Abstract
Questionnaires are a common method in healthcare and clinical research to collect self-reported data on patients’ behaviour and outcomes rather than the clinician’s perspective. As a consequence there is a plethora of questionnaires and rating forms developed to measure a range of concepts such as health-related quality of life and health status. Given that these measures have been developed within a nomothetic paradigm to enhance our understanding of peoples self-perceived health status by translating complex personal feelings and experiences into a simple numeric score, the patient’s illness narrative is lost along the way. This commentary discusses the limitations of the nomothetic approach as completion of a questionnaire is a social and contextually orientated activity and that their development is best viewed within the philosophical tradition of pragmatism, based on sound qualitative methods and rigorous psychometric testing. The commentary discusses the philosophical orientation underpinning PROM development and argues the case for a pragmatic epistemology based on a mixed methods research paradigm which goes beyond the current practice of informing the content validity of a PROM in the early phase of its development but to work towards developing a more composite and holistic picture through mixed methods in the interpretation of a patient’s PROM score. Therefore, it is argued that the quality of data obtained will be enhanced but, also importantly and rightly places the participant at the centre of the research.
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Notes
Professor Lamping’s Presidential Address 2008 ISOQoL annual conference in Montevideo, Uruguay.
See Marsh 1982 for a detailed discussion of anti-positivism.
Comte’s most important works are (1) the Course on Positive Philosophy (1830–1842, six volumes, translated and condensed by Harriet Martineau as The Positive Philosophy of Auguste Comte); (2) the System of Positive Polity, or Treatise on Sociology.
Life writing is the recording of memories, and experiences, whether one’s own or another’s. This applies to many genres and practices, under which can be found autobiography, biography, memoir, diaries, letters, testimonies, personal essays and, more recently, digital forms such as blogs and email.
References
U.S. Department of Health and Human Services Food and Drug Administration Guidance for Industry: Patient-reported outcome measures: Use in medical product development to support labeling claims.
Neale, J., & Strang, J. (2015). Philosophical ruminations on measurement: Methodological orientations of patient reported outcome measures (PROMS). Journal of Mental Health, 24(3), 123–125.
Rothman, M. L., Beltran, P., Cappelleri, J. C., Lipscomb, J., Teschendorf, B., & Mayo/FDA Patient-Reported Outcomes Consensus Meeting Group. (2007). Patient-reported outcomes: Conceptual issues. Value Health, 10(Suppl 2), S66-75.
Bakas, T., McLennon, S. M., Carpenter, J. S., et al. (2012). Systematic review of health-related quality of life models. Health and Quality of Life Outcomes, 10, 134.
Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life. Journal of the American Medical Association, 273, 59–65.
Ferrans, C. E., Zerwic, J. J., Wilbur, J. E., & Larson, J. L. (2005). Conceptual model of health-related quality of life. Journal of Nursing Scholarship, 37(4), 336–342.
Sousa, K. H., & Kwok, O. M. (2006). Putting Wilson and cleary to the test: Analysis of a HRQOL conceptual model using structural equation modeling. Quality of Life Research, 15, 725–737.
Hays, R. D., Morales, L. S., & Reise, S. P. (2000). Item response theory and health outcomes measurement in the 21st century. Medical Care, 38(9 Suppl), II28–II42.
Wiering, B., de Boer, D., & Delnoij, D. (2017). Patient involvement in the development of patient-reported outcome measures: A scoping review. Health Expectations, 20(1), 11–23.
Greenhalgh, J., Gooding, K., Gibbons, E., et al. (2018). How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis. The Journal of Patient-Reported Outcomes, 2, 42.
McClimans, L. (2010). A theoretical framework for patient-reported outcome measures. Theoretical Medicine and Bioethics, 31(3), 225–240.
Kwon, J. Y., Thorne, S., & Sawatzky, R. (2019). Interpretation and use of patient-reported outcome measures through a philosophical lens. Quality of Life Research, 28(3), 629–636.
Henn, M., Weinstien, M., & Foard, N. (2006). A short introduction to social research. Sage.
Gendall, P. (1998). A framework for questionnaire design: Labaw revisited. Marketing Bulletin, 9(3), 28–39.
Hughes, J. (1980). The Philosophy of Social research. Longman Group UK Limited.
Hughes, J. A., & Sharrock, W. W. (1997). The philosophy of social research. Longman.
Travers, M. (2001). Qualitative research through case studies. Sage Publication.
Crotty, M. (1998). The foundations of social research: Meaning and perspective in the research process. SAGE Publications Inc.
Silverman, D. (2015). Doing qualitative research: A practical (2nd ed.). Sage Publications.
Ashworth, M., Guerra, D., & Kordowicz, M. (2019). Individualised or standardised outcome measures: A co-habitation? Administration and Policy in Mental Health, 46, 425–428.
Ashworth, M., Kordowicz, M., & Schofield, S. (2012). ‘PSYCHLOPS’ (Psychological Outcome Profiles): An outcome measure. Integrating Science and Practice, 2, 36–39.
McKenna, S. P., Heaney, A., Wilburn, J., & Stenner, A. J. (2019). Measurement of patient-reported outcomes. 1: The search for the Holy Grail. Journal of Medical Economics, 22(6), 516–522.
Rubin, H. J., & Rubin, I. S. (2012). Research philosophy and qualitative interviews. In H. J. Rubin & I. S. Rubin (Eds.), Qualitative interviewing: The art of hearing (3rd ed.). Sage Publications.
Allport, G. W. (1937). Personality: A psychological interpretation. Holt, Rinehart & Winston.
Allport, G. W. (1961). Pattern and growth in personality. Holt, Rinehart & Winston.
Harvey, L. (2012–20). Social Research Glossary, Quality Research International.
Romm, N. R. A. (2013). Employing questionnaires in terms of a constructivist epistemological stance: Reconsidering researchers’ involvement in the unfolding of social life. International Journal of Qualitative Methods, 12(1), 652–669.
Marsh, C. (1982). Survey method: The contribution of surveys to sociological explanation. Routledge.
Haynes, S. N., Mumma, G. H., & Pinson, C. (2009). Idiographic assessment: Conceptual and psychometric foundations of individualized behavioral assessment. Clinical Psychology Review, 29(2), 179–191.
Lyon, A. R., Connors, E., Jensen-Doss, A., Landes, S. J., Lewis, C. C., McLeod, B. D., Rutt, C., Stanick, C., & Weiner, B. J. (2017). Intentional research design in implementation science: Implications for the use of nomothetic and idiographic assessment. Translational Behavioral Medicine, 7(3), 567–580.
Anderson, C. B., Rapkin, B., Reaves, B. C., Sun, A. J., Morganstern, B., Dalbagni, G., Donat, M., Herr, H. W., Laudone, V. P., & Bochner, B. H. (2017). Idiographic quality of life assessment before radical cystectomy. Psycho-Oncology, 26(2), 206–213.
Van Hout, B., Janssen, M. F., Feng, Y. S., Kolhlmann, T., et al. (2012). Interim scoring for the EQ-5D-5L: Mapping the EQ-5D-5L to EQ-5D-3L value sets. Value in Health, 15(9), 708–715.
Ferreira, N., Ferreira, P. L., Pereira, P. L., Rowen, D., et al. (2015). Exploring the consistency of the SF-6D. Value in Health, 18(8), 1162.
Horsman, J., Furlong, W., Feeny, D., et al. (2003). The Health Utilities Index (HUI®): Concepts, measurement properties and applications. Health and Quality of Life Outcomes, 1, 54.
Mulhern, B., Labeit, A., Rowen, D., Knowles, E., Meadows, K., Elliott, J., & Brazier, J. (2017). Developing preference-based measures for diabetes: DHP-3D and DHP-5D. Diabetic Medicine, 34(9), 1464–5491.
Brazier, J., Rowen, D., Mavranezouli, I., Tsuchiya, A., & Young, T. (2012). Developing and testing methods for deriving preference-based measures of health from condition-specific measures (and other patient-based measures of outcome). Health Technology Assessment, 16(32), 1–114.
Montague, G. P. (2012). Who am i? Who is she? A naturalistic, holistic, somatic approach to personal identity (p. 308). Transaction Books.
Frank, A. (1995). The wounded story-teller. University of Chicago Press.
Galasinski, D. (2008). Constructions of the self in interaction with the Beck Depression Inventory. Health, 12(4), 515–533.
Kangas, I. (2001). Making sense of depression: Perceptions of melancholia in lay narratives. Health, 5(1), 76–92.
De Souza, R. (2004). Motherhood, migration and methodology: Giving voice to the “other.” The Qualitative Report, 9(3), 463–482.
Habermas, J. (1970). Towards a theory of communicative competence. Inquiry, 13, 360–375.
De Souza, R. (2007). Walking a tightrope: Asian health research in New Zealand. Health and Social Care, 4, 9–20.
Kaushik, V., & Walsh, C. A. (2019). Pragmatism as a research paradigm and its implications for social work research. Social Sciences, 8(9), 255.
Biesta, G. (2010). Pragmatism and the philosophical foundations of mixed methods research.pdf. In A. Tashakkori & C. Teddlie (Eds.), Sage handbook of mixed methods in social and behavioural research (2nd ed., pp. 95–117). Sage.
Morgan, D. L. (2007). Paradigms lost and pragmatism regained: Methodological implications of combining qualitative and quantitative methods. Journal of Mixed Methods Research, 1, 48–76.
Tashakkori, A., & Teddlie, E. (Eds.). (2003). Handbook of mixed methods in social and behavioral research. Sage.
Johnson, R. B., & Onwuegbuzie, A. J. (2004). Mixed methods research: A research paradigm whose time has come. Educational Researcher, 33, 14–26.
Tashakkori, A., & Editorial, C. J. W. (2007). The new era of mixed methods. Journal of Mixed Methods Research, 1, 1–6.
Turner, S. F., Cardinal, L. B., & Burton, R. M. (2015). (PDF) Research design for mixed methods: A triangulation-based framework and roadmap. Retrieved from February 18, 2021, from https://www.researchgate.net/publication/284790946_Research_Design_for_Mixed_Methods_A_Triangulation-based_Framework_and_Roadmap.
Timans, R., Wouters, P., & Heilbron, J. (2019). Mixed methods research: What it is and what it could be. Theory and Society, 48, 193–216.
Schoonenboom, J., & Johnson, R. B. (2017). How to construct a mixed methods research design. Kolner Z Soz Sozpsychol, 69(Suppl 2), 107–131.
Special Section on Mixed Methods Research. (2012). Quality of Life Research, 21(3), 1573–2649.
Regnault, A., Willgoss, T., Barbic, S., et al. (2018). Towards the use of mixed methods inquiry as best practice in health outcomes research. Journal of Patient-Reported Outcomes, 2, 19.
Bryman, A. (2006). Integrating quantitative and qualitative research: How is it done? Qualitative Research, 6(1), 97–113.
Doyle, L., Brady, A. M., & Byrne, G. J. (2016). An overview of mixed methods research—revisited. Journal of Research in Nursing, 21(8), 623–635.
Symonds, J. E., & Gorard. (2009). The death of mixed methods: Research labels and their casualties. The British Educational Research Association Annual Conference, Heriot Watt University, Edinburgh, September 3–6.
Denzin, N. K., & Lincoln, Y. S. (1998). Strategies of qualitative inquiry. SAGE Publications.
Cohen, L., Manion, L., & Morrison, K. (2011). Research methods in education (7th ed.). Routledge Falmer.
Denzin, N. K. (1978). Sociological methods: A sourcebook. McGraw-Hill.
Lukkarinen, H. (2005). Methodological triangulation showed the poorest quality of life in the youngest people following treatment of coronary artery disease: A longitudinal study. The International Journal of Nursing Studies, 42(6), 619–627.
Turner, S. F., Cardinal, L. B., & Burton, R. M. (2015). (PDF) Research Design for mixed methods: A triangulation-based framework and roadmap. Organizational Research Methods, 20(2), 243–267.
Jick, T. D. (1979). Mixing qualitative and quantitative methods: Triangulation in action. Administrative Science Quarterly, 24, 602–611.
Fetters, M. D., & Molina-Azorin, J. F. (2017). Journal of Mixed Methods Research, 11(1), 3–10.
Greenhalgh, T. (1999). Why study narrative? BMJ, 318(7175), 48–50.
Pool, R., Montgomery, C. M., Morar, N. S., Mweemba, O., Ssali, A., et al. (2010). A mixed methods and triangulation model for increasing the accuracy of adherence and sexual behaviour data: The Microbicides Development Programme. PLoS ONE, 5(7), e11600.
Rose, D., Thornicroft, G., & Slade, M. (2006). Who decides what evidence is? Developing a multiple perspectives paradigm in mental health. Acta Psychiatrica Scandinavica, 113, 109–114.
Rose, D., Evans, J., Sweeney, A., & Wykes, T. A. (2011). Model for developing outcome measures from the perspectives of mental health service users. The International Review of Psychiatry, 23(1), 41–46.
Frechette, J., Bitzas, V., Aubry, M., Kilpatrick, K., & Lavoie-Tremblay, M. (2020). Capturing lived experience: Methodological considerations for interpretive phenomenological inquiry. International Journal of Qualitative Methods, 3(1), 42–55.
Misak, C. J. (2010). Narrative evidence and evidence-based medicine. Journal of Evaluation in Clinical Practice, 16(2), 392–397.
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Meadows, K.A. A philosophical perspective on the development and application of patient-reported outcomes measures (PROMs). Qual Life Res 31, 1703–1709 (2022). https://doi.org/10.1007/s11136-021-03016-8
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DOI: https://doi.org/10.1007/s11136-021-03016-8