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      Which environmental factors are associated with lived health when controlling for biological health? - a multilevel analysis

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          Abstract

          Background

          Lived health and biological health are two different perspectives of health introduced by the International Classification of Functioning, Disability and Health (ICF). Since in the concept of lived health the impact of the environment on biological health is inherently included, it seems intuitive that when identifying the environmental determinants of health, lived health is the appropriate outcome. The Multilevel Item Response Theory (MLIRT) model has proven to be a successful method when dealing with the relation between a latent variable and observed variables. The objective of this study was to identify environmental factors associated with lived health when controlling for biological health by using the MLIRT framework.

          Methods

          We performed a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data were collected from 17,303 adults living in 15,263 dwellings. The MLIRT model was used for each of the two steps of the analysis to: (1) calculate people’s biological health abilities and (2) estimate the association between lived health and environmental factors when controlling for biological health. The hierarchical structure of individuals in dwellings was considered in both models.

          Results

          Social support, being able to maintain one’s job, the extent to which one’s health needs are addressed and being discriminated against due to one’s health problems were the environmental factors identified as associated with lived health. Biological health also had a strong positive association with lived health.

          Conclusions

          This study identified environmental factors associated with people’s lived health differences within and between dwellings according to the MLIRT-model approach. This study paves the way for the future implementation of the MLIRT model when analysing ICF-based data.

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          Most cited references24

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          The role of the bifactor model in resolving dimensionality issues in health outcomes measures.

          We propose the application of a bifactor model for exploring the dimensional structure of an item response matrix, and for handling multidimensionality. We argue that a bifactor analysis can complement traditional dimensionality investigations by: (a) providing an evaluation of the distortion that may occur when unidimensional models are fit to multidimensional data, (b) allowing researchers to examine the utility of forming subscales, and, (c) providing an alternative to non-hierarchical multidimensional models for scaling individual differences. To demonstrate our arguments, we use responses (N = 1,000 Medicaid recipients) to 16 items in the Consumer Assessment of Healthcare Providers and Systems (CAHPS2.0) survey. Exploratory and confirmatory factor analytic and item response theory models (unidimensional, multidimensional, and bifactor) were estimated. CAHPS items are consistent with both unidimensional and multidimensional solutions. However, the bifactor model revealed that the overwhelming majority of common variance was due to a general factor. After controlling for the general factor, subscales provided little measurement precision. The bifactor model provides a valuable tool for exploring dimensionality related questions. In the Discussion, we describe contexts where a bifactor analysis is most productively used, and we contrast bifactor with multidimensional IRT models (MIRT). We also describe implications of bifactor models for IRT applications, and raise some limitations.
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            Use of The International Classification of Functioning, Disability and Health (ICF) as a conceptual framework and common language for disability statistics and health information systems

            A common framework for describing functional status information is needed in order to make this information comparable and of value. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF), which has been approved by all its member states, provides this common language and framework. The article provides an overview of ICF taxonomy, introduces the conceptual model which underpins ICF and elaborates on how ICF is used at population and clinical level. Furthermore, the article presents key features of the ICF tooling environment and outlines current and future developments of the classification.
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              The effect of the environment on participation of children and youth with disabilities: a scoping review.

              The study’s purpose was to identify and synthesize research evidence regarding the effect of the environment on community participation of children with disabilities.
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                Author and article information

                Contributors
                +41 41 939 65 78 , cristina.bostan@paraplegie.ch
                cornelia.oberhauser@med.uni-muenchen.de
                gerold.stucki@paraplegie.ch
                jerome.bickenbach@paraplegie.ch
                a.cieza@soton.ac.uk
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                27 May 2015
                27 May 2015
                2015
                : 15
                : 508
                Affiliations
                [ ]Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
                [ ]Swiss Paraplegic Research, Nottwil, Switzerland
                [ ]Department of Medical Informatics, Biometry and Epidemiology–IBE, Pettenkofer School of Public Health (PSPHLMU), Research Unit for Biopsychosocial Health, Ludwig Maximilian University (LMU), Munich, Germany
                [ ]Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton, UK
                Article
                1834
                10.1186/s12889-015-1834-y
                4445791
                14e8654d-0fb2-4279-bd98-90d8dc358bce
                © Bostan et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 July 2014
                : 13 May 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Public health
                lived health,biological health,environmental factors,multilevel item response theory,spain

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