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The New Zealand WHOQOL-BREF with national items: Focus group work, item selection, confirmatory factor analysis, and Rasch analysis Chris Krägeloh, Paula Kersten, Patricia Hsu, & Joanna Feng Positive Psychology Conference, AUT, Akoranga Campus 8 June 2013

Positive Psychology Conference 8 June 2013

Activities of the NZ WHOQOL Group • Conducts research in the area of QOL, especially around the WHOQOL tools (WHOQOL-BREF and other modules, such as WHOQOL-SRPB, WHOQOLDIS, WHOQOL-OLD). • We recently validated the WHOQOL-BREF for use in the New Zealand general population. • We developed a NZ version of the WHOQOL-BREF, with 5 additional national items.

Positive Psychology Conference 8 June 2013

Activities of the NZ WHOQOL Group • Monitor the use of the WHOQOL tools in NZ to avoid mis-use.

• Provide general support and advice on the use of the tools; provide general guidelines on scoring and interpretation. • Maintain a current database of WHOQOL data collected in NZ for the purpose of providing reference values for future studies and use in clinical settings.

Positive Psychology Conference 8 June 2013

The NZ WHOQOL Group in PCRC • The NZ WHOQOL Group has recently joined the Outcomes Research Cluster of the Person-Centred Research Centre at AUT. • This cluster has demonstrated expertise on the use of outcome measures in health research. • Through alignment with this cluster, WHOQOL work in NZ will have access to national and international research networks and contribute to the development and use of outcome measure in health research contexts.

Positive Psychology Conference 8 June 2013

Purpose of the present talk 1. Background on the initial focus group work for content validation of the WHOQOL-BREF for use in New Zealand. 2. Development of additional optional national items for the WHOQOL-BREF.

3. Validation of the national items: their alignment with the four domains of the WHOQOL-BREF.

Positive Psychology Conference 8 June 2013

• WHOQOL = World Health Organization Quality of Life Scale. • Health-related QOL assessment. • Developed in the 1990s cross-culturally in 14 countries. Expanded to over 35 country versions since.

• 2005 estimate of 123 researchers in 67 centres and 39 countries involved in studies using WHOQOL instruments.

Positive Psychology Conference 8 June 2013

Rationale behind original WHOQOL development • Need for measurement of health beyond traditional morbidity and mortality to include impact of disease and impairment on daily activities and behaviour. • Desire to find out what patients and clients felt about themselves to supplement what experts thought. • Introduces a humanistic element to health care to balance mechanistic medical approaches.

• Unsatisfactory and culturally biased translations of similar UK and North American measures.

Positive Psychology Conference 8 June 2013

Definition of QOL “individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person’s physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment” (WHOQOL Group, 1995)

Positive Psychology Conference 8 June 2013

Field centres involved in the development of WHOQOL-100 • • • • • • • •

Melbourne, Australia Zagreb, Croatia Paris, France Delhi, North India Madras, South India Beersheba, Israel Tokyo, Japan Tilburg, The Netherlands

• • • • • • •

Panama City, Panama St. Petersburg, Russian Federation Barcelona, Spain Bangkok, Thailand Bath, UK Seattle, USA Harare, Zimbabwe

Additional centres involved in the WHOQOL-BREF • Hong Kong • Leipzig, Germany • Mannheim, Germany

• La Plata, Argentina • Porto Alegre, Brazil

Positive Psychology Conference 8 June 2013

Properties of the WHOQOL • Comprehensive multidimensional profile. • Subjective perceptions: “How satisfied are you with your ability to walk?” • Objective approach “How well can you walk?” • Subjective approach decided upon. • Cross-culturally developed with many languages.

• Standardised 5-point Likert rating scale covering 4 dimensions - intensity (how much), frequency (how often), evaluation (how satisfied), capacity (are you able).

Positive Psychology Conference 8 June 2013

Developmental process 1. Concept clarification (expert review) 2. Qualitative pilot (incl. focus groups) 3. Developmental pilot (300 questions) 4. Field test (series of studies on smaller scale)

Positive Psychology Conference 8 June 2013

Versions and features • WHOQOL-100

= core generic instrument

• WHOQOL-BREF = abbreviated 26-item version • WHOQOL-8 = eight-item version • Additional modules = HIV, OLD, SRPB, DIS

• Some country versions have optional additional national items.

The WHOQOL-BREF is the most widely used WHOQOL instrument. It is also the most widely used QOL tool in the words.

Positive Psychology Conference 8 June 2013

Up until recently, research studies in New Zealand using the World Health Organization Quality of Life questionnaire WHOQOL-BREF have been using the Australian or British versions. In 2008, Prof. Rex Billington and colleagues founded the New Zealand WHOQOL Group. One of the early goals of this group was to validate the instrument for use in New Zealand and thus develop a New Zealand version.

Positive Psychology Conference 8 June 2013

Positive Psychology Conference 8 June 2013

Validation of the New Zealand WHOQOL-BREF: Random sample of participants from the national electoral role to obtain ratings for the existing 26 WHOQOL-BREF items. Sent out 3,000 questionnaires with self-addressed return envelopes. 710 questionnaires were returned (response rate approximately 24%). Young people were underrepresented and supplemented by additional purposive sampling, increasing the total number to 808.

Validation of the New Zealand WHOQOL-BREF:  Conducted confirmatory factor analysis (CFA) with the following specifications:

 Promax rotation  Two types of extraction methods: Diagonally-weighted least squares (DWLS) with polychoric correlations

Positive Psychology Conference 8 June 2013

Validation of the New Zealand WHOQOL-BREF The results suggest a good fit: RMSEA=0.072 (criterion for excellent fit 0.950) SRMR=0.067 (criterion