Back to Journals » Patient Related Outcome Measures » Volume 10

Exploring how to evaluate a qualitative patient-centered outcome measure: literature review and illustrative example – a Perthes child-friendly measure

Authors Long AF, Gambling T

Received 11 May 2019

Accepted for publication 3 August 2019

Published 29 August 2019 Volume 2019:10 Pages 283—298


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Robert Howland

Andrew F Long,1 Tina Gambling2

1School of Healthcare, Faculty of Health and Social Care, University of Leeds, Leeds, UK; 2School of Health Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, UK

Correspondence: Andrew F Long
School of Healthcare, Health Systems Research, University of Leeds, Baines Wing, Leeds LS2 9UT, UK

Purpose: To explore the question of ‘how to evaluate a qualitative patient-centred outcome measure’, comprising predominantly open-ended items, including perhaps emojis, story writing and/or pictures, in a way that does not compromise the strictures of the qualitative paradigm, doing so in a credible and authoritative manner. The paper aims to promote debate and discussion in the measurement validation community.
Methods: Comprehensive literature review of three electronic databases (PubMed; SCOPUS; Web of Science/Knowledge) and searches of three outcome-focused journals.
Results: The vast majority (>90%) of the papers only used qualitative methods in the initial, in particular, content validation of a measure and then used (quantitative) psychometric validation procedures.  The remaining papers comprised articles that were either methodologically or methods focused and the role of qualitative research.  A number of key issues are raised, inter alia: giving primacy to the patient’s perspective; exploring the meaning and interpretation respondents place on the concept and possible items in a measure; prioritising maximising meaningful discrimination from the respondent’s perspective; ensuring face and content validity and relevance of items in the item content pool; and using appropriate qualitative methods, for example, concept elicitation, “think-aloud” and cognitive interviews and expert respondent panels/judges. This approach is applied to validate a child-friendly outcome measure for children with Perthes disease, a paediatric hip condition presenting primarily amongst male children aged 5-8 years.
Conclusions: The core messages are to: (i) not force validation of a qualitative outcome measure into psychometric validation; but (ii) retain full adherence to the principles of the qualitative paradigm and employ procedures drawn from that paradigm. In this manner, primary emphasis would lie on issues of meaningfulness, face and content validity, the meaning of item and measure scores to respondents and, for a child-friendly measure, the child-friendliness of the measure.

Keywords: qualitative validation, outcome measure, psychometric validation, qualitative paradigm, Perthes disease, child-friendly measure

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]