Interpersonal reactivity index adaptation among expectant seroconcordant couples with HIV in Zambézia Province, Mozambique

Daniel E Sack, Michael B Frisby, Matthew A Diemer, Caroline De Schacht, Erin Graves, Aaron M Kipp, Almiro Emílio, Ariano Matino, Ezequiel Barreto, Sara Van Rompaey, Kenneth A Wallston, Carolyn M Audet, Daniel E Sack, Michael B Frisby, Matthew A Diemer, Caroline De Schacht, Erin Graves, Aaron M Kipp, Almiro Emílio, Ariano Matino, Ezequiel Barreto, Sara Van Rompaey, Kenneth A Wallston, Carolyn M Audet

Abstract

Background: The ability to understand another's emotions and act appropriately, empathy, is an important mediator of relationship function and health intervention fidelity. We adapted the Interpersonal Reactivity Index (IRI) - an empathy scale - among seroconcordant expectant couples with HIV in the Homens para Saúde Mais (HoPS+) trial - a cluster randomized controlled trial assessing couple-based versus individual treatment on viral suppression - in Zambézia Province, Mozambique.

Methods: Using baseline data from 1332 HoPS+ trial participants (666 couples), an exploratory factor analysis assessed culturally relevant questions from the IRI. Because empathy is interdependent among couples, we validated the results of the exploratory factor analysis using a dyadic confirmatory factor analysis (CFA) with dyadic measurement invariance testing. Finally, we assessed the relationship between scores on our final scale and basic demographic characteristics (sex, age, education, and depression) using t-tests.

Results: We found two subscales: 1) a seven-item cognitive empathy subscale (Cronbach's alpha 0.78) and 2) a six-item affective empathy subscale (Cronbach's alpha 0.73). The dyadic CFA found acceptable model fit and metric invariance across partners (Comparative Fit Index (CFI) = 0.914, Tucker Lewis Index = 0.904, Root Mean Squared Error of Approximation = 0.056, ΔCFI = 0.011). We observed higher cognitive (p: 0.012) and affective (p: 0.049) empathy among males and higher cognitive (p: 0.031) and affective (p: 0.030) empathy among younger participants. More educated participants had higher affective empathy (p: 0.017) and depressed participants had higher cognitive empathy (p: < 0.001). This two-subscale, 13-item version of the IRI measures cognitive and affective empathy in HoPS+ trial participants and adults while accounting for the interdependent nature of empathy within partner dyads.

Conclusions: This scale will allow us to assess the interplay between empathy and other psychometric constructs (stigma, social support, etc.) in the HoPS+ trial and how each relates to retention in HIV, adherence to treatment, and prevention of maternal to child HIV transmission. Furthermore, this scale can be adapted for other sub-Saharan African populations, which will allow researchers to better assess HIV-related intervention efficacy.

Trial registration: This study is within the context of the HoPS+ trial, registered at ClinicalTrials.gov as number NCT03149237 . Registered May 11, 2017.

Keywords: Dyadic analysis; Empathy; HIV/AIDS; Scale validation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A Conceptual Diagram of the Dyadic Empathy Confirmatory Factor Analysis. Cognitive and Affective dimensions of empathy are uniquely modeled for male and female partners. Dashed lines from each empathy construct to the corresponding items (boxes) indicate the relation between the construct and the items used to model it. Circles pointing to items represent each item’s error term. Covariances, represented by the curved and dashed lines between the constructs, capture the relationships between partners’ dimensions of empathy. Double-headed arrows between error terms capture the interdependence between partners’ responses to survey items

References

    1. (UNAIDS) JUNPoHA . Fact Sheet – July 2018. 2018.
    1. IaM I . Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique (IMASIDA 2015) Maputo: INS; 2017.
    1. John GC, Nduati RW, Mbori-Ngacha DA, Richardson BA, Panteleeff D, Mwatha A, et al. Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections. J Infect Dis. 2001;183(2):206–212.
    1. Audet CM, Blevins M, Chire YM, Aliyu MH, Vaz LM, Antonio E, et al. Engagement of men in antenatal care services: increased HIV testing and treatment uptake in a community participatory action program in Mozambique. AIDS Behav. 2016;20(9):2090–2100.
    1. Audet CM, Graves E, Barreto E, De Schacht C, Gong W, Shepherd BE, et al. Partners-based HIV treatment for seroconcordant couples attending antenatal and postnatal care in rural Mozambique: A cluster randomized trial protocol. Contemp Clin Trials. 2018;71:63–69.
    1. Audet CM, Graves E, Bravo M, Aliyu MH, Alvim F, Green AF, et al. Male engagement strategies effective in improving Option B+ retention in rural Mozambique. Paris: International AIDS Society; 2017.
    1. Dunlap J, Foderingham N, Bussell S, Wester CW, Audet CM, Aliyu MH. Male involvement for the prevention of mother-to-child HIV transmission: A brief review of initiatives in east, west, and Central Africa. Curr HIV/AIDS Rep. 2014;11(2):109–118.
    1. Farquhar C, Kiarie JN, Richardson BA, Kabura MN, John FN, Nduati RW, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr (1999) 2004;37(5):1620–1626.
    1. Ghanotakis E, Hoke T, Wilcher R, Field S, Mercer S, Bobrow EA, et al. Evaluation of a male engagement intervention to transform gender norms and improve family planning and HIV service uptake in Kabale, Uganda. Global Public Health. 2017;12(10):1297–1314.
    1. Peltzer K, Jones D, Weiss SM, Shikwane E. Promoting male involvement to improve PMTCT uptake and reduce antenatal HIV infection: a cluster randomized controlled trial protocol. BMC Public Health. 2011;11:778.
    1. Davis MH. A multidimensional approach to individual differences in empathy. J Pers Soc Psychol. 1980;10:85.
    1. Dvash J, Shamay-Tsoory SG. Theory of mind and empathy as multidimensional constructs neurological foundations. Top Lang Disord. 2014;34(4):282–295.
    1. Leiberg S, Anders S. The multiple facets of empathy: a survey of theory and evidence. Prog Brain Res. 2006;156:419–440.
    1. Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63(606):e76–e84.
    1. Flickinger TE, Saha S, Roter D, Korthuis PT, Sharp V, Cohn J, et al. Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care. Patient Educ Couns. 2016;99(2):220–226.
    1. Mercer SW, Higgins M, Bikker AM, Fitzpatrick B, McConnachie A, Lloyd SM, et al. General practitioners' empathy and health outcomes: A prospective observational study of consultations in areas of high and low deprivation. Ann Fam Med. 2016;14(2):117–124.
    1. Lin C, Li L, Wan D, Wu Z, Yan Z. Empathy and avoidance in treating patients living with HIV/AIDS (PLWHA) among service providers in China. AIDS Care. 2012;24(11):1341–1348.
    1. Devoldre I, Davis MH, Verhofstadt LL, Buysse A. Empathy and social support provision in couples: social support and the need to study the underlying processes. J Psychol. 2010;144(3):259–284.
    1. Peloquin K, Lafontaine MF. Measuring empathy in couples: validity and reliability of the interpersonal reactivity index for couples. J Pers Assess. 2010;92(2):146–157.
    1. Levesque C, Lafontaine MF, Carona A, Flesch JL, Bjornson S. Dyadic Empathy, Dyadic Coping, and Relationship Satisfaction: A Dyadic Model. Europe’s J Psychologty. 2014;10(1):17.
    1. Verhofstadt L, Devoldre I, Buysse A, Stevens M, Hinnekens C, Ickes W, et al. The role of cognitive and affective empathy in Spouses' support interactions: an observational study. PLoS One. 2016;11(2):e0149944.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.
    1. USAID . Education Washington, DC. 2019.
    1. The World Bank . Mozambique Economic Update: Less Poverty, but More Inequality. 2018.
    1. Innamorati M, Ebisch SJH, Gallese V, Saggino A. A bidimensional measure of empathy: empathic experience scale. PLoS One. 2019;14(4):e0216164.
    1. Batchelder L, Brosnan M, Ashwin C. The development and validation of the empathy components questionnaire (ECQ) PLoS One. 2017;12(1):e0169185.
    1. Cox CL, Uddin LQ, Di Martino A, Castellanos FX, Milham MP, Kelly C. The balance between feeling and knowing: affective and cognitive empathy are reflected in the brain's intrinsic functional dynamics. Soc Cogn Affect Neurosci. 2012;7(6):727–737.
    1. Reniers RL, Corcoran R, Drake R, Shryane NM, Vollm BA. The QCAE: a questionnaire of cognitive and affective empathy. J Pers Assess. 2011;93(1):84–95.
    1. Shamay-Tsoory SG. The neural bases for empathy. Neuroscientist. 2011;17(1):18–24.
    1. De Corte K, Buysse A, Verhofstadt LL, Roeyers H, Ponnet K, Davis MH. Measuring empathic tendencies: reliability and validity of the Dutch version of the interpersonal reactivity index. Psychol Belg. 2007;47(4):235–260.
    1. Fernandez AM, Dufey M, Kramp U. Testing the psychometric properties of the interpersonal reactivity index (IRI) in Chile empathy in a different cultural context. Eur J Psychol Assess. 2011;27(3):179–185.
    1. Siu AMH, Shek DTL. Validation of the interpersonal reactivity index in a Chinese context. Res Social Work Prac. 2005;15(2):118–126.
    1. American Psychiatric Association . DSM-5 Task Force. Diagnostic and statistical manual of mental disorders : DSM-5. 5. Washington, D.C.: American Psychiatric Association; 2013. p. 947.
    1. Cholera R, Gaynes BN, Pence BW, Bassett J, Qangule N, Macphail C, et al. Validity of the patient health questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014;167:160–166.
    1. Pence BW, Gaynes BN, Atashili J, O'Donnell JK, Tayong G, Kats D, et al. Validity of an interviewer-administered patient health questionnaire-9 to screen for depression in HIV-infected patients in Cameroon. J Affect Disord. 2012;143(1–3):208–213.
    1. Monahan PO, Shacham E, Reece M, Kroenke K, Ong'or WO, Omollo O, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in Western Kenya. J Gen Intern Med. 2009;24(2):189–197.
    1. Audet CM, Wainberg ML, Oquendo MA, Yu QR, Peratikos MB, Duarte CS, et al. Depression among female heads-of-household in rural Mozambique: A cross-sectional population-based survey. J Affect Disord. 2018;227:48–55.
    1. van Buuren S, Groothuis-Oudshoorn K. Mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45(3):1–67.
    1. Barnfather N, Amod Z. Empathy and personal experiences of trainees in an emotional literacy and persona doll programme in South Africa. S Afr J Psychol. 2012;42(4):598–607.
    1. MacRitchie V, Leibowitz S. Secondary traumatic stress, level of exposure, empathy and social support in trauma workers. S Afr J Psychol. 2010;40(2):149–158.
    1. Team RC. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2018.
    1. Henson RK, Roberts JK. Use of exploratory factor analysis in published research - common errors and some comment on improved practice. Educ Psychol Meas. 2006;66(3):393–416.
    1. Costello AB, Osborne J. Best Practices in Exploratory Factor Analysis: Four Recommendations for Getting the Most From Your Analysis. Pract Assess Res Eval. 2005;10:7.
    1. Cook WL, Kenny DA. The actor-partner interdependence model: A model of bidirectional effects in developmental studies. Int J Behav Dev. 2005;29(2):101–109.
    1. Rosseel Y. Lavaan: an R package for structural equation modeling. J Stat Softw. 2012;48(2):1–36.
    1. Meade AW, Johnson EC, Braddy PW. Power and sensitivity of alternative fit indices in tests of measurement invariance. J Appl Psychol. 2008;93(3):568–592.
    1. Brosseau-Liard PE, Savalei V. Adjusting incremental fit indices for nonnormality. Multivar Behav Res. 2014;49(5):460–470.
    1. Brosseau-Liard PE, Savalei V, Li LB. An investigation of the sample performance of two nonnormality corrections for RMSEA. Multivar Behav Res. 2012;47(6):904–930.
    1. Hu L-t, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6(1):1–55.
    1. Little TD. Longitudinal structural equation modeling. New York: The Guilford Press; 2013. p. 386.
    1. Putnick DL, Bornstein MH. Measurement invariance conventions and reporting: the state of the art and future directions for psychological research. Dev Rev. 2016;41:71–90.
    1. Sakaluk JK, Kilshaw R, Fisher AN, Leshner CE. Dyadic measurement invariance and its importance for replicability in romantic relationship research. preprint. PsyArXiv; 2019 2019/03/06/.
    1. Chen FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct Equ Model Multidiscip J. 2007;14(3):464–504.
    1. Satorra A, Bentler PM. Corrections to test statistics and standard errors in covariance structure analysis. Latent variables analysis: Applications for developmental research. Thousand Oaks: Sage Publications, Inc; 1994. pp. 399–419.
    1. Gruhn D, Rebucal K, Diehl M, Lumley M, Labouvie-Vief G. Empathy across the adult lifespan: longitudinal and experience-sampling findings. Emotion. 2008;8(6):753–765.
    1. Levy J, Goldstein A, Feldman R. The neural development of empathy is sensitive to caregiving and early trauma. Nat Commun. 2019;10(1):1905.
    1. O'Connor LE, Berry JW, Weiss J, Gilbert P. Guilt, fear, submission, and empathy in depression. J Affect Disord. 2002;71(1–3):19–27.
    1. Schreiter S, Pijnenborg GHM, Aan Het Rot M. Empathy in adults with clinical or subclinical depressive symptoms. J Affect Disord. 2013;150(1):1–16.
    1. Thoma P, Zalewski I, von Reventlow HG, Norra C, Juckel G, Daum I. Cognitive and affective empathy in depression linked to executive control. Psychiatry Res. 2011;189(3):373–378.
    1. Tully EC, Ames AM, Garcia SE, Donohue MR. Quadratic associations between empathy and depression as moderated by emotion dysregulation. J Psychol. 2016;150(1):15–35.

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