title: The Minnesota living with heart failure questionnaire: comparison of different factor structures.
abstract: BACKGROUND
  The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is one of the most widely used health-related quality of life questionnaires for patients with heart failure (HF). It provides scores for two dimensions, physical and emotional, and a total score. However, there are some concerns about its factor structure and alternatives have been proposed, some including a third factor representing a social dimension. The objectives of the present study were to analyze the internal structure of the MLHFQ and the unidimensionality of the total score, and to compare the different factor structures proposed.
  
  
  METHODS
  The MLHFQ was given to 2565 patients with HF. The structural validity of the questionnaire was assessed by confirmatory factor analysis (CFA), and Rasch analysis. These two approaches were also applied to the alternative structures proposed.
  
  
  RESULTS
  The CFA results for the hypothesized model of two latent factors and the Rasch analysis confirmed the adequacy of the physical and emotional scales. Rasch analysis for the total score showed only two problematic items. The results of the CFA for other two-factor structures proposed were not better than the results for the original structure. The Rasch analyses applied to the different social factors yielded the best results for Munyombwe's social dimension, composed of six items.
  
  
  CONCLUSIONS
  Our results support the validity of using the MLHFQ physical, emotional and total scores in patients with HF, for clinical practice and research. In addition, they confirmed the existence of a third factor, and we recommend the use of Munyombwe's social factor.
authors.affiliation: Research Unit, Basurto University Hospital (Osakidetza), Bilbao, Bizkaia, Spain. amaia.bilbaogonzalez@osakidetza.eus.|Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain. amaia.bilbaogonzalez@osakidetza.eus.
authors.forename: Amaia
authors.initials: A
authors.lastname: Bilbao
authors.affiliation: Research Unit, Basurto University Hospital (Osakidetza), Bilbao, Bizkaia, Spain. antonio.escobarmartinez@osakidetza.eus.|Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain. antonio.escobarmartinez@osakidetza.eus.
authors.forename: Antonio
authors.initials: A
authors.lastname: Escobar
authors.affiliation: Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain. lidia.garciaperez@sescs.es.|Evaluation Service, Dirección del Servicio Canario de la Salud, Tenerife, Canary Islands, Spain. lidia.garciaperez@sescs.es.
authors.forename: Lidia
authors.initials: L
authors.lastname: García-Perez
authors.affiliation: Epidemiologic Unit, Corporació Parc Tauli Clinic, Sabadell, Barcelona, Spain. GNavarro@tauli.cat.
authors.forename: Gemma
authors.initials: G
authors.lastname: Navarro
authors.affiliation: Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain. quiroslopez77@gmail.com.|Department of Internal Medicine, Costa del Sol Hospital, Marbella, Málaga, Spain. quiroslopez77@gmail.com.
authors.forename: Raul
authors.initials: R
authors.lastname: Quirós
mesh_terms: D000368:Aged; D004644:Emotions; D005163:Factor Analysis, Statistical; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010808:Physical Examination; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards*