Challenges of Instrument Adaptation in Health Disparities Research

Purpose: Research concerned with racial and ethnic health and healthcare disparities is increasing both in the United States and globally. Associated with this growth is the need for instruments to accurately measure the true prevalence of those constructs of interest across diverse racial and ethnic groups.

Methods: To provide a brief overview of issues regarding measurement in diverse populations. We will provide an explication of the approaches used to assess the magnitude and nature of bias (i.e., sample, instrument, response and administration) in measures when applied to diverse racial/ethnic groups.

Results: These approaches include qualitative analyses, classic psychometric studies, and modern psychometric methods. We will consider the concepts of measurement equivalence, different equivalence levels (i.e., configural equivalence (Horn & McArdle, 1992);  metric equivalence (Singh,1995) and scalar equivalence (Meredith, 1993); or calibration equivalence (Mullen, 1995)) and causes of inequivalence, as well as three approaches to the analysis of measurement equivalence – multigroup confirmatory factor analysis, differential item functioning, and multigroup latent class analysis – with special emphasis on their similarities and differences, as well as comparative advantages using data from several published studies of health.

Conclusions: Investigators studying racial and ethnic health and healthcare disparities will learn how to address measurement equivalence, crucial for obtaining accurate results in their cross-cultural comparisons.

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