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A re-examination of the factor structure of traditional Chinese FERTIQOL with subfertile women undergoing ART
Author(s)
Date Issued
2017
Citation
Lau, H. P., Chan, C., Tam, M., & Wong, Q. (2017 Jul 2-5). A re-examination of the factor structure of traditional Chinese FERTIQOL with subfertile women undergoing ART. 33rd Annual Meeting of European Society of Human Reproduction and Embryology, Geneva, Switzerland.
Type
Conference Paper
Abstract
Study question: What is the factor structure of the Traditional Chinese FertiQOL for Chinese women undergoing ART?
Summary answer: Five factors were revealed for the 24 core items of the Traditional Chinese FertiQOL, whereas a 2-factor structure was recovered for the 10 treatment items.
What is known already: FertiQOL has been widely used to measure quality of life in cases of subfertility. Validation studies have been conducted with Dutch, Korean and Taiwanese samples. However, the factor structure of the core and optional treatment items have yet to be scrutinized. A re-examination of the factor structure of FertiQOL will help reveal how Chinese subfertile women understand and construe the impacts of subfertility on their quality of life.
Study design, size, duration: This was a cross-sectional study. 477 Chinese female subfertile patients were approached and 246 completed the questionnaire (response rate: 51.6%). Their average age was 37.2 (SD = 3.4), married for 7.3 years (SD = 3.8) and diagnosed with subfertility for 4.0 years (SD = 2.5). Majority of them had prior experience with ART (66.3%), with a mean ART treatment history of 3.2 years. The study spanned two years.
Participants/materials, setting, methods: Participants were recruited from fertility clinic of a university-affiliated hospital in Hong Kong. Those who have given consent to participate were asked to complete a set of questionnaire including their demographics, reproductive history, ART treatment history and fertility related quality of life (FertiQoL).
Main results and the role of chance: A confirmatory factor analysis (CFA) was conducted to re-examine the fit of the 4-factor structure of the core items (Boivin et al., 2011) on the local dataset. The model fit was insufficient [chisq = 590.927, df = 246, p = .000. CFI = .882, RMSEA = .075]. The core items were then submitted to a principle component analysis with promax rotation.
A 5-factor solution was recovered with 61.4% total variance explained [F1: “Emotion-physical impact” (items 1, 2, 3, 7, 8, 9, 16, 18, 23, 24); F2: “Social alienation” (items 10, 12, 13, 15, 17, 22); F3: “Couple coping efficacy” (items 19, 20); F4: “Satisfaction with relationships” (items 5, 6, 11, 21); F5: “General coping efficacy” (items 4, 14). Another CFA was run for the 2-factor structure (tolerability and environment) of the 10 treatment items, and an adequate model fit was found [chi-sq = 85.169, df = 34, p = .000, CFI = .939, RMSEA =.078]. Significant correlations with anxiety and depression scores supported the convergent validity of the core and treatment subscales (ps <.05). Results of sensitivity analyses suggest that older age and previous pregnancy was related to higher scores on tolerability, environment, emotion-physical impact and social alienation.
Limitations, reasons for caution: The 2 subscales with the lowest eigenvalues (satisfaction with relationships, general coping efficacy) in the core FertiQOL had low Cronbach alphas. The resultant factor solution requires verification with future studies. Self-selection bias and self-report nature of the survey is a concern.
Wider implications of the findings: Our alternative factor structure revealed how Chinese sub-fertile women construe their fertility related quality of life. While the emotional and physical impacts were merged into a single factor, the presence of four social-relational factors demonstrate a nuanced categorization of the social-relational impacts of subfertility.
Trial registration number: not applicable.
Summary answer: Five factors were revealed for the 24 core items of the Traditional Chinese FertiQOL, whereas a 2-factor structure was recovered for the 10 treatment items.
What is known already: FertiQOL has been widely used to measure quality of life in cases of subfertility. Validation studies have been conducted with Dutch, Korean and Taiwanese samples. However, the factor structure of the core and optional treatment items have yet to be scrutinized. A re-examination of the factor structure of FertiQOL will help reveal how Chinese subfertile women understand and construe the impacts of subfertility on their quality of life.
Study design, size, duration: This was a cross-sectional study. 477 Chinese female subfertile patients were approached and 246 completed the questionnaire (response rate: 51.6%). Their average age was 37.2 (SD = 3.4), married for 7.3 years (SD = 3.8) and diagnosed with subfertility for 4.0 years (SD = 2.5). Majority of them had prior experience with ART (66.3%), with a mean ART treatment history of 3.2 years. The study spanned two years.
Participants/materials, setting, methods: Participants were recruited from fertility clinic of a university-affiliated hospital in Hong Kong. Those who have given consent to participate were asked to complete a set of questionnaire including their demographics, reproductive history, ART treatment history and fertility related quality of life (FertiQoL).
Main results and the role of chance: A confirmatory factor analysis (CFA) was conducted to re-examine the fit of the 4-factor structure of the core items (Boivin et al., 2011) on the local dataset. The model fit was insufficient [chisq = 590.927, df = 246, p = .000. CFI = .882, RMSEA = .075]. The core items were then submitted to a principle component analysis with promax rotation.
A 5-factor solution was recovered with 61.4% total variance explained [F1: “Emotion-physical impact” (items 1, 2, 3, 7, 8, 9, 16, 18, 23, 24); F2: “Social alienation” (items 10, 12, 13, 15, 17, 22); F3: “Couple coping efficacy” (items 19, 20); F4: “Satisfaction with relationships” (items 5, 6, 11, 21); F5: “General coping efficacy” (items 4, 14). Another CFA was run for the 2-factor structure (tolerability and environment) of the 10 treatment items, and an adequate model fit was found [chi-sq = 85.169, df = 34, p = .000, CFI = .939, RMSEA =.078]. Significant correlations with anxiety and depression scores supported the convergent validity of the core and treatment subscales (ps <.05). Results of sensitivity analyses suggest that older age and previous pregnancy was related to higher scores on tolerability, environment, emotion-physical impact and social alienation.
Limitations, reasons for caution: The 2 subscales with the lowest eigenvalues (satisfaction with relationships, general coping efficacy) in the core FertiQOL had low Cronbach alphas. The resultant factor solution requires verification with future studies. Self-selection bias and self-report nature of the survey is a concern.
Wider implications of the findings: Our alternative factor structure revealed how Chinese sub-fertile women construe their fertility related quality of life. While the emotional and physical impacts were merged into a single factor, the presence of four social-relational factors demonstrate a nuanced categorization of the social-relational impacts of subfertility.
Trial registration number: not applicable.
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