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Patient attitudes to clinical trials: development of a questionnaire and results from asthma and cancer patients.

OBJECTIVE: To develop a questionnaire to assess patients' views of clinical trials, and to report the results from the questionnaire in two patient groups: asthma and cancer. DESIGN: A 43 item questionnaire asking patients about their views to clinical trials was developed on the basis of interviews with trialists and focus groups with patients. The questionnaire was mailed to patients with a diagnosis of either asthma or cancer. A set of items was then selected, via statistical analyses, to form the core of the questionnaire. PARTICIPANTS: Patients with a diagnosis of cancer in one NHS Hospital Trust, and patients with a diagnosis of asthma in two NHS Hospital Trusts. RESULTS: Completed questionnaires were received from 353 cancer patients and 578 asthma patients. Factor analyses of the data indicated that 22 items contributed to five dimensions: 'positive beliefs', 'safety', 'information needs', 'negative expectations' and 'patient involvement'. Differences between asthma and cancer patients on these dimensions were small. A regression of these dimension scores against a variable asking if patients would be willing to take part in trials found that 'safety' and 'information needs' did not contribute significantly to the model for either asthma or cancer patients. CONCLUSIONS: A questionnaire has been developed for use in assessing patients' views towards clinical trials. Results from the surveys reported here suggest that patient views about the importance of trials and beliefs about the value of patient involvement are likely to be predictive of whether or not patients will agree to take part in a study.

Adult↗

Validation of a migraine screening questionnaire in a Colombian university population.

In studies of migraine prevalence, it is important to be aware of the discriminative capacity of the test used. We set out to validate a Spanish translation of Michel's Standardized Migraine Diagnosis Questionnaire. The questionnaire was applied on all active students of the School of Psychology of the Universidad Autónoma de Bucaramanga, Colombia. A neurologist interviewed a random sample to substantiate the diagnosis of migraine. Cronbach's alpha was calculated and factors analysis was made in order to estimate internal consistency, test-retest to find reproducibility, and ROC curve and diagnostic indicators were calculated to estimate the criteria validity. Of 357 students that answered the questionnaire, 188 (52.7%) were selected at random to attend an appointment with a neurologist, but only 170 had this interview. Cronbach's alpha on these 357 questionnaires is 0.7497. All the questions on the questionnaire represented two main factors. This test had sensitivity in 37.9% [95% confidence interval (CI) 25.8, 51.7], specificity in 99.1% (95% CI 94.4, 100), positive predictive value in 95.7% (95% CI 76.0, 99.8), and negative predictive value in 75.5% (95% CI 67.6, 82.1) for 17 or more points. The area below ROC curve is 0.8529 (95% CI 0.8035, 0.9217). Among 84 students who took the questionnaire a second time, the average score on the first survey was 12.33 +/- 7.46 points, while the average score on the second take was 11.26 +/- 7.85 (P = 0.069). Agreement for migraine is 83.3% (95% CI 73.6, 90.6; Cohen's kappa = 0.6650 +/- 0.1061). The Spanish translation of Michel's Questionnaire is easy to answer and has good internal consistency, but its reproducibility and sensibility are modest; however, the ROC curve is acceptable to discriminate migraine patients from normal subjects.

Adolescent↗

A new questionnaire to assess the quality of life of urinary incontinent women.

OBJECTIVES: To design and validate a condition-specific quality of life questionnaire for the assessment of women with urinary incontinence, and to use the questionnaire to assess the quality of life of women with specific urodynamic diagnoses. SETTING: A tertiary referral urogynaecology unit at King's College Hospital, London. DESIGN: The questionnaire was designed following six different pilot studies; in this study it was tested for validity and reliability using standard psychometric techniques. The questionnaire was used in 293 consecutive women referred for investigation of urinary incontinence. RESULTS: The questionnaire was shown to be reliable both by test-retest analysis and by measurement of its internal consistency. The construct of the questionnaire and the answers by respondents confirmed its face and content validity. Criterion validity was measured by correlation with scores obtained on a validated generic measure of quality of life, the Short Form 36. Women with detrusor instability had greater quality of life impairment than women with other urodynamic diagnoses. CONCLUSION: The questionnaire was easy for the women to use and was a valid and reliable instrument for the assessment of quality of life in women with urinary incontinence. It will be useful for the rapid appraisal and follow up of women with urinary incontinence in many different clinical settings, including the evaluation of new treatments of urinary incontinence in controlled clinical trials.

Adult↗

A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence.

OBJECTIVE: To design and validate a condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. DESIGN: A psychometric study by postal survey. SETTING: South Manchester University Hospital, UK. SAMPLE: Two hundred and twenty women with known anal incontinence. METHOD: The questionnaire was adapted from the King's Health Questionnaire, a condition-specific health-related quality of life questionnaire for the assessment of women with urinary incontinence. The questionnaire was then tested for acceptability, reliability and validity by postal survey. RESULTS: The Manchester Health Questionnaire was found to be highly acceptable to women and showed excellent internal consistency, test-retest reliability, criterion and construct validity. CONCLUSION: The questionnaire is both a valid and reliable instrument for the assessment of health-related quality of life among women with anal incontinence. It will be useful in many different clinical settings and be of practical use in the evaluation of women after childbirth. As the good response rates show it could be a successful part of a postal survey.

Adult↗

Measuring quality of life in dyspeptic patients: development and validation of a new specific health status questionnaire: final report from the Italian QPD project involving 4000 patients.

OBJECTIVE: Despite the fact that gastrointestinal disorders represent one of the most common reasons for medical consultations, formal assessment of patients' health-related quality of life (HRQOL) has been carried out only in a few studies, and in most cases generic questionnaires have been adopted. Because the specific issue of living with dyspeptic problems has been addressed in very few cases and no questionnaire has been shown to be appropriate for the Italian setting, a prospective project was launched to develop a specific HRQOL questionnaire for dyspepsia sufferers tailored to Italian patients but also appropriate in other cultural settings. METHODS: The project consisted in a 3-yr, three-phase survey, in which different versions of the quality of life in peptic disease questionnaire (QPD) were developed through expert and patient focus groups and empiric field studies and then administered to patients recruited in five multicenter studies. Standard psychometric techniques were used to evaluate the validity, reliability, responsiveness, and patient acceptability of the QPD. RESULTS: Three different versions of the QPD questionnaire were self-administered to more than 4000 patients. The final 30-item version, measuring three health concepts related to dyspeptic disease (anxiety induced by pain, social restriction, symptom perception), fulfilled the recommended psychometric criteria in terms of reliability and validity, correlated with health concepts measured with a well-known independent generic HRQOL instrument (the SF-36 Health Survey questionnaire) and was relatively invariant to diagnosis and sociodemographic variables; it also correlated with a measure of gastric pain frequency and was able to detect meaningful differences over time. CONCLUSIONS: Although further validation studies in different cultural and linguistic settings are mandatory before any firm conclusions can be drawn regarding the cross-cultural validity of the QPD, the data obtained provide evidence of the psychometric validity and robustness of the questionnaire when used in a fairly large, well-characterized population of Italian dyspeptic patients.

Adult↗

A comparison of a computer-based questionnaire and personal interviews in determining oral health-related behaviours.

BACKGROUND: A major challenge for survey-based research is to reduce bias. In an interview, subjects may claim more favourable behaviour to please the interviewer or comply with accepted norms. OBJECTIVES: This study aimed to: (i) determine if adolescents give different answers when using a self-completed computer-administered oral health questionnaire compared with a personal interview, (ii) ascertain if responses to a face-to-face interview are dependant on whether a dentist or nonclinical researcher administered the questionnaire and (iii) examine if responses were influenced by whether they undertook the computer questionnaire first or second. METHODS: A randomized crossover design was used to investigate the responses to 15 closed questions on oral health-related practices. These were administered to 453, 12-year olds attending school dental inspections in South Wales. RESULTS: A total of 449 valid pairings of computer/interview responses were available for analysis. Responses to the questionnaire variables demonstrated good to very good levels of agreement (kappa 0.68-0.90) when comparing the face-to-face and computer-administered questionnaire. With the exception of questions on dental attendance, responses were not influenced by whether the questions were posed by the research officer or the dentist. A minimal order effect could be detected when undertaking the computer-administered questionnaire first. CONCLUSIONS: Whilst a study such as this cannot determine the true validity of the responses achieved, it is concluded that a computer-administered questionnaire, comprising closed questions, can be utilized to determine oral health-related behaviours in oral health surveys.

Adolescent↗

Association between erectile dysfunction and sleep disorders measured by self-assessment questionnaires in adult men.

BACKGROUND: Erectile dysfunction (ED) is often associated with sleep disorders and sleep apnea syndrome (SAS) in mostly middle-aged and elderly men. Sleep disorders and ED are also prevalent in younger men. PURPOSE: To study the association between ED, sleep disorders, and SAS, particularly among adult men. METHODS: A health screening program is offered by the Israel Defense Force (IDF) for career servicemen older than 25 years, for the purpose of early detection of ED and sleep disorders, among other concealed morbidities. The Sexual Health Inventory for Man questionnaire (SHIM) was used to measure ED. The Sleep Quality (SQ) questionnaire, developed by the medical services of the IDF, was used to characterize SAS and other sleep disorders. RESULTS: From 2002 through 2003, 3,363 men (mean age, 36.1+/-6.8 years) replied to the SHIM and SQ questionnaires. Of these men, 337 (10%) scored high (>or=25) in the SQ questionnaire, suggesting moderate to severe sleep disorders, and 870 men (25.8%) scored low (<or=21) in the SHIM questionnaire, suggesting ED. There was a negative correlation between the scores in the SHIM questionnaire and in the SQ questionnaire (r=-0.29, P<0.0001)-even after age adjustment and after excluding men with risk factors for both ED and SAS (such as essential hypertension, diabetes mellitus, and obesity; r=-0.21, P<0.0001). This correlation was consistent with all severity levels of ED and sleep disorders. CONCLUSIONS: Sleep disorders, in particular SAS, and ED are prevalent and may be related in adult men. Either ED or sleep disorders should be considered whenever the other is suspected in adult men. Sleep disorders and ED should also be investigated for the purpose of treating underlying systemic diseases and emotional disorders, and in order to prevent late complications of atherosclerosis.

Adult↗

Low scores in the sexual health inventory for men questionnaire may indicate sexual disorders other than erectile dysfunction.

INTRODUCTION: A screening program aimed at early detection of erectile dysfunction, among other hidden morbidities, is offered by the medical services of the Israel Defense Force for career servicemen. Men apparently with erectile dysfunction can turn to a sexual rehabilitation specialist for consultation. AIM: To present our experience in sexual evaluation of men with low scores in the Sexual Health Inventory for Men (SHIM) questionnaire. METHODS: Men aged 25-50 years go through a routine check-up at the Staff Periodic Examination Center. The SHIM questionnaire was used to characterize erectile dysfunction. Men who had scored low in the SHIM questionnaire were referred to a sexual consultation and evaluation. RESULTS: During 2001-2003, 11,914 men reported to the Staff Periodic Examination Center (mean age 34.8 +/- 7.1 years). Among 5,836 men who filled out the SHIM questionnaire (compliance of 48.9%), 1,570 (26.9%) men scored low. Of those men with low SHIM scores, 7.2% (114/1,570) underwent a sexual dysfunction evaluation. Only 50% (57/114) of the men in fact had erectile dysfunction, of whom 15.7% (9/57) also had premature ejaculation. In addition, 38.5% (44/114) of the men were found to have premature ejaculation only, and the rest (14/114, 9.7%) had other sexual dysfunctions or lack of sexual knowledge. CONCLUSION: The SHIM questionnaire is a valuable tool for detecting various sexual dysfunctions other than erectile dysfunction. Incorporating the SHIM questionnaire in a routine check-up encourages men to seek consultation and treatment for sexual disorders. In addition, the SHIM questionnaire encourages men to seek sexual education and increase their awareness of issues concerning sexual health.

Adult↗

Reliability and validity of the School Health Policies and Programs Study 2000 questionnaires.

To help assess the quality of the questionnaires developed for the School Health Policies and Programs Study (SHPPS) 2000, the Centers for Disease Control and Prevention (CDC) conducted a data quality substudy in conjunction with SHPPS 2000. The substudy assessed validity of the state- and district-level questionnaires through telephone interviews with a subsample of the original state- and district-level respondents, and the test-retest reliability of the school- and classroom-level questionnaires through computer-assisted repeat interviews with a subsample of the school- and classroom-level respondents. Results indicated that although a few threats to the validity of responses to the state- and district-level questionnaires were identified, the questionnaires generally produced valid data. Among the school- and classroom-level questionnaires, some questions demonstrated poor reliability, but most exhibited moderate or substantial reliability, and some exhibited almost perfect reliability. CDC will use these results to revise the SHPPS 2000 questionnaires and will consider alternative methods of data collection to improve the quality of data collected in future versions of SHPPS.

Centers for Disease Control and Prevention, U.S.↗

Does anonymity increase response rate in postal questionnaire surveys about sensitive subjects? A randomised trial.

STUDY OBJECTIVE: The aim of the study was to determine whether complete anonymity improves the response rates to a postal questionnaire. DESIGN: The study derived from a series of postal surveys on AIDS knowledge conducted on six different dates in 1986 and 1987. The sample was randomly divided into two, each group being sent the same questionnaire. One group was informed that the replies were anonymous, the other that they were not. The latter were sent reminders. SETTING: Recipients of the questionnaires were drawn from the Southampton electoral rolls. PARTICIPANTS: 300 people in each survey (total 1800) were sent questionnaires, representing on each occasion a different 1:500 systematic sample. RESULTS: Response rate was 49% for the anonymous questionnaires and 51% for the numbered questionnaires. Reminders boosted the response in the numbered group to 72%. CONCLUSIONS: There is no evidence that anonymity improves response to postal questionnaires, but the use of reminders may do so.

Acquired Immunodeficiency Syndrome↗

Questionnaire for the identification of back pain for epidemiological purposes.

OBJECTIVES: To design a questionnaire for the identification and assessment of severity of back pain for epidemiological purposes, and gain preliminary experience of its use. METHODS: A group of specialists, experienced in the epidemiology and clinical assessment of back pain, designed the questionnaire, and tested it individually. It was also given cross sectionally by interview to a population of male coal mine workers. RESULTS: The questionnaire comprised a maximum of 12 questions on the presence, radiation, frequency, and severity of back pain with reference to difficulty with specific activities, interference with normal work, and absence from work. 471 coal miners answered the questionnaire (66% of those invited). 56% (265 men) of the responders reported pain or ache in the back during the previous 12 months, and the incidence of first ever attacks during the same period was reported to be 34%. 69% reported having had back pain at some time. The responses to the questionnaire were partially validated by comparison with certified sickness absence for two days or more attributed to back pain. In men who were symptomatic in the previous 12 months, for the question relating to absence from work because of back pain, the sensitivity was 82% and specificity was 84%. CONCLUSION: The questionnaire is easy to administer and generates clear cut data that could be useful for epidemiological or screening purposes. Preliminary, limited, studies of its validity are reasonably encouraging, although further validation is required. It is hoped that researchers will find the questionnaire useful, will extend its validation, and continue to develop it.

Adult↗

Development and testing of a questionnaire to measure patient satisfaction with intermediate care.

BACKGROUND: Individual trials have suggested high levels of general patient satisfaction with intermediate care, but this topic has not been examined in detail. AIMS: To identify the key elements of patient satisfaction with intermediate care, and to see whether these can be validly measured using a questionnaire. METHOD: A questionnaire was developed on the basis of a literature review and piloting with patients and staff on participating schemes (phase I). In phase II, the questionnaire was tested for validity and reliability in a group of patients recently discharged from two "hospital-at-home" intermediate-care schemes. In phase III, a shortened version of the questionnaire was psychometrically tested in five sites taking part in a national evaluation of intermediate care. RESULTS: 96 patients with an average age of 76.5 years took part in phase II. Test-retest reliability was evaluated by repeating the questionnaire 2 weeks later in a subsample of 42 patients. This was "moderate" (kappa 0.4-0.6) for 12 questions, "fair" (kappa 0.2-0.4) for 6 questions and "poor" (kappa 0.1-0.2) for 5 questions. Scores correlated well with the Client Satisfaction Questionnaire (Spearman's r = 0.75, p<0.001). 843 patients (57% of those eligible) from five intermediate-care schemes took part in phase III. Principal components analysis suggested six factors or subscales: general satisfaction, affective response, cognitive response, timing of discharge, coordination after discharge, and access to pain relief, although the last three factors comprised only one question each. The intraclass correlation coefficients in the first three subscales varied from 0.82 to 0.89. Scores for all subscales differed by scheme, suggesting construct validity. Only one question (on general satisfaction) was found to be redundant. CONCLUSION: The questionnaire, with some minor amendments to improve performance, could be used as a validated tool for audit and research in intermediate care. An amended version and scoring programme is available from us on request.

Aged↗

Relation of passive smoking as assessed by salivary cotinine concentration and questionnaire to spirometric indices in children.

BACKGROUND: Previous studies of the effects of passive exposure to smoke on spirometric indices in children have largely relied on questionnaire measures of exposure. This may have resulted in underestimation of the true effect of passive smoking. Biochemical measures offer the opportunity to estimate recent exposure directly. METHODS: The relation between spirometric indices and passive exposure to tobacco smoke was examined in a large population sample of 5-7 year old children from 10 towns in England and Wales. The effects of passive exposure to smoke on lung function were assessed by means of both salivary cotinine concentration and questionnaire measurements of exposure. Analyses of the relation between spirometric values and cotinine concentrations were based on 2511 children and of the relation between spirometric values and questionnaire measures on 2000 children. RESULTS: Cotinine concentration was negatively associated with all spirometric indices after adjustment for confounding variables, which included age, sex, body size, and social class. The strongest association was with mid expiratory flow rate (FEF50), the fall between the bottom and top fifths of the cotinine distribution being 6%, equivalent to a reduction of 14.3 (95% confidence limits (CL) 8.6, 20.0) ml/s per ng/ml cotinine. Salivary cotinine concentrations were strongly related to exposure to cigarette smoke at home but 88% of children who were from non-smoking households and not looked after by a smoker had detectable cotinine concentrations, 5% being in the top two fifths of the cotinine distribution. A composite questionnaire score based on the number of regular sources of exposure was as strongly related to mid and end expiratory flow rates as the single cotinine measure. The fall in FEF50 per smoker to whom the child was exposed was 51.0 (26.5, 75.5) ml/s. The relationships between the questionnaire score and forced vital capacity (FVC) or forced expiratory volume in one second (FEV1) were not statistically significant. CONCLUSIONS: These effects of passive smoking on respiratory function are consistent with the results of previous studies and, although small in absolute magnitude, may be important if the effects of exposure are cumulative. In children aged 5-7 years the use of a single salivary cotinine concentration as a marker of passive exposure to smoke resulted in clear relationships between exposure and FVC and FEV1, whereas the associations were much weaker and not significant when based on the questionnaire score. The associations between exposure and mid or end expiratory flow rates were of similar magnitude for cotinine concentration and the questionnaire score. The use of salivary cotinine concentration in longitudinal studies may help to determine the extent to which these effects are cumulative or reversible.

Biomarkers↗

Validation of a short questionnaire in English and French for use in patients with persistent upper gastrointestinal symptoms despite proton pump inhibitor therapy: the PASS (Proton pump inhibitor Acid Suppression Symptom) test.

BACKGROUND: The management of persistent symptoms during acid suppression therapy in patients with gastroesophageal reflux disease or dyspepsia might be improved if patient-physician communication regarding the presence and character of these persistent symptoms were facilitated. AIM: To validate a short, simple questionnaire (the Proton pump inhibitor [PPI] Acid Suppression Symptom [PASS] test), in English and French, to identify patients with persistent acid-related symptoms during PPI therapy and document their response to a change in therapy. METHODS: Patients with persistent acid-related symptoms on PPI therapy were interviewed to produce a draft, five-item questionnaire; content validity was evaluated by focus groups comprising English- and French-speaking patients. Psychometric validity was subsequently evaluated in a multicentre, family practice-based study of English- and French-speaking patients with persistent acid-related upper gastrointestinal symptoms despite PPI therapy. The PASS test, Global Overall Symptom scale, Gastrointestinal Symptom Rating Scale (GSRS), Quality of Life in Reflux and Dyspepsia questionnaire and Reflux Disease Questionnaire were completed at baseline and repeated after one week while patients continued their original PPI therapy. All patients then received esomeprazole 40 mg once daily for four weeks, after which all questionnaires and an evaluation of overall treatment effect were completed. RESULTS: Content validity was established in 20 English- and 16 French-speaking patients. Psychometric validation in 158 English- and 113 French-speaking patients revealed good-to-excellent test-retest reliability coefficients: 0.76 for English; 0.68 for French. For construct validity, the PASS test showed moderate-to-high correlation with the GSRS scale (0.51 for English; 0.43 for French). After four weeks of therapy, the PASS test score fell to zero in 30% of English- and 33% of French-speaking patients, while the Global Overall Symptom score fell to one (no symptoms) in 32% of patients (English- and French-speaking); the PASS test demonstrated good responsiveness in comparison with the GSRS, Reflux Disease Questionnaire and Quality of Life in Reflux and Dyspepsia questionnaire. CONCLUSION: The five-item PASS test is a valid tool for the evaluation of persistent acid-related symptoms in patients receiving PPI therapy. It demonstrates good content validity, test-retest reliability, responsiveness and construct validity in both English and French forms. The PASS test is a simple, clinically applicable tool for the identification of patients with persistent acid-related symptoms during therapy and the assessment of their responses to a change in therapy.

Dyspepsia↗

Comparison of questionnaire and diary methods in acute childhood respiratory illness surveillance.

We compared two prospective survey methods, an interviewer-administered questionnaire and a daily diary, used concurrently to record acute respiratory illness experience over a 2-yr period in 422 children 5 to 11 yr of age from East Boston, Massachusetts. Respondents contributed more months of data with the questionnaire than with the diary method. Respiratory symptom and illness rates, as determined for the first year by each of the methods, were compared for 277 children who had less than 4 months of missing data. Respondents from families with more children tended to report a lower total respiratory illness rate by the diary than by the questionnaire method (p = 0.006). Although upper respiratory illness rates did not differ by method, lower respiratory illnesses were reported more frequently (p = 0.0001) by questionnaire than by diary. In the group of 49 children who were identified as having had greater than one lower respiratory illness, 25% of the illnesses reported as having been lower respiratory by questionnaire were reported as having been another form of respiratory illness by diary. For this group the ratio of 3:1 of boys to girls for the diary as compared with 1.5:1 for the questionnaire suggests the presence of reporting bias and no comparability of methods. Standardization of an acute respiratory illness questionnaire would provide greater opportunity than use of diaries for synthesis of prospective data from different epidemiologic studies.

Acute Disease↗

The Contact Lens Impact on Quality of Life (CLIQ) Questionnaire: development and validation.

PURPOSE: To develop and validate a questionnaire for the measurement of the impact of contact lenses on quality of life (QoL): The Contact Lens Impact on Quality of Life (CLIQ) Questionnaire. METHODS: The questionnaire was developed and validated using conventional methods and Rasch analysis to assure content validity, repeatability, construct validity, and low respondent burden. Item identification and selection (647 items) were performed with an extensive literature review, professional advice, and lay focus groups. Item reduction used focus groups and data obtained from 161 subjects completing a 90-item pilot questionnaire. Validity and reliability, from data of 128 additional subjects, were assessed using Rasch analysis, intraclass correlation coefficient, and Bland-Altman limits of agreement. RESULTS: A 28-item CLIQ Questionnaire was developed and shown to have good validity and reliability by Rasch analysis statistics: real person separation, 2.02; model person separation, 2.17; reliability, 0.80; root mean square measurement error, 2.73; mean square+/-SD infit, 1.01+/-0.18; outfit, 1.01+/-0.19. The items (mean score, 49.8+/-4.9) were well targeted to the subjects (mean score, 51.2+/-6.2) with a mean difference of 1.35 (scale range, 0-100) units. Test-retest intraclass correlation coefficient (0.86) and coefficient of repeatability (+/-8.00 units) demonstrated good repeatability. CONCLUSIONS: Rasch analysis and standard psychometric analyses demonstrated that the 28-item CLIQ Questionnaire is a valid and reliable measure of QoL in contact lens wearers. A scoring algorithm is provided for CLIQ Questionnaire users to convert raw scores into the Rasch analysis-derived linear person measures.

Adolescent↗

Questionnaire use in pediatric practice. Survey of practice.

A sample of members of the American Academy of Pediatrics were surveyed to determine the nature and extent of questionnaire use in pediatric practice and to assess practitioners' attitudes toward questionnaires. Thirty-eight percent of 169 respondents (of 300 contacted) reported that they were using a questionnaire in their clinical practice and an additional 36 percent indicated interest in possible future use. Most (89%) questionnaires were constructed by the practitioners themselves. Questionnaire use was associated with group practice and prepaid fee plans. Efficiency was the most common reason given for questionnaire use and impersonality was the most commonly cited objection. Practitioners' attitudes toward questionnaires are discussed.

Attitude of Health Personnel↗

Evaluating the reliability and validity of the Questionnaire for Lung Transplant Patients.

CONTEXT: The Questionnaire for Lung Transplant Patients was designed for clinical use by the pulmonary transplant team in the routine evaluation of lung transplant recipients. Using the self-administered questionnaire, recipients check symptoms that they have had since their last evaluation and rate their shortness of breath, cough, and activity tolerance. OBJECTIVE: To determine whether the questionnaire meets reliability and validity standards for empirical measurement. METHODS: Demographics and disease-severity characteristics were examined in a cross-sectional survey of 37 recipients. Test-retest and intraclass correlation methods were used to estimate stability, and the Cronbach alpha was used to estimate internal consistency. Criterion validity was examined by using The Modified Symptom Frequency/Symptom Distress Scale, Functional Performance Inventory, and visual analog scales for cough and shortness of breath as criterion measures. Construct validity was examined to assess the predicted negative correlation between symptoms and functional performance. RESULTS: The questionnaire and its subscales were internally consistent (Cronbach alpha = 0.82, 0.76, 0.80, and 0.96), and the questionnaire was stable (r = 0.70) and reliable (intraclass correlations = 0.80 and 0.90). Significant correlations were found between the questionnaire and all criterion measures (r = 0.50-0.93). Significant correlations in the predicted negative direction were found between the respiratory subscale and functional performance (r = -0.51) and between cough (r = -0.51) and shortness of breath (r = -0.68) ratings and functional performance. CONCLUSIONS: The Questionnaire for Lung Transplant Patients is reliable and valid, and it provides scientifically sound information for clinical and empirical evaluation of symptoms and their effects on activity tolerance after lung transplantation.

Evaluation Studies as Topic↗