# The Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC): testing for bias across patient characteristics and languages

## TL;DR

This study tested a questionnaire for managing chronic conditions to ensure it works equally well for different groups and in English and Swedish.

## Contribution

The study demonstrates the PRISM-CC's cross-language and cross-group comparability, supporting its use in diverse populations.

## Key findings

- Few items showed potential bias across sociodemographic groups or languages.
- The impact of biased items on overall scores was negligible.
- The PRISM-CC works comparably in English and Swedish versions.

## Abstract

Developed simultaneously in English and Swedish, the Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) assesses patients’ perceived difficulty managing life with long-term health conditions. This study assessed the comparability of the PRISM-CC across sociodemographic groups, number of health conditions and language (English and Swedish).

Differential item functioning (DIF) and differential test functioning (DTF) were analysed by age, gender, education level, and number of conditions using independent English and Swedish datasets. Language-based DIF and DTF were examined using pooled data. An iterative hybrid ordinal logistic regression approach was applied to identify potential DIF across the PRISM-CC’s seven domains. The impact of flagged items on total scores (DTF) was evaluated by comparing test characteristic curves.

Few items were flagged for potential DIF in the English, Swedish or pooled data, and only at low cutoff values. The impact of items with potential DIF on DTF was negligible.

The absence of meaningful DIF and DTF in either the English or Swedish version of the PRISM-CC or between English and Swedish versions provides further support for the PRISM-CC as a valuable tool for assessing self-management ease and difficulty. These results also demonstrate the value of simultaneous development of instruments in two languages. Further evaluation of DIF is necessary in populations with greater self-management challenges, such as among people with severe disease burden.

Health providers and researchers often use questionnaires and surveys to help make decisions, such as who needs treatment or what kind of treatment they need. Misleading or wrong decisions can be made if the tools are not well designed. This study was done to test whether a new tool called the Patient Reported Inventory of Self-Management of Chronic Conditions works equally well for men and women, older and younger people, and those with different levels of education and different numbers of conditions. It also tested whether the tool worked well in English and Swedish. The tool has 36 questions answered by patients, with results showing seven areas that people might find hard to manage. Over 1500 people from around the world provided data for this study. The results show that this tool yields comparable results across different types of patients in either English or Swedish.