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[Accuracy of a self-administered questionnaire on the use of antibiotics].

BACKGROUND: To document the ambulatory use of drugs and the indications for that use, investigators often rely on self-administered questionnaires of questionable accuracy. The present study assessed the accuracy of a French Canadian self-administered questionnaire with regard to documenting current antibiotic drug use. METHODS: The information independently obtained from physicians and pharmacists was compared with the information reported by 340 patients. Patients were asked to participate in the study by their pharmacist at the time that their prescribed antibiotic was dispensed. The proportion of agreement between the data sources was calculated with regard to antibiotic regimen characteristics and indications for use and the nature of the treated infection. RESULTS: Self-reported information demonstrated a high level of agreement with data provided by physicians (k = 0.87) and pharmacists (k = 0.94), with regard to antibiotic names. Regarding the nature of the treated infection, the agreement between self-reported information and data obtained from physicians was substantial (k = 0.63). A total of 242 patients completed the questionnaire twice at two-week intervals. Test-retest reliability was high regarding both the antibiotic name (k = 0.72) and the nature of the treated infection (k = 0.86). CONCLUSIONS: The self-administered questionnaire assessed in this study can reliably and accurately document the name of antibiotics used and the nature of the treated infections. Further work is needed to improve the accuracy of the questionnaire with regard to other components of antibiotics use.

Adolescent↗

[A clinical questionnaire for facilitating consultation with the adolescent].

The use of a self-administered questionnaire, filled in by the adolescent before the first encounter with a physician, represents an excellent screening tool. The questionnaire is highly confidential and its use is optional. This paper analyses the way the questionnaire was accepted and used by 361 young patients, during the first year of activity of the Multidisciplinary Unit for Adolescent Health in Lausanne. It shows the kind of problems which were reported by the adolescents, depending on their gender, their age and their reason for visit. The questionnaire serves several purpose: firstly, it outlines the global conception of health which forms the basis of the multidisciplinary approach used within the UMSA. Secondly, it constitutes a kind of guide for younger physicians training in adolescent medicine and allows them to screen in an appropriate period of time a large array of themes pertaining to health problems and symptoms, mental health, well-being, lifestyles and finally personal as well as environmental resources. Finally, it allows the young patient to disclose preoccupation or problems on very personal, intimate matters, which would be difficult to discuss openly in a first face to face interview. The experience gained during nine months shows that the questionnaire is very well accepted and useful. It's content will however be improved, since, in the opinion of both the patients and the staff, it still is too much focused on negative and problematic issues and not enough oriented towards resources and resilience.

Adolescent↗

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↗

The WOMB (Women's views of birth) antenatal satisfaction questionnaire: development, dimensions, internal reliability, and validity.

BACKGROUND: Antenatal services continue to change, stimulated by the Changing Childbirth report. Women's views should be an important component of assessing the quality of such services. To date, no published quantitative multidimensional assessment instrument has been available to measure their satisfaction with care. AIM: To develop a valid, reliable, multidimensional questionnaire to assess quality of antenatal care. METHOD: A multidimensional satisfaction questionnaire was developed using psychometric methods. Following fieldwork to pilot a questionnaire, three successive versions of it were given by midwives to pregnant women in their final trimester in nine trusts in the old South Western region of England. Their replies were analysed by principal components analysis (PCA) with varimax rotation; internal reliability was assessed by Cronbach's alpha. Face, content, and construct validity were all assessed during development. RESULTS: Out of 196 women, 134 (68.4%) returned the pilot questionnaires. One hundred and seventy-two (57.3%) out of 300 women returned version 1 of the WOMB (WOMen's views of Birth) antenatal satisfaction questionnaire proper, 283 (56.6%) out of 500 returned version 2, and 328 (65.6%) out of 500 returned the final development version. This final version consisted of 11 dimensions in addition to a general satisfaction one. These were [Cronbach's alpha]: five related to antenatal clinic characteristics (travelling to clinic [0.75], waiting at clinic [0.90], clinic environment [0.69], timing of appointment [0.78], car parking [0.85]), three 'professional' characteristics (professional competence [0.80], knowing carers [0.79], information provided [0.81]), antenatal classes [0.76], social support from other pregnant women [0.83], checking for the baby's heart beat [0.63]. There were significant moderate correlations (range = 0.24 to 0.77) between individual dimensions and the general satisfaction dimension. Women's dimension scores were significantly related to age, parity, social class, and best educational achievement. CONCLUSION: This multidimensional satisfaction instrument has good face, content, and construct validity, and excellent internal reliability. It could be used to generally assess antenatal services or to screen them to detect areas where further in-depth qualitative enquiry is merited. Its sensitivity to change over time, external reliability, and transferability to non-Caucasian groups needs to be assessed.

Adult↗

Comparison of the Thai version of the Rose questionnaire for angina pectoris with the exercise treadmill test.

Prior to exercise treadmill testing (ETT), 157 patients (92 males and 65 females) were interviewed twice separately, using a Thai version of the Rose questionnaire for angina pectoris. One interview was conducted by a physician and the other by a nurse. The questionnaire responses were compared with ETT results. Based on physician-conducted interview, the Rose questionnaire had a sensitivity of 30.3 per cent, a specificity of 83.9 per cent, a positive predictive value of 35.3 per cent, a negative predictive value of 81.9 per cent, and the total accuracy of 72.6 per cent. There were gender differences in the validity of the questionnaire, with higher specificity, higher positive predictive value, and lower negative predictive value in males than in females. The sensitivity and accuracy were not different between the two sexes. In 87.9 per cent of cases, responses to physician-conducted and nurse-conducted interview were the same. There were no significant differences between responses to the questionnaires by the physicians and by the nurses.

Adolescent↗

Use of the McGill Pain Questionnaire to compare women with vulvar pain, pelvic pain and headaches.

OBJECTIVE: To assess differences between women with three distinct types of chronic pain conditions using a modified McGill Pain Questionnaire. STUDY DESIGN: Data by self-administered questionnaire were collected on patients presenting to the University of Michigan Medical Center with chronic vulvar pain (144 patients), pelvic pain (198 patients) or headaches (130 patients). Data for analysis included: patient demographics, duration of pain and modified McGill Pain Questionnaire scores. Univariate and multivariate analyses were performed. RESULTS: Patients with vulvar pain had more formal education (P < .001), were more likely to be married (P < .001) and were less likely to be African American (P = .003) as compared to those with chronic pelvic pain and headaches. Chronic pelvic pain patients were younger than those in the other two groups (P = .002), and headache patients were likely to have had their chronic pain for a shorter duration than those with vulvar or pelvic pain (P < .001). Patients with vulvar pain had lower total scores on the McGill Pain Questionnaire as well as on the four subsets of variables: affective, sensory, cognitive and miscellaneous indexes (P < .001). They also chose fewer words to describe their symptoms from the 20-word lists (P < .001) and had lower average scores in each of the 20 categories as compared to the other two groups (P < .0001). Controlling for age, ethnicity and marital status did not alter this significance. CONCLUSION: Patients with vulvar pain were a unique groups when compared to other chronic pain populations. Evaluation of the demographics and McGill Pain Questionnaire scores confirmed the distinct qualities of women with vulvar pain.

Age Factors↗

Research: is an 'ideal' questionnaire possible?

Writing a research protocol and designing a questionnaire are not as easy as might be thought. Producing the 'ideal' questionnaire can be fraught with difficulties, and the guidelines provided are intended to avoid potential pitfalls. Designing a questionnaire takes time and patience. The importance of a pre-test and pilot study cannot be overemphasized and resultant modifications to the questions will increase the validity, reliability and responsiveness of a questionnaire and lend support to any findings following appropriate statistical interpretation of the data. The advantages of the questionnaire research method, together with the disadvantages and the problems associated with poor response rates, are discussed.

Health Services Research↗

Reliability of Thai version of SF-36 questionnaire for the evaluation of quality of life in cardiac patients.

Quality of life is an important measurement of medical outcomes. Reliability of a Thai version of the SF-36 questionnaire has never been reported. The objective of this study was to determine the reliability of a Thai version of the SF-36 questionnaire in cardiac patients. We developed a Thai version of the SF-36 questionnaire and tested it in 212 cardiac patients. Reliability of the Thai version of the SF-36 questionnaire was assessed by internal consistency using Cronbach's Alpha statistic and inter-item correlation. We demonstrated that Cronbach's Alpha coefficient of every aspect of QOL exceeded 0.7, and all inter-item correlation exceeded 0.4. In conclusion, the Thai version of the SF-36 questionnaire is a valuable tool in assessing medical outcomes and medical research in Thai patients with cardiac disease. Whether it can be used in other diseases remains unknown.

Activities of Daily Living↗

[Development and evaluation of a QOL questionnaire for elderly subject living in a community].

A comprehensive, basic and simple QOL questionnaire for elderly subjects living in a community was developed, and its validity and reliability were examined. The subjects were 2944 individuals of 65 years or older living in 5 areas of metropolitan Tokyo and in a town of Aichi Prefecture. The QOL questionnaire with 19 questions was developed based on the component of QOL by Lawton and concept of QOL by Koyano. The questionnaire consisted of 6 subscales (daily activity, satisfaction with health, satisfaction with human support, satisfaction with economic state, symptom of depression and positive mental attitude). Factor analysis revealed that the 19 questions could be clearly separated into 6 components in Tokyo and Aichi districts with total variances of 70.8% and 78.4%, respectively. Scores of daily activity and positive mental attitude were significantly lower with older subjects in both men and women. However, scores for other subscales did not differ with age. Primary factors which are considered to affect QOL were compared with the 6 QOL subscales of this study. Being an outpatient had a significant relation to daily activity and satisfaction with health, presence of a spouse to satisfaction with human support, depressive state, positive mental attitude and possession of ones own room to satisfaction with economical state, and belief in religion to positive mental attitude. The results suggest that the present questionnaire include the basic components necessary for evaluation of QOL in elderly subjects living in a community. Further research is required to examine the validity of this questionnaire with correction of questions.

Aged↗

[Sensitivity and specificity of a questionnaire about respiratory symptoms similar to asthma].

INTRODUCTION: Questionnaires are an epidemiological instrument to detect patients with asthma. MATERIALS AND METHODS: Worldwide standardized questionnaires were selected, taking the most important points for making the diagnosis of asthma. A questionnaire was applied to outpatients who attend to pulmonary disease service. The answers were compared with a "gold standard" proposed, consisted in clinical screening and pulmonary function tests. STATISTICAL ANALYSIS: Kappa coefficient, sensitivity, specificity and predictive values were obtained, with intervals of confidence of 95%. RESULTS: The questionnaires were applied to 120 patients, 70.83% women, the answering percentage was 99%. Mean age was 32 years with a range of 24-40. In 62.5% patients there was already a previous diagnosis of asthma. Positive Familial history was present in 65.83, cough in 85%, dyspnea in 80.83%, sneezes in 53.33% and wheezes in 77.5%. The was of kappa coefficient for previous medical diagnosis 0.96%, followed by positive familial history, wheezes and cough in 0.90%. The greatest specificity was for wheezes, dyspnea and previous medical diagnosis. The greatest specificity for previous medical diagnosis was wheezes and sneezes. CONCLUSIONS: The use of questionnaires for respiratory symptoms similar to asthma can be an option to detect groups of high risk.

Adult↗

The design and assessment of questionnaires in clinical research.

Questionnaires are one of the most commonly used tools for data collection in clinical research. Despite its simplicity and convenience of use, the design of questionnaire instruments that accurately measure health status and their determinants is nevertheless a difficult and challenging task.We review the two most important issues which are reliability and validity. Reliability can be defined as the degree to which a measure gives 'consistent' or 'reproducible' values when applied in different situations. Validity refers to the extent in which the true value of a variable is correctly measured by the instrument. For different types of questionnaire measurement instruments, specific issues of content, construct and criterion validity should be appropriately addressed. Accuracy in questionnaire-based measurement in clinical studies is achieved by paying attention to the relevant specific issues of reliability and validity during development and testing of such questionnaires.

Reproducibility of Results↗

The reliability of a breastfeeding questionnaire.

This research project tests the reliability of a correctly constructed breastfeeding questionnaire. The questionnaire is designed to evaluate the impact of breastfeeding support services on breastfeeding initiation and duration and identify groups of women most at risk of premature weaning. The development of the questionnaire followed a seven-step plan to determine the accuracy of the data and the overall integrity of the questionnaire. Reliability was assessed using the test-retest method on twenty-one women with children between the age of one and three years. The statistic kappa was used to assess nominal data, while ordinal and ratio data were assessed using the correlation coefficient, Pearson's r. This study served as a preliminary analysis of the assertion that the correctly constructed breastfeeding questionnaire is an effective and efficient tool.

Adult↗

A comparison of OHIP 14 and OIDP as interviews and questionnaires.

OBJECTIVE: To assess the completion rates and concurrent validity of the Oral Impacts on Daily Performance (OIDP) and the short form of the Oral Health Impact Profile (OHIP 14) in both questionnaire and interview formats. BASIC RESEARCH DESIGN: Cross sectional social and clinical study. Clinical setting Dental teaching hospital primary care department in London UK. Participants Two week consecutive sample of 183 patients attending setting. PARTICIPANTS: came from 19 ethnic groups, 53% were men and 32% had attended for a dental emergency. MAIN OUTCOME MEASURES: Completion rates and concurrent validity for each instrument and in each format. RESULTS: Completion rates for OHIP 14 and OIDP were similar in interview format. In questionnaire format usable data were provided on 92.9% of the OHIP 14 but only 86.5% of the OIDP questionnaires. Completion of both questionnaires was related to ethnicity. The number of impacts for both measures and total impact scores for OHIP 14 were related to the age of the participants, the presence of oral disease and the order of administration of the instruments. Analysis of the total score for OIDP was weakened by the severe skewness of these data. CONCLUSIONS: The psychometric properties of OHIP 14 and OIDP were not related to the method of administration. However, the use of OIDP in this questionnaire format may result in loss of data, particularly from people who are not White English.

Activities of Daily Living↗

Validation of Italian version of the Women's Health Questionnaire: assessment of quality of life of women from the general population and those attending menopause centers.

OBJECTIVES: The Women's Health Questionnaire has been developed and validated in Anglo-Saxon and Swedish populations. The purpose of this study was to evaluate the Italian version of the questionnaire to determine whether cross-cultural differences exist in the perception of quality of life, and to use it to compare the quality of life in women attending menopause centers with that of women in the general population. METHODS: An Italian version of the Women's Health Questionnaire (WHQ) was produced, using the forward-backward translation method to ensure conceptual equivalence, and approved by the originator. Women were recruited by random selection from the general population and from menopause centers, those taking hormone replacement therapy being ineligible. The questionnaire was completed anonymously at home and mailed to the co-ordinating center. Psychometric evaluation included tests of item convergent and discriminant validity, internal-consistency reliability, test-retest reliability, construct validity and the discriminative properties of the questionnaire. RESULTS: The completeness of the data was good, with missing-value rates consistently low for most items. Item-scale correlations, used to evaluate internal consistency, were also good and the scaling success rate, used to measure item discriminant validity, was high for all scales. Scale scores were reliable for seven out of nine scales and test-retest reliability was excellent. There were few significant differences between the two populations of women in most of the WHQ areas. A comparison of Italian data with published data on English women showed great similarity. CONCLUSION: The Italian version of the WHO is valid and reproducible. The subjective perception of the menopause and its related problems is similar in geographically and culturally different populations.

Affect↗

[The use of exit questionnaires, a survey at 7 hospital centers].

Measuring the satisfaction of hospitalised patients has been mandatory in France since 1996. The most common tool for assessing the level of satisfaction is the use of self-administered questionnaires given to the patient upon his/her release from the hospital. A survey was conducted among seven public hospitals to appraise the development and use of such questionnaires, their results and the way in which these results are taken into account in order to improve the quality of care. The survey's results illustrate that the policy with respect to their construction varies between hospitals, without any evaluation of the validity of the questionnaires produced. In most cases, the questionnaires are passively distributed to the patient at the time of discharge. The response rates are low (ranging from 4 to 18%), and the analysis of the collected questionnaires, to the extent to which it is done, is not necessarily used to improve the quality of care. An appropriate evaluation strategy, one capable of effecting change and improving hospital care, still remains to be established in the hospitals which participated in the survey.

France↗

Using Rasch measurement to investigate the cross-form equivalence and clinical utility of Spanish and English versions of a diabetes questionnaire: a pilot study.

The purpose of this research was to use Rasch measurement to study the psychometric properties of data obtained from a newly developed Diabetes Questionnaire designed to measure diabetes knowledge, attitudes, and self-care. Specifically, a methodology using principles of Rasch measurement for investigating the cross-form equivalence of English and Spanish versions of the Diabetes Questionnaire was employed. A total of fifty diabetes patients responded to the questionnaire, with 26 participants completing the English version. Analyses detected problems with the attitude items. We attributed the scaling problems to the use of negatively worded items with participants having generally low educational backgrounds. Analysis of the knowledge and self-care items yielded unidimensional variables with clinically meaningful item hierarchies that may have relevance to treatment protocols. Furthermore, the knowledge and the self-care items from the two versions of the Diabetes Questionnaire met our criteria for establishing cross-form equivalence and thus allow quantitative comparisons of person measures across versions. Limitations of the study and suggested refinements of the Diabetes Questionnaire are discussed.

Black or African American↗

[Construction and validation of a respiratory epidemiological questionnaire].

This paper illustrates the principles of construction and validation of an epidemiological questionnaire by using various aspects of the questionnaire prepared for the Epidemiological Study of the Genetic and Environmental Factors in Asthma, Bronchial Hyper-responsiveness and Atopy (EGEA). Standardised international questionnaires (for adults and children) were adapted and augmented for the requirements of the study. New areas in relation to international epidemiological studies are described (detailed descriptions of asthma and allergic rhinitis, trigger factors exposure tovarious environmental factors and family history). Various aspects of validation are discussed: the acceptibility by the study of missing data in the description of asthmatic symptoms, the construct validity for a score for allergic rhinitis, the reliability of a new self-administered questionnaire for perceived hyper responsiveness to various stimuli and the validity of reported family history using information obtained from family members. Some of these elements could be used in the context of other clinical and epidemiological studies. The complete questionnaire, together with the source of the questions, instructions for interviewers and the method of coding are presented in an appendix available on the internet (http://www.splf.org/bbo/revues-articles/RMR/depotElectronique/2001-110_Kauffmann/Kauffmann2002.htm) which supplements the printed paper.

Asthma↗

The validity of general health questionnaires, GHQ-12 and GHQ-28, in mental health studies of working people.

The purpose of the study was to determine such cut-off points in the scores of General Health Questionnaires (GHQ-12 and GHQ-28) that allow for optimal identification of people with mental health disorders in the Polish working population attending primary health care settings. The groups under the study covered 419 and 392 patients for GHQ-12, and GHQ-28, respectively. In the GHQ-12 group, 90 and in the GHQ-28 group, 80 subjects filled in the questionnaires and agreed to participate in the second stage of the study--a psychiatric interview. The criterion validity of the GHQs was a mental health diagnosis, based on the Munich version of Composite International Diagnostic Interview. The complete computerized version of interview, covering all diagnostic sections, has been adopted. In the mental health diagnosis only disorders, which currently troubled patients were taken into consideration and disorders which created problems in the distant past were excluded. In the group covered by GHQ-12 examination, 55.6% of persons had at least one type of mental disorder diagnosed, based on the criteria of both Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and the International Classification of Diseases (ICD-10). In the GHQ-28 group, the percentage of persons with mental disorders was 47.5%. After excluding patients with nicotine dependence disorder only, the frequency of mental health problems decreased to 45.5% and 33.8%, respectively. The proposed cut-off points, 2/3 points for GHQ-12 and 5/6 points for GHQ-28, were established at the level of the highest possible sensitivity and specificity not lower than 75%. These principals have been accepted for a practical reason, as the acceptance of the lower level of specificity forces medical practitioners to devote too much time to practically healthy people. At the above mentioned cut-off points for GHQ-12 sensitivity is 64% and specificity--79%, while for GHQ-28 the values are 59% and 75%, respectively. These validity coefficients were calculated from distributions of groups, from which persons with nicotine dependence as the only disorder were excluded. Incorporation of these people in the whole sample reduced the questionnaires' validity. Modification of responses scoring from the standard one--GHQ to CGHQ has not improved the validity of questionnaires. Lower validity coefficients of GHQ-28, in comparison to GHQ-12 validity are the effect of greater influence of somatic disease on the results acquired in this scale version of the questionnaire.

Adult↗