Stakeholder and end-user perspectives to refine the Context-sensitive Positive Health Questionnaire (CPHQ) to measure broad health

PLoS ONE, vol. 21, pp. e0330014

Abstract

INTRODUCTION: Broad health concepts are increasingly embedded in healthcare and other domains. Therefore, in a previous study, we developed and validated the Context-Sensitive Positive Health Questionnaire (CPHQ). The CPHQ is based on Positive Health, the Capability Approach and on perspectives of stakeholders and end-users, including those with a lower socioeconomic position (SEP) with the aim to validly measure broad health. Stakeholders and end-users were involved in the development process. However, professionals working in healthcare, welfare or policy domain were not sufficiently involved, while their perspective on how to measure broad health is needed to support broader applicability and acceptability. OBJECTIVE: We aimed to refine the 32-item CPHQ for cross-domain use through focus group discussions (FGDs) with stakeholders across healthcare, welfare and policy domains, researchers, as well as patients and citizens, including those from a lower SEP, expert review and a member check. METHODS: We conducted nine (FGDs) and one interview with stakeholders from healthcare, welfare, and policy domains, research, patients and (lower SEP) citizens (n = 76). An adapted COMET method analysis and qualitative analysis were used, followed by a member check to validate the changes. RESULTS: Items were omitted, merged or added, leading to a refined CPHQ (28 items). Main themes guiding edits were 1) the importance of avoiding normative phrasing and including subjectively interpretable items, 2) prioritization of items reflecting aspects of experienced health (e.g., "I feel happy" or "I feel healthy"), 3) relevance of functionings. At the same time, views diverged on the inclusion and wording of items related to exclusion, political representation and sense of belonging. These items were subsequently discussed by the core group and evaluated using the predefined decision rules and qualitative feedback. CONCLUSION: The CPHQ refinement involved a wide range of stakeholders, including end-users. This led to a 28-item CPHQ to measure broad health. Future research in different populations and settings is needed to validate and possibly shorten the refined CPHQ.

Authors 13

1. Mirte Boelens corresponding Aachen Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center/Health Campus The Hague, Department of Public Health and Primary Care, The Hague, The Netherlands

2. Cheryl Roumen

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

3. Esther Bloemen‐van Gurp

   Zuyd University of Applied Sciences · Fontys University of Applied Sciences

   Affiliation as printed

   Fontys University of Applied Sciences, Center of Expertise Health, Eindhoven, The Netherlands

   Zuyd University of Applied Sciences, Research Center of community care, Heerlen, The Netherlands

4. John A. J. Dierx

   Avans University of Applied Sciences

   Affiliation as printed

   Avans University of Applied Science, Centre of Expertise Perspective in Health, Research Group Equal Chances on Healthy Choices, Breda, Netherlands

5. Lenny M.W. van Venrooij

   Tilburg University · Jeroen Bosch Ziekenhuis

   Affiliation as printed

   Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands

   Tranzo Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands

6. Tim van Zutphen

   University of Groningen

   Affiliation as printed

   Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, the Netherlands

7. Pien M.R. Christiaanse

   University of Groningen

   Affiliation as printed

   Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, the Netherlands

8. Jaron Schnitzer

   Fontys University of Applied Sciences

   Affiliation as printed

   Fontys University of Applied Sciences, Center of Expertise Health, Eindhoven, The Netherlands

9. M. Elske van den Akker – van Marle Aachen Department of Biomedical Data Sciences Section of Medical Decision Making

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Section of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands

10. Miriam J.J. de Kleijn
    Affiliation as printed

    Institute for Positive Health, Utrecht, The Netherlands

11. Marja van Vliet
    Affiliation as printed

    Institute for Positive Health, Utrecht, The Netherlands

12. Jessica C. Kiefte–de Jong Aachen Department of Public Health and Primary Care

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center/Health Campus The Hague, Department of Public Health and Primary Care, The Hague, The Netherlands

13. Marieke Dingena Spreeuwenberg

    Maastricht University · Care and Public Health Research Institute

    Affiliation as printed

    Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands