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Multi-country health surveys: are the analyses misleading?

Masood M, Reidpath DD

Curr Med Res Opin, 2014 May;30(5):857-63.
PMID: 24328497 DOI: 10.1185/03007995.2013.875466

BACKGROUND: The aim of this paper was to review the types of approaches currently utilized in the analysis of multi-country survey data, specifically focusing on design and modeling issues with a focus on analyses of significant multi-country surveys published in 2010.
METHODS: A systematic search strategy was used to identify the 10 multi-country surveys and the articles published from them in 2010. The surveys were selected to reflect diverse topics and foci; and provide an insight into analytic approaches across research themes. The search identified 159 articles appropriate for full text review and data extraction.
RESULTS: The analyses adopted in the multi-country surveys can be broadly classified as: univariate/bivariate analyses, and multivariate/multivariable analyses. Multivariate/multivariable analyses may be further divided into design- and model-based analyses. Of the 159 articles reviewed, 129 articles used model-based analysis, 30 articles used design-based analyses. Similar patterns could be seen in all the individual surveys.
CONCLUSION: While there is general agreement among survey statisticians that complex surveys are most appropriately analyzed using design-based analyses, most researchers continued to use the more common model-based approaches. Recent developments in design-based multi-level analysis may be one approach to include all the survey design characteristics. This is a relatively new area, however, and there remains statistical, as well as applied analytic research required. An important limitation of this study relates to the selection of the surveys used and the choice of year for the analysis, i.e., year 2010 only. There is, however, no strong reason to believe that analytic strategies have changed radically in the past few years, and 2010 provides a credible snapshot of current practice.

Matched MeSH terms: Health Surveys/standards
Evaluation of a bilingual questionnaire-based assessment on hearing in children with speech delay

Goh LC, Azman A, Ng BHK, Chew LC, Hufaidah K, Kulasegarah J

Med J Malaysia, 2020 03;75(2):136-140.
PMID: 32281594

INTRODUCTION: To correlate the score obtained using a bilingual (Malay and English) 14 points questionnaire in the detection of hearing loss at the University of Malaya, Medical Centre (UMMC), Kuala Lumpur, Malaysia over a 9 month period.
METHODS: This is a prospective instrument correlation study done on 93 children aged 1-4 years of age with speech and language delay for at least 3 months. Hearing status was confirmed using otoacoustic emissions, pure tone audiometry and brainstem evoked response (BSER). Hearing status was then compared to the 14-point questionnaire final scores and is statistically correlated.
RESULTS: There were 26 patients, 15 males (58%) and 11(42%) females who were diagnosed to have hearing loss. The average age of presentation was 2.49 and conductive hearing loss accounted for about 74% of cases of hearing loss. The mean questionnaire score obtained through our patients was 3.83±1.987. Discriminant analysis suggests that a questionnaire score of above 4 was indicative that the child was suffering from hearing loss.
CONCLUSION: Our study suggests that the low-cost bilingual (Malay and English) questionnaire can be used to detect hearing loss in the Malaysian population and could potentially be useful in rural health centres to help detect hearing loss and to determine the urgency of referral to a tertiary health centre.

Matched MeSH terms: Health Surveys/standards*
Construct validity and internal consistency reliability of the Malay version of the 21-item depression anxiety stress scale (Malay-DASS-21) among male outpatient clinic attendees in Johor

Rusli BN, Amrina K, Trived S, Loh KP, Shashi M

Med J Malaysia, 2017 10;72(5):264-270.
PMID: 29197880 MyJurnal

BACKGROUND: The 21-item English version of the Depression Anxiety Stress Scale (DASS-21) has been proposed as a method for assessing self-perceived depression, anxiety and stress over the past week in various clinical and nonclinical populations. Several Malay versions of the DASS-21 have been validated in various populations with varying success. One particular Malay version has been validated in various occupational groups (such as nurses and automotive workers) but not among male clinic outpatient attendees in Malaysia.
OBJECTIVE: To validate the Malay version of the DASS-21 (Malay-DASS-21) among male outpatient clinic attendees in Johor.
METHODS: A validation study with a random sample of 402 male respondents attending the outpatient clinic of a major public outpatient clinic in Johor Bahru and Segamat was carried out from January to March 2016. Construct validity of the Malay-DASS-21 was examined using Exploratory Factor Analysis (KMO = 0.947; Bartlett's test of sphericity is significant, p<0.001) through Principal Component Analysis and orthogonal (varimax) rotation with Kaiser Normalization to confirm the psychometric properties of the Malay-DASS- 21 and the internal consistency reliability using Cronbach's alpha.
RESULTS: Construct validity of the Malay-DASS-21 based on eigenvalues and factor loadings to confirm the three factor structure (depression, anxiety, and stress) was acceptable. The internal consistency reliability of the factor construct was very impressive with Cronbach's alpha values in the range of 0.837 to 0.863.
CONCLUSIONS: The present study showed that the Malay- DASS-21 has acceptable psychometric construct and high internal consistency reliability to measure self-perceived depression, anxiety and stress over the past week in male outpatient clinic attendees in Johor. Further studies are necessary to revalidate the Malay-DASS-21 across different populations and cultures, and using confirmatory factor analyses.

Matched MeSH terms: Health Surveys/standards*
Relationship between frequency and intensity of cigarette smoking and TTFC/C among students of the GYTS in select countries, 2007-2009

Lam E, Giovino GA, Shin M, Lee KA, Rolle I, Asma S

J Sch Health, 2014 Sep;84(9):549-58.
PMID: 25117888 DOI: 10.1111/josh.12185

BACKGROUND: This study assessed the construct validity of a measure of nicotine dependence that was used in the Global Youth Tobacco Survey (GYTS).
METHODS: Using 2007-2009 data from the GYTS, subjects from 6 countries were used to assess current smokers' odds of reporting time to first cigarette or craving positive (TTFC/C+) by the number of cigarette smoking days per month (DPM) and the number of cigarettes smoked per day (CPD).
RESULTS: The percentage of GYTS smokers who reported TTFC/C+ ranged from 58.0% to 69.7%. Compared with students who smoked on 1-2 DPM, those who smoked on 3-9 DPM had 3 times the adjusted odds of reporting TTFC/C+. The adjusted odds of reporting TTFC/C+ were 3 to 7 times higher among those who smoked 10-29 DPM and 6 to 20 times higher among daily smokers. Similarly, the adjusted odds of TTFC/C+ were 3-6 times higher among those who smoked 2-5 CPD and 6 to 20 times higher among those who smoked >6 CPD, compared to those who smoked <1 CPD.
CONCLUSION: Associations of TTFC/C+ prevalence with both frequency and intensity of cigarette smoking provide a construct validation of the GYTS question used to assess respondents' TTFC/C status.

Study site: Six countries: Argentina 2007, Jordan 2007; Malaysia 2009; Slovakia 2007; South Africa 2008; Thailand 2009
Study name: Global Youth Tobacco Survey (GYTS)

Matched MeSH terms: Health Surveys/standards*
SF-36v2 norms and its' discriminative properties among healthy households of tuberculosis patients in Malaysia

Atif M, Sulaiman SA, Shafie AA, Asif M, Ahmad N

Qual Life Res, 2013 Oct;22(8):1955-64.
PMID: 23239084 DOI: 10.1007/s11136-012-0337-x

BACKGROUND: The aim of the study was to obtain norms of the SF-36v2 health survey and the association of summary component scores with socio-demographic variables in healthy households of tuberculosis (TB) patients.
DESIGN: All household members (18 years and above; healthy; literate) of registered tuberculosis patients who came for contact tracing during March 2010 to February 2011 at the respiratory clinic of Penang General Hospital were invited to complete the SF-36v2 health survey using the official translation of the questionnaire in Malay, Mandarin, Tamil and English. Scoring of the questionnaire was done using Quality Metric's QM Certified Scoring Software version 4. Multivariate analysis was conducted to uncover the predictors of physical and mental health.
RESULTS: A total of 649 eligible respondents were approached, while 525 agreed to participate in the study (response rate = 80.1 %). Out of consenting respondents, 46.5 % were male and only 5.3 % were over 75 years. Internal consistencies met the minimum criteria (α > 0.7). Reliability coefficients of the scales were always less than their own reliability coefficients. Mean physical component summary scale scores were equivalent to United States general population norms. However, there was a difference of more than three norm-based scoring points for mean mental component summary scores indicating poor mental health. A notable proportion of the respondents was at the risk of depression. Respondents aged 75 years and above (p = 0.001; OR 32.847), widow (p = 0.013; OR 2.599) and postgraduates (p < 0.001; OR 7.865) were predictors of poor physical health while unemployment (p = 0.033; OR 1.721) was the only predictor of poor mental health.
CONCLUSION: The SF-36v2 is a valid instrument to assess HRQoL among the households of TB patients. Study findings indicate the existence of poor mental health and risk of depression among family caregivers of TB patients. We therefore recommend that caregivers of TB patients to be offered intensive support and special attention to cope with these emotional problems.
Study site: Respiratory clinic, Hospital Pulau Pinang, Malaysia

Matched MeSH terms: Health Surveys/standards