Original Article
The new questionnaire Health-Related Quality of Life for Eating Disorders showed good validity and reliability

https://doi.org/10.1016/j.jclinepi.2005.06.005Get rights and content

Abstract

Background and Objectives

To describe the development and investigate the psychometric properties of a new instrument to measure health-related quality of life (HRQoL) for individuals with an eating disorder (ED).

Methods

Seven focus groups were convened and an extensive literature review was carried out to generate the items. The first draft of the questionnaire was pilot tested. Three hundred twenty-four ED patients took part in the final field study. The 12-Item Short Form Health Survey, the Eating Attitudes Test-26, and two items from the Eating Disorders Inventory-2 also were applied to examine the concurrent validity. Factor analysis, item scale correlation correcting for overlap, test–retest, Cronbach's α coefficient, known-groups validation, and the sensitivity of the questionnaire in different populations also were examined.

Results

The final Health-Related Quality of Life in Eating Disorders (HeRQoLED) questionnaire consisted of 50 items. Principal axis factor analysis identified eight subscales. Concurrent validity showed correlations >.40 with the criteria measures. Excellent reliability and stability were obtained. The HeRQoLED was sensitive in discriminating both between known-different groups and from the general population.

Conclusion

The results provide evidence of the good psychometric properties of the new HeRQoLED questionnaire, except for one domain, which had to be eliminated.

Introduction

Emphasis recently has been placed on the importance of health-related quality of life (HRQoL) in assessing states of health and outcomes of medical care, especially in chronic diseases. The term HRQoL does not have a unique definition; however, there is broad agreement that it is a subjective, multidimensional construct comprising three major aspects of functioning: physical, psychological, and social [1].

After reviewing the literature, we found that few studies have focused explicitly on measuring the HRQoL in patients with anorexia nervosa (AN) and bulimia nervosa (BN) [2], [3], [4], [5], [6]. Interestingly, most studies were concerned with the relationship between binge eating disorder and HRQoL [7], [8], [9], [10], [11], [12]. Padierna et al. [4] reported that patients with AN and BN had a perception of improvement in HRQoL after 2 years of treatment. Nevertheless, these patients were still more dysfunctional compared with the general population. All the studies reviewed may be limited due to the use of a generic HRQoL instrument that “may fail to capture the extent of the disability caused by the illness” [5] for the groups of patients with an eating disorder (ED). The creation of a specific HRQoL instrument would allow greater discrimination of severity of disease and responsiveness to treatment [6], [13], [14].

To offset these deficiencies, we developed the Health-Related Quality of Life in Eating Disorders (HeRQoLED) self-report questionnaire, which is comprised of 50 questions that measure eight health-related domains, including one symptom index (10 items). It also contains three single items that are not used to score any of the domains but provide useful data for clinical practice. They provide information about the regularity of menstrual periods, the effect of certain behaviors on the perception of the patient's quality of life, and the motivation of the patient to change his or her ED.

Section snippets

Aims of the study

We sought to develop an instrument to measure the HRQoL in ED patients. Its psychometric properties were explored, and we also wanted to test whether the HeRQoLED questionnaire could discriminate between subjects with an ED and a group comprised of members of the general population.

Participants and procedures

Four psychiatrists experienced with EDs, from three health centers in Bizkaia, Spain, collaborated in the recruitment of participants. The criteria for inclusion in the study were that participants had to (1) be diagnosed with an ED, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria [15]; (2) be treated on a regular basis in one of the three centers; (3) not have a clinically serious multiorganic disorder, cerebral organic deterioration, or

Results

Data on the 324 respondents were compared against the 70 who did not return the questionnaire. No statistically significant differences were found in any of the variables, including the level of severity of the ED. Nevertheless, we observed that a higher percentage of the patients who did not respond to the HeRQoLED were in the precontemplation phase (i.e., patients responded that they did not consider that they had an eating problem) and contemplation phase (i.e., subjects were starting to

Discussion

As Fairclough pointed out [45], it is preferable to select a previously validated instrument than to create a new one. Should this instrument be unavailable in the required language, it is also advisable to make a cultural adaptation of a good instrument instead of creating a new one. Nevertheless, our creation of the HeRQoLED is reasonable due to the absence of a satisfactorily validated instrument with the basic aim of measuring HRQoL for persons with an ED. The available literature on the

Acknowledgments

This study was funded by the Instituto de Salud Carlos III (Expedient: 00/0115). We are grateful to all the patients with an ED and to the students who participated in the study. We also thank Dra. Esther Calvete, Inmaculada Arostegui, Dra. Begoña Matellanes, and the Foundation Escuela Diocesana de Educadores (Fundación EDE) for helping to recruit the general population group, and to Yarima Etxeberria for her important contribution in the study. We are also grateful for their helpful comments

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