Proposed%20items%20for%20the%20measurement%20of%20Dexterity,%20Vitality,%20Affect,%20Vision

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Proposed items for the measurement of Dexterity,
Vitality, Affect, Vision
Working Paper No.3 Add.2 21 November
2005 STATISTICAL COMMISSION and STATISTICAL
OFFICE OF THE UN ECONOMIC COMMISSION
FOR EUROPEAN COMMUNITIES EUROPE
(EUROSTAT)   CONFERENCE OF EUROPEAN WORLD
HEALTH STATISTICIANS ORGANIZATION
(WHO) Joint UNECE/WHO/Eurostat Meeting on the
Measurement of Health Status (Budapest, Hungary,
14-16 November 2005)   Session 3 Invited paper

• Lidia Gargiulo, Gabriella Sebastiani, Alessandra
  Tinto Elena DePalma ISTAT, Italy

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The domains

• Dexterity (domain 2)
• Vitality/fatigue (domain 3)
• Affect (domain 4)
• Vision (domain 6)

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Development of the proposed items

• The HIS/HES database was used as a reference
• Overview of questions items used in the
  population health surveys and of established
  health status measurement instruments
• Selection of questions should be able to measure
  the concepts underlying each specific domain
• 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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dexterity
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definition

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

dexterity
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• two main aspects
• manipulating
• and grasping

dexterity
dexterity
Carrying, moving and handling objects
(ICF)
Mobility
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how it is measured

• 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.

dexterity
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first proposal and reviews

• The first proposal was selected from the
  European Health Status Module.
• After a discussion within the TF, the
  answer categories were modified to include the
  level of difficulty.

dexterity
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proposed items (1)

• DEX-1. Can you use your fingers to grasp or
  handle a small object like a pen without any
  aids?
• Yes, with no difficulties
• Yes, with some difficulties
• No
• 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

dexterity
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proposed items (2)

• DEX-3. Can you turn on a tap or unscrew the lid
  of a jar of coffee without any aids?
• Yes, with no difficulties
• Yes, with some difficulties
• No
• 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

dexterity

• 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 items

• Uni-dimensional items
• Distinguishing dexterity with and without the use
  of aids allows to identify capacity
• Simplicity and clarity of wording.

dexterity

• Answer categories ?
• Reference period ?

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vitality / fatigue
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Definition

• ICF
• Body Functions
• ?Global Mental functions
• ? Energy and drive functions
• ?energy level (b1300) mental functions
  that produce vigor and stamina

vitality
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vitality

• two main aspects tiredness
• vs refreshed

vitality / fatigue
Energy and drive functions
Mental functions
(ICF)
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tools 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.

vitality
main outcomes
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how it is measured

• rested ? full of pep
• refreshed ? have a lot of energy
• tiredness ? feel tired
• lack of energy ? feel worn out

vitality
positive
negative
From SF - 36
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First proposal and reviews

• 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.

vitality
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proposed items (1)

• VIT-1 How much, during the past 4 weeks, did you
  have a lot of energy?
• All the time
• Most of the time
• Some of the time
• A little of the time
• None of the time
• VIT-2 How much, during the past 4 weeks, did you
  feel tired? All the time Most of the time Some
  of the time A little of the time None of the
  time

vitality
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no energy at all highest level of energy
imaginable______________________________________
____________ 0
100VIT-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)
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.
vitality
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issues of the proposed items

• 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?

vitality
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affect
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definition

• ICF Body Functions ?
• Emotional functions (b152)
• Inclusions functions of appropriate emotions
  and range of emotion, affect, sadness,
  happiness, love, fear, anger, tension, anxiety,
  joy, sorrow, ability of emotion, flattening of
  affect.

affect
specific mental functions related to the
feeling and affective components of the
process of the mind
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• two main aspects
• happiness
• and depression

affect
affect
Emotional functions
Mental functions
(ICF)
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tools used

• various National Health Interview surveys
• European Health Status Module (SF-36 MH module)
• CIDI short form
• World Health Survey
• main 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.

affect
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Selection of the instrument

• 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.

affect
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how it is measured in SF 36

• Positive emotional state
• Calm and peaceful
• Feel happy
• Negative emotional state
• Feel down in dumps
• Feel down hearted
• Feel nervous

affect
From SF - 36
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 couldnt
be respected.
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first proposal and reviews

• 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.

affect
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proposed items (1)

• 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

affect
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Proposed items (2)

• 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

affect
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issues of the proposed items

• 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?

affect
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vision
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Definition

• ICF
• Body 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.

vision
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• two main aspects
• seeing from near
• seeing from far

vision
vision
Seeing functions
Sensory functions
(ICF)
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How 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

vision
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Tools used

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

vision
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First proposal and reviews

• 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.

vision
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Proposed items (1)

• 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 ".)
• Yes
• No
• I am /he is /she is blind or I/he/she cannot see
  at all (next section)

vision
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Proposed items (2)

• VIS-2. How clearly can you/he/she see newspaper
  print?
• Perfectly clearly
• Very clearly
• Somewhat clearly
• Not very clearly
• Not at all clearly
• VIS-3. How clearly can you/he/she see the face
  of someone 4 metres away?
• Perfectly clearly
• Very clearly
• Somewhat clearly
• Not very clearly
• Not at all clearly

vision
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issues of the proposed items

• 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?

vision