Convergent validity of two measures of the quality of life

In the paper, a test of convergent validity is undertaken for two methods of quality of life assessment, one based on a shortened version of the Health Measurement Questionnaire and the other based on professional clinical judgement. The Nottingham Health Profile is used as the comparator, and the data derive from a sample of colorectal cancer patients. Criteria for convergent validity are established and both methods yield outcomes broadly consistent with such criteria.     

Spanish version of the Nottingham Health Profile: translation and preliminary validity.

We report the transfer into Spanish of a multi-dimensional measure of perceived health originally developed in Great Britain, the Nottingham Health Profile (NHP), and an assessment of the preliminary validity of the version is presented. Translation of the questionnaire was obtained from experts and from a Spanish monolingual lay group. Construct validity of the version was assessed in two studies: testing relationship of NHP scores to other self-reported measures of health in a general population survey; and comparing NHP scores for a group of frequent users and for a group of non-users of primary health services. Mean scores of NHP dimensions were higher for people with poorer self-reported health and higher for the frequent health services users than for the non-users. Findings suggest that the Spanish version of the NHP is culturally equivalent to the original questionnaire, and has a similar level of construct validity. Nevertheless, further research on reliability and on the weighting system is required to establish the equivalence of the Spanish version definitively.     

The French version of the Nottingham Health Profile. A comparison of items weights with those of the source version

The efficient and reliable assessment of general community health requires the development of comprehensive and parsimonious measures of proven validity. The Nottingham Health Profile (NHP) has been demonstrated to be a reliable indicator of common expressions of discomfort and stress in the general population. The present paper describes its linguistic adaptation into French, the derivation of item weights by Thurstone's method of paired comparisons and the comparison of item weights across various sociodemographic groups. There is more similarity than variation on the valuation of the state of health explored by the NHP between the French and the British population as little inter-cultural or inter-linguistic variations were found. The differences in judgement of severity elicited across sociodemographic groups in the French sample cast some doubts on the relevance of general weights for use in population surveys.     

Performance of a perceived health measure in different groups of the population: a comprehensive study in Spain

The metric properties of health-related quality of life measures are typically evaluated on selected samples and assumed to hold across different population groups. We assessed the extent to which the measurement properties of the Spanish version of the Nottingham Health Profile (NHP) were stable across sociodemographic, clinical and geographical characteristics. We collected information from all available studies using the NHP in Spain (1986-1995), and obtained data from 9419 individuals. We examined data completeness and distribution, as well as reliability and construct validity. The percentage of missing dimensions was lower than 5%, but increased with age and poor health status. Large ceiling effects in scores were observed for social isolation and energy dimensions, being largest for younger ages and individuals reporting "very good/good" health. Reliability was higher than 0.7 in all population groups considered, except for social isolation and energy dimensions in some subgroups. Mean NHP scores correlated with self-rated overall health (r = 0.48), but they varied substantially by age among those rating their health as "very good/good." We conclude that NHP is adequate for all Spanish populations. Nevertheless, some caution is needed because the reliability of dimension scores is not sufficient for individual purposes. And also, because a non-negligible high ceiling effect renders the instrument inefficient to measure changes over time among healthy populations.     

NHP量表在中牟县外来务工人员生活质量测量中的信度和效度分析

目的探讨诺丁汉健康量表(Nottingham Health Profile,NHP)用于城市外来务工人员生活质量测定的信度和效度。方法采用分层整群抽样的方法,于2008年3-4月间,在郑州市中牟县随机抽取723名外来务工人员进行生活质量测量。用Spearman-Brown公式计算量表的折半信度,Cronbach’sα系数衡量其内部一致性信度,因子分析方差最大旋转法分析其结构效度,Spearman秩相关来考察其内容效度。结果 NHP量表折半信度系数是0.71;总的Cronbach’sα系数为0.75,各维度Cronbach’sα系数均小于0.70,其中最小值0.26(精力水平维度),最大值0.63(情绪反应维度);所有维度的集合效度定标试验成功率为50.00%,区分效度定标试验成功率除去躯体活动维度为95.80%外,其余各维度均为100.00%;因子分析产生的两个公因子,分别代表生理健康和心理健康,累积方差贡献率为60.00%。结论中文版健康测量量表NHP具有良好的信度、效度和可接受性,可以应用于城市外来务工人员生活质量测定,但需在实际应用中进一步完善。     

Translation, cultural adaptation, initial reliability, and validation of Turkish 15D's version: a generic health-related quality of life (HRQoL) instrument

This article describes the adaptation of the Finnish 15D standardized measure of health-related quality of life (HRQoL) instrument for use in Turkey and assesses its psychometric properties. The HRQoL is measured in a sample of 75 patients with Type 2 diabetes using both 15D and Nottingham Health Profile (NHP) instruments. The internal consistency within the domains of 15D was high, with Cronbach's alpha values 0.89 for 15D scale and 0.89 for NHP. Significant correlations were observed between the scores of similar domains of 15D and the NHP in general health perception supporting the construct validity of the new 15D Turkish version. Overall, the results indicated that the adaptation of the 15D for use in Turkey was successful. The Turkish version was found to be a reliable and valid instrument. It is suitable and applicable to both clinical and population-based studies for the measurement of HRQoL in Turkey.     

Development and reliability evaluation of an instrument to measure health-related quality of life in independent elderly

This study presents an instrument, the health-related quality of life (HRQOL) profile for independent elderly, to measure the health-related quality of life of the functionally independent elderly assisted in the outpatient setting, based on the adaptation of four validated scales: Short-Form Health Survey (SF-36), Duke-UNC Health Profile (DUHP), Sickness Impact Profile (SIP), and Nottingham Health Profile (NHP). The study also evaluates the instrument's reliability based on its use by two different observers with a 15-day interval. The instrument includes five dimensions (health perception, symptoms, physical function, psychological function, and social function) and 45 items. Reliability evaluation of the QUASI instrument was based on interviews with 142 elderly outpatients in the city of Rio de Janeiro, Brazil. Prevalence-adjusted kappa statistic was used to assess all 45 items. Correlation was also calculated between overall scores and scores on individual dimensions. In the reliability evaluation, 39 of the 45 items showed prevalence-adjusted kappa greater than 0.60.     

Assessing the validity of the SF-36 General Health Survey

Our objective was to assess the validity of the SF-36 General Health Survey against the Social Maladjustment Schedule (SMS) and two questionnaire measures, the Social Problem Questionnaire and the Nottingham Health Profile (NHP) in a random subsample of 206 men and women from the Whitehall II study, a longitudinal survey of health and disease amongst 10,308 London-based civil servants. We found that social functioning on the SF-36 correlated significantly with social contacts, total satisfaction and total management scores on the SMS, and social isolation and emotional reactions on the NHP. General mental health on the SF-36 was associated with marriage, social contacts, leisure scores, total satisfaction and total management scores on the SMS, and emotional reactions, energy level and social isolation on the NHP. Conversely, physical functioning and physical role limitations were generally not associated with the SMS but were associated with physical abilities and pain on the NHP. In conclusion, this study offers evidence of the discriminant validity of the general mental health and physical functioning scales of the SF-36. We also found moderate construct and criterion validity for the social functioning scale of the SF-36 and considerable overlap between the general mental health and social functioning scales.     

Psychometric properties of the Minnesota Living with Heart Failure—Brazilian version—in the elderly

BACKGROUND: Heart failure (HF) has implications for the quality of life for any age range, more so for the elderly who simultaneously present other limitations imposed by multiple co-morbidities. Although there are several instruments to measure Health Related Quality of Life (HRQL), none is specific to the elderly with HF. Among disease-specific instruments, Minnesota Living with Heart Failure(LHFQ) has not been studied extensively among the elderly with respect to its psychometric properties. OBJECTIVE: The purpose of this study was to evaluate the convergent, divergent and discriminative validity of the Brazilian version of LHFQ applied to elderly HF patients. METHOD: One hundred and seventy (170) elderly were interviewed. LHFQ capacity to discriminate subjects among New York Heart Association (NYHA) Classes I, II and III/IV was analyzed. Convergent and divergent validity was evaluated through the correlation between the domains of LHFQ and the generic instrument, Medical Outcomes Study (MOS) 36-item Short-Form Health Survey (SF-36). RESULTS: The LHFQ total score and physical dimension sub-scale discriminated between the three sub-groups of NYHA Classes I, II and III/IV (P < .0001). The emotional dimension discriminated NYHA Classes I and III/IV (P = .0034). The physical and emotional dimensions of the LHFQ and SF-36 were significantly correlated (coefficients from .46 to .70 for physical dimension and from .31 to .65 for emotional dimension). However, contrary to expectations, the divergent validity was not totally confirmed as there was no difference in the magnitude of the correlations between the LHFQ emotional and physical dimensions and the SF-36 role physical, social functioning and role emotional. Thus, the results suggest that LHFQ seems to be a valid tool to measure HRQL in the elderly, but new studies remain necessary to gain a better understanding of its discriminative validity for more advanced NYHA functional classes and for its divergent validity.     

Child/parent-assessed population health outcome measures: a structured review

AIMS: To identify generic measures of health-related quality of life (HRQL) for children and adolescents developed for use within general populations. Instruments are evaluated on the basis of evidence relating to their reliability and validity. METHODS: Systematic literature searches were used to identify instruments, which were then assessed against predefined criteria. Information relating to instrument content, population, reliability and validity was extracted from published papers. RESULTS: Sixteen instruments were identified that had been evaluated among a general population of children or adolescents. Four instruments had reported data on both internal consistency and test-retest reliability. All except two instruments had undergone some degree of construct validation. CONCLUSIONS: The evidence suggests that the Child Health Questionnaire (CHQ) has been the most extensively evaluated for younger populations but is available as a parent-completed measure only. The new version of the Child Health and Illness Profile (CHIP-CE) is particularly promising and has parallel child- and parent-completed versions for young ages. The weight of evidence suggests that versions of these two instruments are suitable for older children. The Warwick Child Health and Morbidity Profile could be used where information on morbidity and health service contacts is required. Once basic psychometric criteria are fulfilled, instruments should be chosen by assessing their content and design in the light of the prospective application.     

The Spanish version of the Nottingham Health Profile: a review of adaptation and instrument characteristics

The increased interest in measuring health status implies a need for instruments that are appropriate and valid. Adaptation of existing instruments may be a cost-effective strategy. In this paper we describe the adaptation into Spanish of the Nottingham Health Profile (NHP), a self-administered perceived health questionnaire developed in the UK. The characteristics of the adapted questionnaire (validity, reliability, and sensitivity to change), as well as current and purposed applications, are discussed. Some of the principles that were applied in the described adaptation process may be useful for similar future research: involving the investigators that developed the original instrument; using a panel of lay individuals in the translation process; testing the characteristics of the adapted instrument by replicating previous studies with the original instrument, and organizing an international group for the development and use of the European versions of the NHP. Adaptation of health status measures is an opportunity for gaining comparability when measuring health, and for learning about cross-cultural differences in health-related quality of life.A preliminary version of this paper was presented at the Satellite Symposium of the Inaugural Meeting of the International Health-related Quality of Life Society, Brussels, Belgium, 3–4 February 1994.     

The reliability and validity of a ten-item measure of functional status

The accurate assessment of functional status is an important clinical activity in family practice. Many of the measures of function developed for research purposes, however, have questionable applicability to primary care practices. The Duke-UNC Health Profile (DUHP) is a 63-item instrument that assesses four dimensions of function: symptom experiences, physical function, social function, and emotional function. The reliability and validity of a ten-item subset (the mini-DUHP) of the DUHP was examined for 71 white adults with a profile of high stressful life changes and weak social supports. These subjects completed the DUHP on two occasions and provided personal morbidity data by monthly mailed questionnaire for an intervening six-month period. On both administrations of the instrument, mini-DUHP scores were strongly correlated with composite DUHP scores (r = .81 and .84) and moderately correlated with each of the four functional dimension scores. The mini-DUHP demonstrated good temporal stability (r = .58). Mini-DUHP scores, determined both before and after the six-month period, were correlated with cumulative self-reported hospital days, bed disability days, restricted activity days, and physician utilization. Responses to the mini-DUHP strongly predicted bed disability, restricted activity, and physician visits after controlling for the effects of sociodemographic characteristics by multivariate analysis. This ten-item scale may be useful and practical in the assessment and monitoring of function in a primary care setting.     

Psychometric properties of a specific quality of life questionnaire in angina pectoris patients

This paper describes the psychometric properties of the French version of the APQLQ (Angina Pectoris Quality of Life Questionnaire), that is to say, scaling assumptions, reliability and validity. This disease-specific Swedish questionnaire provides a global score as well as four subscores measuring physical activities, somatic symptoms, emotional distress, and life satisfaction. The French version was produced according to the forward-backward translation methodology. In a cross-sectional study, 183 coronary patients filled out the APQLQ and the MOS (Medical Outcomes Study) SF-36; 170 sent it back; the rate of missing data was low (1.3%). The factorial structure and the high level of inter-scale correlations (> 0.60) suggested that the APQLQ measured one global concept rather than separate domains. The multitrait analysis identified one problematic item correlated strongly with all domains. The internal consistency was good ( Cronbach > 0.70). The correlations with the SF-36 scales were consistent with what was expected. The distribution of the scores of the APQLQ according to the clinical severity of Angina Pectoris (AP) was as hypothesized: the more severe the AP, the more impaired the Quality of Life. The score significantly discriminated between symptomatic (n=110) and asymptomatic patients (n=60) except for the emotional distress scale (p=0.14). We recommend to analyze the French APQLQ as an index rather than as a profile. Its reliability, concurrent and clinical validity allowed its use in clinical trials.     

Hungarian adaptation of a questionnaire for determining depression-specific quality of life

INTRODUCTION: The Quality of Life in Depression Scale (QLDS) is a widely used outcome measure available in a large number of languages. No measure of quality of life was available for use with depressed patients in Hungary and a decision was taken to adapt the QLDS for this purpose. The adaptation of a questionnaire for use in a new language involves three stages; translation, testing for face and content validity and assessment of the translated measure's psychometric properties. OBJECTIVES: To adapt the QLDS for use in Hungary and to evaluate its psychometric properties. METHOD: The dual panel method was used to translate the QLDS into Hungarian. The translation was tested for face and content validity by interviews conducted with depressed patients. Finally, a test-retest postal survey was conducted to determine internal consistency, reproducibility and construct validity. RESULTS: Interviews conducted with 25 patients indicated that the QLDS was an appropriate measure and that it was well accepted and completed. The postal survey ( n = 50) showed that the measure had good internal consistency (Cronbach's alpha-coefficients were 0.95 at both administrations) and that the test-retest reliability (0.89) indicated good reproducibility with limited random measurement error. Correlations of QLDS scores with those for the Nottingham Health Profile sections were as expected, providing evidence of convergent and divergent validity. CONCLUSION: Given the acceptability of the Hungarian version of QLDS to depressed patients and the excellent psychometric properties of the adapted questionnaire it is concluded that the adaptation was successful. The measure is suitable for use in clinical practice and studies involving depressed patients in Hungary.     

The Nottingham Health Profile as a measure of quality of life in zoster patients: convergent and discriminant validity

The main symptoms of zoster, a disease caused by the reactivation of the varicella zoster virus (that causes chicken-pox) are: rash, associated with pain, burning, or itching, and pain that outlasts the rash sometimes by months or years. The uncomfortable and long-lasting symptoms of herpes zoster are likely to compromise the patient's quality of life. However, the impact of zoster on health-related quality of life has not previously been measured directly. Recent papers have demonstrated the ability of generic measures to discriminate among patients with different clinical symptoms. In this paper, we demonstrate the convergent validity for zoster of a generic measure, the Nottingham Health Profile (NHP), by measuring its correlation with rash progression, pain levels, and pain medications. The discriminant validity of the NHP was demonstrated by its ability to distinguish between different levels of pain severity. The NHP dimensions most highly correlated with the pain measures, were pain (0.42–0.50), energy (0.34–0.38) and sleep (0.32–0.38). The NHP scores in all six dimensions show large differences at different levels of pain severity that are statistically significant. These results demonstrate the NHP's validity as a measure of health-related quality of life in zoster patients.     

French Cross-Cultural Adaptation of the Health Utilities Indexes Mark 2 (HUI2) and 3 (HUI3) Classification Systems

The McMaster Health Utilities Indexes Mark 2 (HUI2) and 3 (HUI3) are multiattribute health classification systems, for which multiattribute preference functions have been developed in Canada. They provide a comprehensive instrument for use in economic evaluations and population health survey studies. This paper reports on the first results on the adaptation of the HUI2 and HUI3 systems cross-culturally and the assessment of the validity and reliability of the French self-report questionnaire in different patient populations. The cross-cultural adaptation included translation, backtranslations, an expert consensus meeting and pre-test with a few patients and healthy subjects in order to produce a conceptually equivalent French version of the 15 question self-report questionnaire and the HUI2 and HUI3 classification systems. Different groups of patients attending specialized clinics (n = 709) completed the questionnaire and another generic questionnaire (the Sickness Impact Profile (SIP)) for validity assessment. Physicians and patients were also asked for a global subjective assessment of the patient's health status. The French questionnaire was well received by the patients. The criterion and convergent validities of both classification systems (correlations with the patients' and physicians' assessments and with the responses to the SIP questionnaire) were satisfactory. The internal consistency was acceptable too (Cronbach's α = 0.81), as was the 3 day test-retest reproducibility. These first results authorize careful use of the 15 question self-report questionnaire in French. An assessment of the multiattribute preference function for the HUI3 system in France will be the study's next objective. This revised version was published online in June 2006 with corrections to the Cover Date.     

Development of the Korean versions of WHO Quality of Life scale and WHOQOL-BREF

The purpose of this study was to develop the Korean version of World Health Organization Quality of Life study assessment instrument (WHOQOL) and WHOQOL-BREF, an abbreviated version of WHOQOL and to identify contributing factors in the quality of life of Koreans. The WHOQOL and WHOQOL-BREF were translated into colloquial Korean according to instructions of the WHOQOL study group. Then the Korean questionnaire was applied to 538 subjects, composed of 171 medical patients and 367 healthy subjects who volunteered to rate the scale. Finally, 486 subjects completed the rating. Collected data were analyzed statistically. The Korean version of WHOQOL and WHOQOL-BREF domain scores demonstrated good test–retest reliability, internal consistency, criterion validity, content validity and discriminant validity. The physical, psychological, social and environmental domains made a significant contribution to explaining the variance in the quality of life while the independence and spiritual domains made a lesser contribution. The domain scores produced by the WHOQOL-BREF correlated highly with the WHOQOL. The physical health domain contributed most in overall quality of life, while the social domain made the least contribution. These results suggest that the Korean version of WHOQOL and WHOQOL-BREF are valid and reliable in the assessment of quality of life and that physical domain is contributing most and social and spiritual factors are contributing least to the quality of life in Koreans.     

HPLP-Ⅱ健康促进生活方式量表中文版的研制及其性能测试

目的 研制健康促进生活方式量表-Ⅱ（health promoting lifestyle profile-Ⅱ, HPLP-Ⅱ）中文版并验证量表维度及信度和效度。方法 采用随机整群抽样方法,于2014年5月～10月对抽取到的社区居民进行入户面对面调查。测定该量表的心理学特征,包括内部一致性、分半信度、重测信度、条目分析和因子分析。结果 在收回的950份问卷中,18岁以上的有效问卷862份,研究对象年龄在18～84岁,平均年龄（41.02±12.60）岁。探索性因子分析结果显示因子载荷<0.4、在两个及以上因子上有载荷及条目含义与其所在因子概念不符的共计12条目,删除后得到HPLP-Ⅱ的修订版本（health promoting lifestyle profile-Ⅱ, revise, HPLP-ⅡR）。HPLP-ⅡR结果支持6因子结构,共解释总体方差48.95%的变异。HPLP-ⅡR健康促进生活方式量表中文修订版各条目与其所在维度相关性（集合效度）均高于该条目与其他维度间相关性（区分效度）。各维度分半信度为0.64～0.78,Cronbach's α系数为0.63~0.81,量表重测信度为0.69。营养因子平均得分最高（63.63±15.01）分,健康责任因子得分最低（43.11±14.70）分,6个因子间的相关性范围为0.21～0.51。结论 HPLP-ⅡR健康促进生活方式修订量表适用于中国人群测定。     

Health of a team competing in the 1990 World Solar Car Challenge.

The health of a team participating in the 1990 World Solar Car Challenge was recorded for 10 of the 11 race days. Morbidity was collected during daily consultations with the team doctor and the diagnoses were later converted to the ICPC code. Team members' self-perceived health status was also recorded daily, using the Nottingham Health Profile. Team drivers consulted the doctor more often than the support staff and the three full-time drivers had significantly more diagnoses than the support staff. The Nottingham Health Profile scores on sleep, energy and emotional reactions showed correlations between higher minimum temperatures and sleep for all team members and for the three full-time drivers, there were significant correlations between increasing maximum temperatures and emotional reaction scores. The morbidity records and perceived health scores reflect the conditions of the race. Twenty-five per cent of full-time driver consultations dealt with skin, eyelid or finger infections probably caused by the lack of washing water. The scores on sleep and emotional reactions were affected by temperature and previous research reports degradation in concentration and dual tasks with increasing temperature. This may account for the difficulty some drivers had in continuing their shifts. Close supervision of the drivers and the recording of their perceived health status helped reduce the health problems of the team.