Assessment of validity and reliability of the Indonesian version of Short Form 12 (SF-12)


internal consistency
test-retest reliability
factor analysis


Introduction: Psychometric evaluation of the 12-item Short-Form Health Survey (SF-12), a well-used scale for measuring health-related quality of life (HrQoL), has not been done in general populations in Indonesia. This study assessed the validity and reliability of the SF-12 in middle-aged and older adults.

Methods: In total, 161 adults aged 46-81 years (70% female) self-completed the SF-12 and SF-36. Scaling assumptions, internal consistency reliability, and 1-week test-retest reliability were assessed for the SF-12. Confirmatory factor analysis was conducted to assess its construct validity. Correlations between SF-12 and SF-36 component scores were computed to assess convergent and divergent validity. Effect size differences were calculated between SF-12 and SF-36 component scores for assessing criterion validity.

Results: Scaling assumptions were satisfactory. Internal consistency for the SF-12 Physical Component Summary (PCS-12) and the Mental Component Summary (MCS-12) were acceptable (a=0.72 and 0.73, respectively) and test-retest reliability was excellent (ICC=0.88 and 0.75, respectively). A moderate fit of the original two-latent structure to the data was found (root mean square error of approximation [RMSEA]=0.08). Allowing a correlation between physical and emotional role limitation subscales improved fit (RMSEA=0.04). Correlations between SF-12 and SF-36 component summary scores support convergent and divergent validity although a medium effect size difference between PCS-12 and PCS-36 (Cohen’s d=0.61) was found.

Conclusion: This study provides the first evidence that SF-12 is a reliable and valid measure of HrQoL in Indonesian middle-aged and older adults. The algorithm for computing SF-12 and its association with SF-36 in the Indonesian population warrant further investigation.


1. Adioetomo SM, Mujahid G, Posselt H. Indonesia on the threshold of population ageing Jakarta, Indonesia 2014. Available at:
2. Central Bureau of Statistics of Indonesia, United Nations Population Fund. Indonesia population projection 2010-2035: Central Bureau of Statistics of Indonesia; 2013. Available at:
3. Sajid M, Tonsi A, Baig M. Health‐related quality of life measurement. International journal of health care quality assurance. 2008. doi: 10.4103/0975-1483.93568.
4. Lin X-J, Lin I-M, Fan S-Y. Methodological issues in measuring health-related quality of life. Tzu Chi Medical Journal. 2013;25(1):8-12. doi: 10.1016/j.tcmj.2012.09.002.
5. Bottomley A, Reijneveld JC, Koller M, Flechtner H, Tomaszewski KA, Greimel E, Ganz PA, Ringash J, O'connor D, Kluetz PG. Current state of quality of life and patient-reported outcomes research. European Journal of Cancer. 2019;121:55-63. doi: 10.1016/j.ejca.2019.08.016.
6. Hays RD, Sherbourne CD, Mazel RM. The rand 36‐item health survey 1.0. Health economics. 1993;2(3):217-27. doi: 10.1002/hec.4730020305.
7. Arovah NI, Heesch KC. Verification of the Reliability and Validity of the Short Form 36 Scale in Indonesian Middle-aged and Older Adults. Journal of Preventive Medicine and Public Health. 2020;53(3):180-8. doi: 10.3961/jpmph.19.324.
8. Ware Jr JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical care. 1996:220-33. doi: 10.1097/00005650-199603000-00003.
9. Younsi M. Health-related quality-of-life Measures: evidence from Tunisian population using the SF-12 health survey. Value in health regional issues. 2015;7:54-66. doi: 10.1016/j.vhri.2015.07.004.
10. Montazeri A, Vahdaninia M, Mousavi SJ, Omidvari S. The Iranian version of 12-item Short Form Health Survey (SF-12): factor structure, internal consistency and construct validity. BMC public health. 2009;9(1):341. doi: 10.1186/1471-2458-9-341.
11. Lam CL, Eileen Y, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Quality of life Research. 2005;14(2):539-47. doi: 10.1007/s11136-004-0704-3.
12. Kontodimopoulos N, Pappa E, Niakas D, Tountas Y. Validity of SF-12 summary scores in a Greek general population. Health and quality of life outcomes. 2007;5(1):55. doi: 10.1186/1477-7525-5-55.
13. Sanderson K, Andrews G. The SF‐12 in the Australian population: cross‐validation of item selection. Australian and New Zealand journal of public health. 2002;26(4):343-5. doi: 10.1111/j.1467-842x.2002.tb00182.x.
14. Amir M, Lewin-Epstein N, Becker G, Buskila D. Psychometric properties of the SF-12 (Hebrew version) in a primary care population in Israel. Medical Care. 2002:918-28. doi: 10.1097/00005650-200210000-00009.
15. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. Journal of clinical epidemiology. 1998;51(11):1171-8. doi: 10.1016/s0895-4356(98)00109-7.
16. Jakobsson U. Using the 12-item Short Form health survey (SF-12) to measure quality of life among older people. Aging clinical and experimental research. 2007;19(6):457-64. doi: 10.1007/BF03324731.
17. Bentur N, King Y. The challenge of validating SF-12 for its use with community-dwelling elderly in Israel. Quality of Life Research. 2010;19(1):91-5. doi: 10.1007/s11136-009-9562-3.
18. Resnick B, Nahm ES. Reliability and validity testing of the revised 12-item Short-Form Health Survey in older adults. Journal of nursing measurement. 2001;9(2):151-61. doi: 1061-3749.9.2.151.
19. Cernin PA, Cresci K, Jankowski TB, Lichtenberg PA. Reliability and validity testing of the short-form health survey in a sample of community-dwelling African American older adults. Journal of Nursing Measurement. 2010;18(1):49-59. doi: 10.1891/1061-3749.18.1.49.
20. Resnick B, Parker R. Simplified scoring and psychometrics of the revised 12-item Short-Form Health Survey 2001. 161-6]. Available at:
21. Pettit T, Livingston G, Manela M, Kitchen G, Katona C, Bowling A. Validation and normative data of health status measures in older people: the Islington study. International journal of geriatric psychiatry. 2001;16(11):1061-70. doi: 10.1002/gps.479.
22. Shou J, Ren L, Wang H, Yan F, Cao X, Wang H, Wang Z, Zhu S, Liu Y. Reliability and validity of 12-item Short-Form health survey (SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai. Aging Clinical and Experimental Research. 2016;28(2):339-46. doi: 10.1007/s40520-015-0401-9.
23. Shu-Wen S, Dong W. The Reliability and Validity of Short Form-12 Health Survey Version 2 for Chinese Older Adults 2019. 1014]. Available at:
24. Islam N, Khan IH, Ferdous N, Rasker JJ. Translation, cultural adaptation and validation of the English “Short form SF 12v2” into Bengali in rheumatoid arthritis patients. Health and quality of life outcomes. 2017;15(1):109. doi: 10.1186/s12955-017-0683-z.
25. Chariyalertsak S, Wansom T, Kawichai S, Ruangyuttikarna C, Kemerer VF, Wu AW. Reliability and validity of Thai versions of the MOS-HIV and SF-12 quality of life questionnaires in people living with HIV/AIDS. Health and quality of life outcomes. 2011;9(1):15. doi: 10.1186/1477-7525-9-15.
26. Salyers MP, Bosworth HB, Swanson JW, Lamb-Pagone J, Osher FC. Reliability and validity of the SF-12 health survey among people with severe mental illness. Medical care. 2000:1141-50. doi: 10.1097/00005650-200011000-00008.
27. Ibrahim AA, Akindele MO, Ganiyu SO, Kaka B, Abdullahi BB, Sulaiman SK, Fatoye F. The Hausa 12-item short-form health survey (SF-12): Translation, cross-cultural adaptation and validation in mixed urban and rural Nigerian populations with chronic low back pain. PloS one. 2020;15(5):e0232223. doi: 10.1371/journal.pone.0232223.
28. Globe DR, Levin S, Chang TS, Mackenzie PJ, Azen S. Validity of the SF-12 quality of life instrument in patients with retinal diseases. Ophthalmology. 2002;109(10):1793-8. doi: 10.1016/s0161-6420(02)01124-7.
29. Webster KE, Feller JA. Comparison of the short form-12 (SF-12) health status questionnaire with the SF-36 in patients with knee osteoarthritis who have replacement surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(8):2620-6. doi: 10.1007/s00167-015-3904-1.
30. Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health and quality of life outcomes. 2008;6(1):11. doi: 10.1186/1477-7525-6-11.
31. Kathe N, Hayes CJ, Bhandari NR, Payakachat N. Assessment of reliability and validity of SF-12v2 among a diabetic population. Value in Health. 2018;21(4):432-40. doi: 10.1016/j.jval.2017.09.007.
32. Okonkwo OC, Roth DL, Pulley L, Howard G. Confirmatory factor analysis of the validity of the SF-12 for persons with and without a history of stroke. Quality of Life Research. 2010;19(9):1323-31. doi: 10.1007/s11136-010-9691-8.
33. Wicaksana AL, Maharani E, Hertanti NS. The Indonesian version of the Medical Outcome Survey‐Short Form 12 version 2 among patients with cardiovascular diseases. International Journal of Nursing Practice. 2020;26(2):e12804. doi: 10.1111/ijn.12804.
34. Jumayanti J, Wicaksana AL, Sunaryo EYAB. Quality of life in patients with cardiovascular in Yogyakarta. Jurnal Kesehatan. 2020;13(1):1-12. doi: 10.23917/jk.v13i1.11096.
35. Widhowati FI, Farmawati A, Dewi FST. Factors influencing quality of life among type 2 diabetes mellitus patients in Sleman Yogyakarta: An anaysis from the HDSS data 2015-2017 2020. Available at:
36. Falah NM, Putranto R, Setyohadi B, Rinaldi I. Reliability and Validity Test Of Indonesian Version Short Form 12 Quality of Life Questionnaire in Rheumatoid Arthritis Patient. Jurnal Penyakit Dalam Indonesia. 2017;4(3):105-11. doi: 10.7454/jpdi.v4i3.129.
37. Ware Jr JE, Gandek B. Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of clinical epidemiology. 1998;51(11):903-12. doi: 10.1016/s0895-4356(98)00081-x.
38. Ware JE, Keller SD, Kosinski M. SF-12: How to score the SF-12 physical and mental health summary scales: Health Institute, New England Medical Center; 1995. Available at:
39. Lim LL, Seubsman S-a, Sleigh A. Thai SF-36 health survey: tests of data quality, scaling assumptions, reliability and validity in healthy men and women. Health and quality of life outcomes. 2008;6(1):52. doi: 10.1186/1477-7525-6-52.
40. Leung YY, Ho KW, Zhu TY, Tam LS, Kun EW-L, Li EK-M. Testing scaling assumptions, reliability and validity of medical outcomes study short-form 36 health survey in psoriatic arthritis. Rheumatology. 2010;49(8):1495-501. doi: 10.1093/rheumatology/keq112.
41. Sharma B. A focus on reliability in developmental research through Cronbach’s Alpha among medical, dental and paramedical professionals. Asian Pacific Journal of Health Sciences. 2016;3(4):271-8. doi: 10.21276/apjhs.2016.3.4.43.
42. Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological assessment. 1994;6(4):284. doi: 10.1037/1040-3590.6.4.284.
43. Schreiber JB, Nora A, Stage FK, Barlow EA, King J. Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of educational research. 2006;99(6):323-38. doi: 10.3200/JOER.99.6.323-338.
44. MacCallum RC, Browne MW, Sugawara HM. Power analysis and determination of sample size for covariance structure modeling. Psychological methods. 1996;1(2):130. doi: 10.1037/1082-989X.1.2.130.
45. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal. 1999;6(1):1-55. doi: 10.1080/10705519909540118.
46. Shevlin M, Miles JN. Effects of sample size, model specification and factor loadings on the GFI in confirmatory factor analysis. Personality and Individual differences. 1998;25(1):85-90. doi: 10.1016/S0191-8869(98)00055-5.
47. Cohen J. A power primer. Psychological bulletin. 1992;112(1):155. doi: 10.1037//0033-2909.112.1.155.
48. Christensen LN, Ehlers L, Larsen FB, Jensen MB. Validation of the 12 item short form health survey in a sample from region Central Jutland. Social indicators research. 2013;114(2):513-21. doi: 10.1186/1477-7525-9-15.
49. Kline RB. Principles and practice of structural equation modeling: Guilford publications; 2015. 427 p.
50. Myers ND, Ahn S, Jin Y. Sample size and power estimates for a confirmatory factor analytic model in exercise and sport: A Monte Carlo approach. Research quarterly for exercise and sport. 2011;82(3):412-23