Factor Structure of the Multidimensional Health Perceptions Questionnaire in Adults with a History of Traumatic Brain Injury: A TBI Model Systems Study

Background: Health perceptions affect health behaviors, engagement with healthcare providers and treatments, and health outcomes. However, tools to evaluate patient health perceptions are lacking. Therefore, we developed the Multidimensional Health Perceptions Questionnaire (MHPQ) as a comprehensive but brief self-reported measure of an individual’s health perceptions, agnostic to condition. This type of instrument is needed to help evaluate the effect of health perceptions on health-related outcomes in addition to informing adaptation of care to improve patient provider interactions. In a prior study, the MHPQ demonstrated excellent content validity (content validity index=98.1%) and conceptual equivalence in English and Spanish in the general population, with a reading grade level of < 8 ^th grade in both languages. We found a 7-factor structure in the general population (combined English and Spanish speakers), but limitations in the representativeness of the sample warranted further investigation into the factor structure of the MHPQ. ¹ Additionally, validation in unique populations – like traumatic brain injury (TBI) – is consistent with best practice. Objective: To determine the factor structure of the MHPQ among adults with > 1 year history of traumatic brain injury (TBI) that required inpatient rehabilitation. Participants: Participants (n=250) enrolled in the TBI Model Systems National Database across five participating centers who completed a follow-up assessment between September 1 ^st , 2023 and June 19 ^th , 2024. All participants had experienced a TBI requiring inpatient rehabilitation and ranged from 1-35 years post-injury. All were able to complete a self-reported survey. Methods: We administered the original 65-item MHPQ as an electronic survey (REDCap™) or via telephone interview (if preferred) to participants. All items are rated on a 1=Strongly disagree to 5=Strongly agree response scale. Results: N=250 participants with a history of TBI completed the MHPQ in English. The sample was 30.8% CIS-female (68.4% CIS-male, 0.8% Other gender), 18-90 years old (M=45.8, SD=16.2), 16.0% Hispanic/Latino, and predominantly White (68.0%), followed by Black (18%), and all other races (2.0-5.2%). Exploratory Factor Analysis resulted in 53 final items with a multidimensional structure and good internal consistency reliabilities, with the following eight health perceptions domains (% variance, Cronbach’s α): Anticipated Discrimination and Judgement (10 items; α=.90); Communication with Healthcare providers (9 items; α=.79); Spiritual Health Beliefs (8 items, α=.88), Health Self-Efficacy (5 items, α=.73), Trust in Social Health Advice (5 items, α=.78), Trust in Medicine (6 items, α=.76), How Health Affects My Life (5 items, α=.71), and How Others Affect My Health (5 items, α=.64) Conclusions: Results suggest that the MHPQ could be a valid and reliable measure for comprehensively characterizing health perceptions among individuals who have experienced TBI. It demonstrated an 8-factor structure, with 8 distinct subscales each yielding average scores (1-5). Further validation through Rasch analysis and for the Spanish-language version of the MHPQ are forthcoming.