‘Translation is not enough’: using the Global Person Generated Index (GPGI) to assess individual quality of life in Bangladesh, Thailand, and Ethiopia

Abstract

Currently few subjective measures of Quality of Life (QoL) are available for use in developing countries, which limits their theoretical, methodological, and practical contribution (for example, exploring the relationship between economic development and QoL, and ensuring effective and equitable service provision). One reason for this is the difficulty of ensuring that translated measures preserve conceptual, item, semantic, operational, measurement; and functional equivalence (Herdman, M., Fox-Rushby, J., & Badia, X. (1998). Quality of Life Research, 7, 331), which is illustrated by an account of the translation, pre-piloting, and administration of a new individualised QoL measure, the Global Person Generated Index or ‘GPGI’. The GPGI is based on the widely used Patient Generated Index (Ruta, Camfield, & Martin, (2004) Quality of Life Research, 13, 1545.) and offers many of the advantages of the participatory approaches commonly used in developing countries, with added methodological rigour, and quantitative outcomes. It was successfully validated in Bangladesh, Thailand, and Ethiopia, using quantitative and qualitative methods—open-ended, semi-structured interviews (SSIs), conducted immediately post-administration. Both the measure and method of ‘qualitative validation’ described later in the paper offer an exciting alternative for future researchers and practitioners in this field. The quantitative results suggest the GPGI shows cultural sensitivity, and is able to capture both the areas that are important to respondents, and aspects of life one would expect to impact on QoL in developing countries. There were strong correlation between scores from the GPGI and SSIs for the area of health, and moderate correlations for ‘material wellbeing’ (MWB)(‘Material wellbeing’ refers to respondents’ perceptions of their achievement in the areas of farming, debt reduction, assets, crops, livestock, job, land, property, and agriculture) and children. Weak to moderate correlations were observed between the Satisfaction with Life Scale and the GPGI; however, the highest coefficient was between the GPGI and the most conceptually similar item. Statistically significant differences were seen in GPGI scores between rich and poor, urban and rural respondents, and different countries. Health and material wellbeing scores, derived from the SSIs, also showed a linear relationship with GPGI scores, with a suggestion of curvilinearity at the higher levels, as predicted by a general QoL causal model. In conclusion, the GPGI has great potential for use in this area, especially when supported by extensive interviewer training, and supplemented with a cognitive appraisal schedule.

Appendix: Discrepancies between SSI and GPGI responses: A second example

The second example is taken from the responses of an Ethiopian male of unknown age and occupation. He nominated ‘justice’ in his GPGI and mentioned aspects of justice six times throughout his SSI. He seemed very unhappy and angry at what he perceived as injustice:

"I am not happy with the kebele leadership. Government officials prevented us from electing good people. Rather, anti-social and irresponsible persons were appointed so that we are suffering unjust administration."

"I do not like the political system that allowed injustice to prevail. I am not also happy with the land policy that make it state owned. Our land is to be taken by government if we fail to support it." The GPGI rating of 2 for this life area seems to match his SSI, but he only assigned a weight of 0.2 to the area; one might have expected him to attach greater relative importance to this aspect of his life. Children were also nominated in the respondent’s GPGI and mentioned three times in his corresponding SSI. He seemed very happy with this aspect of his life:

"I have good children. I wish to have good wealth in order to help them form their own good homes. "

"At least I have been able to support my family through crop production, although I could not get rich. I wish to keep on living in order to help my children."

The GPGI score of 6 and the relative weight of 0.2 seem to match the SSI. However, he nominated Health and Religion in his GPGI (both given a score of 3 with 2 points spent in step 3), yet there was no mention at all of these areas in his SSI. Finally he nominated ‘land’ as his fifth important life area. This was indeed mentioned seven times in his SSI, yet gave the impression that he was struggling to cope with a bad harvest. For example, when asked to compare his aspirations with his present life conditions, he responded:

"There is big difference between my aspiration and present life conditions. Crop failure being permanent problem we always face food shortage. Even there was a time when I was forced to sell my ox to pay my debts on fertilizer, although my crops totally failed that year."

Also when asked which domain of his life he was least happy with, he replied:

“Shortage of food grain is a constant problem I am worried of and no one is certain in crop production, as it is likely to be destroyed by disease/drought in any year”

Therefore the GPGI score of 4 out of 6 for ‘land’, with a relative weight of 0.2, did not seem to match his SSI. That said, he did state elsewhere that:

“At least I have been able to support my family through crop production, although I could not get rich”

Overall, the respondent’s GPGI QoL index score of 60% does not seem to be reflected in his SSI. However he does value his children and this is an area that he seems very happy with. Health and religion are also rated reasonably highly in the GPGI, although they are not mentioned in the SSI.