Hello, 

I am not sure if you can full validate this questionnaire. One of the limitations is a small sample size (perfectly understood why this is the case). 

I would try to compare your results with these on different diseases from the past. 

Another issue that somehow limits your ability to validate the measure is answer format - with continuous scoring you would have more flexibility and here are some ordinal and dichotomous answer formats I presume.

Regards, Witold

Since you have just mentioned, Domains I,II,III and so on..and not specifically named the domain, the following is to be considered on general terms on Quality of Death/Dying

 Items relating to each of the subscales(domains) have to be first combined to produce means and standard deviations for each subscale. Then you look at the distribution of scores to check that patients were using the full range of possible scores— that is, that they were not giving uniformly satisfied or dissatisfied responses. It should also be checked that scores did not show evidence of skewness—that is, that the distribution of scores was roughly symmetrical about the mean—or kurtosis—that is, that the distributions were not too peaked or too flat.

 To test content validity  Death & dying, related fields of psychology and well being along with the Medical, Nursing, Social work, Palliative Care experts who are well versed in the area will be able to advice on the content appropriateness of the questionnaire

 To test construct validity (a)the factors /variables identified should be found with this sample of patients being studied or used as sample. And the data to be analysed using confirmatory factor analysis. We expect that data would factor out into the same domains  that we had identified if this factor structure is a valid representation of the construct “Quality of Dying”

(b) that scores on each specific subscale correlated significantly with scores on the Quality of dying subscale (using Pearson’s product moment correlation test).

(c) that the scale diVerentiated between diVerent subgroups within the population (using analysis of variance). Please keep in Mind that - One of the most consistent findings in Quality of death or dying literature is that older people report more quality of death than younger people.

Along with determining validity, Internal consistency (reliability) of the scale by investigating whether items within each subscale correlated significantly with each other (using Cronbach’s á statistic) is very vital. And each subscale may produce a values of  0.7 or above, indicating internal reliability.

 “Validity” is not an absolute quality. It’s a continuum, with a questionnaire being valid to a certain degree in certain circumstances, and we must decide (preferably before the validation study is run) what degree of validity is considered sufficient. The above categories also suggest that there are types of validity that relate to the internal validity of the questionnaire (are similar questions answered similarly), others that relate to the ability of the questionnaire to determine a given state in a patient (e.g., that it varies in alignment with the severity of the condition), and still others that involve the validity of comparing different groups on the basis of the questionnaire. Each type of validity is distinct, meaning that a questionnaire can have one kind of validity but not another. Because of that, a questionnaire can never really be fully “validated.” It can only be validated for “n”  patient population, under “x”conditions, and so forth.

 This only implies that it may not be appropriate, for example, to use the same  Quality of death/dying questionnaire for all patients, according to their age, and percent of total body surface area (%TBSA) may not be appropriate.

 A taxonomy of quality of life for dying persons defined quality of life for patients and for loved ones at the end of life. which includes a separate domain labeled the quality of dying, defined as a personal evaluation of the dying experience as a whole, including a subjective evaluation of concepts according to expectations and values. This approach is consistent with the notion of the quality of death defined for the situation or population being studied.

regard

Rathish

the sample size is too small! and the answer for each item was different, the construct validity might not be assessed.  

Thank you very much for your responses. I got no internal consistency within domains and answers didn't also correlate with global ratings. Sample size was suggested as small and was suggested to get answers on likert scale for all of them. 

Many points were similar as mentioned by you all. I guess i will drop this idea for now :)

Thanks all