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

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Juengst, Angelle M. Sander, Monique R. Pappadis, Librada Callender, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7651996/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Health Belief Model Psychometrics Health Literacy Locus of Control Exploratory Factor Analysis Introduction Providing culturally appropriate, person-centered care 2 – 4 is challenging due to lack of reliable methods for efficiently and effectively capturing individual health beliefs, preferences, cultural values, resources, and abilities that affect health and health behaviors across the lifespan. 5 – 7 Existing health perceptions measures are limited to narrowly defined health beliefs (e.g., locus of control alone) or are specific to health conditions (e.g., stroke health beliefs). But health perceptions are complex, multidimensional, and intertwined with cultural values, health literacy, and differences in healthcare experiences or anticipated experiences. Conclusions about individuals based only on racial or ethnic group identity can lead to harmful stereotyping. 3 A broad, multidimensional measure of health perceptions that is agnostic to health condition and available in English and Spanish is a critically needed tool to improve patient-centered and culturally humble care. To meet this need, we previously developed the Multidimensional Health Perceptions Questionnaire (MHPQ), in English and Spanish, using patient-centered outcomes research techniques 8 and integrating constructs from 1) the Health Belief Model 9 to explain factors involved in health behavior change, 2) Social Cognitive Theory 10 to explain individual factors contributing to motivation and ability to change health behaviors, and 3) Ecological Systems Theory 11 to explain how social systems affect health behavior. The initial items for the MHPQ had excellent content validity (98.1%) for assessing health perceptions agnostic to specific health condition. 8 After undergoing rigorous translation and language validation, the final items of the MHPQ were at a reading level of 6th grade in English and 8th grade in Spanish. We then conducted a prospective anonymous survey study among n = 357 community-dwelling adults (n = 331 in English, n = 26 in Spanish) in the general population to determine the multidimensional factor structure of the MHPQ and to evaluate the internal consistency reliabilities of each factor. 1 Exploratory factor analysis yielded a 7-factor solution with 65 final items rated on a 1–5 ordinal agreement scale (1 = strongly disagree to 5 = strongly agree). The MHPQ had seven subscales with good internal consistency reliabilities in the following seven health perceptions domains (e.g., subscales): Anticipated Discrimination and Judgement (α = .92); Spiritual Health Beliefs (α = .89); Social and Emotional Well-being beliefs (α = .71); Confidence in Healthcare Providers and Medicine (α = .85); Health Self-Efficacy (α = .79); Trust in Social Health Advice (α = .74); and Health Literacy (α = .86). 1 However, limitations in the representativeness of the sample (mostly notably the high level of education) 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 in instrumentation and psychometric validation 12 and in accordance with the Standards for Educational and Psychology Testing. 25 Therefore, the purpose of this study was to determine the factor structure of the MHPQ among adults with ≥ 1 year history of traumatic brain injury (TBI) that required inpatient rehabilitation. Methods Design and Participants. We conducted a cross-sectional study of participants enrolled in the TBI Model Systems National Database across five participating centers who completed a follow-up assessment between September 1st, 2023 and June 19th, 2024. Participants had to be ≥ 18 years old, fluent in either English or Spanish (only those who completed the MHPQ in English are included in this analysis; validation among Spanish-speakers is forthcoming), and capable of completing a self-reported assessment independently. To be eligible for the TBI Model Systems, participants had to be admitted for inpatient rehabilitation at a participating site with a diagnosis of TBI defined by one or more of the following: post-traumatic amnesia > 24 hours, loss of consciousness > 30 minutes, Glasgow Coma Scale score < 13 in the emergency department, and/or intracranial neuroimaging abnormalities. As part of the TBI Model Systems National Database study, participants complete follow-up interviews at 1, 2, 5, 10, and every subsequent 5 years following injury, typically via telephone. For this study, participants who completed a TBI Model Systems follow-up interview were asked if they were interested in participating in an additional brief survey study, for which they could receive up to $ 25. If interested, they were provided with a brief description of the study and a REDCap™ link to indicate consent and complete the MHPQ, though participants could opt to complete the assessment via telephone interview if they preferred. All data collection and storage occurred using REDCap™. All research activities were approved by the UT Houston Institutional Review Board, with the other four participating sites’ IRBs providing reliance approval. Measures. Participants completed a brief demographic questionnaire, including probes regarding English and/or Spanish language fluency, Hispanic/Latino ethnicity (Yes/No), race, gender, and age. The MHPQ had 65 items rated on a 1–5-point agreement scale (1 = Strongly Disagree to 5 = Strongly Agree). Instructions for all items were as follows: Please rate how much you agree with each of the following statements. "Healthcare providers" include doctors, nurses, therapists, or any other professional who you see for medical or healthcare services. "Health" refers to how you feel, how well or not well you are, and any specific health conditions that you have. For the final nine items probing anticipated discrimination in healthcare, this additional prompt was provided: Because of my race, ethnicity, gender, age, religion, physical appearance, sexual orientation, or other characteristics… Data Analysis. Summary statistics were calculated to describe our sample. We conducted an Exploratory Factor Analysis (EFA) using IBM SPSS Statistics (v.29.0.2.0) to determine the factor structure of the MHPQ and which items to retain for Rasch analysis. We used Principal Components Analysis with Promax Rotation (as we anticipated subscales would be correlated). To evaluate appropriateness for factor analysis, we examined the Kaiser-Meyer-Olkin measure of sampling adequacy (> .80 is “meritorious” and > .90 is “marvelous”) and Bartlett’s Test for Sphericity. 13 Our multidisciplinary team determined our final factor solution and items based on factor loading scores and conceptual consistency within and across factors when examining the pattern matrix after iterative removal of items. We started with a 7-factor solution, based on prior findings, and explored 6-factor and 8-factor solutions. We set a cut-point for factor loadings in the pattern matrix of ≥ 0.40 to retain an item, then iteratively removed items and reran analyses. We calculated Cronbach’s alpha coefficients within each factor to evaluate internal consistency reliabilities for each subscale, with α > .7 = Acceptable, α > .8 = Good, α > .9 = Excellent, 14 though α > .6 is considered acceptable for exploratory studies. 12 , 15 We also examined Cronbach’s alpha if each item was removed. Final item inclusion/removal decisions were made based on a combination of α’s and consistency with theoretical model. Results Participants . We sent a link to the consent form and MHPQ survey in REDCap to n=297 eligible participants who had completed a self-reported TBIMS follow-up interview in English or Spanish and agree to be contacted about this additional study. Of those, n=283 (95.2%) opened the survey link [261 (92.8%) selected English as their primary language and 22 (7.8%) selected Spanish). Of those 261 who selected English, n=256 (98.0%) consented to the study and n=250 (97.7%) completed the full MHPQ in English. Table 1 presents brief demographics of the sample. Table 1. Participant Characteristics (n=250) Characteristic Mean (SD), Range Age (years) 45.8 (16.2), 18-90 Number (%) Gender CIS-male CIS-female Transgender/non-binary/declined 171 (68.4) 77 (30.8) 2 (0.8) Hispanic/Latino Ethnicity 40 (16) Race Black White Multiracial Indigenous/Native American Asian Other race 45 (18.0) 170 (68.0) 11 (4.4) 7 (2.8) 5 (2.0) 13 (5.2) Factor Structure Exploratory factor analysis yielded an 8-factor solution with 53 final items; 11 items were removed and 1 item related to taking care of loved ones was not part of any factor but kept for contextual relevance. All factors included at least 5 items. See Table 2 for all items and factor loadings. The Kaiser-Meyer-Olkin=.832 (“meritorious” sampling adequacy) and Bartlett’s Test of Sphericity (p<.001) indicated appropriateness of factor analysis in this sample. We named the eight factors: 1) Anticipated Discrimination and Judgement, 2) Communication with Healthcare Providers, 3) Spiritual Health Beliefs, 4) Health Self-Efficacy (Internal LOC), 5) Trust in Social Health Advice, 6) Trust in Medicine, 7) How Health Affects My Life, and 8) How Others Affect My Health. Table 2: Final factor loadings (pattern matrix) Item F1 F2 F3 F4 F5 F6 F7 F8 Healthcare providers see me as a burden. .455 I will be denied healthcare. .783 I will be denied medical tests or procedures. .845 I will not be allowed to see the healthcare provider I want. .824 I will not see a healthcare provider if I think I will feel uncomfortable. .513 -.323 I will receive poor quality healthcare. .754 I will be treated with less respect than other people. .799 Healthcare providers treat me like I am not smart. .707 Healthcare providers treat me like I am dishonest. .761 Healthcare providers act like they think I am beneath them. .809 I can follow instructions to manage my health. .465 .442 I can communicate well with my healthcare providers. .824 I can follow instructions about medications to manage my health. .477 .391 I feel comfortable asking my healthcare providers questions about my health. .712 I understand what my healthcare providers tell me. .743 Health information I get from my providers makes sense to me. .773 I believe my healthcare provider will respect me. .636 My healthcare providers do not understand my point of view. -.549 I am confident that healthcare providers can help me. .449 .358 Lack of faith in God or another higher power can cause poor health. .783 Miracles can make people better when they are sick. .680 Health problems are a punishment from God or another higher power. .398 Praying helps health problems. .813 Faith or spiritual or religious practices can improve health. .732 Evil spirits can cause health problems. .671 God or another higher power is in control of whether my health gets better or worse. .882 Whatever happens to my health is Gods or another higher powers will. .858 My health mostly depends on my behaviors. .616 I can change my health. .670 I am in control of my health. .639 I can manage my health. .679 I can find new ways to improve my health. .627 I trust health advice from family and friends. .391 I trust health advice that I find on the internet. .847 I trust health advice that I see on TV. .881 I trust health advice that I see on social media. .848 I trust health advice from my religious or spiritual leaders. .482 .346 When I don’t feel well, I should talk to a healthcare provider. .592 I trust health advice from healthcare providers. .797 Medicines are effective. .344 .525 Following a doctor’s advice leads to better health. .716 I usually agree with my healthcare providers’ recommendations.* .537 .244 I trust healthcare providers. .414 .435 Health problems make it more difficult to work, go to school or function at home. .737 My health affects my mood. .696 My health affects my sex life. .775 My health problems are a burden to others. .583 I am embarrassed by my health. -.327 .449 Others’ thoughts and feelings affect my health. .645 Being surrounded by people with bad intentions can have a negative effect on my health. .493 My family has a lot to do with how healthy or unhealthy I am. .661 Healthcare providers control my health. .641 I rely on other people (doctors, nurses, family, friends) to take care of me and keep me healthy. -.370 .573 I can manage the health of my loved ones. -.370 KMO=.832, X-squared p<.001 *We kept this item on the Trust in Medicine subscale after considering the conceptual model and flagged it for further evaluation. F1 Anticipated Discrimination and Judgement F2 Communication with Healthcare Providers F3 Spiritual Health Beliefs F4 Health Self-Efficacy F5 Trust in Social Health Advice F6 Trust in Medicine F7 How Health Affects My Life F8 How Others Affect My Health Internal Consistency Reliabilities Cronbach’s alpha coefficients indicated acceptable to excellent internal consistency for all factors, as follows: 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) How Others Affect My Health (5 items, α=.64) As each factor, or subscale, demonstrates unidimensionality, subsequent Rasch analysis will be conducted for each subscale. Individual items were flagged for further investigation during Rasch analysis for Factors 1, 2, 3, 4, and 8, because they cross-loaded with a second factor or because the alpha improved if they were removed from the subscale. Discussion We identified an eight-factor structure for the MHPQ with 53 final items, which maps well to the Multidimensional Health Perceptions Model upon which it was based 8 and addresses some of the more hard to define subscales previously identified in the 7-factor version (e.g., Social and Emotional Health Beliefs, Health Literacy). 1 Items from the previous Social and Emotional Health Beliefs subscale separated to more clearly align with external locus of control ( How Others Affect My Health ) and consequences of health ( How Health Affects My Life ). Items from the previous Health Literacy subscale clearly divided into ability to follow health advice ( Health Self-Efficacy , which also includes items aligning with internal locus of control) and ability to express and to comprehend health needs and instructions ( Communication with Healthcare Providers ). Conceptually consistent and well-defined domains, measured by the subscales, will enable more effective recommendations for how to tailor health communications and recommendations for individuals based on their beliefs and perceptions across these different domains. The Exploratory Factor Analysis revealed that some items cross-loaded to multiple factors, meaning that these items may reflect multiple components of health perceptions. For each of these seven items, we determined which factor the item conceptually aligned with more. Additionally, for some subscales, the Cronbach’s alpha improved with removal of an item. When this happened (for five items), if the item was not considered to be conceptually important by experts, those items were permanently removed from the measure (two items). However, when experts determined that the “removed” item was conceptually important and consistent with the domain, they were retained and flagged for further evaluation during Rasch analysis (three items). For example, although the “I usually agree with healthcare recommendations” item loaded strongly on the Communication with Healthcare Providers subscale in the final iteration of the factor analysis, we kept it in the Trust in Medicine subscale after considering the conceptual model; we flagged it for further evaluation during Rasch analysis. Lastly, as in the prior version of the MHPQ, the item “I can manage the health of my loved ones” was not included in any of the final eight factors but was retained as a stand-alone item relevant to unique health perceptions of informal caregivers. The MHPQ measures an individual’s beliefs about their health and perceptions of factors that may impact their health. If providers can better understand the health perceptions captured by the MHPQ and how these perceptions might affect their patients/clients, they will be empowered to better adapt their communication approaches and practice culturally humble and patient-centered care. Therefore, the MHPQ has the potential to be a helpful tool to inform clinicians how they may best interact in ways that respect and incorporate their patients’ perceptions and values, making it more likely that patients will incorporate recommendations into their daily lives and subsequently improve their health. Limitations Though we had a robust sample size overall, the sample size for primarily Spanish-speaking individuals was small and did not allow us to run the EFA in this group. The results presented here are, therefore, only inclusive of English-speaking participants. We will continue to explore ways to validate the Spanish-language MHPQ that account for the smaller sample size. Overall, the internal consistency reliabilities were all acceptable to excellent, though lower than preferred for How Other Affect My Health (factor 8). Rasch analysis may reveal opportunities to improve this subscale. Lastly, the TBI Model Systems includes individuals with TBI severe enough to require inpatient rehabilitation and those with access to a TBI Model Systems Center; this sample does not, therefore, represent the broader population of adults with TBI whose initial injuries are less severe and/or who do not receive inpatient rehabilitation. Conclusions The MHPQ has a psychometrically strong and clinically meaningful factor structure in a diverse sample of English speakers with a history of TBI requiring inpatient rehabilitation. An individual’s factor scores may guide healthcare providers in how to best communicate recommendations in ways that may enhance their uptake. Further validation of the English-language MHPQ through Rasch analysis and for the Spanish-language version of the MHPQ are forthcoming. Declarations Acknowledgements Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All procedures were approved by the UT Houston IRB which served as the single reliance IRB for all sites. Consent for publication Informed consent was obtained from participants; no identifiable data were included in this publication. Availability of supporting data The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors have no relevant financial or non-financial interests to disclose. Funding The contents of this manuscript were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DPTB0019; 90DPTB0022; 90DPTB0023; 90DPTB0025; 90DPTB0027). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. References Juengst SB, Sander AM, Vega M, Braga MB, Khera A, Pappadis MR. Factor Structure of the Multidimensional Health Perceptions Questionnaire in English- and Spanish-speakers. 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Examining sociodemographic relationships to beliefs about causes, control, and responsibility for cancer and chronic disease prevention in Alberta, Canada. BMC Public Health . 2021;21(1):1047. doi:10.1186/s12889-021-11065-4 Chan IS, Ginsburg GS. Personalized Medicine: Progress and Promise. Annu Rev Genomics Hum Genet . 2011;12(1):217-244. doi:10.1146/annurev-genom-082410-101446 Stevens JP. Applied Multivariate Statistics for the Social Sciences, Fifth Edition . 5 edition. Routledge; 2009. The Standards for Educational and Psychological Testing. http://www.apa.org. Accessed April 19, 2016. http://www.apa.org/science/programs/testing/standards.aspx Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7651996","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":517242816,"identity":"f6f56314-f2ea-46e5-91e0-161e496cfe4f","order_by":0,"name":"Shannon B. 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Institute","correspondingAuthor":false,"prefix":"","firstName":"Dawn","middleName":"","lastName":"Neumann","suffix":""},{"id":517242822,"identity":"430f3580-a0d4-44c4-b41f-2742d2efb6b3","order_by":6,"name":"Therese O'Neil-Pirozzi","email":"","orcid":"https://orcid.org/0000-0002-7597-9482","institution":"Spaulding Rehabilitation Hospital","correspondingAuthor":false,"prefix":"","firstName":"Therese","middleName":"","lastName":"O'Neil-Pirozzi","suffix":""},{"id":517242823,"identity":"f99f2a39-7608-4616-aac0-28a8f6218d45","order_by":7,"name":"Amanda Rabinowitz","email":"","orcid":"https://orcid.org/0000-0001-8027-7111","institution":"Moss Rehabilitation Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Amanda","middleName":"","lastName":"Rabinowitz","suffix":""},{"id":517242824,"identity":"86b06a2c-6748-4d8a-83f8-ee1d5d7c3783","order_by":8,"name":"Kristin Wilmoth","email":"","orcid":"https://orcid.org/0000-0003-4192-8756","institution":"UT Southwestern Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kristin","middleName":"","lastName":"Wilmoth","suffix":""},{"id":517242825,"identity":"f2879407-7e83-4687-ba69-836d615dc374","order_by":9,"name":"Lauren Terhorst","email":"","orcid":"https://orcid.org/0000-0002-2326-8005","institution":"University of Pittsburgh","correspondingAuthor":false,"prefix":"","firstName":"Lauren","middleName":"","lastName":"Terhorst","suffix":""}],"badges":[],"createdAt":"2025-09-18 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08:41:23","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112569,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7651996/v1/cbda1720f8f950ceacdb702b.html"},{"id":91827671,"identity":"c5670e2b-0fc8-4a84-8075-b900ecbb3e7d","added_by":"auto","created_at":"2025-09-22 08:49:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1074500,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7651996/v1/ca0f5d88-593b-4a2b-bdf7-cc0389b0fcf3.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eFactor Structure of the Multidimensional Health Perceptions Questionnaire in Adults with a History of Traumatic Brain Injury: A TBI Model Systems Study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProviding culturally appropriate, person-centered care\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e is challenging due to lack of reliable methods for efficiently and effectively capturing individual health beliefs, preferences, cultural values, resources, and abilities that affect health and health behaviors across the lifespan.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Existing health perceptions measures are limited to narrowly defined health beliefs (e.g., locus of control alone) or are specific to health conditions (e.g., stroke health beliefs). But health perceptions are complex, multidimensional, and intertwined with cultural values, health literacy, and differences in healthcare experiences or anticipated experiences. Conclusions about individuals based only on racial or ethnic group identity can lead to harmful stereotyping.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e A broad, multidimensional measure of health perceptions that is agnostic to health condition and available in English and Spanish is a critically needed tool to improve patient-centered and culturally humble care.\u003c/p\u003e\u003cp\u003eTo meet this need, we previously developed the Multidimensional Health Perceptions Questionnaire (MHPQ), in English and Spanish, using patient-centered outcomes research techniques\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and integrating constructs from 1) the Health Belief Model\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e to explain factors involved in health behavior change, 2) Social Cognitive Theory\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e to explain individual factors contributing to motivation and ability to change health behaviors, and 3) Ecological Systems Theory\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e to explain how social systems affect health behavior. The initial items for the MHPQ had excellent content validity (98.1%) for assessing health perceptions agnostic to specific health condition.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e After undergoing rigorous translation and language validation, the final items of the MHPQ were at a reading level of 6th grade in English and 8th grade in Spanish.\u003c/p\u003e\u003cp\u003eWe then conducted a prospective anonymous survey study among n\u0026thinsp;=\u0026thinsp;357 community-dwelling adults (n\u0026thinsp;=\u0026thinsp;331 in English, n\u0026thinsp;=\u0026thinsp;26 in Spanish) in the general population to determine the multidimensional factor structure of the MHPQ and to evaluate the internal consistency reliabilities of each factor.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Exploratory factor analysis yielded a 7-factor solution with 65 final items rated on a 1\u0026ndash;5 ordinal agreement scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree). The MHPQ had seven subscales with good internal consistency reliabilities in the following seven health perceptions domains (e.g., subscales): Anticipated Discrimination and Judgement (α\u0026thinsp;=\u0026thinsp;.92); Spiritual Health Beliefs (α\u0026thinsp;=\u0026thinsp;.89); Social and Emotional Well-being beliefs (α\u0026thinsp;=\u0026thinsp;.71); Confidence in Healthcare Providers and Medicine (α\u0026thinsp;=\u0026thinsp;.85); Health Self-Efficacy (α\u0026thinsp;=\u0026thinsp;.79); Trust in Social Health Advice (α\u0026thinsp;=\u0026thinsp;.74); and Health Literacy (α\u0026thinsp;=\u0026thinsp;.86).\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHowever, limitations in the representativeness of the sample (mostly notably the high level of education) warranted further investigation into the factor structure of the MHPQ.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Additionally, validation in unique populations \u0026ndash; like traumatic brain injury (TBI) \u0026ndash; is consistent with best practice in instrumentation and psychometric validation\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e and in accordance with the \u003cem\u003eStandards for Educational and Psychology Testing.\u003c/em\u003e \u003csup\u003e25\u003c/sup\u003e Therefore, the purpose of this study was to determine the factor structure of the MHPQ among adults with \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;1 year history of traumatic brain injury (TBI) that required inpatient rehabilitation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eDesign and Participants.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e We conducted a cross-sectional study of participants enrolled in the TBI Model Systems National Database across five participating centers who completed a follow-up assessment between September 1st, 2023 and June 19th, 2024. Participants had to be \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;18 years old, fluent in either English or Spanish (only those who completed the MHPQ in English are included in this analysis; validation among Spanish-speakers is forthcoming), and capable of completing a self-reported assessment independently. To be eligible for the TBI Model Systems, participants had to be admitted for inpatient rehabilitation at a participating site with a diagnosis of TBI defined by one or more of the following: post-traumatic amnesia\u0026thinsp;\u0026gt;\u0026thinsp;24 hours, loss of consciousness\u0026thinsp;\u0026gt;\u0026thinsp;30 minutes, Glasgow Coma Scale score\u0026thinsp;\u0026lt;\u0026thinsp;13 in the emergency department, and/or intracranial neuroimaging abnormalities.\u003c/p\u003e\u003cp\u003eAs part of the TBI Model Systems National Database study, participants complete follow-up interviews at 1, 2, 5, 10, and every subsequent 5 years following injury, typically via telephone. For this study, participants who completed a TBI Model Systems follow-up interview were asked if they were interested in participating in an additional brief survey study, for which they could receive up to \u003cspan\u003e$\u003c/span\u003e25. If interested, they were provided with a brief description of the study and a REDCap\u0026trade; link to indicate consent and complete the MHPQ, though participants could opt to complete the assessment via telephone interview if they preferred. All data collection and storage occurred using REDCap\u0026trade;. All research activities were approved by the UT Houston Institutional Review Board, with the other four participating sites\u0026rsquo; IRBs providing reliance approval.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Participants completed a brief demographic questionnaire, including probes regarding English and/or Spanish language fluency, Hispanic/Latino ethnicity (Yes/No), race, gender, and age. The MHPQ had 65 items rated on a 1\u0026ndash;5-point agreement scale (1\u0026thinsp;=\u0026thinsp;Strongly Disagree to 5\u0026thinsp;=\u0026thinsp;Strongly Agree). Instructions for all items were as follows:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003ePlease rate how much you agree with each of the following statements.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Healthcare providers\" include doctors, nurses, therapists, or any other professional who you see for medical or healthcare services.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Health\" refers to how you feel, how well or not well you are, and any specific health conditions that you have.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor the final nine items probing anticipated discrimination in healthcare, this additional prompt was provided:\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eBecause of my race, ethnicity, gender, age, religion, physical appearance, sexual orientation, or other characteristics\u0026hellip;\u003c/h2\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis.\u003c/h2\u003e\u003cp\u003eSummary statistics were calculated to describe our sample. We conducted an Exploratory Factor Analysis (EFA) using IBM SPSS Statistics (v.29.0.2.0) to determine the factor structure of the MHPQ and which items to retain for Rasch analysis. We used Principal Components Analysis with Promax Rotation (as we anticipated subscales would be correlated). To evaluate appropriateness for factor analysis, we examined the Kaiser-Meyer-Olkin measure of sampling adequacy (\u0026gt;\u0026thinsp;.80 is \u0026ldquo;meritorious\u0026rdquo; and \u0026gt;\u0026thinsp;.90 is \u0026ldquo;marvelous\u0026rdquo;) and Bartlett\u0026rsquo;s Test for Sphericity.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOur multidisciplinary team determined our final factor solution and items based on factor loading scores and conceptual consistency within and across factors when examining the pattern matrix after iterative removal of items. We started with a 7-factor solution, based on prior findings, and explored 6-factor and 8-factor solutions. We set a cut-point for factor loadings in the pattern matrix of \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;0.40 to retain an item, then iteratively removed items and reran analyses. We calculated Cronbach\u0026rsquo;s alpha coefficients within each factor to evaluate internal consistency reliabilities for each subscale, with α\u0026thinsp;\u0026gt;\u0026thinsp;.7\u0026thinsp;=\u0026thinsp;Acceptable, α\u0026thinsp;\u0026gt;\u0026thinsp;.8\u0026thinsp;=\u0026thinsp;Good, α\u0026thinsp;\u0026gt;\u0026thinsp;.9\u0026thinsp;=\u0026thinsp;Excellent,\u003csup\u003e14\u003c/sup\u003e though α\u0026thinsp;\u0026gt;\u0026thinsp;.6 is considered acceptable for exploratory studies.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e We also examined Cronbach\u0026rsquo;s alpha if each item was removed. Final item inclusion/removal decisions were made based on a combination of α\u0026rsquo;s and consistency with theoretical model.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/strong\u003e. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe sent a link to the consent form and MHPQ survey in REDCap to n=297 eligible participants who had completed a self-reported TBIMS follow-up interview in English or Spanish and agree to be contacted about this \u0026nbsp;additional study. Of those, n=283 (95.2%) opened the survey link [261 (92.8%) selected English as their primary language and 22 (7.8%) selected Spanish). \u0026nbsp;Of those 261 who selected English, n=256 (98.0%) consented to the study and n=250 (97.7%) completed the full MHPQ in English. \u003cstrong\u003eTable 1\u003c/strong\u003e presents brief demographics of the sample.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 384px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Participant Characteristics (n=250)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD), Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e45.8 (16.2), 18-90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eCIS-male\u003c/p\u003e\n \u003cp\u003eCIS-female\u003c/p\u003e\n \u003cp\u003eTransgender/non-binary/declined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e171 (68.4)\u003c/p\u003e\n \u003cp\u003e77 (30.8)\u003c/p\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eHispanic/Latino Ethnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e40 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003cp\u003eMultiracial\u003c/p\u003e\n \u003cp\u003eIndigenous/Native American\u003c/p\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003cp\u003eOther race\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (18.0)\u003c/p\u003e\n \u003cp\u003e170 (68.0)\u003c/p\u003e\n \u003cp\u003e11 (4.4)\u003c/p\u003e\n \u003cp\u003e7 (2.8)\u003c/p\u003e\n \u003cp\u003e5 (2.0)\u003c/p\u003e\n \u003cp\u003e13 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFactor Structure\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExploratory factor analysis yielded an 8-factor solution with 53 final items; 11 items were removed and 1 item related to taking care of loved ones was not part of any factor but kept for contextual relevance. All factors included at least 5 items. See \u003cstrong\u003eTable 2\u003c/strong\u003e for all items and factor loadings. The Kaiser-Meyer-Olkin=.832 (\u0026ldquo;meritorious\u0026rdquo; sampling adequacy) and Bartlett\u0026rsquo;s Test of Sphericity (p\u0026lt;.001) indicated appropriateness of factor analysis in this sample. We named the eight factors: 1)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAnticipated Discrimination and Judgement, 2) Communication with Healthcare Providers, 3) Spiritual Health Beliefs, 4) Health Self-Efficacy (Internal LOC), 5) Trust in Social Health Advice, 6) Trust in Medicine, 7) How Health Affects My Life, and 8) How Others Affect My Health.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"912\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e \u003cstrong\u003eTable 2: Final factor loadings (pattern matrix)\u003c/strong\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eHealthcare providers see me as a burden.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.455\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI will be denied healthcare.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.783\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI will be denied medical tests or procedures.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.845\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI will not be allowed to see the healthcare provider I want.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.824\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI will not see a healthcare provider if I think I will feel uncomfortable.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.513\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e-.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI will receive poor quality healthcare.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.754\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI will be treated with less respect than other people.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.799\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eHealthcare providers treat me like I am not smart.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.707\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eHealthcare providers treat me like I am dishonest.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.761\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eHealthcare providers act like they think I am beneath them.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.809\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI can follow instructions to manage my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.465\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI can communicate well with my healthcare providers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.824\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI can follow instructions about medications to manage my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.477\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI feel comfortable asking my healthcare providers questions about my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.712\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI understand what my healthcare providers tell me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.743\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eHealth information I get from my providers makes sense to me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.773\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI believe my healthcare provider will respect me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.636\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eMy healthcare providers do not understand my point of view.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-.549\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI am confident that healthcare providers can help me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.449\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eLack of faith in God or another higher power can cause poor health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.783\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eMiracles can make people better when they are sick.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.680\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eHealth problems are a punishment from God or another higher power.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.398\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003ePraying helps health problems.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.813\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eFaith or spiritual or religious practices can improve health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.732\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eEvil spirits can cause health problems.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.671\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eGod or another higher power is in control of whether my health gets better or worse.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.882\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eWhatever happens to my health is Gods or another higher powers will.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.858\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eMy health mostly depends on my behaviors.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.616\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI can change my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.670\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI am in control of my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.639\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI can manage my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.679\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI can find new ways to improve my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.627\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI trust health advice from family and friends.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.391\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI trust health advice that I find on the internet.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.847\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI trust health advice that I see on TV.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.881\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI trust health advice that I see on social media.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.848\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI trust health advice from my religious or spiritual leaders.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.346\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eWhen I don\u0026rsquo;t feel well, I should talk to a healthcare provider.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.592\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI trust health advice from healthcare providers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.797\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eMedicines are effective.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.525\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eFollowing a doctor\u0026rsquo;s advice leads to better health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.716\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI usually agree with my healthcare providers\u0026rsquo; recommendations.*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.244\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI trust healthcare providers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.435\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eHealth problems make it more difficult to work, go to school or function at home.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.737\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eMy health affects my mood.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.696\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eMy health affects my sex life.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.775\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eMy health problems are a burden to others.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.583\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI am embarrassed by my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e-.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.449\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eOthers\u0026rsquo; thoughts and feelings affect my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.645\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eBeing surrounded by people with bad intentions can have a negative effect on my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.493\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eMy family has a lot to do with how healthy or unhealthy I am.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.661\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eHealthcare providers control my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.641\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI rely on other people (doctors, nurses, family, friends) to take care of me and keep me healthy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e-.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.573\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 374px;\"\u003e\n \u003cp\u003eI can manage the health of my loved ones.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e-.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width: 912px;\"\u003e\n \u003cp\u003eKMO=.832, X-squared p\u0026lt;.001\u003cbr\u003e\u0026nbsp;*We kept this item on the \u003cem\u003eTrust in Medicine\u003c/em\u003e subscale after considering the conceptual model and flagged it for further evaluation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eF1\u0026nbsp;\u003c/strong\u003eAnticipated Discrimination and Judgement\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF2\u0026nbsp;\u003c/strong\u003eCommunication with Healthcare Providers\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF3\u0026nbsp;\u003c/strong\u003eSpiritual Health Beliefs\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF4\u0026nbsp;\u003c/strong\u003eHealth Self-Efficacy\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF5\u0026nbsp;\u003c/strong\u003eTrust in Social Health Advice\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF6\u0026nbsp;\u003c/strong\u003eTrust in Medicine\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF7\u0026nbsp;\u003c/strong\u003eHow Health Affects My Life\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF8\u0026nbsp;\u003c/strong\u003eHow Others Affect My Health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInternal Consistency Reliabilities\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCronbach\u0026rsquo;s alpha coefficients indicated acceptable to excellent internal consistency for all factors, as follows:\u0026nbsp;\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eAnticipated Discrimination and Judgement (10 items; \u0026alpha;=.90)\u003c/li\u003e\n \u003cli\u003eCommunication with Healthcare providers (9 items; \u0026alpha;=.79)\u003c/li\u003e\n \u003cli\u003eSpiritual Health Beliefs (8 items, \u0026alpha;=.88)\u003c/li\u003e\n \u003cli\u003eHealth Self-Efficacy (5 items, \u0026alpha;=.73)\u003c/li\u003e\n \u003cli\u003eTrust in Social Health Advice (5 items, \u0026alpha;=.78)\u003c/li\u003e\n \u003cli\u003eTrust in Medicine (6 items, \u0026alpha;=.76)\u003c/li\u003e\n \u003cli\u003eHow Health Affects My Life (5 items, \u0026alpha;=.71)\u003c/li\u003e\n \u003cli\u003eHow Others Affect My Health (5 items, \u0026alpha;=.64)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAs each factor, or subscale, demonstrates unidimensionality, subsequent Rasch analysis will be conducted for each subscale. Individual items were flagged for further investigation during Rasch analysis for Factors 1, 2, 3, 4, and 8, because they cross-loaded with a second factor or because the alpha improved if they were removed from the subscale.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe identified an eight-factor structure for the MHPQ with 53 final items, which maps well to the Multidimensional Health Perceptions Model upon which it was based\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and addresses some of the more hard to define subscales previously identified in the 7-factor version (e.g., Social and Emotional Health Beliefs, Health Literacy).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Items from the previous Social and Emotional Health Beliefs subscale separated to more clearly align with external locus of control (\u003cem\u003eHow Others Affect My Health\u003c/em\u003e) and consequences of health (\u003cem\u003eHow Health Affects My Life\u003c/em\u003e). Items from the previous Health Literacy subscale clearly divided into ability to follow health advice (\u003cem\u003eHealth Self-Efficacy\u003c/em\u003e, which also includes items aligning with internal locus of control) and ability to express and to comprehend health needs and instructions (\u003cem\u003eCommunication with Healthcare Providers\u003c/em\u003e). Conceptually consistent and well-defined domains, measured by the subscales, will enable more effective recommendations for how to tailor health communications and recommendations for individuals based on their beliefs and perceptions across these different domains.\u003c/p\u003e\u003cp\u003eThe Exploratory Factor Analysis revealed that some items cross-loaded to multiple factors, meaning that these items may reflect multiple components of health perceptions. For each of these seven items, we determined which factor the item conceptually aligned with more. Additionally, for some subscales, the Cronbach\u0026rsquo;s alpha improved with removal of an item. When this happened (for five items), if the item was not considered to be conceptually important by experts, those items were permanently removed from the measure (two items). However, when experts determined that the \u0026ldquo;removed\u0026rdquo; item was conceptually important and consistent with the domain, they were retained and flagged for further evaluation during Rasch analysis (three items). For example, although the \u0026ldquo;I usually agree with healthcare recommendations\u0026rdquo; item loaded strongly on the \u003cem\u003eCommunication with Healthcare Providers\u003c/em\u003e subscale in the final iteration of the factor analysis, we kept it in the \u003cem\u003eTrust in Medicine\u003c/em\u003e subscale after considering the conceptual model; we flagged it for further evaluation during Rasch analysis. Lastly, as in the prior version of the MHPQ, the item \u0026ldquo;I can manage the health of my loved ones\u0026rdquo; was not included in any of the final eight factors but was retained as a stand-alone item relevant to unique health perceptions of informal caregivers.\u003c/p\u003e\u003cp\u003eThe MHPQ measures an individual\u0026rsquo;s beliefs about their health and perceptions of factors that may impact their health. If providers can better understand the health perceptions captured by the MHPQ and how these perceptions might affect their patients/clients, they will be empowered to better adapt their communication approaches and practice culturally humble and patient-centered care. Therefore, the MHPQ has the potential to be a helpful tool to inform clinicians how they may best interact in ways that respect and incorporate their patients\u0026rsquo; perceptions and values, making it more likely that patients will incorporate recommendations into their daily lives and subsequently improve their health.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThough we had a robust sample size overall, the sample size for primarily Spanish-speaking individuals was small and did not allow us to run the EFA in this group. The results presented here are, therefore, only inclusive of English-speaking participants. We will continue to explore ways to validate the Spanish-language MHPQ that account for the smaller sample size. Overall, the internal consistency reliabilities were all acceptable to excellent, though lower than preferred for \u003cem\u003eHow Other Affect My Health\u003c/em\u003e (factor 8). Rasch analysis may reveal opportunities to improve this subscale. Lastly, the TBI Model Systems includes individuals with TBI severe enough to require inpatient rehabilitation and those with access to a TBI Model Systems Center; this sample does not, therefore, represent the broader population of adults with TBI whose initial injuries are less severe and/or who do not receive inpatient rehabilitation.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe MHPQ has a psychometrically strong and clinically meaningful factor structure in a diverse sample of English speakers with a history of TBI requiring inpatient rehabilitation. An individual\u0026rsquo;s factor scores may guide healthcare providers in how to best communicate recommendations in ways that may enhance their uptake. Further validation of the English-language MHPQ through Rasch analysis and for the Spanish-language version of the MHPQ are forthcoming.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All procedures were approved by the UT Houston IRB which served as the single reliance IRB for all sites. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from participants; no identifiable data were included in this publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of supporting data\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003c/em\u003e\u003c/strong\u003eThe contents of this manuscript were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DPTB0019; 90DPTB0022; 90DPTB0023; 90DPTB0025; 90DPTB0027). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). \u0026nbsp;The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJuengst SB, Sander AM, Vega M, Braga MB, Khera A, Pappadis MR. Factor Structure of the Multidimensional Health Perceptions Questionnaire in English- and Spanish-speakers. Published online January 19, 2024. doi:10.21203/rs.3.rs-3873462/v1\u003c/li\u003e\n\u003cli\u003eLum D. \u003cem\u003eCulturally Competent Practice: A Framework for Understanding\u003c/em\u003e. Cengage Learning; 2010.\u003c/li\u003e\n\u003cli\u003eSaha S, Beach MC, Cooper LA. 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In: \u003cem\u003eHealth Behavior and Health Education: Theory, Research, and Practice.\u003c/em\u003e 3rd ed. Jossey-Bass; 2022:45-65.\u003c/li\u003e\n\u003cli\u003eWang C, O\u0026rsquo;Neill SM, Rothrock N, et al. Comparison of risk perceptions and beliefs across common chronic diseases. \u003cem\u003ePrev Med\u003c/em\u003e. 2009;48(2):197-202. doi:10.1016/j.ypmed.2008.11.008\u003c/li\u003e\n\u003cli\u003eOwnby RL, Acevedo A, Waldrop-Valverde D, Jacobs RJ, Caballero J. Abilities, skills and knowledge in measures of health literacy. \u003cem\u003ePatient Educ Couns\u003c/em\u003e. 2014;95(2):211-217. doi:10.1016/j.pec.2014.02.002\u003c/li\u003e\n\u003cli\u003eRajaram S, Bockrath S. Cultural Competence: New Conceptual Insights into its Limits and Potential for Addressing Health Disparities. \u003cem\u003eJ Health Disparities Res Pract\u003c/em\u003e. 2015;7(5). https://digitalscholarship.unlv.edu/jhdrp/vol7/iss5/6\u003c/li\u003e\n\u003cli\u003eMackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? \u003cem\u003eMed Decis Mak Int J Soc Med Decis Mak\u003c/em\u003e. 2016;36(6):741-759. doi:10.1177/0272989X16638330\u003c/li\u003e\n\u003cli\u003eCurtin KD, Thomson M, Nykiforuk CIJ. Who or what is to blame? Examining sociodemographic relationships to beliefs about causes, control, and responsibility for cancer and chronic disease prevention in Alberta, Canada. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2021;21(1):1047. doi:10.1186/s12889-021-11065-4\u003c/li\u003e\n\u003cli\u003eChan IS, Ginsburg GS. Personalized Medicine: Progress and Promise. \u003cem\u003eAnnu Rev Genomics Hum Genet\u003c/em\u003e. 2011;12(1):217-244. doi:10.1146/annurev-genom-082410-101446\u003c/li\u003e\n\u003cli\u003eStevens JP. \u003cem\u003eApplied Multivariate Statistics for the Social Sciences, Fifth Edition\u003c/em\u003e. 5 edition. Routledge; 2009.\u003c/li\u003e\n\u003cli\u003eThe Standards for Educational and Psychological Testing. http://www.apa.org. Accessed April 19, 2016. http://www.apa.org/science/programs/testing/standards.aspx\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"700a0d4e-90dc-4604-87f0-35fbe8f0b1f5","identifier":"10.13039/100009157","name":"National Institute on Disability, Independent Living, and Rehabilitation Research","awardNumber":"90DPTB0019; 90DPTB0022; 90DPTB0023; 90DPTB0025; 90DPTB0027","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"TIRR Memorial Hermann","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health Belief Model, Psychometrics, Health Literacy, Locus of Control, Exploratory Factor Analysis","lastPublishedDoi":"10.21203/rs.3.rs-7651996/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7651996/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground: \u003c/strong\u003e\u003c/em\u003eHealth 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.\u0026nbsp; 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 \u003cu\u003e\u0026lt;\u003c/u\u003e8\u003csup\u003eth\u003c/sup\u003e 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.\u003csup\u003e1\u003c/sup\u003e Additionally, validation in unique populations – like traumatic brain injury (TBI) – is consistent with best practice.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eObjective: \u003c/strong\u003e\u003c/em\u003eTo determine the factor structure of the MHPQ among adults with \u003cu\u003e\u0026gt;\u003c/u\u003e1 year history of traumatic brain injury (TBI) that required inpatient rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eParticipants: \u003c/strong\u003e\u003c/em\u003eParticipants (n=250) enrolled in the TBI Model Systems National Database across five participating centers who completed a follow-up assessment between September 1\u003csup\u003est\u003c/sup\u003e, 2023 and June 19\u003csup\u003eth\u003c/sup\u003e, 2024. All participants had experienced a TBI requiring inpatient rehabilitation and ranged from 1-35 years post-injury. All were\u0026nbsp; able to complete a self-reported survey.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e\u003c/em\u003eWe 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u003c/em\u003eN=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)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003e\u003c/em\u003eResults 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.\u003c/p\u003e","manuscriptTitle":"Factor Structure of the Multidimensional Health Perceptions Questionnaire in Adults with a History of Traumatic Brain Injury: A TBI Model Systems Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 08:33:18","doi":"10.21203/rs.3.rs-7651996/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f115a983-6b69-42b9-8d81-4a7f0271d2df","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T08:33:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 08:33:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7651996","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7651996","identity":"rs-7651996","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}