NHS goes to the PROMS

Applying an extended theoretical framework for data collection mode to health services research

Background

Over the last 30 years options for collecting self-reported data in health surveys and questionnaires have increased with technological advances. However, mode of data collection such as face-to-face interview or telephone interview can affect how individuals respond to questionnaires. This paper adapts a framework for understanding mode effects on response quality and applies it to a health research context.

Discussion

Data collection modes are distinguished by key features (whether the survey is self- or interviewer-administered, whether or not it is conducted by telephone, whether or not it is computerised, whether it is presented visually or aurally). Psychological appraisal of the survey request will initially entail factors such as the cognitive burden upon the respondent as well as more general considerations about participation. Subsequent psychological response processes will further determine how features of the data collection mode impact upon the quality of response provided. Additional antecedent factors which may further interact with the response generation process are also discussed. These include features of the construct being measured such as sensitivity, and of the respondent themselves (e.g. their socio-demographic characteristics). How features of this framework relate to health research is illustrated by example.

Summary

Mode features can affect response quality. Much existing evidence has a broad social sciences research base but is of importance to health research. Approaches to managing mode feature effects are discussed. Greater consideration must be given to how features of different data collection approaches affect response from participants in studies. Study reports should better clarify such features rather than rely upon global descriptions of data collection mode.

The 14-item Paediatric Throat Disorders Outcome Test: a valid, sensitive, reliable, parent-reported outcome measure for paediatric throat disorders

Objectives:

We modified and abbreviated a pre-existing research questionnaire, the Tonsil and Adenoid Health Status Instrument, to make it suitable for rapid completion as a disease-specific, health-related quality of life research tool for children with tonsil and adenoid disease in the UK. We determined the main psychometric properties of the resulting 14-item Paediatric Throat Disorders Outcome Test.

Design, setting and participants:

Pre- and post-operative questionnaires were completed by the parents of children with throat disorders referred to two large hospitals. We included children with recurrent tonsillitis and with obstructive sleep apnoea. A separate cohort of healthy children of comparable age range was also studied.

Main outcome measures:

The test's internal consistency and responsiveness were analysed and its construct validity documented via known-group differences.

Results:

A total of 126 completed questionnaires were received from the hospital referral group. The children's mean age was 6.5 years (range one to 16). The 40 unaffected children were well matched in age to the study population (mean 6.1 years, range two to 15). Cronbach's α coefficient for the pre-operative assessment total score was 0.84. The test–retest reliability coefficient for the total score was 0.98, indicating very high reproducibility. The 14-item Paediatric Throat Disorders Outcome Test discriminated well between children known to suffer with throat problems and a group of healthy controls (p < 0.0001; t = 24.016). Six months after surgical intervention, parentally reported questionnaire scores had improved (i.e. were lower) (p < 0.0001; t = 7.01). The standard effect size (i.e. change in mean divided by baseline standard deviation) for children for whom post-operative questionnaires were completed was 1.53; this is very large.

Conclusions:

The 14-item Paediatric Throat Disorders Outcome Test is an appropriate, disease-specific, parent-reported outcome measure for children with throat disorders, for which we have demonstrated internal consistency, reliability, responsiveness to change and two forms of construct validity.

"Barking up the right tree": challenges for health care reform

Current approaches to health care reform are largely based on the metaphor of imminent flood waves threatening to inundate the health care system. This metaphor reflects the system's preoccupation with disease and disease management in a hospital-centric environment. We suggest that the debate needs to be reframed around health, or more precisely the patient's health experience. Most patients are healthy most of the time, and even those with identifiable morbidities generally regard themselves as being in good health. The majority of people receive most of their care in the community from primary care professionals. An integrated, effective and efficient primary health care system supports continuity of care through a primary care provider and fosters clinical leadership that is supported by other primary health care professionals and medical specialists. Each primary care setting will have its own model that best provides flexible and responsive services to meet its patients' needs and expectations.