English-speaking Respondents Research Articles

The discriminative power of the EuroQol visual analog scale is sensitive to survey language in Singapore

BackgroundExisting evidence for validity of the visual analog scale of the EQ-5D-3L questionnaire (EQ-VAS) is weak in Chinese-speaking respondents in Singapore. We therefore investigated the validity of the Chinese (Singapore) version of EQ-VAS in patients with diabetes.MethodsIn a cross-sectional survey, patients with type 2 diabetes seen in a primary care facility completed an identical Chinese or English questionnaire containing the EQ-5D-3L and questions assessing other health and disease-related characteristics. Convergent and known-groups validity of the EQ-VAS was examined for Chinese- and English-speaking respondents separately.ResultsThe EQ-VAS was correlated with the EQ-5D-3L health index and a 5-point Likert-type scale for assessing global health in both Chinese-speaking (N = 335) and English-speaking respondents (N = 298), suggesting convergent validity. The mean EQ-VAS scores differed between English-speaking patients with differing duration of diabetes (< 10 years versus ≥ 10 years), comorbidity status (absence versus presence), and complications of diabetes (absence versus presence), providing evidence for known-groups validity. However, the EQ-VAS scores for Chinese-speaking respondents known to differ in these characteristics were similar, even among subgroups of relatively younger patients or those with formal school education.ConclusionsChinese- and English-speaking Singaporeans respond differently to the EQ-VAS. The Chinese version of EQ-VAS appears less sensitive than its English version for measuring global health in patient populations in Singapore.

Integrated or isolated? The impact of public housing redevelopment on social network homophily

Do mixed income housing programs increase the poor's social network diversity? Using unique, longitudinal, egocentric social network data, this research investigates changes in social network homophily for both Vietnamese and English-speaking original residents of a public housing redevelopment site. Changes in mixing occur for both those who return and those who moved away, but only increases in ethnic mixing were associated with returning to the new site. Thus, changes in social networks may be associated with disruption rather moving to a mixed-income site. Vietnamese residents also experienced increases in ethnic diversity compared to English-speaking respondents. The results raise questions about the social mixing intent of such programs. The high expectations for social network benefits of income mixing housing programs should be tempered.

Reports of alcohol‐related problems and alcohol dependence for demographic subgroups using interactive voice response versus telephone surveys: The 2005 US National Alcohol Survey

Interactive voice response (IVR), a computer-based interviewing technique, can be used within a computer-assisted telephone interview (CATI) survey to increase privacy and the accuracy of reports of sensitive attitudes and behaviours. Previous research using the 2005 National Alcohol Survey indicated no overall significant differences between IVR and CATI responses to alcohol-related problems and alcohol dependence. To determine if this result holds for demographic subgroups that could respond differently to modes of data collection, this study compares the prevalence rates of lifetime and last-year alcohol-related problems by gender, ethnicity, age and income subgroups obtained by IVR versus continuous CATI interviewing. As part of the 2005 National Alcohol Survey, subsamples of English-speaking respondents were randomly assigned to an IVR group that received an embedded IVR module on alcohol-related problems (n = 450 lifetime drinkers) and a control group that were asked identical alcohol-related problem items using continuous CATI (n = 432 lifetime drinkers). Overall, there were few significant associations. Among lifetime drinkers, higher rates of legal problems were found for white and higher income respondents in the IVR group. For last-year drinkers, a higher percentage of indicators of alcohol dependence was found for Hispanic respondents and women respondents in the CATI group. Data on alcohol problems collected by CATI provide largely comparable results to those from an embedded IVR module. Thus, incorporation of IVR technology in a CATI interview does not appear strongly indicated even for several key subgroups.

Beliefs About Heritability of Cancer and Health Information Seeking and Preventive Behaviors

Individuals' beliefs about cancer heritability could affect their health information seeking and health behaviors. Data from 5813 English-speaking adult respondents to the 2003 Health Information National Trends Survey were analyzed. Individuals who believed that knowledge of family history or genes can reduce cancer risk were significantly more likely to have ever looked for cancer information. Ever smokers who believed that genes are the main cause of lung cancer were significantly more likely to smoke currently. Patients need to be educated about genetic susceptibility to cancer in ways that support information seeking and engagement in protective behaviors.

Development and Validation of a Functional Health Literacy Test

: Three validated functional health literacy tests (FHLTs) have been developed for use in healthcare settings. However, none of these tests has been shown to be readily applicable for use in the general public. : To develop and validate an FHLT for screening the functional health literacy level of the general public and patients in healthcare settings. : Maze procedure, expert judgment, and interviews with 55 respondents were used to develop the 21-item FHLT, which was modified from public health education material entitled Guidelines on Taking Medicines published by the Singapore Health Promotion Board. The finalized FHLT was then distributed by convenience sampling among eligible English-speaking respondents from the general public and rheumatic patients in Singapore. Descriptive analysis was used to summarize the sociodemographic characteristics and health status of the respondents. Cronbach's α was used to assess the reliability of the test. Partial correlation coefficients were used to investigate the convergent validity between scores on the FHLT and the Rapid Estimate of Adult Literacy in Medicine (REALM), and the divergent validity between the FHLT score and education level. Test-retest reliability was assessed by intraclass correlation coefficient (ICC). : Data were analyzed from 223 respondents from the general public (mean [SD] age: 43.8 [14.2] years, 49.3% female, 45.7% with >12 years of education) and 200 rheumatic patients (mean [SD] age: 46.6 [14.7], 70.5% female, 45.5% with >12 years of education). Cronbach's α for the FHLT was 0.72 and 0.68 for the general public and rheumatic patients, respectively, suggesting adequate reliability. Convergent validity was demonstrated with a strong correlation between scores on the FHLT and REALM (0.65 [p < 0.01] for the general public, 0.68 [p < 0.01] for rheumatic patients). Divergent validity was shown by the weak correlation between the FHLT score and education level (0.33 [p < 0.01] for the general public, 0.28 [p < 0.01] for rheumatic patients). Test-retest reliability of the FHLT among rheumatic patients (n = 112, response rate = 56%) was shown to be high (ICC = 0.95). ICC was not calculated for the test-retest reliability among the general public because of a poor response rate of 9%. : The 21-item FHLT has been shown to be a reliable and valid screening test for measuring functional health literacy levels of the general public as well as patients in healthcare settings. The availability of the FHLT would contribute to the effectiveness of health education programs and better health-related outcomes in the general population.

Cancer information-seeking experiences: The implications of Hispanic ethnicity and Spanish language

Strategies to support cancer information-seeking among Hispanics are needed. We analyzed data from the 2005 Health Information National Trends Survey (HINTS) to explore cancer information-seeking experiences among respondents according to ethnicity and language of interview. Over 80% of Spanish-speaking Hispanics had never looked for cancer information. Compared to English-speaking respondents, Spanish-speaking Hispanics who sought cancer information indicated their search took a lot of effort (67%), was hard to understand (54%), and frustrating (42%). Spanish-speaking Hispanics noted minimal confidence in obtaining cancer information. Language and cultural differences must be considered in the design, implementation, and dissemination of cancer information.

Does the ‘gateway’ matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication

The 'gateway' pattern of drug initiation describes a normative sequence, beginning with alcohol and tobacco use, followed by cannabis, then other illicit drugs. Previous work has suggested that 'violations' of this sequence may be predictors of later problems but other determinants were not considered. We have examined the role of pre-existing mental disorders and sociodemographics in explaining the predictive effects of violations using data from the US National Comorbidity Survey Replication (NCS-R). The NCS-R is a nationally representative face-to-face household survey of 9282 English-speaking respondents aged 18 years and older that used the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to assess DSM-IV mental and substance disorders. Drug initiation was estimated using retrospective age-of-onset reports and 'violations' defined as inconsistent with the normative initiation order. Predictors of violations were examined using multivariable logistic regressions. Discrete-time survival analysis was used to see whether violations predicted progression to dependence. Gateway violations were largely unrelated to later dependence risk, with the exception of small increases in risk of alcohol and other illicit drug dependence for those who initiated use of other illicit drugs before cannabis. Early-onset internalizing disorders were predictors of gateway violations, and both internalizing and externalizing disorders increased the risks of dependence among users of all drugs. Drug use initiation follows a strong normative pattern, deviations from which are not strongly predictive of later problems. By contrast, adolescents who have already developed mental health problems are at risk for deviations from the normative sequence of drug initiation and for the development of dependence.

Characteristics of anti-tuberculosis medication adherence in South Africa

Adherence to anti-tuberculosis (TB) medications is a critical issue in limiting the spread of the disease throughout the world. In South Africa, medications to treat TB are available at no cost. The purpose of this study was to examine the characteristics of medication adherence in a sample of patients diagnosed with TB ( N = 159). The relationships among sociodemographic variables, social support, quality of life, and adherence were explored in this cross-sectional and descriptive study. Self-report data were obtained from a community-based sample of TB-infected individuals who received care in outpatient clinics in Durban, South Africa. Data were collected from the 159 Zulu- and/or English-speaking respondents who agreed to participate in the study. Logistic regression analyses indicated that 41% of the variance in adherence was explained by the model, with nonadherent participants more likely to have less frequent symptoms and more available nutrition than their adherent counterparts. The adherent group was more likely to have increased symptoms, more days with nothing to eat, and fewer appointments with their health care provider. Implications for clinical practice and research are discussed.

Understanding Mental Health Treatment in Persons Without Mental Diagnoses

Epidemiologic surveys have consistently found that approximately half of respondents who obtained treatment for mental or substance use disorders in the year before interview did not meet the criteria for any of the disorders assessed in the survey. Concerns have been raised that this pattern might represent evidence of misallocation of treatment resources. To examine patterns and correlates of 12-month treatment of mental health or substance use problems among people who do not have a 12-month DSM-IV disorder. Data are from the National Comorbidity Survey Replication, a nationally representative face-to-face US household survey performed between February 5, 2001, and April 7, 2003, that assessed DSM-IV disorders using a fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI). A total of 5692 English-speaking respondents 18 years and older. Patterns of 12-month service use among respondents without any 12-month DSM-IV CIDI disorders. Of respondents who used 12-month services, 61.2% had a 12-month DSM-IV CIDI diagnosis, 21.1% had a lifetime but not a 12-month diagnosis, and 9.7% had some other indicator of possible need for treatment (subthreshold 12-month disorder, serious 12-month stressor, or lifetime hospitalization). The remaining 8.0% of service users accounted for only 5.6% of all services and even lower proportions of specialty (1.9%-2.4%) and general medical (3.7%) visits compared with higher proportions of human services (18.9%) and complementary and alternative medicine (7.6%) visits. Only 26.5% of the services provided to the 8.0% of presumably low-need patients were delivered in the mental health specialty or general medical sectors. Most services provided for emotional or substance use problems in the United States go to people with a 12-month diagnosis or other indicators of need. Patients who lack these indicators of need receive care largely outside the formal health care system.

Epidemiological patterns of extra-medical drug use in the United States: Evidence from the National Comorbidity Survey Replication, 2001–2003

Background In 1994, epidemiological patterns of extra-medical drug use in the United States were estimated from the National Comorbidity Survey. This paper describes such patterns based upon more recent data from the National Comorbidity Survey Replication (NCS-R). Methods The NCS-R was a nationally representative face-to-face household survey of 9282 English-speaking respondents, aging 18 years and older, conducted in 2001–2003 using a fully structured diagnostic interview, the WHO Composite International Diagnostic Interview (CIDI) Version 3.0. Results The estimated cumulative incidence of alcohol use in the NCS-R was 92%; tobacco, 74%; extra-medical use of other psychoactive drugs, 45%; cannabis, 43% and cocaine, 16%. Statistically robust associations existed between all types of drug use and age, sex, income, employment, education, marital status, geography, religious affiliation and religiosity. Very robust birth cohort differences were observed for cocaine, cannabis, and other extra-medical drug use, but not for alcohol or tobacco. Trends in the estimated cumulative incidence of drug use among young people across time suggested clear periods of fluctuating risk. Conclusions These epidemiological patterns of alcohol, tobacco, and other extra-medical drug use in the United States in the early 21st century provide an update of NCS estimates from roughly 10 years ago, and are consistent with contemporaneous epidemiological studies. New findings on religion and religiosity, and exploratory data on time trends, represent progress in both concepts and methodology for such research. These estimates lead to no firm causal inferences, but contribute to a descriptive epidemiological foundation for future research on drug use and dependence across recent decades, birth cohorts, and population subgroups.

Assessing Risk Propensity in American Soldiers: Preliminary Reliability and Validity of the Evaluation of Risks (EVAR) Scale—English Version

Risk-taking propensity is a critical component of judgment and decision-making in military operations. The Evaluation of Risks scale (EVAR) was recently developed to measure state and trait aspects of risk proneness. The scale, however, was psychometrically normed in French and no data are available for the English translation. We administered the English version of the EVAR to 165 U.S. soldiers to obtain reliability, validity, and normative data for English-speaking respondents. Confirmatory factor analysis suggested that the factor structure of the English EVAR differs from that obtained in the French studies. Instead, a three-factor solution, including recklessness/impulsivity, self-confidence, and need for control, emerged. Internal consistency was comparable to the French version. EVAR scores correlated with age, military rank, and years of service, and discriminated soldiers with histories of high-risk behavior. The data support the reliability and validity of the English version of the EVAR for evaluating risk propensity in U.S. soldiers.

Usefulness of the Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) Questionnaire in Patients with Diabetes in a Multi-Ethnic Asian Country

Asia will be at the forefront of the current epidemic of diabetes mellitus. Quality of life (QOL) is an important outcome measure in the assessment of diabetes care. However, few QOL instruments are culturally suitable for use in Asian countries. The Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) questionnaire is a third-generation individualised QOL instrument. Individualised instruments such as the ADDQoL have the potential to be useful and less costly alternatives to computerised adaptive testing (CAT), which may not be practical in developing countries. To evaluate and validate the ADDQoL questionnaire in English-speaking patients with diabetes in Singapore, a multi-ethnic Asian country. The ADDQoL and EQ-5D were administered to English-speaking respondents with type 1 or 2 diabetes (aged > or =18 years) recruited from a tertiary acute-care referral hospital by convenience sampling. The usefulness of the key design features of the ADDQoL were assessed by measuring the number of zero-importance responses, the change in item ranking with and without weighting for importance, and the frequency of utilisation of the 'not applicable' (NA) options. The acceptability, factor structure and internal consistency (Cronbach's alpha) of the ADDQoL were also assessed. Data were subjected to unforced factor analysis with oblimin rotation and then the condition was set to force a one-factor solution. The validity of the ADDQoL was tested with the following hypotheses: those with moderate or severe problems on the EQ-5D would have worse ADDQoL average weighted impact (AWI) scores than those with a perfect health rating on the EQ-5D; those with better Present QOL scores on the ADDQoL would have better EQ-5D utility and visual analogue scale (VAS) scores; on the ADDQoL, AWI scores would correlate better with diabetes-dependent QOL than with Present QOL scores; and female respondents, those who required insulin or had longer duration of known diabetes would have worse ADDQoL AWI scores (known-group validity). We analysed data from 152 respondents (49% Chinese, 34% Indian; 45% female; mean age 52 years, range 18-80; mean duration of known diabetes 10 years, range 0-62). There were few missing data. Weighted scoring and NA options were shown to be necessary, thus supporting the usefulness of individualised health-related QOL measures. Factor structure of the ADDQoL was supported and internal consistency was high (alpha = 0.94). All hypotheses were fulfilled except for one that was partially fulfilled; respondents with longer duration of known diabetes did not report worse ADDQoL AWI scores. The ADDQoL is culturally appropriate, valid, reliable and well accepted among Singaporean patients with diabetes. Individualised measures such as the ADDQoL allow one to obtain precise score estimates and may offer developing countries a useful alternative to CAT.

A cross-linguistic study on the linguistic expressions of Cantonese and English requests

This study investigates the cross-linguistic devices of requests written by native English-speaking (NSE) and native Cantonese-speaking (NCS) respondents in an academic context on the basis of 197 discourse completion tests. Both groups asked in a direct sequence accompanied by a different proportion of syntactic and lexical devices to reduce directness. NES used a higher frequency and a wider range of syntactic downgraders than NCS. NCS, however, used a higher frequency of lexical downgraders and a greater number of combinations of lexical devices than NES. The cross-linguistic comparison of the linguistic features of Cantonese and Engish requests demonstrates how the distinctive linguistic properties of each language and social factors combine to constitute a request. Further investigation could be made between idealized and authentic English and Cantonese requests for a range of age groups and contexts, or to compare the linguistic forms of requests made by NCS in English with the linguistic forms of requests made by NES in Cantonese.

Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication

Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

Twelve-Month Use of Mental Health Services in the United States

Dramatic changes have occurred in mental health treatments during the past decade. Data on recent treatment patterns are needed to estimate the unmet need for services. To provide data on patterns and predictors of 12-month mental health treatment in the United States from the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey using a fully structured diagnostic interview, the World Health Organization's World Mental Health Survey Initiative version of the Composite International Diagnostic Interview, carried out between February 5, 2001, and April 7, 2003. A total of 9282 English-speaking respondents 18 years and older. Proportions of respondents with 12-month DSM-IV anxiety, mood, impulse control, and substance disorders who received treatment in the 12 months before the interview in any of 4 service sectors (specialty mental health, general medical, human services, and complementary and alternative medicine). Number of visits and proportion of patients who received minimally adequate treatment were also assessed. Of 12-month cases, 41.1% received some treatment in the past 12 months, including 12.3% treated by a psychiatrist, 16.0% treated by a non-psychiatrist mental health specialist, 22.8% treated by a general medical provider, 8.1% treated by a human services provider, and 6.8% treated by a complementary and alternative medical provider (treatment could be received by >1 source). Overall, cases treated in the mental health specialty sector received more visits (median, 7.4) than those treated in the general medical sector (median, 1.7). More patients in specialty than general medical treatment also received treatment that exceeded a minimal threshold of adequacy (48.3% vs 12.7%). Unmet need for treatment is greatest in traditionally underserved groups, including elderly persons, racial-ethnic minorities, those with low incomes, those without insurance, and residents of rural areas. Most people with mental disorders in the United States remain either untreated or poorly treated. Interventions are needed to enhance treatment initiation and quality.

Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication

Little is known about the general population prevalence or severity of DSM-IV mental disorders. To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents 18 years and older. Twelve-month DSM-IV disorders. Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population. Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.

Trust in One's Physician: The Role of Ethnic Match, Autonomy, Acculturation, and Religiosity Among Japanese and Japanese Americans

Trust is a cornerstone of the physician-patient relationship. We investigated the relation of patient characteristics, religiosity, acculturation, physician ethnicity, and insurance-mandated physician change to levels of trust in Japanese American and Japanese patients. A self-administered, cross-sectional questionnaire in English and Japanese (completed in the language of their choice) was given to community-based samples of 539 English-speaking Japanese Americans, 340 Japanese-speaking Japanese Americans, and 304 Japanese living in Japan. Eighty-seven percent of English-speaking Japanese Americans, 93% of Japanese-speaking Japanese Americans, and 58% of Japanese living in Japan responded to trust items and reported mean trust scores of 83, 80, and 68, respectively, on a scale ranging from 0 to 100. In multivariate analyses, English-speaking and Japanese-speaking Japanese American respondents reported more trust than Japanese respondents living in Japan (P values <.001). Greater religiosity (P <.001), less desire for autonomy (P <.001), and physician-patient relationships of longer duration (P <.001) were related to increased trust. Among Japanese Americans, more acculturated respondents reported more trust (P <.001), and Japanese physicians were trusted more than physicians of another ethnicity. Among respondents prompted to change physicians because of insurance coverage, the 48% who did not want to switch reported less trust in their current physician than in their former physician (mean score of 82 vs 89, P <.001). Religiosity, autonomy preference, and acculturation were strongly related to trust in one's physician among the Japanese American and Japanese samples studied and may provide avenues to enhance the physician-patient relationship. The strong relationship of trust with patient-physician ethnic match and the loss of trust when patients, in retrospect, report leaving a preferred physician suggest unintended consequences to patients not able to continue with their preferred physicians.

The equivalence and difference between the English and Chinese versions of two major, cancer‐specific, health‐related quality‐of‐life questionnaires

English and Chinese are two of the most widely used primary languages in the world. Patients in many cancer centers have a variety of ethnic backgrounds and primary languages. The comparability of version 4 of the English and Chinese versions of the Functional Assessment of Cancer Therapy-General (FACT-G) and version 3 of the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) have not been established. In total, 1136 ethnic Chinese patients with cancer were recruited from the National Cancer Centre of Singapore. Patients chose to answer an English or Chinese questionnaire, according to their own preference. Multiple regression analysis was used to adjust for differences in demographic and health characteristics. Equivalence was confirmed if the 90% confidence intervals of the adjusted mean difference fell completely within an equivalence zone of +/- 0.25 standard deviations (SD). The English and Chinese versions of the Total, Emotional, and Functional Well Being Scales of the FACT-G and the Physical and Emotional Functioning Scales of the EORTC QLQ-C30 were equivalent. Scores for the other scales on the two questionnaires, at most, had a small differences that did not exceed 0.5 SD. Nevertheless, the Chinese translation of the question "I have a lack of energy" in the Physical Well Being Scale of the FACT-G produced results that differed from the results produced by the original English version. Data collected from English-speaking and Chinese-speaking respondents were capable of being pooled, and either version could be used for bilingual respondents. Nevertheless, the authors recommend modification of the Physical Well Being question that produced different results ("I have a lack of energy").

Perceptions of, and willingness to consider, total joint arthroplasty in a population-based cohort of individuals with disabling hip and knee arthritis.

To examine perceptions of total joint arthroplasty (TJA) and how they relate to willingness to consider TJA. A population-based survey in Oxford County, Ontario, Canada identified 1,735 subjects > or =55 years with disabling hip or knee arthritis; 435 English-speaking respondents with no prior TJA and not on a TJA waiting list were invited to participate, and 379 (37.1%) agreed. We assessed demographics; comorbidity; evaluated and perceived arthritis severity; perceived risks, benefits, indications for, and knowledge of TJA; preferred decision-making style; self efficacy; and willingness to consider TJA by questionnaire. Participants' mean age was 67.6 years; 33.5% were willing (definitely or probably) to consider TJA as a treatment option. Willingness was independently associated with younger age (odds ratio [OR] <75 versus > or =75 years 2.42, P = 0.01); worse perceived arthritis severity (OR per unit increase 1.30, P < 0.001); perceiving TJA as appropriate for moderate, controlled joint pain (OR 3.29, P = 0.004); walking limited to <1 block (OR 1.99, P = 0.015); the risk of revision as acceptable (OR 3.73, P < 0.001); and friends as an important health information source (OR 2.49, P = 0.01). Participants overestimated the pain and disability needed to warrant TJA. These misperceptions were strongly associated with unwillingness to consider TJA and should be addressed at a population level.

Development of a pain and discomfort module for use with the WHOQOL-100.

Clinicians and researchers have become increasingly interested in the impact of chronic pain (CP) on quality of life (QoL). This report describes the qualitative stages of developing a pain and discomfort module for persons with CP to be used with the UK World Health Organisation generic measure of quality of life (WHOQOL). The aims were to investigate patients' perceptions of CP and its effect on QoL, and to generate items to be used in the development of a module appended to the UK WHOQOL-100. At the first stage (study 1), six focus groups of patients were invited to discuss how living with pain and discomfort affected QoL. At the second stage (study 2), an international web survey was conducted with English-speaking respondents. Ten new facets of QoL were identified by the focus groups: flare-ups, pain relief, anger and frustration, vulnerability/fear/worry, uncertainty, loss/loneliness/feeling alone, positive strategies, communication, guilt and burdening others, and relationship with health care providers. The web-survey confirmed and validated these new facets. Although the WHOQOL-100 is a reliable and valid measure of QoL for use in CP, this study shows that additional areas must be assessed when measuring the impact of CP on QoL.