3.4.3 What should I include? A review of the techniques used to generate items in quality of life questionnaires (201)

Simon Palfreyman, Research Nurse, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom Co authors: Angela Tod, John Brazier & Jonathan Michaels Simon.Palfreyman@sth.nhs.uk

Abstract:

When assessing and evaluating health care, there needs to be a means of determining whether an intervention is improving, or adversely affecting, the quality of life. The ability to be able to measure how clinical intervention or treatments improve patient outcome is especially important in chronic conditions where the capacity to cure may be limited. One method is to simply ask the patient using a structured questionnaire focused on perception of perceived quality of life. Past QoL questionnaires have relied on the expertise of clinicians and excluded the views of patients. In designing such questionnaires the primary consideration is the choice of items to include but such decisions can be problematic. It is clearly important to include items that reflect the priorities and experiences of the patient. If attributes that impact on quality of life are omitted then the validity of the questionnaire can be severely compromised.

This presentation argues for a rigorous bottom up approach starting with qualitative techniques to incorporate the views of the patients. However, this approach can encounter problems particularly with representativeness, prioritising and data analysis. The next stage, which uses quantitative methods and aims to prioritise and reduce the number of items, can also be challenging. This data reduction uses techniques such as Factor and Rasch analysis and these too can rely on subjective decisions. For example, researcher needs to decide the number of factors based on those items that “best fit”, “make the most sense”.

This paper seeks to examine the methods that can be used to select attributes and items to include in quality of life instruments. It will review the advantages and disadvantages of both qualitative and quantitative techniques using an example of an instrument developed to measure outcomes in venous ulceration.

Biography:

Simon currently works as a research nurse at the Sheffield Vascular Institute at the Sheffield Teaching Hospitals NHS Foundation Trust. He was awarded the Smith and Nephew Foundation Doctoral Studentship in 2005 to examine quality of life and venous leg ulcers. He has a honorary lecturers post in the Department of Acute and Critical Care, University of Sheffield School of Nursing.