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Not another questionnaire! Maximizing the response rate, predicting non-response and assessing non-response bias in postal questionnaire studies of GPs.

BACKGROUND: Non-response is an important potential source of bias in survey research. With evidence of falling response rates from GPs, it is of increasing importance when undertaking postal questionnaire surveys of GPs to seek to maximize response rates and evaluate the potential for non-response bias. OBJECTIVES: Our aim was to investigate the effectiveness of follow-up procedures when undertaking a postal questionnaire study of GPs, the use of publicly available data in assessing non-response bias and the development of regression models predicting responder behaviour. METHOD: A postal questionnaire study was carried out of a random sample of 600 GPs in Wales concerning their training and knowledge in palliative care. RESULTS: A cumulative response rate graph permitted optimal timing of follow-up mailings: a final response rate of 67.6% was achieved. Differences were found between responders and non-responders on several parameters and between sample and population on some parameters: some of these may bias the sample data. Logistic regression analysis indicated medical school of qualification and current membership of the Royal College of General Practitioners to be the only significant predictors of responders. Late responders were significantly more likely to have been qualified for longer. CONCLUSIONS: This study has several implications for future postal questionnaire studies of GPs. The optimal timing of reminders may be judged from plotting the cumulative response rate: it is worth sending at least three reminders. There are few parameters that significantly predict GPs who are unlikely to respond; more of these may be included in the sample, or they may be targeted for special attention. Publicly available data may be used readily in the analysis of non-response bias and generalizability.

Adult↗

Repeatability and validity of an upper limb and neck discomfort questionnaire: the utility of the standardized Nordic questionnaire.

The repeatability and validity of a questionnaire for upper limb and neck complaints were assessed in a population of 105 hospital outpatients with a range of upper limb and neck disorders (including cervical spondylosis, adhesive capsulitis, lateral epicondylitis, carpal tunnel syndrome and Raynaud's phenomenon). Subjects were asked to complete a modified Nordic-style upper limb and neck discomfort questionnaire on two occasions closely spaced in time. The repeatability of their responses was assessed by calculating a kappa coefficient (kappa), and the sensitivity and specificity of component items in the questionnaire were determined for specific diagnostic categories of upper limb and neck disorder. Symptom reports for pain in the upper limb and neck, pain interfering with physical activities, neurological symptoms and blanching were all found to be highly repeatable (kappa = 0.63-0.90). A number of regional pain reports proved to be very sensitive in relation to specific upper limb disorders, but, with the exception of reported finger blanching in patients with Raynaud's phenomenon, none proved to have a good specificity (range = 0.33-0.38). We conclude that a modified Nordic-style questionnaire is repeatable and sensitive, and is likely to have a high utility in screening and surveillance. However a complementary examination schedule of adequate specificity and repeatability is essential to establish a clinical diagnosis.

Adult↗

Retrospective information from questionnaires. II. Intrarater reliability and comparison of questionnaire types.

Medical and dietary consumption histories obtained at two times from cases or controls and their next-of-kin as part of a study of colon cancer in the five Pennsylvania counties of the Philadelphia metropolitan area were compared. The case population was confined to whites aged 45-69 years who had resided in the region for at least two years prior to diagnosis and were diagnosed with colon cancer after July 1, 1976. Controls were selected using an area probability sampling scheme and were frequency-matched to the case group. Questionnaires for randomly selected subsamples of cases and controls were administered by interviewers; questionnaires for next-of-kin were randomly allocated to be self- or interviewer-administered. Agreement when respondents received the interviewer-administered questionnaire at both interviews was greater than when the self-administered questionnaire was used. Medical variables exhibited high agreement, the percentage agreement exceeded 80 for over 80% of the comparisons, the kappa statistic exceeded 0.6 for half of the comparisons. Diet histories were more variable (average agreement ranging from 56% to 67% and average kappa values from 0.16 to 0.40 for the different comparisons).

Beverages↗

The OnyCOE-t questionnaire: responsiveness and clinical meaningfulness of a patient-reported outcomes questionnaire for toenail onychomycosis.

BACKGROUND: This research was conducted to confirm the validity and reliability and to assess the responsiveness and clinical meaningfulness of the OnyCOE-t, a questionnaire specifically designed to measure patient-reported outcomes (PRO) associated with toenail onychomycosis. METHODS: 504 patients with toenail onychomycosis randomized to receive 12 weeks of terbinafine 250 mg/day with or without target toenail debridement in the IRON-CLAD trial completed the OnyCOE-t at baseline, weeks 6, 12, 24, and 48. The OnyCOE-t is composed of 6 multi-item scales and 1 single-item scale. These include a 7-item Toenail Symptom assessment, which comprises both Symptom Frequency and Symptom Bothersomeness scales; an 8-item Appearance Problems scale; a 7-item Physical Activities Problems scale; a 1-item Overall Problem scale; a 7-item Stigma scale; and a 3-item Treatment Satisfaction scale. In total, 33 toenail onychomycosis-specific items are included in the OnyCOE-t. Clinical data, in particular the percent clearing of mycotic involvement in the target toenail, and OnyCOE-t responses were used to evaluate the questionnaire's reliability, validity, responsiveness, and the minimally clinical important difference (MCID). RESULTS: The OnyCOE-t was shown to be reliable and valid. Construct validity and known groups validity were acceptable. Internal consistency reliability of multi-item scales was demonstrated by Cronbach's alpha > .84. Responsiveness was good, with the Treatment Satisfaction, Symptom Frequency, Overall Problem, and Appearance Problem scales demonstrating the most responsiveness (Guyatt's statistic of 1.72, 1.31, 1.13, and 1.11, respectively). MCID was evaluated for three different clinical measures, and indicated that approximately an 8.5-point change (on a 0 to 100 scale) was clinically meaningful based on a 25% improvement in target nail clearing. CONCLUSION: The OnyCOE-t questionnaire is a unique, toenail-specific PRO questionnaire that can be used with confidence in future studies of toenail onychomycosis. MCID was evaluated for three different clinical measures, and indicated that approximately a 7-point change (on a 0 to 100 scale) was clinically meaningful based on a 12.5% improvement in target nail clearing.

Adolescent↗

The French version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report the results of the cross-cultural adaptation and validation into the French language of two health status instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health related quality of life instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. Five hundred children were enrolled including 306 patients with JIA classified into systemic (23%), polyarticular (22%), extended oligoarticular (25%), and persistent oligoarticular (30%) subtypes, and 194 healthy children. Both instruments were reliable with intra-class correlation (ICC) coefficients for the test-retest procedure of 0.91 for the CHAQ, and 0.87 and 0.89 for the physical and psychosocial summary scores of CHQ, respectively. Agreement between parents and children evaluated for the CHAQ was high with an ICC of 0.89 for the disability index; weighted kappa coefficients for the 8 domains ranged from 0.61 to 0.72. Convergent validity was demonstrated by significant correlations with the JIA core set of variables (physician and parent global assessment, scores for active joints and joints with limited range of motion, erythrocyte sedimentation rate) for both instruments. Both CHAQ and CHQ discriminated between healthy and JIA children, but only the disease specific CHAQ questionnaire discriminated clearly between the 4 JIA subtypes. In conclusion, the French versions of the CHAQ and the CHQ are reliable, and valid health assessment questionnaires to be used in children suffering from JIA.

Adolescent↗

[Multisite validation study of questionnaire assessing out-patient satisfaction with care questionnaire in ambulatory chemotherapy or radiotherapy treatment].

Patient satisfaction is now recognised as an important quality of care outcome which is particularly relevant in oncology. Adapted from the EORTC In-Patsat32, the Out-Patsat35 is a 35-item satisfaction with care questionnaire measuring cancer outpatients' perception of hospital doctors and nurses, as well as aspects of care organisation and services. This study assessed the psychometric properties of this scale. Patients undergoing ambulatory chemotherapy (CT) or radiotherapy (RT) in 7 cancer centres in France were invited to complete at home the Out-Patsat35 as well as EORTC QLQ-C30 for psychometric testing. Of 416 eligible patients recruited, 96% returned the questionnaire. Most patients (71% in CT; 69% in RT) completed this scale within 15 minutes and the mean rate of item omission was only 4.4%. Confirmatory analyses revealed good convergent validity and excellent internal consistency, although some subscales within the Out-Patsat35 were relatively highly correlated. Items and subscales of the Out-Patsat35 and of the QLQ-C30 were not significantly correlated, underlying that the two questionnaires are assessing quite distinct concepts. The subscales of the Out-Patsat35 were not related to age, gender and education, suggesting a cultural evolution in French cancer patients towards a greater homogeneity in their opinion toward care. This study supports the acceptability to patients, and the psychometric properties of the EORTC Out-Patsat35 questionnaire.

Ambulatory Care↗

A comparison of the standard and the computerized versions of the Well-being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ).

In the present study, the equivalence of paper and pencil assessment versus computer assessment of two self-administered questionnaires was investigated by means of a randomized cross-over design. Therefore, 105 out-patients with diabetes were invited to participate; 76 patients completed both the computer and the paper and pencil version of the Well-being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) in a randomized order, with a mean interval of 7 days. The scales showed high test-retest correlations and the means, dispersions, kurtosis and skewness were found to be approximately the same in both versions. In both modes of assessment, the depression and the energy scale proved to be sensitive for carry-over effects, resulting in better well-being scores at the second measurement. Almost all subjects reported that using the personal computer in the realization of a questionnaire was easy. It is concluded that the paper and pencil and the computerized versions of the WBQ and DTSQ can be considered equivalent. Therefore, the norms and cut-off scores obtained from paper and pencil assessments can be used in computerized versions of the WBQ and DTSQ and vice versa.

Adaptation, Psychological↗

The Transplant Effects Questionnaire (TxEQ): The development of a questionnaire for assessing the multidimensional outcome of organ transplantation - example of end stage renal disease (ESRD).

OBJECTIVES: To develop a questionnaire to assess the responses of transplant recipients to the receipt of an organ, including their self-care behaviour. DESIGN: Following a literature review, open-ended interviews and a focus group, a transplant questionnaire was developed. Two studies (Study 1: N = 231, Study 2: N = 105) were conducted to evaluate its psychometric properties. METHODS: A pool of 51 items was derived from themes identified in published studies and from interviews and a focus group discussion with renal transplant recipients. These were constructed into a questionnaire and were then administered to two renal transplant out-patients populations. Item responses of study sample 1 were subjected to principal components analysis (PCA) using varimax rotation to examine the structure of responses. In order to investigate the stability of the factor structure found in Study 1, item responses of the second sample were subjected to confirmatory factor analysis (CFA) using structural equation modelling. RESULTS: PCA indicated six factors that accounted for 64.2% of the variance. With extraneous items omitted, the final questionnaire derived from Study 1 has 24 items clustered around five conceptual coherent factors: worry about transplant (22.1%), guilt regarding donor (11.9%), disclosure (9.58%), medication adherence (8.73%), and responsibility (6.63%). CFA on the final 24-item version of the TxEQ revealed that the resulting model was a good fit for the Study 2 data (RMSEA = 0.08, pclose =.005). CONCLUSIONS: The TxEQ has potential application as a measure in the area of transplantation research. CFA demonstrated that the factor structure of the TxEQ is consistent across different renal transplant out-patients populations. Further research is currently in progress to assess other groups of transplant recipients and to examine its relationship to other measures.

Journal Article↗

The validity of a questionnaire on medicines used in health care practice: comparison of a questionnaire and computerized medical record survey.

BACKGROUND: To assess the effect of sociodemographic characteristics, perceived health, chronic disease, and country of birth on use of medicines and the validity of a questionnaire survey on the use of medicines. METHODS: A questionnaire was handed out to all 1776 patients aged 16 years or over who had attended Jordbro Health Center, Haninge municipality, Sweden, during the preceding 6 months (response rate 81%), and the findings were linked to information obtained from the computerized prescriptions of medicines. Three measurements were used: medicine used, prescriptions, and medicines prescribed. RESULTS: The data were analyzed by logistic regression technique in univariate and multivariate forms. Of the respondents 73% reported using some type of medicine, compared to 63% who had been given a prescription by a physician in the Health Center during the past year. The number of medicines used was 3.26 vs. 4.17 prescribed, but after controlling for possible confounders the figures were 3.51 vs. 3.94. Female gender and chronic disease were related to high prevalence of drug use. Old age, female gender, sick-leave or disability pension, and chronic disease were also related to a high prevalence of prescribed medicines, while old age, sick-leave, perceived bad health, and chronic disease were related to the numerous medicines used. Old age, perceived bad health, and chronic disease were related to a large number of prescriptions, while old age and chronic disease were related to a large number of prescribed medicines. CONCLUSIONS: Differences were found between the two methods used to analyze data. The prevalence of medicines used was overestimated, but the number of medicines used was underestimated. This indicates that the prevalence rates based on analysis of the questionnaire are more reliable, while the number of used medicines should be interpreted with caution, and the effect of patient-concordance should be considered in future studies.

Adolescent↗

The scleroderma Assessment Questionnaire (SAQ). A new self-assessment questionnaire for evaluation of disease status in patients with systemic sclerosis.

OBJECTIVE: To develop a self-assessment questionnaire and estimate its validity in the evaluation of disease status in patients with systemic sclerosis. PATIENTS AND METHODS: The developed questionnaire (SAQ) consists of 23 questions divided into four groups related to symptoms of vascular, respiratory, gastrointestinal and musculoskeletal dysfunction. One hundred and five patients with systemic sclerosis filled in the SAQ. Answers were assessed on a 0-3 scale and Index of Vascular Status (IVS), Index of Respiratory Status (IRS), Index of Gastrointestinal Status (IGS), Index of Musculoskeletal Status (IMMS) and Index of Disease Status (IDS) were calculated. Mann-Whitney and Kruskal-Wallis tests were used to examine the correlation of index score for particular organ system with various disease damage indicators. RESULTS: Mean score for IVS was significantly higher in patients with finger-tip ulcers or finger-tip osteolysis than in patients without, and was also higher in patients who had more severe capillary damage. Mean score for IRS was significantly higher in patients with pulmonary fibrosis, also in patients with reduced FVC, DLCO and DLCO/VA. Patients with esophageal hypomotility had a higher mean score for IGS than patients with normal esophageal motility. The mean score for IMSS showed a strong correlation with the skin score and was significantly higher in patients with reduced hand motility, joint contractures, muscle weakness or arthralgia/arthritis. The mean score for IDS was significantly higher in patients who had multisystemic involvement. CONCLUSIONS: The Scleroderma Assessment Questionnaire (SAQ) is a sensitive measurement of disease status and level of impairment of different organ systems in patients with systemic sclerosis.

Adult↗

PEAPS-Q: a questionnaire to measure the psychosocial effects of having an abnormal pap smear. Psychosocial Effects of Abnormal Pap Smears Questionnaire.

We have developed the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q) which measures distress experienced by women undergoing follow-up investigation after an abnormal Pap smear result. A thorough literature review and qualitative research resulted in the development of a questionnaire which was tested on 350 women attending a Family Planning New South Wales (FPNSW) clinic. This sample included women at different stages of management after detection of a cervical abnormality: 93 first colposcopy clients and 257 follow-up colposcopy clients. Factor analysis identified four dimensions of distress: experience of medical procedures, beliefs/feelings about cervical abnormality and changes in perception of oneself, worry about infectivity and effect on sexual relationships. Repeatability of the PEAPS-Q was indicated by intra-class correlations of 0.88 overall and at least 0.60 for each scale. Internal consistency was shown by Cronbach's alpha of 0.84 overall and at least 0.72 for each scale. Validity was demonstrated by the correlation of scale scores with the 12-item General Health Questionnaire (GHQ) score of 0.32 (95% CI 0.22-0.41). The PEAPS-Q is a valid, reliable and multidimensional instrument for quantifying distress experienced by women with abnormal Pap smears.

Adult↗

A modified inflammatory bowel disease questionnaire and the Vaizey Incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading.

PURPOSE: Simple scales with greater sensitivity than Radiation Therapy Oncology Group (RTOG) grading to detect acute gastrointestinal toxicity during pelvic radiotherapy, could be clinically useful. METHODS AND MATERIALS: Do questionnaires used in benign gastrointestinal diseases detect toxicity in patients undergoing radiotherapy? The patient-completed Inflammatory Bowel Disease (IBDQ) and Vaizey Incontinence questionnaires were compared prospectively at baseline and at Week 5 to physician-completed RTOG grading. RESULTS: A total of 107 patients, median age 63 years, were recruited. After 5 weeks of treatment, patients with gynecologic and gastrointestinal cancer were more symptomatic than urologic patients (p = 0.012; p = 0.014). Overall, 94% had altered bowel habits, 80% loose stool, 74% frequency, 65% difficult gas, 60% pain, >48% distress, 44% tenesmus, >40% restrictions in daily activity, 39% urgency, 37% fecal incontinence, and 40% required antidiarrheal medication. The median RTOG score was 1 (range, 0-2), median IBDQ score 204.5 (range, 74-224), and median Vaizey score 5 (range, 0-20). Chemotherapy preceding radiotherapy increased fecal incontinence (p = 0.002). RTOG scores stabilized after 3 weeks, IBDQ scores peaked at Week 4, and Vaizey scores worsened throughout treatment. IBDQ and Vaizey scores distinguished between groups with different RTOG scores. CONCLUSION: The IBDQ and Vaizey questionnaires are reliable and sensitive, offering greater insight into the severity and range of symptoms compared with RTOG grading.

Adult↗

Concordance between supervised and postal administration of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) was very high.

BACKGROUND AND OBJECTIVE: There is increasing international interest in using patient-based outcome measures to evaluate interventions. We compared responses to postal administration of Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) with the gold standard of supervised self-completion. STUDY DESIGN AND SETTING: Validation study involving 96 adults, recruited from U.K. general practice, sent the postal questionnaires with an instruction sheet 1 week before supervised self-completion. Responses for those whose quality of life (n=56) or asthma control (n=61) had 'not changed' between postal and supervised completions were compared using paired-sample t-tests, Pearson's correlation coefficient (r), and intraclass correlation coefficient (ICC). RESULTS: For the MiniAQLQ, overall mean scores were similar in both groups: Postal=5.14 (SD=1.42) vs. Supervised=5.17 (SD=1.39), with mean difference of -0.03 (95% CI=-0.14, 0.08; P=.59), with a high degree of correlation (r=.96, P<.001) and concordance (ICC=0.96; 95% CI=0.93, 0.98; P<.001). For the ACQ, overall mean scores (with SD) were also similar in both groups: Postal=1.24 (SD=1.09) vs. Supervised=1.26 (SD=1.10), with mean difference of -0.02 (95% CI=-0.12, 0.08; P=.74), with good correlation (r=.94, P<.01) and concordance (ICC=0.94; 95% CI=0.90, 0.96; P<.01). CONCLUSIONS: Correlation and concordance between supervised and postal administration of the MiniAQLQ and ACQ are very high. Users may confidently choose the mode of administration most appropriate to their needs.

Adult↗

Development of a questionnaire to measure heart disease risk knowledge in people with diabetes: the Heart Disease Fact Questionnaire.

This paper describes a paper and pencil questionnaire that measures heart disease risk knowledge in people with diabetes. The Heart Disease Fact Questionnaire (HDFQ) is a 25-item questionnaire that was developed to tap into respondents' knowledge of major risk factors for the development of CHD. Approximately half of these items specifically address diabetes-related CHD risk factors. Based on extensive pilot data, the current study analyzed responses from 524 people with diabetes to assess the psychometric properties. The HDFQ is readable to an average 13-year old and imposes little burden. It shows good content and face validity. It demonstrates adequate internal consistency, with Kuder-Richardson-20 formula = 0.77 and good item-total correlations. Item analysis showed a desirable range in P-values. In discriminant function analyses, HDFQ scores differentiated respondents by knowledge of their own cardiovascular health, use of lipid lowering medications, health insurance status, and educational attainment, thus indicating good criterion related validity. This measure of heart disease risk knowledge is brief, understandable to respondents, and easy to administer and score. Its potential for use in research and practice is discussed. Future research should establish norms as well as investigate its test-retest reliability and predictive validity.

Adult↗

[The quality of life in asthma: an evaluation of the AQLQ questionnaire for its use on a Spanish population. Asthma Quality of Life Questionnaire].

The study of morbidity in asthma requires consideration not only of standard physiopathologic and function parameters, but also of the impact the disease has on the patient's life-style as he or she perceives it and evaluates it. The quantification of this factor, known as health-related quality of life (HRQL), is achieved by administering questionnaires specially designed for the purpose. We analyzed the reliability, content validity and construct validity (convergence and divergence) of one instrument, the Asthma Quality of Life Questionnaire (AQLQ) designed by Marks and colleagues. This questionnaire covers 4 dimensions (breathlessness, mood, social limitation and worrying) and gives a total score. After a process of translation and back translation the AQLQ was administered to 102 adult asthmatics living in an urban center, all of whom had been stable for at least the preceding 4 weeks. The following data were recorded: age, sex, duration of disease, FEV1, medication, dyspnea, hospital visits, nighttime symptoms and severity of disease (from the patient's own point of view and according to the scale of the International Consensus Report [ICR]). The reliability study (internal consistency with Crombach's alpha coefficient and inter-item correlation analysis) gave satisfactory results in all cases (range of r = 0.39 to 0.78; alpha = 0.78 to 0.91). Content validity (factorial analysis of the main components, oblique and orthogonal rotations) was less satisfactory, although 4 factors were found; these factors adjusted relatively well to one of the proposed sub-scales and together explained 65.2% of the total variance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Health-related quality of life in asthma: a comparison between the St George's Respiratory Questionnaire and the Asthma Quality of Life Questionnaire.

The aim of the study is to compare the performance of the Juniper Asthma Quality of Life Questionnaire (AQLQ) and the St George's Respiratory Questionnaire (SGRQ) in a sample of asthmatic patients, representative of a broad spectrum of asthma severity. We studied 116 patients with a mean age (SD) of 42.6 (18.3) year. Patients were assessed twice, at recruitment and after 2 months, to determine the reliability, validity and responsiveness of the AQLQ and the SGRQ. Both questionnaires showed good reliability coefficients (> or = 0.70) which reached the standards for comparison at individual level (> or = 0.90) in the case of activity, impacts and overall SGRQ scores as well as symptoms, activities and overall AQLQ scores. Both AQLQ and SGRQ were able to discriminate among groups of patients based on asthma severity and control and showed, except for the symptoms domain of the SGRQ, large (standardized response means >0.8) and significant changes in the group of patients that improved at follow-up. We conclude that the AQLQ and SGRQ have shown high reliability and validity and, with the exception of the SGRQ symptoms, a high level of responsiveness. In overall terms, not one of these instruments seems to behave better than the other.

Adult↗

Developing a community-specific health-related quality of life (HRQOL) questionnaire for asthma: the Asthma-Specific Quality of Life Questionnaire for Native American Adults (AQLQ-NAA).

The Asthma Quality of Life Questionnaire for Native American Adults (AQLQ-NAA) was developed by modifying the Asthma Quality of Life Questionnaire-Marks (AQLQ-M) using the focus group technique. The 19-item AQLQ-NAA has emphasis on restrictions in social, community, and cultural activities. Higher scores indicate a better quality of life. The modified questionnaire was administered to a sample of 51 Native American adults with asthma at the Albuquerque USPHS Indian Hospital and its affiliated field clinics. Principal components analysis identified three domains with eigenvalues greater than 1.00: Community and Social Restrictions (CSR), Psychological Impact (PIM), and Symptoms (SYM). Cronbach's coefficient alpha for the AQLQ-NAA was 0.95 and ranged from 0.82 to 0.93 for the individual domains, indicating good internal consistency. The AQLQ-NAA score correlated negatively and significantly to urgent care visits, physician visits, and total number of medications taken for asthma in the past 6 and 12 months (p < 0.05). Additionally, the AQLQ-NAA score was correlated positively and significantly to medication adherence in the past 6 and 12 months (p < 0.05). Similar patterns of correlations were found with all three domain scores. These results indicated that there is evidence for the construct validity of the AQLQ-NAA and its domains. The AQLQ-NAA should provide a useful measure of HRQOL in asthma-specific medical interventions for the population in which it was developed.

Adult↗

Is shorter always better? Relative importance of questionnaire length and cognitive ease on response rates and data quality for two dietary questionnaires.

In this study, the authors sought to determine the effects of length and clarity on response rates and data quality for two food frequency questionnaires (FFQs): the newly developed 36-page Diet History Questionnaire (DHQ), designed to be cognitively easier for respondents, and a 16-page FFQ developed earlier for the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The PLCO Trial is a 23-year randomized controlled clinical trial begun in 1992. The sample for this substudy, which was conducted from January to April of 1998, consisted of 900 control and 450 screened PLCO participants aged 55-74 years. Controls received either the DHQ or the PLCO FFQ by mail. Screenees, who had previously completed the PLCO FFQ at baseline, were administered the DHQ. Among controls, the response rate for both FFQs was 82%. Average amounts of time needed by controls to complete the DHQ and the PLCO FFQ were 68 minutes and 39 minutes, respectively. Percentages of missing or uninterpretable responses were similar between instruments for questions on frequency of intake but were approximately 3 and 9 percentage points lower (p < or = 0.001) in the DHQ for questions on portion size and use of vitamin/mineral supplements, respectively. Among screenees, response rates for the DHQ and the PLCO FFQ were 84% and 89%, respectively, and analyses of questions on portion size and supplement use showed few differences. These data indicated that the shorter FFQ was not better from the perspective of response rate and data quality, and that clarity and ease of administration may compensate for questionnaire length.

Aged↗