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PubMed1992

Comparison of two physical activity questionnaires, with a diary, for assessing physical activity in an elderly population.

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.

Activities of Daily Living↗

PubMed1985

Reproducibility and validity of a semiquantitative food frequency questionnaire.

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.

Adult↗

PubMed1988

Reproducibility and validity of dietary assessment instruments. II. A qualitative food frequency questionnaire.

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.

Ascorbic Acid↗

PubMed1990

Validation and comparison of eight physical activity questionnaires.

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.

Adult↗

PubMed1985

Use of a questionnaire in general practice to increase the recognition of patients with excessive alcohol consumption.

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.

Adolescent↗

PubMed1991

Investigating the proxy effect and the saliency principle in household based postal questionnaires.

STUDY OBJECTIVE: The aim was to investigate two possible sources of bias inherent in using a household based postal questionnaire, the "proxy effect", inaccurate reporting about characteristics of others, and the "saliency principle", reporting of only the most salient features. This is of importance in surveys concerned with screening the population to identify individuals with certain characteristics, and so possibly relying on one member of the household to reply on behalf of all others. DESIGN AND SETTING: A two stage survey of disablement in the population was undertaken. A first phase postal questionnaire was sent to 25,168 households in Calderdale, West Yorkshire, England, to ascertain the prevalence of physical disability and of troubles with the joints. The second phase comprised in depth interviews with a sample of individuals identified in the first phase as being disabled. RESPONDENTS: A total of 21,889 postal questionnaires were returned (87%) representing households containing 42,826 people aged 16 years and over. A disproportionately stratified random sample of 950 respondents reporting disability was taken in the second phase. Of these 891 were still available, and 838 (94%) were interviewed. MEASUREMENTS AND MAIN RESULTS: The postal questionnaire found that almost 29% of those who lived "alone" (without another adult) reported some level of disability, compared to only 10% of those who lived with others. The difference remained significant after standardisation. This apparent underreporting or "proxy effect" was present for reporting about disability overall, but not for severe disability (dependence on help of others), which suggests the operation of the "saliency principle". Reporting on joint troubles appeared to be affected by the proxy effect both for any joint problems, and when more than five joints were affected. Analysis of a small set of postal questionnaires from respondents who reported joint problems only at interview and where we could identify who had completed the postal questionnaire supports the hypothesis of a proxy effect; two thirds of the original postal questionnaires had been completed by a proxy. The results were further complicated by an interaction between reporting of disability and joint troubles: the greater the level of disability, the less likely the reporting of joint troubles. CONCLUSIONS: The findings have general implications for studies involving postal household screening questionnaires, and raises additional concerns about those that are multitopic in content. In surveys of symptoms and minor disability, a proxy effect is likely to be operative. This effect is not apparent for obvious and long standing problems such as dependence on others for help. However the interaction between the reporting of disability and joint symptoms carries important implications for the development of multitopic postal screening questionnaires.

Adolescent↗

PubMed1989

Questionnaire reliability and validity for aluminum potroom workers.

As a part of a study on the respiratory symptoms of aluminum potroom workers, the reliability of a self-administered questionnaire and an interview questionnaire was studied with the use of 261 and 49 employees, respectively. The validity of the self-administered questionnaire (134 persons examined) and the interview questionnaire (90 persons examined) was assessed in a comparison of the statements with the case histories. The reliability of the self-administered questionnaire was fairly high, the kappa coefficient ranging from 0.58 to 0.83, while the reliability of the interview questionnaire varied from -0.03 to 0.45. The same pattern was present with regard to validity, as the self-administered questionnaire showed the highest mean sensitivity, specificity, and agreement in a comparison with the case histories. The self-administered questionnaire seemed to discriminate well between symptomatic and asymptomatic individuals, whereas supplemental information about symptoms, as obtained by a standardized interview questionnaire, appeared to be less valid.

Adult↗

PubMed1992

A self-administered hip-rating questionnaire for the assessment of outcome after total hip replacement.

The hip-rating questionnaire was developed for the assessment of the outcome of total hip replacement. The purpose of this study was to evaluate its reproducibility, validity, and responsiveness. The questionnaire uses a 100-point scale in which equal weight is given to the domains of global or over-all impact of arthritis, pain, walking, and function. Ninety-eight patients were enrolled in the prospective study and have been followed for at least three months; sixty-two patients have been followed for six months; and forty-two patients have been followed for one year. Reproducibility was tested with the use of the kappa statistic in fifty patients whose condition was stable clinically, and it was found to be good or excellent both for individual questions and for the total score. The validity of the questionnaire was assessed by comparison with the scores from a six-minute walking-distance test and arthritis impact-measurement scales. The result of the six-minute walking-distance test correlated with the patient's response concerning walking distance on the hip-rating questionnaire. The score for pain from the hip-rating questionnaire correlated well with the score for pain from the arthritis impact-measurement scales, and the total score from the hip-rating questionnaire correlated well with the total score from the arthritis impact-measurement scales. The score on the hip-rating questionnaire was responsive to the change in the clinical condition of the patient, as indicated by a favorable index of responsiveness. The results of the questionnaire were sensitive enough to demonstrate differences among treatment groups with relatively small sample sizes. This questionnaire has the characteristics of a useful instrument for assessment of outcomes, such as that after an operation.

Activities of Daily Living↗

PubMed1990

The relative value of consultation, questionnaires and laboratory investigation in the identification of excessive alcohol consumption.

Alcohol is a major cause of morbidity and mortality in Britain. Consultation, questionnaires and laboratory tests may all be used to help identify alcohol abuse and thereby prevent and treat alcohol-related problems. Consultation which can identify 80% of alcohol abusers involves recording the findings of alcohol and general histories and physical examination. The accuracy of the assessment depends on the reliability of the respondent and the respondent's relations and friends, and on the skill of the investigator; however, thorough assessment is time-consuming and expensive. Questionnaires may identify up to 80% of alcoholics. They are generally based on the Michigan Alcohol Screening Test and CAGE questionnaires and are simple, rapid to complete, inexpensive and not dependent on skilled investigators; however, the principal disadvantage of using questionnaires is that a personal relationship is not developed with the subject. Finally, simple and complex laboratory tests may be used. Of the simple laboratory tests, raised GGT or MCV levels are the most useful and when these values are combined, 90% of alcoholics may be identified correctly. Complex laboratory tests may exhibit greater sensitivity and specificity and provide useful additional information; however, their restricted availability limits their widespread use. The value of each of these methods depends on the objective of the assessment. For population surveys, questionnaires are of greatest relative value and consultation and laboratory tests may be used to confirm the presence of alcohol abuse. In general practice and the hospital setting, it is imperative to include questions on alcohol intake and alcohol-related problems in all interviews with patients. Laboratory tests may be used to confirm suspected alcohol abuse and questionnaires may provide useful screening tools. Finally, in the specialist alcohol unit, consultation, questionnaires and laboratory investigations are all important for identifying alcohol abuse. In this setting, consultation is of particular importance and the alcohol history and physical examination should be recorded by a skilled investigator and the results confirmed with relatives and close friends. Questionnaires are useful as initial screening or assessment tools and computer-based systems may facilitate data collection. Simple and complex laboratory tests may be used to confirm the diagnosis and help ascertain the extent of disease. By assuming that 'all patients have alcohol-related problems until proven otherwise', and through the appropriate application of consultation, questionnaires and laboratory tests, identification of excessive alcohol consumption and the prevention of its sequelae will be facilitated.

Alcoholism↗

PubMed1986

Questionnaire assessment of patients' attitudes and beliefs about asthma.

The feasibility, face validity and repeatability of a self-complete questionnaire to assess patients' attitudes and beliefs about asthma was evaluated in 45 adult patients attending a hospital asthma clinic. The questionnaire consisted of 40 statements with which the patient agreed or disagreed by placing an 'X' along a visual analogue line. Patients completed questionnaires at their clinic consultation and then were interviewed to ascertain whether questionnaire responses agreed with a verbal description of their attitudes and beliefs. Repeatability was assessed by having patients complete an identical questionnaire four weeks after their interview. The questionnaire responses showed excellent agreement with interview findings, suggesting that face validity was good. Repeatability also appeared satisfactory in that agreement between responses on the first and second questionnaires was significant for 31 of the 40 items. Many patients (22%) incorrectly used the analogue line response scale making feasibility unacceptably low. However, subsequent studies showed this problem could be overcome by the use of a four-point Likert response scale. These findings suggest that this questionnaire is a satisfactory instrument for assessing patients' attitudes and beliefs about asthma. Its face validity appeared good and, with certain modifications, it was both feasible and repeatable.

Adolescent↗

PubMed1985

Validation of a self administered questionnaire to elicit gastrointestinal symptoms.

Self administered questionnaires are becoming popular investigative tools in medical research, yet few reports state the extent of methods used to validate these questionnaires before their general use. A pilot study was therefore carried out to validate a 41 item questionnaire for use in a population screening study for gastrointestinal disease. Participants in the study comprised 69 population controls, 40 patients with benign disease, and 35 patients with gastrointestinal cancer. Acceptability, ease of completion, reliability, and reproducibility of the questionnaire were all assessed. Only one subject refused to complete the questionnaire. Ninety six per cent of the questions were completed by each subject and only one response in 1440 was altered in the reproducibility study. The questionnaire disclosed symptoms similar to those elicited by a clinician and highlighted unreported gastrointestinal symptoms in the control group. Three questions were found to be unreliable and were altered before the questionnaire was put into general use. It is concluded that a pilot study to validate a new questionnaire is simple to perform and necessary to identify unreliable questions.

Gastrointestinal Neoplasms↗

PubMed1992

Accuracy of a quantitative food frequency questionnaire applied in elderly Norwegian women.

The accuracy (reproducibility and relative validity) of a self-administered quantitative food frequency questionnaire including 180 food items was evaluated. A total of 38 elderly women kept multiple weighed diet records for a total of 14 days over a 6-week period and filled in the questionnaire both before and after this period. Spearman rank correlations between the nutrient intakes from the two questionnaires varied from 0.43 for carbohydrate to 0.88 for energy percentage from alcohol. The median correlation was 0.70. Seven women whose recorded average energy intake was less than 1.17 times their measured basal metabolic rate were excluded from the analysis comparing the questionnaire and the diet records. The first questionnaire gave on the average 10% higher nutrient median values than the records, while the second questionnaire did not in general produce higher values. Unadjusted correlation coefficients comparing intakes measured by the two methods ranged from 0.31 for vitamin C to 0.79 for energy percentage from carbohydrate, the median coefficient being 0.61. On the average 77% of the subjects were classified in the same (+/- 1) quintile in the first food frequency questionnaire and the diet records. The present study indicates that the self-administered quantitative food frequency questionnaire is useful for measuring individual or group intakes for a variety of nutrients.

Aged↗

PubMed1992

The use of a videotaped questionnaire for studying asthma prevalence. A pilot study among New Zealand adolescents.

OBJECTIVE: To examine the feasibility of measuring asthma prevalence by means of an audio-visual presentation of asthma symptoms and signs (video questionnaire) and to compare this technique with a standard written questionnaire for predicting bronchial hyperresponsiveness. DESIGN: A cross-sectional study comparing the ability of a video questionnaire and a written, interviewer administered questionnaire to predict bronchial hyperresponsiveness. Bronchial responsiveness was measured with hand held nebulisers. SETTING: Community survey of a New Zealand rural secondary school. SUBJECTS: A total of 456 adolescent school children aged 12-19 years (mean 15.5 years). OUTCOME MEASURES: Comparison of the sensitivity and specificity of a standard questionnaire versus a video questionnaire for bronchial hyperresponsiveness. RESULTS: The technique was easy to administer in the community setting. Overall sensitivity and specificity for the prediction of bronchial hyperresponsiveness were similar for the video and interviewer administered questionnaires. CONCLUSIONS: This new technique is easily used in the community setting, and gives predictions of bronchial hyperresponsiveness similar to those of a standard interviewer administered questionnaire. Further examination of the technique in comparisons of asthma prevalence among different populations is planned.

Adolescent↗

PubMed1992

Comparison of two dietary questionnaires validated against multiple dietary records collected during a 1-year period.

The validity of two dietary history questionnaires was examined, one the Health Habits and History Questionnaire (HHHQ) developed by Block et al and the other a questionnaire developed by investigators at the University of Michigan (UM). The reference data consisted of the mean of four 4-day dietary records and recalls collected for 1 year before administration of the questionnaires. The sample of 85 persons included black and white men and women aged 25 to 50 years. The HHHQ was entirely self-administered; the UM questionnaire had both self- and interviewer-administered components. The HHHQ group means were similar to food record estimates for energy and most nutrients, whereas the UM questionnaire produced overestimates for energy and all nutrients examined. Correlations ranged from .31 to .60 (median = .48) for the UM questionnaire and from .42 to .68 (median = .57) for the HHHQ. Use of respondent-reported portion sizes with the HHHQ produced higher correlations than use of investigator-determined "standard" portion sizes (median r = .43 vs .57). Food frequency questionnaires can provide useful nutrient data for individuals as well as groups.

Adult↗

PubMed1987

Hidden psychiatric illness: use of the general health questionnaire in general practice.

A 10% random sample comprising 234 adults attending a general practitioner was studied to obtain an estimate of conspicuous and hidden psychiatric morbidity and to determine the value of the general health questionnaire in improving case recognition in general practice. Patients completed the 28-item general health questionnaire before seeing the general practitioner, who completed a rating sheet without seeing the general health questionnaire score. The doctor identified a psychiatric component in 38% of men and 53% of women and diagnosed psychiatric disorder in 22% of men and 31% of women. Using a cut off point of nine or above, high general health questionnaire scores were found in 25% of men and 29% of women. Agreement between the general health questionnaire and the doctor's assessment was better for males (misclassification rate 16%) than for females (20%). A subsample of patients scoring over the recommended threshold (five or above) on the general health questionnaire were interviewed by the psychiatrist to compare the case detection of the general practitioner, an independent psychiatric assessment and the 28-item general health questionnaire at two different cut-off scores. The general health questionnaire may be a useful tool for improving recognition of psychiatric morbidity in general practice if the cut-off point is raised above that recommended for epidemiological research.

Family Practice↗

PubMed1978

A historical and epidemiologic perspective on respiratory symptoms questionnaires.

Since 1960 the British Medical Research Council (MRC) standardized questionnaire on respiratory symptoms has been used in epidemiologic investigations of chronic respiratory diseases. This review describes the validity, reliability, and susceptibility to bias of the MRC questionnaire. The validity of the phlegm questions as a sensitive index of sputum production has been established but adequate validation of other symptom questions has been hindered by the absence of appropriate, independent criteria for comparison. Consistency of response averages 80 per cent for symptom questions and may reach 99 per cent for reporting of smoking habits. With proper use, the results of the MRC questionnaire are not biased by the observer, by the season of administration, or by method of administration. Modification of the questionnaire by individual investigators may lead to bias when comparisons are made between studies. Because a large literature based on the MRC questionnaire is now available, any new respiratory symptoms questionnaires should be compatible with the MRC questionnaire, and should be calibrated against it.

Boston↗

PubMed1988

Reproducibility and validity of dietary assessment instruments. I. A self-administered food use questionnaire with a portion size picture booklet.

A self-administered food use questionnaire which included 276 food items and mixed dishes and a portion size picture booklet with 122 photographs was developed for a large lung cancer intervention trial among approximately 27,000 Finnish men aged 50-69 years. The reproducibility and validity of this questionnaire were studied from March to October 1984. In the reproducibility study, 121 men aged 55-69 years completed the questionnaire three times, at three-month intervals. The intraclass correlations varied from 0.56 for vitamin A to 0.88 for alcohol, with most falling between 0.60 and 0.70. In the validity study, 190 men of similar age 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 nutrient intake values from the food records and the food use questionnaires ranged from 0.40 for selenium to 0.80 for alcohol. Among subjects who belonged to the lowest quintile on the basis of the food record measurement, an average of 51 per cent fell into the same quintile and 76 per cent fell into the lowest two quintiles when they were categorized on the basis of the food use questionnaire. Findings were similar for the upper tail of the distribution. These data indicate that the self-administered food use questionnaire is useful for measuring individual or group intakes for a variety of nutrients.

Aged↗

PubMed1988

Validation of a self-administered questionnaire for assessing occupational and environmental exposures of pregnant women.

The present investigation sought to determine whether a self-administered questionnaire could be used to obtain occupational information from pregnant women attending the obstetrical clinics at the University of California, San Francisco from July to November 1986. The authors compared the accuracy of responses of 57 women on the self-administered questionnaire with those obtained on a detailed clinical interview by an occupational health professional. The self-administered questionnaire and the clinical interview included information on the woman's job title, the type of company she worked for, the level of physical activity, her exposures on the job and at home, and her partner's occupation. The authors also examined whether the "validity" of the self-administered questionnaire could be improved on review by an industrial hygienist. The questionnaire took less than 20 minutes to complete, with over 90% of the women answering three-quarters of it. It was "substantially" accurate in obtaining information on number of hours worked during pregnancy, type of shift worked, and stress level in the workplace; exposure to radiation, video display terminals, fumes, gases, and cigarette smoke in the workplace; and exposure to pesticides, paint, and cigarette smoke at home. On those variables for which the responses on the self-administered questionnaire were less accurate, review by the industrial hygienist improved the level of accuracy considerably. These findings suggest that a self-administered questionnaire can be used to obtain valid information from pregnant women attending a prenatal clinic.

Adult↗