Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts
There is a deterioration in the quality of life (QoL) of survivor victims of warlike conflicts. Because there is a need to guaran-tee the effectiveness of assessment tools for these populations, we studied the adequacy of the World Health OrganizationQuality of Life Questionnaire (WHOQoL-BREF) to as...
- Autores:
-
Morales Valiente, Claudia
Mok, Liu
Wong, Alina
Manzanero Puebla, Antonio Lucas
Guarch Rubio, Marta
Simancas Fernández, Marlen Raquel
Celedón Rivero, José Carlos
Salas Picón, Wilson Miguel
- Tipo de recurso:
- Article of investigation
- Fecha de publicación:
- 2023
- Institución:
- Universidad Cooperativa de Colombia
- Repositorio:
- Repositorio UCC
- Idioma:
- eng
- OAI Identifier:
- oai:repository.ucc.edu.co:20.500.12494/54229
- Acceso en línea:
- https://hdl.handle.net/20.500.12494/54229
https://doi.org/10.1177/10731911231201145
- Palabra clave:
- Quality of life
WHOQoL-BREF
Victims
Factorial analysis
Bifactor model
- Rights
- closedAccess
- License
- http://creativecommons.org/publicdomain/zero/1.0/
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dc.title.eng.fl_str_mv |
Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts |
title |
Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts |
spellingShingle |
Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts Quality of life WHOQoL-BREF Victims Factorial analysis Bifactor model |
title_short |
Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts |
title_full |
Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts |
title_fullStr |
Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts |
title_full_unstemmed |
Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts |
title_sort |
Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts |
dc.creator.fl_str_mv |
Morales Valiente, Claudia Mok, Liu Wong, Alina Manzanero Puebla, Antonio Lucas Guarch Rubio, Marta Simancas Fernández, Marlen Raquel Celedón Rivero, José Carlos Salas Picón, Wilson Miguel |
dc.contributor.author.none.fl_str_mv |
Morales Valiente, Claudia Mok, Liu Wong, Alina Manzanero Puebla, Antonio Lucas Guarch Rubio, Marta Simancas Fernández, Marlen Raquel Celedón Rivero, José Carlos Salas Picón, Wilson Miguel |
dc.subject.proposal.eng.fl_str_mv |
Quality of life WHOQoL-BREF Victims Factorial analysis Bifactor model |
topic |
Quality of life WHOQoL-BREF Victims Factorial analysis Bifactor model |
description |
There is a deterioration in the quality of life (QoL) of survivor victims of warlike conflicts. Because there is a need to guaran-tee the effectiveness of assessment tools for these populations, we studied the adequacy of the World Health OrganizationQuality of Life Questionnaire (WHOQoL-BREF) to assess the QoL of 1,136 surviving victims of the armed conflict inColombia. Although this questionnaire has yielded promising results, questions remain about its psychometric suitability forspecific populations. We used model modification at the item level, comparisons of models with different factor structures,and dimensionality analysis to address the psychometric problems encountered. Dimensionality analysis using a bifactormodel suggests that WHOQoL-BREF total scores might be a more appropriate way of reporting results when model fit ade-quacy is not reached. Conclusions are offered on the psychometric properties of the WHOQoL-BREF, the evaluation ofspecial populations, and possible strategies to address future questionnaire modifications. |
publishDate |
2023 |
dc.date.issued.none.fl_str_mv |
2023 |
dc.date.accessioned.none.fl_str_mv |
2024-02-06T21:15:49Z |
dc.date.available.none.fl_str_mv |
2024-02-06T21:15:49Z |
dc.type.none.fl_str_mv |
Artículos Científicos |
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info:eu-repo/semantics/publishedVersion |
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http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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Text |
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Morales-Valiente, C., Mok, L., Wong, A., Manzanero, A. L., Guarch-Rubio, M., Simancas, M., Celedón-Rivero, J. C., & Salas-Picón, W. M. (2023). Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts. Assessment, 10731911231201144. https://doi.org/10.1177/10731911231201145 |
dc.identifier.issn.none.fl_str_mv |
10731911 |
dc.identifier.uri.none.fl_str_mv |
https://hdl.handle.net/20.500.12494/54229 |
dc.identifier.doi.none.fl_str_mv |
https://doi.org/10.1177/10731911231201145 |
dc.identifier.eissn.none.fl_str_mv |
15523489 |
identifier_str_mv |
Morales-Valiente, C., Mok, L., Wong, A., Manzanero, A. L., Guarch-Rubio, M., Simancas, M., Celedón-Rivero, J. C., & Salas-Picón, W. M. (2023). Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts. Assessment, 10731911231201144. https://doi.org/10.1177/10731911231201145 10731911 15523489 |
url |
https://hdl.handle.net/20.500.12494/54229 https://doi.org/10.1177/10731911231201145 |
dc.language.iso.none.fl_str_mv |
eng |
language |
eng |
dc.relation.citationendpage.none.fl_str_mv |
13 |
dc.relation.citationvolume.none.fl_str_mv |
2023 |
dc.relation.ispartofjournal.none.fl_str_mv |
Assessment |
dc.relation.references.none.fl_str_mv |
Alavi M., Visentin D. C., Thapa D. K., Hunt G. E., Watson R., Cleary M. (2020). Chi-square for model fit in confirmatory factor analysis. Journal of Advanced Nursing, 76(9), 2209–2211. https://doi.org/10.1111/jan.1439 Benitez-Borrego S., Guàrdia-Olmos J., Urzúa-Morales A. (2014). Factorial structural analysis of the Spanish version of WHOQOL-BREF: An exploratory structural equation model study. Quality of Life Research, 23(8), 2205–2212. https://doi.org/10.1007/s11136-014-0663-2 Bentler P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246. https://doi.org/10.1037/0033-2909.107.2.238 Bentler P. M. (1992). On the fit of models to covariances and methodology to the Bulletin. Psychological Bulletin, 112(3), 400–404. https://doi.org/10.1037/0033-2909.112.3.400 Bollen K. A. (1989). A new incremental fit index for general structural equation models. Sociological Methods & Research, 17(3), 303–316. https://doi.org/10.1177/0049124189017003004 Bollen K. A., Bauldry S. (2011). Three Cs in measurement models: Causal indicators, composite indicators, and covariates. Psychological Methods, 16(3), 265–284. https://doi.org/10.1037/a0024448 Chen F. F., West S., Sousa K. (2006). A comparison of bifactor and second-order models of quality of life. Multivariate Behavioral Research, 41(2), 189–225. https://doi.org/10.1207/s15327906mbr4102_5 Dueber D. M. (2017). Bifactor indices calculator. University of Kentucky Libraries. https://doi.org/10.13023/EDP.TOOL.01 Fayers P. M., Machin D. (2001). Quality of life: Assessment, analysis and interpretation [Reprint]. Wiley. Gagliardi J., Brettschneider C., König H.-H. (2021). Health-related quality of life of refugees: A systematic review of studies using the WHOQOL-BREF instrument in general and clinical refugee populations in the community setting. Conflict and Health, 15(1), 44. https://doi.org/10.1186/s13031-021-00378-1 Guaracha-Basáñez G. A., Contreras-Yáñez I., Hernández-Molina G., Estrada-González V. A., Pacheco-Santiago L. D., Valverde-Hernández S. S., Galindo-Donaire J. R., Peláez-Ballestas I., Pascual-Ramos V. (2022). Quality of life of patients with rheumatic diseases during the COVID-19 pandemic: The biopsychosocial path. PLOS ONE, 17(1), e0262756. https://doi.org/10.1371/journal.pone.0262756 Hammer J. H., Heath P. J., Vogel D. L. (2018). Fate of the total score: Dimensionality of the Conformity to Masculine Norms Inventory-46 (CMNI-46). Psychology of Men & Masculinity, 19(4), 645–651. https://doi.org/10.1037/men0000147 Hancock G. R., Mueller R. O. (2001). Rethinking construct reliability within latent variable systems. In Cudeck R., du Toit S., Soerbom D. (Eds.), Structural equation modeling: Present and future—A Festschrift in honor of Karl Joreskog (pp. 195–216). Scientific Software International. Hargreaves S. M., Nakano E. Y., Han H., Raposo A., Ariza-Montes A., Vega-Muñoz A., Zandonadi R. P. (2021). Quality of life of Brazilian vegetarians measured by the WHOQOL-BREF: Influence of type of diet, motivation and sociodemographic data. Nutrients, 13(8), 2648. https://doi.org/10.3390/nu13082648 Hewitt-Ramírez N., Juárez F., Parada-Baños A. J., Nuñez-Estupiñán X., Quintero-Barrera L. (2020). Efficacy of a primary care mental health program for victims of the armed conflict in Colombia. Peace and Conflict: Journal of Peace Psychology, 26(1), 62–77. https://doi.org/10.1037/pac0000436 Hu L., Bentler P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424–453. https://doi.org/10.1037/1082-989X.3.4.424 Hu L., Bentler P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118 Jackson D. L., Gillaspy J. A., Purc-Stephenson R. (2009). Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods, 14(1), 6–23. https://doi.org/10.1037/a0014694 Kline T. (2005). Psychological testing: A practical approach to design and evaluation. Sage. Lee S.-Y., Song X.-Y., Skevington S., Hao Y.-T. (2005). Application of structural equation models to quality of life. Structural Equation Modeling: A Multidisciplinary Journal, 12(3), 435–453. https://doi.org/10.1207/s15328007sem1203_5 López Huerta J. A., González Romo R. A., Tejada Tayabas J. M. (2017). Propiedades psicométricas de la versión en español de la escala de calidad de vida WHOQoL BREF en una muestra Mexicana [Psychometric properties of the Spanish version of the WHOQoL BREF quality of life scale in a Mexican sample]. Revista Iberoamericana de Diagnóstico y Evaluación—e Avaliação Psicológica, 44(2), 105–115. https://doi.org/10.21865/RIDEP44.2.09 Lucas-Carrasco R. (2012). The WHO Quality of Life (WHOQoL) Questionnaire: Spanish development and validation studies. Quality of Life Research, 21(1), 161–165. https://doi.org/10.1007/s11136-011-9926-3 MacCallum R. C. (1995). Model specification: Procedures, strategies, and related issues. In Hoyle R. H. (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 16–36). Sage. Martini S., Setia Ningrum D. A., Abdul-Mumin K. H., Yi-Li C. (2022). Assessing quality of life and associated factors in post-stroke patients using the world health organization abbreviated generic quality of life questionnaire (WHOQOL-BREF). Clinical Epidemiology and Global Health, 13, 100941. https://doi.org/10.1016/j.cegh.2021.100941 Masaeli N., Billieux J. (2022). Is problematic internet and smartphone use related to poorer quality of life? A systematic review of available evidence and assessment strategies. Current Addiction Reports, 9(3), 235–250. https://doi.org/10.1007/s40429-022-00415-w Ohaeri J. U., Awadalla A. W., El-Abassi A.-H. M., Jacob A. (2007). Confirmatory factor analytical study of the WHOQOL-BREF: Experience with Sudanese general population and psychiatric samples. BMC Medical Research Methodology, 7(1), 37. https://doi.org/10.1186/1471-2288-7-37 Oliveira S. E. H., Carvalho H., Esteves F. (2016). Toward an understanding of the quality of life construct: Validity and reliability of the WHOQOL-BREF in a psychiatric sample. Psychiatry Research, 244, 37–44. https://doi.org/10.1016/j.psychres.2016.07.007 Perera H. N., Izadikhah Z., O’Connor P., McIlveen P. (2018). Resolving dimensionality problems with WHOQOL-BREF item responses. Assessment, 25(8), 1014–1025. https://doi.org/10.1177/1073191116678925 Reise S. P., Bonifay W. E., Haviland M. G. (2013). Scoring and modeling psychological measures in the presence of multidimensionality. Journal of Personality Assessment, 95(2), 129–140. https://doi.org/10.1080/00223891.2012.725437 Rodriguez A., Reise S. P., Haviland M. G. (2016). Evaluating bifactor models: Calculating and interpreting statistical indices. Psychological Methods, 21(2), 137–150. https://doi.org/10.1037/met0000045 Schermelleh-Engel K., Moosbrugger H., Müller H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8(2), 23–74. Simancas-Fernández M. R., Celedón-Rivero J. C., Salas-Picón W. M., Salgado-Ruiz D. E., Echeverry-Londoño M. C., Vásquez-Campos J. H., Guarch-Rubio M., Manzanero A. L. (2021). Trauma, reparation, and quality of life in victims of armed conflict after peace agreements. Anuario de Psicología Jurídica, 32(1), 79–86. https://doi.org/10.5093/apj2021a21 Singh A., Palaniyandi S., Palaniyandi A., Gupta V. (2022). Health related quality of life among rural elderly using WHOQOL-BREF in the most backward district of India. Journal of Family Medicine and Primary Care, 11(3), 1162–1168. https://doi.org/10.4103/jfmpc.jfmpc_1073_21 Steiger J. H. (2007). Understanding the limitations of global fit assessment in structural equation modeling. Personality and Individual Differences, 42(5), 893–898. https://doi.org/10.1016/j.paid.2006.09.017 Stucky B. D., Edelen M. O. (2014). Using hierarchical IRT models to create unidimensional measures from multidimensional data. In Reise S. P., Revicki D. A. (Eds.), Handbook of item response theory modeling (pp. 201–224). Routledge, Taylor & Francis Group. Stucky B. D., Thissen D., Orlando Edelen M. (2013). Using logistic approximations of marginal trace lines to develop short assessments. Applied Psychological Measurement, 37(1), 41–57. https://doi.org/10.1177/0146621612462759 Theuns P., Hofmans J., Mazaheri M., Van Acker F., Bernheim J. L. (2010). Cross-national comparability of the WHOQOL-BREF: A measurement invariance approach. Quality of Life Research, 19(2), 219–224. https://doi.org/10.1007/s11136-009-9577-9 Vinaccia S., Fernández H., Pedro E. M. S., Padilla G. V. (2006). Aplicación de la versión española del cuestionario Quality of Life Measure for Rheumatoid Arthritis (QOL-RA) en Colombia [Application of the Spanish version of the Quality of Life Measure for Rheumatoid Arthritis (QOL-RA) questionnaire in Colombia]. Revista Colombiana de Reumatología, 13(4), 7. Weston R., Gore P. A. (2006). A brief guide to structural equation modeling. The Counseling Psychologist, 34(5), 719–751. https://doi.org/10.1177/0011000006286345 Whittaker T. A. (2012). Using the Modification Index and standardized expected parameter change for model modification. The Journal of Experimental Education, 80(1), 26–44. https://doi.org/10.1080/00220973.2010.531299 The WHOQoL Group. (1998). The World Health Organization quality of life assessment (WHOQOL): Development and general psychometric properties. Social Science & Medicine, 46(12), 1569–1585. https://doi.org/10.1016/S0277-9536(98)00009-4 Widaman K. F., Thompson J. S. (2003). On specifying the null model for incremental fit indices in structural equation modeling. Psychological Methods, 8(1), 16–37. https://doi.org/10.1037/1082-989X.8.1.16 Yao G., Chung C.-W., Yu C.-F., Wang J.-D. (2002). Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. Journal of the Formosan Medical Association, 101(5), 10. Yuan K.-H. (2005). Fit indices versus test statistics. Multivariate Behavioral Research, 40(1), 115–148. https://doi.org/10.1207/s15327906mbr4001_5 |
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Morales Valiente, ClaudiaMok, LiuWong, AlinaManzanero Puebla, Antonio LucasGuarch Rubio, MartaSimancas Fernández, Marlen Raquel Celedón Rivero, José Carlos Salas Picón, Wilson Miguel 2024-02-06T21:15:49Z2024-02-06T21:15:49Z2023Morales-Valiente, C., Mok, L., Wong, A., Manzanero, A. L., Guarch-Rubio, M., Simancas, M., Celedón-Rivero, J. C., & Salas-Picón, W. M. (2023). Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts. Assessment, 10731911231201144. https://doi.org/10.1177/1073191123120114510731911https://hdl.handle.net/20.500.12494/54229https://doi.org/10.1177/1073191123120114515523489There is a deterioration in the quality of life (QoL) of survivor victims of warlike conflicts. Because there is a need to guaran-tee the effectiveness of assessment tools for these populations, we studied the adequacy of the World Health OrganizationQuality of Life Questionnaire (WHOQoL-BREF) to assess the QoL of 1,136 surviving victims of the armed conflict inColombia. Although this questionnaire has yielded promising results, questions remain about its psychometric suitability forspecific populations. We used model modification at the item level, comparisons of models with different factor structures,and dimensionality analysis to address the psychometric problems encountered. Dimensionality analysis using a bifactormodel suggests that WHOQoL-BREF total scores might be a more appropriate way of reporting results when model fit ade-quacy is not reached. Conclusions are offered on the psychometric properties of the WHOQoL-BREF, the evaluation ofspecial populations, and possible strategies to address future questionnaire modifications.13 p.engCanadaUniversidad Cooperativa de Colombia, Facultad de Ciencias Sociales, Psicología, Monteríahttp://creativecommons.org/publicdomain/zero/1.0/info:eu-repo/semantics/closedAccessCC0 1.0 Universalhttp://purl.org/coar/access_right/c_14cbhttps://journals.sagepub.com/doi/full/10.1177/10731911231201145?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.orgAdequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed ConflictsArtículos Científicosinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/coar/version/c_970fb48d4fbd8a85Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/publishedVersion132023AssessmentAlavi M., Visentin D. C., Thapa D. K., Hunt G. E., Watson R., Cleary M. (2020). Chi-square for model fit in confirmatory factor analysis. Journal of Advanced Nursing, 76(9), 2209–2211. https://doi.org/10.1111/jan.1439Benitez-Borrego S., Guàrdia-Olmos J., Urzúa-Morales A. (2014). Factorial structural analysis of the Spanish version of WHOQOL-BREF: An exploratory structural equation model study. Quality of Life Research, 23(8), 2205–2212. https://doi.org/10.1007/s11136-014-0663-2Bentler P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246. https://doi.org/10.1037/0033-2909.107.2.238Bentler P. M. (1992). On the fit of models to covariances and methodology to the Bulletin. Psychological Bulletin, 112(3), 400–404. https://doi.org/10.1037/0033-2909.112.3.400Bollen K. A. (1989). A new incremental fit index for general structural equation models. Sociological Methods & Research, 17(3), 303–316. https://doi.org/10.1177/0049124189017003004Bollen K. A., Bauldry S. (2011). Three Cs in measurement models: Causal indicators, composite indicators, and covariates. Psychological Methods, 16(3), 265–284. https://doi.org/10.1037/a0024448Chen F. F., West S., Sousa K. (2006). A comparison of bifactor and second-order models of quality of life. Multivariate Behavioral Research, 41(2), 189–225. https://doi.org/10.1207/s15327906mbr4102_5Dueber D. M. (2017). Bifactor indices calculator. University of Kentucky Libraries. https://doi.org/10.13023/EDP.TOOL.01Fayers P. M., Machin D. (2001). Quality of life: Assessment, analysis and interpretation [Reprint]. Wiley.Gagliardi J., Brettschneider C., König H.-H. (2021). Health-related quality of life of refugees: A systematic review of studies using the WHOQOL-BREF instrument in general and clinical refugee populations in the community setting. Conflict and Health, 15(1), 44. https://doi.org/10.1186/s13031-021-00378-1Guaracha-Basáñez G. A., Contreras-Yáñez I., Hernández-Molina G., Estrada-González V. A., Pacheco-Santiago L. D., Valverde-Hernández S. S., Galindo-Donaire J. R., Peláez-Ballestas I., Pascual-Ramos V. (2022). Quality of life of patients with rheumatic diseases during the COVID-19 pandemic: The biopsychosocial path. PLOS ONE, 17(1), e0262756. https://doi.org/10.1371/journal.pone.0262756Hammer J. H., Heath P. J., Vogel D. L. (2018). Fate of the total score: Dimensionality of the Conformity to Masculine Norms Inventory-46 (CMNI-46). Psychology of Men & Masculinity, 19(4), 645–651. https://doi.org/10.1037/men0000147Hancock G. R., Mueller R. O. (2001). Rethinking construct reliability within latent variable systems. In Cudeck R., du Toit S., Soerbom D. (Eds.), Structural equation modeling: Present and future—A Festschrift in honor of Karl Joreskog (pp. 195–216). Scientific Software International.Hargreaves S. M., Nakano E. Y., Han H., Raposo A., Ariza-Montes A., Vega-Muñoz A., Zandonadi R. P. (2021). Quality of life of Brazilian vegetarians measured by the WHOQOL-BREF: Influence of type of diet, motivation and sociodemographic data. Nutrients, 13(8), 2648. https://doi.org/10.3390/nu13082648Hewitt-Ramírez N., Juárez F., Parada-Baños A. J., Nuñez-Estupiñán X., Quintero-Barrera L. (2020). Efficacy of a primary care mental health program for victims of the armed conflict in Colombia. Peace and Conflict: Journal of Peace Psychology, 26(1), 62–77. https://doi.org/10.1037/pac0000436Hu L., Bentler P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424–453. https://doi.org/10.1037/1082-989X.3.4.424Hu L., Bentler P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118Jackson D. L., Gillaspy J. A., Purc-Stephenson R. 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Multivariate Behavioral Research, 40(1), 115–148. https://doi.org/10.1207/s15327906mbr4001_5Quality of lifeWHOQoL-BREFVictimsFactorial analysisBifactor modelPublicationLICENSElicense.txtlicense.txttext/plain; charset=utf-84334https://repository.ucc.edu.co/bitstreams/6f6793df-9815-4ddb-8218-59b2bd456b97/download3bce4f7ab09dfc588f126e1e36e98a45MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8701https://repository.ucc.edu.co/bitstreams/5e60ae02-df2c-4338-a4a2-f0282e922916/download42fd4ad1e89814f5e4a476b409eb708cMD52ORIGINAL20.500.12494/54229oai:repository.ucc.edu.co:20.500.12494/542292024-08-10 09:34:56.028http://creativecommons.org/publicdomain/zero/1.0/CC0 1.0 Universalmetadata.onlyhttps://repository.ucc.edu.coRepositorio Institucional Universidad Cooperativa de 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