Cross-country Comparability Research Articles

Developing survey instruments for low back and neck pain to improve disease severity estimates for burden of disease assessment

Abstract Two people living with the same disease can have very different experiences; one has little consequence, whilst the other struggles with much more debilitating consequences that impacts how they live their lives day-to-day. A growing body of research highlights the need for better estimates of disease severity to facilitate better estimation of the non-fatal burden of disease (BOD). Routine data does not always offer solutions because it’s often not coded at a granular enough level to map to individual health states. Data offering solutions are scarce and therefore not available across time or space. Most commentators have quantified the problem of assuming the same proportional severity splits to fill data gaps; a problem common to the Global Burden of Disease (GBD) study and independent BOD studies. However, whilst the need for highlighting the problems associated with this assumption remains, there are other positive steps that can be taken to overcome it. We propose how reproducible approaches can be developed, and present how they can be used to develop disease severity estimates. This involves developing a survey instrument to estimate the overall and health state prevalence of back pain and neck pain, basing health state definitions from the GBD non-fatal disease models, where the classification of cases by severity is based on the combination of respondent’s answers. Furthermore, we discuss how self-assessed severity estimates allow for internal validity checks, but also more widely offer opportunities to appraise the appropriateness of GBD non-fatal disease models. The development, and publication, of survey instruments can assist both independent studies and the GBD study to improve estimates of disease severity, as well as retaining important opportunities for cross-country comparability. Understanding the spectrum of severity is important for understanding how disease impacts populations and can inform healthcare provision and expenditure strategies.

Hypertension cascade across three healthcare systems and in relation to the level of implementation of the integrated care package of hypertension

Introduction: Primary health care (PHC) systems across the globe are struggling to produce an effective response to the rising burden of disease related to Type 2 Diabetes (T2D). However, effective T2D care at the PHC level – the ‘Integrated Care Package (ICP)’– exists and is cost-effective. Further, there is evidence that this integrated care package ((1) structure) leads to improved care processes (2), to health care responsive to people’s needs and eventually to better health outcomes (3). There is however a clear need for an assessment framework to enable countries to evaluate their progress towards integrated care for T2D.
 We aim to test an assessment framework incorporating these 3 elements: (1) a tool to assess the degree to which the T2D care provided corresponds to the ICP for T2D (structure); (2) cascades-of-care to visualize and detect the ‘leakages’ at each separate step of the care continuum (process and outcomes of T2D care); and (3) a contextualization of (1) and (2) in order to explain why the implementation of specific ICP elements has or has not led to the expected outcomes. This framework will be tested in 3 countries with different PHC approaches, namely Slovenia, Belgium and Cambodia.
 Methods: A mixed methods design is used. First, information about the level of ICP implementation is collected using the ICP Grid at the health care facility level. Secondly, patient level data is used to build de T2D cascades-of-care: we rely on representative survey data (5000 individuals) in Cambodia, on health insurance (+ laboratory) data in Belgium and routine data in Slovenia. Where feasible, we used ICP scores as explanatory variables explaining the drops in the cascade. Thirdly, expert consultations and stakeholder interviews were used to contextualize the findings.
 Results: The ICP grid scores showed considerable variations in the implementation of the ICP for patients with T2D between Belgium, Slovenia, and Cambodia – with Slovenia consistently reporting the highest scores. However, important in-country variations were observed for Belgium and Cambodia indicating that specific initiatives have resulted in higher levels of integrated care. In terms of T2D care process and outcomes, the country cascades-of-care display similar profiles with the biggest drops at the ‘diagnosis’ and ‘under control’-bars. The qualitative data on the health system clearly demonstrate that the context can hamper (1) the construction of the cascades (i.e. in Belgium and Cambodia due an absence of a routine monitoring system) and (2) the linking of the ICP grid data with the cascade-of-care data (i.e. in Cambodia where the private sector takes up a large proportion of T2D care).
 Conclusions: The developed framework offers a promising strategy to assess (1) the progress made in ICP implementation in PHC for T2D as well as (2) its impact on the T2D care process and outcomes. As such, the framework offers policy makers and stakeholders a tool to monitor T2D care and adapt specific elements where required. The study, however, also indicated severe challenges in collecting the required data which also limited the cross-country comparability of the produced outcomes.

ORPHAcodes use for the coding of rare diseases: comparison of the accuracy and cross country comparability

BackgroundEstimates of rare disease (RD) population impact in terms of number of affected patients and accurate disease definition is hampered by their under-representation in current coding systems. This study tested the use of a specific RD codification system (ORPHAcodes) in five European countries/regions (Czech Republic, Malta, Romania, Spain, Veneto region-Italy) across different data sources over the period January 2019-September 2021.ResultsOverall, 3133 ORPHAcodes were used to describe RD diagnoses, mainly corresponding to the disease/subtype of disease aggregation level of the Orphanet classification (82.2%). More than half of the ORPHAcodes (53.6%) described diseases having a very low prevalence (< 1 case per million), and most commonly captured rare developmental defects during embryogenesis (31.3%) and rare neurological diseases (17.6%). ORPHAcodes described disease entities more precisely than corresponding ICD-10 codes in 83.4% of cases.ConclusionsORPHAcodes were found to be a versatile resource for the coding of RD, able to assure easiness of use and inter-country comparability across population and hospital databases. Future research on the impact of ORPHAcoding as to the impact of numbers of RD patients with improved coding in health information systems is needed to inform on the real magnitude of this public health issue.

Patterns of Womenʼs exposure to psychological violence: A global examination of low- and middle-income countries

IntroductionUnder Sustainable Development Goal 5, prevalence of intimate partner violence (IPV) is a globally reportable indicator. There is a lack of consensus on how to measure and report psychological IPV, affecting prevalence estimates and cross-country comparability. We examine similarities and differences in the patterning of women's experiences of psychological abuse in low- and middle-income countries (LMICs) to inform common cut points. MethodsData include 13,452 ever-partnered women from six LMICs participating in the WHO multi-country study on women's health and domestic violence against women and 306,101 from 47 LMICs participating in the Demographic and Health Surveys. A confirmatory latent class analysis (LCA) approach was applied to identify the optimal class structure using the 3 DHS and 4 WHO psychological IPV items, assessed the impact of physical and sexual IPV on class structure, and tested class generalizability across countries. We validated the three-class solution by regressing the classes on physical IPV, sexual IPV, controlling behaviors, and injury due to domestic violence. We used item response theory (IRT) methods to assess item-level characteristics of the items. ResultsAnalysis confirmed the three-class structure in most countries. Addition of physical and sexual IPV did not change overall class structure or improve discrimination or homogeneity of the items. The three-class structure was invariant within most WHO-classified regions. Operationalized classes informed by the LCA resulted in prevalences of roughly 90% low-to-no class, 7% moderate-intensity class, and 3% high-intensity class. Classes showed convergent validity with all outcomes tested. IRT analysis revealed good discriminations but substantial information overlaps over a narrow range of the latent psychological violence construct. ConclusionsThis study confirms the three-class pattern but suggests some differences across countries. and regions. We suggest cut points distinguishing violent from non-violent acts and demarcating levels of severity for future study. Findings offer evidence-based guidance to rectify challenges.

Reliability and cross-country equivalence of the 8-item version of the Patient Health Questionnaire (PHQ-8) for the assessment of depression: results from 27 countries in Europe.

The 8-item version of the Patient Health Questionnaire (PHQ-8) is one of the self-reported questionnaires most frequently used worldwide for the screening and severity assessment of depression. However, in some European countries its reliability is unknown, and it is unclear whether its psychometric properties vary between European countries. Therefore, the aim of this study was to assess the internal structure, reliability and cross-country equivalence of the PHQ-8 in Europe. All participants from the 27 countries included in the second wave of the European Health Interview Survey (EHIS-2) between 2014 and 2015 with complete information on the PHQ-8 were included (n=258,888). The internal structure of the PHQ-8 was assessed using confirmatory factor analyses (CFA) for categorical items. Additionally, the reliability of the questionnaire was assessed based on the internal consistency, Item Response Theory information functions, and item-discrimination (using Graded Response Models), and the cross-country equivalence based on multi-group CFA. The PHQ-8 shows high internal consistency for all countries. The countries in which the PHQ-8 was more reliable were Romania, Bulgaria and Cyprus and less reliable were Iceland, Norway and Austria. The PHQ-8 item with highest discrimination was item 2 (feeling down, depressed, or hopeless) in 24 of the 27 countries. Measurement invariance between countries in Europe was observed from multigroup CFA at the configural, metric and scalar levels. The results from our study, likely the largest study to the date assessing the internal structure, reliability and cross-country comparability of a self-reported mental health assessment measure, shows that the PHQ-8 has an adequate reliability and cross-country equivalence across the 27 European countries included. These results highlight the suitability of the comparisons of the PHQ-8 scores in Europe. They could be helpful to improve the screening and severity assessment of depressive symptoms at the European level. This work was partially funded by CIBER Epidemiology and Public Health (CIBERESP) as part of the Intramural call of 2021 (ESP21PI05).

A Novel Indicator to Correct for Individual Reported Heterogeneity. An Application to Self-Evaluation of Later-Life Depression.

Program evaluations often investigate complex or multi-dimensional constructs, such as individual opinions or attitudes, by means of ratings. A different interpretation of the same question may affect cross-country comparability, leading to the Differential Item Functioning problem. Anchoring vignettes were introduced in the literature as a way to adjust self-evaluations from this interpersonal incomparability. In this paper, we first introduce a new nonparametric solution to analyse anchoring vignette data, recoding a variable based on a rating scale to a new corrected-variable that guarantees comparability in any cross-country analysis. Then, we exploit the flexibility of a mixture model introduced to account for uncertainty in the response process (the CUP model) to test if the proposed solution is effectively able to remove this reported heterogeneity. This solution is easy to construct and has important advantages compared with the original nonparametric solution adopted with anchoring vignette data. The novel indicator is applied to investigate self-reported depression in an old population. Data that will be analysed come from the second wave of the Survey of Health, Ageing and Retirement in Europe, collected in 2006/2007. Results highlight the need of correcting for reported heterogeneity comparing individual self-evaluations. Once interpersonal incomparability resulting from the different uses of response scales is removed from the self-assessments, some estimates are reversed in magnitude and signs with respect to the analysis of the collected data.

Measuring Patient Experience and Patient Satisfaction—How Are We Doing It and Why Does It Matter? A Comparison of European and U.S. American Approaches

(1) Background: Patients' experiences and satisfaction with their treatment are becoming increasingly important in the context of quality assurance, but the measurement of these parameters is accompanied by several disadvantages such as poor cross-country comparability and methodological problems. The aim of this review is to describe and summarize the process of measuring, publishing, and utilizing patient experience and satisfaction data in countries with highly developed healthcare systems in Europe (Germany, Sweden, Finland, Norway, the United Kingdom) and the USA to identify possible approaches for improvement. (2) Methods: Articles published between 2000 and 2021 that address the topics described were identified. Furthermore, patient feedback in social media and the influence of sociodemographic and hospital characteristics on patient satisfaction and experience were evaluated. (3) Results: The literature reveals that all countries perform well in collecting patient satisfaction and experience data and making them publicly available. However, due to the use of various different questionnaires, comparability of the results is difficult, and consequences drawn from these data remain largely unclear. (4) Conclusions: Surveying patient experience and satisfaction with more unified as well as regularly updated questionnaires would be helpful to eliminate some of the described problems. Additionally, social media platforms must be considered as an increasingly important source to expand the range of patient feedback.

Italian cross-cultural adaptation of the patient-reported outcome measure of ataxia.

The patient-reported outcome measure of ataxia (PROM-Ataxia) is the first patient-reported questionnaire specifically developed for use in patients with cerebellar ataxia. The scale was recently designed and validated in English language, and it consists of 70 items encompassing all aspects associated with the patient experience, including physical and mental health and their consequences on activities of daily living. The aim of the study was to translate and culturally adapt into Italian the PROM-Ataxia questionnaire, before assessing its psychometric properties. We translated and culturally adapted into Italian the PROM-Ataxia following the ISPOR TCA Task Force guidelines. The questionnaire was field tested via cognitive interviews with users. The Italian patients found that the questionnaire was complete, and no significant contents related to the physical, mental, and functional dimensions were missing. Some items were found redundant or ambiguous. Most of the identified issues pertained to semantic equivalence, and a few to conceptual and normative equivalence, while the questionnaire did not contain any idiomatic expression. The translation and cultural adaptation of the PROM-Ataxia questionnaire in the Italian patient population represent the pre-requisite for the subsequent psychometric validation of the scale. This instrument may be valuable for cross-country comparability that would allow the merging of the data in collaborative multinational research studies.

Measuring non-cognitive skills exploiting log-files on online behaviour

Non-cognitive skills are important components of individuals’ human capital and good predictors of educational and labour market outcomes. Conventional self-reported measures of non-cognitive skills suffer from measurement errors stemming from self-presentation and reference group effects, which can produce paradoxical results in cross-country comparisons. We propose a novel source of measures derived from computer-generated log files on the behaviour of individuals taking an online test or respondents taking an online survey. We analyse measures of two desirable non-cognitive skills, perseverance and deep learning, constructed with log-file data from two large-scale educational surveys. Compared with the self-reported measures, our log-based behavioural measures have higher cross-country comparability, as they predict the performance of tests consistently at both individual and country levels. They also show high predictive validity in schooling and labour market outcomes, offering promise for a wide range of applications. We discuss the methodological implications of log-based behavioural measures and encourage researchers to apply them in combination with conventional self-reported measures.

IFRS Adoption and the Financial Statements Comparability: The Case of Russia and Canada

The effect of International Financial Reporting Standards (IFRS) adoption on the level of financial statements comparability was investigated for Russia in the current article. Canada was chosen for comparison due to the close time frame of IFRS adoption, which also allowed comparing the influence of IFRS adoption for both types of economies &#8211; well developed and emerging. Initial sample selection had been created from 23 companies that are presented on the stock exchange markets of the particular countries. Each sample contains semi-annual data for four years of the pre-adoption period (2008 to 2011 for Russia, 2007 to 2010 for Canada) in which companies use their home country accounting standards and four years of the post-adoption period (2012 to 2015 for Russia, 2011 to 2014 for Canada) in which companies use IFRS standards. The research was performed on the country level and industry level for both countries. Two measures had been used for the research: earnings-return regression and earnings-cash flow regression. The overall result of the study shows that the application of IFRS improved information comparability between companies only in Canada, while the same was not the case for Russian companies and the cross-country comparability. However, the study confirms an increase in the comparability level in the post-adoption period in such industries as Energy and Basic materials not only between companies inside of the given country but on the cross-country level as well.

From local prices to the global economy: A unique global collaboration that underpins the International Comparison Program

The International Comparison Program (ICP) is a unique example of enduring statistical cooperation and collaboration across national, regional, and global agencies. For over fifty years, the Program has delivered a vital public good: purchasing power parities (PPPs) and price level indexes (PLIs) for economies across the globe. PPPs enable a wealth of metrics on economic output, material well-being, and consumption, as well as a host of PPP-based indicators across the socioeconomic spectrum, many of which are used for monitoring progress towards the Sustainable Development Goals. Fundamental to these data and metrics is cross-country comparability, and the ICP’s multi-agency partnership ensures that this is achieved through agreement on common statistical standards and methods in price data collection, in national accounts expenditure data compilation, in quality assurance, and in the calculation and dissemination of results. Working within a comprehensive governance structure overseen by the United Nations Statistical Commission, the ICP Global Office at the World Bank, and five regional agencies, together with Statistical Office of the European Union (Eurostat) and Organisation for Economic Co-operation and Development (OECD), collaborate with over 170 national agencies to ensure that the work carried out across all economies adheres to these established benchmarks and processes, resulting in both bespoke ICP price collections that reflect both nationally relevant and globally comparable goods and services, and expenditure data that follow international standards. This paper presents an overview of this unique global partnership and highlights how different challenges and processes are addressed by stakeholders working with shared knowledge towards a common goal.

A novel measure of developing countries' agricultural and food policy readiness

Positive agricultural and food policy environments are critically important to the success and inclusiveness of agricultural growth and transformation. Despite the catalytic potential of enabling policies, countries vary in their willingness, capacity, and ability to improve policy: in other words they have varying degrees of policy readiness. The profession has spawned a plethora of 'policy readiness' indices over the past decade. These indices are welcome first steps, but they are non-statistical compilations of a collection of inherently different measures with unclear relationships: to borrow Ravallion's term, they are mash-up indices.In this paper we propose a novel, empirically-based policy readiness index. In contrast to prior literature, we approach the problem from a measurement perspective. This perspective enables us to aggregate items into a multi-component index such that their combination achieves superior statistical properties and assures cross-country comparability, through the application of Rasch modeling. With these empirical qualities, the meaning and robustness of the scores then become clear. We apply the model to a unique data set of policy actions prioritized in 2012/13, and the extent to which these actions were executed by Fall of 2015. The results are statistically- and measurement-valid measures of both country policy readiness and the degree of difficulty of various dimensions of policy actions.The resulting policy readiness scores are a novel index that significantly advances the dialogue on countries' abilities to execute those agricultural and food policy changes that are priorities for accelerating agricultural transformation.Policy implications include continued support for capacity building in low-readiness countries and cross-country support through continental or global processes for lowering the burden across all countries of making progress in the most difficult policy areas.

Taking a snapshot of Extension and Advisory Systems performance and outcomes: insights on a semi-quantitative evaluation approach

ABSTRACT Purpose To evaluate pluralistic Extension and Advisory Services (EAS) systems performance and outcomes, and share the experiences made with applying a participatory semi-quantitative approach allowing for cross-country comparability. Design/methodology/approach The Food and Agriculture Organization of the United Nations (FAO) developed the ‘Extension and Advisory Services (EAS) System – Yardstick’ (EAS-Y), a semi-quantitative assessment approach relying on expert-based scores to evaluate the EAS system performance on the one hand, and users’ scores to measure the system outcomes on the other. The tool was applied in three countries, Costa Rica, Ecuador, and Peru. Findings Results revealed an overall weak performance on most assessed criteria. Experts pointed out a lack of adequate policies addressing agricultural extension, insufficient funding, and poor infrastructure. On the other hand, the increased focus on sustainability, increased inclusiveness levels, and steady uptake of digitalization technologies are areas where progress was recently made. On the outcomes side, users perceived EAS contributed mainly to acquiring technical skills, while less to entrepreneurial and social skills. Practical Implications EAS-Y represented a user-friendly and cost-effective solution to identify performance gaps and assess outcomes in a semi-quantitative way. Therefore, we consider the latter has the potential to be applied to prioritize areas for intervention and guide decision-making processes. Theoretical implications The commonly existing data gap not allowing for a quantitative evaluation of pluralistic EAS systems can be overcome using a participatory evaluation tool that relies on expert and user’s judgments. Originality/Value We used an innovative evaluation approach to assess pluralistic extension systems in three Latin American countries.

Can students’ attitudes towards mathematics and science be compared across countries? Evidence from measurement invariance modeling in TIMSS 2019

This study examines the measurement invariance and cross-country comparability of noncognitive scales in international educational large-scale assessments. Specifically, the TIMSS 2019 scales measuring fourth and eighth grade students’ attitudes towards mathematics and science are analyzed using an item response theory (IRT) modeling approach with partial invariance assumptions. This approach allows the estimation of international (common) item parameters that are appropriate for most countries, while allowing for unique item parameter estimates in some countries to treat differential item functioning (DIF) and improve model-data fit. Results of this empirical evaluation show that items are comparable across most countries, supporting cross-cultural comparisons of the mathematics and science attitudes scales.

Nonlinear effects of ıncome ınequality on economic growth: A comparative analysis of selected countries

Purpose ― The paper queries the impacts of income inequality on economic growth in selected advanced and emerging market economies by adopting nonlinearity and endogeneity. Methods ― This research analysis is based on a balanced panel from 1996 to 2018 and employs the dynamic panel threshold analysis after baseline estimations with the fixed-effect, system Generalized Method of Moments, and difference Generalized Method of Moments. Findings ― This study finds a nonlinearity between income inequality and economic growth. Income inequality has a significant threshold effect on the growth of both panels. Besides, the threshold effect of emerging market countries is higher than the level for advanced countries. This means emerging market economies are negatively affected above the estimated threshold value according to the advanced economies. Implication ― This paper supports that inequality may harm much more economic growth above a specific level. On the other hand, these distorting effects are related to the other economic issues of countries, such as government spending, inflation, export of goods and services, gross fixed capital formation, and foreign direct investment. Originality ― This paper contributes to the literature by focusing on the nonlinear effects of income inequality and different aspects of economic growth above or below the estimated threshold value, thereby providing cross-country comparability and endogeneity.

In Search for Comparability: The PECUNIA Reference Unit Costs for Health and Social Care Services in Europe.

Improving the efficiency of mental healthcare service delivery by learning from international best-practice examples requires valid data, including robust unit costs, which currently often lack cross-country comparability. The European ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) aimed to harmonize the international unit cost development. This article presents the methodology and set of 36 externally validated, standardized reference unit costs (RUCs) for five health and social care services (general practitioner, dentist, help-line, day-care center, nursing home) in Austria, England, Germany, Hungary, The Netherlands, and Spain based on unambiguous service definitions using the extended DESDE PECUNIA coding framework. The resulting PECUNIA RUCs are largely comparable across countries, with any causes for deviations (e.g., country-specific scope of services) transparently documented. Even under standardized methods, notable limitations due to data-driven divergences in key costing parameters remain. Increased cross-country comparability by adopting a uniform methodology and definitions can advance the quality of evidence-based policy guidance derived from health economic evaluations. The PECUNIA RUCs are available free of charge and aim to significantly improve the quality and feasibility of future economic evaluations and their transferability across mental health systems.

Missing the wealthy in the HFCS: micro problems with macro implications

Wealth aggregates implied by the Household Finance and Consumption Survey (HFCS) usually yield much lower amounts than macroeconomic statistics reported in the National Accounts. An important source of this gap may be the under-representation of the wealthiest households in the HFCS. This article therefore combines a semi-parametric Pareto model estimated from top survey data and observations from rich lists with a non-parametric stratification approach to quantify the impact of the missing wealthy households on component-specific micro-macro gaps. We find that unadjusted micro data substantially underestimates wealth inequality. The largest effects are documented for equity. For other components, the missing wealthy explain less than ten percentage points of the micro-macro gap. We find that differences in oversampling strategies limit the cross-country comparability of unadjusted survey-implied wealth distributions and that our top tail adjustment leads to measures that are internationally better comparable.

Measuring public support for European integration using a Bayesian item response theory model

This study proposes the use of Bayesian item response theory models to measure aggregate public support for European integration. This approach addresses the limitations of other indicators and produces valid estimates of public attitudes over long time periods, even when available indicators change over time or present interruptions. I compare Bayesian item response theory models with alternative approaches used in the study of support for European integration, and demonstrate that they produce more accurate estimates of latent public opinion. The estimates are validated by showing their association both to alternative public opinion measures and to the vote share of Eurosceptic parties across Europe. I show that Bayesian models solve unaddressed issues like ensuring cross-country comparability of the estimates and modelling responses with multiple answer options.

Cross-country comparability of a social-emotional skills assessment designed for youth in low-resource environments

We evaluate the measurement invariance of a 48-item instrument designed to measure general social and emotional skills of youth in low resource environments. We refer to the skills measured as positive self-concept, negative self-concept, higher order thinking skills, and social and communication skills. These skills are often associated with economic development and can be used to evaluate programs designed to enhance economic development. Our evaluation is based on a sample of 1,794 in and out-of-school youth from Uganda and Guatemala’s Western Highlands. We conduct the analyses using a multiple group confirmatory factor analysis approach, breaking the sample by country, gender, and socio-economic status (high vs. low). Overall, our analysis points to strong invariance for all four measures across the different groups being compared. These findings contribute to the validity of the instrument as a tool for better understanding youth in diverse, developing economies.

Nový přístup v testování ekvivalence na příkladu měření subjektivního blahobytu

Survey-based measures of subjective well-being are more and more often analyzed cross-culturally. However, international comparison of these measures requires measurement invariance. Therefore, the major goal of this study was to investigate the cross-country comparability of the five-item subjective well-being scales used in the International Social Survey Programme (2011, 2017). This study applied both the traditional exact and the more recent Bayesian approximate approach to assess whether the subjective well-being scales were measurement invariant. The Bayesian approach detected several non‑invariant items that were problematic for cross-national comparison and could be dropped from the scales. Consequently, measurement invariance was established in all countries for the reduced scales, allowing researchers to meaningfully compare their latent mean scores and the relationships with other theoretical constructs of interest. Thus, the study highlighted the advantages of using multiple indicators and the necessity of measurement invariance testing in subjective well-being research.