Proposed items for the measurement of Dexterity, Vitality, Affect, Vision

Proposed items for the Proposed items for the measurement of Dexterity, measurement of Dexterity,

Vitality, Affect, VisionVitality, Affect, Vision

Lidia Gargiulo, Gabriella Sebastiani, Alessandra Tinto & Elena DePalma –

ISTAT, Italy

Working Paper No.3 Add.2

21 November 2005

STATISTICAL COMMISSION and STATISTICAL OFFICE OF THEUN ECONOMIC COMMISSION FOR EUROPEAN COMMUNITIESEUROPE (EUROSTAT)

CONFERENCE OF EUROPEAN WORLD HEALTHSTATISTICIANS ORGANIZATION (WHO)

Joint UNECE/WHO/Eurostat Meetingon the Measurement of Health Status (Budapest, Hungary, 14-16 November 2005)

Session 3 – Invited paper

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 2005

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The domainsThe domains

Dexterity (domain 2)

Vitality/fatigue (domain 3)

Affect (domain 4)

Vision (domain 6)


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Development of the Development of the proposed itemsproposed items

The HIS/HES* database was used as a reference

1. Overview of questions items used in the population health surveys and of established health status measurement instruments;

2. Selection of questions should be able to measure the concepts underlying each specific domain;

3. Analysis of the main characteristics of each question (wording, reference period, answer categories ...), similarities and difference among selected questions.

* www.iph.fgov.be/hishes/


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dexteritydexterity


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definitiondefinition

ICF :fine hand use (d440) performing the coordinated actions of handling objects, picking up, manipulating and releasing them using one’s hand, fingers, and thumb, such as required to lift coins off a table or turn a dial or knob.


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two main aspects:

manipulating and grasping

Mobility

Carrying, moving and handling objects

dexterity

(ICF)


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Manipulating: Using fingers to grasp or handle a small object like a pen

Grasping: Turning a tap or unscrew a lid

Both dimensions are covered in the proposed items.

howhow it isit is measuredmeasured


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The first proposal was selected The first proposal was selected from from the the European Health Status European Health Status Module.Module.

After a discussion within the TF, After a discussion within the TF, the the answer categories were modified answer categories were modified to to include the level of difficulty.include the level of difficulty.

first proposal and first proposal and reviewsreviews


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DEX-1. Can you use your fingers to grasp or handle a small object like a pen without any aids?

Yes, with no difficultiesYes, with some difficultiesNo

If no:

DEX-2. Can you use your fingers to grasp or handle a small object like a pen with aids?

Yes No Has no aids

proposedproposed items items (1)(1)


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DEX-3. Can you turn on a tap or unscrew the lid of a jar of coffee without any aids?

Yes, with no difficultiesYes, with some difficultiesNo

If no:

DEX-4. Can you turn on a tap or unscrew the lid of a jar of coffee with aids?

Yes No Has no aids

proposed items proposed items (2)(2)

By using different examples in each country, it would be clearer what is intended with the term aids.


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issues of the proposed issues of the proposed itemsitems

Uni-dimensional items;

Distinguishing dexterity with and without the use of aids allows to identify capacity;

Simplicity and clarity of wording.

Answer categories ?

Reference period ?


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vitalityvitality / / fatiguefatigue


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DefinitionDefinition

ICF :Body Functions

Global Mental functions Energy and drive functions

energy level (b1300): mental functions that produce vigor and

stamina


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two main aspects: tiredness

vs refreshed

Mental functions

Energy and drive functions

vitality / fatigue

(ICF)


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tools usedtools used various National Health Interview surveys European Health Status Module World Health Survey

used from 1 up to 4 questions 4 questions SF-36 adapted time reference:

“the past 4 weeks/last 30 days/past month”.

response categories: measure the frequency in time spent being in a certain health state.

main outcomesmain outcomes


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how it is measuredhow it is measured

rested full of peprefreshed have a lot of

energy

tiredness feel tiredlack of energy feel worn out

positive

negative

From SF - 36


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The first proposal was the European Health Status Module that include questions on vitality of SF-36.

After a discussion within the TF, aiming to introduce a measure of intensity, just 2 questions out of 4 were selected.

First proposal and First proposal and reviewsreviews


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VIT-1 How much, during the past 4 weeks, did you have a lot of energy?

All the time Most of the timeSome of the timeA little of the timeNone of the time

VIT-2 How much, during the past 4 weeks, did you feel tired?

All the timeMost of the timeSome of the timeA little of the timeNone of the time

proposed items (1)proposed items (1)


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no energy at all highest level of energy imaginable|__________________________________________________ || |0 100

VIT-4 Thinking about the past 4 weeks, on a scale from 1-100 how intense was the level of tiredness on average: 0 is lowest level and 100 is the highest level imaginable.

no tiredness at all highest level of tiredness imaginable|__________________________________________________ || |0 100

proposed items (2)proposed items (2)

VIT-3 Thinking about the past 4 weeks, on a scale from 1-100 how intense was the level of energy on average: 0 is lowest level and 100 is the highest level imaginable.


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issues of the proposed issues of the proposed itemsitems Include both positive and negative aspects Measure the frequency of refreshed and tiredness Measure the intensity of refreshed and tiredness Uni-dimensional items Simplicity and clarity of wording Number of countries using the question (translated

into many languages and wide knowledge of instrument);

use of medicines? reference period?


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affectaffect


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definitiondefinition

ICF : Body Functions

Emotional functions (b152)Emotional functions (b152)::

Inclusions: functions of appropriate emotions and range of emotion, affectaffect, sadness, happiness, love, fear, anger, tension, anxiety, joy, sorrow, ability of emotion, flattening of affect.

specific mental functions related to the feeling andaffective components of the process of the mind


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two main aspects: happiness

and depression

Mental functions

Emotional functions

affect

(ICF)


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tools usedtools used

various National Health Interview surveys European Health Status Module (SF-36 MH

module) CIDI – short form World Health Survey

main outcomesmain outcomes reference period: “the past 4 weeks/ 2 weeks in

the last 12 months /last 30 days”. response categories: mainly measure the

frequency in time spent being in a certain emotional state.


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Selection of the Selection of the instrumentinstrument

Comparing the instruments, the MH module of SF-36 was selected for following reasons:

WHS and CIDI Short Form are mainly oriented to the measure of negative emotional states

CIDI Short Form seems to be of difficult comprehension for the respondents due to the double time reference period (2 weeks in a raw within the last 12 months)

SF 36 Mental Health is oriented to measure positive and negative emotional states; it is widely used in HIS and it is easy to administer with different data collection techniques in population surveys.


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Positive emotional state Calm and peaceful Feel happy

Negative emotional state Feel down in dumps Feel down hearted Feel nervous

A lot of specific aspects from both emotional states are excluded. To analyze depression, for example, several other items are considered in measurement scales used in psychiatry but including them the parsimonious criteria couldn’t be respected.

how it is measured in SF how it is measured in SF 3636

From SF - 36


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The initial proposal was the European Health Status Module that

includes the Mental Health scale of SF-36 (except the quest of feeling

nervous). After a discussion within the TF, aiming to introduce a measure of intensity, just two questions out of five

were selected.

first proposal and reviewsfirst proposal and reviews


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AFF-1. How much, during the past 4 weeks have you been happy? All of the time Most of the time Some of the time A little of the time None of the time

AFF-2. How much, during the past 4 weeks have you felt down-hearted and depressed? All of the time Most of the time Some of the time A little of the time None of the time

proposed items (1)


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AFF-3. Thinking about the past 4 weeks, on a scale from 1-100 how intense was the level of happiness on average: 0 is lowest level and 100 is the highest level imaginable.

Not happy at all As happy as I could ever imagine|____________________________________________________________|| |0 100

AFF-4. Thinking about the past 4 weeks, on a scale from 1-100 how intense was the level of depression on average: 0 is lowest level and 100 is the highest level imaginable.

Not depressed at all The highest level of depression imaginable |____________________________________________________________|| |0 100

Proposed items (2)


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issues of the proposed issues of the proposed itemsitems Include both positive and negative aspects; Measure the frequency of the emotional state; Measure the intensity of the emotional state; Uni-dimensional items Simplicity and clarity of wording; Number of countries using the questions

(translated into many languages and wide knowledge of instrument);

Limited number of questions make it very difficult to detect this specific domain

use of medicines? reference period?


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visionvision


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DefinitionDefinition

ICFBody Functions

Sensory functions Seeing functions

Visual acuity functions (b2100):

seeing functions of sensing form and contour, both binocular and monocular,for both distant and near vision.


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two main aspects: seeing from near seeing from far

Seeing functions

vision

(ICF)Sensory functions


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How it is measuredHow it is measured

Seeing from near: arms length one meter distance newsprint letters.

Seeing from far: across the street four meters distance 20 meters distance


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Tools usedTools used

various National Health Interview surveys European Health Status Module World Health Survey.

Main outcomesMain outcomes time reference: mainly not included response categories: mainly focalized for the

individuation of the problem rather than measuring severity

visual aids: most of surveys clarify if included or not


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The initial proposal was the adapted European Health Status Module

integrated with a question of WHS on the use of visual aids.

After a discussion within the TF, the answering categories were changed

in order to measure the severity of sight problem.

First proposal and First proposal and reviewsreviews


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VIS-1. Do [you/he/she] wear glasses, contact lenses or other visual aids?(If Respondent says YES to this question, preface the next 2 questions with "Please answer the following questions taking into account your glasses, contact lenses or other visual aids ".)

YesNoI am /he is /she is blind or I/he/she cannot see at all (next section)

Proposed items (1)


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VIS-2. How clearly can [you/he/she] see newspaper print? Perfectly clearlyVery clearlySomewhat clearlyNot very clearlyNot at all clearly

VIS-3. How clearly can [you/he/she] see the face of someone 4 metres away? Perfectly clearlyVery clearlySomewhat clearlyNot very clearlyNot at all clearly

Proposed items (2)


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issues of the proposed issues of the proposed itemsitems Identification of use of visual aids or being blind; Identification seeing difficulties considering use

of visual aids; Measure the level of severity of the problem; Number of countries using the questions; Simplicity and clarity of wording; Improving the cross-cultural comparability

(standard formulas i.e. distance in meters).

Answer categories?

Proposed items for the measurement of Dexterity, Vitality, Affect, Vision

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