Debra G. Froberg

METHODOLOGY FOR MEASURING HEALTH-STATE PREFERENCES-II: SCALING METHODS

This paper begins with a discussion of measurement principles relevant to determining health-state preferences. Six scaling methods are described and evaluated on the basis of their reliability, validity, and feasibility. They are the standard gamble, time trade-off, rating scale, magnitude estimation, equivalence, and willingness-to-pay methods. Reliability coefficients for most methods are acceptable although the low coefficients for measurements taken a year apart suggest that preferences change over time. Convergent validity among methods has been supported in some but not all studies, and there are limited data supporting hypothetical relationships between preferences and other variables. The category ratings method is easiest to administer and appears to yield valid scale values; thus, it is recommended for large-sample studies. However, decision-oriented methods, particularly the time trade-off and standard gamble, may be more effective in small-scale investigations and individual decision making.

METHODOLOGY FOR MEASURING HEALTH-STATE PREFERENCES-I: MEASUREMENT STRATEGIES

Values play a critical part in decision making at both the individual and policy levels. Numerous methodologies for determining the preferences of individuals and groups have been proposed, but agreement has not been reached regarding their scientific adequacy and feasibility. This is the first of a four-part series of papers that analyzes and critiques the state-of-the-art in measuring preferences, particularly the measurement of health-state preferences. In this first paper we discuss the selection of relevant attributes to comprise the health-state descriptions, and the relative merits of three measurement strategies: holistic, explicitly decomposed, and statistically inferred decomposed. The functional measurement approach, a statistically inferred decomposed strategy, is recommended because it simultaneously validates the process by which judges combine attributes, the scale values they assign to health states, and the interval property of the scale.

Methodology for measuring health-state preferences—IV: Progress and a research agenda

Remaining questions relative to the measurement of health-state preferences are outlined and applications discussed. We recommend more widespread use of functional measurement to better understand preference structures. Further research should be conducted on the reliability and validity of preference values produced by different scaling methods, including careful examination of the content validity of health-state descriptions. Construct validation studies using the multitrait-multimethod matrix would be useful as well as comparisons of stated preferences with revealed preferences. Despite the many unanswered measurement questions, preference values are currently being used in decision making at both the individual and societal levels. Several global health status measures incorporate preference values, and preferences are increasingly being used in cost-effectiveness studies. If preferences are to be used effectively, research on their measurement must accelerate to keep pace with the urgency for application.

Postpartum mental and physical problems: How common are they?

PreviewRisk of certain mental and physical problems—some of which are unique to this period—is increased during the puerperium. Perhaps the best-known such condition is postpartum blues, but other mental health disturbances and numerous physical problems can occur. Are you aware of the factors that may affect risk of postpartum depression? Of the measures that can be used to treat maternal sleep disturbances? This article covers these as well as a wide range of other problems and includes helpful tables outlining recommended treatments.

An analysis of the employment patterns, roles and functions of master's-prepared occupational health nurses. Part II.

Patricia McGovern, RN, MPH, Instructor and Acting Director, Occupational Health Nursing Unit, Public Health Nursing Program, School of Public Health, University of Minnesota, Minneapolis. Elaine Richard, RN, MS, Director of Occupational Health, Healthline, SI. Josephs Hospital, Tampa, Florida. Margaret Christensen, RN, MPH, Occupational Health Coordinator, Group Health, Inc., Minneapolis, Minnesota. Debra Froberg, PhD, Research Associate, Program in Public Health Nursing. School of Public Health, University of Minnesota, Minneapolis. Okwuoma Chi Abanobi, PhD, Assistant Professor, Health Sciences, Towson State University, Baltimore, Maryland.

User-Centered Evaluation.

Much has been written on graduate medical education and its evaluation. Seldom, however, are mentioned the uses made or the benefits of such evaluations. Drawing on current models for increasing the use of information from external evaluations, the authors offer a usercentered approach for increasing the use of results from internal evaluations, the more typical form of evaluation in graduate medical education. The overriding emphasis of the user-centered approach to evaluation is the utility of the resultant data. Three features characterize user-centered evaluation: an ordered set of steps with usefulness as the primary concern at each step; delineation of evaluator and decision-maker roles; and attention to the general communication aspects of evaluation. This article describes these three characteristics, concluding with two fundamental points: (1) A user-centered approach to evaluation will help evaluation do what it is supposed to do: provide information that gets used to increase the effectiveness of everyday decisions. (2) A user-centered evaluation accomplishes this, first, by having a pervasive attitude of utility and, second, by carefully attending to the three characteristic features of this approach to evaluation.

Consistency of Self-Ratings Across Measurement Conditions and Test Administrations

An experiment was conducted to examine the consistency of self-ratings of ability across four different measurement conditions and the relative leniency of retrospective pretest self-ratings compared to pretest self-ratings. Participants in a continuing education conference, randomly assigned to one of four measurement conditions, rated their knowledge of the conference content three times: pretest, retrospective pretest, and posttest. Of the four measurement conditions, two yielded significantly different mean self-rating scores (p < .05). Participants who were asked tojustify their self-ratings to the investigator rated themselves significantly lower than participants who were encouraged to keep their selfratings as evidence of their achievement for future career advancement. In addition, retrospective pretest self-ratings (p <. 001), and females rated themselves significantly higher than males rated themselves (p < .05). These findings have implications for evaluators and other users of self-ratings.