Health Education Impact Questionnaire (heiQ™)

Measuring impact and quality of health education

Please select any of these items to skip to the relevant section:

• Background
• The heiQ™ evaluation system
• Development of the heiQ™
• Refinement of the heiQ™
• The heiQ™ instruments
• Become a licensed user
• Using the heiQ™
• Administering the heiQ™ to participants
• Scoring the heiQ™

Background

Self-management programs are available to consumers in a variety of forms including facilitator-led groups, telephone coaching and web-based services. These programs are intended to have a wide range of impacts and include general educational information about health and disease, motivation to change risk factors, compliance with medical regimens, coping, general 'empowerment' and techniques for self-management.

Evaluation of self-management and health education programs has been hampered by a lack of standardised and comprehensive assessment.

The development of the Health Education and Impact Questionnaire (heiQ™) arose out of demands from funders, the community sector and researchers for a valid and relevant evaluation and data management system for health education and self-management programs. Its development was funded by the Australian Government Department of Health & Ageing.

The heiQ™ evaluation system

The heiQ™ is an Australian-developed health education impact evaluation system. It consists of 51 questions, organised into a set of eight scales . Each scale is an independent questionnaire and together the 8 scales provide a comprehensive profile of the intended outcomes of health education / self-management programs.

• Health directed behaviour
• Positive and active engagement in life
• Emotional well-being
• Self monitoring and insight
• Constructive attitudes and approaches
• Skill and technique acquisition
• Social integration and support
• Health service navigation

The heiQ™ is designed to measure effectiveness of health education programs and to inform health professionals and researchers on the outcomes of health education programs delivered to people with chronic diseases. The heiQ™ system provides course leaders and their affiliated institutions with valuable information about consumer satisfaction, service delivery quality, and effects of quality improvement activities. The above 8 scales can be ‘mixed and matched’ depending on what you need to measure, the intended outcomes of you program, and how brief your assessment needs to be.

Development of the heiQ™

The development of the heiQ™ was guided by extensive consultation, workshops and interviews with stakeholders. This process enabled the development of important and well-defined indicators of course impact.

The questionnaire was first constructed using results from 591 course participants. The final 51 items (heiQ™ V1.2) were selected using state-of-the-art psychometric techniques including Structural Equation Modeling and Item Response Theory. The scales were then validated in an additional independent sample of 592 people with a wide range of chronic diseases and demographic characteristics. The results showed that the heiQ™ is a reliable and sensitive method to assess the benefits of a broad range of health education programs. The eight scales are independent, so that each scale could be used on its own. While it is highly recommend that all scales (i.e., all 51 items) are administered, if shorter assessment and less impact information are required, then individual scales may be administered. However, item order must be preserved.

Details of the full community consultation, development and validation of the heiQ™ are contained within two key publications;

Osborne RH, Elsworth GR, Whitfield K. The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Education and Counseling, 66(2):192-201. Epub 2007 Feb 22 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17320338.

Nolte S, Elsworth GR, Sinclair AJ, Osborne RH. The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey. Patient Education and Counseling, 65(3), 351-360. Epub 2006 Oct 5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17027221.

Refinement of the heiQ™

Following feedback obtained on the barriers and enablers to heiQ™ implementation outlined in the pilot report “Quality Assurance in the delivery of the Stanford Self-management Program” the heiQ™ has recently undergone further improvement.

To address concerns that the heiQ™ could be challenging for participants with low literacy skills a new version of the heiQ™ (heiQ™ V2.0) was developed, so that it would be possible to test this against the previously validated version (heiQ™ V1.2). The heiQ™ V2.0 was implemented nationally and tested using results from 1341 course participants with a wide range of chronic diseases and demographic characteristics and attended a wide variety of self-management programs.

Examination of the structure of questionnaire with confirmatory factor analysis using MPlus resulted in the following:

• Reduction of the response scale from 6 to 4 options
• Refinement of one item (covering use of aides and devices) that had modest psychometric properties in follow-up psychometric analyses. The refined item was worded “: I have a good understanding of equipment that could make my life easier” in the Skill and technique acquisition domain.
• Two items were found to be unacceptably multifactorial and were deleted without substantial loss of breadth or reliability. These were: I have effective skills that help me handle stress (Skill and technique acquisition domain), and: I know when my lifestyle (e.g., exercise, diet, stress) is creating health problems for me (Self monitoring and insight domain).

These changes are reflected in the heiQ™ V3.0 now available to licensed users.

Comparison of heiQ™ versions 1.2 and 3.0:
The heiQ™ questionnaire previously available for use: heiQ™ Core Version 1.2

• 42 core questions + 9 course quality questions and demographics
• 6 option response scale
• data analysis carried out by the CRD as part of research being conducted or own data analysis required

The revised version of the heiQ™ questionnaire currently available for use: heiQ™ Core Version 3.0

• 40 core questions + 9 course quality questions and demographics (as shown in the 'heiQ™ Items by Domain V3.0’ document)
• 4 option response scale
• own data analysis required

In addition, the heiQ™ V2.0 has also been translated into 9 other languages. These include: Arabic, Chinese, Greek, Italian, Macedonian, Polish, Spanish, Turkish and Vietnamese.

And a communication leaflet was developed to assist CALD groups in accessing self management patient education programs which was successfully piloted in English, Greek, Italian, Vietnamese, Mandarin and Arabic across a variety of health settings, nationally. An example of the English version is available for download.

With input from pilot sites the CRD also carried out a ranking exercise to order the eight heiQ™ domains in order of importance to further inform groups that may require shorter assessment and less impact information. This order is reflected in the 'heiQ™ Items by Domain V3.0' document. While it is recommended that the heiQ™ is used in its entirety, certain groups that require a shorter version of the questionnaire can choose to select only particular domains to be administered. However, please note that only the full version of the heiQ™ has been validated.

The heiQ™ Instruments

There are 3 sections of the heiQ™ that can be used independently of each other or in combination. These sections are:

The heiQ™ Core Dimensions:

This section covers the eight program impact domains;

• Health directed behaviour
• Positive and active engagement in life
• Emotional well-being
• Self monitoring and insight
• Constructive attitudes and approaches
• Skill and technique acquisition
• Social integration and support
• Health service navigation

The above 8 scales can be ‘mixed and matched’ depending on what you need to measure, the intended outcomes of your program, and how brief your assessment needs to be. However, please note that only the full version of the heiQ™ has been validated.

heiQ™ Program (course quality):

Nine further questions cover the quality of delivery of the course. In this section participants rate questions such as "Difficult topics and discussions were handled well by my course leader", "I trust the information I was given in the program" or "I feel it was worth my time and effort to take part in the program". The questions are completed in confidence to facilitate honest answers from participants.

This questionnaire is not designed to be a "smile sheet" but to deliver pertinent information to course leaders and managers about Quality Indicators for improvement.

This domain has been included in the heiQ™ Items by Domain V3.0 document (scale 9).

heiQ™ Perspective (response shift):

Nine additional heiQ™ items were developed to measure potential benefits of self-management courses while also determining if participants in chronic disease self-management courses have a change of perspective of their health status (a response shift), and if this is measurable with a paper-based questionnaire. These items were based on the core constructs of the heiQ™ developed previously. Sensitivity, specificity, and overall accuracy of these items were calculated using cognitive interviews as a relative gold standard. Response shift can be negative (i.e., after the course, participants realize that, before the course, they were worse than they thought they were), positive (i.e., participants now realize they were better than they thought they were), or absent (no change).

These items are distributed alongside the heiQ™ core component and are administered retrospectively. For further information please view the response shift questions and an article that was published on this topic - Osborne RH, Hawkins M, Sprangers MAG. Change of perspective: a measurable and desired outcome of chronic disease self-management intervention programs that violates the premise of preintervention/postintervention assessment. Arthritis Care & Research; 55(3): 458-465

The revised version of the heiQ™ questionnaire currently available for use is the heiQ™ Version 3.0.
This version consists of:

• 40 core questions + 9 course quality questions and demographics (as shown in the 'heiQ™ Items by Domain V3.0' document)
• 4 option response scale
• own data analysis required

Please note: the heiQ™ system is subject to copyright and reproduction and alterations are not permitted without written permission from the authors.

Become a licensed user

All sections and versions of the heiQ™ , including the heiQ™ -Core, heiQ™ -Program, heiQ™ -Perspectives, heiQ™ V1.2, heiQ™ V1.3, heiQ™ V1.4, heiQ™ V2.0 and heiQ™ V3.0 are copyright and may only be used with permission from one of the authors. A database of registered users is maintained to ensure that copyright is not breached.

To be able to use the heiQ™ questionnaires you will need to purchase a license. Following submission of your license request you will be contacted via email regarding the cost of the license and upon acceptance of the quote provided you will be issued with a tax invoice. Please note that each organisation and research project must be registered separately to use the heiQ™ .

To request a quote and/or to obtain a heiQ™ license agreement please complete the heiQ™ license application form and return this to:

Raymond Kee
Finance and Resources Manager
Royal Melbourne Hospital Academic Centre
Faculty of Medicine, Dentistry and Health Sciences
The University of Melbourne, 3010
Email: keer@unimelb.edu.au

Please see below for a list containing some of the organisations that have been licensed to administer the heiQ™ for one or more projects or programs.

Major collaborations also exist with Osaka University and Hannover Medical School for the translation of the heiQ™ to test the efficacy of the heiQ™ within health systems of Japan and Germany.

Using the heiQ™

Upon receipt of the license fee and provision of an executed license agreement in the name of your study, project or program you will be a licensed user for the specified conditions under your agreement and welcome to use the heiQ™ questionnaires for the nominated project.

All licensed heiQ™ users will receive:

• Technical support including advice on research questions involving heiQ™ instruments and interpretation of the results.
• Information on new developments in heiQ™ measurement can be obtained from the Chronic Disease Education Research Unit.

Administering the heiQ™ to participants

The heiQ™ is administered at Baseline (before the course starts) and at Follow-up (after the course finishes). The follow-up may be at the last session of the course and/or up to six months later.

To assist you with the administration of the heiQ™ please view the Guidelines for administering the heiQ™ document.

Scoring the heiQ

Scoring is a simple additive system where each scale is standardised to range from 1 to 4 for heiQ™ Versions 2.0 and 3.0 or 1 to 6 for heiQ™ Version 1.2 which reflects the response options available in these versions of the questionnaire.

Although scoring of the heiQ™ can be done by hand, it is difficult and time-consuming and is therefore not recommended. Scoring is better done electronically using the prepared statistical (SPSS code) algorithm available.

If you require further assistance with computer algorithms for scoring the heiQ™ we recommend contacting:

Roy Batterham, Evaluation and Strategic Planning Consultant
Mail: 3/2 Scotia Street, North Melbourne VIC 3051
Phone: (03) 9329 1083 / (03) 944 6756 
Mobile: 0414 393 509
Fax: (03) 8660 2377
E-mail: info@plexusconsulting.com.au
Web: http://www.plexusconsulting.com.au

Roy has worked with our centre and been involved in the development and application of the heiQ™ . He is a consultant experienced in providing advice and support to human service organisations needing to conduct evaluations, strategic planning or systematic performance monitoring and review and may be able to assist in the analysis and interpretation heiQ™ results.

Please note: Because we are interested in further evidence regarding the reliability and validity of the heiQ™ instruments, we ask heiQ™ users to check this website periodically for updates and to supply us with copies of any publications resulting from use of any of the heiQ™ instruments.

For more information on the heiQ™ please click on the email link below or contact the heiQ™ team at:

Raymond Kee
Finance and Resources Manager
Royal Melbourne Hospital Academic Centre
Faculty of Medicine, Dentistry and Health Sciences
The University of Melbourne, 3010
Email: keer@unimelb.edu.au