Health vulnerability questionnaire in heart failure, social version: internal structure

Cestari, Virna Ribeiro Feitosa; Florêncio, Raquel Sampaio; Borges, José Wicto Pereira; Garces, Thiago Santos; Pessoa, Vera Lúcia Mendes de Paula; Moreira, Thereza Maria Magalhães

doi:10.37689/acta-ape/2025AO00982

Brazil

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Original Article • Acta Paul Enferm 38 • 2025 • https://doi.org/10.37689/acta-ape/2025AO00982i linkcopy

Health vulnerability questionnaire in heart failure, social version: internal structure

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: To assess evidence of internal structure validity and reliability of the social version of the Health Vulnerability Questionnaire in Heart Failure.

Methods: This is a methodological study, based on psychometrics, carried out with 1,008 people with heart failure, treated at a health institution. Internal structure was assessed through exploratory and confirmatory factor analysis, dimensionality, through parallel analysis, and factor reliability, through Cronbach’s alpha, itemtotal correlation, composite reliability and McDonald’s omega.

Results: A three-factor model was obtained: Health System (Factor 1: three items), Hospital Discharge (Factor 2: five items) and Social Support (Factor 3: four items), reliable (Factor 1: Cronbach’s alpha of 0.91 and composite reliability of 0.94; Factor 2: Cronbach’s alpha of 0.66 and composite reliability of 0.90; Factor 3: Cronbach’s alpha of 0.57 and composite reliability of 0.79; McDonald’s omega of 0.79), with accuracy indices (Factor 1=0.910; Factor 2=0.830 and Factor 3=0.955), construct representativeness (Factor 1=0.954; Factor 2=0.911 and Factor 3=0.977), replicability (Factor 1=0.830; Factor 2=0.955 and Factor 3=0.910) and acceptable quality/adjustment (Non-Normed Fit Index of 0.986; Comparative Fit Index of 0.993; Goodness of Fit Index of 0.990; Adjusted Goodness of Fit Index of 0.981; Root Mean Square Error of Approximation of 0.042 and Root Mean Square of Residuals of 0.045).

Conclusion: Factor analysis indicated a questionnaire with three dimensions, with evidence of structural validity and reliability, with theoretical refinement, suitable for measuring the social aspects of health vulnerability of people with heart failure.

Items			Factor loadings		h²
Items		F1	F2	F3	h²
10	Do you receive emotional support from family/friends?	0.147	-0.142	0.881^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	0.791
12	Can you turn to your family/friends in times of illness crisis?	0.055	-0.057	0.941^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	0.882
13	Do your family/friends accept your decisions related to the disease?	0.021	-0.011	0.944^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	0.890
14	Do your family/friends understand your illness?	-0.015	0.063	0.822^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	0.685
26	Does the institution where you are treated facilitate scheduling appointments?	0.841^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	-0.039	-0.105	0.714
27	Does the healthcare institution where you receive care refer you to other institutions, if necessary?	0.876^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	0.078	0.089	0.801
28	Is it possible to attend unscheduled consultations at the healthcare institution where you are treated?	0.882^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	-0.036	-0.021	0.769
30	Do you believe that the healthcare system does what it can to make your health better?	-0.216	0.657^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	0.043	0.431
31	Do you participate in your hospital discharge planning?	-0.035	0.526^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	0.182	0.312
32	Is hospital discharge carried out by all multidisciplinary team members?	-0.133	0.702^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	0.033	0.480
33	Was a return date set at the institution at the time of your hospital discharge?	0.183	0.759^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	-0.145	0.674
34	When you were discharged from the hospital, did the healthcare professionals provide guidance on what care you	0.184	0.649^* * Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities	-0.070	0.501

Items	Item-total correlation	Cronbach’s alpha if item excluded	Cronbach’s alpha	Composite reliability
10	0,792	0,980	0,91	0,94
12	0,842	0,871
13	0,836	0,872
14	0,735	0,907
26	0,484	0,548
27	0,402	0,652	0,66	0,90
28	0,533	0,476
30	0,361	0,500
31	0,396	0,470
32	0,374	0,483	0,57	0,79
33	0,303	0,548
34	0,313	0,535
Cronbach’s alpha of the instrument			0,60
Composite instrument reliability				0,95
McDonald’s Omega			0,79

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Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
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[TFN2] ^*
Items with factor loading > 0.3; F1: Health System; F2: Hospital Discharge; F3: Social Support; F: Factor; h2: commonalities