Towards a Reconsideration of the Use of Agree-Disagree Questions in Measuring Subjective Evaluations

Agree-disagree (AD) or Likert questions (e.g., “I am extremely satisfied: strongly agree … strongly disagree”) are among the most frequently used response formats to measure attitudes and opinions in the social and medical sciences. This review and research synthesis focuses on the measurement properties and potential limitations of AD questions. The research leads us to advocate for an alternative questioning strategy in which items are written to directly ask about their underlying response dimensions using response categories tailored to match the response dimension, which we refer to as item-specific (IS) (e.g., “How satisfied are you: not at all … extremely”). In this review we: 1) synthesize past research comparing data quality for AD and IS questions; 2) present conceptual models of and review research supporting respondents’ cognitive processing of AD and IS questions; and 3) provide an overview of question characteristics that frequently differ between AD and IS questions and may affect respondents’ cognitive processing and data quality. Although experimental studies directly comparing AD and IS questions yield some mixed results, more studies find IS questions are associated with desirable data quality outcomes (e.g., validity and reliability) and AD questions are associated with undesirable outcomes (e.g., acquiescence, response effects, etc.). Based on available research, models of cognitive processing, and a review of question characteristics, we recommended IS questions over AD questions for most purposes. For researchers considering the use of previously administered AD questions and instruments, issues surrounding the challenges of translating questions from AD to IS response formats are discussed

Prevalence of osteoarthritis in lower middle- and low-income countries: a systematic review and meta-analysis

Evidence from the Global Burden of Disease studies suggests that osteoarthritis (OA) is a significant cause of disability globally; however, it is less clear how much of this burden exists in low-income and lower middle-income countries. This study aims to determine the prevalence of OA in people living in low-income and lower middle-income countries. Four electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science) were systematically searched from inception to October 2018 for population-based studies. We included studies reporting the prevalence of OA among people aged 15 years and over in low-income and lower middle-income countries. The prevalence estimates were pooled across studies using random effects meta-analysis. Our study was registered with PROSPERO, number CRD42018112870.The search identified 7414 articles, of which 356 articles were selected for full text assessment. 34 studies were eligible and included in the systematic review and meta-analysis. The pooled prevalence of OA was 16·05% (95% confidence interval (CI) 12·55–19·89), with studies demonstrating a substantial degree of heterogeneity (I2 = 99·50%). The pooled prevalence of OA was 16.4% (CI 11·60–21.78%) in South Asia, 15.7% (CI 5·31–30·25%) in East Asia and Pacific, and 14.2% (CI 7·95–21·89%) in Sub Saharan Africa. The meta-regression analysis showed that publication year, study sample size, risk of bias score and country-income categories were significantly associated with the variations in the prevalence estimates. The prevalence of OA is high in low-income and lower middle-income countries, with almost one in six of the study participants reported to have OA. With the changing population demographics and the shift to the emergence of non-communicable diseases, targeted public health strategies are urgently needed to address this growing epidemic in the aging population

The experiences and needs of supporting individuals of young people who self-harm: A systematic review and thematic synthesis

Self-harm in young people is a serious international health concern that impacts on those providing informal support: the supporting individuals of young people. We aimed to highlight the experiences, views, and needs of these supporting individuals of young people. We conducted a systematic review and thematic synthesis: PROSPERO CRD42020168527. MEDLINE, PsycINFO, EMBASE, AMED, CINAHL, ASSIA, and Web of Science were searched from inception to 6 May 2020 with citation tracking of eligible studies done on 1 Oct 2021. Primary outcomes were experiences, perspectives, and needs of parents, carers, or other family members of young people aged 12–25. Searches found 6167 citations, of which 22 papers were included in synthesis. Supporting individuals seek an explanation for and were personally affected by self-harm in young people. It is important that these individuals are themselves supported, especially as they negotiate new identities when handling self-harm in young people, as they attempt to offer support. The GRADE-CERQual confidence in findings is moderate. Recommendations informed by the synthesis findings are made for the future development of interventions. Clinicians and health service providers who manage self-harm in young people should incorporate these identified unmet needs of supporting individuals in a holistic approach to self-harm care. Future research must co-produce and evaluate interventions for supporting individuals

Assessing the effectiveness of the ‘‘human givens’’ approach in treating depression: a quasi experimental study in primary care

Purpose: This paper aims to present the findings of research commissioned by a Primary Care Trust in the UK to assess the implementation of a new pilot Human Givens mental health service (HGS) within primary care. Method: Participating General Practitioners practices were designated as either ‘Human Givens’ or ‘Control’ practices. The study focused on service users with mild to moderate depressed mood measured using HADS. The well-being of these participants was examined at the point of referral, and after four, eight and 12 months using three well being questionnaires. Findings: The results revealed that emotional well being significantly improved during the first four months following referral for both groups and this improvement was maintained up to and including one year post referral. Human Givens therapy was found to be shorter, lasting 1-2 sessions in duration compared to standard treatment which lasted on average four sessions. Originality/value: Apart from the psychological insight and emotional support, Human Givens therapy helps the client to better function in society and maintain their sense of social integration. This has benefits to other providers of social care

The emotional needs audit (ENA): a report on its reliability and validity

Purpose – To broaden the range of well-being outcomes that can be measured for patients with depressed mood and/or other mental health issues the aim is to determine the reliability and validity of a self-reported instrument that was designed by the Human Givens Institute to evaluate emotional distress (emotional needs audit – ENA). Design/methodology/approach – The ENA was administered to 176 patients, aged between 18-65 years (mean age: 39.2 years). The acceptability of the ENA was examined as well as its internal consistency (Cronbach's alphas). ENA was administered at four time points and test-retest reliability was conducted between times 1 and 2. The data from three scales also administered to these patients (SWLS, CORE-OM and HADS) were used to aid the conduct of the ENA construct validity (concurrent and discriminant). Analysis of the ENA sensitivity/specificity was also performed. Findings – All the ENA items (except one) were shown to have good acceptability. The internal consistency was also very strong (Cronbach's alpha: 0.84); the construct validity also revealed positive results for the ENA: concurrent validity (r=0.51-0.62; p<0.001); discriminant validity (r=0.22-0.28; p<0.01). Test-retest reliability was r=0.46 (p<0.001). Finally, ENA demonstrated high sensitivity (80 per cent), and moderate specificity (35 per cent). Originality/value – ENA was shown to be a valid and reliable instrument for measuring wellbeing, quality of life and emotional distress. It also allows insight into the causes of symptoms, dissatisfaction and distress. It is suggested that this tool has complementarity to standardised tools when used in clinical practice

Self-directed self-management interventions to prevent or address distress in young people with long-term physical conditions: a rapid review.

Background: Comorbid distress in adolescents and young adults with physical long‐ term conditions (LTCs) is common but can be difficult to identify and manage. Self‐ directed self‐management interventions to reduce distress and improve wellbeing may be beneficial. It is unknown, however, which intervention characteristics are successful in supporting young people. This rapid review aimed to identify characteristics of self‐directed self‐management interventions that aimed, in whole or part, to address distress, wellbeing or self‐efficacy in this population. Methods: A systematic search was conducted for relevant controlled studies in six databases. Data on study settings, population, intervention characteristics, outcome measures, process measures and summary effects were extracted. The risk of bias was assessed using the Cochrane Risk of Bias tool v1, and the strength of evidence was rated (informed by Grading of Recommendations, Assessment, Development and Evaluations). Patient and public involvement members supported the review process, including interpretation of results. The rapid review was registered with PROSPERO (ID: CRD42021285867). Results: Fourteen studies were included, all of which were randomised trials. Heterogeneity was identified in the health conditions targeted; type of intervention; outcome measures; duration of intervention and follow‐up. Three had distress, wellbeing or self‐efficacy as their primary outcome. Four modes of delivery were identified across interventions—websites, smartphone applications, text messages and workbooks; and within these, 38 individual components. Six interventions had a significant benefit in mental health, wellbeing or self‐efficacy; however, intervention characteristics were similar for beneficial and non‐beneficial interventions. Conclusions: There is a paucity of interventions directly targeting distress and wellbeing in young people with physical LTCs. In those identified, the heterogeneity of interventions and study design makes it difficult to identify which characteristics result in positive outcomes. We propose the need for high‐quality, evidence‐based self‐management interventions for this population; including (1) more detailed reporting of intervention design, content and delivery; (2) robust process evaluation; (3) a core outcome set for measuring mental health and wellbeing for self‐ management interventions and (4) consistency in follow up periods. Public Contribution: Seven young people with an LTC were involved throughout the rapid review, from the development of the review protocol where they informed the focus and aims, with a central role in the interpretation of findings.peer-reviewe

Healthcare professionals’ priorities for training to identify and manage distress experienced by young people with a stoma due to inflammatory bowel disease: a consensus study using online nominal group technique

Young people with a stoma due to inflammatory bowel disease (IBD) commonly experience distress; however, this is not always well managed in clinical settings. More effective support may/is likely to reduce the possibility of individuals experiencing sustained distress, which may engender depression or anxiety. This study aimed to gain consensus among a multidisciplinary group of healthcare professionals (HCPs) on priorities for training in the identification and management of distress in this population. One of the authors is a young person with a stoma. Design Participants were recruited through Twitter (X) and the researchers’ clinical/research contacts. Two consensus group meetings were conducted using Nominal Group Technique, involving participants generating, discussing and rating on a Likert scale, topics for inclusion in an HCP training package. Setting Online video conferencing. Participants were located across England, with one based in the USA. Participants Nineteen HCPs participated: three general practitioners, three stoma nurses, two IBD nurses, nine clinical psychologists and two gastroenterologists. Results Twenty-five topics were generated by participants; 19 reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7-point Likert scale. These included: recognising and validating different levels of, and variation in, distress; tackling stigma and normalising having a stoma; everyday practicalities of stoma management, including food and sleep; opening and holding conversations about stoma-related distress; considering the impact of different cultural beliefs on adaptation after stoma surgery; training in simple techniques for gauging the patient’s distress during clinical encounters; having conversations about body image; and myth-busting common fears, such as odour. Conclusions This study is the first to identify HCP training priorities for managing stoma-related distress in young people. Consensus was reached for 19 topics, reflecting the varied needs of young people with a stoma. Findings will inform development of a training package for HCPs treating young people with IBD and a stoma.peer-reviewe

Young people’s priorities for the self-management of distress after stoma surgery due to inflammatory bowel disease: a consensus study using online nominal group technique

Abstract Introduction: The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self-management of stoma-related distress. The current identification and management of distress in young people with a stoma is often sub-optimal in clinical settings and there is a need for improved support resources.Methods: Two consensus group meetings were carried out via online video conferencing, using Nominal Group Technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self-management intervention.Results: Nineteen young people, aged 19-33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty-nine topics were generated by participants, seven of which reached consensus of &gt;80%, that is, a mean of &gt;5.6 on a 7-point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/ addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma ‘hacks’, e.g. useful everyday tips regarding clothing, making bag changes easier etc.; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey.Conclusions: Findings extend previous research on young people’s experiences of stoma surgery, by generating consensus on young peoples’ priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self-management resource for young people with an IBD stoma and have relevance for the clinical management of stoma-related distress in this population.<br/

Can the fire and rescue service work with primary care to improve identification of mental health problems in older adults?

Mental ill-health in older adults (aged 60 years and over) is often under-diagnosed and under-treated. Older adults are less likely to access mental health services due to perceived stigma and fear of being a burden. Non-traditional providers of healthcare, such as the Fire and Rescue Service (FRS) may provide a possible solution to facilitate early detection of problems and help-seeking among older adults, especially in the context of pressured statutory services. The aim of this study was to examine whether and how Fire and Rescue Service Home Fire Safety Visits (HFSV) could be optimized to include detection and sign-posting for mental health problems, particularly anxiety and depression, in older adults. A mixed-method qualitative study took place in the West Midlands, UK, in 2022. This study involved focus groups (n=24), and interviews with Fire and Rescue Service staff (n=4), to develop an in-depth, contextual understanding of acceptability and feasibility of expanding the HFSV to include identification of anxiety and depression. FRS staff were open to expanding their HFSVs to include more on mental health, providing they had sufficient training and support from partner agencies in primary and social care settings to accept referrals for service users (SU) presenting with symptoms of anxiety and/or depression. The positive reputation of FRS staff and engagement with older adults suggests that Home Fire Safety Visits could support the detection of anxiety and depression in older adults and appropriate sign-posting to other services including primary care