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PubMed2003

Pretesting survey instruments: an overview of cognitive methods.

This article puts forward the case that survey questionnaires, which are a type of measuring instrument, can and should be tested to ensure they meet their purpose. Traditionally survey researchers have been pre-occupied with 'standardising' data collection instruments and procedures such as question wording and have assumed that experience in questionnaire design, coupled with pilot testing of questionnaires, will then ensure valid and reliable results. However, implicit in the notion of standardisation are the assumptions that respondents are able to understand the questions being asked, that questions are understood in the same way by all respondents, and that respondents are willing and able to answer such questions. The development of cognitive question testing methods has provided social researchers with a number of theories and tools to test these assumptions, and to develop better survey instruments and questionnaires. This paper describes some of these theories and tools, and argues that cognitive testing should be a standard part of the development process of any survey instrument.

Attitude to Health↗
PubMed1998

Mail-in questionnaire for monitoring nausea and vomiting in oncology outpatients.

A patient questionnaire designed to help pharmacists monitor nausea and vomiting in outpatients receiving cancer chemotherapy was studied. A 12-item questionnaire was designed by combining items from the Morrow Assessment of Nausea and Emesis (MANE) and the Functional Living Index-Emesis (FLIE). Items included number of vomiting episodes, duration of nausea, number of antiemetics, severity of nausea and vomiting, impact on quality of life, and adverse effects. The questionnaire was printed on an addressed, postage-paid card. Over an eight-week period, outpatients in a hospital's oncology clinic were asked to complete the questionnaire at home during the three days after chemotherapy. Of 48 patients asked, 42 (88%) agreed to complete the questionnaire, and 36 (86%) of these patients mailed it back to the clinic. Of the respondents, 11 reported at least one episode of vomiting, and 22 reported nausea. Thirteen respondents logged nausea ratings of 3 or higher on a 7-point scale. Twenty respondents used antiemetics. Responses given by the patients in follow-up telephone interviews did not differ significantly from the responses collected with the questionnaire. More than 90% of patients who returned the questionnaire rated it as simple to complete. Pharmacists used the self-reports of nausea or vomiting in 7 (17%) of 42 cases to recommend alternative antiemetic regimens. A mail-in questionnaire for monitoring nausea and vomiting in outpatients undergoing chemotherapy was completed and returned by a high percentage of patients and was useful to clinic pharmacists.

Adult↗
PubMed2000

Respiratory-related quality of life: relation to pulmonary function, functional exercise capacity, and sputum biophysical properties.

One of the difficulties in assessing mucoactive therapy is selecting clinical outcome variables that reflect the impact of clearing airway secretions on quality of life (QOL). Petty and colleagues developed a questionnaire designed to evaluate the clinical impact of mucoactive therapy in patients with chronic bronchitis (CB). We evaluated this questionnaire in a multicenter study of a mucolytic medication used in patients with CB and hypothesized that spirometry, exercise capacity, and sputum clearability changes would correlate with QOL changes. This was a multicenter trial in 159 patients with stable CB (111 completed the 16-week study). Spirometry, plethysmography, the 6-minute walk test (6MWT), and Petty score as a measure of QOL were assessed at each visit. Sputum was collected at each visit. Cough transportability was measured in a cough machine, and mucociliary transportability was measured on the frog palate. Cohesivity was measured in a filancemeter, interfacial tension by de Noüy ring, and wettability by contact angle analysis. Within the entire data set of 694 evaluations, there was no correlation between pulmonary function and QOL. There was an inverse correlation with distance covered in a 6MWT (R(2) = 0.041, p < 0.0001). Sputum CTR was directly correlated with QOL (R(2) = 0.027, p < 0.0001). Change from baseline (mean of first three visits) was computed and compared the change in the mean of values at the 8- and 12-week visits (n = 108 sets of data pairs). This was analyzed as a percentage of change for continuous measurements, and as QOL is normative, we calculated the absolute change in QOL. There was no relation between QOL and 6MWT changes. There was an inverse relation between change in forced expiratory volume in 1 second and QOL (R(2) = 0.092, p = 0.0021) as well as between forced vital capacity and QOL (R(2) = 0.05, p = 0.024). There was a direct relation between CTR and QOL (R(2) = 0.039, p = 0.048). The relation between QOL and 6-minute walk distance was expected but weak. The consistent relation between CTR and QOL (suggesting that improved CTR of sputum is associated with decreased QOL) is difficult to explain. A change in forced expiratory volume in 1 second and forced vital capacity did correlate with a change in QOL. There is a need for a good QOL tool to evaluate mucus clearance devices or medications. The Petty questionnaire was designed specifically for this task, but the effect on sputum properties by current mucoactive agents may be too small to elicit a significant change in the Petty score.

Analysis of Variance↗
PubMed1994

Clinical and symptom measures.

We present a review of specific health status measures, including symptoms, physical examination, and laboratory tests (exclusive of lung function tests), in terms of their suitability for assessing the presence and severity of asthma in epidemiologic and clinical research. We focus on the validity, reliability, and responsiveness to clinical intervention of these measures. Several adult questionnaires designed for epidemiologic research include questions on asthma and wheezing that have demonstrated repeatability and validity against concurrent measurements of nonspecific airway responsiveness. The International Union Against Tuberculosis Bronchial Symptoms Questionnaire was designed specifically to detect asthma and airway hyperresponsiveness in adult populations, and its reliability and validity have been well documented. A childhood questionnaire developed by Australian investigators has been demonstrated to provide information on asthma and wheezing that is reliable and valid against the criterion of concurrently measured nonspecific airway responsiveness. Although suitable for epidemiologic research, these questionnaires do not provide sufficient data on the severity of current asthma symptoms (aspects of which include intensity, duration, and frequency of symptoms) to be useful for clinical research involving subjects with established asthma. Many different methods of obtaining and analyzing symptom data have been used in clinical trials, but these have not received the methodologic scrutiny that allow the recommendation of a "best" approach for evaluating symptoms in clinical trials of interventions for asthma. The use of daily symptom diaries in short-term drug trials is common, but the optimal symptom-reporting interval for such studies has not been established. Similarly, a particular approach to integrating different symptoms (wheeze, dyspnea, cough, sputum) and the different aspects of these symptoms (intensity, duration, frequency) cannot be recommended on the basis of available data. Physical examination findings have little utility as asthma outcome measures because they may be normal between symptom episodes, they have relatively poor interobserver reliability, and they are relatively poor predictors of the outcome of emergency room visits for asthma. The finding of an elevated arterial PCO2 has utility as an indicator of a severe asthma attack, but arterial blood gas measurements have little other utility as asthma outcome measures. The chest radiograph is generally normal in patients with asthma and therefore not useful as an asthma outcome measure.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

Development of the Leeds Dependence Questionnaire (LDQ): a questionnaire to measure alcohol and opiate dependence in the context of a treatment evaluation package.

The Leeds Dependence Questionnaire (LDQ) has been developed as part of a treatment evaluation package. The LDQ is a 10-item, self completion questionnaire designed to measure dependence upon a variety of substances; it has been shown to be understood by users of alcohol and opiates. The questionnaire was designed to be sensitive to change over time and to be sensitive through the range from mild to severe dependence; the follow-up data are insufficient to demonstrate change over time, but are encouraging. It is expected that both clinicians and researchers will find it useful to have a single measure relating to substance use, but not limited by specific substances. All items are scored 0-1-2-3; there are no normative data. The procedure for establishing content validity is described and estimates of concurrent, discriminant and convergent validities are reported; these validities are thought to be satisfactory. A principal components analysis produced a single factor accounting for 64% of the variance. Cronbach's alpha was 0.94. Test-retest reliability was found to be 0.95.

Adult↗
PubMed1993

Variations in the treatment of childhood asthma.

OBJECTIVE: To survey the assessment and management of childhood asthma by paediatricians, general practitioners, and respiratory physicians, and compare these findings with the Australian and New Zealand Consensus Statement guidelines on asthma management in children. SETTING AND DESIGN: A six-item postal questionnaire designed to cover assessment, management of acute and mild asthma, use of prophylaxis and methods of delivery of medication. PARTICIPANTS: A random sample of 100 paediatricians, 300 general practitioners and 100 respiratory physicians. RESULTS: Response rates were: paediatricians, 88%; general practitioners, 66%; and respiratory physicians 51%. There was agreement between all three groups in most aspects of asthma management. Deviations from the Consensus Statement guidelines included: between 38% and 49% not using oxygen as one of the first-line treatments for acute asthma; a higher use of orally administered beta 2-agonists by general practitioners (up to 40% for children between one and three years compared with 17% of paediatricians and 12% of respiratory physicians); a tendency to use intravenously administered aminophylline before corticosteroids (20% of paediatricians, 40% of general practitioners and 30% of respiratory physicians); a preference among general practitioners and respiratory physicians to prescribe inhaled corticosteroids rather than sodium cromoglycate for prophylaxis in older children; and a low incidence of use of spacer devices in older children. CONCLUSIONS: If currently published recommendations on managing asthma in children are followed, there should be: more education and emphasis on the value of oxygen and short courses of orally administered corticosteroids in acute asthma management; less reliance on intravenously administered aminophylline; decreased use of orally administered beta 2-agonists coupled with a more wide-spread use of spacer devices; and an increased emphasis on sodium cromoglycate as first-line daily prophylaxis.

Acute Disease↗
PubMed1999

Evaluating the outcomes of low vision rehabilitation.

The requirement for those providing healthcare to measure outcomes raises the fundamental question of how these should be measured. Both the scale of the low vision population and the different models of care proposed make it a pressing need to determine outcomes using valid and reliable measures. In this study we describe the development and piloting of a questionnaire designed to meet this requirement. The questionnaire was piloted on 56 subjects with age-related macular degeneration (ARMD). Test-retest reliability of the questionnaire was estimated using a further sample of 28 subjects with ARMD. Pilot testing confirmed the feasibility of administering the questionnaire to an elderly population with ARMD. A total of 87% of the sample reported using an LVA (65% on a daily basis), predominantly for a reading task. The number of tasks an LVA was used for, its frequency of use, length of continuous use and ease of use are significantly associated with the rating of an LVA as important/less important (P < 0.0001), but the acuity achieved with the device is not significantly associated with rated importance (P = 0.11), reinforcing doubt about the validity of visual function outcomes. The limitations of this pilot study and earlier case series in describing the outcomes of low vision care are discussed and a randomised controlled trial using a broad range of outcomes is proposed in order to fully describe the effectiveness of low vision rehabilitation and inform the debate about models of care.

Aged↗
PubMed1999

The quest for better questionnaires.

The development of questionnaires is a neglected enterprise in epidemiology. It has recently been proposed that a prestigious health authority such as the World Health Organization establish a committee to tackle issues of questionnaire quality, moving eventually toward standardized instruments. However, standardization may not be the best way to invigorate this enterprise. As an alternative, the author suggests that the first step in improving questionnaires would be to make them more accessible. Ideally, questionnaires should be as easily scrutinized as a study's methods or results. To this end, the author suggests that when a research paper is published, the entire questionnaire be made available on the worldwide web. Electronic access to questionnaires could stimulate a new era of awareness about the importance of questionnaire design.

Data Collection↗
PubMed1992

Adolescent medicine practice in urban Pittsburgh--1990.

Adolescent medicine has emerged as a discipline in the present era with few key curricular or skill areas clarified and little consensus regarding the acceptance and interest generated in pediatricians by this area. This investigation was undertaken to ascertain present adolescent medicine practice patterns in Pittsburgh, Pennsylvania. The data generated are intended to serve as a basis for future comparisons. The methodology was a questionnaire design, with 178 (54%) of the questionnaires returned and subjected to analysis. The results indicated that 6% of pediatricians actually limit their practices to patients 16 years of age or younger, and 65% limit their practices to patients younger than 19 years of age. Most practices (64%) do not have a gynecological table. Only 20% of practices offer clinical services which would match the needs of adolescent patients, such as the prescription of oral contraceptives, counseling for homosexuality, or treatment of dysfunctional uterine bleeding. Most interestingly, pediatricians report seeing few adolescents with drug and alcohol problems or sexually transmitted diseases. These data provide the basis for future investigations.

Adolescent↗
PubMedDate not supplied

Outpatient satisfaction: validation of a French-language questionnaire: data quality and identification of associated factors.

OBJECTIVES: Following 1996 legislation requiring French hospitals to assess patient satisfaction, this study developed and validated a brief French-language multidimensional questionnaire designed to measure outpatient satisfaction with hospital visits and compared data quality for two patient-satisfaction survey methods. DESIGN: Authors developed a 19-item questionnaire following a strict procedure (identification of dimensions to explore, formulation, and selection of items). SETTING: Validation data were obtained from patients of six outpatient clinics in a teaching hospital. PARTICIPANTS: 586 consenting eligible patients were randomized to receive the questionnaire 2 weeks after their visit with one of two survey methods: a mailed self-administered questionnaire or a telephone interview. RESULTS: The response rate (79%) was not significantly different between the two survey methods. The risk of having one or more missing values was higher in the mail survey group (odds ratio, 1.65; 95% confidence interval, 1.03-2.63), but mail respondents were less likely to use the "extremely positive" response category. Principal component analysis identified four factors that accounted for 56% of the variance: interpersonal skills and information transfer, physical surroundings, convenience, and appointment delay. Patients' comments on open-ended questions validated the semantic content of the factorial construct. The internal consistency coefficient was greater than 0.70 for three of four subscales. Patient background characteristics accounted for less than 10% of the factorial score variance. Patient satisfaction was correlated with age, type of visit, and, to a lesser extent, gender and education level. CONCLUSION: This easily administered, multidimensional out-patient-satisfaction questionnaire provided encouraging preliminary psychometric characteristics.

Adolescent↗
PubMed1997

The impact of chronic urticaria on the quality of life.

The impact of chronic urticaria (CU) on the quality of life is undocumented. We assessed quality of life in patients with CU, including patients with associated delayed pressure urticaria (DPU). One hundred and forty-two out-patients completed self-administered questionnaires: a disease-specific, purpose designed questionnaire, and the Nottingham health profile (NHP). Many patients reported problems attributable to their skin condition in facets of everyday life including home management, personal care, recreation and social interaction, mobility, emotional factors, sleep, rest and work. The NHP part I scores showed restriction in the areas of mobility, sleep, energy, and demonstrated pain, social isolation and altered emotional reactions. Part II of the NHP showed that patients experienced difficulties in relation to work, looking after the home, social life, home relationships, sex life, hobbies and holidays. The patients with DPU had significantly more problems with mobility, gardening and choice of clothing than the uncomplicated CU patients. They also suffered more pain, had more problems with work and were more restricted in their hobbies.

Activities of Daily Living↗
PubMed2003

Validation of a self-reported questionnaire assessing adherence to antiretroviral medication.

The aim of this study was to verify the validity of a new self-reported questionnaire designed to assess nonadherence to antiretroviral medication among patients with HIV. Two hundred fifty-six patients from four clinics participated in a prospective longitudinal study. The questionnaire was designed to measure if patients with HIV were taking less than the total number of antiretroviral pills prescribed by their physician. Change in viral load was used as the criterion for validity analyses. Self-reported adherence, viral load and CD4 cell count were assessed at T0 (baseline), T3 (3-month), and T6 (6-month). The findings indicated that the questionnaire had adequate validity (sensitivity, 71%; specificity, 72%; correct classification, 72%; odd ratio, 6.15). These best values were obtained when the analyses excluded individuals with an unstable viral load and a CD4 cell count of less than 200 copies per milliliter over the 6-month follow-up period. This study has shown that this questionnaire has satisfactory psychometric qualities to assess nonadherence to antiretroviral medication among patients with HIV. The questionnaire is brief, simple, and can be used in both clinical or research settings regardless of the patients' antiretroviral regimens.

Adult↗
PubMed1995

Measuring the prevalence of bronchial hyper-responsiveness in children.

BACKGROUND: The aim of this study was to assess the effectiveness of an asthma prevalence video questionnaire (involving the audiovisual presentation of clinical asthma), a standard written questionnaire (based on the IUATLD Bronchial Symptoms Questionnaire) and a new written questionnaire (designed for an international study of asthma and allergies in childhood [ISAAC]) in predicting bronchial hyper-responsiveness (BHR) (PD20 < or = 7.8 mumol methacholine). METHODS: The IUATLD and video questionnaires were administered to 193 schoolchildren (13-16 years). The ISAAC questionnaire was administered to 87 of these children. All children subsequently underwent bronchial challenge to methacholine. RESULTS: The sensitivity and specificity for predicting BHR were similar for individual questions from the IUATLD and video questionnaires. The video questions with the highest Youden's index related to moderate wheezing at rest (0.46), severe wheezing at rest (0.38), and nocturnal wheezing (0.37). The ISAAC questionnaire was similar in effectiveness to the IUATLD questionnaire in predicting BHR. CONCLUSIONS: The video questionnaire is a valid method of assessing the prevalence of BHR, and may be particularly useful when comparing populations with differing languages and cultures. Some video questions appeared more effective than others in relation to predicting BHR. A new written questionnaire (ISAAC) designed for a large international asthma prevalence study in children also is an effective method for measuring the prevalence of BHR.

Adolescent↗
PubMed2000

Parental perception of the quality of life among children with epilepsy or diabetes with a new assessment questionnaire.

This paper describes the evaluation of a newly designed questionnaire to assess the quality of life among children with epilepsy or diabetes. Factor analysis identified one factor, the impact on the parents and the family, which was responsible for over a third of the variance in the two illness groups. Two other factors, impact on development and impact on health, were also found in the epilepsy group. The questionnaire discriminates well between children with epilepsy or diabetes, showing that the former is more affected than the latter. Children with more severe epilepsy are seen by parents to have a worse quality of life than children whose epilepsy is well controlled.

Chi-Square Distribution↗
PubMed2000

What do children with cystic fibrosis and their parents know about nutrition and pancreatic enzymes?

OBJECTIVE: To describe the development and validation of questionnaires designed to assess nutrition and pancreatic enzyme replacement therapy knowledge and cystic fibrosis self-management skills, and the results obtained when the questionnaires were used. DESIGN: A cross-sectional study using validated questionnaires to interview the respondents. The outcome measures were scores for knowledge, appropriate and inappropriate self-management, and Socioeconomic Index. SUBJECTS: Forty-two children with cystic fibrosis aged 6 to 11 years and 55 caregivers of 2 to 11-year-old patients of the Princess Margaret Hospital Cystic Fibrosis Clinic, Perth, Australia. STATISTICAL ANALYSES: Descriptive statistics and correlations between scores were used for statistical analyses. Associations between knowledge scores were examined using Pearson's correlation coefficient. Spearman's rank correlation was used to examine the associations between knowledge and self-management scores and socioeconomic index. RESULTS: Children's and caregivers' mean knowledge scores were 63% and 85%, respectively. Mean appropriate and inappropriate self-management scores for children were 55% and 21%, respectively, and for the caregivers were 74% and 32%, respectively. There was a statistically significant (P < .05) positive association between caregivers' and children's knowledge (r = 0.32), and children's knowledge and appropriate self-management scores (r = 0.41); and a statistically significant negative association between caregivers' knowledge and inappropriate self-management scores (r = -0.35); and no statistically significant associations between Socioeconomic Index and children's and caregivers' knowledge and self-management scores. APPLICATIONS: This study identified areas in which the nutrition knowledge of children with cystic fibrosis and their caregivers needs to be enhanced to increase the likelihood that optimum dietary and pancreatic enzyme therapy is achieved. The questionnaires that were developed for the study could be refined and used in the clinical setting to identify knowledge and self-management deficits. Alternatively, the questionnaires could become valuable research tools for assessing the type of intervention required and in planning and evaluating programs.

Adult↗
PubMed2003

Symptoms related to sleep-disordered breathing in white and Hispanic children: the Tucson Children's Assessment of Sleep Apnea Study.

STUDY OBJECTIVES: The Tucson Children's Assessment of Sleep Apnea (TuCASA) study is designed to investigate the prevalence and correlates of objectively measured sleep-disordered breathing (SDB) in preadolescent children. This article describes the parental report of sleep symptoms associated with SDB in Hispanic and white children. DESIGN: A 13-question sleep habits screening questionnaire designed to assess the severity of sleep-related symptoms associated with SDB in children 4 to 11 years of age. SETTING: Questionnaires were completed by the parents of children attending elementary school in the Tucson Unified School District, Tucson, AZ. PARTICIPANTS: There were 1,494 questionnaires returned, which comprised a sample of whites (38%), Hispanics (45%), and other races (17%). Of these questionnaires, 1,214 were returned for the children of white (45.8%; 556 children) or Hispanic (54.2%; 658 children) ethnicity only. The primary analysis was completed on these 613 boys (50.5%) and 601 girls (49.5%). RESULTS: In the total sample of 1,494 children, parents were more likely to report excessive daytime sleepiness (EDS) in female children than in male children (p <.01), however, this association did not achieve significance in the sample of only white and Hispanic children (p <.07). Composite variables for EDS and witnessed apnea (WITAP) show that parents of Hispanic children were more likely to report EDS (p <.01) and WITAP (p <.007). Hispanic children were also more likely to have learning problems (LPs) [p <.03] and to snore frequently (SN) [p <.02] than were white children. There were no significant differences between boys and girls for SN or WITAP. Hispanic boys were more likely to have reports of EDS (p <.02) and LPs (p <.04) than white boys, however, there were no other significant differences in gender or ethnicity in reports of EDS or LPs for white or Hispanic boys and girls. Those children with frequent LPs were significantly more likely to have SN (p <.001), EDS (p <.001), and WITAP (p <.001). A logistic regression model predicting LP resulted in significant adjusted odds ratios (ORs) of 2.4 for SN, 2.5 for EDS, and 2.1 for children aged 8 to 11 years. A similar model for EDS resulted in significant adjusted ORs of 3.2 for SN, 5.7 for WITAP, and 1.6 for female gender. Ethnicity was not significant in either model. CONCLUSIONS: Hispanic children in the population-based TuCASA study experienced more frequent symptoms associated with SDB, such as SN, EDS, WITAP, and LPs, than did white children. Children with LPs are 2.4 times more likely to have SN, 2.5 times more likely to have EDS, and were 2.1 times more likely to be between the ages of 8 and 11 years. Children with EDS were 3.2 times more likely to have SN, 5.7 times more likely to have WITAP, and were 1.6 times more likely to be a girl.

Arizona↗
PubMed1994

Myth of substituted judgment. Surrogate decision making regarding life support is unreliable.

OBJECTIVE: To identify factors predicting the accuracy of surrogate decision making in life support decisions. DESIGN: Questionnaire. SETTING: Urban Veterans Affairs hospital. PATIENTS AND DESIGN: Fifty hospitalized patients and their chosen surrogates were given questionnaires describing life support modalities and four common medical scenarios in which life support would be contemplated. An additional 50 patients also completed the questionnaire. Patients gave their choices of life support in the different scenarios. Surrogates guessed the patients' answers (substituted judgment). Details of the patient-surrogate relationship were asked. Patients completed a depression inventory. MAIN RESULTS: Surrogates correctly guessed patients' wishes about life support overall on 59.3% of the questions, not better than random chance (kappa = .09). The only predictor of accurate surrogate decision making was specific discussion between patient and surrogate about life support. SECONDARY RESULTS: Patients had an overall low desire for life support (35%), and a majority favored euthanasia under some circumstances (62%). There was no relationship between depression score and desire for life support. CONCLUSIONS: Substituted judgment by surrogates is not more accurate than random chance. Discussion between patient and surrogate about life support correlated with more accurate substituted judgment.

Adult↗
PubMedDate not supplied

A teaching evaluation questionnaire for postmyocardial infarction patients.

The above report is primarily a methodologic presentation of a questionnaire designed to assess the knowledge of patients with a recent myocardial infarction (MI) concerning the nature of their disease, emergency treatment, diet and smoking, resumption of physical activity, psychological factors important in heart disease, and problems encountered when returning home and to work. This questionnaire was designed to asses an in-hospital teaching program for post-MI patients in these areas. Test, re-test results from our first group of 24 patients indicated they significantly increased their knowledge about problems surrounding their return home and to work during their time in the hospital. The failure of these patients to demonstrate a learning effect in the other areas covered has stimulated changes in the teaching program.

Aftercare↗