Confirmatory Factor Analysis (CFA) supported the suitability of the original three-factor model for the present study data, yielding acceptable model fit indices (χ²/df = 4.1, SRMR = 0.03, RMSEA = 0.06, CFI = 0.99, GFI = 0.96, CIF = 0.98, and TLI = 0.97) and factor loadings ranging from 0.63 to 0.86. Cronbach’s alpha for the three factors ranged from 0.81 to 0.90, confirming the high reliability of the questionnaire. Rasch analysis further validated the person and item separation reliability for the three factors. Additionally, all items of the Ar-HRQ-6D fell within the acceptable infit and outfit ranges. All thresholds were appropriately ordered, ranging from -5.27 to 2.86. Significant differences were observed in the median Ar-HRQ-6D scores across the various health status categories (p < 0.001), with the healthy category showing significantly higher median scores than the other categories. These findings confirm the predictive validity of the Ar-HRQ-6D.

The study confirmed the reliability, validity, and predictive accuracy of the Arabic version of the Ar-HRQ-6D. This tool is suitable for assessing patients’ HRQOL across various medical settings.