Original Article
Translation, Validation, and Norming of the Dutch Language Version of the SF-36 Health Survey in Community and Chronic Disease Populations

https://doi.org/10.1016/S0895-4356(98)00097-3Get rights and content

Abstract

The primary objectives of this research were to translate, validate, and generate normative data on the SF-36 Health Survey for use among Dutch-speaking residents of the Netherlands. Translation of the SF-36 into Dutch followed the stepwise, iterative procedures developed by the IQOLA Project. Following extensive pilot testing, the SF-36 was administered to: (1) a random sample of adult residents of Amsterdam (n = 4172); (2) a random, nationwide sample of adults (n = 1742); (3) a sample of migraine sufferers (n = 423); and (4) a sample of cancer patients undergoing active anti-neoplastic treatment (n = 485). Data quality across the four studies was consistently high. The rates of missing data ranged from 1% to 5% at the item level, and from 1.2% to 2.6% at the scale level. Multitrait scaling analysis confirmed the hypothesized scale structure of the SF-36 and associated scale scoring in all four samples. Cronbach’s alpha coefficients surpassed the 0.70 criterion for group comparisons in all but one case (the Social Functioning scale in the cancer sample), with a mean alpha coefficient across all scales and samples of 0.84. Known-group comparisons yielded consistent support for the validity of the SF-36. In the two community samples, statistically significant differences in SF-36 mean scale scores were observed as a function of age, gender, and the prevalence of chronic health conditions. In the migraine and cancer samples, mean SF-36 scale scores varied significantly as a function of various indicators of disease severity. The SF-36 profiles for the two community samples were highly similar. The cancer sample yielded the lowest SF-36 scores, with the migraine sample holding an intermediate position. On-going studies will generate data on the responsiveness of the SF-36 to within-group changes in health over time. Efforts are underway to translate and validate the questionnaire for use among ethnic minority groups in the Netherlands. j clin epidemiol 51;11:1055–1068, 1998.

Introduction

During the past several decades there has been increased recognition of the need to develop brief, standardized, and psychometrically robust health status questionnaires for use in population-based health surveys, in health services research, and in clinical studies of health care interventions and new medical technologies.

Broadly defined, there are two types of self-report health status questionnaires (sometimes also referred to as “health-related quality of life” questionnaires): (1) generic instruments intended for use both in general population surveys and in studies of patients with diverse health conditions; and (2) condition-specific instruments developed for use among specific patient populations (e.g., cancer patients, diabetics, etc.). The large majority of these measures has been developed in English-speaking countries and, until relatively recently, the accumulated empirical evidence supporting their validity and reliability has been derived primarily from studies conducted among English-speaking patients. More recently, however, there has been interest expressed on the part of both public (e.g., multinational clinical trial groups, government health care agencies) and private (the pharmaceutical industry) sponsors of health care research in generating health status instruments appropriate for use in international and multicultural settings 1, 2, 3.

One of the most widely used generic health status measures is the SF-36 Health Survey. The SF-36 was developed in the United States in the late 1980s as part of the Medical Outcomes Study (MOS), a longitudinal investigation of the self-reported health status of patients with a range of chronic conditions [4]. Empirical data from the MOS and other studies have provided consistent support for the underlying scale structure, reliability, and validity of the SF-36 when used in the United States and the United Kingdom 4, 5, 6, 7, 8, 9.

In 1991, the International Quality of Life Assessment Project (IQOLA), was initiated to translate, adapt, and validate the SF-36 for use in some 15 countries 10, 11. An additional goal of the IQOLA Project was to generate normative or reference group data within each participating country. Such data can aid in the interpretation of SF-36 scores obtained in future studies, and can facilitate the comparison of the health status of populations across countries. The present article reports on the work carried out, to date, on translating, psychometrically testing, and norming the SF-36 in the Netherlands.

Section snippets

The SF-36 Health Survey

The SF-36 Health Survey is composed of 36 questions and standardized response choices, organized into eight multi-item scales: physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and general mental health (MH). Both a “standard” and “acute” version of the questionnaire (the former employing a 4-week time frame; the latter a

amsterdam sample

In total, 8686 Amsterdam residents were randomly selected from the municipal registry, of whom 4364 (50.2%) were successfully contacted and completed the SF-36. One hundred ninety-two of these respondents were younger than 16 years of age, resulting in a final sample of 4172 respondents for purposes of the current analysis. While this response rate may seem on the low side, it is not atypical of the rates obtained in recent surveys conducted in major metropolitan areas of the Netherlands [36].

Discussion

In this article we have reported on the translation, psychometric testing, and norming of the SF-36 Health Survey for use among the Dutch-speaking population of the Netherlands. Using a common translation protocol developed specifically within the IQOLA Project, translation of the SF-36 into Dutch proved to be relatively straightforward. The close collaboration among the members of the IQOLA Project team facilitated seeking common solutions to certain minor translation issues. For example, for

Acknowledgements

The research reported in this article was supported, in part, by grants from the Dutch Cancer Society, the Dutch Ministry of Health, Glaxo Wellcome, Inc., and Schering-Plough Corporation.

References (39)

  • M. Bullinger et al.

    Translating health status questionnaires and evaluating their qualityThe IQOLA project approach

    J Clin Epidemiol

    (1998)
  • S.D. Keller et al.

    Testing the equivalence of translations of widely-used response choice labelsResults from the IQOLA project

    J Clin Epidemiol

    (1998)
  • R.G. Brooks

    EuroQoL—the current state of play

    Health Policy

    (1996)
  • N. Sartorius

    The World Health Organization method for the assessment of health-related quality of life (WHOQOL)

  • National Cancer Institute/National Center for Nursing Research. Quality of Life Assessment in Special Populations. RFA...
  • American Society of Clinical Oncology

    Outcomes of cancer treatment for technology assessment and cancer treatment guidelines

    J Clin Oncol

    (1996)
  • J.E. Ware et al.

    The MOS 36-Item Short-Form Health Survey (SF-36)I. Conceptual framework and item selection

    Med Care

    (1992)
  • C.A. McHorney et al.

    The MOS 36-Item Short-Form Health Survey (SF-36)II. Psychometric and clinical tests of validity in measuring physical and mental health constructs

    Med Care

    (1993)
  • C.A. McHorney et al.

    The MOS 36-Item Short-Form Health Survey (SF-36)II. Tests of data quality, scaling assumptions, and reliability across diverse patient groups

    Med Care

    (1994)
  • J.E. Brazier et al.

    Validating the SF-36 Health Survey QuestionnaireNew outcome measure for primary care

    Br Med J

    (1992)
  • C. Jenkinson et al.

    Short Form 36 (SF-36) Health Survey QuestionnaireNormative data for adults of working age

    Br Med J

    (1993)
  • A.M. Garratt et al.

    The SF-36 Health Survey QuestionnaireII. Responsiveness to changes in health status for patients with four common clinical conditions

    Quality Life Res

    (1994)
  • N.K. Aaronson et al.

    International quality of life assessment (IQOLA) project

    Quality Life Res

    (1992)
  • J.E. Ware et al.

    The SF-36 Health SurveyDevelopment and use in mental health research and the IQOLA project

    Int J Ment Health

    (1994)
  • J.E. Ware et al.

    SF-36 Health Survey Manual and Interpretation Guide

    (1993)
  • J.E. Ware et al.

    SF-36 Physical and Mental Summary ScalesA User’s Manual

    (1994)
  • J.E. Ware et al.

    Evaluating translations of health status questionnaires

    Int J Technol Health Care

    (1995)
  • J.P. Sandwijk et al.

    Licit and Illicit Drug Use in Amsterdam IIReport of a Household Survey in 1994 on the Prevalence of Drug Use Among the Population of 12 Years and Older

    (1995)
  • L. van Royen et al.

    The societal impact of migraine

    Pharmacoeconomics

    (1995)
  • Cited by (1845)

    View all citing articles on Scopus
    View full text