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eCAM Advance Access published online on September 30, 2009
eCAM, doi:10.1093/ecam/nep141
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© The Author(s) 2009. Published by Oxford University Press.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Construct Validity of the Holistic Complementary and Alternative Medicines Questionnaire (HCAMQ)—An Investigation Using Modern Psychometric Approaches

Paula Kersten1, P. J. White1 and A. Tennant2

1School of Health Sciences, University of Southampton and 2Academic Unit of Musculoskeletal and Rehabilitation Medicine, University of Leeds, UK

The scientific basis of efficacy studies of complementary medicine requires the availability of validated measures. The Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) is one such measure. This article aimed to examine its construct validity, using a modern psychometric approach. The HCAMQ was completed by 221 patients (mean age 66.8, SD 8.29, 58% females) with chronic stable pain predominantly from a single joint (hip or knee) of mechanical origin, waiting for a hip (40%) or knee (60%) joint replacement, on enrolment in a study investigating the effects of acupuncture and placebo controls. The HCAMQ contains a Holistic Health (HH) Subscale (five items) and a CAM subscale (six items). Validity of the subscales was tested using Cronbach alpha's, factor analysis, Mokken scaling and Rasch analysis, which did not support the original two-factor structure of the scale. A five-item HH subscale and a four-item CAM subscale (worded in a negative direction) fitted the Rasch model and were unidimensional ({chi}2 = 8.44, P = 0.39, PSI = 0.69 versus {chi}2 = 17.33, P = 0.03, PSI = 0.77). Two CAM items (worded in the positive direction) had significant misfit. In conclusion, we have shown that the original two-factor structure of the HCAMQ could not be supported but that two valid shortened subscales can be used, one for HH Beliefs (four-item HH), and the other for CAM Beliefs (four-item CAM). It is recommended that consideration is given to rewording the two discarded positively worded CAM questions to enhance construct validity.

Keywords: acupuncture – health beliefs – outcomes research – Rasch analysis

For reprints and all correspondence: Paula Kersten, School of Health Sciences, Building 45, University of Southampton, Southampton SO17 1BJ, UK. Tel: +44-23-80595299; Fax: +44-23-80595301; E-mail: p.kersten{at}soton.ac.uk

Received February 11, 2009; accepted August 17, 2009


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