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Report on theBudapest Initiative*
*Joint UNECE/WHO/Eurostat Task Force on Measurement of Health Status
Jennifer H. MadansNational Center for Health Statistics, USA
6th Annual Meeting of the Washington Group
Kampala, Uganda, October 10-13, 2006
The Budapest InitiativeGoals:
• To develop a new common instrument to measure health state.
• To coordinate with existing groups such as the Eurostat Group on EHIS and the Washington Group.
Meetings:
• 24-26 May 2004
• 14-16 November 2005
Products:
• Domain structure
• Draft question set
Followup:
• Creation of a Working Group to incorporate the Task Force’s comments, develop a revised set of questions for consideration, and develop a test protocol.
Health Status and Health States
Health states (capacities)
Determinants of health
Genetic contribution
Lifestyle/behaviour
Death
Physical environment
Physiological risk factors and
risk markers
Diseases, symptoms
and injuries
Domain 1
Domain 2
Domain N2
. .
.
.
HEALTH STATUS
Domain N1
Economic environment
Social environment
Physiological risk factors
and risk markers
Quality of life
Wellbeing
Health State: an individual’s levels of functioning within
a set of health domains.
Final List of Recommended Domains
• Vision• Hearing• Mobility• Cognition• Affect• Pain or discomfort• Fatigue• Social Relationships
Conceptual and Logistic Issuesfor Item Construction and Domain Questions
• Number of questions per domain• Dimensionality• Duration of the recall period• Dealing with assistive devices and medications• Item wording and response categories
Conceptual and Logistic Issuesfor Item Construction and Domain Questions
Outstanding Issues
• Measure capacity or performance?
• Include use of assistive devices or not?
• Response categories:
• none, mild, moderate, severe, extreme – or –
• a little, some, a lot, unable?
• Include social relationships as a final domain?
• Should mobility domain ask about “moving around” or “walking and stair climbing”?
Proposed Questions for Testing
Vision“Do you wear glasses or contacts?”
If yes: “Please answer the following question according to your normal use of glasses or contacts.”
“Overall, during the past four weeks, how much difficulty did you have….”
• in recognizing the face of someone four meters away (for example, across a road)?
• in seeing printed text (for example, in a newspaper or book)?
Proposed Questions for Testing
Hearing“Do you wear a hearing aid?”
If yes: “Please answer the following question according to your normal use of [a] hearing aid(s).”
“Overall, during the past four weeks, how much difficulty did you have….”
• in hearing the other person when [you/he/she] were having one-on-one conversations?
• in hearing what was said in conversations with multiple people?
Proposed Questions for Testing
Mobility“Do you use any aids or specialized equipment for [moving
around/walking]?”
If yes: “Which of the following types of aids or specialized equipment do you use for [moving around/walking]?”
• cane or walking stick
• walker
• wheelchair
• other (interviewer record)
Proposed Questions for Testing
MobilityIf yes: “Please answer the following question without the use of
your aids or specialized equipment.”
“Overall, during the past four weeks, how much difficulty did you have….”
• in moving around? or
• with walking short distances (for example, 100 meters)?
• with walking long distances (for example, 500 meters)?
• with walking up or down stairs?or
• with walking?
Proposed Questions for Testing
Cognition“Overall, during the past four weeks, how much difficulty did
you have….”
• with concentrating or remembering things?
• with thinking clearly and solving daily problems?
Proposed Questions for Testing
“Overall, during the past four weeks, ….”
Affect• how sad, low or depressed did you feel? • how worried, nervous, or anxious did you feel?
Fatigue• how much of a problem did you have with feeling tired or
fatigued?
Proposed Questions for Testing
Pain or Discomfort“Overall, during the past four weeks, ….”
• how much bodily pain or discomfort did you have?
If asked: “When answering, please consider both the times you were taking medication and the times you were not and try to come up with an overall or average rating.”
Proposed Questions for Testing
Social Relationships
“Generally speaking, how much difficulty do you have….”
• in creating or maintaining social relationships?
The Testing Protocol
• Standard protocol used at each site• Structured questions administered to respondents• Questions asked twice
• Open-ended
• Response sets (split sample)
• Unstructured probes for interviewers
• How do respondents interpret the question, choose a response, and do they adhere to the recall period?
Relationship with Washington Group Work
• Overlapping domains
• Same conceptual issues
• Different contexts
• Different approaches
Next Steps…
October 2006 – November 2006:
• Finalize testing protocol
• Conduct tests (Italy, USA, Canada)
December 2006 – January 2007:
• Write and review final test reports
February 2007:
• Make recommendations to European Statistical System