PROM_A_226576 1..10

s, 80 full-text articles were left. Additional searches in Embase and Psych Info found 12 and 9 articles, respectively, but no additional PROMs were identified. Specific measures: We identified four PROMs specifically developed to measure domains of QoL among patients with multimorbidity. None of these PROMs have yet been evaluated using COSMIN guidelines according to the COSMIN database (searched 22.05.2018). A fifth PROM was identified from reference lists, and a sixth was published after our main search and appeared in our updated searches during work with this review. In the following, each of the six identified PROMs are evaluated according to the COSMIN checklist in relation to development, content validity, structural validity, and internal consistency. Health Care Hassles Scale (HCHS) The HCHS was developed among American war veterans with both single and multiple diseases in order to examine the relationship between attributes of primary care and healthcare system hassles. The HCHS included questions regarding problems with seeking information and interacting with healthcare providers, problems with taking medications, and problems with accessing healthcare. PROM Development and Content Validity The origin of the construct to be measured and the conceptual framework were not described adequately. Furthermore, the target population of the designed PROM was unclear, both in the development process and for future assessments. In a pilot study, 26 items were tested in 132 primary care patients, but it was unclear whether the definition “primary care patients” covers “veterans with one or more chronic diseases”, which was the population the PROM was aimed for. It was described how focus groups with patients with two or more chronic diseases were used to add further items to the item pool, but the origin of the items was not described further. Therefore, we were not able to validate the content validity of the HCHS. Structural Validity and Internal Consistency The process of the mentioned “review of initial psychometric properties” before the final version of HCHS was not described. The final version included 16 items, and the items were coded on a 4-point scale and summarized in a total score of 0–64. Item-total correlations ranged from 0.45 to 0.81 with a Chronbach’s alpha (α) at 0.94. Exploratory factor analysis (EFA) was used to examine structural validity. Measurement Adequacy According to COSMIN Checklist Box 1–4 The development process of the measure was not described adequately. The content validity of the HCHS was rated as “invalid”, as it was not described. The analyses on structural validity and internal consistency were rated as “adequate”, but since HCHS was based on an inadequate development process it was implicitly inadequate. HealthCare Task Difficulty (HCTD) Boyd et al aimed at developing a comprehensive measure of “HealthCare Task Difficulty” among elderly patients with multimorbidity. HCTD covers themes about obtaining medication, planning medication schedules, administering medication, changing medications, problems with bills, scheduling appointments, transportation, and getting information. Furthermore, the measure includes questions about diet, medical equipment, and problems with community services. PROM Development and Content Validity The definition of multimorbidity was not specified. The HCTD was developed using 11 items about healthcare tasks generated from a literature review and input from clinical experts in geriatric medicine. Three items were excluded because they had an additional response category, compared with the 8 remaining items. The item development process was not described further: There was no information about whether items were tested separately on patients and professionals, nor about the methods and analyses used. There were references to a study about the feasibility of an intervention called: “Guided Care”. However, this pilot study describes an intervention to enhance the quality of primary care experiences for chronically ill persons aged 65 and above. It did not describe the development of HCTD any further or tests of items. Therefore, we were not able to assess HCTD’s content validity. Structural Validity and Internal Consistency EFAwas used to assess the dimensionalities of the HCTD, revealing one factor with an eigenvalue greater than 1. Afterwards, unidimensionality of this factor was verified by confirmatory factor analysis (CFA). α was 0.89 for all 8 items, although analyses found two subscales indicating multi-dimensionality. α was not calculated for these two potential subscales. Møller et al Dovepress submit your manuscript | www.dovepress. com DovePress Patient Related Outcome Measures 2020:11 4 P at ie nt R el at ed O ut co m e M ea su re s do w nl oa de d fr om h ttp s: //w w w . d ov ep re ss . c om / b y 54 . 7 0. 40 . 1 1 on 2 6A pr -2 02 0 F or p er so na l u se o nl y. Powered by TCPDF (www.tcpdf.org)