The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions

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Abstract

Objective

This paper describes the development and validation of the Health Education Impact Questionnaire (heiQ). The aim was to develop a user-friendly, relevant, and psychometrically sound instrument for the comprehensive evaluation of patient education programs, which can be applied across a broad range of chronic conditions.

Methods

Item development for the heiQ was guided by a Program Logic Model, Concept Mapping, interviews with stakeholders and psychometric analyses. Construction (N = 591) and confirmatory (N = 598) samples were drawn from consumers of patient education programs and hospital outpatients. The properties of the heiQ were investigated using item response theory and structural equation modeling.

Results

Over 90 candidate items were generated, with 42 items selected for inclusion in the final scale. Eight independent dimensions were derived: Positive and Active Engagement in Life (five items, Cronbach's alpha (α) = 0.86); Health Directed Behavior (four items, α = 0.80); Skill and Technique Acquisition (five items, α = 0.81); Constructive Attitudes and Approaches (five items, α = 0.81); Self-Monitoring and Insight (seven items, α = 0.70); Health Service Navigation (five items, α = 0.82); Social Integration and Support (five items, α = 0.86); and Emotional Wellbeing (six items, α = 0.89).

Conclusion

The heiQ has high construct validity and is a reliable measure of a broad range of patient education program benefits.

Practice Implications

The heiQ will provide valuable information to clinicians, researchers, policymakers and other stakeholders about the value of patient education programs in chronic disease management.

Introduction

The acute healthcare sector is designed to identify and treat individuals and discharge them back to the community as ‘resolved encounters’ in a prompt manner. However management of individuals with chronic conditions is more complex than that for acute problems due to an array of concomitant risk factors, care needs and social circumstances over a lifetime. For many people with chronic diseases, encounters with acute healthcare are brief, sporadic and unresolved interactions.

The great preponderance of chronic disease care and management therefore occurs in the individual's residence by the affected individual (and/or their carer), and this is most often quite separate from healthcare professionals. As a result, self-management has emerged as a critical component of care for individuals with chronic disease.

There is increasing national and international interest in patient education and self-management programs [1], [2]. A wide variety of organizations including hospitals and community-based facilities are offering patient education and rehabilitation programs [2]. The programs’ curricula include behavioral risk factor information, medication compliance as well as techniques to reduce symptoms, overcome distress and improve coping. The ultimate anticipated outcome for individuals attending these programs is improvement in quality of life. Patient empowerment, self-efficacy and self-management have also been found to be key intermediate outcomes but to date have been somewhat difficult to operationalize, measure and subsequently report on in terms of patient impact [2], [3], [4].

Patient education programs should reinforce individualised advice obtained from within consultations, putting that advice into a wider context, suggesting further sources of information, and helping the recipient to gain more from the healthcare system. At a minimum, such programs should improve both health knowledge and health literacy, which increase an individual's capacity to obtain, process, and understand basic health information and services needed to make appropriate health-related decisions. Recent literature promotes these principles as key elements needed to overcome the growing burden of chronic disease [5], [6].

Given the finite resources in the health care sector a broad range of stakeholders require clear information on the value of patient education programs. However there is currently no specific, validated and comprehensive questionnaire for their evaluation. The overall aim of this research was to develop a questionnaire that would inform health professionals, policymakers and researchers on the outcomes of patient education programs. The questionnaire was required to be appropriate for a wide range of courses and diseases, user-friendly and psychometrically robust.

Section snippets

Methods

The questionnaire development techniques involved: review of current practice; development of a Program Logic; Concept Mapping;, rigorous item development; item testing and selection; and validation in an independent sample.

Program Logic

This workshop detailed types of potential immediate outputs through to distal impacts of patient education programs on public health (see Fig. 1) [3]. Two overarching streams were identified; empowerment of patients and carers and improved partnerships within the healthcare system and with other organizations. The difficulty of demonstrating outcomes increases as one progresses down the model. Many of these outcomes can already be measured reliably by questionnaire (see the non-italicized

Discussion

The development of the heiQ involved extensive stakeholder consultation, careful attention to item content and rigorous statistical analyses. The dimensions covered by the questionnaire target the areas that patients, clinicians, course leaders, policymakers and researchers regard as crucial outcomes of patient education programs for people with chronic disease. Eight independent scales, all with very good or good psychometric properties, were developed. These scales provide a rich range of

Conflict of interest

The authors state that there are no conflicts of interests.

Acknowledgments

The authors wish to thank: Roy Batterham, Plexus Consulting, Melbourne who facilitated and analyzed the data from the Concept Mapping workshops; Ian Wicks, Jean Spinks, Angelo Iezzi, Australian Arthritis Foundations; Diana Aspinal, Ann-Maree Colborne, Alanah Coughlan, Ric Forlano, Elizabeth Scrivener, Phillip Hopkin, Gillian Leech, Ambrose Nicholls-Skene, Jacqui Slyp and Bob Unger; Sandra Nolte.

This work was funded in part by a grant from the National Arthritis and Musculoskeletal Conditions

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1

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Tel.: +61 3 8344 3148; fax: +61 3 9342 7632.

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