A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.

https://www.jstor.org/stable/pdf/3765916.pdf

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.

Global strategy for asthma management and prevention

Cross-sectional data from the Medical Outcomes Study (MOS) were analyzed to test the validity of the MOS 36-Item Short-Form Health Survey (SF-36) scales as measures of physical and mental health constructs. Results from traditional psychometric and clinical tests of validity were compared. Principal

The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.

The world health organization quality of life assessment (WHOQOL) - position paper from the world health organization

Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines.

The final development of the Sickness Impact Profile (SIP), a behaviorally based measure of health status, is presented. A large field trial on a random sample of prepaid group practice enrollees and smaller trials on samples of patients with hyperthyroidism, rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses. Test-retest reliability (r = 0.92) and internal consistency (r - 0.94) were high. Convergent and discriminant validity was evaluated using the multitrait--multimethod technique. Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores. The relationship between the SIP and criterion measures were moderate to high and in the direction hypothesized. A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis. The final SIP contains 136 items in 12 categories. Overall, category, and dimension scores may be calculated.

The Sickness Impact Profile: development and final revision of a health status measure.

The effectiveness of medical practice is largely dependent on the quality of provider-patient communication Inputs to the provider-patient encounter include prior experience with medical care patient objectives for the visit patient age type of medical problem the number of patient concerns and characteristics of the physicians practice setting Outcomes linked to the communication process include patient knowledge provider-patient congruence on problems or recommendations patient satisfaction patient compliance with provider recommendations and resolution of patient concerns or symptoms The development of interactional analysis systems for the description of provider-patient communication processes in medical encounters should permit reasonably detailed descriptive research on these phenomena Among the problems in this area have been the lack of a theoretical base for taxonomic categories of behavior overlapping categories the arcane nature of many disciplinary taxonomies and lack of rigorous operational definitions for measurements Given the rudimentary state of development of this field descriptive designs for research will continue to be appropriate However interactional analysis systems will require additional development so that provider-patient encounters can be understood as episodes of information transfer through several channels The development of hypotheses for experimental testing of efficacy of clinical strategies for communication requires measurement of pre to postencounter change

https://www.jstor.org/stable/pdfplus/3764987.pdf

Problems and Prospects for Health Services Research on Provider-Patient Communication

Interactional analysis (IA) systems have been devised and applied to doctor-patient dialogues to describe encounters and to relate process to outcomes. Prior work in this area has been typified by the use of a single taxonomy for classifying verbal behaviors and limited outcomes (compliance and/or satisfaction). We applied three different IA systems (Bales, Roter's modified Bales with affective ratings, and Stiles' "Verbal Response Modes") to 101 new-patient visits to a general medical clinic for which multiple outcomes had been determined: several measures of patient knowledge of problems at conclusion of visit; patient compliance with drugs (over the ensuing three months); and patient satisfaction with the visit (perceived technical, interpersonal and communication quality). Within IA systems, cross tabulations and multiple regressions were performed to relate encounter events to outcomes. Across IA systems, multiple regression R2 and R2 adjusted (R2a) for the number of independent variables entering were used to characterize strength of relationships. Roter's IA system showed stronger relationships to outcomes of knowledge (41% R2, 27% R2a) and compliance (44% R2, 28% R2a) than did Bales' or Stiles' systems. R2 for patient satisfaction was identical for Bales and Roter (35%), and greater than R2 for Stiles (14%). We conclude that choice of IA system for research or teaching purposes should be based on behaviors and outcomes of particular interest and importance to the user. Based on audioreview of tapes, Roter's approach is less time-consuming and may perform as well as more complex systems requiring transcript analysis.

Outcome-based doctor-patient interaction analysis: I. Comparison of techniques

Three interactional analysis (IA) systems (Bales', Roters modified Bales and Stiles' "Verbal response modes") were used to characterize behavioral elements of provider-patient dialogues of 101 new-patient visits in a general medical clinic. In a previous article, the explanatory power of these IA systems was compared. In this article, specific provider and patient behaviors within segments of the encounter (introduction-history, physical examination and conclusion), which were shown to be related to encounter outcomes of knowledge, compliance and satisfaction, were examined. Review of interactional behaviors entering regression analysis with a significant F-to-enter (p less than or equal to 0.05) and supplementary contextual analyses suggested the importance of several categories of physician and patient behavior. Behaviors manifesting tension bear important and complex relationships to encounter outcomes. For example, patient and physician expressions of tension generally bear strong negative relationships to patient satisfaction, while patient expressions interpreted as tension release are positively related to both satisfaction and compliance. The timing of other behaviors appears to be critical to subsequent outcomes. If patient requests for medication occur early in the encounter, this behavior is positively related to subsequent patient satisfaction. However, if they occur in the concluding segment, a negative relationship results. Finally, several relationships taken together indicate that physician teaching in the concluding segment may be important. While useful observations may emerge from application of currently available IA techniques, the resulting information is best characterized as hypothesis-generating. These IA systems have many limitations, and research is needed to derived more clinically oriented systems that may permit more consistent demonstrations of critical process-outcome relationships.

Outcome-based doctor-patient interaction analysis: II. Identifying effective provider and patient behavior.

Pediatric clinicians frequently must offer support (eg, reassurance) to anxious, stressed parents. Supportive clinician behaviors were studied to determine their impact on parents. Forty initial health supervision visits to a pediatric clinic were videotaped through a one-way mirror. Mothers were interviewed immediately before and 1 week after the visits to ascertain changes in concerns, opinions of clinicians, perceptions of infants, and self-confidence. Mothers also completed a postvisit satisfaction questionnaire. Coders blinded to these outcomes identified and enumerated three supportive clinician behaviors: encouragement, reassurance, and empathy. Analyses compared visit outcomes according to high and low levels of maternal exposure to clinician support. Mothers exposed to high levels of encouragement had significant improvement in their opinions of clinicians and higher satisfaction (P = .02). Mothers exposed to high levels of empathy had higher satisfaction and greater reduction in concerns (P less than .05). No significant differences in outcome were found for exposure to reassurance. Differences in visit outcomes were not related to either maternal demographic factors or clinician type (pediatricians v pediatric nurse practitioners). These results suggest that pediatric clinicians' support for parents makes a difference. Additional outcome-based analyses are needed to identify the full range of effective pediatric communication.

William B. Carter

Papers

The Sickness Impact Profile: development and final revision of a health status measure.

Problems and Prospects for Health Services Research on Provider-Patient Communication

Outcome-based doctor-patient interaction analysis: I. Comparison of techniques

Outcome-based doctor-patient interaction analysis: II. Identifying effective provider and patient behavior.

Pediatric clinicians' support for parents makes a difference: an outcome-based analysis of clinician-parent interaction.