Creation and Initial Validation of a Picture-Based Version of the Limitations of Activity Domain of the SF-36

Those with limited language comprehension or literacy face problems completing written questionnaires evaluating their health or physical status on which treatment plans are based. This brief report describes how a picture-based version of the 10 items in the limitations of activities section of the short form 36 health survey questionnaire (SF-36) was developed iteratively and then piloted. Study participants were 101 community-living volunteers (58 female and 43 male volunteers aged 18-93 yrs) educated to postsecondary level (52), high school grades 10-12 (44), and grade 9 or less (5). They first completed the picture-based SF-36 LoA and described verbally and in writing what they understood each picture to mean and then completed the English text version of the SF-36 limitations of physical activities domain for comparison assessment. Additional feedback suggested where pictures could be altered to increase information capture. Subjects rated their health as 26.7% excellent, 25.7% very good, 29.8% good, 10.9% fair, and 6.9% poor. Analysis showed strong correlation between text-based SF-36 LoA questions and the picture-based visual score-VSF-36 LoA-(intraclass correlation coefficient = 0.98) with question 10 correlating highest (intraclass correlation coefficient = 0.90) and question 2 lowest (intraclass correlation coefficient = 0.82). The VSF-36 LoA is the first picture-based version of the SF-36; good correlation with the text-based version and global need warrants further development to aid those with limited literacy or language comprehension.