title: Development of a new multimedia instrument to measure cancer-specific quality of life in Portuguese-speaking patients with varying literacy skills.
abstract: OBJECTIVE
  To develop and validate a new multimedia instrument to measure health-related quality of life (HRQOL) in Portuguese-speaking patients with cancer.
  
  
  METHODS
  A mixed-methods study conducted in a large Brazilian Cancer Hospital. The instrument was developed along the following sequential phases: identification of HRQOL issues through qualitative content analysis of individual interviews, evaluation of the most important items according to the patients, review of the literature, evaluation by an expert committee, and pretesting. In sequence, an exploratory factor analysis was conducted (pilot testing, n = 149) to reduce the number of items and to define domains and scores. The psychometric properties of the IQualiV-OG-21 were measured in a large multicentre Brazilian study (n = 323). A software containing multimedia resources were developed to facilitate self-administration of IQualiV-OG-21; its feasibility and patients' preferences ("paper and pencil" vs. software) were further tested (n = 54).
  
  
  RESULTS
  An exploratory factor analysis reduced the 30-item instrument to 21 items. The IQualiV-OG-21 was divided into 6 domains: emotional, physical, existential, interpersonal relationships, functional and financial. The multicentre study confirmed that it was valid and reliable. The electronic multimedia instrument was easy to complete and acceptable to patients. Regarding preferences, 61.1 % of them preferred the electronic format in comparison with the paper and pencil format.
  
  
  CONCLUSIONS
  The IQualiV-OG-21 is a new valid and reliable multimedia HRQOL instrument that is well-understood, even by patients with low literacy skills, and can be answered quickly. It is a useful new tool that can be translated and tested in other cultures and languages.
authors.affiliation: Divisão de Mama e Ginecologia, Departamento de Oncologia Clínica, Barretos Cancer Hospital, Rua Antenor Duarte Vilella, 1331, Bairro Dr Paulo Prata, Barretos, São Paulo CEP: 14784-400 Brazil ; Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Center for Research Support - NAP, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Paiva
authors.affiliation: Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil.
authors.forename: Felipe Augusto Ferreira
authors.initials: FA
authors.lastname: Siquelli
authors.affiliation: Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil.
authors.forename: Gabriela Rossi
authors.initials: GR
authors.lastname: Zaia
authors.affiliation: InORP - Oncology Institute of Ribeirão Preto, Ribeirão Prêto, São Paulo 14025-270 Brazil.
authors.forename: Diocésio Alves Pinto
authors.initials: DA
authors.lastname: de Andrade
authors.affiliation: Hospital das Clínicas de Botucatu, Botucatu, São Paulo 18618-970 Brazil.
authors.forename: Marcos Aristoteles
authors.initials: MA
authors.lastname: Borges
authors.affiliation: Department of Clinical Oncology, Mater Dei Hospital, Belo Horizonte, Minas Gerais 30140-093 Brazil.
authors.forename: Alexandre A
authors.initials: AA
authors.lastname: Jácome
authors.affiliation: Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil.
authors.forename: Gisele Augusta Sousa Nascimento
authors.initials: GA
authors.lastname: Giroldo
authors.affiliation: Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil.
authors.forename: Henrique Amorim
authors.initials: HA
authors.lastname: Santos
authors.affiliation: Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hahn
authors.affiliation: Botucatu Medical School, Universidade Estadual Paulista -UNESP, Botucatu, São Paulo 18618-970 Brazil.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Uemura
authors.affiliation: Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Center for Research Support - NAP, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil.
authors.forename: Bianca Sakamoto Ribeiro
authors.initials: BS
authors.lastname: Paiva
keywords: Development; IqualiV-OG-21; Low literacy; Multimedia; Quality of life; Validation