Assessment tools and patient questionnaires
Assessment tools and patient questionnaires, such as The Flinders Partners in Health Scale and the Patient Activation Measure, are often used to engage a person in their own health care and health outcomes.
Assessment tools and questionnaires are not diagnostic tools and do not replace taking a health history.
Take these steps before using an assessment tool or questionnaire:
Be clear about why you are asking someone to complete the tool or questionnaire.
Explain to the person why the questions are relevant to their situation, eg, to help everyone to focus on what really matters to them.
Choose how you are going to administer the tool or questionnaire, eg, orally, in writing, electronically, in the waiting room before an appointment or during an appointment.
Consider how factors such as language barriers and cultural perceptions may affect a person’s ability to understand the tool or questionnaire.
Consider whether it is better to ask a couple of open-ended questions, such as “What is it about your diabetes that you find difficult?”, rather than using a long, written questionnaire.
Decide how you will use the results. If people go to the effort of completing an assessment, you need to both discuss with them the information they have provided and use that information.
Selecting an assessment tool
When selecting an assessment tool, ask yourself the following questions:
What is the purpose of using the tool? For example, it may be to find out initial information and then monitor progress over time.
What health issues am I trying to identify? For example, do you want to understand a person’s health needs to develop a care and support plan, or do you have concerns about their mental health?
What is the validity of the tool? How well does the tool work?
How can the tool or questionnaire be integrated into your practice workflow and systems? Useful implementation guidance on health assessment in primary care can be found here.
Has your team been trained in how to use the tool?
Be aware a person’s responses may change over time for reasons other than treatment. This is called a ‘response shift’. For example, prior to a care plan conversation, a person may score themselves quite highly on an item such as taking medications or managing symptoms. However, on a follow-up assessment they may allocate a lower score to that item.
This may be because they have realised, as a result of the care planning conversation, that they were not doing as well as they originally thought. This makes it important that responses be discussed so differences such as this are not taken as signs of failure or regression.
Assessment tools and questionnaires
This is a list of a few validated broad-based tools that can be used as part of delivering long-term condition care. Some tools can measure progress over time. Most of the tools and questionnaires do not require the person administering them to be trained, although some do come with user guides. In either case, you need to discuss in your team how to interpret and use any tool you consider introducing. Some of these tools can only be used under licence.
Hua Oranga measures outcomes consistent with Māori concepts of health and wellness, but it can be used with anyone who finds the domains relevant.
Hua Oranga uses the application of the 4 dimensions of Te Whare Tapa Whā:
· te taha wairua (spiritual wellbeing)
· te taha hinengaro (mental and emotional wellbeing)
· te taha tinana (physical wellbeing)
· te taha whānau (family and relationship wellbeing).
Hua Oranga can be used in a general health setting and is also being extensively used in mental health settings, as it recognises the interconnectedness of all aspects of health.
If used more than once with an individual, change or outcome can be measured. A 5-point scale is used to rate the domains.
Hua Oranga has 3 schedules reflecting the different perspectives of the people involved in the wellbeing of the tangata whaiora (client/consumer). All 3 questionnaires are similar and contain 4 sections or domains.
Ideally the questionnaires are completed by the tangata whaiora, a clinician and a whānau (family) member. However, this may not always be possible and it may be useful to start with self-assessment by the tangata whaiora.
If all 3 parties are able to complete the questionnaires this provides an opportunity to discuss the similarities and differences in perceptions and feelings that are important to supporting wellbeing.
A copy of Hua Oranga is available here:
A report describing the validation of Hua Oranga as a measure of mental health outcomes is available here:
More information about Te Whare Tapa Whā can be found on Health Navigator.
The Flinders Partners in Health scale (PIH)
The Partners in Health Scale is a validated questionnaire based on the principles of self-management. The client/patient completes the questionnaire by scoring their response to each of 12 questions on a 9-point scale. The questions cover the following areas:
knowledge of the condition
knowledge of treatment
ability to take medication
ability to share in decisions
ability to deal with health professionals
ability to attend appointments
ability to monitor and record
ability to manage symptoms
ability to manage the physical impact
ability to manage the emotional impact
ability to manage the social impact
progress towards a healthy lifestyle.
The questionnaire takes about 10 minutes to complete and can be used to monitor change over time. There is a New Zealand version of the PIH here.
More information about the Flinders programme is available here.
The Patient Activation Measure (PAM)
The Patient Activation Measure consists of a set of 13 statements. Respondents are asked to indicate their level of agreement with each statement using a 4-point scale.
Scores are calculated for all respondents who answer at least 10 of the 13 questions using a spreadsheet provided by the licensing authority Insignia Health LLC. This produces scores ranging, theoretically, from 0 to 100 but most fall between 39 and 95.
PAM is not freely available. You have to buy a licence to use it. More information about the PAM is available here:
The Patient Assessment of Care for Chronic Conditions (PACIC)
Originally developed by researchers at the Group Health Research Institute, the PACIC survey is designed to measure a person’s experience of care received as part of a long-term condition management programme.
The original 20-item questionnaire has been further developed, with an additional 6 questions added. The additional questions are designed to capture whether a patient-centered model of behavioural counselling has been provided and whether self-management support and linkages to community resources have been included in the model of care.
The Meke Meter
The Meke Meter is an indigenous, image-based, holistic self-reflection tool that has minimal text and is designed to capture an individual’s perception of their wellbeing. It is not dependent on reading and writing skills, and enables users to track their social, mental and physical wellbeing over time.
Individuals can set up a free account, and organisations can set up an account and get organisational reporting. More information about the Meke Meter can be found here.
Measuring psychological distress
There are several tools designed to measure psychological distress such as depression and anxiety.
More information about the following tools are available on Health Navigator: