Development and validation of a questionnaire assessing household work limitations (HOWL-Q) in women with rheumatoid arthritis

Abstract

Introduction Rheumatoid arthritis (RA) has female preponderance and interferes with the ability to perform job roles. Household work has 2 dimensions, paid and unpaid. There is not a validated instrument that assesses the impact of RA on limitations to perform household work. We report the development and validation of a questionnaire that assesses such limitations, the HOWL-Q. Methods The study was performed in 3 steps. Step-1 consisted on HOWL-Q conceptual model construction (literature review and semi-structured interviews to 20 RA outpatients and 20 controls, household workers, who integrated sample (S)-1). Step-2 consisted of instructions selection (by 25 outpatients integrating S-2), items generation and reduction (theory and key informant suggestions, modified natural semantic network technique, and pilot testing in 200 household workers outpatients conforming S-3), items scoring, and questionnaire feasibility (in S-3). Step-3 consisted of construct (exploratory factor analysis) and criterion validity (Spearman correlations), and HOWL-Q reliability (McDonald's Omega and test-retest), in 230 household work outpatients integrating S-4. Results Patients conforming the 4 samples were representative of typical RA outpatients. The initial conceptual model included 8 dimensions and 76 tasks/activities. The final version included 41 items distributed in 5 dimensions, was found feasible and resulted in 62.46% of the variance explained: McDonald's Omega = 0.959, intraclass-correlation-coefficient = 0.921 (95% CI = 0.851-0.957). Moderate-to-high correlations were found between the HOLW-Q,

Factors Associated With Household Work Limitations in Mexican Patients With Rheumatoid Arthritis

“…At study entry, patients had the previously described standardized rheumatic assessment and were additionally administered the HOLW-Q (Supplementary Table S1, http://links.lww.com/RHU/A524), 2 a survey to assess family responsibilities, household work characteristics, and the patient economic dependency (Appendix, http://links.lww.com/RHU/A523), and the family APGAR index (Adaptation, Partnership, Growth, Affection, and Resolve) 15,16 …”

“…2 This oversight is surprising given the higher prevalence of RA among middle-aged women, particularly in the Latin American region. 2,11 For various reasons, household work remains predominately the domain of women, and this figure is extreme in Latin America. There is an urgent need to make household work more visible and adopt a more comprehensive approach to the impact of RA on women's life.…”

“…The International Labour Organization (ILO) defines domestic work as “work performed in or for a household.” It recognizes that occupations and tasks considered as domestic work vary across countries and time 1 . One conceptual aspect of the ILO definition is that the terms domestic workers do not rely on a listing of specific tasks but rather on the common feature that domestic workers perform for private households; accordingly, unpaid household work is defined by the work primarily women do for their families 1,2 . The ILO estimates that there are 67 million domestic workers, 83% of which are women, ceiling of 92% in Latin America and the Caribbean region, where the paid dimension of household work has differential characteristics, which are well-recognized sources of vulnerability 1 .…”

“…Scientific evidence has also reported significant limitations in patients' ability to carry out tasks and activities that define household work, although with limited studies and tasks/activities evaluated 8–10 . We recently developed and validated in Mexican RA patients a questionnaire that assesses the impact of the disease on limitations with performing paid and unpaid household work, the Household Work Limitations Questionnaire (HOWL-Q) 2 …”

“…Finally, in the clinical context of RA, some research has focused on the patient's social functioning in terms of work roles. In contrast, relatively little attention has been given to other social roles, such as domestic work 2 . This oversight is surprising given the higher prevalence of RA among middle-aged women, particularly in the Latin American region 2,11 .…”