Sajobi, Tolulope TimothyLawal, Oluwaseyi Adetutu2023-04-132023-04-132023-04-06Lawal, O. A. (2023). Measurement validity of the Seattle angina questionnaire in coronary artery disease (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.https://prism.ucalgary.ca/handle/1880/116061https://dx.doi.org/10.11575/PRISM/dspace/40907Patient-reported outcome measures (PROMs), such as the Seattle angina questionnaire (SAQ), are widely used to directly elicit perceptions of health status and quality of life (QOL) in individuals with coronary artery disease (CAD). The SAQ has been used in clinical and epidemiological studies to evaluate the effectiveness of treatment interventions, compare population groups, and inform quality improvement for CAD management. However, there is limited investigation of its measurement validity between groups and over time. The overarching goal of this research is to evaluate the validity of the SAQ in individuals with CAD between groups and over time. Specifically, the objectives are to (1) examine the factorial validity of the SAQ in a Canadian population of patients with CAD, (2) assess if the SAQ construct is equivalent across subgroups and over time and (3) test and adjust for response shift (RS) effect in the SAQ subscales over time. Data for this research were obtained from the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease (APPROACH) registry, a comprehensive, longitudinal inception cohort of all adult Canadians who received cardiac catheterization in Alberta, Canada. Exploratory and Confirmatory factor analysis (CFA) was used to investigate the underlying factor structure of the SAQ. CFA revealed that the factorial structure of the original 19-item SAQ, with five subscales, was inconsistent in this cohort. Instead, a 16-item Canadian version of this SAQ (SAQ-CAN), which includes four subscales, was found to be a better fit for the data and was a more valid and reliable instrument to measure QOL in CAD patients. Multigroup-CFA of the SAQ-CAN provides evidence supporting the equivalence of the underlying latent construct across sex, age, angina type, and treatment groups cross-sectionally and longitudinally in a sample of patients with CAD. Finally, the longitudinal structural equation model revealed the presence of small RS effects in the treatment-related experience subscale of the SAQ-CAN, which attenuated longitudinal changes on the SAQ-CAN subscales when not accounted for. In conclusion, this study proposes the use of SAQ-CAN as a valid and reliable instrument for assessing differences and temporal measures of QOL in individuals with CAD.enUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.Measurement InvarianceResponse shiftLongitudinal Measurement InvarianceDifferential item functioningCoronary artery diseaseSeattle Angina QuestionnaireMeasurement ValidityPatient reported outcome measurespatient reported outcomesPsychometric EvaluationExploratory factor analysisconfirmatory factor analysisHistory--CanadianEducation--Tests and MeasurementsLiterature--ComparativeBiostatisticsStatisticsdoctoral thesis