Validity and internal consistency of the HELP Scor einstrument for assessing the severity of hyperemesis gravidarum symptoms

Abstract

Objectives: To determine the validity and internal consistency of the HELP Score instrument, designed to assess the severity of symptoms in hyperemesis gravidarum.

Material and methods: A validation study of a measurement instrument was conducted within a cross-sectional study framework, that included women with hyperemesis gravidarum. Content validity was evaluated using the Content Validity Coefficient (CVC). Correlation analysis, exploratory factor analysis, and confirmatory factor analysis were performed using the Kaiser method, Cattell’s scree plot, the chi-square/degrees of freedom ratio (χ²/df), the Comparative Fit Index (CFI), and the Standardized Root Mean Square Residual (SRMR). Internal consistency was assessed using Cronbach’s alpha. The sample consisted of 60 pregnant women from the Colombian Caribbean region.

Results: The mean age was 24 ± 5.14 years, and the mean gestational age was 11.2 ± 3.76 weeks. The content validity coefficient ranged from 0.83 to 0.99. Exploratory factor analysis identified two factors with eigenvalues >1, explaining 78.9% of the total cumulative variance, confirmed by Cattell’s scree plot. Confirmatory factor analysis suggested the use of only 10 items from the HELP instrument, with χ²/df, CFI, and SRMR values of 2.9, 0.90, and 0.04, respectively. However, based on expert judgment, two excluded items (items 9 and 12) were retained due to their clinical relevance. Cronbach’s alpha coefficient was 0.95.

Conclusions: The HELP Score instrument is a valid tool for assessing the severity of hyperemesis gravidarum, facilitating medical decision-making regarding necessary interventions. Further evaluation of criterion validity by comparing the HELP Score with the modified PUQE instrument, sensitivity to change, and additional reliability testing are needed to confirm its utility.