W.J.A. van den Heuvel

Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q)

Objective:To evaluate the psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q) in patients with atrial fibrillation. Design: A prospective study of the patients who underwent DC electrical cardioversion. Setting: Clinics of cardiology and thoracic surgery of the University Hospital in Groningen, the Netherlands. Main outcome measures: The disease-specific MLHF-Q and generic measures of quality of life were administered. The sensitivity to change over time was tested with effect sizes (ES). Internal consistency of MLHF-Q scales was estimated with Cronbachs alpha. To evaluate the construct validity multitrait–multimethod analysis was applied. The ‘known group validity’ was evaluated by the comparison of mean scores and effect sizes between two groups of the New York Heart Association (NYHA) classification (NYHA I versus II–III). Stability of MLHF-Q scales was estimated in a subgroup of patients who remained stable. Perfect congruence analysis and factor analysis were applied to confirm the a priori determined structure. Results: Cronbachs alpha was ≥0.80 of the MLHF-Q scales. Perfect congruence analysis (PCA) showed that the results resemble quite well the a priori assumed factor structure. Multitrait–multimethod analysis showed convergent validity coefficients ranging from 0.59 to 0.73 (physical impairment dimension) and 0.39 to 0.69 (emotional dimension). The magnitude of change can be interpreted as medium (ES = 0.50). The results of a ‘test–retest’ analysis in a stable group can be valued as satisfactory for the MLHF-Q scales (Pearsons r > 0.60). The physical dimension and the overall score of the MLHF-Q discriminated significantly between the NYHA I and II–III groups (p < 0.001) with large effect sizes (ES > 1.0). Conclusions: The MLHF-Q has solid psychometric properties and the outcome of the current study indicates that the MLHF-Q is an effective and efficient instrument.

Socioeconomic inequity in health care : A study of services utilization in Curacao

The aim of this study is to examine whether there is socioeconomic equity in health care utilization in Curaçao, Netherlands Antilles. We explore how educational level is related to utilization of GPs, specialists, hospitals; dentists and physiotherapists, taking into account the effects of sex, age and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis: probability (or incidence) of services use versus overall volume of contacts. The data were derived from the Curaçao Health Study, a health interview survey among a random sample (N = 2248) of the non-institutionalized population aged 18 and over. The results indicate that there is socioeconomic inequity in the probability of health care utilization in Curaçao. People with a higher educational level are more likely to consult a specialist, dentist or physiotherapist, and are also more likely to be hospitalized. This is not only the case when the mediating effects of socioeconomic inequalities in health (need) are taken into account, but also before adjustment for health inequalities. In other words: there appears to be both vertical inequity (i.e. greater needs for services are not met by greater use) and horizontal inequity (i.e. similar needs for care are not met by similar levels of services use). The observed inequalities in use of specialists and hospitals contrast with findings from international research. The volume of health services use (i.e. the numbers of consultations) appears to be hardly connected with a persons position in the SES hierarchy; only dental services are used more extensively by higher educated individuals.

EFFECTS OF CONTACTS BETWEEN CANCER PATIENTS ON THEIR PSYCHOSOCIAL PROBLEMS

Abstract In this article results are presented of a study on the effects of patient -to-patient support on the psychosocial problems of cancer patients. Data were collected at two points in time from samples of lymphoma and breast cancer patients in accordances with a quasi-experimental, non-equivalent control group design. Regular contacts between fellow patients decreased negative feelings (depression, anxiety and psychological complaints) and increased self-esteem. This was true especially for patient under treatment and those, whose illness had recurred. Regular contacts with other breast cancer patients decreased feelings of uncertainty especially if they had not received relevant information from their doctor. Uncertainty was also reduced in patients with Hodgkins disease who indicated having received relevant information from their doctor. However, for those Hodgkins disease patients who indicated that they did not receive relevant information from their specialist, having only a few contacts with fellow sufferers led to an increase in feelings of uncertainty.

Compliance after 17 years of breast cancer screening.

Objective –To investigate changes in attendance over the course of a population based breast screening programme. Design – Longitudinal; analysis of registered data over nine screening rounds. Setting –Subjects belong to the screening population of the Nijmegen experimental breast screening programme (1975–1990). Subjects –A cohort of 6898 women who were enrolled in 1975 at the age of 50–69 years and who were invited to nine subsequent screening rounds, irrespective of their attendance at previous rounds. Results –Attendance of women aged 50–53 years at entry was high at the initial screening (88%), decreased in the course of the programme, but remained well over 60% until round 8; 39% completed nine rounds and 24% completed seven to eight rounds. Attendance of women who were older at entry was somewhat lower at the initial screening (87%–82%) and declined more strongly. Regular compliance was also lower. Specific compliance patterns are found that can be relevant for further research. Conclusions –A substantial proportion of eligible women can be committed to mammography every two years, possibly even after reaching the age of 70, if the age at entry is around 50 and the screening programme is well established in the community. Starting a screening programme in older women seems ineffective.

Effectiveness of provision of outdoor mobility services and devices in the Netherlands

Objective: To answer the following questions: What are the problems encountered by people with outdoor mobility disabilities? What solutions are being offered to them in the Netherlands? How effective are these solutions? How responsive is the IPPA instrument (Individually Prioritized Problem Assessment)? Design: Analysing the results of a follow-up study using the IPPA instrument. Setting: The Dutch Service for the Disabled Act (SDA, in Dutch: WVG) provision system. This act is responsible for the provision of mobility aids and home adaptations. Subjects: Fifty-nine people with outdoor mobility disabilities. Interventions: The provision of outdoor mobility service and devices. Main outcome measures: Effectiveness of provisions as measured using IPPA (i.e., the degree to which activities have become less difficult to perform), effect size of IPPA with this intervention. Results: Problems identified by clients are very diverse and specific but can be classified fairly well on the basis of the International Classification of Functioning, Disability and Health (ICF); in the main, the solutions they are provided with are very similar and generic. Effectiveness is excellent at a group level, but insufficient for some at an individual level. The IPPA instrument is highly responsive in this setting. Most mobility problems respondents identified, although very individual and specific, were related to shopping, social visits or leisure activities. These specific sets of problems were solved using ‘standard’, generic solutions. Conclusions: The Dutch provision system should be more ‘demand oriented’ and less ‘supply oriented’. IPPA turns out to be a useful, structured and individualoriented method to evaluate service delivery.

Opinions on changes in the Romanian health care system from people's point of view: a descriptive study

After 10 years of changes, the Romanian people were asked to assess the consequences of the reforms that were carried out through the health care system in the last decennium. This article studies the opinion of changes among individuals and socio-economic-demographic groups living in Dolj region. Such surveys are rare in Romania. People show to have different opinions on quality of care, accessibility and on attitudes of politicians to health care comparing the present state of affaires with the past one. Overall the people judge the actual situation preferable to the past. The elderly, the chronically ill and the people who believe that people were happier 10 years ago have a more critical view on the changes especially in terms of accessibility. The higher educated people have a more positive opinion on the consequences of the reforms. The results may help to improve the communication between policy makers and the population. It is suggested that the involvement of the citizens in the health care reforms may realize a better implementation of Romanian health care reforms. This involvement is lacking.

Rural-urban differences in the utilization of care by the elderly.

Nowadays the rural-urban dimension in sociological research is being replaced more and more by the direct measurement of relevant variables. In this paper the utilization of care by the elderly and, in particular, community mental health care for the elderly has been analysed by comparing a rural and urban area in the Netherlands with respect to the needs of the elderly and the availability of services. Based on a short review of the literature on rural-urban differences, two hypotheses on the relation between the needs of the elderly and care provision and utilization have been put forward. No unequivocal support was found for the hypothesis that the need and supply of services varies systematically between rural and urban areas. Elderly who are either physically or mentally in a less favourable condition do not utilize services to a greater extent. The availability of services has some influence on utilization. With respect to old peoples homes, mental hospitals and psychogeriatric nursing homes, a direct relationship was found between the capacity of services and their utilization, irrespective of the area of residence.