Testing for intersectional measurement invariance with the alignment method: Evaluation of the 8‐item patient health questionnaire

• Published in: Health services research Vol. 58; no. 4; pp. 248 - 261
• Main Authors: Cintron, Dakota W., Matthay, Ellicott C., McCoach, D. Betsy
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2023; Health Research and Educational Trust
• Subjects: Adult; Alignment; Analysis; Baccalaureate degrees; Depression, Mental; Ethnicity; Evaluation; evaluation design and research; Female; Gender; gender/sex differences in health and health care; health equity; Health status; Health surveys; Humans; Identities; Intersectional Framework; Intersectionality; Invariance; Male; Measurement; Measures; Mental depression; Methods; Minority & ethnic groups; Multiculturalism & pluralism; Patient Health Questionnaire; Polls & surveys; psychometrics; Psychometrics - methods; Questionnaires; Race; racial/ethnic differences in health and health care; Reproducibility of Results; Social categories; Socioeconomic status; Socioeconomics; Subgroups; Surveys; Surveys and Questionnaires; United States; New York; psychometrics; evaluation design and research; health equity; racial/ethnic differences in health and health care; gender/sex differences in health and health care
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.14189

Objective To demonstrate the use of the alignment method to evaluate whether surveys function similarly (i.e., have evidence of measurement invariance) across culturally diverse intersectional groups. Intersectionality theory recognizes the interconnected nature of social categories such as race, gender, ethnicity, and socioeconomic status. Data Sources A total of 30,215 American adult's responses to the eight‐item Patient Health Questionnaire depression assessment scale (PHQ‐8) from the 2019 National Health Interview Survey (NHIS). Study Design Using the alignment method, we examined the measurement invariance (equivalence) of the PHQ‐8 depression assessment scale across 16 intersectional subgroups defined at the intersection of age (under 52, 52 and older), gender (male, female), race (Black, non‐Black), and education (no bachelor's degree, bachelor's degree). Principal Findings Overall, 24% of the factor loadings and 5% of the item intercepts showed evidence of differential functioning across one or more of the intersectional groups. These levels fall beneath the benchmark of 25% suggested for determining measurement invariance with the alignment method. Conclusions The results of the alignment study suggest that the PHQ‐8 functions similarly across the intersectional groups examined, despite some evidence of different factor loadings and item intercepts in some groups (i.e., noninvariance). By examining measurement invariance through an intersectional lens, researchers can investigate how a person's multiple identities and social positions possibly contribute to their response behavior on an assessment scale.