Improving the Measurement of Late-Life Disability in Population Surveys Beyond ADLs and IADLs: Summary of a Workshop (2009) / Chapter Skim
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4 Improving the Validity of Cross-Population Comparisons
4 Improving the Validity of Cross-Population Comparisons
Pages 51-68
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From page 51... ...
Approaches to cognitive and field testing of disability measures for cross-cultural and cross-national comparability ADDITIONAL MEASURES OF LIMITATIONS IN COGNITIVE FUNCTIONING AND DISABILITY Craig Velozo's (University of Florida and the Veterans Affairs Medical Center in Gainesville) presentation addressed the relationship of limitations in cognitive functioning and disability, additional measures of cognition, and item response theory (IRT)
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From page 52... ...
Relative to content limitation, MMSE does not address the effects of cognition in a person's daily life. MMSE also does not generate separate cognitive domain measures that are more typical in the neuropsychological literature, such as attention, memory, and executive function.
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The purpose of the study is to develop a measure of cognition that reflects the impact of cognitive challenges in everyday life; to design measures for separate domains of cognition (e.g., attention, memory, executive function) ; and to maximize measurement efficiency and precision using IRT approaches and CAT.
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From page 54... ...
Results of rater comparisons showed that patient self-reports correlated with the caregiver proxy reports in the fair to moderate range for all domains except limb praxis. Patients and caregivers rated items in a similar way, as indicated by low levels of differential item functioning (DIF)
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In conclusion, Velozo said that CAMFC-Stroke can exist as a single measure or as a battery of nine domain measures (excluding limb praxis)
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However, a comparison for the age group 55 to 64 shows that people in the Netherlands actually suffer less from chronic health conditions than people in the United States. This finding suggests that the two countries may differ less in measured work disability than is reported by individuals.
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Van Soest and his colleagues applied the vignette approach to worklimiting disability to obtain not only international comparisons that are corrected for DIF, but also comparisons of different groups within a given country, such as systematic testing of hypotheses of differences by sex, age, or socioeconomic status. Vignettes were developed in three domains of disability: (1)
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They consistently found that vignettes on work-limiting disabilities do help to correct for cross-country differences in scales used in self-reports. Corrections using vignettes reduced the estimated difference in work-limiting disability between the United States and the Netherlands by more than half.
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There are two characteristics of the question development projects that have significantly influenced the way in which the testing and evaluation methods have developed: the specific desire to not rely blindly on existing questions, which may erroneously be considered "gold standards," and the fact that the questions are intended for use in trend analysis and cross-cultural comparative work. Weeks stated that she would describe the question development initiatives and then turn to the impact that these initiatives have had on the way cognitive question testing is conducted now, both at NCHS and at partner sites around the world.
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The major focus of the Budapest Initiative is on the development of measures suitable for population surveys that capture health status or "health state." In this context, health state reflects one's functional ability ("within the skin" as opposed to with the use of aids or other assistance) ; that is, capacity, rather than performance, in a reasonable environment.
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Ultimately, the goal of both the Washington Group and the Budapest Initiative is to develop internationally comparable data that are suitable for censuses and surveys and that capture most disabled people (or the broad spectrum of health states) in a consistent fashion.
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This need required a huge paradigm shift in the cognitive testing lab and ultimately changed the way the testing and the evaluations are being conducted. In effect, the qualitative process is subject to far more of the scientific principles associated with quantitative analysis: a structured cognitive interview, data quality, data analysis (multiple levels of analysis, including an examination of patterns of respondent interpretation and calculation)
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From page 63... ...
and form the basis of the data from the cognitive testing that are analyzed in a very quantitative fashion. The results of this process are • validity tied to rich detail, • findings that are grounded, • insight into question interpretation, • insight into patterns of calculation, and • knowledge of question performance.
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In summary, the Washington Group and Budapest Initiative question development work is located at the most basic levels of activity and participation in core health domains. The goal is to measure ability (or inability)
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, rather than performance, in a reasonable environment. A new methodology for integrating cognitive testing concepts into a standardized, quantitative testing procedure was developed in the process in order to meet the specific need of testing measures of disability and health state suitable for international comparisons.
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From page 66... ...
In response to the question about whether the vignette methodology has been used to look at racial or ethnic differences in the United States, van Soest replied that it could be used in such surveys as the Health and Retirement Study, but he does not know if it has been used. The focus for using vignettes to date has been almost exclusively on cross-national comparisons.
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From page 67... ...
Connie Citro (Committee on National Statistics, DBASSE) commended the Washington Group initiative, which is clearly going back to basics as the way of making a start at getting some very carefully tested questions that will provide basic monitoring information across a whole range of countries.
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