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View all copies of this ISBN edition:. Synopsis About this title A guide to measures of health and functioning, including psychological well-being, emotional well-eing, social networks and support. Review : " Siegrist found differences in effectiveness and perceived effectiveness of medical treatments in different cultural contexts,[21] and Grossi found several cultural variables to be important determinants of individual psychological wellbeing.

The traditional philosophy of psychometric instrument construction assumes that the instrument's set of items indicator variables reflects unobservable latent constructs intended for measurement, indicating their level or degree e. Of prime importance in an instrument that includes causal variables are basic properties such as test-retest reliability, content validity, discriminant validity ability to detect differences between groups known to be different , predictive validity sensitivity to changes over time and clinical interpretability.

Also needed are simplicity, understandability by the patient and applicability within the socioeconomic and cultural context of the population studied.


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Thus, measuring HRQOL in Cuban breast cancer patients receiving radiotherapy requires an instrument developed in the Cuban socioeconomic and cultural environment. This will provide information about problems distressing patients from their own perspectives, since they know their own emotions best. As a result, when deciding appropriate therapies, patient needs could be more fully considered: subjective morbidity negative emotional states and psychosomatic symptoms as well as the impact of the disease and its treatment on patient lifestyles.

In addition, knowledge derived from the instrument's application would facilitate identification of patients requiring specialized attention to improve their individual and social responses to the real challenges of daily life. The purpose of this research was to construct and validate just such an instrument. Excluded were patients unable to communicate orally or in writing, and patients with mental retardation, psychopathological symptoms, senile dementia or cerebral metastasis.

The work was done in two phases: development and validation of the instrument. Development phase The different items were generated by a qualitative method after collecting testimonies from patients attending their last session of ambulatory radiotherapy. Sample size was determined using the saturation of information criterion, interviews stopped when no novel points emerged, that is, when the last five women reported items that had already been included.

Measuring Health-related quality of life (HRQoL)

To keep interviews uniform, a question guide was elaborated, including different aspects of HRQOL documented in the literature. All interviews were done in settings providing adequate privacy. To encourage patient spontaneity, no recording equipment was used for the focus group interviews; patients were asked to stay on topic for each question asked. For analysis and qualitative interpretation of the information gathered, a problem list was created and organized by topic, eliminating those that repeated the same idea and grouping those with similar meaning. This allowed identification of terms that were later included under the same item e.

A preliminary version of the instrument, called CV-MRT-P, was constructed with 42 items distilled by semantic analysis from the 61 problems identified , using a 5-point Likert-like scale;[31] it described the items clearly and plainly, used positive and negative language, and avoided technical jargon. Each item was evaluated according to whether it was: 1 important to patients, 2 easy for patients to understand, 3 clearly and explicitly associated with the HRQOL concept to be measured, 4 associated with the domains of the instrument, 5 formulated to be consistent with the question's possible responses, 6 capable of eliciting varying responses among different patients, 7 worded in a way compatible with its operationalization scale categories equidistant and hierarchically related to the data , and 8 not in violation of ethical principles.

Background

Face validity was assessed by 20 eligible patients not involved in generating the items. They were asked to answer the questions included in the CV-MRT-P and to give their opinion about the instrument's clarity, comprehensibility and simplicity. The mean scores for component items in each HRQOL domain were summarized for each corresponding synthetic variable:. The variable scores were then summed with the score for one discrete variable, perceived general health pH , and divided by five to create the global HRQOL scale.

Thus the scale expression was:. Validation phase CV-MRT-P with one modification, described in Results was administered to participants individually at three different times: before radiotherapy, at the end of radiotherapy and 4 weeks later. Information collected was stored in a database using SPSS Dimensionality, construct validity, reliability test-retest repeatability and internal consistency , discriminant validity, predictive validity, interpretability and response burden were evaluated.

Dimensionality Exploratory factor analysis EFA and varimax rotation with Kaiser normalization were used to explore instrument structure and to reduce dimensionality, minimizing information loss.

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Construct validity was assessed by examining convergent and divergent validity using the multitrait multimethod correlation matrix. This method examines both types of validity using Pear-son correlation. Reliability The Pearson correlation coefficient was used to assess test-retest repeatability and Cronbach alpha for internal consistency.

Predictive validity is the ability of the instrument to detect changes in HRQOL produced over time by a particular event or intervention. It estimates the magnitude of changes in the scale and its domains by standardized mean response, calculated by dividing the mean change between initial and final time by its SD.

Clinical interpretability is the degree to which quantitative scores for the scale and its domains translate into qualitative clinical meaning concerning HRQOL deterioration. Results presented for CV-MRT-P include dimensionality, construct validity, repeatability, internal consistency and response burden.

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Results presented for CV-MRT include dimensionality, construct validity, test-retest reliability repeatability and internal consistency , discriminant validity, predictive validity and interpretability. Response burden was not analyzed in this second round because the modified scale was not administered to patients.

Participants gave written informed consent following an explanation of the study's objectives, ben efits and risks. Participant age range was years mean 51 years for those involved in generating the items and assessing face validity, Breast cancer stage distribution for the latter group was: stage I, These problems were confirmed by the nominal group without additions.

The experts judged content validity favorably, and the 20 patients who assessed the instrument's face validity had no negative comments. In the preliminary version, EFA extracted four main components able to reproduce the correlations between observed variables; they explain The first factor included all items in the PhF domain and explained the highest percentage of data variance The second component explained This domain was therefore renamed physical and emotional adverse effects of disease and treatment.

They were therefore eliminated from the revised instrument. Two of these had changes in number of items: three from PsF were moved to AE. EFA for this version extracted four components that explained somewhat more variance than the original Variance explained by specific components was similar in both versions.

Table 3 displays the multitrait multimethod matrix resulting from calculation of Pearson correlations between synthetic variables and HRQOL scores for CV-MRT at two points before and on completion of radiotherapy. Overall internal consistency of the instrument and its domains was satisfactory for all three measurements Cronbach alpha 0. The most important items for internal consistency are those that, when eliminated, decrease Cronbach alpha, i.

In this sense, the most important items were: perform housework; continue working as before; fatigue, low energy or lack of energy; malaise; trouble swallowing; breast inflammation or dryness; pain or increased sensitivity in the breast area; stinging irritation or burning sensation in the breast area; sadness, despair or frustration; decreased desire to enjoy what you used to like most; decreased sexual interest; tendency to hide the disease; family's support in the way you need it; friends' support in the way you need it; pH; and pQ.

Analysis of discriminant validity or concurrent validity for CV-MRT confirmed that, at the end of radiotherapy, patients with more advanced stages of the disease suffered slightly greater decrease in levels of physical and psychological functioning than did patients in less advanced stages values 3. Exceptions were SR, for which standardized-mean response remained stable throughout. There were negative changes observed in PhF and PsF between beginning and end of radiotherapy, but both improved by four weeks after completion of radiotherapy Table 4.

Table 5 illustrates the clinical interpretability of the scale and its domains. This inference was confirmed by clinical observation, since none of the women exhibited severe secondary reactions to radiotherapy.

Measuring Health: A Review of Quality of Life Measurement Scales

Average completion time was 7. A multi-item instrument was constructed, validated and improved; experts and patients agree that it covers all aspects required to evaluate the impact of breast cancer and radiotherapy on Cuban women's HRQOL. The structure of this tool correlates well with the degree of psychological functioning, social and family relations, physical functioning, and physical and emotional adverse effects of disease and treatment, as well as with two discrete items: perception of general health and perception of HRQOL.

For the PhF and AE domains, we used clinimetric scales that measure sequence and severity of symptoms and adverse effects of treatment. The Cuban instrument has nine PsF items and the SR domain includes three items about relations with family, spouse and friends, whose formulation in the way you need it was influenced by patient focus groups.