Working Paper No.2
22 November 2005
STATISTICAL COMMISSION and
UN ECONOMIC COMMISSION FOR
EUROPE
STATISTICAL OFFICE OF THE
EUROPEAN COMMUNITIES
(EUROSTAT)
CONFERENCE OF EUROPEAN
STATISTICIANS
WORLD HEALTH
ORGANIZATION (WHO)
Joint UNECE/WHO/Eurostat Meeting
on the Measurement of Health Status
(Budapest, Hungary, 14-16 November 2005)
Session 2-Invited paper
Task Force on the Development of a
Common Instrument to Measure Health States:
Identification of Domains
Sarah Connor Gorber; Cameron N. McIntosh; Julie Bernier;
Jean-Marie Berthelot; Michael C. Wolfson
Statistics Canada
Ottawa, Ontario, Canada
1
Identifying Domains for the Common Instrument

Objective
Identify a compact yet comprehensive set of domains that cover the
major aspects of health (i.e., physical, mental, and social); and are
meaningful in an international context.

Method
Applied pre-established criteria to reduce an initially extensive list of
candidate domains into a more manageable subset of core domains;
periodic open discussions among task force members supplemented
the criteria
2
Initial List of Candidate Health Domains
1. Physical Functioning: lower body
2. Physical Functioning: upper body
3. Dexterity
4. Self-Care
5. Usual Activities
6. Vitality/Fatigue
7. Sleep
8. Breathing
9. Urinary Incontinence
10. Cognition: memory and concentration
11. Cognition: thinking and problem-solving
12. Alertness
13. Communication
14. Affect: happiness, depression
15. Psychological Functioning: mastery, sense of coherence, life outlook
3
Initial List of Candidate Health Domains
16. Anxiety: nervousness, uneasiness, worry, concern, fear, stress
17. Self-esteem
18. Relaxation and Leisure
19. Vision (visual acuity rather than the ability to recognize)
20. Hearing (auditory acuity rather than the ability to understand)
21. Speech (ability to articulate words rather than be understood)
22. Pain and Discomfort
23. Taste and Eating
24. Smell
25. Touch
26. Interpersonal/Social Relationships: formation and maintenance
27. Social Functioning
28. Social Support
29. Reproductive Functioning
30. Sexual Functioning
4
Criteria for Domain Selection: Global and Relational
(1) Global Criteria – do not depend on other domains in the list
(a) Face validity
(b) Within, on, or near the skin
(c) Importance for population health monitoring
(d) Feasibility (potential for assessment with a variety of methods)
(e) Consistency across varying socio-cultural contexts
(f) Heterogeneity (sufficient inter-individual variability in functioning)
(g) Can be described in terms of a clear series of functional levels
(h) Reflect key selected ideas of the ICF
5
Criteria for Domain Selection: Global and Relational
(2) Relational Criteria – depend on other domains in the list
(a) Breadth of coverage
(b) Statistical independence
(c) Structural independence
(d) Parsimony (comprehensive yet compact set of domains)
(e) Amenability to preference measurement
6
Selection of Domains

Initial list of candidate domains was minimized via an iterative
process: assessment against the established criteria plus discussion
and debate among task force members
Examples
Mobility and Dexterity – included since they are fundamental and largely
independent health domains covering much of the spectrum of day-today physical functioning; measured in the bulk of national survey
modules and standardized measuring instruments
Self-care and Usual Activities – excluded given considerable
redundancy with Mobility and Dexterity; might also be difficult to
operationally define a vague concept like “usual activities”, such that it
has consistent meaning and interpretation across varying socio-cultural
contexts
7
Controversies

Deciding on the status of certain domains posed much more
difficulty than others, and inspired lively discussions among task
force members
Examples
Social Relationships – disagreement as to whether this domain
could be conceptualized as “within-the-skin.” However,
we could lose information by excluding the social aspect of health,
so it was agreed to try and assess Social Relationships in terms
of capacity
Speech – disagreement as to whether there was sufficient
heterogeneity in functioning on this domain to warrant its direct
Inclusion on the common instrument. It was decided that Speech
would not be directly assessed but rather captured by Social
Relationships (which would include aspects of Communication)
8
Selected Domains
Assessing the 30 candidate domains, using the pre-established criteria as
well as refinements based on discussion sessions, resulted in the
selection of the following 10 domains for inclusion on the common
instrument:
1. Physical Functioning: Mobility
2. Physical Functioning: Dexterity
3. Vitality/Fatigue
4. Affect (happiness, depression)
5. Anxiety (worry, fear, nervousness)
6. Vision (visual acuity)
7. Hearing (auditory acuity)
8. Pain and Discomfort
9. Social Relationships (including aspects of communication)
10. Cognition
(a) memory and concentration
(b) problem solving and thinking
9
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