Translation, adaptation and validation of the “heiQ” (Health Education Impact Questionnaire) - a generic instrument for evaluating patient training and self-management programs
Dr. M. Schwarze; Dr. I. Ehlebracht-König; Prof. Dr. Chr. Gutenbrunner; Dipl.-Psych. R. Kirchhof
Prof. Dr. Dr. Faller; Dipl.-Psych. M. Schuler; Dipl.-Psych. G. Musekamp
Scientific cooperation partners:
- Osborne, Richard H. (Prof. Ph.D.) - Deakin University, Faculty of Health, Medicine, Nursing and Behavioural Sciences , Australia
- Nolte, Sandra (Ph.D.) - AFV Centre for Rheumatic Diseases, The University of Melbourne, De-partment of Medicine;
- Rehazentrum Bad Eilsen
- Klinik Taubertal Bad Mergentheim
- Deegenbergklinik Bad Kissingen
- Klinik Bad Oexen
- Klinikum Bad Bramstedt
- Klinik Norderney
As aims of patient training programs, a strengthening of patients’ self-management abilities as well as an increase in compliance and empowerment have been defined (Faller et al, 2005). Evaluations of patient training programs have mostly ensued, however, through the measurement of target parameters unrelated to the training, such as quality of life, return to work etc. However, so far, there are barely any assessment instruments for evaluating training-based target parameters in Germany and internationally. Therefore, at the University of Melbourne, Osborn and colleagues (2007) developed the questionnaire set “heiQ”, which consists of the three questionnaires “heiQ-Core", “heiQ-Program" und “heiQ-Perspective". The central questionnaire “heiQ-Core” uses 40 items on the following eight scales to measure training-based parameters of patient training programs: “health-conducive behaviour”, “active participation in life”, “emotional well-being”, “self-monitoring and understanding of illness”, “constructive attitudes”, “acquisition of skills and action strategies”, “social integration and support”, and “cooperation and finding one’s way in the health care system”. The heiQ-Program (10 items) serves to evaluate the implementation of patient training. The heiQ-Perspective uses nine items to measure possible changes in response behaviour which can be caused by so-called response shifts.
Aims of the project
In the German language-speaking area, so far, there are barely any validated questionnaires assessing generic proximal target criteria of patient training programs (e.g. self-management, empowerment). Thus, the aim of this project consisted of providing a concept-faithful translation, adaptation and psychometric validation of the Australian-developed questionnaire heiQ, which uses 40 items on 8 scales to measure training-related target criteria and shows very good psychometric parameters in its original version.
Experimental design and methods
The translation of the heiQ was implemented using international translation guidelines by means of forward and backward translations. The final German version of the heiQ resulted from the agreement of the original authors, the independent translators and the scientists and clinicians of the University Medical Hospital of Hanover and the University of Würzburg. Additionally, following the translation, cognitive interviews were carried out (N=14) in order to minimise questionnaire-based errors (e.g. ambiguous formulations). The psychometric evaluation took place in a sample of 1202 patients from 7 cooperating clinics with different indications. All included patients had taken part in a patient training program in the framework of a rehabilitation measure. The patients filled out the heiQ as well as several validation scales (SF-36; IRES-24; IPQ-R; PHQ-9; GAD-7) at three time points, directly before the patient training, t1, directly after the patient training, t2, and three months after the patient training, t3). The factor validity was determined by means of confirmatory factor analyses, the construct validity through contextual analyses with the validation scales and the reliability by means of Raykov’s Rho. Additionally, in order to determine the change sensitivity, a subsample (N=58) filled out the heiQ three weeks before the patient training, and in order to determine the retest reliability, a further subsample (N=48) filled out the heiQ one week after the patient training.
Results to date
Translation and cognitive interviews
The translated items of the heiQ were broadly understood by the patients easily and in the intended sense. Upon the patients’ suggestion, several small formulation changes were made and agreed with the author of the original version.
Factorial validity: In line with the hypothesis, three scales show very good fit values (CFI>0.98, RMSEA>0.06), and for the other 5 scales, good to very good fit values for each scale could be achieved by the (well interpretable as regards content) release of the covariance between each of 2 items. Reliability: Raykov’s Rho lies in the area of satisfactory to very good (0.71-0.88). Construct validity: The correlations between the heiQ scales and the validation scales (at t1) lie mostly between 0.2 and 0.6 in the expected dimensions. Change sensitivity: The pre(t1)-post(t2) differences fluctuate between d=0.11 and d=0.62.
The scales of the German version can be seen as comprehensible as regards content, factor valid and reliable. First results on pre-post differences indicate that the constructs measured by the heiQ scales are changed through the rehabilitation. In further analyses, courses in the heiQ scales up to the follow-up time point, associations between changes in the heiQ scales and changes in the validation scales as well as indication-determined differences should be analysed. Based on the results gathered so far, the German version of the heiQ appears to be a promising instrument for measuring proximal target criteria of patient training programs.
Publications on the project:
- Schwarze, M., Kirchhof, R., Schuler, M., Musekamp, G., Nolte, S., Osborne, R.H., Ehlebracht-König, I., Faller, H., & Gutenbrunner, C. (2009). Measuring the Outcome and Effectiveness of Patient Education and Self-Management Programmes in Chronic Diseases: Translation and Cultural Adaption of the Health Education Impact Questionnaire (heiQ) in Germany. Journal of Rehabili-tation Medicine, (Suppl. 48), im Druck.
- Kirchhof, R., Schwarze, M., Ehlebracht-König, I., Gutenbrunner, C., Schuler, M., Musekamp, G. & Fal-ler, H. (2008). Erfassung von Selbstmanagementkompetenzen zur Bewertung von Patienten-schulungen - der generische Fragebogen heiQ. Das Gesundheitswesen, 70(8/9), P05, A182.
Schwarze, M., Kirchhof, R., Schuler, M., Musekamp, G., Nolte, S., Jordan, J.E., Osborne, R.H., Eh-lebracht-König, I., Faller, H. & Gutenbrunner, C. (2008). Ein Blick Down Under: Selbstmanage-mentinitiativen und Patientenschulungen in Australien. Zeitschrift für Rheumatologie, 67(3), 189-198.
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