Item reduction
Based on the item-level evaluations and further informed by qualitative data from the initial instrument development, three items were removed from NASH-CHECK: the item “need to rest” was considered redundant due to high inter-item correlations; the item “worry to family” was considered potentially multidimensional due to multiple loadings in EFA and relatively low inter-item correlations; and “food restriction” was considered unrelated to the intended concept due to relatively low inter-item correlations and EFA factor loadings. Removal of these items resulted in the final 28-item version of NASH-CHECK.