Percentile ranks and benchmark estimates of change for the Health Education Impact Questionnaire: Normative data from an Australian sample

Abstract

Objective:Participant self-report data play an essential role in the evaluation of health education activities, programmes and policies. When questionnaire items do not have a clear mapping to a performance-based continuum, percentile norms are useful for communicating individual test results to users. Similarly, when assessing programme impact, the comparison of effect sizes for group differences or baseline to follow-up change with effect sizes observed in relevant normative data provides more directly useful information compared with statistical tests of mean differences and the evaluation of effect sizes for substantive significance using universal rule-of-thumb such as those for Cohen’s ‘d’. This article aims to assist managers, programme staff and clinicians of healthcare organisations who use the Health Education Impact Questionnaire interpret their results using percentile norms for individual baseline and follow-up scores together with group effect sizes for change across the duration of typical chronic disease self-management and support programme.Methods:Percentile norms for individual Health Education Impact Questionnaire scale scores and effect sizes for group change were calculated using freely available software for each of the eight Health Education Impact Questionnaire scales. Data used were archived responses of 2157 participants of chronic disease self-management programmes conducted by a wide range of organisations in Australia between July 2007 and March 2013.Results:Tables of percentile norms and three possible effect size benchmarks for baseline to follow-up change are provided together with two worked examples to assist interpretation.Conclusion:While the norms and benchmarks presented will be particularly relevant for Australian organisations and others using the English-language version of the Health Education Impact Questionnaire, they will also be useful for translated versions as a guide to the sensitivity of the scales and the extent of the changes that might be anticipated from attendance at a typical chronic disease self-management or health education programme.

Children’s Physical Self-Concept and Body Image According to Weight Status and Physical Fitness

“…These cut-offs represent a feasible measure within primary school context [41]. The use of percentiles has been established as a useful and important alternative to mean-based indicators for obtaining conclusions when working with skewed data from questionnaires [42].…”

Effects of a COPD self-management support intervention: a randomized controlled trial

“… 86 , 87 An effect size of 0.32 is considered small, according to Cohen, 88 but is higher than the estimated benchmark effect sizes for change in Constructive attitudes and approaches, varying from 0.19 to 0.21. 67 The salutogenic orientation of Better Living with COPD could be one explanation for the positive effect on Constructive attitudes and approaches. A salutogenic orientation focuses on health as a continuum, the person’s history, active adaption, and salutary factors, and stressors are seen as possibly salutary, 29 , 36 , 37 , 89 and may have contributed to a shift in participants’ attitudes and approaches.…”

“…This is in accordance with the findings in the longitudinal study by Turner et al 22 Still, the effect size in this study ( d =0.15) was smaller than the estimated benchmark effect sizes for change in this domain in chronic diseases in general. 67 Also, the benchmark sizes presented for changes in heiQ scores are not benchmark sized for clinical relevance. 67 Therefore, the clinical relevance of the improvements found on Self-monitoring and insight, as well as on the Constructive attitudes and approaches and Skill and technique acquisition domains, is uncertain.…”

“…Higher scores indicate higher levels of self-management ability for all domains, except for the Emotional distress domain, where a higher score indicates more emotional distress. This generic questionnaire has shown satisfactory validity and reliability across diverse settings, 28 , 64 – 67 and has been used in studies including people with COPD. 22 , 68 , 69 Cronbach’s alpha ranged from 0.63 (Health service navigation) to 0.90 (Emotional distress).…”

Symptom burden and self-management in persons with chronic obstructive pulmonary disease

“…The heiQ has been translated into several languages, including Norwegian, 23 and shown to produce satisfactory psychometrical results across diverse settings. 9 , 23 – 26 …”