Cited by 747Psychometric Methodologies and TestingMental Health Research TopicsHealth Systems, Economic Evaluations, Quality of Life

The role of the bifactor model in resolving dimensionality issues in health outcomes measures

Reise, Steven P., Morizot, Julien, Hays, Ron D.·2007·Quality of Life Research

Abstract

Objectives We propose the application of a bifactor model for exploring the dimensional structure of an item response matrix, and for handling multidimensionality. Background We argue that a bifactor analysis can complement traditional dimensionality investigations by: (a) providing an evaluation of the distortion that may occur when unidimensional models are fit to multidimensional data, (b) allowing researchers to examine the utility of forming subscales, and, (c) providing an alternative to non-hierarchical multidimensional models for scaling individual differences. Method To demonstrate our arguments, we use responses (N = 1,000 Medicaid recipients) to 16 items in the Consumer Assessment of Healthcare Providers and Systems (CAHPS2.0) survey. Analyses Exploratory and confirmatory factor analytic and item response theory models (unidimensional, multidimensional, and bifactor) were estimated. Results CAHPS items are consistent with both unidimensional and multidimensional solutions. However, the bifactor model revealed that the overwhelming majority of common variance was due to a general factor. After controlling for the general factor, subscales provided little measurement precision. Conclusion The bifactor model provides a valuable tool for exploring dimensionality related questions. In the Discussion, we describe contexts where a bifactor analysis is most productively used, and we contrast bifactor with multidimensional IRT models (MIRT). We also describe implications of bifactor models for IRT applications, and raise some limitations.

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Crossref · 10.1007/s11136-007-9183-7

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Authors
Reise, S. P., Morizot, J., & Hays, R. D.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Reise, Steven P.
Venue
Quality of Life Research
Published
2007-05-04
Volume
16
Issue
S1
Pages
19-31
ISSN
  • 0962-9343 (ISSN-L)
  • 1573-2649
OpenAlex
W2088832685
Cited by
747
References
1
Citations by year
2026: 22 · 2025: 20 · 2024: 25 · 2023: 39 · 2022: 37 · 2021: 58 · 2020: 36 · 2019: 58 · 2018: 53 · 2017: 45 · 2016: 55 · 2015: 49 · 2014: 54 · 2013: 56 · 2012: 46
FWCI
24.88
Type
journal article
Language
en
Open access
closed
Locations
  • Quality of Life Research (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5p20md000148-05)
  • Agency for Healthcare Research and Quality (5 U18 HS00924)
  • National Institute on Aging (AG-02-004)
  • National Institute on Minority Health and Health Disparities (P20-MD00148-01)
Topics
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
bifactor model, dimensionality, multidimensionality, item response theory, multidimensional item response theory, general factor, subscales, measurement precision, Medicaid beneficiaries, individual differences
MeSH terms
Factor Analysis, Statistical, Health Status, Humans, Models, Theoretical, Pilot Projects, Surveys and Questionnaires, Research, Models, Statistical, Outcome Assessment, Health Care

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