Report on the Budapest Initiative Joint UNECEWHOEurostat Task Force on Measurement of Health Status

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Report on theBudapest InitiativeJoint
UNECE/WHO/Eurostat Task Force on Measurement of
Health Status

• Jennifer H. Madans
• National Center for Health Statistics, USA
• 6th Annual Meeting of the Washington Group
• Kampala, Uganda, October 10-13, 2006

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The Budapest Initiative

• Goals
• To develop a new common instrument to measure
  health state.
• To coordinate with existing groups such as the
  Eurostat Group on EHIS and the Washington Group.
• Meetings
• 24-26 May 2004
• 14-16 November 2005
• Products
• Domain structure
• Draft question set
• Followup
• Creation of a Working Group to incorporate the
  Task Forces comments, develop a revised set of
  questions for consideration, and develop a test
  protocol.

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Health Status and Health States
Health State an individuals levels of
functioning within a set of
health domains.
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Final List of Recommended Domains

• Vision
• Hearing
• Mobility
• Cognition
• Affect
• Pain or discomfort
• Fatigue
• Social Relationships

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Conceptual and Logistic Issuesfor Item
Construction and Domain Questions

• Number of questions per domain
• Dimensionality
• Duration of the recall period
• Dealing with assistive devices and medications
• Item wording and response categories

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Conceptual and Logistic Issuesfor Item
Construction and Domain QuestionsOutstanding
Issues

• Measure capacity or performance?
• Include use of assistive devices or not?
• Response categories
• none, mild, moderate, severe, extreme or
• a little, some, a lot, unable?
• Include social relationships as a final domain?
• Should mobility domain ask about moving around
  or walking and stair climbing?

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Proposed Questions for Testing

• Vision
• Do you wear glasses or contacts?
• If yes Please answer the following question
  according to your normal use of glasses or
  contacts.
• Overall, during the past four weeks, how much
  difficulty did you have.
• in recognizing the face of someone four meters
  away (for example, across a road)?
• in seeing printed text (for example, in a
  newspaper or book)?

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Proposed Questions for Testing

• Hearing
• Do you wear a hearing aid?
• If yes Please answer the following question
  according to your normal use of a hearing
  aid(s).
• Overall, during the past four weeks, how much
  difficulty did you have.
• in hearing the other person when you/he/she
  were having one-on-one conversations?
• in hearing what was said in conversations with
  multiple people?

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Proposed Questions for Testing

• Mobility
• Do you use any aids or specialized equipment for
  moving around/walking?
• If yes Which of the following types of aids or
  specialized equipment do you use for moving
  around/walking?
• cane or walking stick
• walker
• wheelchair
• other (interviewer record)

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Proposed Questions for Testing

• Mobility
• If yes Please answer the following question
  without the use of your aids or specialized
  equipment.
• Overall, during the past four weeks, how much
  difficulty did you have.
• in moving around?
• or
• with walking short distances (for example, 100
  meters)?
• with walking long distances (for example, 500
  meters)?
• with walking up or down stairs?
• or
• with walking?

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Proposed Questions for Testing

• Cognition
• Overall, during the past four weeks, how much
  difficulty did you have.
• with concentrating or remembering things?
• with thinking clearly and solving daily problems?

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Proposed Questions for Testing

• Overall, during the past four weeks, .
• Affect
• how sad, low or depressed did you feel?
• how worried, nervous, or anxious did you feel?
• Fatigue
• how much of a problem did you have with feeling
  tired or fatigued?

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Proposed Questions for Testing

• Pain or Discomfort
• Overall, during the past four weeks, .
• how much bodily pain or discomfort did you have?
• If asked When answering, please consider both
  the times you were taking medication and the
  times you were not and try to come up with an
  overall or average rating.

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Proposed Questions for Testing

• Social Relationships
• Generally speaking, how much difficulty do you
  have.
• in creating or maintaining social relationships?

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The Testing Protocol

• Standard protocol used at each site
• Structured questions administered to respondents
• Questions asked twice
• Open-ended
• Response sets (split sample)
• Unstructured probes for interviewers
• How do respondents interpret the question, choose
  a response, and do they adhere to the recall
  period?

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Relationship with Washington Group Work

• Overlapping domains
• Same conceptual issues
• Different contexts
• Different approaches

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Next Steps

• October 2006 November 2006
• Finalize testing protocol
• Conduct tests (Italy, USA, Canada)
• December 2006 January 2007
• Write and review final test reports
• February 2007
• Make recommendations to European Statistical
  System