Original ArticleTranslation, Validation, and Norming of the Dutch Language Version of the SF-36 Health Survey in Community and Chronic Disease Populations
Introduction
During the past several decades there has been increased recognition of the need to develop brief, standardized, and psychometrically robust health status questionnaires for use in population-based health surveys, in health services research, and in clinical studies of health care interventions and new medical technologies.
Broadly defined, there are two types of self-report health status questionnaires (sometimes also referred to as “health-related quality of life” questionnaires): (1) generic instruments intended for use both in general population surveys and in studies of patients with diverse health conditions; and (2) condition-specific instruments developed for use among specific patient populations (e.g., cancer patients, diabetics, etc.). The large majority of these measures has been developed in English-speaking countries and, until relatively recently, the accumulated empirical evidence supporting their validity and reliability has been derived primarily from studies conducted among English-speaking patients. More recently, however, there has been interest expressed on the part of both public (e.g., multinational clinical trial groups, government health care agencies) and private (the pharmaceutical industry) sponsors of health care research in generating health status instruments appropriate for use in international and multicultural settings 1, 2, 3.
One of the most widely used generic health status measures is the SF-36 Health Survey. The SF-36 was developed in the United States in the late 1980s as part of the Medical Outcomes Study (MOS), a longitudinal investigation of the self-reported health status of patients with a range of chronic conditions [4]. Empirical data from the MOS and other studies have provided consistent support for the underlying scale structure, reliability, and validity of the SF-36 when used in the United States and the United Kingdom 4, 5, 6, 7, 8, 9.
In 1991, the International Quality of Life Assessment Project (IQOLA), was initiated to translate, adapt, and validate the SF-36 for use in some 15 countries 10, 11. An additional goal of the IQOLA Project was to generate normative or reference group data within each participating country. Such data can aid in the interpretation of SF-36 scores obtained in future studies, and can facilitate the comparison of the health status of populations across countries. The present article reports on the work carried out, to date, on translating, psychometrically testing, and norming the SF-36 in the Netherlands.
Section snippets
The SF-36 Health Survey
The SF-36 Health Survey is composed of 36 questions and standardized response choices, organized into eight multi-item scales: physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and general mental health (MH). Both a “standard” and “acute” version of the questionnaire (the former employing a 4-week time frame; the latter a
amsterdam sample
In total, 8686 Amsterdam residents were randomly selected from the municipal registry, of whom 4364 (50.2%) were successfully contacted and completed the SF-36. One hundred ninety-two of these respondents were younger than 16 years of age, resulting in a final sample of 4172 respondents for purposes of the current analysis. While this response rate may seem on the low side, it is not atypical of the rates obtained in recent surveys conducted in major metropolitan areas of the Netherlands [36].
Discussion
In this article we have reported on the translation, psychometric testing, and norming of the SF-36 Health Survey for use among the Dutch-speaking population of the Netherlands. Using a common translation protocol developed specifically within the IQOLA Project, translation of the SF-36 into Dutch proved to be relatively straightforward. The close collaboration among the members of the IQOLA Project team facilitated seeking common solutions to certain minor translation issues. For example, for
Acknowledgements
The research reported in this article was supported, in part, by grants from the Dutch Cancer Society, the Dutch Ministry of Health, Glaxo Wellcome, Inc., and Schering-Plough Corporation.
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