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Abstract
Objective To validate the Danish Multimorbidity Treatment Burden Questionnaire (MTBQ) and obtain a population-based evaluation of treatment burden.
Design Mixed-methods.
Setting Danish population-based survey.
Participants Translation by professional translators and an expert group. The scale was tested by 13 407 participants (aged ≥25 years) in treatment.
Measures The 10-item MTBQ was translated into Danish using forward-backward translation and used in a large population health survey. A global MTBQ score was calculated and factor analysis and Cronbach’s alpha assessed dimensional structure and internal consistency reliability, respectively. Spearman’s rank correlations between global MTBQ scores and scores of self-rated health, health-related quality of life and the number of long-term conditions, respectively, assessed construct validity. MTBQ scores were grouped into four categories (no, low, medium, high burden) to assess interpretability and population-based evaluation of treatment burden.
Results The scale showed high internal consistency (α=0.87), positive skewness and large floor effects. Factor analysis supported a one-dimensional structure of the scale with a three-dimensional structure as a less parsimonious alternative. The MTBQ score was negatively associated with self-rated health (rS−0.45, p<0.0001) and health-related quality of life (rS−0.46/−0.51, p<0.0001), and positively associated with the number of long-term conditions (rS 0.26, p<0.0001) and perceived stress (rS 0.44, p<0.0001). Higher treatment burden was associated with young age, male sex, high educational level, unemployment, being permanently out of work, not living with a spouse/cohabitant, living with child(ren) and long-term conditions (eg, heart attack, stroke, diabetes and mental illness).
Conclusion The Danish MTBQ is a valid measure of treatment burden with good construct validity and high internal reliability. This is the first study to explore treatment burden at a population level and provides important evidence to policy makers and clinicians about sociodemographic groups at risk of higher treatment burden.
- statistics & research methods
- health services administration & management
- public health
- epidemiology
Data availability statement
Data are available on reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available on reasonable request.
Supplementary materials
Supplementary Data
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Footnotes
Editor's note Copyright The MTBQ was developed by Professor Chris Salisbury and Dr Polly Duncan. Copyright (including the Danish version) belongs to the University of Bristol but it is freely available for use under licence. Please see https://www.bristol.ac.uk/primaryhealthcare/resources/mtbq/ for details. Permission was obtained to translate the MTBQ into Danish.
Twitter @polly_duncan, @prof_tweet
Contributors FBL was responsible for the translation process. MHP, PD, FBL, CS and KF participated in the design of the further validation and population-based evaluation with MHP being the main person responsible for the final design of this part. FBL, MHP, KF and ML were responsible for the collection of survey data. Data analyses were conducted by MHP with contributions from FBL, KF and ML. MHP drafted the scientific manuscript with contributions from PD and FBL. All authors contributed to interpretation, critically revised the paper, contributed to the final draft, approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MHP is the guarantor.
Funding The 2017 'How are you?' survey was funded by the Central Denmark Region (Region Midtjylland).
Disclaimer The views and opinions expressed in the article are those of the authors and do not necessarily reflect those of the Central Denmark Region.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.