Development, validation and reliability of the Smith Toolkit for Integrated Health Related Quality of Life (STI-HRQoL)

Authors: Lynn Smith, Heather Morris-Eyton



Department of Sport and Movement Studies, Faculty of Health Sciences, University of Johannesburg, South Africa



Background. The current burden on the public healthcare system in South Africa has been exacerbated by a shortage of medical staff, insufficient consultation time and patients’ inability to have regular health screenings due to financial constraints and logistical challenges. An integrated toolkit assessing health-related quality of life would be useful in identifying the areas that need improvement in disease management, enabling patients to reach their full potential.

Aims. This study aimed to develop a valid and reliable toolkit to assess the health-related quality of life of patients with hypertension, type 2 diabetes and cardiovascular disease in South Africa.

Methods. The study followed a sequential and exploratory mixed method research design. An expert panel of healthcare practitioners (n1=12) and pilot group (n2=14) underwent focus group discussions and semi-structured interviews. Test-retest was conducted on patients with hypertension, type 2 diabetes and/or cardiovascular disease (n3=257). Principle component analysis was performed on all items. The Pearson and Spearman correlation coefficients, interclass correlation coefficient (ICC) and the coefficient of repeatability (CR) were computed to determine the relative and absolute reliability of the items.

Results. The long form (37 items) and short form (25 items) make up the final toolkit. Each questionnaire yielded an excellent Pearson’s r (0.89*; 0.89*), Spearman’s rho (0.88*; 0.89*), and ICC (0.94; 0.94). The CR was considered acceptable, at ±12.04% for the long form and ±12.50% for the short form.

Conclusions. Both forms of the toolkit are highly reliable and provide healthcare practitioners with a comprehensive and cost-effective tool to assess and manage noncommunicable diseases.


Key words: Assessment tool, chronic disease, disease management.


Development, validation and reliability of the Smith Toolkit for Integrated Health Related Quality of Life (STI-HRQoL)