# Presentation: 409446

## Report on theBudapest Initiative**Joint UNECE/WHO/Eurostat Task Force on Measurement of Health Status

- Jennifer H. Madans
- 	National Center for Health Statistics, USA
- 	6th Annual Meeting of the Washington Group
- 	Kampala, Uganda, October 10-13, 2006

## The Budapest Initiative

- Goals:
- 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 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 Issuesfor 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 Issuesfor 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

**Mobility**
- If 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