Proposed items for the measurement of Dexterity, Vitality, Affect, Vision Lidia Gargiulo, Gabriella Sebastiani, Alessandra Tinto & Elena DePalma – ISTAT, Italy Working Paper No.3 Add.2 21 November 2005 STATISTICAL COMMISSION andSTATISTICAL OFFICE OF THE UN ECONOMIC COMMISSION FOREUROPEAN COMMUNITIES EUROPE (EUROSTAT) CONFERENCE OF EUROPEAN WORLD HEALTH STATISTICIANS ORGANIZATION (WHO) Joint UNECE/WHO/Eurostat Meeting on the Measurement of Health Status (Budapest, Hungary, November 2005) Session 3 – Invited paper

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November The domains Dexterity(domain 2) Vitality/fatigue(domain 3) Affect(domain 4) Vision(domain 6)

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November Development of the proposed 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. *

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

5 definition 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.

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November two main aspects: manipulating and grasping Mobility Carrying, moving and handling objects dexterity (ICF)

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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. how it is measured

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November The first proposal was selected from the European Health Status Module.  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.  After a discussion within the TF, the answer categories were modified to include the level of difficulty. first proposal and reviews

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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 proposed items (1)

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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 proposed items (2)  By using different examples in each country, it would be clearer what is intended with the term aids.

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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. Answer categories ? Reference period ?

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November vitality / fatigue

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November Definition ICF : Body Functions  Global Mental functions  Energy and drive functions  energy level (b1300): mental functions that produce vigor and stamina

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November two main aspects: tiredness vs refreshed Mental functions Energy and drive functions vitality / fatigue (ICF)

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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. main outcomes

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November how it is measured rested  full of pep refreshed  have a lot of energy tiredness  feel tired lack of energy  feel worn out positive negative From SF - 36

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

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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 proposed items (1)

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November no energy at allhighest level of energy imaginable |__________________________________________________| || VIT-4 Thinking about the past 4 weeks, on a scale from how intense was the level of tiredness on average: 0 is lowest level and 100 is the highest level imaginable. no tiredness at allhighest level of tiredness imaginable |__________________________________________________| || proposed items (2) VIT-3 Thinking about the past 4 weeks, on a scale from how intense was the level of energy on average: 0 is lowest level and 100 is the highest level imaginable.

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

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

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November definition ICF : Body Functions  Emotional functions (b152): affect 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. specific mental functions related to the feeling and affective components of the process of the mind

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November two main aspects: happiness and depression Mental functions Emotional functions affect (ICF)

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

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

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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 36 From SF - 36

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

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

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November AFF-3. Thinking about the past 4 weeks, on a scale from how intense was the level of happiness on average: 0 is lowest level and 100 is the highest level imaginable. Not happy at allAs happy as I could ever imagine |____________________________________________________________| | AFF-4. Thinking about the past 4 weeks, on a scale from 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 |____________________________________________________________| | Proposed items (2)

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

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

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

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November two main aspects:  seeing from near  seeing from far Seeing functions vision (ICF) Sensory functions

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

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

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

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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) Proposed items (1)

WHO-Eurostat-UNECE Meeting "Measurement of Health Status", Budapest, November 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 Proposed items (2)

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