Issues in conducting cross-cultural research: implementation of an agreed international protocol [corrected] designed by the WHOQOL Group for the conduct of focus groups eliciting the quality of life of older adults

Methodological and ethical challenges in designing and conducting research at the end of life: A systematic review of qualitative and textual evidence

AIM

This systematic review aims to identify methodological and ethical challenges in designing and conducting research at the end of life from the perspective of researchers and provide a set of recommendations.

BACKGROUND

Conducting research with patients and family carers facing end-of-life issues is ethically and methodologically complex.

DESIGN

A systematic review was conducted.

DATA SOURCES

Four databases (MEDLINE, EMBASE, CINAHL, PsycInfo) were searched from inception until the end of 2021 in February 2022.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews was followed, and the JBI Approach to qualitative synthesis was used for analysis.

RESULTS

Seventeen of 1983 studies met inclusion criteria. Data were distilled to six main themes. These included (1) the need for flexibility at all stages of the research process; (2) careful attention to timing; (3) sensitivity in approach; (4) the importance of stakeholder collaboration; (5) the need for unique researcher skills; and (6) the need to deal with the issue of missing data.

CONCLUSION

The findings illuminate several considerations that can inform training programmes, ethical review processes and research designs when embarking on research in this field.

Validity and reliability of the Korean version of the world health organization quality of life instrument-older adults module

The World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) is a scale that measures quality of life (QoL) based on the characteristics of older adults. This study aimed to evaluate the reliability and validity of the Korean version of the WHOQOL-OLD. It was administered to 273 older adults by convenience sampling in Jeonbuk, South Korea. The six-factor model was validated by confirmatory factor analysis (χ²=462.52 [p<.001], normed χ²=1.95, comparative fit index=0.94, Tucker-Lewis index=0.92, standardized root mean residual=0.06, root mean square error of approximation=0.059). Concurrent validity was demonstrated with the WHOQOL-BREF (r = 00.708), SF-12 (r = 0.508) and the Depression, Anxiety and Stress Scale (r=-0.499). In addition, the Korean version of the WHOQOL-OLD was evaluated for known group validity. Cronbach's alpha coefficient for the total scale was 0.897. The Korean version of the WHOQOL-OLD showed acceptable validity and reliability for measuring QoL in older Korean adults.

Health-Related Quality of Life, Gender, and Culture of Older People Users of Health Services in the Multicultural Landscape of the City of Ceuta (Spain): A Cross-Sectional Study

INTRODUCTION

Perceptions of health-related quality of life (HRQOL) are influenced by sociodemographic variables and by cultural-religious concepts of health, disease, and old age, among others.

PURPOSE

To assess the HRQOL of older people in a population with a long history of multiculturalism, the city of Ceuta (Spain), and to compare the results with Spanish reference values.

METHOD

A total of 372 individuals (55.4% females) were interviewed using the Spanish version of the Short Form-36 questionnaire. The subjects' mean age was 70.9 (SD = 5) years: 253 were Christians, 93 Muslims, and 26 Jews, representing the proportions in the overall population of these cultural-religious groups.

RESULTS

HRQOL differs according to the cultural-religious affiliation, which specifically affects social and psychological dimensions.

DISCUSSION AND CONCLUSIONS

All groups obtained lower social function scores than the reference values, especially the Muslim and Jewish groups.

IMPLICATIONS FOR PRACTICE

Health care providers may consider integrating culturally sensitive interventions to improve HRQOL.

Using the WHOQOL-BREF in persons with dementia: a validation study

Increasing evidence suggests that persons with early dementia can give reliable and valid assessments about their own quality of life (QOL), thereby improving accuracy, and reducing the need for proxy informants. The objective of this study was to examine QOL in persons diagnosed with dementia (Diagnostic and Statistical Manual of Mental Disorder-IV) using a battery of subjective assessments including the new World Health Organization Quality of Life (WHOQOL-BREF). Persons with mild-to-moderate dementia (n=104) were recruited and interviewed at 6 Spanish centers to obtain sociodemographic information, health perceptions, depressive symptoms (Geriatric Depression Scale 15-item version), functional ability (Barthel Index), generic QOL (WHOQOL-BREF), and specific QOL (DEMQOL-28). Analysis was performed using classical psychometric methods. Internal consistency reliability for the WHOQOL-BREF domains ranged from moderate (0.54 for social) to good (0.79 for psychological). Test-retest reliability (intraclass correlation) ranged from moderate (0.51 for psychological) to good (0.70 for physical). Associations were confirmed between WHOQOL-BREF domains with DEMQOL-28, Geriatric Depression Scale 15-item version, and Barthel dimensions. With regard to contrasting groups' differences, WHOQOL-BREF scores significantly differentiated between healthy and unhealthy and depressed and nondepressed participants. This study is the first to report on the use of the WHOQOL-BREF in persons with mild-to-moderate dementia. These results indicate that it is a useful tool in assessing these groups, as it includes important dimensions commonly omitted from other dementia measures.

Effects of a physical activity governmental health programme on the quality of life of elderly people

Background:

The population ageing occurring worldwide resulted in multiple researches on sedentary ageing and quality of life.

Purpose:

To verify the effects of a physical activity programme on the quality of life (QOL) of elderly individuals served by a governmental health programme.

Design:

Descriptive inquiry research.

Methods:

Randomly distributing 70 elderly individuals in a control group ( n=35; mean±SD 69.80±8.05 years) and an experimental group ( n=35; 68.66±5.93 years) plus QOL evaluation via WHOQOL-Old.

Results:

The experimental group showed significant best results on the post-test by repeated-measures ANOVA on sensorial functioning (Δ%=0.022%, p=0. 0001), social participation (Δ%=0.012%, p=0.013), perceptions of death and dying (Δ%=0.04%, p=0.009), intimacy (Δ%=0.059%, p=0.05), and total score (Δ%=0.001, p=0.000).

Conclusions:

Sensorial functioning, social participation, perceptions of death and dying, and intimacy play an important role in the positive relationship between physical activity and QOL.

The quality of life of medical students studying in New Zealand: a comparison with nonmedical students and a general population reference group

BACKGROUND

Quality of life is an essential component of learning and has strong links with the practice and study of medicine. There is burgeoning evidence in the research literature to suggest that medical students are experiencing health-related problems such as anxiety, depression, and burnout.

PURPOSE

The aim of the study was to investigate medical students' perceptions concerning their quality of life.

METHODS

Two hundred seventy-four medical students studying in their early clinical years (response rate = 80%) participated in the present study. Medical students were asked to fill in the abbreviated version of the World Health Organization Quality of Life questionnaire to elicit information about their quality of life perceptions in relation to their physical health, psychological health, social relationships, and environment. Subsequently, their responses were compared with two nonmedical students groups studying at a different university in the same city and an Australian general population norm. The findings were compared using independent group's t tests, confidence intervals, and Cohen's d.

RESULTS

The main finding of the study indicated that medical students had similar quality of life perceptions to nonmedical students except in relation to the environment domain. Furthermore, the medical student group scored lower than the general population reference group on the physical health, psychological health, and environment quality of life domains.

CONCLUSIONS

The results suggest that all university students are expressing concerns related to quality of life, and thus their health might be at risk. The findings in this study provided no evidence to support the notion that medical students experience lower levels of quality of life compared to other university students. When compared to the general population, all student groups examined in this study appeared to be experiencing lower levels of quality of life. This has implications for pastoral support, educationalists, student support personnel, and the university system.

Quality of life and physical activity in a sample of Brazilian older adults

OBJECTIVE

To investigate the association between physical activity and quality of life in a sample of Brazilian older adults.

METHOD

The Portuguese version of the World Health Organization Quality of Life Instrument-Older Adults Module and International Physical Activity Questionnaire was administered to 1,204 subjects (645 women and 559 men) aged ≥ 60 years.

RESULTS

Older adults of both genders who reported to be more physically active attributed higher scores to the sensory ability, autonomy, and intimacy domains, in addition to presenting significantly higher overall quality of life, irrespectively of age, marital status, educational level, and socioeconomic status. Specifically in women, the scores obtained for the social participation domain were significantly higher in the strata of active and very active subjects when compared to sedentary subjects.

DISCUSSION

The results indicate that increases in the levels of physical activity can contribute to improvements in quality of life of older adults.

Perceptions of persons with Parkinson's disease, family and professionals on quality of life: an international focus group study

PURPOSE

Parkinson's disease (PD) is a progressive neurodegenerative disorder. Motor and non-motor symptoms have an impact on persons' lives. To what extent this is effecting persons' quality of life (QOL) is not clear. Therefore, the aim of this qualitative study was to identify factors that persons perceive as eminently important for QOL.

METHOD

Focus groups were employed with persons with PD, caregivers and health professionals.

RESULTS

The results, obtained through thematic and conceptual qualitative analysis, largely support the framework of domains and facets of the World Health Organization Quality of Life (WHOQOL) assessment instrument. Three new themes were identified, reflecting (i) practical adaptations to PD, (ii) personal adaptations to PD and (iii) the ability to communicate and the availability of communication supports.

CONCLUSION

This study demonstrated that focus groups are a valid and reliable way of eliciting views on QOL from persons with PD, caregivers and professionals. The focus group method confirmed the original WHOQOL parameters and also provided some new QOL themes. In addition, the results of this study pointed out that the impact of PD on QOL goes beyond the physical, social and emotional domains of health-related QOL (HRQOL).

The Quality of Care and Support (QOCS) for people with disability scale: development and psychometric properties

This paper describes the development of a Quality of Care and Support (QOCS) scale for use with adult persons with physical and intellectual disabilities. In the pilot phase of the study, 12 centers from around the world carried out focus groups with people with physical and disabilities, their carers, and with professionals in order to identify themes that were relevant for their quality of care. Items generated from the focus groups were then tested in a pilot study with 1400 respondents from 15 different centers worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with 3772 respondents, again with the use of both classical and modern psychometric methods. The outcome of the two rounds of data collection and analysis is a 17-item module for assessment of quality of care in physically or intellectually disabled people. Further modifications are also proposed for the use of the QOCS with adults with intellectual disabilities, including simplification of wording of some of the items, the use of a three-point response scale, and the inclusion of smiley faces.

Quality of Life after Brain Injury (QOLIBRI): scale development and metric properties

The consequences of traumatic brain injury (TBI) for health-related quality of life (HRQoL) are poorly investigated, and a TBI-specific instrument has not previously been available. The cross-cultural development of a new measure to assess HRQoL after TBI is described here. An international TBI Task Force derived a conceptual model from previous work, constructed an initial item bank of 148 items, and then reduced the item set through two successive multicenter validation studies. The first study, with eight language versions of the QOLIBRI, recruited 1528 participants with TBI, and the second with six language versions, recruited 921 participants. The data from 795 participants from the second study who had complete Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) data were used to finalize the instrument. The final version of the QOLIBRI consists of 37 items in six scales (see Appendix ). Satisfaction is assessed in the areas of "Cognition," "Self," "Daily Life and Autonomy," and "Social Relationships," and feeling bothered by "Emotions," and "Physical Problems." The QOLIBRI scales meet standard psychometric criteria (internal consistency, alpha = 0.75-0.89, test-retest reliability, r(tt) = 0.78-0.85). Test-retest reliability (r(tt) = 0.68-0.87) as well as internal consistency (alpha = 0.81-0.91) were also good in a subgroup of participants with lower cognitive performance. Although there is one strong HRQoL factor, a six-scale structure explaining additional variance was validated by exploratory and confirmatory factor analyses, and with Rasch modeling. The QOLIBRI is a new cross-culturally developed instrument for assessing HRQoL after TBI that fulfills standard psychometric criteria. It is potentially useful for clinicians and researchers conducting clinical trials, for assessing the impact of rehabilitation or other interventions, and for carrying out epidemiological surveys.

Comparing the importance of different aspects of quality of life to older adults across diverse cultures

BACKGROUND

there is limited research examining the relative importance of aspects of quality of life (QOL) to older adults across cultures.

OBJECTIVE

to examine the relative importance of 31 internationally agreed areas of QOL to older adults in 22 countries in relation to health status, age and level of economic development.

DESIGN

a survey quota sampling design was used to collect cross-cultural data. This study reports a secondary analysis of WHOQOL-OLD pilot study, which was collected simultaneously in 22 centres.

SETTINGS

a variety of community, primary, secondary and tertiary health care settings located in Australia, France, Switzerland, England, Scotland, USA, Israel, Spain, Japan, China (mainland and Hong Kong), Turkey, Lithuania, Czech Republic, Hungary, Canada, Norway, Sweden, Denmark, Germany, Brazil and Uruguay.

PARTICIPANTS

the total sample contained 7,401 people over 60 years with a mean age of 73.1 years; 57.8% were women and 70.1% considered themselves 'healthy'.

RESULTS

there were significant differences in the importance given to various aspects of QOL for people living in medium and high-development countries. Culture explained 15.9% of the variance in the importance ratings of QOL. However, the interaction showed that cultural differences were reduced once health status, gender and age were taken into account. The importance of QOL to age bands in different cultures was not significantly affected by whether or not participants perceived themselves to be healthy.

CONCLUSION

understanding the self-reported importance of diverse aspects of QOL for different cultures and for healthy and less healthy people may assist national and international policy makers to decide on priorities for the development of programmes for the ageing population.

Elderly quality of life impacted by traditional Chinese medicine techniques

BACKGROUND

The shift in age structure is having a profound impact, suggesting that the aged should be consulted as reporters on the quality of their own lives.

OBJECTIVES

The aim of this research was to establish the possible impact of traditional Chinese medicine (TCM) techniques on the quality of life (QOL) of the elderly.

SAMPLE

Two non-selected, volunteer groups of Rio de Janeiro municipality inhabitants: a control group (36 individuals), not using TCM, and an experimental group (28 individuals), using TCM at ABACO/Sohaku-in Institute, Brazil.

METHODS

A questionnaire on elderly QOL devised by the World Health Organization, the WHOQOL-Old, was adopted and descriptive statistical techniques were used: mean and standard deviation. The Shapiro-Wilk test checked the normality of the distribution. Furthermore, based on its normality distribution for the intergroup comparison, the Student t test was applied to facets 2, 4, 5, 6, and total score, and the Mann-Whitney U rank test to facets 1 and 3, both tests aiming to analyze the P value between experimental and control groups. The significance level utilized was 95% (P < 0.05).

RESULTS

The experimental group reported the highest QOL for every facet and the total score.

CONCLUSIONS

The results suggest that TCM raises the level of QOL.

Avaliação da qualidade de vida em idosas residentes em ambientes urbano e rural

A expressão "qualidade de vida" tem sido utilizada sob diversos enfoques e é tema de pesquisas imprescindíveis na área da saúde. Muitas pesquisas têm-se dedicado a estudar a velhice sob novas óticas, mas a maioria desses estudos se refere a idosos que habitam ambientes urbanos, sendo poucas as pesquisas que abordam o tema do envelhecimento no ambiente rural. O instrumento utilizado foi o WHOQOL-OLD, modificado para pessoas idosas, com o objetivo de avaliar e comparar a qualidade de vida de idosas residentes em ambientes urbano e rural. A amostra foi constituída de 30 mulheres, com idade igual ou superior a 60 anos. O tratamento estatístico foi composto por análise descritiva e inferencial. Os dados foram analisados através SPSS, versão 13.0 para Windows. O nível de significância e erro estatístico considerado foi de 5% (p<0,05). Após análise dos resultados, as idosas foram classificadas com média do Qvg-old igual ou superior a 13 como sendo detentoras de qualidade de vida suficiente; 46% das idosas residentes na área urbana apresentaram níveis iguais ou acima de 13, sobrepondo-se aos 40% dos indivíduos residentes na zona rural, que obtiveram níveis superiores a 13. Constatou-se que o fato de residir em regiões geograficamente diferentes não interferiu nos níveis de qualidade de vida. Recomenda-se a realização de outros estudos, a fim de complementar e comparar os resultados de qualidade de vida com idosos de outras regiões, na perspectiva de obter uma classificação qualitativa da qualidade de vida da população idosa com diversas características sócio-demográficas e culturais.

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

Background

People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions.

Methods and design

HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities.

Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems.

Discussion

A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities.

Brazilian WHOQOL-OLD Module version: a Rasch analysis of a new instrument

OBJECTIVE

To evaluate the Brazilian version of WHOQOL-OLD Module and to test potential changes to the instrument to increase its psychometric adequacy.

METHODS

A total of 424 older adults living in a city in Southern Brazil completed the WHOQOL-OLD instrument, in 2005. Rasch analysis was used to explore the psychometric performance of the scale, as implemented by the RUMM2020 software. Item-trait interaction, threshold disorders, presence of differential item functioning and item fit, were analyzed.

RESULTS

Two ("death and dying" and "sensory abilities") out of six domains showed inadequate item-trait interactions. Rescoring the response scale and deleting the most misperforming items led to scale improvement. The evaluation of domains and items individually showed that the "intimacy" domain does perform well in contrast to the findings using the classical approach. In addition, the "sensory abilities" domain does not derive an interval measure in its current format.

CONCLUSIONS

Unidimensionality and local independence were seen in all domains. Changes in the response scale and deletion of problematic items improved the scale's performance.

Development of the WHOQOL-old module

This paper describes the development of an add-on module for the WHOQOL measures of quality of life (QoL) for use with older adults. The add-on module, known as the WHOQOL-OLD, was derived following standard WHOQOL methodology. In the pilot phase of the study, 22 centres from around the world carried out focus groups with older adults, with carers, and with professionals working with older adults in order to identify gaps in the coverage of the WHOQOL-100 that were relevant for QoL in older adults. Items generated from the focus groups were then tested in over 7400 respondents from the centres, with items being tested and reduced using both classical and modern psychometric methods. These analyses indicated a further gap in the coverage of the items, so further items were generated that specifically assessed intimate relations in older adults. A field trial study was then carried out in a further approximately 5500 respondents, again with the use of both classical and modern psychometric methods. The outcome of this second round of data collection and analysis is a 24-item 6-facet module which can be used in conjunction with the WHOQOL-BREF or the WHOQOL-100 for assessment of QoL in older adults.