Use of the SF-12 Instrument for Measuring the Health of Homeless Persons

Autor: Celia O. Larson
Rok vydání: 2002
Předmět:
Zdroj: Health Services Research. 37:733-750
ISSN: 1475-6773
0017-9124
DOI: 10.1111/1475-6773.00046
Popis: Health status indicators derived from self-report have been shown to be useful in a variety of settings for the purpose of assessing and monitoring the functional health of an individual or population. This information can be used by medical practitioners, clinical researchers, and policymakers to identify health needs to improve decision making, resource utilization, and health outcomes. Application of self-reported health status results is dependent on the development of valid and reliable tools that are appropriate for diverse population groups. Numerous standardized tools have emerged that measure single- and multiple-health constructs (Bergner et al. 1981; Stewart and Ware 1991; McDowell and Newell 1996). Most notable is the 36-item Short Form (SF-36) that measures eight constructs of functioning: physical function, mental health, role emotional, role physical, social function, bodily pain, vitality, and general health (Ware, Kosinski, and Keller 1996). To reduce the respondent burden and the time needed for questionnaire administration, additional short form questionnaires have been developed that consist of a single item to 12 items, assess various aspects of functioning, and have been tested with both adults and adolescents (Ware, Kosinksi, and Keller 1996; McHorney, Ware, and Raczek 1996; Radosevich 1997; Nelson et al. 1987; Nelson et al. 1994; Wasson et al. 1994; Ware et al. 1992; Ware et al. 1995; Stewart, Hays, and Ware 1988; McHorney et al. 1992; Nelson et al. 1996). These include instruments such as the 12-item Short Form Health Survey (Ware, Kosinski, and Keller 1996). The 12-item Short Form Survey (SF-12), derived from the SF-36, has been demonstrated to be reliable and valid in clinical and population-based applications in the U.S. and other countries (Ware, Kosinski, and Keller 1996; Gandek et al. 1998; Lundberg et al. 1999; Sugar et al. 1998; Jenkinson et al. 1997; Lim and Fisher 1999). The physical health and mental health summary scores that reproduce the summary scores derived from the SF-36, have been demonstrated to account for most of the variance in the eight subscales of health functioning, and differentiate well between groups known to differ in the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, self-reported changes in health, and recovery from depression (Ware, Kosinski, and Keller 1996; Ware, Kosinski, and Keller 1998; Ware et al. 1995; Ware, Kosinski, and Keller 1994). Because of the established reliability, validity, and brevity of this tool, it would be a desirable choice for use in settings that assess the health status and needs of impoverished populations such as the homeless. However, there is a need to empirically evaluate the appropriateness of its use with this previously untested population. At first glance, the face validity of some SF-12 items appear questionable for very poor, nonworking populations, such as item content references to “playing golf,” “bowling,” “pushing a vacuum cleaner,” and performing “work outside the home” or “housework.” This observation points to a need to explore the construct validity of the SF-12 before adopting it for use with homeless persons. For example, it is important to determine if the summary scores differentiate health between those homeless persons who vary in self-reported health status as has previously been found in studies of the general population. Thus, this study explores answers to the overall question, Can the SF-12 be successfully implemented with the homeless to provide valid health status information? Research has also shown differences in health status based on demographic strata such as income level and gender. The homeless experience more barriers in accessing health care compared to domiciled persons and have a higher prevalence of physical illness, substance dependence, and chronic mental illness (Burt et al. 1999; Wood and Valdez 1991; Gallagher et al. 1997). In addition, some research has suggested that females score lower on measures of health status compared to males (Stewart, Hays, and Ware 1988; Lim and Fisher 1999). Thus to elucidate upon the construct validity of the SF-12 among the homeless, this study compares SF-12 scores from a sample of homeless persons to SF-12 scores of a sample from the domiciled general population. In addition, comparisons are made between the scores of homeless men and women. This paper describes the application of the SF-12 at a day shelter and provides some evidence of construct validity for the use of this instrument in assessing and monitoring health status among homeless persons.
Databáze: OpenAIRE
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