Psychometric Validation of the Kazakh Version of the 9-Item European Heart Failure Self-Care Behaviour Scale

Introduction: Heart failure (HF) remains a leading global health challenge, with high hospitalization and mortality rates. Beyond pharmacological and device-based treatment, patient self-care is essential. The European Heart Failure Self-care Behaviour Scale (EHFScBS-9) is widely used to assess self-care, but no validated Kazakh version exists. This study aimed to translate, culturally adapt, and psychometrically validate the EHFScBS-9 in patients with chronic HF.
Methods: Translation followed the Brislin model with three independent forward translations, focus group review, and back-translation by a professional translator unfamiliar with the original instrument. The back-translation was reviewed and approved by the author of the scale, Professor T. Jaarsma (Linköping University, Sweden). A total of 78 patients with chronic HF hospitalized in the cardiology department between December 2024 and June 2025 were enrolled. Exclusion criteria were cognitive impairment (Mini-Cog <3) and non-Kazakh speakers. Ethical approval and informed consent were obtained. Participants completed both the Kazakh EHFScBS-9 and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Diagnosis and management of HF were performed in accordance with the clinical guidelines of the Ministry of Health of the Republic of Kazakhstan. Internal consistency was evaluated using Cronbach’s alpha, construct validity by factor analysis, and discriminant validity by Spearman’s correlation with the KCCQ.
Results: mean age of participants  was 64.5 years (28–88), with 63.3% males. The mean left ventricular ejection fraction was 40.3 ± 7.2%. The average EHFScBS-9 score was 25.9 ± 9.1, while the mean KCCQ score was 51.6 ± 14.6. The Kazakh EHFScBS-9 showed good internal consistency (Cronbach’s alpha = 0.82). Factor analysis supported the scale’s construct validity. A moderate negative correlation with the KCCQ (r = -0.47; p < 0.001) confirmed discriminant validity.
Conclusion: The Kazakh version of the EHFScBS-9 is reliable and valid for assessing self-care in patients with chronic HF, making it suitable for clinical practice and research in Kazakhstan.