Background. Workshop. Using the WHOQOL in NZ

Transcription

1 Using the WHOQOL in NZ Australasian Mental Health Outcomes Conference Workshop Using WHOQOL in New Zealand Prof Rex Billington, Dr Daniel Shepherd, & Dr Chris Krägeloh Rex Billington Chris Krageloh What is the WHOQOL. How it was developed. What are its features. The NZ WHOQOL Group. NZ version of the WHOQOL-BREF. NZ norms and psychometric properties. Rex Billington QOL in Mental Health Recovery. Pilot research. Additional module. Importance items Break Part II: Daniel Shepherd Completing a WHOQOL. Analysing the results Your ideas Background WHOQOL = World Health Organization Quality of Life Scale. Health-related QOL assessment. Developed in the 1990s cross-culturally in 14 countries. Expanded to over 35 country versions since estimate of 123 researchers in 67 centres and 39 countries involved in studies using WHOQOL instruments. Purposes behind WHOQOL development Need for measurement of health beyond traditional morbidity and mortality to include impact of disease and impairment on daily activities and behaviour. Desire to find out what patients and clients felt about themselves to supplement what experts thought. Introduces a humanistic element to health care to balance mechanistic medical approaches. Unsatisfactory and culturally biased translations of similar UK and North American measures. Definition of QOL an individual s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person s physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment Versions and features WHOQOL = core generic instrument WHOQOL - BREF = abbreviated 26 item version WHOQOL - 8 = eight-item version Additional modules = HIV, OLD, SRPB Subjective questions Self-rating Comprehensive multidimensional profile. Includes national items. 1

2 WHOQOL -100 Domains Physical Psychological Level of independence Social relations Environment Spirituality/religiousness/personal beliefs 24 Facets of 4 questions each. WHOQOL BREF Domains 26 item BREF 1 question per facet plus two global questions. Alternative 4 domain WHOQOL-BREF domain structure: * Physical Health * Psychological * Social relations * Environment Where: Level of independence - to physical health domain Spirituality/religiousness/personal beliefs to psychological domain Domain Domains and Facets Facets incorporated within domains Overall Quality of Life and General Health 1. Physical Health Energy and fatigue Pain and discomfort Sleep and rest 2. Psychological Bodily image and appearance Negative feelings Positive feelings Self-esteem Thinking, learning, memory and concentration 3. Level of Independence Mobility Activities of daily living Dependence on medicinal substances and medical aids Work capacity 4. Social Relations Personal relationships Social support Sexual activity 5. Environment Financial resources Physical safety and security Health and social care: availability and quality Home environment Opportunities for acquiring new information and skills Participation in and opportunities for recreation / leisure Physical environment (pollution/ noise / traffic/ climate) Transport 6. Spirituality/Religion/ Religion / Spirituality / Personal beliefs Personal Beliefs (Single facet) Developmental process Experts meeting Geneva multifaceted scale agreed. Recruited 15 collaborating centres who conducted countrylevel focus group with consumers, patients and health experts to examine domains and develop facets ideas returned to Geneva and sorted. Next collaborating centres generated 2500 questions. Translated/back translated. Again sorted in Geneva. 236 items and 29 facets in the first international trial to examine construct validity of domains and facets and to select best items. 19 centres involved in the field testing of the WHOQOL with 8294 subjects involved. Selection of 24 facets on basis of their importance and 100 items on the basis of item analysis data. Properties of the WHOQOL Comprehensive multidimensional profile. Subjective perceptions: How satisfied are you with your ability to walk Objective approach How well can you walk Subjective approach decided upon. Cross-culturally developed/many languages. Standardized 5-point Likert rating scale covering 4 dimensions - intensity (how much), frequency (how often), evaluation (how satisfied), capacity (are you able). 2

3 Uses of the WHOQOL Medical practice Medical audit Clinical trials Research Policy making The NZ WHOQOL Group Up until now, research studies in New Zealand using the World Health Organization Quality of Life questionnaire WHOQOL-BREF have been using the Australian or English versions. In 2008, Prof. Rex Billington and colleagues founded the New Zealand WHOQOL Group. One of the early goals of this group was to validate the instrument for use in New Zealand and thus develop a New Zealand version. Data from the general population were obtained using a random sample from the national electoral roll, and analysed using confirmatory factor analysis. National items developed in focus groups were also tested for their suitability. A second goal was to compare the results from the general population with those of a sample of university students. Previous research showed that some of the items in the WHOQOL-BREF do not perform adequately with young people, such as Items 3 (pain) and 4 (medical treatment). Development of New Zealand national Items: Conducted 13 focus groups with general community members, people with disabilities, and health experts. Wrote potential new items based on themes that had emerged from those focus groups. Used random sample of 3,000 participants from the national electoral role to obtain importance ratings for these items. Those with low importance were dropped. Validation of the New Zealand WHOQOL-BREF: Example possible new items are: How satisfied are you that you eat healthily? To what extent are you able to manage personal difficulties? To what extent do you feel you have individual freedom? Used another random sample of participants from the national electoral role to obtain ratings for the existing 26 WHOQOL-BREF items and the potential national items. Sent out 2,000 questionnaires with self-addressed return envelopes. 712 questionnaires returned (response rate approximately 36%). 3

4 Validation of the New Zealand WHOQOL-BREF: Conducted confirmatory factor analysis (CFA) with the following specifications: Promax rotation Two types of extraction methods: Maximum likelihood (ML) with polychoric correlations Diagonally-weighted least squares (DWLS) Convenience sample of undergraduate university students completing the New Zealand WHOQOL- BREF: 713 students completed the questionnaire, of which 679 were valid. Students were approached in lecture theatres and returned questionnaires straightaway (response rate approximately 70%). CFA as above, as well as a multigroup CFA. Shown are values from ML estimation, and in parentheses those from DWLS. *Cut-off values for excellent fits: RMSEA < 0.060; CFI > 0.950; SRMR < Multigroup configural invariance test confirmed that the factor structure for the two samples are identical, with RMSEA=0.072 (0.072 for DWLS), CFI=0.961 (0.967 for DWLS), and SRMR=0.067 (0.063 for DWLS). Mean ratings were significantly different: Conclusion from these studies The four-domain structure of the WHOQOL- BREF was confirmed in a New Zealand sample of the general population and in a sample of New Zealand university students. Goodness-of-fit indices indicate very good to excellent fits, although there may be some concerns of multicollinearity for some items. **p <.01 4

5 Domain scores from the general population sample were significantly higher than those from university students, which is consistent with other research. More data is being collected to finalise the selection of national items. Quality of life and mental health recovery Permanently disabled report levels of personal well being 2 years after an accident equal to what it was before they were disabled. Recovery from mental illness = learning to live with the problem. Periodic QOL assessment can be a therapeutic discussion resource Facet level analysis. Ongoing assessment using mental health status measures may reveal little change in the mental illness. Some pilot research projects Framework Trust Connect Psychological therapies project Mind and Body Using WHOQOL with recovery clients considerations: Ratings for some facets may drop over time. Importance of all facets to recovery clients. Need for an additional mental health module. The WHOQOL-BREF is copyrighted to WHO, but can be used free of charge for non-commercial purposes. We ask anyone intending to use the instrument in NZ to register with the NZ WHOQOL Group: Prof. Rex Billington (rex.billington@aut.ac.nz) Dr. Daniel Shepherd (daniel.shepherd@aut.ac.nz) Dr. Chris Krägeloh (chris.krageloh@aut.ac.nz) 5