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Evaluating the psychometric properties of the Spanish Version of the SF-12v2 in Hispanics with type 2 diabetes and their family members

Jie Hu, Thomas P McCoy, Fei Zhan, Debra C Wallace, Sheryl L Coley, Karen A Amirehsani


Background: The SF-12 has been used to measure health-related quality of life in populations with various health conditions. However, few studies have examined the conceptual equivalence and psychometric properties of the SF-12 in Hispanics. The purpose of this study was to evaluate the reliability and validity of the Spanish version of the SF-12v2® in Hispanics with type 2 diabetes and their family members.

Methods: Data were collected as part of an intervention study for Hispanics with type 2 diabetes and their family members. Participants (N=182) were recruited from clinics and communities in the Southeastern U.S. The data were collected through face-to-face interviews. Reliability and validity were assessed using composite reliability, principal components analysis and known-groups comparisons.

Results: The reliability of the physical and mental component summaries was adequate. Known-groups comparisons revealed lower average health-related quality of life for every subscale of the Spanish version of SF-12v2® as well as for the 2 component summaries. Factorial validity was supported for the 8 subscale structure but less so for the 2 component summaries.

Conclusion: The Spanish version of the SF-12v2® showed good reliability and validity. Healthcare providers can use the SF-12v2® to measure health-related quality of life in Hispanics with type 2 diabetes and their family members.


Chronic disease management, co-morbidity, culturally unique groups, health-related quality of life, Hispanics, patient-reported outcomes, perception of ill health, person-centered healthcare, reliability and validity, Spanish version of the SF-12v2, type

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National Diabetes Statistics Report | Data & Statistics | Diabetes | CDC [Internet]. (2017). Available from: [cited 2017 July 20].

CDC. Hispanic Diabetes Prevention [Internet]. Centers for Disease Control and Prevention. (2017). Available from: [cited 2017 October 23].

Dominguez, K., Penman-Aguilar, A., Chang, M-H., Moonesinghe, R., Castellanos, T., Rodriguez-Lainz, A., Schieber, R. & Centers for Disease Control and Prevention (CDC). (2015). Vital signs: Leading causes of death, prevalence of diseases and risk factors, and use of health services among Hispanics in the United States - 2009-2013. MMWR Morbidity and Mortality Weekly Report 64 (17) 469-478.

Mazhar, K., Varma, R., Choudhury, F., McKean-Cowdin, R., Shtir, C.J., Azen, S.P. & Los Angeles Latino Eye Study Group. (2011). Severity of diabetic retinopathy and health-related quality of life: the Los Angeles Latino Eye Study. Ophthalmology 118 (4) 649-655.

Health-Related Quality of Life (HRQOL) | CDC [Internet]. [cited 2017 April 6]. Available from:

Kleefstra, N., Landman, G.W.D., Houweling, S.T., Ubink-Veltmaat, L.J., Logtenberg, S.J.J., Meyboom-de Jong, B., Coyne, J.C., Groenier, K.H. & Bilo, H.J. (2008). Prediction of mortality in type 2 diabetes from health-related quality of life (ZODIAC-4). Diabetes Care 31 (5) 932-933.

Xie, G., Laskowitz, D.T., Turner, E.L., Egger, J.R., Shi, P., Ren, F., Gao, W. & Wu, Y. (2014). Baseline health-related quality of life and 10-year all-cause mortality among 1739 Chinese adults. PLoS ONE 9 (7) e101527.

Deshpande,. P.R., Rajan, S., Sudeepthi, B.L. & Abdul Nazir, C.P. (2011). Patient-reported outcomes: A new era in clinical research. Perspectives in Clinical Research 2 (4) 137-144.

Ware, J., Kosinski, M. & Keller, S.D. (1996). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care 34 (3) 220-233.

Vilagut, G., Forero, C.G., Pinto-Meza, A., Haro, J.M., de Graaf, R., Bruffaerts, R., Kovess, V., de Girolamo, G., Matschinger, H., Ferrer, M., Alonso, J. & ESEMeD Investigators. (2013). The mental component of the short-form 12 health survey (SF-12) as a measure of depressive disorders in the general population: results with three alternative scoring methods. Value in Health 16 (4) 564-573.

Membrilla-Mesa, M.D., Cuesta-Vargas, A.I., Pozuelo-Calvo, R., Tejero-Fernández, V., Martín-Martín, L. & Arroyo-Morales, M. (2015). Shoulder pain and disability index: cross cultural validation and evaluation of psychometric properties of the Spanish version. Health and Quality of Life Outcomes 13, 200.

Hunger, M., Holle, R., Meisinger, C., Rathmann, W., Peters, A. & Schunk, M. (2014). Longitudinal changes in health-related quality of life in normal glucose tolerance, prediabetes and type 2 diabetes: results from the KORA S4/F4 cohort study. Quality of Life Research 23 (9) 2515-2520.

Thiel, D.M., Al Sayah, F., Vallance, J.K., Johnson, S.T. & Johnson, J.A. (2017). Association between Physical Activity and Health-Related Quality of Life in Adults with Type 2 Diabetes. Canadian Journal of Diabetes 41 (1) 58-63.

Mora, D.C., Grzywacz, J.G., Anderson, A.M., Chen, H., Arcury, T.A., Marín, A.J. & Quandt, S.A. (2014). Social isolation among Latino workers in rural North Carolina: exposure and health implications. Journal of Immigrant and Minority Health 16 (5) 822-830.

Green, A.J., Bazata, D.D., Fox, K.M. & Grandy, S. (2012). Quality of Life, Depression, and Healthcare Resource Utilization among Adults with Type 2 Diabetes Mellitus and Concomitant Hypertension and Obesity: A Prospective Survey. Cardiology Research and Practice 2012:404107.

Green, A.J., Fox, K.M. & Grandy, S. (2012). Self-reported hypoglycemia and impact on quality of life and depression among adults with type 2 diabetes mellitus. Diabetes Research and Clinical Practice 96 (3) 313-318.

Lopez-Garcia, E., Guallar-Castillón, P., Garcia-Esquinas, E. & Rodríguez-Artalejo, F. (2016). Metabolically healthy obesity and health-related quality of life: A prospective cohort study. Clinical Nutrition. Available from:[cited 2017 Apr 14].

Brewer, J.V.V., Miyasato, G.S., Gates, M.A., Curto, T.M., Hall, S.A. & McKinlay, J.B. (2013). Contributors to self-reported health in a racially and ethnically diverse population: focus on Hispanics. Annals of Epidemiology 23 (1) 19-24.

Stacciarini, J-M.R., Smith, R., Garvan, C.W., Wiens, B. & Cottler, L.B. (2015). Rural Latinos’ mental wellbeing: a mixed-methods pilot study of family, environment and social isolation factors. Community Mental Health Journal 51 (4) 404-413.

Lemon, S.C., Rosal, M.C. & Welch, G. (2011). Measuring quality of life in low-income, Spanish-speaking Puerto Ricans with type 2 diabetes residing in the mainland U.S. Quality of Life Research 20 (9) 1507-1511.

Ylitalo, K.R., McEwen, L.N., Karter, A., Lee, P. & Herman, W.H. (2013). Physical Functioning and Mortality among Individuals with Type 2 Diabetes: Insights from TRIAD. Journal of Diabetes Complications 27 (6) 565-569.

Ebert, D.D., Nobis, S., Lehr, D., Baumeister, H., Riper, H., Auerbach, R.P., Snoek, F., Cuijpers, P. & Berking, M. (2017). The 6-month effectiveness of Internet-based guided self-help for depression in adults with Type 1 and 2 diabetes mellitus. Diabetic Medicine 34 (1) 99-107.

Markle-Reid, M., Ploeg, J., Fisher, K., Reimer, H., Kaasalainen, S., Gafni, A., Grunier, A., Kirkconnell, R., Marzouk, S., Akhtar-Danesh, N., Thabane, L., Rojas-Fernandez, C. & Upshyr, R. (2016). The Aging, Community and Health Research Unit - Community Partnership Program for older adults with type 2 diabetes and multiple chronic conditions: a feasibility study. Pilot and Feasibility Studies 2 (1). Available from: [cited 2017 April 14].

Ell, K., Katon, W., Xie, B., Lee, P-J., Kapetanovic, S., Guterman, J. & Chou, C.P. (2010). Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial. Diabetes Care 33 (4) 706-713.

Sugiyama, T., Steers, W.N., Wenger, N.S., Duru, O.K. & Mangione, C.M. (2015). Effect of a community-based diabetes self-management empowerment program on mental health-related quality of life: a causal mediation analysis from a randomized controlled trial. BMC Health Services Research 15 115.

Ware, J.E. & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30 (6) 473-483.

McHorney, C.A., Ware, J.E. & Raczek, A.E. (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care 31 (3) 247-263.

Hu, J., Amirehsani, K.A., Wallace, D.C., McCoy, T.P. & Silva, Z. (2016). A Family-Based, Culturally Tailored Diabetes Intervention for Hispanics and Their Family Members. The Diabetes Educator 42 (3) 299-314.

Ware, J.E., Jr., Kosinski, M., Gandek, B., Bjorner, J.B., Turner-Bowker, D. M. & Maruish, M.E. (2004). How to score version 2 of the SF-12 health survey (with a supplement documenting version 1). (2nd edn). Lincoln, RI: QualityMetric, Inc.

Wukich, D.K., Sambenedetto, T.L., Mota, N.M., Suder, N.C. & Rosario, B.L. (2016). Correlation of SF-36 and SF-12 Component Scores in Patients With Diabetic Foot Disease. Journal of Foot and Ankle Surgery 55 (4) 693-696.

Ware, J.E., Kosinski, M., Gandek, B., Bjorner, J.B., Tuner-Bowker, D.M. & Maruish, M.E. (2010). User’s Manual for the SF-12v2 Health Survey (2nd edn.). Lincoln, RI: QualityMetric Inc.

Nunnally, J.C. & Bernstein, I.H. (1994). Psychometric Theory (3rd edn.). New York, NY: McGraw-Hill.

Hatcher, L. (1994). A Step-by-Step Approach to Using SAS for Factor Analysis and Structural Equation Modeling. Cary, NC: SAS, Inc.

Kenward, M.G. & Roger, J.H. (1997). Small Sample Inference for Fixed Effects from Restricted Maximum Likelihood. Biometrics 53 (3) 983.

SPSS. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

SAS. SAS (Version 9.3). (2014). Cary, NC: SAS Institute. Available from:

Cheak-Zamora, N.C., Wyrwich, K.W. & McBride, T.D. (2009). Reliability and validity of the SF-12v2 in the medical expenditure panel survey. Quality of Life Research 18 (6) 727-735.

Desouky, T.F., Mora, P.A. & Howell, E.A. (2013). Measurement invariance of the SF-12 across European-American, Latina, and African-American postpartum women. Quality of Life Research 22 (5) 1135-1144.

Fleishman, J.A. & Lawrence, W.F. (2003). Demographic variation in SF-12 scores: true differences or differential item functioning? Medical Care 41 (Supplement 7) III75-III86.

Hagell, P., Westergren, A. & Årestedt, K. (2017). Beware of the origin of numbers: Standard scoring of the SF-12 and SF-36 summary measures distorts measurement and score interpretations. Research in Nursing & Health 40 (4) 378-386.

Kamradt, M., Krisam, J., Kiel, M., Qreini, M., Besier, W., Szecsenyi, J. & Ose, D. (2017). Health-related quality of life in primary care: Which aspects matter in multimorbid patients with type 2 diabetes mellitus in a community setting? PLoS ONE 12 (1) e0170883.

Wanat, K.A., Kovarik, C.L., Shuman, S., Whitaker, R.C., Foster, G.D. & O’Brien, M.J. (2014). The association between obesity and health-related quality of life among urban Latinos. Ethnicity & Disease 24 (1) 14-18.

Guerra, C.E. & Shea, J.A. (2007). Health literacy and perceived health status in Latinos and African Americans. Ethnicity & Disease 17 (2) 305-312.

Farivar, S.S., Cunningham, W.E. & Hays, R.D. (2007). Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V.1. Health and Quality of Life Outcomes 5 (1) 54.

Fleishman, J.A., Selim, A.J. & Kazis, L.E. (2010). Deriving SF-12v2 physical and mental health summary scores: a comparison of different scoring algorithms. Quality of Life Research 19 (2) 231-241.

Preacher, K.J. & MacCallum, R.C. (2003). Repairing Tom Swift’s Electric Factor Analysis Machine. Understanding Statistics 2 (1) 13-43.

Centers for Disease Control and Prevention. (2016). Diabetes: Working to reverse the epidemic. [Internet]. Centers for Disease Control and Prevention. Available from:



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