Exploratory and Confirmatory Factor Analyses for Testing Validity and Reliability of the Malay Language Questionnaire for Urinary Incontinence Diagnosis (QUID)

Hardip Kaur Dhillon¹, Md. Zain Anuar Zaini¹, Kia Fatt Quek¹, Harbindar Jeet Singh², Gurpreet Kaur³, Bin Nordin Rusli⁴

¹Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.
²Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
³National Institutes of Health, Institute for Health Management, Kuala Lumpur, Malaysia.
⁴Jeffrey Cheah School of Medicine & Health Sciences, Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Malaysia.

DOI: 10.4236/ojpm.2014.411095                

Abstract

This study examines the construct validity and reliability of the Malay language questionnaire for urinary incontinence diagnosis (QUID) in women. Study Design: Random sampling design was used in this cross-sectional survey. Materials and Methods: The Americanized English language questionnaire was translated to the Malay language and distributed to community-dwelling Malaysian women living in various locations in Selangor. The construct validity was tested using exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). The reliability was determined using Cronbach’s α. Results: A total of 111 women completed the Malay language QUID in this pilot study. The Keiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.675 and Bartlett’s test of sphericity (χ² = 284.633, df = 15, p = 0.001) indicated that the EFA was possible. The total variance and the scree plot identified two factors above the initial eigenvalue of 1 while a third factor was just below it (0.758). The CFA output showed a recursive model with the solution being not admissible because two unobserved and exogenous variables had negative variance estimates. The following values of absolute fit indices showed an acceptable level of fit: 1) Chi-square test with χ² = 4.997, df = 5, p = 0.416, indicated a smaller difference between the expected and observed covariance matrices; 2) GFI = 0.986, AGFI = 0.939, RMR = 0.021 and CMIN/DF = 1.0 indicated acceptable level of fit; 3) The baseline comparison values of NFI = 0.983 and CFI = 1.0 also indicated a good fit to the data; 4) RMSEA = 0.000 was considered a perfect fit indicating that the hypothesized model was a good fit to the observed data. Under the hypothesis of “close fit”, the probability of getting a sample RMSEA as large as 0.000 was 0.567. The Cronbach’s α coefficient of 0.823 indicated good reliability. Conclusion: The Malay language QUID is a valid and reliable instrument for diagnosing female urinary incontinence in the Malaysian population.

Keywords

Confirmatory Factor Analysis, Exploratory Factor Analysis, Malay Language, Questionnaire for Urinary Incontinence Diagnosis, Reliability

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Lim, P.H.C. and Lapitan, M.C. (2006) Epidemiology: Asia. In: Cardozo, L. and Staskin, D., Eds., Textbook of Female Urology and Urogynecology, 2nd Edition, Informa Healthcare, Abingdon, 51-52.
[2]	Lapitan, M.C. and Chye, P.L. (2001) The Epidemiology of Overactive Bladder among Female in Asia: A Questionnaire Survey. International Urogynecology Journal and Pelvic Floor Dysfunction, 12, 226-231. http://dx.doi.org/10.1007/s001920170043
[3]	Diokno, A. (2005) Epidemiology of Urinary Incontinence in Women—Clinical Implications. Business Briefing: US Kidney & Urological Disease, 1-4.
[4]	Hempel, C., Wienhold, D., Benken, N., et al. (1997) Prevalence and Natural History of Female Incontinence. European Urology, 3, 2-12.
[5]	Low, B.Y., Liong, M.L., Kah, H.Y., Chong, W.L., Chee, C., Wing, S.L., et al. (2006) Study of Prevalence, Treatment-Seeking Behavior, and Risk Factors of Women with Lower Urinary Tract Symptoms in Northern Malaysia. Urology, 68, 751-758. http://dx.doi.org/10.1016/j.urology.2006.05.021
[6]	Zalina, N., Aruku, N., Azura, N., Shahida, N., Akmarina, N. and Dian, F. (2011) Prevalence of Lower Urinary Tract Symptoms (LUTS) among Young Age Medical Population. The International Medical Journal Malaysia, 10, 7-15.
[7]	Mohd Sidik, S. (2010) The Prevalence of Urinary Incontinence among the Elderly in a Rural Community in Selangor. Malaysian Journal of Medical Sciences, 17, 18-23.
[8]	Poi, P. (1995) Giants of Geriatrics II—Incontinence. In: Srinivas, P., Ed., Proceedings of 1st National Symposium on Gerontology, University Malaya, Kuala Lumpur, 98-110.
[9]	Chia, Y.C. (1995) Primary Care in the Elderly. In: Srinivas, P., Ed., Proceedings of 1st National Symposium on Gerontology, University Malaya, Kuala Lumpur, 98-110.
[10]	Dhillon, H.K., Singh, H.J., Shuib, R., Hamid, A.M. and Mohd Zaki Nik Mahmood, N. (2006) Prevalence of Menopausal Symptoms among Women in Kelantan, Malaysia. Maturitas, 54, 213-221. http://dx.doi.org/10.1016/j.maturitas.2005.11.001
[11]	Botlero, R., Urquhart, D., Davis, S. and Bell, R. (2008) Prevalence and Incidence of Urinary Incontinence in Women: Review of the Literature and Investigation of Methodological Issues. International Journal of Urology, 15, 230-234. http://dx.doi.org/10.1111/j.1442-2042.2007.01976.x
[12]	Bradley, C.S., Rovner, E.S., Morgan, M.A., Berlin, M., Novi, J., Shea, J. and Arya, L.A. (2005) A New Questionnaire for Urinary Incontinence Diagnosis in Women. Development and Testing. American Journal of Obstetrics & Gynecology, 192, 66-73. http://dx.doi.org/10.1016/j.ajog.2004.07.037
[13]	Botlero, R., Davis, S.R., Urquhart, D.M., Shortreed, S. and Bell, R.J. (2009) Age-Specific Prevalence of, and Factors Associated with, Different Types of Urinary Incontinence in Community-Dwelling Australian Women Assessed with a Validated Questionnaire. Maturitas, 62, 134-139. http://dx.doi.org/10.1016/j.maturitas.2008.12.017
[14]	Israel, G. (2012) Determining Sample Size. EDIS Website. https://edis.ifas.ufl.edu
[15]	Acquadro, C., Conway, K., Giroudet, C. and Mear, I. (2002) Linguistic Validation Manual for Patient Reported Outcomes (PRO) Instruments. Mapi Research Institute, 2004 MAPI Research Institute, Lyon.
[16]	Hinton, P.R., Brownlow, C., McMurray, I. and Cozens, B. (2011) SPSS Explained. Introduction to Factor Analysis. Routledge Taylor & Francis Group, London, 339-354.
[17]	Ng, J., Skorupski, W., Frey, B. and Wolf-Wendel, L. (2013) ACES: The Development of a Reliable and Valid Instrument to Assess Faculty Support of Diversity Goals in United States. Research & Practice in Assessment (RPA), 8, 29-41.
[18]	Hinton, P.R., Brownlow, C., McMurray, I. and Cozens, B. (2011) SPSS Explained. Using SPSS to Analyse Questionnaires: Reliability. Routledge Taylor & Francis Group, London, 355-365.
[19]	DeVellis, R. (2003) Scale Development: Theory and Applications. Sage, Thousand Oaks.
[20]	Bland, J. and Altman, D. (1997) Statistics Notes: Cronbach’s Alpha. BMJ, 314, 572. http://dx.doi.org/10.1136/bmj.314.7080.572
[21]	https://statistics.laerd.com/spss-tutorials/principal-components-analysis-pca-using-spss- statistics.php#procedure
[22]	Ugulu, I. (2013) Confirmatory Factor Analysis for Testing Validity and Reliability of Traditional Knowledge Scale to Measure University Students’ Attitudes. Educational Research and Reviews, 8, 1399-1408.