ArticleValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research2026
Development and Validation of a Brief Healthcare Insecurity Scale in a Sample of US Adults Living With and Without HIV.
Article in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Financial, housing, food, and healthcare insecurities and their independent and joint associations with depressive symptoms and stress in a U.S. cohort of adults with and without HIV.Social science & medicine (1982) · 2026Article
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11 authors.
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Abstract
objectivesHealthcare insecurity is pervasive in the United States and abroad, with implications for health, particularly among people living with chronic conditions. Yet, a common definition is lacking and current measures are limited.
methodsWe developed and validated an 8-item healthcare insecurity scale (HCIS) using cross-sectional data collected from 2021 to 2022 from individuals living with and without HIV in the United States (n = 2513). Psychometric properties were assessed through confirmatory factor analysis and item response theory models, and measurement invariance was tested. Criterion and convergent validity were evaluated by examining associations between HCIS scores and health insurance status, socioeconomic factors, perceived stress, and self-reported physical, mental, and general health, adjusting for income and demographics.
resultsThe unidimensional scale demonstrated good local fit and sufficient global fit. Each item was strongly correlated with the latent trait of healthcare insecurity (standardized factor loadings ranging from 0.69 to 0.90). The scale showed strong measurement invariance across groups defined by HIV serostatus and gender. Mean (SD) HCIS scores were 1.2 (2.5). Higher scores among those with no health insurance demonstrated criterion validity. Higher scores among those with lower income, unemployment, or disability, as well as strong positive associations between HCIS scores and perceived stress and self-reported health supported convergent validity.
conclusionsThe HCIS is a psychometrically sound tool for comprehensively assessing healthcare insecurity in people living with or vulnerable to HIV, even in a sample highly linked to care. The brevity and scope of HCIS support its applicability in research on healthcare insecurity beyond access to health insurance.
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