Validation of the 36-item version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) for assessing women's disability and functioning associated with maternal morbidity

Silveira, Carla; Parpinelli, Mary Angela; Pacagnella, Rodolfo Carvalho; Andreucci, Carla Betina; Angelini, Carina Robles; Ferreira, Elton Carlos; Cecatti, José Guilherme; ,

doi:10.1055/s-0037-1598599

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev. Bras. Ginecol. Obstet. 39 (02) • Feb 2017 • https://doi.org/10.1055/s-0037-1598599 copy

Validation of the 36-item version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) for assessing women's disability and functioning associated with maternal morbidity

Validação da versão de 36 itens do WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) para a avaliação de incapacidade e funcionalidade da mulher associada à morbidade materna

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To validate the translation and adaptation to Brazilian Portuguese of 36 items from the World Health Organizaton Disability Assessment Schedule 2.0 (WHODAS 2.0), regarding their content and structure (construct), in a female population after pregnancy.

Methods

This is a validation of an instrument for the evaluation of disability and functioning and an assessment of its psychometric properties, performed in a tertiary maternity and a referral center specialized in high-risk pregnancies in Brazil. A sample of 638 women in different postpartum periods who had either a normal or a complicated pregnancy was included. The structure was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while the content and relationships among the domains were assessed through Pearson's correlation coefficient. The sociodemographic characteristics were identified, and the mean scores with their standard deviations for the 36 questions of the WHODAS 2.0 were calculated. The internal consistency was evaluated byCronbach's α.

Results

Cronbach's α was higher than 0.79 for both sets of questons of the questionnaire. The EFA and CFA for the main 32 questions exhibited a total variance of 54.7% (Kaiser-Meyer-Olkin [KMO] measure of sampling adequacy = 0.934; p < 0.001) and 53.47% (KMO = 0.934; p < 0.001) respectively. There was a significant correlation among the 6 domains (r = 0.571-0.876), and a moderate correlation among all domains (r = 0.476-0.694).

Conclusion

The version of the WHODAS 2.0 instrument adapted to Brazilian Portuguese showed good psychometric properties in this sample, and therefore could be applied to populations of women regarding their reproductive history.

Keywords:
International Classification of Functioning; Disability and Health (ICF); pregnancy complications; validation studies; maternal and child health

Factor (domains)	Mean	SD	N	Cronbach's Alpha if item deleted
With 32 questions of the Brazilian Portuguese version of the WHODAS 2.0^a
D1- Cognition	21.420	18.214	636	0.826
D2- Mobility	13.760	19.013	636	0.815
D3- Self-care	5.367	12.338	636	0.844
D4- Getting along	14.592	20.240	636	0.823
D5a- Life activities: household	23.354	28.348	636	0.806
D6- Participation	20.336	20.717	636	0.793
With all 36 questions of the Brazilian Portuguese version of the WHODAS 2.0^b
D1- Cognition	20.108	17.392	297	0.870
D2- Mobility	10.212	15.725	297	0.863
D3- Self-care	4.602	11.099	297	0.881
D4- Getting along	12.675	18.231	297	0.867
D5a- Life activities: household	20.146	27.072	297	0.850
D5b- Life activities: work and school	15.897	23.646	297	0.845
D6- Participation	17.432	19.784	297	o.844

Factor*
Questions and their main topics	1	2	3	4	5	6	7
D11a- Concentration	0.220	0.138	0.195	0.157	0.596	0.113	0.097
D12a- Remembering to do important things	0.167	0.138	0.033	0.077	0.654	0.087	0.039
D13a- Problem-solving	0.140	0.101	0.149	0.199	0.614	0.020	0.167
D14a- Learning a new task	0.121	0.147	0.098	0.154	0.493	−0.003	−0.027
D15a- Understanding	0.030	0.119	0.124	0.286	0.476	0.059	0.069
D16a- Conversation	0.038	0.099	0.142	0.394	0.512	−0.011	0.054
D21a- Standing for long periods	0.209	0.684	0.113	0.030	0.172	0.093	0.056
D22a- Standing up from sitting	0.150	0.679	0.173	0.095	0.128	0.115	0.090
D23a- Moving around inside home	0.126	0.632	0.139	0.108	0.159	0.174	0.066
D24a- Getting out of home	0.157	0.673	0.195	0.253	0.132	0.216	0.005
D25a- Walking a long distance	0.332	0.595	0.209	0.125	0.120	0.171	0.096
D31a- Washing your whole body	0.155	0.177	0.113	0.059	0.076	0.817	0.076
D32a- Getting dressed	0.130	0.250	0.098	0.085	−0.017	0.806	0.111
D33a- Eating	0.117	0.066	0.173	0.062	0.095	0.494	0.093
D34a- Staying by self for a few days	0.114	0.143	0.091	0.120	0.158	0.214	0.202
D41a- Dealing with strangers	0.122	0.050	0.118	0.573	0.251	0.101	0.091
D42a- Maintaining a friendship	0.151	0.114	0.068	0.782	0.137	0.080	0.127
D43a- Getting along with people close	0.076	0.145	0.110	0.555	0.216	0.077	0.208
D44a- Making new friends	0.131	0.115	0.129	0.748	0.200	0.025	0.127
D45a- Sexual activities	0.278	0.177	0.234	0.270	0.219	0.093	0.153
D51a- Household responsibilities	0.765	0.225	0.245	0.167	0.155	0.138	0.079
D52a- Do important household tasks well	0.742	0.184	0.252	0.163	0.173	0.137	0.108
D53a- Do all needed household work	0.754	0.271	0.276	0.115	0.197	0.211	0.121
D54a- Household work performed as quickly as needed	0.605	0.293	0.327	0.139	0.245	0.142	0.134
D61a- Joining in community activities	0.334	0.264	0.330	0.345	0.145	0.127	0.187
D62a- Because of environmental barriers	0.113	0.060	0.180	0.184	0.083	0.175	0.699
D63a- Others affect one's dignity	0.139	0.093	0.116	0.268	0.091	0.078	0.579
D64a- Health affects time consumption	0.235	0.209	0.645	0.095	0.133	0.166	0.128
D65a- Health affects one's emotions	0.311	0.201	0.597	0.146	0.233	0.123	0.198
D66a- Health affects family finances	0.225	0.120	0.705	0.093	0.102	0.165	0.056
D67a- Health affects family	0.199	0.210	0.657	0.144	0.131	0.055	0.080
D68a- Doing things for relaxation or pleasure	0.269	0.208	0.462	0.200	0.242	0.116	0.328
% Variance	320.71	60.35	40.15	30.77	20.79	30.04	10.87
% Cumulative variance	320.71	390.07	430.22	460.99	490.78	520.81	540.69

Questions and their main topics	Factor
Questions and their main topics	1	2	3	4	5	6	7
D11a- Concentration	0.141	0.194	0.202	0.153	0.593	0.122	0.099
D12a- Remembering to do important things	0.138	0.032	0.154	0.071	0.645	0.090	0.047
D13a- Problem-solving	0.100	0.147	0.125	0.195	0.611	0.027	0.167
D14a- Learning a new task	0.145	0.099	0.110	0.150	0.491	0.003	−0.028
D15a- Understanding	0.120	0.122	0.019	0.282	0.462	0.060	0.072
D16a- Conversation	0.099	0.139	0.030	0.387	0.502	−0.009	0.052
D21a-Standing for long periods	0.677	0.116	0.188	0.034	0.180	0.095	0.052
D22a-Standing up from sitting	0.676	0.176	0.127	0.097	0.136	0.114	0.087
D23a- Moving around inside home	0.612	0.145	0.110	0.111	0.165	0.171	0.068
D24a- Getting out of home	0.654	0.194	0.139	0.248	0.148	0.210	0.018
D25a- Walking a long distance	0.600	0.212	0.308	0.127	0.132	0.174	0.098
D31a- Washing your whole body	0.189	0.106	0.135	0.061	0.074	0.837	0.070
D32a- Getting dressed	0.267	0.097	0.118	0.088	−0.016	0.769	0.110
D33a- Eating	0.076	0.172	0.105	0.064	0.090	0.487	0.095
D34a- Staying by self for a few days	0.149	0.091	0.103	0.123	0.157	0.212	0.200
D41a- Dealing with strangers	0.057	0.111	0.111	0.560	0.259	0.107	0.097
D42a- Maintaining a friendship	0.116	0.070	0.139	0.768	0.156	0.085	0.120
D43a- Getting along with people close	0.141	0.111	0.063	0.555	0.227	0.080	0.200
D44a- Making new friends	0.119	0.127	0.119	0.725	0.220	0.025	0.132
D45a- Sexual activities	0.181	0.240	0.262	0.269	0.228	0.093	0.155
D51a- Household responsibilities	0.242	0.266	0.738	0.169	0.172	0.147	0.088
D52a- Do important household tasks well	0.201	0.271	0.718	0.165	0.188	0.146	0.115
D53a- Do all needed household work	0.290	0.296	0.727	0.120	0.209	0.220	0.123
D54a- Household work performed as quickly as needed	0.308	0.342	0.579	0.142	0.258	0.149	0.130
D61a- Joining in community activities	0.270	0.338	0.312	0.347	0.159	0.131	0.182
D62a- Because of environmental barriers	0.060	0.184	0.098	0.189	0.085	0.183	0.700
D63a- Others affects one's dignity	0.095	0.127	0.129	0.277	0.100	0.084	0.527
D64a- Health affects time consumption	0.219	0.616	0.218	0.098	0.149	0.169	0.132
D65a- Health affects one's emotions	0.213	0.582	0.286	0.152	0.245	0.137	0.192
D66a- Health affects family finances	0.130	0.693	0.201	0.093	0.115	0.175	0.063
D67a- Health affects family	0.212	0.664	0.171	0.146	0.142	0.063	0.077
D68a- Doing things for relaxation or pleasure	0.210	0.464	0.246	0.207	0.248	0.128	0.313
% Variance	320.51	50.99	40.19	30.58	20.66	20.83	10.69
% Cumulative variance	320.51	380.50	420.69	460.27	480.93	510.77	530.46

WHODAS 2.0	D1	D2	D3	D4	D5a	D6	Summary Score
D1- Cognition	1	0.430	0.286	0.544	0.494	0.503	0.743
D2- Mobility		1	0.463	0.424	0.613	0.561	0.757
D3- Self-care			1	0.320	0.455	0.470	0.571
D4- Getting along				1	0.487	0.560	0.724
D5a- Life activities					1	0.694	0.825
D6- Participation						1	0.876
Summary Score							1

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[1] Address for correspondence Jose Guilherme Cecatti, Departmento de Obstetrícia e Ginecologia, Universidade Estadual de Campinas, Rua Alexander Fleming, 101, 13083-891 Campinas, SP, Brazil (e-mail: cecatti@unicamp.br).