title: Validation of the howRu and howRwe questionnaires at the individual patient level.
abstract: BACKGROUND
  The howRu and howRwe are new short questionnaires which are meant to measure health-related quality of life and patient experience. However, validation at the individual patient level has not yet taken place. We aimed to investigate the validity of both questionnaires at the individual patient level.
  
  
  METHODS
  In this prospective validation study, patients were asked to complete both questionnaires and comment on their answers in a semi-structured in-depth interview. Based on the transcribed interviews, a panel of 45 general practitioners and 45 patients filled out the questionnaires as they thought the patients had completed them. The questionnaires were considered valid instruments when a reliable and acceptable level of agreement was reached between the patient's score and the score of a review panel, defined as a concordance correlation coefficient (CCC) of ≥0.70. Bland-Altman plots were also made.
  
  
  RESULTS
  Ninety patients were included. The CCC of the howRu total score of the review panel and patients was 0.80 (95 % CI 0.73 to 0.86). Bland-Altman plots showed a mean difference of -0.96 and the limits of agreement ranged from -2.87 to 0.95. The CCC of the howRwe total score was 0.57 (95 % CI 0.42 to 0.69). The mean difference on the Bland-Altman plots was -0.54 and the limits of agreement ranged from -3.59 to 2.52.
  
  
  CONCLUSIONS
  The howRu seems to be a valid questionnaire for measuring health-related quality of life at the individual patient level. We do not advice to use the tested version of the howRwe questionnaire for assessing patient experience at the individual patient level.
  
  
  BACKGROUND
  The study was registered at clinicaltrials.gov NCT01830803 . Registration date: 5 April 2013.
authors.affiliation: Diabetes Centre, Isala, Zwolle, The Netherlands. s.hendriks@isala.nl.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Hendriks
authors.affiliation: Diabetes Centre, Isala, Zwolle, The Netherlands. rutgersj@isala.nl.
authors.forename: Jojanneke
authors.initials: J
authors.lastname: Rutgers
authors.affiliation: Diabetes Centre, Isala, Zwolle, The Netherlands. p.r.van.dijk@isala.nl.
authors.forename: Peter R
authors.initials: PR
authors.lastname: van Dijk
authors.affiliation: Department of General Practice, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. k.h.groenier@umcg.nl.
authors.forename: Klaas H
authors.initials: KH
authors.lastname: Groenier
authors.affiliation: Diabetes Centre, Isala, Zwolle, The Netherlands. H.J.G.Bilo@isala.nl.|Department of Internal Medicine, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. H.J.G.Bilo@isala.nl.|Department of Internal Medicine, Isala, Zwolle, The Netherlands. H.J.G.Bilo@isala.nl.
authors.forename: Henk J G
authors.initials: HJ
authors.lastname: Bilo
authors.affiliation: Diabetes Centre, Isala, Zwolle, The Netherlands. n.kleefstra@isala.nl.|Department of Internal Medicine, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. n.kleefstra@isala.nl.|Langerhans Medical Research Group, Zwolle, The Netherlands. n.kleefstra@isala.nl.
authors.forename: Nanne
authors.initials: N
authors.lastname: Kleefstra
authors.affiliation: Department of General Practice, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. j.w.h.kocks@umcg.nl.
authors.forename: Janwillem W H
authors.initials: JW
authors.lastname: Kocks
authors.affiliation: Diabetes Centre, Isala, Zwolle, The Netherlands. k.j.j.van.hateren@isala.nl.
authors.forename: Kornelis J J
authors.initials: KJ
authors.lastname: van Hateren
authors.affiliation: Department of General Practice, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. marcoblanker@gmail.com.
authors.forename: Marco H
authors.initials: MH
authors.lastname: Blanker
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires