Quality Of Life Questionnaires Flashcards
True or false
Quality of life questionnaires are subjective
True
How has the World Health Organisation defined quality of life?
Individuals perception of their positions in life in the context of culture and the value systems in which they live and in relation to their goals, expectations, standards and concerns
What is the classical McMillan 2000 definition of quality of life?
McMillan definition:
Quality of life is a multidimensional, experiential continuum.
It compromises of affective states, broadly classified as comfort-discomfort and pleasure states.
In general the greater the pleasant and lesser the unpleasant affects the higher the quality of life.
Quality of life is a unique individual experience and should be measured from the perspective of the individual.
What does McMillan mean by multidimensional?
Many aspects need to be taken into account when measuring quality of life
What does McMillan mean by experiential continuum?
An experience over time
What does McMillan mean by comfort-discomfort and pleasant states?
Negative and positive states
What does McMillan mean by greater the pleasant and lesser the unpleasant?
Greater the pleasant and lesser the unpleasant refers to the balance of cumulative negative and positive effects being tilted towards higher cumulative positive effects
In 2003 what did McMillan create?
The balance model of quality of life
Explain McMillan 2003’s balance model of quality of life
McMillan views quality of life as a balance between unpleasant feelings and pleasant feeling
McMillan believes that feelings have evolved to encode a vast array of internal and external stimuli that the animal is receiving from its environment
McMillan also suggests that the intensity of the feelings indicates the degree of importance of that feeling in that time
However, McMillan also believes that unpleasant feelings command more attention/priority/urgency because they protect against threats critical for survival
McMillan also argues that the intensity of some feelings can increase over time as urgency increases
McMillan also suggests that the timeframe in which the urgency of a feeling increases may differ between feelings
What are the 4 criticisms of McMillan 2003’s balance model of quality of life?
1) What balance is appropriate?
2) What if pleasant feelings don’t compensate for unpleasant feelings?
3) What if there is some effect of the preceding emotional state on the evaluation, or intensity, of the next emotional state?
4) Some chronic unpleasant states can interfere with the ability to experience pleasure states
True or false (McMillan balance model)
The fact that intensity of some feelings increases over time as urgency increases can effect when we measure an individual’s quality of life
True
What is Wiseman-Orr et al 2006’s quality of life definition?
Quality of life is the subjective and dynamic evaluation by the individual of its circumstances and the extent to which these meet its expectations, which results in, or includes, an affective response to those circumstances
Quality of life is the subjective and dynamic evaluation by the individual of its circumstances (internal and external) and the extent to which these meet its expectations (that may be innate or learned and that may not include anticipation of future events) which results in, or includes, an affective (emotional) response to those circumstances (the evaluation may be a conscious or an unconscious process, with a complexity appropriate to the cognitive capacity of the individual)
What does Wiseman-Orr et al 2006 mean by dynamic evaluation by the individual of its circumstances?
Dynamic evaluation by the individual of its circumstances refers to ongoing monitoring and evaluation of the individuals circumstances over a period of time
What is Wiseman-Orr et al 2006 arguing when they mention emotions?
Wiseman-Orr et al is basically arguing that we can measure an individual’s quality of life by measuring their emotional states
What is Belshaw et al 2015’s quality of life definition?
An individual’s satisfaction with its physical and psychological health, its physical and social environment and its ability to interact with that environment
An individual’s satisfaction (the fulfillment of one’s individual needs or positive mood or valence derived from this) with its physical and psychological health (the state of being free from illness and injury), its physical and social environment and its ability to interact with that environment
Belshaw et al 2015 refers to needs, positive moods, and valence meaning we can use what kinds of welfare framework to measure quality of life?
5 needs
Positive mood
Valence measures
Associated affects
True or false
Belshaw et al 2015 refers to physical and psychological health suggesting that we can also use animal related measures to measure quality of life
True
True or false
Belshaw et al 2015 refers to physical and social environment suggesting that we can use resource related measures to measure an individual’s quality of life
True
Belshaw et al 2015 also suggests that we need to measure how the individual interacts with the physical and social environment which means we should look at what?
As a result we should look at both animal related indicators and resource based indicators together since they may support each others findings
True or false
Based on Belshaw et al 2015 definition it can be argued that doing a comprehensive welfare assessment can also be a measure of quality of life
True
What is Wiseman-Orr et al 2006’s definition of health-related quality of life?
The subjective evaluation of circumstances that include an altered health state and related interventions
True or false
Often quality of life and health-related quality of life are used interchangeably in the literature despite not being the same
True
True or false
In the literature the most validated questionnaires are mostly relevant only for health-related quality of life contexts, but this is usually not specified in the literature
True
True or false
Most health-related quality of life assessment tools focus on pain-associated conditions
True
When should you use questionnaires?
Questionnaires are useful for contexts when we can’t directly observe the animal, or collect data comprehensively
In what situations are questionnaires preferred?
In some situations questionnaires are preferred because when doing a quality of life assessment behaviour can alter in unfamiliar environments or unfamiliar people
Also for some things familiarity with the animal is helpful
Also questionnaires are less time consuming and expensive than other welfare assessments
Give an example of when familiarity with the animal is helpful
An example of these situations is that indirectly observing behaviour over long timeframes isn’t practical in many situations
So a proxy that knows the individual well will be able to notice any subtle changes which better shows their quality of life
True or false
Questionnaires allow us to quantify changes over time so we can constantly monitor improvements or declines in a situation
True
Questionnaires allow us to quantify changes over time so we can constantly monitor improvements or declines in a situation
What is this useful for?
This is very useful for monitoring:
- rehabilitation following treatment
- pain assessments and management
They’re also useful in making decisions on:
- euthanasia
- action with a chronic condition where intervention has its own drawbacks
- where to focus improvements
True or false
Questionnaires are also useful to evaluate/refine husbandry environments/managements and compare procedures to find out if a practice is useful
True
True or false
Questionnaires can aid in staff training
True
How can questionnaires aid in staff training?
Doing questionnaires can help remind staff which aspects of welfare they should be monitoring for
Some staff may forget or see some aspects as not that important and so ignore it or not monitor it as closely
Quality of life assessments should encourage consideration of what?
Quality of life assessments should encourage consideration of all aspects of an animals life
However, when tailoring it to a health-related quality of life questionnaire which aspects of the animals life we focus on depends on the area of interest
When making a health-related quality of life questionnaire what 3 things must you take into account?
1) The species of the individual
2) The specific population
Are the the animals in the wild or captivity?
Which sector are they in?
Farm
Zoo
Companion
3) What is the purpose of the questionnaire
True or false
When developing a health-related quality of life questionnaire we need a good definition of what we’re actually trying to measure and what we mean by health-related quality of life and quality of life
True
When developing a health-related quality of life questionnaire it’s also important to be aware of what 4 questions?
1) How can it be used?
2) Who is going to use it as the proxy?
3) How often will it be used?
4) What will be done with the data collected?
When developing a questionnaire it’s important to identify what?
When developing a questionnaire it’s important to identify all the candidate domains/themes of interest for measurements
When creating an assessment framework for comprehensive assessment of all relevant dimensions what must you be aware of?
When doing this it is always important to ensure that you stay aware of all the limitations of any framework you use
What are 2000 McMillan’s 6 quality of life domains?
1) Social relationships
2) Mental stimulation
3) Health
4) Control
5) Stress
6) Food consumption
What does McMillan 2000’s social domain look at?
Positive social interactions and companionship
Negative separation and social isolation
The effects of these things on an individual will depend on whether or not the individual is from a social species or not
What does McMillan 2000’s health domain look at?
Anything that directly impacts health
Anything that indirectly effects health
What does McMillan 2000’s control domain look at?
Controllability of a situation
Predictability of a situation
How is McMillan 2000’s control domain important?
McMillan 200’s control domain is important in terms of the individuals perception of a particular stress and their ability to cope with the challenge
To do this the individual will modify the impact of a negative stimulus on them and in turn modifying there ability to cope with the stressor
What is a criticism of McMillan 2000’s control domain?
McMillan 2000’s control domain is fairly difficult to actually get data on in terms of useful data for a quality of life assessment
What does McMillan 2000’s stress domain look at?
Negative emotional states
Ability to cope with stressor
What is a criticism of McMillan 2000’s stress domain?
How McMillan used stress was really vague especially considering the term stress has different meanings to laypeople and in certain scientific fields
This makes things hard to know what to measure since some definitions of stress can cause the stress domain to overlap with other domains kinda making it useless
More importantly if the stress domain overlaps with other domains it can be hard to get data that is specific for each domain
In 2015, Belshaw et al constructed a health-related quality of life questionnaire
What were Belshaw et al 2015’s 4 domains?
1) Physical domain
2) Psychological domain
3) Physical environment
4) Social environment
What consisted Belshaw et al 2015’s physical domain?
Food quality and nutritional quality Dehydration Disease Injury Mobility Skin irritation Sleep deprivation Respiration
What does Belshaw et al 2015’s psychological domain consist of?
Fear/anxiety Pain Frustration Boredom Depression
What does Belshaw et al 2015’s physical environment domain consist of?
Exercise
Comfort of housing
Temperature
What does Belshaw et Al 2015’s social environment consist of?
Social interactions
Human-animal interactions
Stability of the environment
When constructing a health-related quality of life questionnaire what do you do after you’ve decided on your domains?
Once the domains or themes are decided you then need to determine what specific indicators you’ll use to measure each domain aspects for the specific species and population of interest
If you’re constructing your own domains and framework what sources can you use to help identify potential domain indicators to measure each domain?
Expert opinion
Scientific literature
Potentially looking at equivalent human populations
If there’s no data available you can do experimental observations with and without a condition to get a better idea of what your domain should look like
After the domains and indicators are decided on you can create the questions for the questionnaire
What are the questions referred to as?
Items
The questions in a questionnaire are referred to as items
Once the items are created for the questionnaire they’re then scored and may get grouped into relevant domains/themes
How can the items be scored?
The items can be scored in terms of:
Agree vs disagree
Rating the:
Amount of something
Intensity of something
Quality of something
Frequency of something
Duration of something
Analogue scales
Likert scale
When looking at an emotional state what should the items focus on?
Even when looking at emotional states it’s easier to ask about the frequency of a specific sign or indicator associated with feeling rather than asking about their subjective mood
This increases the reliability of the data generated
What do you do after you’ve constructed your questionnaire?
Pilot study
Once you’ve constructed your questionnaire you need to run pilot tests
What must the pilot study consist of?
The pilot study will consist of a representative sample of your desired target population
Why must you do a pilot test?
Pilot tests are done to test the readability and comprehensibility of the questionnaire
Why must you do a pilot test?
Pilot tests are done to test the readability and comprehensibility of the questionnaire
What do you do after you’ve completed a successful pilot test?
After the pilot test you’ll establish content and face validity
How do you establish content and face validity?
You would usually send your questionnaire to multiple experts and ask them for any improvements or if it’s good enough to use for the intended purpose
You will then need an agreement from the majority of the experts at a significant standard for you to be able to say that your questionnaire has face validity
How do you know if a questionnaire has face validity?
A questionnaire has face validity if “on the face of it” the items appear relevant to, and comprehensively sample, the domains that you’re trying to assess
What do you do once you get face validity?
Once face validity is established you can then distribute your questionnaire to proxies of healthy and affected individuals
This is done to collect some data with your questionnaire
The data collected will then be used to test how valid the data collected is
What do you do with the collected data once face validity is confirmed?
First you’ll use the data collected to test your questionnaires construct validity
How do you test for construct validity?
To test for construct validity you’d first run each domains set of data through statistical analysis
You’d usually run the items data through either factor analysis or principal component analysis
You would then look at the results of the statistical analysis and see if the data matches the domains as intended
All responses to items within a domain should positively correlate with each other
Domains that should have opposite impacts should be negatively correlated
If any item doesn’t correlate with the domain then they’ll be removed
What do you do after construct validity is met?
After construct validity has been established you’d then test for criterion validity
How do you test criterion validity?
First you send out the modified questionnaire to a representative sample of healthy and affected individual proxies
At the same time you’d use gold standard methods and already validated measures to measure the domains
You will then see how well your questionnaire results match the gold standard and validated measures
What does the questionnaires data need to do for criterion validity to be established?
To establish criterion validity you’d need to make sure that the questionnaires data can discriminate between individuals with and without the condition
What do you do after criterion validity has been met?
After criterion validity has been met you’ll test your questionnaires reliability
How do you test your questionnaires reliability?
To test reliability of a questionnaire you will reassess the same subjects within a short interval to check the intra-rater reliability of the questionnaire
You will then do a test-retest test for the reliability of the questionnaire
The test-retest reliability assessment is where the same sample does the questionnaire 2 times with a minimum gap of 2 weeks between questionnaires
You will then do an inter-rater reliability test
The inter-rater test will be where there’s an independent assessment of the same subjects by several different observers to check inter-rater reliability
After the questionnaire is made as reliable as possible what happens?
After the questionnaire is made as reliable as possible you will test the questionnaire for its responsiveness
What are you looking at when checking a questionnaires responsiveness?
Responsiveness is where you look to see if the questionnaire is sensitive to changes in the condition that are important to the assessor or the animal
You want to be able to measure subtle changes in the condition not just the presence or absence of it
Your questionnaire is considered responsive if it can do what 3 things?
1) It can discriminate different degrees of health and welfare compromises
2) It can pick up on changes with the animal
3) It was tested for floor and ceiling effects
This is where large numbers of the sample population score the lowest or highest possible scores
This would suggest that the scales are not sufficient to capture the populations conditions degree levels effectively and need to be changed
True or false
Validation and reliability testing usually happens in 1 study
False
Validation and reliability testing usually does not happen in 1 study
The questionnaire is usually tested in multiple studies with different sample groups
True or false
Very few studies actually test their questionnaire, or measurement tool, in controlled trials in a way that does track changes in an individual
True
Few studies actually conduct any parallel observations to test owner reliability in reporting behaviour
What is the problem with this and what could be the cause of this?
The main problem with this is that we don’t know if the owner can provide the relevant data
This could be due to:
Owners not being observant enough to actually correctly measure the frequency of a certain behaviour
Owners may not be the best proxy
How can you measure owner reliability?
Compare questionnaire data with other external measures
True or false
Just because a questionnaire, or other tool, has been published in a journal does mean that the questionnaire is valid
False
What 8 things do you need to be careful of with a questionnaire?
1) The same circumstances may present different quality of life evaluations for different individuals
2) Perception can differ between individuals
3) Quality of life can shift within individuals
4) Quality of life ratings are affected disproportionately by current mood
5) Questionnaires are better at detecting gradual changes than rapid changes
6) We tend to make predictions about stuff that focus only on adversity, which can lead to poor quality of life predictions
7) We as proxies may give weightings to different domains
8) The proxies circumstances may alter their assessment
