Author Identifier

Ebenezer Afrifa-Yamoah

ORCID : 0000-0003-1741-9249

Kwasi Frimpong

ORCID : 0000-0001-5021-7804

Esther Adama

ORCID : 0000-0002-7771-2722

Wei Wang

ORCID : 0000-0002-1430-1360

Document Type

Journal Article

Publication Title

Health and Quality of Life Outcomes


Springer Nature / BMC


Centre for Precision Health / School of Science / School of Medical and Health Sciences




Edith Cowan University - Open Access Support Scheme 2021


Adua, E., Afrifa-Yamoah, E., Frimpong, K., Adama, E., Karthigesu, S. P., Anto, E. O., ... Wang, W. (2021). Construct validity of the suboptimal health status questionnaire-25 in a Ghanaian population. Health and Quality of Life Outcomes, 19, article 180.



The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure Suboptimal Health Status has been used worldwide, but its construct validity has only been tested in the Chinese population. Applying Structural Equation Modelling, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.


The study involved healthy Ghanaian participants (n = 263; aged 20–80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups.


The extracted domains were reliable with Cronbach’s ɑ of 0.846, 0.820 and 0.864 respectively, for fatigue, immune-cardiovascular and cognitive. The CFA revealed that the model fit indices were excellent

(RMSEA = 0.049 < 0.08, CFI = 0.903 > 0.9, GFI = 0.880 < 0.9, TLI = 0.907 > 0.9).

The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts were smaller than the corresponding maximum shared variance. The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.


The validity tests suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect chronic diseases especially in developing countries where access to facilities is diminished.



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This work is licensed under a Creative Commons Attribution 4.0 License.

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