Ann Rheum Dis doi:10.1136/annrheumdis-2012-201807
  • Clinical and epidemiological research
  • Extended report

Measurement invariance of the Illness Invalidation Inventory (3*I) across language, rheumatic disease and gender

  1. Rinie Geenen1,2
  1. 1Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
  2. 2Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Department of Methods and Statistics, Utrecht University, Utrecht, The Netherlands
  4. 4Department of Psychology, Catholic University San Antonio, Murcia, Spain
  5. 5Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
  6. 6Department Rheumatology, University Hospital Coimbra, Coimbra, Portugal
  7. 7Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
  8. 8Department of Developmental and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
  9. 9Department of Psychology, Wayne State University, Detroit, Michigan, USA
  10. 10Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to Marianne Belia Kool, Department of Clinical and Health Psychology, Utrecht University, PO Box 80140, Utrecht 3508 TC, The Netherlands; m.b.kool{at}
  • Received 3 April 2012
  • Revised 18 January 2013
  • Accepted 20 January 2013
  • Published Online First 14 February 2013


Objectives The Illness Invalidation Inventory (3*I) assesses patients’ perception of responses of others that are perceived as denying, lecturing, not supporting and not acknowledging the condition of the patient. It includes two factors: ‘discounting’ and ‘lack of understanding’. In order to use the 3*I to compare and pool scores across groups and countries, the questionnaire must have measurement invariance; that is, it should measure identical concepts with the same factor structure across groups. The aim of this study was to examine measurement invariance of the 3*I across rheumatic diseases, gender and languages.

Methods Participants with rheumatic disease from various countries completed an online study using the 3*I, which was presented in Dutch, English, French, German, Portuguese and Spanish; 6057 people with rheumatic diseases participated. Single and multiple group confirmatory factor analyses were used to test the factorial structure and measurement invariance of the 3*I with Mplus.

Results The model with strong measurement invariance, that is, equal factor loadings and thresholds (distribution cut-points) across gender and rheumatic disease (fibromyalgia vs other rheumatic diseases) had the best fit estimates for the Dutch version, and good fit estimates across the six language versions.

Conclusions The 3*I showed measurement invariance across gender, rheumatic disease and language. Therefore, it is appropriate to compare and pool scores of the 3*I across groups. Future research may use the questionnaire to examine antecedents and consequences of invalidation as well as the effect of treatments targeting invalidation.

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