Original Article
Concordance between supervised and postal administration of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) was very high

https://doi.org/10.1016/j.jclinepi.2005.01.010Get rights and content

Abstract

Background and Objective

There is increasing international interest in using patient-based outcome measures to evaluate interventions. We compared responses to postal administration of Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) with the gold standard of supervised self-completion.

Study Design and Setting

Validation study involving 96 adults, recruited from U.K. general practice, sent the postal questionnaires with an instruction sheet 1 week before supervised self-completion. Responses for those whose quality of life (n = 56) or asthma control (n = 61) had ‘not changed’ between postal and supervised completions were compared using paired-sample t-tests, Pearson's correlation coefficient (r), and intraclass correlation coefficient (ICC).

Results

For the MiniAQLQ, overall mean scores were similar in both groups: Postal = 5.14 (SD = 1.42) vs. Supervised = 5.17 (SD = 1.39), with mean difference of −0.03 (95% CI = −0.14, 0.08; P = .59), with a high degree of correlation (r = .96, P < .001) and concordance (ICC = 0.96; 95% CI = 0.93, 0.98; P < .001). For the ACQ, overall mean scores (with SD) were also similar in both groups: Postal = 1.24 (SD = 1.09) vs. Supervised = 1.26 (SD = 1.10), with mean difference of −0.02 (95% CI = −0.12, 0.08; P = .74), with good correlation (r = .94, P < .01) and concordance (ICC = 0.94; 95% CI = 0.90, 0.96; P < .01).

Conclusions

Correlation and concordance between supervised and postal administration of the MiniAQLQ and ACQ are very high. Users may confidently choose the mode of administration most appropriate to their needs.

Introduction

Increasing recognition of the importance of focusing on patient concerns in order to evaluate interventions has led to an expanding literature using patient-based outcome measures [1], [2]. Although such instruments are typically developed as research tools for completion under supervision, there is increasing interest in postal administration, particularly for studies assessing interventions in the context of normal clinical practice. Postal administration of questionnaires may reduce the need for study visits and minimize disruption for the patient [3].

Validity, however, is not a fixed property of an instrument; it must be assessed in relation to a specific purpose and setting [1], [4]. It is recognized that people may give more favorable responses when personally interviewed than when self-completing [5]. For example, one study showed that elderly people reported more problems on a postal questionnaire than were detected by interview [6]. Well-being and perceived quality of life may be influenced by environmental factors, such as the home or clinic location in which the questions are completed [7]. Postal administration raises practical issues such as the absence of a trained supervisor to check completion, resulting in higher error rates [6], [8], [9]. Other factors that may influence responses include interaction with family and friends, which cannot be prevented (and indeed may be necessary to aid completion) when questionnaires are completed at home [6].

Researchers will be reluctant to use postal questionnaires without a formal evaluation of postal administration confirming that the responses obtained will be complete and valid. This is of particular importance if results obtained by different means are to be used for sequential monitoring of a condition. Few studies have specifically addressed this issue. Although several studies raise concerns about poor agreement between interviewer-administered questionnaires and postal self-completion [6], [10], [11], [12], [13], the few studies comparing self-completed questionnaires (i.e., not involving an interviewer) administered in a clinic or by post are more encouraging [12], [14]. Our study explores the validity of postal vs. clinic self-completion in a primary care population of two frequently used asthma questionnaires, a clinical control and a disease-related quality of life.

Section snippets

The Mini Asthma Quality of Life Questionnaire

The Asthma Quality of Life Questionnaire [15] is widely used as a research tool [2], and development of the shortened, self-completed version (MiniAQLQ) [16] has further increased its popularity. The MiniAQLQ is a validated 15-question, self-administered instrument to measure the physical and emotional problems that are most troublesome to adults with asthma. The questions are scored on a scale of 1 to 7 (where 1 is greatest impairment and 7 is least impairment). The questions are grouped into

Results

A sample of 96 participants were recruited, with a mean age of 58.5 years (SD = 15.7; range 25–82 years). Volunteers were significantly older (P < .01) than the 391 eligible patients, whose mean age was 48.4 years (SD = 18.5; range 18–89 years). The gender ratio in the two groups was similar: 66 of 96 participants were female (69%), compared with 60% female for the full recruitment pool (P < .13). The postal response rate was 94 of 96 (98%), and 86 of 96 (90%) attended for supervised completion of

Discussion

Our data show that, for both the MiniAQLQ and ACQ, postal and supervised administration generate comparable results. The postal form of the questionnaires (with accompanying instruction sheet) [8] can therefore be used with confidence as a convenient and valid method for collecting data.

Acknowledgments

The study was undertaken in the Whitstable Medical Practice. Toni Bowey undertook the administration of the study. We gratefully acknowledge the advice of the referees whose thoughtful reviews helped us to improve this paper. H.P. initiated the idea for the study and led the development of the protocol, securing of funding, study administration, data analysis, interpretation of results, and writing of the paper. A.S. contributed to the development of the protocol and securing of funding and

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