Development and Validation of a Context-Sensitive Positive Health Questionnaire (CPHQ) to Measure Health.

A valid context-specific measurement of health is critical for evaluating health policies and interventions. The Positive Health dialogue is a tool that is increasingly being used to evaluate health. However, this tool is meant to spark conversations about health rather than measure context-specific health. In this paper, we advance the Positive Health dialogue tool into a measurement instrument, that we denote as the Context-sensitive Positive Health Questionnaire (CPHQ). We build on previous efforts to create the CPHQ, using the Capability Approach as a theoretical framework. The measurement was developed in three stages: 1) focus groups, 2) expert consultations, and 3) validation among a representative panel of Dutch citizens. The goal of both the (1) focus groups and (2) expert consultations phases was to pilot test and refine previously proposed Positive Health questionnaires into an initial version of the CPHQ. The validation phase (3) sought to examine the initial CPHQs factorial validity, using Factor Analysis, and its concurrent validity, using Multivariate Regression Analysis. The developed questionnaire demonstrated adequate factorial and concurrent validity. Furthermore, it explicitly accounts for resilience, which is a key component of Positive Health. We introduced four benefits by aligning the CPHQ instrument with the Capability Approach. First, it embedded the measurement in a theoretical framework, which is required for theory development and testing. Second, it focused the questionnaire on a key concept of Positive Health - that is, on the "ability to adapt." Third, it addressed issues of health equity by taking contextual factors into account. Fourth, it aided in developing more understandable measurement items. The introduced measurement (i.e., the CPHQ) includes 11 dimensions, which we labeled as follows: relaxation, autonomy, fitness, perceived environmental safety, exclusion, social support, financial resources, political representation, health literacy, resilience, and enjoyment. Highlights- The Context-sensitive Positive Health Questionnaire (CPHQ) was developed using items from Positive Health questionnaires and the Capability Approach, which were then refined through focus groups and professional advice. - The questionnaire considers individuals unique environment, an aspect often overlooked in health measurements that can affect how someone feels. - By aligning the CPHQ instrument with the Capability Approach, we embedded the measurement in a theoretical framework, which is required for theory development and testing. - By embedding the measurement in the Capability Approach and including the Brief Resilience Scale into the initial questionnaire, we accounted for a key concept of Positive Health - that is, the "ability to adapt." - The developed scale showed adequate factorial validity and concurrent validity.