‘The thing is not knowing’: patients' perspectives on surveillance of an indeterminate pulmonary nodule

Background

The hundreds of thousands of patients found to have a potentially malignant pulmonary nodule each year are faced with tremendous uncertainty regarding what the nodule is and how it should be evaluated.

Objective

To explore patients’ responses to the detection and evaluation of a pulmonary nodule.

Design

Qualitative study based on four focus‐group discussions. We performed inductive analysis using principles of grounded theory to identify themes relating to responses to the nodule and strategies to manage uncertainty.

Setting and participants

Twenty‐two patients from two medical centres who were undergoing surveillance for an indeterminate pulmonary nodule.

Results

Patient responses to an indeterminate pulmonary nodule were varied and evolved over time. Although almost all patients reported an initial fear about cancer, subsequent depictions of the nodule diverged into four types defined on two dimensions: cognitive (‘it's cancer’ vs. ‘I don't know what it is’ vs. ‘it's nothing serious’) and emotional (anxiety vs. equanimity). Most eventually accepted that the nodule was unlikely to be malignant; however, some remained anxious, convinced the nodule could turn into cancer at any time and should be aggressively monitored for life. Patients used results of surveillance tests as well as their own strategies (e.g. vigilance for symptoms, information‐seeking, contemplating and controlling modifiable risk factors, avoidance, faith) to manage uncertainty.

Conclusions

Surveillance for a pulmonary nodule can weigh heavily on some patients for months or years. Our findings may help clinicians prepare patients with a newly detected pulmonary nodule for the burden of the prolonged uncertainty of surveillance.     

‘Calling executives and clinicians to account’: user involvement in commissioning cancer services

Background

English NHS guidance emphasizes the importance of involving users in commissioning cancer services. There has been considerable previous research on involving users in service improvement, but not on involvement in commissioning cancer services.

Objective

To identify how users were involved as local cancer service commissioning projects sought to implement good practice and what has been learned.

Design

Participatory evaluation with four qualitative case studies based on semi‐structured interviews with project stakeholders, observation and documentary analysis. Users were involved in every stage from design to analysis and reporting.

Setting and participants

Four English cancer network user involvement in commissioning projects, with 22 stakeholders interviewed.

Results

Thematic analysis identified nine themes: initial involvement, preparation for the role, ability to exercise voice, consistency and continuity, where decisions are made, closing the feedback loop, assessing impact, value of experience and diversity.

Discussion

Our findings on the impact of user involvement in commissioning cancer services are consistent with other findings on user involvement in service improvement, but highlight the specific issues for involvement in commissioning. Key points include the different perspectives users and professionals may have on the impact of user involvement in commissioning, the time necessary for meaningful involvement, the importance of involving users from the beginning and the value of senior management and PPI facilitator support and training.

Conclusions

Users can play an important role in commissioning cancer services, but their ability to do so is contingent on resources being available to support them.     

Development of a patient-reported measure of the interpersonal quality of family planning care

Objective

The objective was to describe the development and assess evidence of the validity of a patient-reported scale measuring the interpersonal quality of contraceptive counseling.

Empirically driven definitions of “good,” “moderate,” and “poor” levels of functioning in the treatment of schizophrenia

Purpose

This study used an empirical approach to identify and validate the classification of patients with schizophrenia in “good,” “moderate,” or “poor” functioning groups based on the assessment of functional measures.

Methods

Using data from a study of schizophrenia outpatients, patients were classified into functional groups using cluster analysis based on the Heinrich–Carpenter Quality of Life Scale (QLS), the 36-item Short-Form Health Survey (SF-36) Mental Component Summary Score, and a productivity measure. A three-cluster solution was chosen. Concurrent, convergent, and discriminant validity were assessed. Criteria for classifying patient functioning as “good,” “moderate,” or “poor” were established using classification and regression tree analysis.

Results

The three clusters consistently differentiated patients on the QLS, SF-36 Mental Component Summary Score, and productivity measure. The clusters also differed on other functional measures and were concordant with previous functional classifications. Concurrent, convergent, and discriminant validity were good. “Good” functioning was identified as a QLS total score ≥84.5; “moderate” and “poor” functioning were separated by a cutoff score of 15.5 on the QLS intrapsychic foundation domain. Sensitivity ranged from 86 to 93 % and specificity from 89 to 99 %.

Conclusions

The heterogeneity in functioning of schizophrenia patients can be classified reliably in an empirical manner using specific cutoff scores on commonly used functional measures.     

‘We don't tell people what to do’: ethical practice and Indigenous health promotion

Health promotion aspires to work in empowering, participatory ways, with the goal of supporting people to increase control over their health. However, buried in this goal is an ethical tension: while increasing people's autonomy, health promotion also imposes a particular, health promotion‐sanctioned version of what is good. This tension positions practitioners precariously, where the ethos of empowerment risks increasing health promotion's paternalistic control over people, rather than people's control over their own health. Herein we argue that this ethical tension is amplified in Indigenous Australia, where colonial processes of control over Indigenous lands, lives and cultures are indistinguishable from contemporary health promotion ‘interventions’. Moreover, the potential stigmatisation produced in any paternalistic acts ‘done for their own good’ cannot be assumed to have evaporated within the self‐proclaimed ‘empowering’ narratives of health promotion. This issue's guest editor's call for health promotion to engage ‘with politics and with philosophical ideas about the state and the citizen’ is particularly relevant in an Indigenous Australian context. Indigenous Australians continue to experience health promotion as a moral project of control through intervention, which contradicts health promotion's central goal of empowerment. Therefore, Indigenous health promotion is an invaluable site for discussion and analysis of health promotion's broader ethical tensions. Given the persistent and alarming Indigenous health inequalities, this paper calls for systematic ethical reflection in order to redress health promotion's general failure to reduce health inequalities experienced by Indigenous Australians.     

‘You put up a certain attitude’: a 6‐year qualitative study of emotional socialisation

Context

Emotions play a central role in the professional development of doctors; however, research into how students are socialised to deal with emotions throughout medical school is still lacking.

Objectives

This study aimed to gain a better understanding of the emotional socialisation of medical students (e.g. how they learn to express and respond to emotions evoked in clinical practice in the process of becoming a doctor).

Methods

In this longitudinal study, 12 medical students participated in annual, individual, semi‐structured interviews, capturing the full 6‐year medical school period. We carried out a thematic analysis, which was iterative and inductive.

Results

The socialisation of emotion in the process of becoming a doctor happens in a complex interplay between student and context. We identified two modes of emotional socialisation (e.g. explicit and implicit teaching about emotions), the latter including how the people observed by students express their emotions and how they respond to the emotions expressed by students. Although the main message conveyed to students still seemed one about hiding or suppressing emotion, we found that students were able to identify and build upon the emotional expression and responses they observed in positive role models and managed to create their own opportunities to express their emotions. We found large differences between students in how they perceived, presented and developed themselves.

Conclusions

Students differ in how they respond to and what they need from their environment and thus may benefit from tailored supervision in learning how to experience, express and respond to emotion. Providing students with real and authentic responsibility for patients and allowing them time and opportunity to talk about emotion might help them to create an emotional space.     

‘Oh my God,I can't handle this!’: trainees’ emotional responses to complex situations

Context

Dealing with emotions is critical for medical trainees’ professional development. Taking a sociocultural and narrative approach to understanding emotions, we studied complex clinical situations as a specific context in which emotions are evoked and influenced by the social environment. We sought to understand how medical trainees respond to emotions that arise in those situations.

Methods

In an international constructivist grounded theory study, 29 trainees drew two rich pictures of complex clinical situations, one exciting and one frustrating. Rich pictures are visual representations that capture participants’ perceptions about the people, situations and factors that create clinical complexity. These pictures were used to guide semi‐structured, individual interviews. We analysed visual materials and interviews in an integrated way, starting with looking at the drawings, doing a ‘gallery walk’, and using the interviews to inform the aesthetic analysis.

Results

Participants’ drawings depicted a range of personal emotions in response to complexity, and disclosed unsettling feelings and behaviours that might be considered unprofessional. When trainees felt confident, they were actively participating, engaged in creative problem‐solving strategies, and emphasised their personal involvement. When trainees felt the situation was beyond their control, they described how they were running away from the situation, hiding themselves behind others or distancing themselves from patients or families.

Conclusions

A sense of control seems to be a key factor influencing trainees’ emotional and behavioural responses to complexity. This is problematic, as complex situations are by their nature emergent and dynamic, which limits possibilities for control. Following a social performative approach to emotions, we should help students understand that feeling out of control is an inherent property of participating in complex clinical situations, and, by extension, that it is not something they will ‘grow out of’ with expertise.

     

Chart stalking,list making,and physicians’ efforts to track patients’ outcomes after transitioning responsibility

Context

Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians’ activities in practice as they sought follow‐up information about patients.

Methods

Using a constructivist grounded theory approach, semi‐structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants’ strategies when deliberately conducting follow‐up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT ) to explore interactions among the social, cultural and material influences related to follow‐up.

Results

The authors identified three themes related to follow‐up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow‐up. Analysis of participants' follow‐up processes as an activity system highlighted key tensions in the system and participants’ work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients’ outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients’ health information (rules) led to rule‐breaking or abandoning activities of locating information. Finding time to conduct desired follow‐up produced tension between this and other activity systems.

Conclusion

In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow‐up. The authors offer four recommendations to address the tensions identified through AT : (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians’ skill development in developing and maintaining tracking systems for follow‐up; (iii) dedicate time in physicians’ work schedules for conducting follow‐up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians’ learning and respect patients’ privacy.

     

Capabilities and quality of life in Dutch psycho-geriatric nursing homes: an exploratory study using a proxy version of the ICECAP-O

Purpose

To validate the ICECAP-O capability measure in psycho-geriatric elderly in nursing homes, we compared the capability scores of restrained and unrestrained clients. Both nursing staff and family were used as proxies for assessing clients?? capabilities.

Method

For 122 psycho-geriatric elderly, a total of 96 nursing professionals and 68 family members completed a proxy questionnaire. We investigated the convergent and discriminant validity of the ICECAP-O and measures of care dependency, health-related quality of life, and overall quality of life. We also directly compared ICECAP-O scores of the 56 clients for whom both nursing staff and family members had completed the questionnaire.

Results

Convergent validity between ICECAP-O and care dependency, health-related, and overall quality of life measures could be established, as well as discriminant validity for the restrained and unrestrained groups. Nursing and family proxy ICECAP-O tariffs were not significantly correlated.

Discussion

ICECAP-O measures a more general concept than health-related quality of life and can differentiate between restrained and non-restrained psycho-geriatric clients. Since nurses seem to be able to assess the current quality of life of clients using the ICECAP-O more precisely than the family proxies, for now the use of nursing proxies is recommended in a nursing home setting.     

Psychometric and factor analytic evaluation of the 15D health-related quality of life instrument: the case of Greece

Purpose

To investigate the dimensionality, construct validity in the form of factorial, convergent, discriminant, and known-groups validity, as well as scale reliability of the fifteen dimensional (15D) instrument.

Methods

15D data were collected from a large Greek general population sample (N = 3,268) which was randomly split into two halves. Data from the first sample were used to examine the distributional properties of the 15 items, as well as the factor structure adopting an exploratory approach. Data from the second sample were used to perform a confirmatory factor analysis of the 15 items, examine the goodness of fit of several measurement models, and evaluate reliability and known-groups validity of the resulting subscales, along with convergent and discriminant validity of the constructs.

Results

Exploratory factor analysis, using a distribution-free method, revealed a three-factor solution of the 15D (functional ability, physiological needs satisfaction, emotional well-being). Confirmatory factor analysis provided support for the three-factor solution but suggested that certain modifications should be made to this solution, involving freeing certain elements of the matrix of factor loadings and of the covariance matrix of measurement errors in the observed variables. Evidence of convergent validity was provided for all three factors, but discriminant validity was supported only for the emotional well-being construct. Scale reliability and known-groups validity of the resulting three subscales were satisfactory.

Conclusions

Our results confirm the multidimensional structure of the 15D and the existence of three latent factors that cover important aspects of the health-related quality of life domain (physical and emotional functioning). The implications of our results for the validity of the 15D and suggestions for future research are outlined.     

Psychometric properties of the EuroQol Five Dimensional Questionnaire (EQ-5D-3L) in caregivers of autistic children

Purpose

This study aimed to ascertain the psychometric properties of EuroQol Five Dimensional Questionnaire (EQ-5D-3L) in primary caregivers of children with autism. The convergent validity, discriminant validity, known-groups validity, internal consistency reliability, and floor and ceiling effects of EQ-5D-3L were analyzed.

Methods

A cross-sectional design was used for study purposes. Through an online survey, relevant study information was collected from 316 primary caregivers of children with autism. Study participants were from families of children with autism living in the United States who were registered with the Interactive Autism Network. Convergent validity of the EQ-5D-3L was assessed through its correlation with other measures of similar constructs. Discriminant validity was assessed by observing the correlation of EQ-5D-3L domains with theoretically unrelated constructs. Known-groups validity was tested by comparing EQ-5D-3L index and visual analog scale (VAS) scores across levels of autism severity among the care recipients. Internal consistency reliability of EQ-5D-3L was tested. Lastly, floor and ceiling effects of EQ-5D-3L were assessed.

Results

More than 60 % of participants reported problems of ‘anxiety/depression.’ Convergent and discriminant validity of the EQ-5D-3L was good. Significant correlation (convergent validity) was observed among EQ-5D-3L index and VAS and (SF-12v2) physical component summary and mental component summary scores. Caregivers’ EQ-5D-3L index and VAS scores varied by levels of autism severity among care recipients, providing evidence of known-groups validity. Reliability assessed through Cronbach’s alpha was less than satisfactory; however, corrected item-total correlations were adequate.

Conclusions

The EQ-5D-3L is a psychometrically sound tool to elicit health state preferences among caregivers of children with autism.     

Comparing the nine‐item Shared Decision‐Making Questionnaire to the OPTION Scale – an attempt to establish convergent validity

Background

While there has been a clear move towards shared decision‐making (SDM) in the last few years, the measurement of SDM‐related constructs remains challenging. There has been a call for further psychometric testing of known scales, especially regarding validity aspects.

Objective

To test convergent validity of the nine‐item Shared Decision‐Making Questionnaire (SDM‐Q‐9) by comparing it to the OPTION Scale.

Design

Cross‐sectional study.

Setting and participants

Data were collected in outpatient care practices. Patients suffering from chronic diseases and facing a medical decision were included in the study.

Methods

Consultations were evaluated using the OPTION Scale. Patients completed the SDM‐Q‐9 after the consultation. First, the internal consistency of both scales and the inter‐rater reliability of the OPTION Scale were calculated. To analyse the convergent validity of the SDM‐Q‐9, correlation between the patient (SDM‐Q‐9) and expert ratings (OPTION Scale) was calculated.

Results

A total of 21 physicians provided analysable data of consultations with 63 patients. Analyses revealed good internal consistency of the SDM‐Q‐9 and limited internal consistency of the OPTION Scale. Inter‐rater reliability of the latter was less than optimal. Association between the total scores of both instruments was weak with a Spearman correlation of r = 0.19 and did not reach statistical significance.

Discussion

By the use of the OPTION Scale convergent validity of the SDM‐Q‐9 could not be established. Several possible explanations for this result are discussed.

Conclusion

This study shows that the measurement of SDM remains challenging.     

Prioritisation of patients on waiting lists for hip and knee arthroplasties and cataract surgery: Instruments validation

Background  

Prioritisation instruments were developed for patients on waiting list for hip and knee arthroplasties (AI) and cataract surgery (CI). The aim of the study was to assess their convergent and discriminant validity and inter-observer reliability.     

24th Annual Conference of the International Society for Quality of Life Research

Purpose

Generic preference-based quality of life (PbQoL) measures are sometimes criticized for being insensitive or failing to capture important aspects of quality of life (QoL) in specific populations. The objective of this study was to systematically review and assess the construct validity and responsiveness of PbQoL measures in Parkinson’s.

Methods

Ten databases were systematically searched up to July 2015. Studies were included if a PbQoL instrument along with a common Parkinson’s clinical or QoL measure was used, and the utility values were reported. The PbQoL instruments were assessed for construct validity (discriminant and convergent validity) and responsiveness.

Results

Twenty-three of 2758 studies were included, of which the majority evidence was for EQ-5D. Overall good evidence of discriminant validity was demonstrated in the Health Utility Index (HUI)-3, EQ-5D-5L, EQ-5D-3L, 15D, HUI-2, and Disability and Distress Index (DDI). Nevertheless, HUI-2 and EQ-5D-3L were shown to be less sensitive among patients with mild Parkinson’s. Moderate to strong correlations were shown between the PbQoL measures (EQ-5D-3L, EQ-5D-5L, 15D, DDI, and HUI-II) and Parkinson’s-specific measures. Twelve studies provided evidence for the assessment of responsiveness of EQ-5D-3L and one study for 15D, among which six studies reached inconsistent results between EQ-5D-3L and the Parkinson’s-specific measures in measuring the change overtime.

Conclusions

The construct validity of the PbQoL measures was generally good, but there are concerns regarding their responsiveness to change. In Parkinson’s, the inclusion of a Parkinson’s-specific QoL measure or a generic but broader scoped mental and well-being focused measure to incorporate aspects not included in the common PbQoL measures is recommended.

     

The Audit of Diabetes-Dependent Quality of Life 19 (ADDQoL): feasibility, reliability and validity in a population-based sample of Australian adults

Purpose

This study aims to analyse the psychometric properties of the most recent 19 item version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) in a large, population-based sample of adults living in Australia.

Methods

A total of 3,951 people living with diabetes completed the ADDQoL as part of the Living With Diabetes Study. Data analysis investigated the feasibility of using the ADDQoL in a large, population-based survey; internal consistency; adherence to a single-factor structure; and convergent/discriminant validity.

Results

Data support the feasibility of using the ADDQoL in population-based survey research. Although a strict single-factor structure for the ADDQoL was not demonstrated, the results overall support an interpretation of essential unidimensionality. A validation matrix provides support for the convergent and divergent validity of the measure, as does the ADDQoL??s ability to discriminate between respondents based on insulin dependence and complications.

Conclusions

The ADDQoL has good psychometric properties and provides clinicians and researchers with a useful tool for comprehensively assessing quality of life in adults with diabetes.     

‘You just change the channel if you don't like what you're going to hear’: gamblers’ attitudes towards,and interactions with,social marketing campaigns

Objectives

To investigate how gamblers interact with, and respond to, downstream social marketing campaigns that focus on the risks and harms of problem gambling and/or encourage help seeking.

Methods

Qualitative study of 100 gamblers with a range of gambling behaviours (from non‐problem to problem gambling). We used a Social Constructivist approach. Our constant comparative method of data interpretation focused on how participants'' experiences and interactions with gambling influenced their opinions towards, and interactions with social marketing campaigns.

Results

Three key themes emerged from the narratives. (i) Participants felt that campaigns were heavily skewed towards encouraging individuals to take personal responsibility for their gambling behaviours or were targeted towards those with severe gambling problems. (ii) Participants described the difficulty for campaigns to achieve ‘cut through’ because of the overwhelming volume of positive messages about the benefits of gambling that were given by the gambling industry. (iii) Some participants described that dominant discourses about personal responsibility prevented them from seeking help and reinforced perceptions of stigma.

Conclusions and implications

Social marketing campaigns have an important role to play in the prevention of gambling risk behaviours and the promotion of help seeking. Social marketers should explore how to more effectively target campaigns to different audience segments, understand the role of environmental factors in undermining the uptake of social marketing strategies and anticipate the potential unforeseen consequences of social marketing strategies.     

Injection Drug Use Quality of Life scale (IDUQOL): A validation study

Background  

Existing measures of injection drug users' quality of life have focused primarily on health and health-related factors. Clearly, however, quality of life among injection drug users is impacted by a range of unique cultural, socioeconomic, medical, and geographic factors that must also be considered in any measure. The Injection Drug User Quality of Life (IDUQOL) scale was designed to capture the unique and individual circumstances that determine quality of life among injection drug users. The overall purpose of the present study was to examine the validity of inferences made from the IDUQOL by examining the (a) dimensionality, (b) reliability of scores, (c) criterion-related validity evidence, and (d) both convergent and discriminant validity evidence.     

Validation of Child Behavior Rating Scale in Singapore (Part 2): Convergent and Discriminant Validity

Background/Objective

In a previous study, the Child Behavior Rating Scales (CBRSs) were found to assess interpersonal social skills (IPS) and learning-related social skills (LRSS) in young Singaporean children. This study aimed to evaluate the convergent validity of the IPS scale within the CBRS and the discriminant validity of the LRSS scale within the CBRS with a dynamic occupational therapist assessment, the Evaluation of Social Interaction (ESI).

Methods

Teachers of 117 Singaporean children completed the CBRS. An occupational therapist assessed these children using the naturalistic observational tool ESI. The Rasch-derived scores from the two CBRS scales were correlated with the ESI scores.

Results

The IPS scale within the CBRS demonstrated moderate correlation with ESI, indicating convergent validity. The LRSS scale within the CBRS demonstrated low correlation with ESI, indicating discriminant validity.

Conclusion

This study provides additional validity evidence for the two newly identified CBRS scales. Results of this study suggest the potential of these scales for use by occupational therapists to measure different types of young children’s social skills.     

Measuring health-related quality of life and well-being: a head-to-head psychometric comparison of the EQ-5D-5L,ReQoL-UI and ICECAP-A

Objective

This study aimed to assess the psychometric properties of three generic preference-based measures and compare their performance in a sample of Hong Kong general population.

Methods

Data used for this analysis were obtained from a cross-sectional telephone-based survey in July 2020. Participants were asked to complete several measures, including The EuroQol five-dimensional five levels (EQ-5D-5L), Recovering Quality of Life-Utility Index (ReQoL-UI) and ICEpop CAPability measure for adults (ICECAP-A). Acceptability, reliability, convergent and discriminant validity of three measures were assessed as well as the agreement between these instruments.

Results

Based on data from 500 participants to the survey, a lower mean score of the ICECAP-A (mean?=?0.85) was observed compared to the other two measures (mean_ReQoL-UI?=?0.92; mean_EQ-5D-5L?=?0.92). All three measures showed an acceptable internal consistency reliability (Cronbach’s alpha?=?0.74, 0.82 and 0.77, respectively) as well as good test–retest reliability (intra-class correlation coefficient?=?0.74, 0.82 and 0.77, respectively). Correlation analyses confirmed satisfactory convergent validity and the ability of the measures to differentiate between participants with different health or from socioeconomic status groups. The Bland–Altman plot revealed poor agreement between the three measures.

Conclusions

This study confirmed that EQ-5D-5L, ReQoL-UI and ICECAP-A were psychometrically robust to measure HRQoL in the general HK population. The EQ-5D-5L was more suitable for assessing physical HRQoL, whereas the ICECAP-A and ReQoL-UI were more appropriate for measuring interventions aimed at improving people’s well-being and mental health.

     

Discriminant and convergent validity of a subjective quality-of-life instrument aimed at high content validity for schizophrenic persons

Objective

To analyse whether a subjective quality-of-life (QoL) instrument (QLiS—Quality-of-Life in Schizophrenia), developed on the basis of a large number of open-ended interviews with schizophrenic patients, has sufficient discriminant and convergent validity to justify its application as a schizophrenia-specific QoL instrument.

Method

The discriminant and convergent validity of the QLiS (comprising 12 subscales) was analysed in a cross-sectional study. Schizophrenic persons (n = 135) from different care settings were surveyed using the QLiS, the WHOQOL-Bref, the SWN and 7-point satisfaction items. Partial correlational analyses and regression analyses controlling for general life satisfaction were conducted comparing the QLiS subscales with those of the other instruments.

Results

Positive correlation coefficients were found among all subscales of the QLiS and the other QoL instruments (WHOQOL-BREF from r = 0.29 to r = 0.72; SWN, r = 0.14 to r = 0.83; satisfaction scales, r = 0.18 to r = 0.69). One QLiS subscale (cognitive functioning) was shown to be empirically redundant (r>0.80) to the mental functioning subscale of the SWN. All other subscales proved to have unique variance. The non-QLiS QoL instruments only accounted for substantial amounts of variance (>20% after controlling for global life satisfaction) in the QLiS subscales leading a normal life, appreciation by others, appraisal of accommodation/housing and social contacts.

Discussion

Most of the QLiS subscales can be regarded as sufficiently distinct from other QoL instruments, and thus show evidence of discriminant and convergent validity.

Conclusion

A subjective QoL questionnaire with high content validity can provide additional empirical information about schizophrenics’ QoL not accounted for by other common QoL instruments.