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Article
The Validity of Disease-specific Quality of Life Attributions Among Adults with Multiple Chronic Conditions
University of Massachusetts Medical School Faculty Publications
  • John E. Ware, Jr., University of Massachusetts Medical School
  • Barbara L. Gandek, University of Massachusetts Medical School
  • Jeroan J. Allison, University of Massachusetts Medical School
UMMS Affiliation
Department of Quantitative Health Sciences
Date
1-1-2016
Document Type
Article
Abstract
BACKGROUND: A crucial assumption underlying all disease-specific quality of life (QOL) measures, that patients can validly differentiate a specific disease in the presence of multiple chronic conditions, has not been tested using multiple methods. Our objective was to evaluate the convergent and discriminant validity of QOL attributions to specific diseases among adults with multiple chronic conditions (MCC). METHODS: Adults age 18 and older (N=4,480) sampled from eight pre-identified condition groups (asthma, COPD, angina/MI with angina, congestive heart failure, diabetes, chronic kidney disease, osteoarthritis, rheumatoid arthritis) completed an Internet survey. Comorbid conditions were determined using a 35-condition checklist. Product-moment correlations were analyzed separately by pre-identified condition group using the multitrait-multimethod of construct validation, where traits were defined by 9-26 conditions and each condition was measured by two methods: disease severity rating and Disease-specific Quality of Life Impact Scale (QDIS) global rating. A third method (symptom or clinical marker) was available for the eight pre-identified conditions. Convergent validity was supported when correlations among different methods of measuring the same condition (trait) were substantial (r > /=0.40). Discriminant validity was supported when correlations between the same and different methods of measuring different conditions were significantly lower than corresponding convergent correlations. RESULTS: In support of convergent validity, 22 of 24 convergent correlations were substantial (r=0.38-0.84, median=0.53). In support of discriminant validity, 833 of 924 tests (90.2%) yielded significantly higher convergent than discriminant correlations across the eight pre-identified conditions. Exceptions to this pattern of results were most often observed for comorbid conditions within the same clinical area. CONCLUSIONS: Collectively, convergent and discriminant test results support the construct validity of disease-specific QOL impact attributions across MCC within the eight pre-identified conditions. Noteworthy exceptions should be considered when interpreting some specific QOL impact attributions and warrant further study. Pursuit of a summary disease-specific QOL impact score standardized across MCC is recommended.
Rights and Permissions
Citation: Int J Stat Med Res. 2016;5(1):17-40.
Related Resources
Link to Article in PubMed
Keywords
  • Disease-specific measures,
  • Health-related quality of life,
  • Multiple chronic conditions,
  • Multitrait-multimethod analysis,
  • Patient-reported outcomes,
  • Validity
PubMed ID
27087882
Citation Information
John E. Ware, Barbara L. Gandek and Jeroan J. Allison. "The Validity of Disease-specific Quality of Life Attributions Among Adults with Multiple Chronic Conditions" Vol. 5 Iss. 1 (2016) ISSN: 1929-6029 (Linking)
Available at: http://works.bepress.com/john_ware/224/