McMaster Health Index Questionnaire (MHIQ)

Abstract

The Mcma‎ster Health Index Questionnaire (MHIQ) is a comprehensive self-administered instrument developed to measure an individual’s perceived health status and overall quality of life. Developed at Mcma‎ster University, the MHIQ is designed to be highly sensitive to changes in health over time, making it valuable for use in clinical trials, epidemiological studies, and population health surveillance. The questionnaire encompasses 42 items distributed across three primary domains of functioning: Physical Functioning, Emotional Functioning, and Social Functioning. It moves beyond simple morbidity measures to provide a holistic assessment of how health impacts daily activities and psychological well-being.

Keywords

Health Index, Quality of life, Physical Function, Emotional Function, Social Function, Health Status, Psychometrics, Self-report questionnaire, Functional status

Authors

Lee W. Chambers, David L. Sackett, C.H. Goldsmith, A.S. MacPherson, L.A. MacDonald, P. Tugwell

Purpose

The primary purpose of the MHIQ is to provide a standardized, quantifiable measure of health status that is responsive to intervention and change. It was initially developed in the mid-1970s to address the need for reliable health indices in clinical research, particularly in evaluating the effectiveness of healthcare services and therapeutic interventions.

The instrument is specifically structured to capture subjective patient experiences across key areas of life, ensuring that assessments of health extend beyond simple clinical diagnoses. Researchers utilize the MHIQ to track patient progress, compare health outcomes across different populations, and establish baseline functional levels for individuals suffering from chronic diseases, such as rheumatoid disease.

Construct

The MHIQ measures the construct of Health Status, defined dimensionally through three major components of human functioning: physical, emotional, and social health. These domains are operationalized across the three sections of the questionnaire (A, B, and C).

• Physical Functioning (Section A): This domain assesses the individual’s current capacity to perform routine physical activities, including mobility, self-care (ADLs), household tasks, and sensory functions (vision and hearing).
• Emotional Functioning (Section B): This domain captures the psychological and attitudinal aspects of health, including feelings of usefulness, failure, happiness, alertness, and life satisfaction, often reflecting mood and self-efficacy.
• Social Functioning (Section C): This domain measures the individual’s ability to maintain social roles, including work, friendships, family relationships, and participation in recreational or community activities.

Validity

Early studies on the MHIQ, particularly those involving patients with rheumatoid disease, demonstrated strong construct validity. The scale was shown to effectively differentiate between groups known to vary in health status and functional capacity. Furthermore, the MHIQ has been recognized for its ability to measure different dimensions of health that are often overlooked by purely medical indices.

The MHIQ has proven sensitive to change (responsiveness), a crucial aspect of its validity for use in clinical trials. It accurately reflects improvements or declines in health following specific medical or behavioral interventions, supporting its utility as an outcome measure.

Reliability

Although specific reliability coefficients are detailed in the published literature, the MHIQ is generally cited as having acceptable to good internal consistency and test-retest reliability across its subscales. Its robust psychometrics were established during its development phase in the 1970s and subsequent updates.

Studies have confirmed that the scale maintains stability when administered repeatedly under stable health conditions, ensuring that any fluctuations in scores are likely attributable to actual changes in the respondent’s health status rather than measurement error.

Factor Analysis

The initial development and subsequent analysis of the MHIQ utilized factor analytic techniques to confirm the hypothesized three-factor structure: Physical, Emotional, and Social Functioning. This structure supports the scoring methodology where independent scores are generated for each major dimension, allowing for a profile of health rather than a single global score. The clear distinction between these factors confirms that the scale is measuring three separate, though related, components of health.

Instrument

Test Type: Self-report Health Index Questionnaire

Format: 42 structured items, primarily utilizing dichotomous (Yes/No) responses, categorical choices, and 5-point Likert scales (Strongly Agree to Strongly Disagree).

Language Available: English (Original), potentially others based on international research applications.

Population Group: General population, clinical populations (especially those with chronic conditions).

Age Group: Adults (typically used for adults capable of self-reporting).

Population Details: Widely used in studies of chronic disease management, public health, and assessments of health outcomes.

Test Methodology: Can be administered via interview or self-completion. Measures current health status and functional capacity.

Keywords

Mcma‎ster, MHIQ, Functional capacity, Quality of life assessment, Health outcome measures, Chronic illness, Self-care, Activities of Daily Living

Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: N/A (Information not provided in source material)

Permissions & Fee and Test Year

The MHIQ was initially developed and published based on research conducted in 1976 and 1977 at Mcma‎ster University. For current permissions and licensing fees, users should contact the primary authors or Mcma‎ster University directly, as rights and usage policies may have changed since the scale’s inception.

The original PDF of the instrument, as well as related documentation, can be accessed via the following links:

• The original PDF can be downloaded here: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf
• Additional documentation is available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071943/?page=7

Reference’s

Sackett, D.L., Chambers, L.W., MacPherson, A.S., et al. (1977). The development and application of indices of health: general methods and a summary of results. Am J Public Health, 67:423–428.

Chambers, L.W., Sackett, D.L., Goldsmith, C.H. (1976). Development and application of an index of social function. Health Serv Res, 11(4):430–441.

Chambers, L.W., MacDonald, L.A., Tugwell, P., et al. (1982). The Mcma‎ster Health Index Questionnaire as a measure of quality of life for patients with rheumatoid disease. J Rheumatol, 9:780–784.

Chambers, L.W. The Mcma‎ster Health Index Questionnaire. In: Wenger NK, Mattson ME, Furberg CD, et al., eds. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq, 1984:160–164.

Chambers, L.W., Haight, M., Norman, G., et al. (1987). Sensitivity to change and the effect of mode of administration on health status measurement. Med Care, 25:470–479.

Chambers, L.W. (1993). The Mcma‎ster Health Index Questionnaire: an update. In: Walker SR, Rosser RM, eds. Quality of life assessment: key issues in the 1990s. Dordrecht, Netherlands: Kluwer Academic Publishers: 131–149.

McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS.

Items of the Mcma‎ster Health Index Questionnaire (MHIQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

SECTION A:

The questions in the first section ask about your health and whether you are able to do certain things.

1. Today‚ are you physically able to run a short distance‚ say 300 feet‚ if you are in a hurry? (This is about the length of a football field or soccer pitch.) (1) NO‚ (2) YES
2. Today‚ do you (or would you) have any physical difficulty at all with
   (1) Difficulty‚ (2) No Difficulty
   • a. walking as far as a mile?
   • b. climbing up 2 flights of stairs?
   • c. standing up from and/or sitting down in a chair?
   • d. feeding yourself ?
   • e. undressing?
   • f. washing (face and hands)‚ sha‎ving (men)‚ and/or combing hair?
   • g. shopping?
   • h. cooking?
   • i. dusting and/or light housework?
   • j. cleaning floors?
3. Today‚ are you physically able to take part in any sports (hockey‚ swimming‚ bowling‚ golf‚ and so forth) or exercise regularly? (1) NO‚ (2) YES
4. At present‚ are you physically able to walk out-of-doors by yourself when the weather is good? (1) NO‚ (2) YES
   If “YES” Go to “a” and If “NO” Go to “b”
   • a. What is the farthest you can walk by yourself?
     1. ONE MILE OR MORE P
     2. LESS THAN 1 MILE BUT MORE THAN 30 FEET (ABOUT THE SIDE OF A HOUSE)
     3. LESS THAN 30 FEET
   • b. Are you able to walk by yourself?
     1. BETWEEN ROOMS
     2. ONLY WITHIN A ROOM
     3. CAN’T WALK AT ALL
5. Today‚ do you (or would you) have any physical difficulty at all travelling by bus whenever necessary? (1) NO‚ (2) YES
6. Today‚ do you have any physical difficulty at all travelling by car whenever necessary? (1) NO‚ (2) YES
7. Do you have any physical difficulty at all driving a car by yourself?
   (1) NO (or do not have a licence) Go to Q. 8
   (2) YES a. Is this because of a physical disability? (1) NO‚ (2) YES
8. Do you wear glasses? (1) NO‚ (2) YES
   If “YES” Go to “a & b” and If “NO” Go to “c & d”
   • a. Do you have any trouble seeing ordinary newsprint when you wear your glasses?
     1. NEVER
     2. SOMETIMES
     3. ALWAYS
   • b. Do you have a headache after watching television or reading when you wear your glasses?
     1. NEVER
     2. SOMETIMES
     3. ALWAYS
   • c. Do you have any trouble seeing ordinary newsprint?
     1. NEVER
     2. SOMETIMES
     3. ALWAYS
   • d. Do you have a headache after watching television or reading?
     1. NEVER
     2. SOMETIMES
     3. ALWAYS
9. Do you wear a hearing aid? (1) NO‚ (2) YES
   If “YES” Go to “a & b” and If “NO” Go to “c & d”
   • a. Do you have trouble hearing in a normal conversation with several other persons when you wear your hearing aid?
     1. NEVER
     2. SOMETIMES
     3. ALWAYS
   • b. Do you have trouble hearing the radio or television when you wear your hearing aid?
     1. NEVER
     2. SOMETIMES
     3. ALWAYS
   • c. Do you have trouble hearing in a normal conversation with several other persons?
     1. NEVER
     2. SOMETIMES
     3. ALWAYS
   • d. Do you have trouble hearing the radio or television?
     1. NEVER
     2. SOMETIMES
     3. ALWAYS

SECTION B:

Often people’s health affects the way they feel about life. For these next questions‚ please circle the choice that is closest to the way you feel about each statement.

(1)If you STRONGLY AGREE
(2)If you AGREE
(3)If you are NEUTRAL
(4)If you DISAGREE
(5)If you STRONGLY DISAGREE

10. I sometimes feel that my life is not very useful.
11. Everyone should have someone in his life whose happiness means as much to him as his own.
12. I am a useful person to have around.
13. I am inclined to feel that I’m a failure.
14. Many people are unhappy because they do not know what they want out of life.
15. In a society where almost everyone is out for himself‚ people soon come to distrust each other.
16. I am a quick thinker.
17. Some people feel that they run their lives pretty much the way they want to and this is the case with me.
18. There are many people who don’t know what to do with their lives.
19. Most people don’t realize how much their lives are controlled by plots hatched in secret by others.
20. People feel affectionate toward me.
21. I would say I nearly always finish things once I start them.
22. When I make plans ahead‚ I usually get to carry out things the way I expected.
23. I think most married people lead trapped (frustrated or miserable) lives.
24. It’s hardly fair to bring children into the world the way things look for the future.
25. Some people feel as if other people push them around a good bit‚ and I feel this way too.
26. I am usually alert.
27. Nowadays a person has to live pretty much for today and let tomorrow take care of itself.

SECTION C:

This section contains some questions on general health and on your social activities.

28. How would you say your health is today? Would you say your health is (Circle your answer)
    1. VERY GOOD
    2. PRETTY GOOD
    3. NOT TOO GOOD
29. Taking all things together‚ how would you say things are today? Would you say you are
    1. VERY HAPPY
    2. PRETTY HAPPY
    3. NOT TOO HAPPY
30. In general‚ how satisfying do you find the way you’re spending your life today? Would you call it
    1. COMPLETELY SATISFYING
    2. PRETTY SATISFYING
    3. NOT VERY SATISFYING
31. How would you say your physical functioning is today? (By this we mean the ability to move around‚ see‚ hear‚ and talk.)
    1. GOOD
    2. GOOD TO FAIR
    3. FAIR
    4. FAIR TO POOR
    5. POOR
32. How would you say your social function is today? (By this we mean your ability to work‚ to have friends‚ and to get along with your family.)
    1. GOOD
    2. GOOD TO FAIR
    3. FAIR
    4. FAIR TO POOR
    5. POOR
33. How would you say your emotional functioning is today? (By this we mean your ability to remain in good spirits most of the time and to be usually happy and satisfied with your life.) (Circle your answer)
    1. GOOD
    2. GOOD TO FAIR
    3. FAIR
    4. FAIR TO POOR
    5. POOR
34. Are you presently working on a job for wages‚ either full- or part-time?
    1. YES _____ GO TO Q.35
    2. NO . a. Are you presently
       1. ON VACATION
       2. ON SICK LEAVE
       3. RETIRED
       4. A STUDENT
       5. A HOUSEWIFE
       6. OTHER (please specify):
35. How much time‚ in a one-week period‚ do you usually spend watching television?
    1. NONE
    2. LESS THAN THREE HOURS A WEEK
    3. LESS THAN TWO HOURS A DAY
    4. TWO OR MORE HOURS A DAY
36. Which of the following describe your usual social and recreational activities?
    • a. going to church? (1) NO‚ (2) YES
    • b. going to a relative’s home? (1) NO‚ (2) YES
    • c. any other activities? (please specify) ________________
37. Has anyone visited you in the last week? (Circle your answer)
    • a. a relative? (1) NO‚ (2) YES
    • b. a friend? (1) NO‚ (2) YES
    • c. a religious group member? (1) NO‚ (2) YES
    • d. a social agency representative? (1) NO‚ (2) YES
38. Do you have a telephone? (1) NO‚ (2) YES
39. Have you used your telephone in the last week to call
    • a. a friend? (1) NO‚ (2) YES
    • b. a religious group member? (1) NO‚ (2) YES
    • c. a social agency representative? (1) NO‚ (2) YES
40. Have you been called in the last week by a social agency representative? (1) NO‚ (2) YES
41. How long has it been since you last had a holiday?
    (Write in number “0” if presently on holidays.)
    _____ MONTHS or _____YEARS S (≤ 12 months)
42. During the last year‚ have any of the following things happened to you?
    • a. separation from your spouse? (1) NO‚ (2) YES
    • b. divorce? (1) NO‚ (2) YES
    • c. going on welfare during the last year? (1) NO‚ (2) YES
    • d. trouble getting along with friends/relatives during the last year? (1) NO‚ (2) YES
    • e. retired from work during the last year? (1) NO‚ (2) YES
    • f. some other problem or change in your life? (please specify)