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As overall fit to the model was achieved it was decided not to remove this item and to retain it for further investigation.
(KI-1, Kongwa) Another member of the CHMT added that: Sometimes during budgeting someone at the Ministry commented that we as the Ministry [government] have decided to put our efforts into medicine so remove this item [health promotion].
In situations where one form of review bias does not apply there are two possibilities: either score the relevant item as "yes" or remove this item from the list.
The level of education is included in the MDHAQ-S but, since it has no correlation with health literacy, it may be possible to remove this item from MDHAQ-S in the future [ 41].
Considering this item refers to "satisfaction with sex life" and the literature has reported that participants infrequently respond to this item [ 30] and that FACIT permits its exclusion, we decided to remove this item from the analysis.
This may be an indication that this item is more distinctive, and less strongly consistent with the content of the remainder: when H i values in this range are observed, one suggestion for a practical step in the analysis is that we could remove this item, and recompute H i values for the remaining set of items.
Similar(53)
Firstly, none of the respondents scored positive on item A6: " Do you need help with eating?" Therefore, we removed this item from the model.
Nevertheless removing this item had no impact on global model fit, thus suggesting that improvement should be expected from a better translation of the original item.
An additional explanation could be that item 24 displayed some signs of misfit in the DIF-adjusted scale, although removing this item did not lead to unequivocal improvements.
Removing this item from the total painDETECT score lowered the proportion of patients with possible NP from 38.4 % to 29%% in the current study.
All items appeared to be worthy of retention: the greatest increase in alpha came from deleting the item that referred to threatening with a knife or a firearm, but removing this item increased the alpha by only 0.01.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com