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[Validity and reliability of an instrument to assess the clinical interviews of residents in family and community medicine: the GATHA-RES questionnaire].

OBJECTIVE: To check the validity of content, the internal consistency and the intra-observer reliability of a questionnaire to evaluate the doctor-patient communication of family medicine residents. DESIGN: Observation study, to validate a measurement instrument. SETTING: Primary care. Family and community medicine teaching units. STUDY POPULATION: For the validity analysis: 25 family and community medicine residents. For the reliability analysis: 48 doctors in the same speciality. MEASUREMENTS AND INTERVENTIONS: The questionnaire was constructed on the basis of a version (GATHA-BASE) composed of 42 items selected by a panel of 60 general practitioners. For content validity, 68 clinical encounters with simulated patients, video-recorded and evaluated, were used. The questionnaire's validity content was studied through a factorial analysis. To measure its internal consistency, Cronbach's alpha coefficients were calculated. Intra-observer reliability of the GATHA-RES version was evaluated through the kappa indexes and the intra-class correlation coefficients. RESULTS: We obtained a version of the GATHA-RES with 27 items. The factorial analysis revealed that there were 9 factors (< >, < >, < >, < >, < >, < >, < > and < >) which showed close correlation with the theoretical and formal contents of the original questionnaire (originally grouped in three sections: attitudes, communication tasks and skills). All the intraclass correlation coefficients had figures > or = 0.90. CONCLUSIONS: The GATHA-RES questionnaire is a valid and reliable instrument that can be used for evaluating the communication skills of general practitioners in training.

Communication↗

Psychometric properties of the Pain Attitudes Questionnaire (revised) in adult patients with chronic pain.

Previous evidence supports the utility of the newly developed pain attitudes questionnaire (PAQ) for assessing pain-related stoicism and cautiousness in community-dwelling pain-free adults (Yong et al., 2001). A revised questionnaire (PAQ-R) was examined in the present study to determine the generalizability of psychometric properties when used with chronic pain patients. Results from both exploratory and confirmatory factor analyses suggest that the factor-structure of the revised questionnaire was best represented by a five- rather than a four-factor solution, thus, suggesting that chronic pain patients do not conceptualize the questionnaire items, in particular, with respect to the stoicism attitudes, in the same manner as the community-dwelling adults. A satisfactory internal consistency reliability of the PAQ-R was replicated in chronic pain patients. There was also evidence to suggest that chronic pain patients from different age cohorts do apply a similar frame of reference and calibration scale when responding to the items on the questionnaire. However, the cohorts of patients across the age spectrum show some differences in pain attitudes and possible reasons were discussed.

Adult↗

The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients.

The European Association of Palliative Care recommends the Brief Pain Inventory questionnaire (BPI) as a pain assessment tool in clinical studies. After translation into Norwegian, we administered the BPI to 300 hospitalized cancer patients. Cronbach's alphas were computed to assess reliability, and factor analysis was utilized to ascertain construct validity. The BPI interference and pain severity scales were validated against items on pain intensity and pain influence on daily function in the European Organization for Research and Therapy of Cancer (EORTC) QLQ-C30 questionnaire. In total, 235 patients (78%) were able to complete the BPI questionnaire, but 82 (35%) of these questionnaires had one or more missing items. Cronbach's alphas were 0.87 for the pain severity and 0.92 for the interference scales. A factor analysis identified three factors; pain intensity, interference with physical function, and interference with psychological functions/sleep. These three factors explained 82% of the variance. The correlation between BPI pain severity index and the EORTC QLQ-C30 item on pain intensity was 0.70 (P < 0.001). The correlation between BPI interference index and the EORTC QLQ-C30 item on pain influence on daily living was 0.62 (P < 0.001). We conclude that BPI has satisfactory psychometric properties, but is not completed by a significant proportion of patients. Further research is needed to establish pain assessment tools for patients unable to answer a comprehensive pain questionnaire, to establish routines for analysis of missing values, and to investigate if pain interference items also reflect disease-related impairment.

Adult↗

Validation of a Questionnaire to Screen University Students for Learning Disabilities.

Learning disabilities (LD) may cause academic failures among university students, but minor accommodations may in some instances allow students to progress satisfactorily. The current study validates a questionnaire for detecting students likely to have an LD. University students, 57 with a documented LD and 134 without, completed a Likert-scale questionnaire to assess the degree of self-perceived difficulty for 50 learning or testing situations. Wilcoxon rank sum test, separate logistic regression models, and determination of the best joint set of predictors of LD were carried out. The mean per-item questionnaire score was higher in the LD group (p < 0.0001); 47 individual items were significant predictors (i.e., p < 0.05) of LD status. The best joint set of predictors consisted of items dealing with word pronunciation, comprehending mathematical word problems, formulating summaries, spelling, slow reading rate, finishing tests in the allotted time, note-taking in lectures, and falling asleep while reading. Incorporating responses to these eight items, a formula was derived to determine the probability of LD. Taking 0.26 as the threshold for predicting the presence of an LD, the sensitivity of the questionnaire was 88%, the specificity was 87% for this population. The questionnaire could be an effective screening tool to detect university or professional students who should consider comprehensive testing for LD.

Journal Article↗

[Measuring fatigue of cancer patients in the German-speaking region: development of the Fatigue Assessment Questionnaire].

UNLABELLED: Fatigue is recognised as one of the most frequent and distressing symptoms of patients with cancer. Whilst causal relationships mainly remain unclear, researchers meanwhile acknowledge its multidimensional nature. Causes and manifestations are complex and multifaceted and therefore, measurement in the past has been difficult. In recent years, some instruments have been developed in the English language. It is the aim of this article to describe the development of a new fatigue measurement instrument in the German language, the Fatigue Assessment Questionnaire. The following steps are described: 1. Concept analysis, 2. Identification of measurement criteria, 3. Comparison of these criteria with those described in the literature available, 4. Construction of a measurement scale, 5. Testing the new instrument, 6. Use of the instrument in a large study population. Steps 5 and 6 primarily deal with validity and reliability testing while step 6 also tests the hypothesis that patients with some types and stages of cancer suffer more from distressing fatigue than patients with other types and stages. CONCLUSION: Validity of the measurement items in the Fatigue Assessment Questionnaire was supported by the fact that they were derived from qualitative interviews with cancer patients. The first test with 77 cancer patients and 77 healthy individuals led to small adaptations and the following study, including 592 cancer patients, supported the reliability and validity of the Fatigue Assessment Questionnaire. It was able to distinguish between different populations. Factor analyses supported the earlier generated model of physical, affective and cognitive fatigue. Internal consistency of the questionnaire was supported by the Alpha Coefficient 0.90 (Cronbach). A difference was found in physical tiredness for patients with different types of cancer (p = 0.008) but this was not the case for affective and cognitive tiredness. More fatigue feelings were experienced by cancer patients with advanced disease than by patients in remission and this was true for physical fatigue (p = 0.0001), affective fatigue (p = 0.01), cognitive fatigue (p = 0.02) as well as for fatigue intensity (p = 0.0001) and distress (p = 0.0001). This group of patients also experienced significantly higher levels of depression and anxiety (p = 0.0001). The Fatigue Assessment Questionnaire, developed in the German speaking part of Switzerland, can be used for further activities in the field of quality of life and nursing care in oncology. The instrument and a proposed scoring system are published as an addendum to this article.

Adolescent↗

Head-HUNT: validity and reliability of a headache questionnaire in a large population-based study in Norway.

We have assessed the validity and reliability of a self-administered headache questionnaire used in the 'Nord-Trøndelag Health Survey 1995-97 (HUNT)' in Norway, by blindly comparing questionnaire-based headache diagnoses with those made in a clinical interview of a sample of the participants. Restrictive questionnaire-based diagnostic criteria for migraine, assessed according to modified criteria of the International Headache Society, performed excellently in selecting 'definite' migraine patients (100% positive predictive value). The best agreement concerning migraine diagnoses was achieved by using a liberal set of criteria (kappa 0.59). Similar agreement was found evaluating patient status as headache sufferers, and as sufferers from frequent headaches (>6 days per month) (kappa 0.57 and 0.50, respectively). The kappa values of non-migrainous headache and chronic headache (> 14 days per month) were 0.43 and 0.44, respectively. The results suggest that our self-administered questionnaire may be suitable in identifying a population with 'definite' migraine, and the questionnaire is an acceptable instrument in determining the prevalence in Nord-Trøndelag of headache sufferers, migraine, non-migrainous headache, and frequent or chronic headache sufferers.

Confidence Intervals↗

A questionnaire for the assessment of pruritus: validation in uremic patients.

A questionnaire was constructed for the evaluation and measurement of pruritus. The questionnaire, based on the short form of the McGill Pain Questionnaire, was tested in 145 patients suffering from uremic pruritus and currently undergoing hemodialysis treatment in 3 centers. The newly developed questionnaire proved to be reliable and provided valid data on the sensory, affective and overall intensity of uremic pruritus. The data suggest that uremic pruritus tends to be prolonged, frequently intense and a major source of distress to the patient. Dialysis was not found to influence the pruritus. The questionnaire may also be useful in pruritus secondary to other causes.

Adult↗

Assessment of sun-related behaviour in individuals with dysplastic naevus syndrome: a comparison between diary recordings and questionnaire responses.

In Sweden, individuals with dysplastic naevus syndrome (DNS-D2), a high risk group for malignant melanoma, are regularly screened and informed about self-examination and sun protection. During the summer of 1994, 54 out of 65 consecutive patients completed 1 month of daily self-recordings of sun-related behaviour. The diary report was compared with questionnaire responses obtained 6 months later concerning sun-related behaviour, both habitual and during the month of self-recording. The correspondence between the sun-related behaviour recorded in the diary and given in response to the questionnaire was fairly high, but 48% underestimated and 29% overestimated their actual number of sunbathing occasions in the questionnaire. Few patients indicated habitual high frequencies of sunbathing, although some of them recorded six or more occasions during 1 month in the diary. Those who recorded multiple sunburns reported the highest number of sunburns in the questionnaire. Patients who scored high on sunbed use also recorded high numbers of sunbathing occasions. Diaries should be used when detailed information about the magnitude of sun-related behaviour is essential, whereas questionnaires should be sufficient in studies aiming to differentiate between high and low frequencies of such behaviour.

Adolescent↗

Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints.

Sleep-related breathing disturbances, especially obstructive sleep apnoea syndrome (OSAS), are commonly encountered. Epidemiological studies from different countries have shown that poor sleep and complaints about insufficient sleep or poor sleep are often related to poor health. Different studies are, however, difficult to compare with each other. One of the main reasons for this is the frequent methodological differences between questionnaires. There is a need for uniform methods: we need to know the prevalence and incidence of sleep disorders, judged using the same criteria, and also the severity of each problem, i.e. how often a problem or a symptom happens/occurs. In 1988 the Scandinavian Sleep Research Society formed a task group for developing a standardized questionnaire that could be used as a basis for questionnaires used in the Nordic countries. In this article we describe the Basic Nordic Sleep Questionnaire (BNSQ). The main change compared to many previous questionnaires is the five-point scale (scale from 1 to 5) stressing on how many nights/days per week something happens. The basic scale is: 1, 'never or less than once per month'; 2, 'less than once per week'; 3, 'on 1-2 nights per week'; 4, 'on 3-5 nights per week'; and 5, 'every night or almost every night'. For questions about specific rare events the first category may be divided into 'never' and 'less than once per month'. Habitually occurring events such as 'habitual snoring' are defined here as snoring every night or almost every night. The BNSQ has been used widely in a variety of studies performed in Nordic countries during the last years, and it has proven to be a valid tool.

Journal Article↗

SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM-III-R.

A modified version of the SCID Screen questionnaire covering 103 criteria by means of 124 questions was compared with SCID II interviews in 69 psychiatric patients. The correlation between the number of criteria fulfilled in the SCID II interviews or the questionnaires was 0.84. In the SCID interviews, 54% of the patients had a personality disorder. When the SCID Screen questionnaire was used, 73% had a personality disorder. When the cut-off level for diagnosis was adjusted, the frequency found by means of the SCID screen questionnaire or the interviews was roughly the same, 58% and 54%, respectively. The overall kappa for agreement between the SCID II interviews and questionnaire with adjusted cut-off was 0.78.

Adult↗

The McGill Pain Questionnaire: a replication of its construction.

The McGill Pain Questionnaire is in widespread use as a means of understanding the pain patient and monitoring treatment response. The current study consists of a replication of the construction of the questionnaire through the use of maximally dissimilar methodology and statistical techniques. The study comprised two stages: (a) an attempt to replicate the grouping of words within the questionnaire; and (b) an investigation of the intensity relationships of words within each subgroup. A direct grouping technique was used for stage (a), whereby 90 subjects sorted the words into semantically similar groups. A similarity matrix was constructed in terms of the number of times each word was associated with each of the other 78 words and subjected to cluster analysis. Inspection of the 20-group solution revealed considerable similarity with the original questionnaire. The intensity relationships were examined by asking a further group of 20 subjects to rate words on analogue scales. The results suggest a unidimensional solution to be inappropriate for a proportion of the subgroups. While there was a close resemblance with the MPQ, there was evidence for reducing the number of subgroups, as a 16-group solution offered a sensible and statistically parsimonious amalgamation. The implications of this work for the use of questionnaire methods are discussed.

Female↗

Psychiatric disorders in inpatients on a neurology ward: estimate of prevalence and usefulness of screening questionnaires.

BACKGROUND: Patients on neurology wards have been shown to have high rates of psychiatric illness. Prevalence figures of 39-64% have been reported previously. However a low rate of recognition of psychiatric illness is also observed in this population. OBJECTIVES: To estimate the prevalence of psychiatric illness in neurology inpatients in a regional neuroscience centre and to assess the sensitivity and specificity of a batch of screening questionnaires. METHOD: Patients were assessed using the following screening questionnaires: Primary Care Evaluation of Mental Disorders, Mini Mental State Examination, Frontal Assessment Battery, Alcohol Use Disorders Identification Test and a neurologist-rating scale of organicity. All patients also had a full psychiatric assessment using the Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV). The screening questionnaires were then compared with our "gold standard", the psychiatric assessment. RESULTS: The prevalence of psychiatric illness (as determined by the psychiatric interview) in neurology inpatients in a tertiary referral centre was found to be 51.3% (95% confidence interval 44 to 58%). The sensitivity of this batch of screening questionnaires is 81.2% and the specificity is 77.1%. CONCLUSION: A high prevalence of psychiatric disorder was observed in inpatients on a dedicated neurology ward. The screening questionnaires used had a high sensitivity and specificity and could therefore be used as a simple way of identifying those with psychiatric illness.

Adolescent↗

Agreement in alcohol consumption levels as measured by two different questionnaires.

OBJECTIVE: We evaluated the agreement in reported alcohol consumption between a standard food frequency questionnaire (FFQ) and a risk factor questionnaire (RFQ) developed for a genetic epidemiologic study of breast cancer. METHOD: The FFQ measured intake of alcoholic beverages by asking which of nine levels were consumed during a single time period. In contrast, the RFQ used open-ended questions to measure intake of alcoholic beverages during numerous time periods. Subjects (N = 765) completed both questionnaires at home. RESULTS: Mean daily alcohol consumption levels were consistently higher in the FFQ than in the RFQ; for example, the mean alcohol consumption for all subjects was 7.0 g/day in the FFQ versus 5.3 g/day in the RFQ. Moreover, the RFQ overestimated the number of nondrinkers relative to the FFQ. Nonetheless, the Spearman correlation coefficients between daily alcohol consumption levels as measured by the two questionnaires were relatively high: total alcohol, r = 0.72; beer, r = 0.69; wine, r = 0.69; and distilled spirits, r = 0.54. CONCLUSIONS: The reasonable agreement between these questionnaires supports the validity of historical alcohol consumption levels measured by the RFQ.

Adult↗

Psychotherapists' attitudes toward observations of nonverbal communication in a greeting situation: I. Psychometrics of a questionnaire.

A questionnaire was designed for the assessment of psychotherapists' attitudes toward nonverbal communication and their observation of it in a reference situation, i.e., the first time the therapist and the patient meet in a waiting room. The interrater reliability of the questionnaire was measured. Upon minor modifications, a final version of the questionnaire was completed, and the intrarater (test-retest) reliability, the discriminating capacity, and the homogeneity of the questionnaire were studied. The questionnaire has satisfactory psychometric qualities for use in research on nonverbal communication in psychotherapeutic greeting.

Attitude of Health Personnel↗

Reliability, validity, and factor structure of the Arabic version of the 12-item General Health Questionnaire.

The aim was to examine the psychometric properties of the Arabic 12-item General Health Questionnaire in a sample of university students. A sample of 157 university students was screened using this questionnaire and the Hopkins Symptom Checklist-90. A standardized clinical interview using SCID was conducted on a subset of screened students. Reliability, validity, and factor analysis of the questionnaire were evaluated. Using factor score discrimination between cases and noncases was also evaluated. The Arabic version of the GHQ-12 proved to be reliable as indicated by Cronbach alpha of .86. The best balance between sensitivity and specificity was found at the General Health Questionnaire cut-off point of 15/16: at this threshold, sensitivity was .88 and was paired with a specificity of .84. Principal component analysis with varimax rotation identified three factors, namely, Factor A (general dysphoria), Factor B (lack of enjoyment), and Factor C (social dysfunction). Factors A and C discriminated between clinically distressed and clinically nondistressed subjects. The General Health Questionnaire-12 as a whole is a reliable and valid screening tool in university settings.

Arabs↗

Aspects of the construct validity of a preliminary self-concept questionnaire.

The aim of the study was to assess the construct validity of a Preliminary Self-concept Questionnaire and an Afrikaans version of the Self-description Questionnaire of Marsh, Smith, and Barnes. Questionnaires were administered to 57 boys and 57 girls in Grades 5 and 7. Their self-concepts were rated by their teachers on a teacher's rating scale, based on the four subscales of the Preliminary Self-concept Questionnaire. Correlations among the total scores of the three self-concept measures were calculated, as well as correlations among corresponding subscale scores. These values supported the construct validity of the Preliminary Self-concept Questionnaire and the convergent validity of three of the four subscales.

Adolescent↗

[Spanish version of the personality diagnostic questionnaire-4+ (PDQ-4+)].

INTRODUCTION: The Personality Diagnostic Questionnaire is one of the most frequently used instruments for diagnosing personality disorders (PD). Its last version (PDQ-4+) combines the easy applicability of a questionnaire with the control of state symptoms interference of an interview. The aim of this paper is to present preliminary results on the Spanish version of the PDQ-4+. METHOD: 159 psychiatric outpatients were assessed using the questionnaire of PDQ-4+. Among them, a sample of 47 were also evaluated using the short interview of clinical significance that completed the PDQ-4+. RESULTS: Results obtained were very similar to that from previous research, indicating similar psychometric properties of the PDQ-4+ Spanish version, to English, Italian, Chinese and Norway versions. In general, the internal consistency was acceptable; the obsessive-compulsive PD scale showing the lowest Cronbach's alpha. The high prevalence of PD obtained with the PDQ-4+ questionnaire was dramatically reduced when the clinical significance scale was added. These results are in more agreement with previous epidemiological studies. DISCUSSION: Overall, the PDQ-4+ questionnaire seems a good screening instrument in clinical use. Best results are obtained when the clinical significance scale is also administered.

Adult↗

[Scharfetter's EPP (Ego-Psychopathology) questionnaire in Polish setting].

AIM: To estimate the basic indices of reliability, validity and feasibility of the Scharfetter's EPP questionnaire--a clinical tool for assessment of ego disorders according to the author's theoretical model. METHOD: A group of 180 adults of clinically and demographically different characteristics were examined including 78 patients with a diagnosis of schizophrenia, 51 patients with depression in the course of affective disorders according to the ICD-10 criteria and 51 healthy persons as a control group. A Polish version of the EPP questionnaire with a slightly modified method of evaluation of subjects' responses was studied. Psychopathology was evaluated with PANSS and KOSS scales and some aspects of the clinical course were noted. RESULTS: A comparable percentage of positive responses was found between the EPP questionnaire in the original Scharfetter's Swiss group and the group under study. A high factor of internal consistency (Cronbach's alpha) both for the whole scale and its 5 dimensions were found. A relatively high correlation in the expected direction between the EPP and other psychopathology measures, as well as with basic characteristics of the course of the illness was established. Indices of disordered self-experience were significantly higher among patients with schizophrenia than with depression, and higher among both groups of patients then among healthy persons. Cluster analysis of EPP led to similar findings and allowed for distinguishing persons in the study into three clusters consisting mainly of: schizophrenic patients (highest profile), depressed patients (middle profile) and healthy persons (lowest profile). CONCLUSIONS: These preliminary, empirical evaluations of the Scharfetter's EPP questionnaire prove that its Polish version reveals rather satisfactory measures of reliability and validity, and observations suggest, that EPP can be successfully used in the clinical work with patients suffering from schizophrenia. The questionnaire indicates its clinical usefulness and prompts to further studies on the tool itself, as well as on the phenomenon of ego disorder for which it has been constructed.

Adult↗