| Research Instrument |
| Accession Number |
| 2003097423. |
| Authors |
| Ware JE Jr. |
| Author Affiliation |
| Medical Outcomes Trust. |
| Corporate Author |
| Medical Outcomes Trust. |
| Title |
| Short Form-36 Health Survey (SF-36). |
| Source |
| Ware, JE. (2000). SF-36 Health Survey Update. SPINE, 25(24):3130-3139 ** 2000 (6 p) (21 ref) |
| Legal Cases |
| Legal Cases Case No: 300079, Riverside Superior Court, California. |
| CINAHL Subject Headings |
| Factor Analysis *Health Status/Evaluation Perception Questionnaires Reliability and Validity Self Report Summated Rating Scaling |
| Abstract |
| The Short-Form-36 Health Survey (SF-36) is a widely-used, 36-item, generic questionnaire designed to evaluate various aspects of health from the individual's point of view. Taken from the survey used in the Medical Outcomes Study, it examines eight health-related concepts selected from 40 of that study (physical functioning, role limitations due to physical or emotional problems, general mental health, general health perceptions, bodily pain, and vitality) but with far fewer questions. The SF-36 is one of several questionnaires (SF-12, SF-8) published by QualityMetric Incorporated that measure the same eight domains of health with only some common questions. The longer instruments are more precise than the shorter but take longer to administer. |
| Description |
| YEAR DEVELOPED: 1988 (developmental form); 1990 (standard form); 1996 (SF-36v2) |
| PURPOSE: To measure various aspects of an individual's health in a comprehensive yet brief manner and from the individual's point of view. |
| VARIABLES OF INTEREST: Measures eight health concepts: physical functioning, social functioning, role limitations due to physical health problems, role limitations due to emotional problems, general mental health, general health perceptions, bodily pain, and vitality. These concepts were selected from 40 in the Medical Outcomes Study which had evolved from the Rand Health Insurance Experiment. |
| ORIGINAL POPULATION: English speaking adults who participated in the Medical Outcomes Study in 1986-1987 in Chicago, Illinois, Boston, Massachusetts, and Los Angeles, California. Over 15,000 patients completed the questionnaire. Clinicians of these patients provided information about their health status. |
| QUESTION FORMAT: The most recent version of the survey (SF-36v2 Health Survey CO 1996, 2000 by QualityMetric Incorporated and Medical Outcomes Trust) contains 11 questions, most consisting of Likert-type responses. For example, a question concerning the existence of problems resulting from physical health causing the respondent to accomplish less than desired has a five-choice response ranging from "all of the time" to "none of the time." In an earlier version of the instrument the available choices were simply "yes" and "no." |
| The concept Physical Functioning is represented by 10 items; Role-Physical by 4 items; Bodily Pain by 2 items; General Health by 5 items. These make up the Physical Health Component. The Mental Health Component consists of Vitality (4 items); Social Functioning (2 items); Role-Emotional (3 items); and Mental Health (5 items). |
| ADMINISTRATION: The instrument can be self administered or administered by interview, either in person or by telephone, in less than 15 minutes. Details of administration and scoring are described in user manuals available from the publisher at http://www.qualitymetric.com. |
| SCORING: Current recommendations involve a "norm-based" scoring system which standardizes each of the eight scales, allows for easier interpretation, and makes comparisons of the scales possible. Current norms based on 1998 data are available from the publisher. |
| One item, a self-rating of current health status compared to a year ago (five choices ranging from "much better" to "much worse"), is not included in the scoring. |
| PSYCHOMETRICS: Factor analysis has validated the existence of eight scales which fall into either the Physical or Mental Health Components mentioned above. Many reliability and validity studies (Jenkinson, Wright, & Coulter, 1994; McHorney, Ware, & Raczek, 1993) have been conducted on the SF-36, and in most, reliability coefficients have been greater .70. Analyses have also produced evidence of content, concurrent, criterion, construct, and predictive validity. Individual scales and summary measures have been useful in screening and measuring aspects of specific diseases and conditions. |
| HOW TO OBTAIN: Individuals wishing to use the SF-36 must be licensed and must obtain permission from the copyright holders. A license form is available on the website http://www.qualitymetric.com. Samples of the various versions of the instrument are also available on this website. Manuals for its use and scoring can be purchased from the site as well. The guide, "SF-36 Health Survey: Manual and Interpretation Guide," is included in the reference list of this description. |
| The full text of the current instrument (SF-36v2) is also included in this description. The full text of the earlier SF-36 can be found in the McDowell and Newell (1996) citation in the reference list. |
| COPYRIGHT OWNER(S): Copyright CO 1993, 2000 by John E. Ware, Jr., Ph.D. SF-36 is a registered trademark of Medical Outcomes Trust. |
| MODIFICATIONS: Researchers in the Rand Corporation's Health Insurance Experiment (HIE) and Medical Outcomes Study (MOS) produced the 149-item Functioning and Well-Being Profile using various instruments such as the General Psychological Well-Being Inventory and the Health Perceptions Questionnaire, among several others, as sources of items that were modified to meet their needs. A short form, the SF-20, was published in 1988 but was criticized as being too brief and not sensitive to health status changes. The SF-36 was developed in response to these criticisms. |
| As of this writing, the SF-36 Standard Version has been translated into over 50 languages including Afrikaans, Chinese, French, various versions of Spanish, and Turkish (see the complete list on the QualityMetric Incorporated website listed above.) The SF-36v2 is available in English, French, German, Italian, and Spanish. |
| Version 2.0, introduced in 1996, includes "simpler instructions and questionnaire items, an improved layout for questions and answers in the self-administered version, greater comparability with widely used translations and cultural adaptations, and five-level response choices in place of dichotomous response choices for items in two role functioning scales" (Ware, 2000, p. 3130). |
| The website also provides information about the SF-12 and the SF-8, shorter versions of the SF-36. |
| NOTES OF INTEREST: Several useful manuals are available
from the QualityMetric Incorporated website. They contain descriptions
of the history and development of the various instruments along with detailed
psychometric, administration, and scoring information. They also contain
information about comparability between the tools. Additionally, the Ware
(2000) article in the reference list is an excellent summary and update
on the SF-36 Health Survey. |
| POTENTIAL USES: The SF-36 has been used in a wide range of disease-related studies (Andresen, Gravitt, & Podgorski, 1999; Brazier et al., 1992; Dorman, Dennis, & Sandercock, 1999; Jette & Downing, 1994; Tunis, Croghan, Heilman, Johnstone, & Obenchain, 1999) from low back pain in pregnancy (Ciardi, Gozzo, & Wilmarth, 2002), COPD (Ferreira et al., 2003), traumatic brain injury (Findler, Cantor, Haddad, Gordon, & Ashman, 2001) to multiple sclerosis (Nortvedt, Riise, Myhr, & Nyland, 2000). Because it is a generic instrument rather than a disease-specific instrument it can be useful in comparing the effects of different conditions on an individual or comparing patients to individuals in the general population. It can also be used in repeated measures of the same patients over time. According to Ware (2000), experience with the SF-36 "has been documented in more than 1000 publications" (p. 3130). |
| TITLE VARIATIONS: SF-36, SF-36v2 |
| Description Copyright CO 2003, Cinahl Information Systems. |
| Cited References |
| Andresen, E. M., Gravitt, G. W., Aydelotte, M. E., & Podgorski, C. A. (1999). Limitations of the SF-36 in a sample of nursing home residents. Age and Ageing, 28, 562-566. [CINAHL Accession Number: 200021897; PMID: 10604509]. |
| Brazier, J. E., Harper, R., Jones, N. M. B., O'Cathain, A., Thomas, K. J., Usherwood, T., et al. (1992). Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ, 305, 160-164. [PMID: 1285753]. |
| Ciardi, S., Gozzo, V., & Wilmarth, M. A. (2002). Pregnant women's response to a prenatal body mechanics and exercise program for the prevention of low back pain: report on a pilot study. Journal of the Section on Women's Health, 26(4), 17-22. [CINAHL Accession Number: 2003065158]. |
| Dorman, P. J., Dennis, M., & Sandercock, P. (1999). How do scores on the EuroQol relate to scores on the SF-36 after stroke? Stroke, 30(10), 2146-2151. [CINAHL Accession Number: 2000005952; PMID: 10512920]. |
| Ferreira, C. A. S., Stelmach, R., Feltrin, M. I. Z., Filho, W. J., Chiba, T., & Cukier, A. (2003). Evaluation of health-related quality of life in low-income patients with COPD receiving long-term oxygen therapy. Chest, 123(1), 136-141. [CINAHL Accession Number: 2003067199; PMID: 12527614]. |
| Findler, M., Cantor, J., Haddad, L., Gordon, W., & Ashman, T. (2001). The reliability and validity of the SF-36 health survey questionnaire for use with individuals with traumatic brain injury. Brain Injury, 15(8), 715-723. [CINAHL Accession Number: 2003065545; PMID: 11485611]. |
| Harrison, M. B., Browne, G. B., Roberts, J., P., T., Gafni, A., & Graham, I. D. (2002). Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition. Medical Care, 40(4), 271-282. [CINAHL Accession Number: 2003067807; PMID: 12021683]. |
| Jenkinson, C., Wright, L., & Coulter, A. (1994). Criterion validity and reliability of the SF-36 in a population sample. Quality of Life Research, 3, 7-12. |
| Jette, D. U., & Downing, J. (1994). Health status of individuals entering a cardiac rehabilitation program as measured by the Medical Outcomes Study 36-Item Short Form Survey (SF-36). Physical Therapy, 74(6), 521-527. [CINAHL Accession Number: 1994189475; PMID: 8197238]. |
| Keller, S. D., Majkut, T. C., Kosinski, M., & Ware, J. E. (1999). Monitoring health outcomes among patients with arthritis using the SF-36 Health Survey. Overview. Medical Care, 37(5 Suppl), M51-M59. [PMID: 10335739]. |
| Kopjar, B. (1996). The SF-36 health survey: a valid measure of changes in health status after injury. Injury Prevention, 2(2), 135-139. [PMID: 9346078]. |
| McDowell, I., & Newell, C. (1996). The Short-Form-36 Health Survey. In Measuring Health. A Guide to Rating Scales and Questionnaires (Second ed., pp. 446-456). New York: Oxford University Press. |
| McHorney, C. A., Kosinski, M., & Ware, J. E., Jr. (1994). Comparisons of the costs and quality of norms for the SF-36 Health Survey collected by mail versus telephone interview: results from a national survey. Medical Care, 32(6), 551-567. [PMID: 8189774]. |
| McHorney, C. A., Ware, J. E., Jr., Lu, J. F., & Sherbourne, C. D. (1994). The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32(1), 40-66. [PMID: 8277801]. |
| McHorney, C. A., Ware, J. E., Jr., & Raczek, A. E. (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31(3), 247-263. [PMID: 8450681]. |
| Nortvedt, M. W., Riise, T., Myhr, K. M., & Nyland, H. I. (2000). Performance of the SF-36, SF-12, and RAND-36 summary scales in a multiple sclerosis population. Medical Care, 38(10), 1022-1028. [PMID: 11021675]. |
| Pai, C. W., & Wan, T. H. (1997). Confirmatory analysis of health outcome indicators: the 36-Item Short-Form Health Survey (SF-36). Journal of Rehabilitation Outcomes Measurement, 1(2), 48-59. |
| Smith, H. J., Taylor, R., & Mitchell, A. (2000). A comparison of four quality of life instruments in cardiac patients: SF-36, QLI, QLMI, and SEIQoL. Heart, 84(4), 390-394. [CINAHL Accession Number: 2001006337; PMID: 10995407]. |
| Tunis, S. L., Croghan, T. W., Heilman, D. K., Johnstone, B. M., & Obenchain, R. L. (1999). Reliability, validity, and application of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in schizophrenic patients treated with olanzapine versus haloperidol. Medical Care, 37(7), 678-691. [PMID: 10424639]. |
| Ware, J. E., Jr. (2000). SF-36 Health Survey update. Spine, 25(4), 3130-3139. [PMID: 11124729]. |
| Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473-483. [PMID: 1593914]. |
| Ware, J. E., Jr., Snow, K. K., & Kosinski, M. (1993; 2000). SF-36(R) Health Survey: Manual and Interpretation Guide. Lincoln, RI: QualityMetric Incorporated. |
| Document Type |
| Research Instrument. |
| Language |
| English |
| Images |
| 2003097423.pdf |
| Entry Month |
| 20030725 |