[Once more: questionnaires in selection situations. Norms of the ABQ (Amsterdam Biographical Questionnaire) and the AMT (Achievement Motivation Test) for selection studies].
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The assessment of physical activity by questionnaire is currently the most popular and practical method of quantifying physical activity levels. Many questionnaires, past and present, have considered overall or habitual physical activity, which includes occupational (or nonleisure) activity. Others have focused specifically on leisure-time physical activity (LTPA) owing to the recognition of its dominating contribution to the total physical activity of developed populations. This review covers questionnaires that wholly or in part attend to LTPA levels. Typically, self-complete or interviewer-administered questionnaires record information on the types, frequency and duration of activities performed over a particular period of time. Activity-specific energy cost values, expressed in metabolic equivalents (METS) or kilocalories, are then commonly used to estimate the total energy expenditure from all activities and/or categories of activities. The validation of LTPA questionnaires has had to rely upon indirect methods, such as the assessment of cardiorespiratory fitness, body composition and activity diaries. The reporting of the reliability of questionnaires has frequently been ignored, although in cases where it has been reported, doubt exists as to whether the consistency of the questionnaire or the consistency of subjects' physical activity habits were being examined. LTPA questionnaires first appeared in the literature in the mid-1960s for use among specific, mainly middle-aged male population groups. Though they varied in their modes of scoring, periods of activity recall, and overall complexity, associations were universally observed between physical activity levels and chronic health conditions. However, it became apparent that different questionnaires did not yield the same results. In 1978, a questionnaire to assess only LTPA, the Minnesota LTPA Questionnaire, was published and despite its substantial limitations, has since established itself as the most popular option available. In recent years, shorter and simpler alternatives have been advocated, though most have yet to be adequately scrutinised. Associations have been found between LTPA and fitness levels, prompting the use of LTPA questionnaires in large-scale fitness surveys of both adults and children. Although LTPA has continued to be estimated in terms of energy expenditure, little attempt has been made to extend existing knowledge on the energy cost of physical activities. Existing values do not accommodate for individual intensities and inter-population activity variations. Consequently, standardised questionnaires are not yet viable. There exists considerable scope for further work with LTPA questionnaires, especially since the association between coronary heart disease and physical activity is now well recognised. Efforts ought to be directed at wider social groups for whom leisure-time activity may have distinct implications.
The aim of this prospective study was to assess the applicability of a computerised medical history system at the open-access endoscopy unit of a University Hospital during routine clinical practice. We studied feasibility, acceptability and reproducibility of computerised questionnaires designed for patients referred for endoscopy of either the upper or lower gastrointestinal (GI) tract, partly in comparison with almost identical paper questionnaires. In the first period of the study 1134 patients were referred of whom 73% answered the paper questionnaire, and during the second period 537 patients were referred of whom 64% answered the computerised questionnaire (P less than 0.001). There was no sex dependency regarding the ability to answer both types of questionnaires. A significant age dependency regarding the ability to answer the paper questionnaires was observed for patients referred for upper and lower GI endoscopy (P less than 0.0001 and P less than 0.0001). Corresponding with this observation, the ability to answer the computerised questionnaires significantly decreased with increasing age for both groups of patients (P less than 0.0001 and P less than 0.0001). The average completion times of both computerised questionnaires, designed for the upper and lower GI tract, were 11 min. The completion times did not depend on sex, but there was a slight positive correlation with age (P less than 0.0001 with multiple R = 0.27 and P = 0.0593 with multiple R = 0.12). Answering our computerised questionnaires was consistently reported to be interesting and easy, and did not last too long according to the respondents. After patients had answered the computerised history system, the insight into their complaints had increased in 40%, and 45% could put their complaints into words more easily. Only 25% of the patients were unable to express all their complaints. A reproducibility of medical history data of 85% was observed between paper and computerised questionnaires. Our computerised questionnaires can provide us with a detailed and uniformly acquired medical history of most patients referred for GI endoscopy. They are well accepted by the patients and can be completed during the normal waiting period. The medical history data obtained with these questionnaires are quite reproducible.
This study was conducted during the preparation of a case-control study on patients with adenomatous polyps or cancer of the large bowel. It was done to compare two dietary history methods for assessing individual current dietary intakes. Subjects were interviewed concerning their food consumption by meal in one of the questionnaires and by broad food groups in the other questionnaire. Two groups of 20 volunteers, comparable according to sex and age, were interviewed by a dietitian who used one of the questionnaires. Data on diets obtained with the questionnaire were compared with those of a 14-day dietary record. The subjects were informed of the importance of the validation procedure. Whatever the type of questionnaire, mean daily intakes of nutrients and foods were rather similar for the questionnaires and for the 14-day records. Thus, there were more significant correlations between the questionnaire by meal and the record than between the questionnaire by food group and the record. When using tertiles, it appears that the questionnaire by meal was better at classifying individuals with regard to their food intake than the questionnaire by food groups. Although extrapolating these results to a patient population is not straightforward, it seemed likely that interviewing patients on diet without using a pattern of meals would prove even less reliable than for healthy subjects. The questionnaire by meal was preferred to the questionnaire by food groups for the ongoing case-control study. Further studies are needed to know whether these results could be extrapolated to studies on past diet and to non-Latin populations.
The reproducibility and validity of responses for 55 specific foods and beverages on a self-administered food frequency questionnaire were evaluated. One hundred and seventy three women from the Nurses' Health Study completed the questionnaire twice approximately 12 months apart and also recorded their food consumption for seven consecutive days, four times during the one-year interval. For the 55 foods, the mean of correlation coefficients between frequencies of intake for first versus second questionnaire was 0.57 (range = 0.24 for fruit punch to 0.93 for beer). The mean of correlation coefficients between the dietary records and first questionnaire was 0.44 (range = 0.09 for yellow squash to 0.83 for beer and tea) and between the dietary records and the second questionnaire was 0.52 (range = 0.08 for spinach to 0.90 for tea). Ratios of within- to between-person variance for the 55 foods were computed using the mean four one-week dietary records for each person as replicate measurements. For most foods this ratio was greater than 1.0 (geometric mean of ratios = 1.88), ranging from 0.25 (skimmed milk) to 14.76 (spinach). Correlation coefficients comparing questionnaire and dietary record for the 55 foods were corrected for the within-person variation (mean corrected value = 0.55 for dietary record versus first questionnaire and 0.66 versus the second). Mean daily amounts of each food calculated by the questionnaire and by the dietary record were also compared; the observed differences suggested that responses to the questionnaire tended to over-represent socially desirable foods. This analysis documents the validity and reproducibility of the questionnaire for measuring specific foods and beverages, as well as the large within-person variation for food intake measured by dietary records. Differences in the degree of validity for specific foods revealed in this type of analysis can be useful in improving questionnaire design and in interpreting findings from epidemiological studies that use the instrument.
It has become a common practice among psychological researchers to administer batteries of individual difference assessments to research participants, although little is known about whether the substantive and psychometric integrity of the questionnaires are maintained when they are administered after the subject has completed other instruments. The studies presented here consider these issues in relation to the assessment of self-esteem and depression. In the first study, college students responded to a self-esteem inventory (a) by itself (control group), (b) after one prior questionnaire, (c) after three prior questionnaires, or (d) after five prior questionnaires. Results indicated that filling out one or more questionnaires before an assessment of self-esteem resulted in reports of lower self-esteem relative to the control condition. Additional analyses revealed that filling out three or five prior questionnaires created lower reliabilities of subscale scores and lower estimates of concurrent validity between self-esteem and depression. When the effect of prior questionnaires on the General Self-Esteem subscale was examined, the aforementioned results were replicated, and the prior questionnaire treatment created heterogeneous variances across the experimental groups. The second study was designed as a replication of the first study, using an assessment of depression as the target questionnaire. These results revealed that reports of depressive symptomatology increased as the number of prior questionnaires increased. Again, the prior questionnaire treatment created heterogeneity of variance between the groups, but did not adversely affect its internal consistency.
Three hundred and eighty-eight men undergoing transurethral resection of the prostate for benign prostatic hypertrophy completed a presurgical questionnaire and three follow-up questionnaires 3, 6 and 12 months after surgery. The questionnaires covered details of prostatic symptoms, general health, and expectations and results of surgery. At each follow-up point 40 randomly selected patients were interviewed by two female research assistants. The response rate to the questionnaires was over 90% at each follow-up point while that for the interviews was lower at around 80%. We examine the reliability of the postal questionnaires in assessing health status by comparing questionnaire and interview responses, with a view to the wider employment of such a method in the follow-up of surgical patients. In general, and as reported elsewhere, responses to questions on easily defined topics are highly comparable between questionnaire and interview. Responses to more subjective questions are moderately reliable, but with a tendency for postal questionnaires to underestimate a patient's health problems. It is difficult to assess the reliability of the questionnaires with regard to questions of an intimate nature since such questions caused embarrassment during interview with consequent incomplete responses.
Validation of the London School of Hygiene (Rose) Questionnaire with objective measures of myocardial ischemia is incomplete. Therefore, we compared the Rose Questionnaire with exercise thallium-201 myocardial scintigraphy in 147 male and 97 female patients with chest pain referred for clinical exercise testing. Of those with "Rose Questionnaire angina", 26% of the females and 73% of the males had positive thallium-201 scans. Negative results on both the Rose Questionnaire and thallium-201 scintigraphy were observed in 71% of the females and 47% of the males. The sensitivity of the Rose Questionnaire was similar in females (41%) and males (44%). The specificity was 77% in males, while in females it was significantly lower at 56%. The specificity values reflect the higher (p less than 0.05) prevalence of "false positive" Rose Questionnaire results in females (75%) compared with males (27%). In addition, males had a greater (p less than 0.05) number of "false negative" results (53%) than females (29%). The accuracy of the Rose Questionnaire for myocardial ischemia was 0.19 in females, 0.48 in males, and 0.29 overall when including both males and females. Our results indicate a generally poor relationship between Rose Questionnaire angina and thallium-201 scintigraphy, an objective measure of myocardial ischemia in patients with chest pain referred to clinical exercise testing. Further, there are gender-specific differences in this relationship between the questionnaire and exercise thallium-201 imaging.
Measurement of physical activity in epidemiological studies is usually achieved by means of a questionnaire. Little work has been done to determine which questionnaire format has greater validity in an elderly population. In this study of elderly subjects, physical activity as reported in two self-administered questionnaires (A and B), which differed in format and length, were compared to activity reported in a 4 day diary. As compared with the diary, moderate/heavy activity was more accurately reported in Questionnaire A (mean difference 5 min), the longer more detailed questionnaire, than B (mean difference 170 min). Light activity was under reported in Questionnaire A (mean difference 68 min) and over reported in B (mean difference 88 min) as compared with the diary. In contrast, time spent sitting was more accurately reported in Questionnaire B (mean difference 40 min) than in A (mean difference 230 min) as compared with the diary. The longer more detailed questionnaire was the more accurate instrument for assessing moderate/heavy activity in this elderly population. The shorter questionnaire was more accurate for assessing time spent sitting.
The aim of this study was to evaluate the reproducibility and validity of a 61-item semiquantitative food frequency questionnaire used in a large prospective study among women. This form was administered twice to 173 participants at an interval of approximately one year (1980-1981), and four one-week diet records for each subject were collected during that period. Intraclass correlation coefficients for nutrient intakes estimated by the one-week diet records (range = 0.41 for total vitamin A without supplements to 0.79 for vitamin B6 with supplements) were similar to those computed from the questionnaire (range = 0.49 for total vitamin A without supplements to 0.71 for sucrose), indicating that these methods were generally comparable with respect to reproducibility. With the exception of sucrose and total carbohydrate, nutrient intakes from the diet records tended to correlate more strongly with those computed from the questionnaire after adjustment for total caloric intake. Correlation coefficients between the mean calorie-adjusted intakes from the four one-week diet records and those from the questionnaire completed after the diet records ranged from 0.36 for vitamin A without supplements to 0.75 for vitamin C with supplements. Overall, 48% of subjects in the lowest quintile of calorie-adjusted intake computed from the diet records were also in the lowest questionnaire quintile, and 74% were in the lowest one of two questionnaire quintiles. Similarly, 49% of those in the highest diet record quintile were also in the highest questionnaire quintile, and 77% were in the highest one or two questionnaire quintiles. These data indicate that a simple self-administered dietary questionnaire can provide useful information about individual nutrient intakes over a one-year period.
The reproducibility and validity of a food frequency questionnaire designed to measure intakes of total fat, saturated and polyunsaturated fats, vitamins A, C, and E, selenium, and dietary fiber were tested from March to October 1984 among 297 Finnish men aged 55-69 years. The questionnaire asked about consumption of 44 food items. In the reproducibility study, 107 subjects filled in the questionnaire three times, at three-month intervals. Intraclass correlations varied from 0.52 for vitamin A to 0.85 for polyunsaturated fat. In the validity study, 190 subjects kept food consumption records for 12 two-day periods distributed evenly over a period of six months and filled in the questionnaire both before and after this period. Correlations between the nutrient intake values from the food records and those from the food frequency questionnaires ranged from 0.33 for selenium to 0.68 for polyunsaturated fat. On the average, 40-45% of the subjects in the lowest and highest quintiles based on food records were in the same respective quintiles when assessed by the food frequency questionnaire, and 70-75% were in the two lowest and two highest questionnaire quintiles, respectively. The food frequency questionnaire and a quantitative food use questionnaire tested in the same study were compared. Use of these two instruments in large-scale epidemiologic studies is discussed.
Several questionnaires are available for assessing physical activity, but few of these instruments have been validated, particularly with respect to energy balance. Twenty-one healthy men 28-55 years old participating in a free-living, controlled feeding experiment completed eight widely used physical activity questionnaires. These were compared with measured caloric intake and resting energy expenditure during a period of stable body weight. Physical activity indices or daily energy expenditure estimates derived from the questionnaires generally increased with energy intake. The questionnaires were moderately well correlated with each other; interquestionnaire correlation coefficients ranged from 0.09 to 0.81 (median = 0.53). Correlations between the questionnaires and energy intake, which ranged from 0.13 for the Minnesota Leisure Time Activity instrument to 0.49 for the Harvard Alumni questionnaire, were higher than between the questionnaires and nonresting energy expenditure; that is, energy intake minus resting energy expenditure (correlation coefficient range 0.05-0.32). The Five-City Project questionnaire yielded an average estimate of total caloric expenditure that most closely approximated intake (96%). These data indicate that although estimates of individual energy expenditure or physical activity may be less than optimal, most of the questionnaires evaluated provide reasonable group means for these parameters.
A self administered questionnaire, the health survey questionnaire, was designed to detect excessive alcohol consumption and mailed to patients who were registered with two general practices. Replies were received from 2572(75%) of 3452 patients. Excessive consumption was taken as 42 units of alcohol per week or more for men and 21 units per week or more for women: 1 unit = approximately 10 g ethanol and is equivalent to a half pint of beer, one glass of wine, or one standard measure of spirits. One hundred and twenty men (11%) and 68 women (5%) were identified by their responses to the questionnaire as excessive drinkers. According to their responses, roughly half of these expressed some concern about their drinking. In the practice where a disease register was kept 18 patients had been recorded as heavy drinkers before the study, and an additional 74 were detected by the questionnaire. Within 12 months after the questionnaire survey three groups of respondents were reviewed: (a) the excessive drinkers, (b) those who indicated concern about drinking but did not exceed the limits for excessive consumption, and (c) a random sample of those who were in neither of these two categories. Patients in these three groups were interviewed in a standard fashion to determine their alcohol consumption. Breath alcohol measurement was also carried out and a blood sample taken for the estimation of mean cell volume, gamma glutamyltranspeptidase activity, and serum aspartate transaminase activity. There were highly significant correlations between estimates of consumption obtained by the questionnaire and those obtained at interview except among the women who were excessive consumers, whose responses to the questionnaire indicated levels of consumption that were much higher than those to which they admitted at interview. Stated weekly consumption at interview that was above the limits set for the study was used as the standard measure for comparing the questionnaire with the other indicators of excessive drinking. The questionnaire had a considerably greater estimated sensitivity in detecting male excessive consumers than any of the blood tests. Among the women it apparently performed less well, although the numbers stating excessive consumption at interview were small. Breath alcohol measurement was positive in only a few of the excessive drinkers. The use of this simple and inexpensive instrument is likely to prove widely acceptable to patients in general practice and should result in a considerable increase in the recognition by general practitioners of patients with excessive alcohol consumption.