Psychometric properties of the RAND-36 among three chronic diseases (multiple sclerosis, rheumatic diseases and COPD) in The Netherlands.

OBJECTIVE: In this article, psychometric properties both of the total RAND-36 and of its subscales, such as unidimensionality, differential item functioning (DIF or item bias), homogeneity and reliabilities, are examined. METHODS: The data from populations with three chronic illnesses, multiple sclerosis (n = 448), rheumatism (n = 336) and COPD (n = 259), have been collected in different parts of the Netherlands. The main technique used was Mokken scale analysis for polytomous items. RESULTS: All subscales of the RAND-36 appeared to be unidimensional. For the subscales 'mental health' and general health perceptions' some minor indications of DIF for the different chronic illnesses were found. Reliabilities of almost all subscales in all subpopulations were higher than 0.80, while the homogeneities of almost all subscales in all subpopulations were higher than 0.50, indicating 'strong unidimensional, hierarchical scales'. CONCLUSIONS: In general, the subscales of the RAND-36 can be used to compare persons with different chronic illnesses. The subscale 'general health perceptions' did not function as well as would be preferred.

Health care utilization by people with multiple sclerosis in The Netherlands: results of two separate studies.

PURPOSE: For chronically ill persons it is assumed that they make heavy demands on health care services. In the literature one hardly finds any publications to substantiate or refute this assumption. The main purpose of our study is to describe the health care utilization of people with multiple sclerosis (MS) in the Netherlands and its relationships with severity and duration of the disease. METHODS: Two different samples of persons with MS were used. In the first sample (University Hospital Groningen) severity of MS was based on medical judgement, while in the second sample (Dutch Multiple Sclerosis Society) severity was self-reported. In both samples, use of health care facilities was assessed with a mail questionnaire. RESULTS: The methods for determining severity resulted in different distributions for severity of MS. However, the results were quite similar with respect to health care utilization. It appeared that the severity of MS was related to the number of professional caretakers MS-patients had contact with during one year. Duration of MS seemed not to be related to the number of caretakers. Only for specific caretakers, most notably GP, physiotherapist, home help and ergotherapist, the contact frequency increased with severity of MS. No such relationship was found between the frequency of contact with the neurologist and severity of MS. CONCLUSIONS: People with MS do not make a heavy demand on health care facilities in general but only on certain health care provisions. This is in contrast with the general notion that all chronically ill make a heavy demand on health care facilities in general.

A reliability and utility study of the care dependency scale.

The purpose of this study was to examine the reliability and utility of the Care Dependency Scale (CDS). This 15-item scale has been developed recently for assessing the care dependency of demented or mentally handicapped inpatients. Data for this study were collected from 153 demented and 139 mentally handicapped inpatients. The sample was measured three times. Internal consistency was determined using Cronbach's alpha and ranged from 0.95 to 0.97. Interrater reliability revealed moderate to substantial weighted Kappa statistics between 0.51 and 0.83. Test-retest reliability analysis resulted in substantial weighted Kappas between 0.66 and 0.89. Utility tests also revealed satisfactory results. The findings support the reliability and utility of the CDS.

Construct validity of the Nursing Care Dependency Scale.

This paper describes the results of a study determining construct validity aspects of the Nursing Care Dependency (NCD) Scale. This 15-item instrument has been developed recently for the assessment of the care dependency of dementia or learning-disabled inpatients. Data was collected for 450 dementia and 203 learning-disabled patients using the NCD instrument. Factor analysis of the NCD instrument resulted in one Factor. With Mokken scale analysis an H-coefficient of 0.75 was found, which implied a strong hierarchical scale. Cronbach's alpha coefficients (0.97) were high enough to use the NCD instrument in clinical practice, at both group and individual levels.

The perception of aggression.

Several academic and clinical disciplines are involved in clarifying the concept of aggression by formulating operational and descriptive definitions. In the present paper the validity of the definitions of aggression, reported by nurses in an earlier qualitative study, is examined, using a survey approach among nurses of five general psychiatric hospitals in the Netherlands. Three dimensions of aggression were found; aggression as a normal, adaptive reaction, aggression as a violent reaction and aggression as a functional reaction. These findings match the results of the qualitative study. It was investigated whether there was a relation between personal and environmental characteristics of the nurses and the way they perceive aggression. The gender of the respondents, the setting in which they were working, the degree to which they used constraint measures and whether patients were voluntarily admitted or not, were related to the perception of aggression. The study points out that different instruments are needed to measure the prevalence or incidence of aggression and to diagnose or to intervene on aggression in clinical practice.

A study of the unidimensionality and cumulativeness of the MOS Short-form General Health Survey.

The unidimensionality and cumulativeness of the subscales Health Perceptions, Mental Health, Physical Pain, and Social Functioning of the MOS Short-form General Health Survey were investigated using the Mokken Scale Analysis for Polychotomous Items (MSP). From the analyses, two unidimensional, cumulative subscales appeared, Health Perceptions including the item on Social Functioning, and Mental Health. Both subscales met the requirements of the Mokken model, with the first scale being a 'moderately strong' hierarchical scale (H = 0.49, rho = 0.89) and the second a 'weak' hierarchical scale (H = 0.38, rho = 0.85).