title: Making robust decisions about the impact of health education programs: Psychometric evaluation of the Health Education Impact Questionnaire (heiQ) in diverse patient groups in Norway.
abstract: To undertake a rigorous psychometric evaluation of the widely used eight-scale heiQ version 2.0 (evaluating immediate effects of self-management interventions) in diverse patient groups in Norway.
  
  
  
  Cross-sectional survey data were collected from 1019 Norwegians. Data were extracted from studies among people with musculoskeletal disorders (n=516), psoriasis (n=254), heart disease (n=97), and Type 2 diabetes (n=152). To investigate the factorial validity of the Norwegian heiQ, confirmatory factor analyses (CFA) were carried out using Mplus.
  
  
  
  One-factor model fit, without modifications, was acceptable for the Emotional distress scale. Only one correlated residual was required to be fitted in each of the other scales to achieve satisfactory model fit. The postulated highly restricted full eight-factor model (no cross-loadings, no correlated residuals) showed good fit to the data. Internal consistency was acceptable for most scales (0.72-0.90) but low for Self-monitoring and insight.
  
  
  
  This study of the Norwegian heiQ replicates the factor structure of the original Australian heiQ, using robust and highly restricted CFA procedures, demonstrating a clean independent clusters model structure.
  
  
  
  Researchers, program implementers and policymakers could use the Norwegian heiQ with confidence to generate reliable information on program outcomes and support quality improvement activities.
authors.affiliation: Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway. Electronic address: a.k.wahl@medisin.uio.no.
authors.forename: Astrid K
authors.initials: AK
authors.lastname: Wahl
authors.affiliation: Deakin Univerity, Health Systems Improvement Unit, School of Health and Social Development, Geelong, VIC, Australia. Electronic address: richard.osborne@deakin.edu.au.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.affiliation: Faculty of Health and Social Sciences, Bergen University College, Norway. Electronic address: eva.langeland@hib.no.
authors.forename: Eva
authors.initials: E
authors.lastname: Langeland
authors.affiliation: Centre for Child and Adolescent Mental Health, Eastern and Southern Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway. Electronic address: tore.wentzel-larsen@r-bup.no.
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.affiliation: Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway. Electronic address: a.m.mengshoel@medisin.uio.no.
authors.forename: Anne Marit
authors.initials: AM
authors.lastname: Mengshoel
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Nursing, Oslo, Norway. Electronic address: lis.ribu@hioa.no.
authors.forename: Lis
authors.initials: L
authors.lastname: Ribu
authors.affiliation: Vestfold Hospital Trust, Norway. Electronic address: kari.peersen@siv.no.
authors.forename: Kari
authors.initials: K
authors.lastname: Peersen
authors.affiliation: Deakin Univerity, Health Systems Improvement Unit, School of Health and Social Development, Geelong, VIC, Australia. Electronic address: gerald.elsworth@deakin.edu.au.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Elsworth
authors.affiliation: Deakin Univerity, Health Systems Improvement Unit, School of Health and Social Development, Geelong, VIC, Australia; Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: sandra.nolte@charite.de.
authors.forename: Sandra
authors.initials: S
authors.lastname: Nolte
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000523:psychology; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D007802:Language; D008297:Male; D009664:Norway; D010353:Patient Education as Topic; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: Chronic disease; Confirmatory factor analysis (CFA); Health Education Impact Questionnaire (heiQ); Norway; Self-management