Overview of validated instruments used in interviews
| Theme | Questionnaire | Description |
| Sociodemographic factors | None | |
| Social and environmental factors | Modified Medical Outcome Survey Social Support Scale (mMOS-SSS) | The mMOS-SSS is an 8-item measure of the availability of different kinds of social support scored on a 5-point Likert scale ranging from: 1 (none of the time) to 5 (all of the time). The higher the total score, the more perceived support.55 |
| Health factors, part I | Self-report generated Charlson Comorbidity Index (SRG-CCI) | The SRG-CCI is an index consisting of 10 comorbidity categories and have associated weights ranging from 1 to 6 based on risk of mortality or resource use.56 The sum of all the weights results in a single comorbidity score for a patient. The higher the score, the more likely the predicted outcome will result in mortality or higher resource use. |
| Rose Angina Questionnaire (RAQ) | RAQ was developed to detect ischaemic heart pain (angina pectoris and myocardial infarction) for epidemiological field surveys.57 Angina pectoris is indicated by responses to seven questions and possible myocardial infarction is indicated by response to a single question. Five items have binary response options and three items are categorical. | |
| European Community Respiratory Health Survey II (ECRHS II) Main Questionnaire | A selection of 14 items from the ECRHS II Main questionnaire was included to assess respiratory symptoms. Items assess the presence of wheezing, tightness in chest, shortness of breath, cough and phlegm with binary responses.58 | |
| Medical Research Council (MRC) Dyspnea Scale | The MRC Dyspnea Scale was developed to categorise the level of disability in chronic obstructive pulmonary disease.59 The scale has one item with five levels which range from ‘not troubled by breathlessness except on strenuous exercise’ to ‘too breathless to leave the house, or breathless when dressing/undressing’. | |
| Health factors, part II | Patient Health Questionnaire (PHQ15) | PHQ15 is a 15-item somatic symptom scale which measures the severity of somatisation in patients60. Items relate to 15 physical symptoms experienced in the past 4 weeks, with responses rated on a 3-point Likert scale 0 (‘not bothered at all’) to 2 (‘bothered a lot’). The summary score ranges 0–30 and classified as minimal (0–4); mild (5–9); moderate (10–14) and high (15–30) severity of somatic symptoms. |
| Health system factors | European Task Force on Patient Evaluations of General Practice Care (EUROPEP) | Europep is a 23-item questionnaire which measures patient satisfaction with primary healthcare services such as doctor–patient relationship; medical care; information and support; continuity and cooperation, and accessibility61. All items are aggregated into two dimensions: clinical behaviour (items 1–16) and organisation of care (items 17–23). Responses are rated on a 5-point Likert scale 1 (poor) to 5 (excellent). |
| Lifestyle behaviour, part I | None | |
| Lifestyle behaviours, part II | Stages of Change Survey | The Stages of Change Survey assesses the stage of lifestyle change based on the stages of change model and has one item with five statements for each type of lifestyle behaviour (smoking, alcohol consumption, nutritional consultation, physical activity) which represent different stages of change. Participants must choose from the list of statements which most closely matches what they currently do.62 |
| Smoking Abstinence Self-Efficacy Questionnaire (SASEQ) | SASEQ has six items with statements of various situations where one might be tempted to smoke and asks for the participant’s confidence level that they will not smoke.63 Response options are on a 5-point Likert scale ranging from certainly (4) to certainly not (0). | |
| Health-Specific Self-Efficacy Scales (HSSES) | The HSSES assesses a person’s optimistic self-belief about being capable to resist temptations and to adopt a healthy lifestyle64. The question ‘How certain are you that you could overcome the following barriers?’ is followed by a list of barriers for each of the following lifestyle behaviours: nutrition (five items), physical exercise (five items) and alcohol consumption (three items). Response options range on a 4-point Likert scale from (1) very uncertain to (4) very certain. | |
| RAND-12 Health Status Inventory (RAND-12 HSI) | The RAND-12 HSI is a 12-item version of the RAND-36 HSI, which measures health-related quality of life.65 The RAND-12 HSI provides estimated scores on Physical Health, Mental Health and Global Health composites of the 36-item instrument. The RAND-12 HSI uses the item response theory (IRT) and oblique (correlated) factor rotations to generate the physical and mental health summaries.65 The composite scores range from 0 to 100, where a 0 score indicates the lowest level of health and 100 indicates the highest level of health. | |
| Psychological factors, part I | Depression, Anxiety, Stress Scale (DASS-21) | Depression, anxiety and stress were measured using the DASS-21,45 66 a 21-item questionnaire consisting of three subscales, each containing seven items scored on a 4-point Likert scale ranging from 0 (did not apply to me at all) to 3 (applied to me very much), and multiplied by 2. The scores are classified as depression 0–9 (normal), 10–13 (mild), 14–20 (moderate), 21–27 (severe), ≥28 (very severe); anxiety 0–7 (normal), 8–9 (mild), 10–14 (moderate), 15–19 (severe) ≥20 (very severe); stress 0–14 (normal); 15–18 (mild), 19–25 (moderate), 26–33 (severe), ≥34 (very severe). |
| Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) | PC-PTSD-5 is a 5-item screen designed for primary care settings. The first item assesses whether the respondent has had any exposure to traumatic events. If a respondent denies exposure, the PC-PTSD-5 is complete with a score of 0. However, if a respondent indicates that they have experienced a traumatic event over the course of their life, five additional items are asked regarding how that trauma exposure has affected them over the past month. Each item receives a binary score: 0 (no) or 1 (yes). The scores are classified as: ≤2 (improbable PTSD) and ≥3 (probably PTSD).67 | |
| Resilience Scale (RS-14) | RS-14 is a 14-item questionnaire that assesses individual resilience in a general population.68 Items are scored on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). Scores are categorised into very low (14–56), low (57–64), on the low end (65–73), moderate (74–81), moderately high (82–90) and high (91–98). | |
| Psychological factors, part II | Self-esteem (SE) | SE is a 1-item scale developed as an alternative to the Rosenberg self-esteem scale69. It is measured on a 7-point Likert scale from 1 (not true of me) to 7 (very true of me). |
| Health examination | Not applicable |
PTSD, post-traumatic stress disorder.