Assessment of Chronic Illness Care with the German version of the ACIC in different primary care settings in Switzerland

Background  

In Switzerland the extent to which patients with chronic illnesses receive care congruent with the Chronic Care Model (CCM) is unknown.     

Developing a Danish version of the “Impact on Participation and Autonomy Questionnaire”

Abstract

Objective: To translate the “Impact on Participation and Autonomy Questionnaire” into Danish (IPAQ-DK), and estimate its internal consistency and test–retest reliability in order to promote participation-based interventions and research. Design: Translation and two successive reliability assessments through test–retest. Subjects: 137 adults with varying degrees of impairment; of these, 67 participated in the final reliability assessment. Methods: The translation followed guidelines set forth by the “European Group for Quality of Life Assessment and Health Measurement”. Internal consistency for subscales was estimated by Chronbach's alpha. Weighted kappa coefficients and intraclass correlation coefficients were calculated to assess the test–retest reliability at item and subscale level, respectively. Results: A preliminary reliability assessment revealed residual issues regarding the translation and cultural adaptation of the instrument. The revised version (IPAQ-DK) was subsequently subjected to a similar assessment demonstrating Chronbach's alpha values from 0.698 to 0.817. Weighted kappa ranged from 0.370 to 0.880; 78% of these values were higher than 0.600. The intraclass correlation coefficient covered values from 0.701 to 0.818. Conclusion: IPAQ-DK is a useful instrument for identifying person-perceived participation restrictions and satisfaction with participation. Further studies of IPAQ-DK's floor/ceiling effects and responsiveness to change are recommended, and whether there is a need for further linguistic improvement of certain items.     

How Health Care Complexity Leads to Cooperation and Affects the Autonomy of Health Care Professionals

Health professionals increasingly face patients with complex health problems and this pressurizes them to cooperate. The authors have analyzed how the complexity of health care problems relates to two types of cooperation: consultation and multidisciplinary teamwork (MTW). Moreover, they have analyzed the impact of these two types of cooperation on perceived professional autonomy. Two teams were studied, one team dealing with geriatric patients and another treating oncology patients. The authors conducted semi-structured interviews, studied written documents, held informal discussions and observed the teams at work. Consultation was most likely to take place when a patient had multiple problems. However, if these problems were interrelated, i.e. the solution for one problem interfered with solving another, then MTW was favored. The same was true when the available information was equivocal such that there were conflicting interpretations of a problem. How the professionals perceived the relationship between complexity and the need to cooperate depended on their expertise, their occupational background, and their work orientation. Consultation did not affect the professional autonomy of the health care professionals. MTW however did decrease the perceived level of professional autonomy. The extent to which this occurred seemed to depend on the quality of the interpersonal relations within the team. The findings can help in selecting the most appropriate and efficient type of cooperation based on the complexity of a patient’s problems. They can also help team leaders to stimulate reflection and feedback processes, and medical trainers to develop competencies among students related to such teamwork behaviors.     

The psychometric properties of the Spanish version of the Foot Health Status Questionnaire

Purpose

Clinical studies suggest that foot pain may be problematic in one-third of patients in early disease. The Foot Health Status Questionnaire (FHSQ) was developed and validated to evaluate the effectiveness of conservative (orthoses, taping, stretching) and surgery interventions. Despite this fact, there are few validated instruments that measure foot health status in Spanish. Thus, the primary aim of the current study was to translate and evaluate psychometrically a Spanish version of FHSQ.

Methods

A cross-sectional study was designed in a university community-based podiatric clinic located in south of Spain. All participants (n = 107) recruited consecutively completed a Spanish version of FHSQ and EuroQoL Health Questionnaire 5 dimensions, and 29 participants repeated these same measures 48 h later. Data analysis included test–retest reliability, construct and criterion-related validity and factor analyses.

Results

Construct validity was appropriate with moderate-to-high corrected item–subscale correlations (α = ≥0.739) for all subscales. Test–retest reliability was satisfactory (ICC > 0.932). Factor analysis revealed four dimensions with 86.6 % of the common variance explained. The confirmatory factor analysis findings demonstrated that the proposed structure was well supported (comparative fit index = 0.92, standardized root mean square = 0.09). The Spanish EuroQoL 5D score negatively correlated with the FHSQ pain (r = ?0.445) and positively with general foot health and function (r = 0.261 ? 0.579), confirming criterion-related validity.

Conclusion

The clinimetric properties of the Spanish version of FHSQ were satisfactory.     

A comparison of an electronic version of the SF-36 General Health Questionnaire to the standard paper version

Because of its sound psychometric properties the SF-36 General Health Questionnaire is used throughout the world, yet it is difficult to analyse and score. Using a newly developed software package, onto which any questionnaire can be loaded, we developed an electronic version of the SF-36 General Health Questionnaire. The purpose of this study is test the effect of the electronic mode of administration on the measurement properties of the SF-36. In a randomised cross-over design study 79 healthy individuals and 36 chronic pain patients completed both electronic and paper versions of the SF-36. Seventy-one percent preferred the electronic SF-36, 7% stated no preference, and 22% preferred the paper version. Completion time for the electronic SF-36 was slightly less, and there were no missing or problematical responses, whereas 44% of participants had at least one missing or problematical response in the paper version. Data entry and auditing time was 8 hours. There was less than 4% inter-version difference for any of the SF-36 sub-scales. The electronic SF-36 was well accepted and slightly quicker to complete than the paper version. We conclude that the electronic SF-36 is equivalent in performance and more effective than the paper version.     

Validation of the Portuguese version of the King's Health Questionnaire for urinary incontinent women

OBJECTIVE: To translate into Portuguese and evaluate the condition-specific quality of life King's Health Questionnaire (KHQ) for female urinary incontinence. METHODS: Two Brazilian translators, aware of the aim of the project, prepared two versions of the KHQ into Portuguese, which were back-translated into English by two other English translators. The differences were harmonized and pre-tested in a pilot study. The final version of the KHQ and the "Short-Form Health Survey" (SF-36), which has already been translated and validated into Portuguese were simultaneously administered to 156 and 119 women respectively. KHQ's psychometric properties such as reliability (internal consistency and retest) and construct validity were tested. A retest was performed within 2 weeks from the start date. RESULTS: The cultural adjustment process resulted in no changes in the KHQ Portuguese version, although for low schooling patients the questionnaire had to be read by the researcher during face-to-face interview. For all other patients, the KHQ was self-administered. KHQ's standardized Cronbach's alpha was 0.87 and when assessed by domains ranged from 0.49 to 0.92. Reliability measured by intraclass correlation (ICC) was considered moderate to strong for all domains and the severity measure scale ranged from 0.53 to 0.81. Pearson's correlation coefficient between KHQ and SF-36 was considered weak to moderate in the majority of the related domains, ranging from -0.27 to -0.53. CONCLUSIONS: The KHQ Portuguese version was translated and adjusted for Brazilian women with urinary incontinence complaints. It represents an important tool for the assessment of incontinent women in clinical trials.     

Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire

Introduction

Hospitalization due to cardiac conditions is increasing worldwide, and follow-up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients’ perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ.

Methods

This was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ.

Results

A total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ-12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's α: .91, ordinal α: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ-12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of the four response options could be evaluated.

Conclusion

The PCCQ-12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization.

Patient or Public Contribution

Patients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.     

Cross-cultural validation of the German version of the Four-Dimensional Symptom Questionnaire (4DSQ) in multimorbid elderly people

Purpose

Psychosomatic symptoms and mental health problems are highly prevalent in multimorbid elderly people challenging general practitioners to differentiate between normal stress and psychopathological conditions. The 4DSQ is a Dutch questionnaire developed to detect anxiety, depression, somatization, and distress in primary care. This study aims to analyze measurement equivalence between a German version and the original Dutch instrument.

Methods

A Dutch and a German sample of multimorbid elderly people, matched by gender and age, were analyzed. Equivalence of scale structures was assessed by confirmatory factor analysis (CFA). To evaluate measurement equivalence across languages, differential item functioning (DIF) was analyzed using Mantel–Haenszel method and hybrid ordinal logistic regression analysis. Differential test functioning (DTF) was assessed using Rasch analysis.

Results

A total of 185 German and 185 Dutch participants completed the questionnaire. The CFA confirmed one-factor models for all scales of both 4DSQ versions. Nine items in three scales were flagged with DIF. The anxiety scale showed to be free of DIF. DTF analysis revealed negligible scale impact of DIF.

Conclusions

The German 4DSQ demonstrated measurement equivalence to the original Dutch instrument. Hence, it can be considered a valid questionnaire for the screening for mental health problems in primary care.

     

Creating the Climate for Diversity and Race Equality in Health Care

In 1997 the Department of Health funded eight projects to demonstrate 'mainstreaming' responses to minority ethnic health in the NHS. 'Mainstreaming' is understood to require cultural, organisation and practice change; sustaining such change is a major challenge. Evaluation of the projects identified that leadership was a critical factor in encouraging change that was lasting. Other important issues were maintaining the desire changes in a turbulent organisational context and linking changes in practice with other priorities and initiatives. The agenda for the New NHS presents an opportunity for learning from this programme to be put into practice across the Department of Health and the NHS.     

Validation of the Tunisian version of the Health Assessment Questionnaire (HAQ) in rheumatoid arthritis patients

METHODS: One hundred twenty two rheumatoid arthritis patients were consecutively included in the study. Test-retest reliability was assessed in 61 patients based on the intra-class correlation coefficient. RESULTS: for the 122 patients (104 female and 18 male) the median age was 47 years (18-70). The mean age of the patients who filled in the questionnaire at test and retest times was 45 years (18-70). Test- retest reliability of the HAQ was 0.84. Internal consistency was 0.94. There was a good correlation between the HAQ and the Lee index (r = 0.75, p <10(-4)), the HAQ and the RAQoL (rs = 0.96, p <10(-4)). In a logistic regression model Lee index, RAQoL and age account for the variance of the HAQ. CONCLUSION: The Tunisian version of the HAQ preserves the metrological properties of the original version and can be used for measuring and following functional abilities of Tunisian rheumatoid arthritis patients.     

The reliability and validity of the Chinese version of the Metacognitions about Health Questionnaire in college students

Quality of Life Research - In order to explain the potential mechanism that might motivate and maintain health anxiety (HA), researchers have developed several measures to assess the level of HA...     

A German version of the Night Eating Questionnaire (NEQ): Psychometric properties and correlates in a student sample

Night eating syndrome (NES) is marked by substantial evening or nocturnal food intake, insomnia, morning anorexia, and depressed mood. The Night Eating Questionnaire (NEQ) is the most frequently used instrument for the assessment of NES and available in several languages. The current study aimed at providing and validating a German version of the NEQ using an online study among students (N = 729). The German NEQ had acceptable internal consistency (α = .71) and three-week retest-reliability (r = .77). The four-factor structure of the original version (morning anorexia, evening hyperphagia, mood/sleep, nocturnal ingestions) could be replicated, except for one item. Convergent validity was supported by moderate positive correlations with eating pathology, emotional eating, and habitual food cravings. Discriminant validity was supported by small positive correlations with relevant, but not eating-related constructs (eveningness preference, impulsivity). Scores on the NEQ were also positively, but weakly, correlated with body mass index (r = .18). The German version of the NEQ appears to be a useful tool for future investigations on night eating.     

The Brazilian version of the Fear Avoidance Beliefs Questionnaire

The aim of the present study was to investigate the psychometric properties and validate the Portuguese version of the Fear Avoidance Beliefs Questionnaire (FABQ-Brazil). This instrument assesses how beliefs and fear of individuals with lower back pain affect two subscales related to their physical activities (FABQ-Phys) and work (FABQ-Work). The questionnaire was translated into Brazilian Portuguese, following the recommended methodology, and applied to 53 individuals with non-specific chronic lower back pain. The test-retest intra-class correlation coefficients (ICC = 0.84 and 0.91) and the internal consistency (Cronbach's = 0.80 and 0.90) for FABQ-Phys and FABQ-Work, respectively, were acceptable. The stepwise multiple regression analyses revealed statistically significant correlations between all isolated items with their respective subscales, and the set of the items explained 99% of the changes in scores for each subscale. No significant correlations were found between the subscales; however, both the FABQ-Phys and FABQ-Work subscales were positively associated with pain intensity (visual numerical scale) and degree of disability (Roland Morris Questionnaire). These findings supported the evidence that the FABQ-Brazil showed adequate psychometric properties for individuals with chronic lower back pain.     

德国医院透明管理制度与标准解读

在美国JCI及国际ISO质量认证体系逐步进入我国后,德国KTQ评审也以其科学的方式和精确的标准得到了国内的广泛关注,文章将从KTQ评审机构、KTQ评审方法、KTQ评审标准、KTQ信息发布及监管几个方面对德国医院评审制度进行解读,以期为我国医院评审提供借鉴.     

Translation,cultural adaptation and construct validity of the German version of the Adult Social Care Outcomes Toolkit for informal Carers (German ASCOT-Carer)

Quality of Life Research - The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer), developed in England, measures the effects of long-term care (LTC) services and carer support on informal...     

Validation of the Brazilian version of Chronic Liver Disease Questionnaire

Purpose

The aim of this study was to validate the Chronic Liver Disease Questionnaire (CLDQ) for use in Brazilian population.

Method

A total of 200 patients with chronic liver disease and varying disease severity answered a socio-demographic questionnaire, t CLDQ, and the Medical Outcome Study Short Form 36 (SF-36). Patients returned in 1–15 days to answer CLDQ again. The Cronbach’s alpha of the total CLDQ score was 0.95 and fluctuated between 0.69 and 0.83 in its six domains.

Results

The intra-class correlation between total CLDQ scores in two evaluations was 0.97 and in all domains was >0.93. CLDQ was moderately correlated with the SF-36, 0.63 (total CLDQ vs. vitality, SF-36), 0.62 (CLDQ and mental health, SF-36), 0.62 (preoccupation, CLDQ, vs. General Health, SF-36), 0.59 (fatigue, CLDQ, vs. vitality, SF-36), 0.59 (activity, CLDQ, vs. vitality, SF-36), and 0.59 (fatigue, CLDQ, vs. mental health, SF-36). The highest scores were found in non-cirrhotic group. Child A patients had higher average scores than Child B and C groups in all domains, while patients with MELD <15 scored higher than patients with MELD ≥15.

Conclusion

CLDQ-BR was validated in Brazilian population and was appropriate for use in patients with liver disease of different etiologies and degrees of severity.     

汉化版情商问卷在大学生中应用的信效度评价

评价汉化版情商问卷在大学生中使用的信度和效度,为情商研究提供有效的测量工具.方法 采用汉化版情商问卷及Young网络成瘾量表,对选修北京某医科大学《生活技能教育与心理健康促进》课程和河北某理工科大学《健康与发展》课程的大学生共556名进行问卷调查.采用Cronbach'sα系数法、相关分析和因子分析评价量表的信度和结构效度,用Young网络成瘾诊断量表评价区分效度.结果 汉化版情商问卷的Cronbach's α系数为0.887.各条目与总量表得分间相关系数在0.19 ~0.72间(P值均<0.01).探索性因子分析提取了9个因子(累计解释方差为50.78%),仅有个别题目的归属与情商问卷的假设不一致.量表除“快乐”外所有的维度和总分上,有无网瘾者的得分差异均有统计学意义(P值均<0.05).结论 中文版情商问卷有较好的信度和区分效度,但是仍然需要扩大样本在将来的研究中更深入地验证并改进其结构效度.