Title:

Primary Care & Health Services Research Initiatives for Families: Health Assessment and Health Empowerment Programmes for Trekkers Families

Principal Investigator:

Cindy L. K. Lam

Co-Investigators:

Dr. Patrick Ip, Department of Paediatrics & Adolescent Medicine, HKU; Dr. Calvin Kalun Or, Dept. of Industrial and Manufacturing Systems Engineering, HKU; Dr. Daniel Fong, School of Nursing Studies, HKU; Dr. Emily Tse, Dr. Amy Ng, Dr. Carlos Wong, Dr. William Wong & Dr. Ben Fong, Department of Family Medicine and Primary Care, HKU

Background:

Poverty is associated with worse health outcomes, which can become a vicious cycle that perpetuates for generations. In 2012, the Kerry Group Kuok Foundation (Hong Kong) Limited (KGKF) established the Trekkers Family Enhancement Scheme (TFES) with a goal to stop trans-generation poverty through empowerment of low-income families to achieve their full potentials. Our research team partners with the TFES to promote health equity in low income families through multidisciplinary and medical-social integrative Health Empowerment and Health Assessment programmes.

Objectives:

The Health Empowerment Programme (HEP) is to enhance health literacy, raise health awareness and enable self-care. The Health Assessment programme (HAP) is to identify physical and mental illnesses and health risk factors early in order to enable early interventions and appropriate use of primary care services.

Design. Setting and Participant:

A prospective comparative cohort study of adults and children of 185 families in the TEFS and 203 comparison low-income families who have not participated int the TEFS in the community in Hong Kong.

Main outcome measures:

The primary outcome is self-care enablement. Secondary outcomes include cardiovascular risk factors, mental health in adults, behaviour in children, and health-related quality of life (HRQoL).

Methods:

Regular health empowerment activities and annual health assessments were available for voluntary participations by TEFS families, and health assessments were available on enrolment and after 5 years for comparison families. Self-care enablement is measured by the 6-item Patient Enablement Instrument-2 (PEI-2), cardiovascular risk factors are measured by physical examination and blood tests; mental health is measured by the 21-item DASS, behaviour in children is measured by the Strength and Difficulties Questionnaire (SDQ) and HRQOL is measured by the SF-12v2 (adults) and the Child Health Questionnaire-28-PF (children),

Significance:

HEP and HAP may be effective interventions to reduce health inequity associated with poverty.

Output Results and Potential applications :

Preliminary analysis shows significant greater improvements in self-care enablement, stress, mental health-related quality of life in adults, and less behavioural problems in children in TFES families than their counterparts in comparison low-income families. Medical-social integrative HEP and HAP are feasible and effective in enabling self-care and enhancing mental and behavioural health of low income families.

Title:

Effectiveness of Routine Measurement of Health-Related Quality of Life in Improving the Outcomes of Patients with Musculoskeletal Problems– A Randomized Controlled Trial

Period:

2020-2022

Principal Investigator:

Cindy LK Lam

Co-Investigators:

David VK Chao, Daniel Fong, Calvin KL Or, Carlos KH Wong, Jason PY Cheung, Eliza LY Wong, Paul Kind.

Background:

Musculoskeletal (MS) problems are common in primary care and they are detrimental to quality of life. Current management of chronic MS problems focuses mainly on pain control with medications, but the outcomes are often unsatisfactory and sometimes harmful. The provision of the patient’s health-related quality of life (HRQOL) information to the doctor may trigger management to improve quality of life.

Objectives:

This is an effectiveness-implementation hybrid trial that aims to find out whether the implementation of routine measurement and reporting on the patient’s EQ-5D-5L HRQOL data with an electronic platform can improve HRQOL and pain in patients with chronic knee or back problems in primary care. We will also assess the acceptability of routine electronic measurement and reporting of the EQ-5D-5L in real-world primary care.

Methods:

This is a multi-center prospective cluster-randomized controlled trial in six public primary care clinics in Hong Kong. The six clinics will be randomized to the intervention or control group. We shall recruit 1374 (229 from each clinic) subjects with symptomatic chronic knee or back problems through the attending doctors in the clinics. Subjects of the Intervention clinics will complete the electronic EQ-5D-5L at recruitment and every follow up during the next 12 months, and a report on their longitudinal EQ-5D-5L data will be shown to the doctors during the consultations. Subjects of the control clinics will receive care as usual. All subjects will complete a set of patient reported outcome measures (PRO) including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) on HRQOL and a 10-point Pain Rating Scale (PRS), and a structured questionnaire on sociodemographics, morbidity and service utilization rates at recruitment, and at 3, 6 and 12 months by telephone.

Outcome Measures and Data Analysis:

The primary outcome is change in WOMAC total score. The secondary outcomes are change in pain, other PRO scores and doctor rated severity of disease. Group difference in changes of WOMAC and other outcome scores over time will be analyzed using generalized estimating equation model under intention-to-treat principle. The acceptability of routine measurement of HRQOL by electronic EQ-5D-5L will be analyzed by descriptive statistics.

Potential application:

Routine measurement of HRQOL by an electronic EQ-5D-5L platform can be applied to other outpatient clinics to improve care of MS problems and other conditions to facilitate more effective and patient-centered care.

Title:

Evaluation of the responsiveness of Short Form-12 Health Survey version 2 (SF-12v2) in Chinese patients with hypertension in primary care

Eric Yuk Fai Wan, Esther Yee Tak Yu, Weng Yee Chin, Edmond Pui Hang Choi, Tingting Wu & Cindy Lo Kuen Lam

Purpose:

There is limited evidence on the responsiveness of the Short Form-12 Health Survey version 2 (SF-12v2) in hypertensive patients. This study aimed to evaluate both the responsiveness of the SF-12 measures in Chinese hypertensive patients.

Methods:

A prospective longitudinal study was conducted on hypertensive patients managed in public primary care clinics between 2012 and 2013. A total of 583 and 431 patients were surveyed and completed SF-12v2 at baseline and at 12-month follow-up interviews, respectively. Using global rating of change scale as an external anchor, the responsiveness was assessed by linear mixed effect models, multiple linear regression models, and receiver operating characteristic (ROC) curve analysis.

Results:

SF-12v2 managed to detect negative changes among hypertensive patients in worsened general health group but failed to identify changes among hypertensive patients in improved general health group. Meanwhile, some domains of SF-12v2 detected a significant difference in difference between patients of worsened and stable/improved group and between patients of stable and improved group, but none of the domains and the summary scales reached the recommended standard of 0.7 in any comparisons in ROC analysis.

Conclusion:

The SF-12v2 was responsive to worsening of HRQOL but not to improvements in HRQOL among hypertensive patients. The overall responsiveness of SF-12v2 in hypertensive patients is unsatisfactory. Further studies are needed to identify HRQOL measures with good internal and external responsiveness for hypertensive patients.

https://link.springer.com/article/10.1007/s11136-019-02225-6

Title:

Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies

Zhisong Zhang , Kaising Sun, Chonnakarn Jatchavala, John Koh , Yimian Chia , Jessica Bose, Zhimeng Li, Wanqiu Tan, Sizhe Wang, Wenjing Chu,, Jiayun Wang, Bach Tran, Roger Ho

Background:

In psychiatry, stigma is an attitude of disapproval towards people with mental illnesses. Psychiatric disorders are common in Asia but some Asians receive inadequate treatment. Previous review found that Asians with mental illness were perceived to be dangerous and aggressive. There is a need for renewed efforts to understand stigma and strategies which can effectively reduce stigma in specific Asian societies.

Objective

To provide an up-to-date overview of existing research and status on stigma experienced by psychiatric patients and anti-stigma campaigns in China, Hong Kong, Japan, Singapore, Korea, and Thailand

Methods:

A systematic literature search was conducted in the following databases, including PubMed, PsycINFO, Embase, Web of Science, and local databases. Studies published in English and the official language of included countries/territories were considered for inclusion in the systematic review. Any article on stigma related to any form of psychiatric illness in the six Asian societies was included.

Results:

One hundred and twenty-three articles were included for this systematic review. This review has six major findings. Firstly, Asians with mental illnesses were considered as dangerous and aggressive, especially patients suffering from schizophrenia and bipolar disorder; second, psychiatric illnesses in Asian societies were less socially-acceptable and were viewed as being personal weaknesses; third, stigma experienced by family members was pervasive and this is known as family stigma; fourth, this systemic review reported more initiatives to handle stigma in Asian societies than a decade ago; fifth, there have been initiatives to treat psychiatric patients in the community; and sixth, the role of supernatural and religious approaches to psychiatric illness was not prevailing.

Conclusion:

This systematic review provides an overview of the available scientific evidence that points to areas of needed intervention to reduce and ultimately eliminate inequities in mental health in Asia.

https://www.mdpi.com/1660-4601/17/1/280

Title:

Mapping the kidney disease quality of life 36-item short form survey (KDQOL-36) to the EQ-5D-3L and the EQ-5D-5L in patients undergoing dialysis

Fan Yang, Carlos K H Wong, Nan Luo, James Piercy, Rebecca Moon, James Jackson

Objectives:

To develop algorithms mapping the Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) onto the 3-level EQ-5D questionnaire (EQ-5D-3L) and the 5-level EQ-5D questionnaire (EQ-5D-5L) for patients with end-stage renal disease requiring dialysis.

Methods:

We used data from a cross-sectional study in Europe (France, n = 299; Germany, n = 413; Italy, n = 278; Spain, n = 225) to map onto EQ-5D-3L and data from a cross-sectional study in Singapore (n = 163) to map onto EQ-5D-5L. Direct mapping using linear regression, mixture beta regression and adjusted limited dependent variable mixture models (ALDVMMs) and response mapping using seemingly unrelated ordered probit models were performed. The KDQOL-36 subscale scores, i.e., physical component summary (PCS), mental component summary (MCS), three disease-specific subscales or their average, i.e., kidney disease component summary (KDCS), and age and sex were included as the explanatory variables. Predictive performance was assessed by mean absolute error (MAE) and root mean square error (RMSE) using 10-fold cross-validation.

Results:

Mixture models outperformed linear regression and response mapping. When mapping to EQ-5D-3L, the ALDVMM model was the best-performing one for France, Germany and Spain while beta regression was best for Italy. When mapping to EQ-5D-5L, the ALDVMM model also demonstrated the best predictive performance. Generally, models using KDQOL-36 subscale scores showed better fit than using the KDCS.

Conclusion:

This study adds to the growing literature suggesting the better performance of the mixture models in modelling EQ-5D and produces algorithms to map the KDQOL-36 onto EQ-5D-3L (for France, Germany, Italy, and Spain) and EQ-5D-5L (for Singapore).

https://link.springer.com/article/10.1007/s10198-019-01088-5

Title:

Responsiveness of EQ-5D Youth version 5-level (EQ-5D-5L-Y) and 3-level (EQ-5D-3L-Y) in Patients With Idiopathic Scoliosis

Carlos King Ho Wong, Prudence Wing Hang Cheung, Nan Luo, Jiaer Lin, Jason Pui Yin Cheung

Study Design

Prospective cohort study OBJECTIVE.: The aim of this study was to evaluate the responsiveness of EQ-5D Youth version (EQ-5D-Y) 5-level and 3-level in patients with idiopathic scoliosis SUMMARY OF BACKGROUND DATA.: A new version of EQ-5D-Y increasing the number of response levels from 3 (3LY) to 5 (5LY) has been recently introduced. Although the validity and reliability of 5LY and 3LY for use in idiopathic scoliosis patients are compared, responsiveness of two questionnaires among children and adolescents is unknown.

Methods:

A total of 129 children or adolescents attending the spine clinics of a tertiary hospital in Hong Kong, China, completed 3LY and 5LY. At 3-month follow-up, 110 (85.2%) patients completed two EQ-5D-Y questionnaires, and the single-item Global Rating on Change Scale determining "worsened,", "unchanged,", or "improved" global health. Among those indicating "unchanged" in global health from baseline to follow-up, agreement in responses to each 3LY and 5LY item was examined. Mean changes in EQ-5D-Y scores during the past 3 months in patients with "worsened," "unchanged," and "improved" health were calculated.

Results:

Most patients (82.7%) reported no change in global health, whereas about 12.7% and 4.5% of them felt better and worse, respectively, compared to baseline. Among those reporting "unchanged health," the "Looking after myself" item exhibited the largest proportion of agreement in responses (5LY: 96.36%; 3LY: 95.50%), followed by "Mobility" (5LY 90.91%; 3LY 90.99%), "Usual activities" (5LY 83.64%; 3LY 87.39%), "Pain/discomfort"(5LY 68.18%; 3LY 76.58%), and "Feeling worried/sad/unhappy" (5LY 66.36%; 3LY 72.07%). In the "improved" or "worsened" group, the 3-month follow-up 5LY and 3LY scores were higher or lower compared with baseline, respectively.

Conclusion:

The 5LY is demonstrated as responsive as the 3LY for patients with idiopathic scoliosis.

https://pubmed.ncbi.nlm.nih.gov/31634302/

Title:

A head-to-head comparison of five-level (EQ-5D-5L-Y) and three-level EQ-5D-Y questionnaires in paediatric patients

Carlos King Ho Wong, Prudence Wing Hang Cheung, Nan Luo, Jason Pui Yin Cheung

Purpose:

The aim of this study was to assess the psychometric properties of a youth version of the EQ-5D five-level questionnaire (5LY) and its three-level version (3LY) in a sample of Chinese paediatric patients.

Methods:

A consecutive sample of idiopathic scoliosis patients were recruited from a referral outpatient scoliosis center at Hong Kong, China in October 2017 and completed the two versions of EQ-5D-Y. Redistribution properties in each dimension of EQ-5D-Y were analyzed between 5LY and 3LY by logistics regressions. Absolute reduction and relative reduction in ceiling effects from the 3LY to the 5LY were calculated. Test-retest reliability was assessed by examining the Gwet's agreement coefficient (Gwet's AC) for five individual dimension responses over the 2-week period.

Results:

A total of 129 idiopathic scoliosis patients completed the two versions of EQ-5D-Y at baseline assessment, among which 70 patients completed the test-retest interview in 2-3 weeks after baseline assessment. For redistribution properties, the proportion of inconsistency was low in all the dimensions, ranging from 0.0% ("Usual activities") to 3.9% ("Pain/discomfort"). Ceiling effects were reduced in four dimensions. "Usual activities" dimension showed significant reduction (absolute and relative reductions: 3.9% and 4.3%; p = 0.025) and the "worried/sad/unhappy" dimension showed the largest significant reduction in ceiling effects (absolute and relative reductions: 7.8% and 9.8%; p = 0.012). The 3LY and 5LY showed very good agreement (> 80%) of individual dimension responses between two assessments, except for the "worried/sad/unhappy" dimension in 3LY.

Conclusion:

Through this head-to-head comparison, the 5LY had significant improvements in ceiling effects in two dimensions when compared to 3LY but other measurement properties of 3LY and 5LY performed similar in the idiopathic scoliosis patient group.

https://pubmed.ncbi.nlm.nih.gov/30600469/

Title:

Psychometric validation of the EuroQoL 5-dimension (EQ-5D) questionnaire in patients with spondyloarthritis

Helen Hoi Lun Tsang, Jason Pui Yin Cheung, Carlos King Ho Wong, Prudence Wing Hang Cheung, Chak Sing Lau, Ho Yin Chung

Background:

Spondyloarthritis (SpA) has a significant impact on patients' quality of life due to functional impairments. Generic health instruments like the EuroQoL 5-dimension (EQ-5D) is important for the cost-utility analysis of health care interventions and calculation of quality-adjusted life years. However, the applicability of the EQ-5D health measure in Chinese patients with SpA is currently unknown. Hence, the aim of the study is to test the psychometric properties and to validate the use of the EQ-5D health measure for utility analyses in Chinese patients with SpA.

Methods:

Prospective and consecutive recruitment of 220 Chinese patients with SpA was conducted. Demographic data including smoking and drinking habits, education level, income, and occupation was collected. Disease-associated data including disease duration, the presence of back pain, peripheral arthritis, dactylitis, enthesitis, uveitis, psoriasis, and inflammatory bowel disease was also recorded. Questionnaires regarding disease activity and functional disability (BASDAI, BASFI, BASGI, BASMI, ASDAS, ODI), mental health (HADS depression and anxiety), and the EQ-5D scores were recorded. SF-36 scores were used to verify the findings. Baseline correlations were performed along with test-retest reliability, validity, and internal consistency tests. Specifically, the relationship between EQ-5D and disease activity and functional scores was studied.

Results:

EQ-5D scores achieved acceptable internal consistency and reliability. A ceiling effect was observed for all domains of the EQ-5D except for pain/discomfort. No floor effect was observed. Significant negative correlations were observed between ODI, HADS, BASFI, BASMI, BASDAI, and ASDAS-CRP and with EQ-5D. A higher disease activity was well-differentiated by EQ-5D, as with the disability and mental health scores.

Conclusion:

The EQ-5D demonstrates satisfactory psychometric properties for assessment of SpA patients. It has high utility for demonstrating changes in disease activity and disability.

https://pubmed.ncbi.nlm.nih.gov/30700326/

Title:

SF-6D utility scores of smokers and ex-smokers with or without respiratory symptoms attending primary care clinics

Sau-nga Fu, Man-Chi Dao, Carlos King-Ho Wong & Wai-cho Yu /p>

Introduction:

The aim of this paper is to find out generic preference-based Short-Form 6 Dimensions (SF-6D) utility scores of smokers and ex-smokers with varying cigarette exposure, with and without respiratory symptoms.

Methods:

Seven hundred thirty one people aged ≥30 with a history of smoking who attended 5 public primary care clinics completed a cross-sectional survey using SF-6D utility score, Breathlessness, Cough, and Sputum Scale (BCSS©) and office spirometry.

Results:

Most of the subjects were men (92.5%) in an older age group (mean age 62.2 ± 11.7 years). About half of them (48.3%) were current smokers while the other half (51.7%) were ex-smokers. More than half of them (54.2%) reported mild respiratory symptoms (mean BCSS score 0.95 ± 1.12). The most common symptoms were sputum (45.1%), followed by cough (34.2%) and breathlessness (6.0%). The SF-6D overall utility score was 0.850 ± 0.106. The subjects reported significantly lower SF-6D scores when they had breathlessness (0.752 ± 0.138; p = < 0.001), cough (0.836 ± 0.107; p = 0.007), sputum (0.838 ± 0.115; p = 0.004) or any of the above symptom (0.837 ± 0.113; p < 0.001). In both groups of current smokers and ex-smokers, there was no statistically significant difference in the scores among light, moderate or heavy smokers. In the Tobit regression model of factors affecting SF-6D utility score, subjects who reported more respiratory symptoms (i.e. higher BCSS©) had lower SF-6D scores (B = − 0.018 ± 0.007, p < 0.001), while men had higher SF-6D scores than women (B = 0.037 ± 0.031, p = 0.019). Subjects who attended middle or high school had higher SF-6D score than those attended the University or above. The presence of airflow obstruction was not associated with the score./p>

Conclusion:

The study yielded SF-6D utility scores of smokers and ex-smokers with different reported cigarette exposure, which could be useful in future clinical studies and cost-effectiveness analysis.

https://link.springer.com/article/10.1186%2Fs12955-019-1115-z

Title:

The mediating role of sleep quality in the association between nocturia and health-related quality of life

Edmond Pui Hang Choi, Eric Yuk Fai Wan, Jojo Yan Yan Kwok, Weng Yee Chin & Cindy Lo Kuen Lam

Background:

Even though the negative impacts of nocturia on sleep quality and health-related quality of life (HRQOL) have been documented in previous research, their interrelationship has been poorly studied. This study aimed to explore whether nocturia would affect sleep quality, which in turn affects HRQOL.

Methods:

Participants aged 40 and above were randomly recruited from a Hong Kong public primary care clinic. Participants were asked to report the average number of nocturia (waking up at night to void) pisodes per night over a 1-month period. The Pittsburgh Sleep Quality Index (PSQI) and the 12-Item Short Form Health Survey version 2 (SF-12 v2) were administered. The mediation analysis was tested using multistage regression approach and bootstrap method.

Results:

Of the 500 subjects who completed the survey, 31.2% reported symptomatic nocturia (having ≥2 nocturia episodes per night), and 60.4% experienced poor sleep quality (a PSQI global score > 5). Respondents with symptomatic nocturia had a poorer HRQOL in the domains of physical functioning (PF), role physical (RP) and social functioning (SF), general health (GH), vitality (VT) and physical component summary (PCS) of the SF-12 v2 than those without. Compared with the respondents without poor sleep quality, those with poor sleep quality had poorer HRQOL across all domains and summaries of the SF-12 v2. Mediation analysis found that sleep quality fully mediated the association between nocturia and the PF, RP and SF domains of the SF-12 v2, respectively, and partially mediated the association between nocturia and the GH, VT and PCS domains of the SF-12 v2, respectively.

Conclusion:

We found that sleep quality mediated the association between nocturia and HRQOL. To enhance the HRQOL of patients with nocturia, clinicians should not only focus on nocturia symptoms, but also on their sleep quality.

https://hqlo.biomedcentral.com/articles/10.1186/s12955-019-1251-5

Title:

Effects of health‐related quality of life on health service utilisation in patients with colorectal neoplasms

Man Yu Wong, Yingsi Yang. Zhiqiang Cao, Vivian Y. W. Guo, Cindy L. K. Lam, Carlos K. H. Wong

Abstract:

This study was to assess the impact of HRQOL on health service utilisation using four different count data models. The HRQOL was measured using the Short‐Form Six‐Dimension instrument and the functional assessment of cancer therapy‐colorectal whereas health service utilisation was measured by the number of monthly clinical consultations and the number of monthly hospitalisation. Different count data models (Poisson's regression, negative binomial regression, zero‐inflated Poisson's regression and zero‐inflated negative binomial regression) were used to assess the association between HRQOL and health service utilisation. A performance comparison was made between the models. Goodness‐of‐fit statistics (the Pearson's chi‐squared test statistic, the Akaike and Bayesian information criteria) were used to determine the best‐fitting model. The negative binomial model performed the best in assessing the association between HRQOL measures and health service utilisation in patients with colorectal neoplasm and thus recommended. Physical well‐being of patients was negatively and significantly associated with the monthly rate of health service utilisation after controlling for patient demographics. Both physical and function well‐beings of patients were negatively and significantly associated with the number of monthly hospitalisations. If the data for the condition‐specific FACT ‐C are not available, SF ‐6D showed a very strong negative relationship with health service utilisation. Such models can be used to guide the allocation of clinical resources and funding for the care of colorectal cancer patients.

https://onlinelibrary.wiley.com/doi/abs/10.1111/ecc.12926

Title:

Psychometric validation of the cross-culturally adapted traditional Chinese version of the Back Beliefs Questionnaire (BBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ)

Prudence Wing Hang Cheung, Carlos King Ho Wong, Jason Pui Yin Cheung

Purpose:

To translate and cross-culturally adapt the Back Beliefs Questionnaire (BBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ) into traditional Chinese for their use in patients experiencing low back pain (LBP).

Methods:

This was a prospective questionnaire translation and psychometric validation of the BBQ and FABQ in Chinese patients with back pain. Patients also completed the Traditional Chinese (Hong Kong) versions of the Oswestry Disability Index (ODI), the Short Form-12 version 2 (SF-12v2) questionnaires and the visual analogue scale (VAS) for LBP. Construct validity was assessed using Spearman's correlation test against the subscales and domains with similar constructs. Internal consistency was assessed by Cronbach's alpha (α). Sensitivity was determined by known-group comparisons.

Results:

A total of 100 patients were recruited. Both BBQ (α = 0.810) and FABQ (α = 0.859) demonstrated excellent overall internal consistency. BBQ scores significantly correlated with ODI scores, VAS-LBP and all domains of SF-12v2 (p < 0.01-0.05), whereas only FABQ Work subscale correlated with ODI scores (p < 0.01) and VAS-LBP (p < 0.05). Both FABQ subscales correlated with only specific domains of SF-12v2 (p < 0.01-0.05). FABQ-W was sensitive to difference between patients with acute versus chronic back pain.

Conclusion:

Both the adapted BBQ and FABQ (Traditional Chinese-Hong Kong) were demonstrated to have satisfactory psychometric properties, with adequate internal consistencies, construct validity and sensitivity to certain clinical parameters. Our findings were based on a clinically relevant patient group and provides insight into patients' own perception of back pain which may often be different from that of surgeons. This is a platform for future cross-cultural comparisons.

https://pubmed.ncbi.nlm.nih.gov/29610990/

Title:

SF-6D population norms for the Hong Kong Chinese general population

Carlos K. H. Wong, Brendan Mulhern, Garvin H. L. Cheng, Cindy L. K. Lam

Purpose:

To estimate population norms for the SF-6D health preference (utility) scores derived from the MOS SF-36 version 1 (SF-36v1), SF-36 version 2 (SF-36v2), and (SF-12v2) health surveys collected from a representative adult sample in Hong Kong, and to assess differences in SF-6D scores across sociodemographic subgroups.

Methods:

A random telephone survey of 2410 Chinese adults was conducted. All respondents completed questionnaires on sociodemographics and presence of chronic diseases (hypertension, diabetes, chronic rheumatism, chronic lung diseases, stroke, and mental illness), and the short-form 36-item health survey (SF-36) version 1, and selected items of the SF-36v2 that were different from those of SF-36v1. Responses of short-form 12-item health survey (SF-12) were extracted from responses of the SF-36 items. SF-6D health utility scores were derived from SF-36 version 1 (SF-6DSF-36v1), SF-36 version 2 (SF-6DSF-36v2), and SF-12 version 2 (SF-6DSF-12v2) using Hong Kong SF-6D value set.

Results:

Population norms of SF-6DSF-36v1, SF-6DSF-36v2, and SF-6DSF-12v2 for the Hong Kong Chinese were 0.7947 (± 0.0048), 0.7862 (± 0.0049), and 0.8147 (± 0.0050), respectively. Three SF-6D scores were highly correlated (0.861–0.954), and had a high degree of reliability and absolute agreement. Males had higher health utility scores (SF-6DSF-36v1: 0.0025; SF-6DSF-36v2: 0.025; SF-6DSF-12v2: 0.018) but reported less problems in all the dimensions than women. Respondents with a higher number of chronic diseases had lower SF-6D scores. Among all respondents with one or more chronic diseases, those with hypertension scored the highest whereby those with mental illness scored the least.

Conclusion:

The SF-6D utility scores derived from different SF-36 or SF-12 health surveys were different. The population norms based on these three health surveys enable the normative comparisons of health utility scores from specific population or patient groups, and provide estimates of age–gender adjusted health utility scores for health economic evaluations.

https://pubmed.ncbi.nlm.nih.gov/29797176/

Title:

Measurement properties of ThyPRO short-form (ThyPRO-39) for use in Chinese patients with benign thyroid diseases

Carlos K. H. Wong, Edmond P. H. Choi, Y. C. Woo & Brian H. H. Lang

Purpose:

To evaluate the validity and reliability of a newly-translated Thyroid-specific Patient-Reported Outcome short-form (ThyPRO-39) instrument for ethnic-Chinese patients suffering from benign thyroid diseases.

Methods:

The translation and cross-cultural adaptation of the English ThyPRO-39 were performed using the double forward translation, reconciliation, single backward translation, and cognitive debriefing, followed by a panel review. Cross-sectional data of 308 patients with benign thyroid diseases were utilized for this psychometric evaluation of ThyPRO-39 instrument. Convergent validity between similar construct in the ThyPRO-39, SF-6D, and SF-12v2 was assessed using Spearman correlations. The internal construct validity was assessed by corrected item-total correlations. Sensitivity of the ThyPRO-39 domain scores was determined by performing known group comparisons by independent t test. The internal consistency reliability was assessed by Cronbach’s alpha coefficient.

Results:

Significant floor effects were observed in 9 out of 13 domains of the ThyPRO-39. The hypothesized correlations between similar constructs in the ThyPRO-39 and the SF-12v2 and SF-6D were generally observed, supporting convergent validity. The internal construct validity was supported in most items, except eight items in six scales. Scale score of hyperthyroid symptoms of the ThyPRO-39 was significantly higher in the group with Graves’ disease or hyperthyroid disease than the group without Graves’ disease nor hyperthyroid disease. Scale scores of eye symptoms and impaired daily life were significantly higher in the incidental group than the non-incidental group. For six domains (hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, tiredness, depressivity, and emotional susceptibility), Cronbach’s alpha did not reach the recommended standard of 0.7.

Conclusion:

This was the first psychometric study to translate and adapt the ThyPRO-39 instrument for non-Caucasian patients, and report its validity and reliability for use in Chinese patients with benign thyroid diseases. Given the low item-total correlations in eight items and low internal consistency reliability in respective scales of the ThyPRO-39, we suggest that the improvement of those eight items should produce a more valid and reliable ThyPRO-39 instrument.

https://link.springer.com/article/10.1007/s11136-018-1857-9

Title:

Health-related quality of life and health utility of Chinese patients undergoing nocturnal home haemodialysis in comparison with other modes of dialysis

Carlos K H Wong, Julie Y Chen, Samuel K S Fung, Wai Kei Lo, Sing Leung Lui, Tak Mao Chan, Yuk Lun Cheng, Irene Kong, Eric Y F Wan, Cindy L K Lam

Background:

To compare the health-related quality of life (HRQOL) and health utility of Chinese patients with end-stage renal disease (ESRD) undergoing nocturnal home haemodialysis (Home HD) against those patients undergoing other modes of dialysis.

Methods:

Chinese ESRD patients undergoing Home HD were recruited in renal specialist outpatient clinics at three public hospitals in Hong Kong. SF-12 Health Survey (SF-12) was used to measure HRQOL and generate the SF-6D heath utility score. Mean scores of SF-12 domains, physical and mental component summary and SF-6D health utility of 41 patients undergoing Home HD were compared with available scores of patients receiving other forms of dialysis, namely, peritoneal dialysis (PD) (n = 103), hospital in-centre HD (n = 135) or community in-centre HD (n = 118). Adjusted linear regression models were used to examine the impact of mode of dialysis on the HRQOL and health utility scores, accounting for the sociodemographic and clinical characteristics.

Results:

ESRD patients undergoing PD and community in-centre HD had better health utility, physical and mental component summary scores than the hospital in-centre HD. Adjusted analysis showed that hospital in-centre HD reported worse physical component summary and health utility scores when compared with PD and community in-centre HD.

Conclusion:

HRQOL and health utility scores of patients undergoing Home HD were similar to those undergoing PD and community in-centre HD. Better physical aspects of HRQOL and health utility was observed in PD and community-based HD than hospital in-centre HD, providing evidence for the increase in capacity of non-hospital-based HD, which provided flexibility as well as patient centredness and empowerment in Hong Kong.

https://pubmed.ncbi.nlm.nih.gov/29926521/

Title:

Evaluation of the internal and external responsiveness of Short Form-12 Health Survey version 2 (SF-12v2) in patients with type 2 diabetes mellitus

Eric Yuk Fai Wan, Edmond Pui Hang Choi, Esther Yee Tak Yu, Weng Yee Chin, Colman Siu Cheung Fung, Anca Ka Chun Chan, Cindy Lo Kuen Lam

Purpose:

The evidence on the responsiveness of the Short Form-12 Health Survey version 2 (SF-12v2) in patients with type 2 diabetes mellitus (T2DM) is limited. The aim of this study was to examine both the internal and external responsiveness of the SF-12 measures in Chinese patients with T2DM.

Methods:

A prospective longitudinal observational study was conducted on 1443 T2DM patients managed in public primary care clinics between 2012 and 2013. These patients were surveyed at baseline and at 12 months using SF-12v2. The internal responsiveness was evaluated by linear mixed effect models. Meanwhile, the external responsiveness was tested by multiple linear regression models and receiver operating characteristic (ROC) curve analysis.

Results:

The internal responsiveness of the SF-12v2 to detect negative change was satisfactory among T2DM patients in worsened group, but only the general health domain of SF-12v2 could detect positive change among T2DM patients with improved group. For external responsiveness, the SF-12v2 detected a significant difference-in-difference between patients with worsened and stable/improved group, but not between patients with stable and improved group. The areas under the ROC curve for all domains and summary scales of the SF-12v2 were not statistically different from 0.7.

Conclusion:

This study showed that the responsiveness of SF-12v2 might not achieve the standard. Despite the wide use of the SF-12v2, we would like to urge that both clinicians and researchers should use it with caution in longitudinal study.

https://pubmed.ncbi.nlm.nih.gov/29948606/

Title:

Spillover Effects of Maternal Chronic Disease on Children's Quality of Life and Behaviors Among Low-Income Families /p>

Vivian Y W Guo 1 , Carlos K H Wong 2 , Rosa S M Wong 1 3 , Esther Y T Yu 1 , Patrick Ip 3 , Cindy L K Lam 1

Background:

Mothers with chronic diseases may have spillover effects on their children.

Objective:

The aim of this study was to estimate the spillover effects of mothers with chronic disease on their children's health-related quality of life (HRQOL) and behavior.

Method:

A cross-sectional study was conducted on 255 mother-child pairs (130 boys and 125 girls, mean age 8.4 years) from low-income Chinese families. We asked the mothers to self-report any doctor-diagnosed chronic diseases, and evaluate their children's HRQOL and behaviors with the Child Health Questionnaire-Parent Form-50 (CHQ-PF50) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Multiple linear regression analysis was conducted to assess the independent spillover effect of maternal chronic disease on children's HRQOL and behaviors, with adjustment for confounders. The differential impact of maternal physical and mental diseases was also investigated.

Results:

Over one-third of mothers (n = 88, 34.5%) reported one or more doctor-diagnosed chronic diseases. Multiple linear regression analysis showed that children of mothers with chronic diseases had significantly lower CHQ-PF50 scores in the parental impact-time, parental impact-emotional, and family activities subscales and psychosocial summary scores, as well as more hyperactive and inattentive problems measured by SDQ after adjustment for confounders. Maternal mental and physical disease showed a differential impact on children's HRQOL and behavior.

Conclusion:

Chronic disease in mothers might exert adverse effects on their children's HRQOL and behaviors. The effects could differ by maternal physical or mental disease status. Special attention and support should be paid to children of mothers with chronic disease as these children are at an increased risk of poor HRQOL and problematic behaviors.

https://pubmed.ncbi.nlm.nih.gov/29777517/

Title:

Poverty and health-related quality of life of people living in Hong Kong: comparison of individuals from low-income families and the general population.

Lam C.L.K., Guo V.Y., Wong C.K.H., Yu E.Y.T., Fung C.S.C.

Background:

To assess health-related quality of life (HRQOL) among Chinese adults from low-income households in Hong Kong, and to explore any threshold of household income that impaired HRQOL.

Methods:

A cross-sectional analysis was conducted on 298 adults from low-income families when they enrolled into a cohort study between 2012 and 2014. HRQOL was measured by the 12-item Short-Form Health Survey-version 2 (SF-12v2). Their mean SF-12v2 subscale and summary scores were compared with those of 596 age-sex-matched subjects randomly selected from a database of 2763 adults from the Hong Kong general population (ratio = 1:2). Multiple linear regressions were conducted to determine any association between monthly household income and HRQOL.

Results:

Subjects from low-income households had significantly lower SF-12v2 bodily pain, general health, vitality and physical component summary (PCS) scores than the age-sex matched subjects from the general population. Subgroup analysis showed that a household income <50% of the median monthly household income in Hong Kong (HK$10 000 ≈ US$1290, i.e. poverty line in Hong Kong) was independently associated with poorer PCS and mental component summary (MCS) scores after adjustment for socio-demographics and co-morbidities.

Conclusion:

Chinese adults from low-income households had poorer HRQOL, and <50% of the median monthly household income seems to be the threshold for impairment of both physical and mental HRQOL. The findings support the current definition of the poverty line.

https://pubmed.ncbi.nlm.nih.gov/27222238/

Title:

Is the SF-12 version 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese?

Lam ETP, Lam CLK., Fong DYT., Huang WW.

Rationale and Obectives:

The scoring algorithm of the 12-item Short-Form Health Survey (SF-12) was revised in the second version (SF-12v2), but information on its psychometric properties is lacking. This study determined whether the SF-12v2 was a valid and equivalent substitute for the SF-36v2 Health Survey (version 2) for the Chinese.

Methods:

A total of 2410 Chinese adults in Hong Kong completed the SF-36 Health Survey by telephone. The SF-12v2 data were extracted from the SF-36 data. Internal consistency was assessed by Cronbach's alpha, and test-retest reliabilities were evaluated by intraclass correlation. Criterion validity and equivalence were assessed using the SF-36v2 scores as a gold standard. Construct validity and sensitivity were assessed by known-group comparison.

Results:

Internal consistency and test-retest reliabilities were good (range 0.67-0.82) for all except three scales. The SF-12v2 summary scores explained >80% of the total variances of the SF-36v2 summary scores. Construct validity and sensitivity were confirmed by significantly lower SF-12v2 scores in people with chronic diseases than those without. Effect size differences were less than 0.3 and relative validities were greater than 0.7 between SF-12v2 and SF-36v2 scores for different groups.

Conclusion:

The SF-12v2 was valid, reliable and sensitive for the Chinese. It is an equivalent substitute for the SF-36v2 for the summary scales.

https://pubmed.ncbi.nlm.nih.gov/22128754/

Title:

Valuation of the SF-6D health states is feasible, acceptable, reliable and valid in a Chinese population.

Lam CL, Brazier J, McGhee SM.

Objective:

The SF-6D is a preference-based measure of health (PBMH) derived from the SF-36 for economic evaluation. The aim of this study was to find out whether it was feasible, acceptable, reliable, and valid to use the standard gamble (SG) method to generate preference-based values for the SF-6D in a Chinese population.

Method:

The SF-6D was translated into Chinese by forward and backward translations. Forty-nine states defined by the SF-6D were selected using an orthogonal design and grouped into seven sets. An age-sex stratified sample of 126 Chinese adults with low education levels valued a set of 7 and the pits (worst) SF-6D health states by the SG method. The data were modeled at the individual and mean levels to predict preference values for all SF-6D states. The quality of data and the predictive power of the models were compared with results from the United Kingdom.

Results:

All respondents completed the interviews with 3% finding the process very difficult and 21% felt some degree of irritation or boredom. A total of 907 SG valuations (90% out of 1008 observations) were useable for econometric modeling. There was no significant change in the test-retest values from 21 subjects. The main mean effect models achieved a good fit with a mean absolute error of 0.054. Some differences between the Chinese and UK preference coefficients were found especially in the physical functioning dimension. The range of SG values predicted by the HK function is slightly longer, with the pits state having a value of 0.152 compared to 0.271 in the UK.

Conclusion:

It was feasible, acceptable, reliable, and valid to value the SF-6D with the SG method in a Chinese population with relatively low education levels. The results supported the feasibility and validity of valuing PBMH in Asian populations. Further studies are required to determine whether the differences in the SF-6D scoring algorithms between the British and Chinese populations are important.

https://pubmed.ncbi.nlm.nih.gov/18380642/

Title:

The SF-36 summary scales were valid, reliable, and equivalent in a Chinese population

Lam C.L.K., Tse E.Y.Y., Gandek B. Fong D. Y. T.

Objective:

To find out whether the SF-36 physical and mental health summary (PCS and MCS) scales are valid and equivalent in the Chinese population in Hong Kong (HK).

Study Design and Setting:

The SF-36 data of a cross-sectional study on 2,410 Chinese adults randomly selected from the general population in HK were analyzed.

Results:

The hypothesized two-factor structure of the physical and mental health summary scales (PCS and MCS) was replicated and the expected differences in scores between known morbidity groups were shown. The internal reliability coefficients of the PCS and MCS scales ranged from 0.85 to 0.87. The effect size differences between the U.S. standard and HK-specific PCS and MCS scores were mostly <0.5. The effect size differences in the standard PCS and MCS scores of specific groups between the U.S. and H.K. populations were all <0.5.

Conclusion:

The PCS and MCS scales were applicable to the Chinese population in HK. The high level of measurement equivalence of the scales between the U.S. and H.K. populations suggests that data pooling between the two populations could be possible. To our knowledge, this is the first study to show that the SF-36 summary scales are valid and equivalent in an Asian population.

https://pubmed.ncbi.nlm.nih.gov/16018917/

Title:

Can the Dartmouth COOP/WONCA charts be used to assess the functional status of Chinese patients?

C L Lam, C van Weel, I J Lauder

Abstract:

This is the first study on the use of the Dartmouth functional health assessment charts COOP/WONCA in the assessment of the functional status of Chinese patients. The Chinese are the world's largest ethnic group and make up more than one-fifth of the world's population. We have developed a Chinese translation of the Dartmouth COOP/WONCA charts that satisfies the two minimal and one intermediate criteria on translation of scales and instruments set by the European Research Group in Health Outcome (ERGHO). We tested the charts on 84 Chinese patients with previous strokes when they attended follow-up at the General Practice Unit of the University of Hong Kong from 1 August to 30 November 1992. We found that the Dartmouth COOP/WONCA charts in Chinese were easy to administer and were well accepted by our patients. All but one patient understood all the charts. There was good face validity in the results obtained by the charts. The consulting doctors found that the information detected by the charts was moderately useful in 64% of the patients and was very useful in 5% of the patients. Our translation can be applied to other Chinese in Hong Kong as well as other countries, because there is only one written Chinese language. It is hoped that our pilot study will stimulate further research to establish the reliability, validity and clinical application of the COOP/WONCA charts in Chinese.

https://pubmed.ncbi.nlm.nih.gov/8034158/

Title:

In depth cost-effectiveness study of Patient Empowerment Programme (PEP) of the Hospital Authority

Principal Investigator:

William CW Wong

Co-Investigators:

Weng-Yee Chin, Julie Y Chen, Colman SC Fung, Daisy Dai, Eva LH Tsui, Esther YT Yu. Daniel YT Fong, Cindy LK Lam

Objectives:

To evaluate the cost-effectiveness of the HA’s Patient Empowerment Programme (PEP) for those with diabetes mellitus, or hypertension.The objectives are 1) to obtain data on outcomes from the accompanying studies on quality of care and to translate this into measures of benefit for a cost-effectiveness analysis (CEA) 2) to obtain cost information for each relevant part of the programmes, ideally marginal cost information i.e. the cost of dealing with one extra patient under PEP 3) to estimate cost-effectiveness using a variety of outcome measures 4) to model cost-effectiveness over the longer term and program expansion to identify cost-drivers and areas of uncertainty 5) to perform a value of perfect information (VPI) analysis to determine the worth of collecting further information to assist in determining cost-effectiveness 6) to collate all information into a robust model which can test variations in assumptions and parameters and aid decision-making about long term cost-effectiveness.

Methods:

Each participating clinic will complete a structured evaluation questionnaire and the data of all patients with diabetes mellitus or hypertension who have enrolled in the PEP programme will be included in the evaluation. Age, sex and disease-severity matched control patients (n=1300) who have not been enrolled into the PEP programme will be recruited as controls for the PEP CEA. A further 130 PEP participants and 130 non-PEP participants will be followed up by telephone to evaluate the effect of the programme on quality of life (QOL). Clinical indicators and data on public health service utilization will be retrieved from the HA clinical medical system. The primary health-related outcomes are the proportion of participants who achieve appropriate clinical outcomes (e.g. for diabetes the proportion with HbA1c level <7%), changes in complication risk status which can then be translated to likely changes in numbers of bad outcomes (e.g. stroke, heart attack, renal failure, blindness) over the longer term and the QOL information (translated to a utility score). The viewpoint for this CEA will be societal including patient, HA/provider and NGO viewpoints. The main costs from the provider/HA viewpoint are likely to be the cost of arranging and maintaining NGO involvement. The costs from the NGO viewpoint will be the costs of delivering the services and from the patient viewpoint will include any fees paid and other out of pocket costs including travel and time. The societal viewpoint will include productivity loss or gain for those of working age. The costs are planned to be estimated at around two years and four years of operation in order to better utilize the research staff but this will be reviewed as necessary. Any changes in health care utilization for patients in PEP will be determined by comparing the data from the HA clinical medical system on public service utilization (inpatient and outpatient, including Accident and Emergency services) for the PEP and non-PEP participants. Other data will include estimation of future patient numbers, life table data to estimate life years saved and QALYs gained by the patients, clinical data from the HA clinical management system to characterize patient risk and changes in this. Some of this data will be collected longitudinally. Both cost and outcome data will be compiled and initial simple measures of cost and outcome will be generated. These data will be used to develop a model which will be updated with the longitudinal information and will be used to estimate relative cost-effectiveness of PEP taking into account uncertainties and missing data which will be tested in sensitivity analyses and potential cost drivers which will be used to generate costs per outcome over varying time periods, acceptability curves, the parameters most likely to affect cost-effectiveness and the amount worth spending on obtaining further information (VPI analysis), budget impact for the HA in different cost categories(staffing, organizational costs) and for PEP, for patients and NGOs under various assumptions of the future development of the service.

Results:

The cost-effectiveness of the PEP programmes will be determined as well as the cost-drivers and potential for future cost-effectiveness.

Title:

A Study on Health-related Quality of Life of patients with Colorectal Neoplasm and Cost-Effectiveness Analysis of Colorectal Cancer Screening in Hong Kong

Principal Investigator:

Cindy L. K. Lam

Introduction:

Colorectal cancer (CRC) is the second most common cancer among Chinese in Hong Kong and the second leading cause of cancer death in this population. Several screening strategies has been associated with improved survival and may affect patients' health-related quality of life (HRQOL). HRQOL impact should be used to adjust for survival in terms of quality adjusted life years (QALY) in the evaluation of cost-effectiveness of any intervention including screening.

Objectives:

to determine the HRQOL and health preference of patients with different stages of colorectal neoplasm, and to determine the most cost-effective CRC screening strategy for increasing QALYs. Design and Subjects: A longitudinal survey to collect data on HRQOL associated with colorectal neoplasm for Markov modeling on cost-effectiveness of CRC screening. A stratified sample of 420 patients with colorectal polyps and different stages of CRC will be recruited from colorectal clinics of Queen Mary Hospital for health preference and HRQOL assessment. The HRQOL over time will be measured at baseline, 6 and 12 months later. Health preference data will be integrated with cost and effectiveness data obtained from the literature to determine the cost-effectiveness of currently recommended CRC screening strategies by Markov modeling.

Main outcome measures:

The primary outcome measure is the SF-6D health preference value and QALYs. Secondary outcomes are the SF-12v2 and FACT-C scores. The outcomes will be compared between patients with different stages of colorectal neoplasm. Markov modeling study will estimate the expected QALYs gained and incremental cost-effectiveness ratio for each CRC screening strategy.

Results:

The study will provide information on HRQOL of patients with colorectal neoplasm to guide health services. The Markov Model will identify the most cost-effective CRC screening strategy for Hong Kong Chinese, which can inform policy makers and the public for the prevention of CRC of the population.

Title:

Development of the brief version of the Chinese Quality of Life (ChQOL) Instrument

Principal Investigator:

Wendy Wong

Co-Investigators:

Kwok Fai Leung, Li Zhao,Feng Bin Liu, Justin Wu

Purpose:

The Chinese Quality of Life Instrument (ChQOL)is the first patients reported outcome (PRO) established bas-ing on the health concept of Traditional Chinese Medicine(TCM) among most instruments based on Western culture. Ithas been culturally adapted in China, Australia, France andHong Kong with satisfactory psychometric properties. ChQOLconsists of 50 items in 13 facets which are grouped in threedomains: (1) physical form, (2) vitality and spirit and (3) emo-tion. However, the ChQOL was regarded as lengthy, whichhinders its application as an outcome measure. Therefore, weaim at developing a brief version ranging from 13-26 items ofthe ChQOL to ease administration and facilitate wider appli-cation

Methods:

Two short forms of ChOQL (26-item or 13-itemwith 1-2 items per facet) were developed by a secondary anal-ysis (regression analysis and classical test theory), based onempirical data of 1,410 of healthy to a wide range of diseasesseverity subjects. These two short forms of ChQOL were val-idated by (1) 20 registered Chinese Medicine practitioners onthe content and (2) a sample of 1,056 subjects, covering a rangeof health status (from healthy to severely ill) in Hong Kong. Thebrief versions of ChQOL were examined on the structure fit-ness, construct validity, equivalency when compared with thefull version.

Results:

Complied with ISOPOR, the psychometric proper-ties of two short forms were investigated and compared withthe full version.

Conclusion:

The first PRO, based on the health concept ofTCM, ChQOL will be shortened to facilitate a wider application.

Title:

A Prospective Randomized Study on Health-related Quality of Life of Patients With Incidental Small (<2cm) Asymptomatic Thyroid Nodules and Cost-effectiveness Analysis in Managing Small Incidental Thyroid Nodules

Principal Investigator:

Cindy L. K. Lam

Brief Summary:

Ideally randomized controlled trials should be carried out to compare the cost-effectiveness between FNAC and watchful waiting but such studies are very difficult to conduct in practice because they require following up very large number of subjects for a long period of time. The aims are to determine the health-related quality of life (HRQOL) and HRQOL preference (utility) of patients undergoing watchful observation (no FNAC) and routine FNAC, and to determine the cost-effectiveness of two strategies in managing small incidental thyroid nodules for the Chinese population in Hong Kong.

Title:

A pilot study on the validity and reliability of the Patient Enablement Instrument (PEI) in a Chinese population

Principal Investigator:

Professor Cindy L.K. Lam

Co-Investigators:

Natalie YK Yuen, Stewart W Mercer, Wendy Wong

Background:

The Patient Enablement Instrument (PEI) was developed to measure patients’ enablement, which is an indicator of the effectiveness of a primary care consultation; however, to date, the PEI has not been tested in Asian populations.

Objectives:

The purpose of this study is to test the acceptability, validity, reliability and other psychometric properties of a Chinese [Hong Kong (HK)] translation of the PEI in Chinese patients in Hong Kong and whether these properties would be affected by different timing of administration.

Methods:

A Chinese (HK) translation of the PEI was developed by iterative forward–backward translations and the content validity was assessed by a cognitive debriefing interview with 10 Chinese patients. It was then administered to 152 adult patients attending a government-funded primary care clinic in Hong Kong both immediately after the consultation and 2–3 weeks later by telephone. Internal construct validity was assessed by item-scale correlations and factor analysis, test–retest reliability was assessed by intraclass correlation (ICC) and sensitivity was assessed by known group comparison.

Results:

The Chinese (HK) PEI was semantically equivalent to the original PEI for all items. Acceptability of the PEI was high with 83.1% response and 100% completion rates. Statistical analyses showed no difference between test and retest means as well as good reproducibility (ICC 0.75). Internal reliability determined by Cronbach’s alpha was >0.8 irrespective of timing of administration. Scale construct validity was confirmed by strong (r > 0.4) item-scale correlations and resumed to a one-factor hypothesized structure. PEI scores were significantly higher in younger patients supporting sensitivity. There was no significant difference in the psychometric properties or scores between the assessment results from immediately after and 2-weeks post-consultation.

Conclusions:

A Chinese (HK) translation of the PEI equivalent to the original is now available for application to Chinese populations. Pilot testing supported its acceptability, validity, reliability and sensitivity. Further studies to confirm its construct validity and responsiveness will help to establish the Chinese (HK) PEI as an outcome measure of the effectiveness of primary care consultations in Chinese patients.