Duke Health Profile (Duke-PH)

Abstract

The Duke Health Profile (Duke-PH) is a brief, widely used psychometric instrument designed to measure health status and dysfunction across multiple domains. Developed primarily for use in primary care settings, the Duke-PH evolved from the earlier Duke-UNC Health Profile. It is particularly valued for its brevity and ability to quickly assess key dimensions of health, including physical, mental, and social function, alongside measures of anxiety, depression, and self-esteem. The scale exists in several variations (e.g., 17-item, 15-item, and 8-item versions) to suit different research and clinical needs.

Keywords

Duke Health Profile, Duke-PH, health status, Quality of Life, primary care, psychological scale, self-esteem, anxiety, depression, functional health

Authors

George R. Parkerson, Jr., S.H. Gehlbach, E.H. Wagner, W.E. Broadhead, C.K.J. Tse

Purpose

The primary purpose of the Duke Health Profile (Duke-PH) is to provide a concise and reliable assessment of an individual’s health status and functional capacity. It was specifically developed to be practical for routine use in primary care settings where time constraints necessitate quick, yet comprehensive, screening tools. The instrument aims to capture both positive aspects of health (e.g., perceived health, self-esteem) and specific areas of dysfunction (e.g., pain, disability, and emotional distress).

The scale is instrumental in clinical research and practice for monitoring changes in health over time, evaluating the effectiveness of interventions, and predicting health outcomes, such as utilization of health services or severity of illness. Its flexibility, offered through various item counts (17, 15, or 8 items), allows researchers to tailor the measurement complexity to the specific study population and objectives.

Construct

The Duke-PH measures a multidimensional construct encompassing both functional health and psychological well-being. The core dimensions assessed include Physical Health, Mental Health, and Social Health. Beyond these core functional domains, the scale explicitly measures several specific health indicators and dysfunctions.

Specific constructs measured by the different versions of the scale include: General health, self-esteem, perceived health, pain, disability, anxiety, and depression. Items often focus on recent experience (e.g., “During the past week”), ensuring that the profile reflects the current state of the respondent’s functioning and distress levels. The instrument is thus a comprehensive measure of functional health, covering physical limitations, emotional stability, and social integration.

Validity

The validity of the Duke Health Profile has been extensively documented since its introduction. The instrument demonstrates strong construct validity, aligning conceptually with established definitions of health status and quality of life. Furthermore, studies have shown its criterion validity through comparisons with other established measures, such as the MOS Short-Form (SF) in healthy young adults, confirming its ability to measure similar underlying constructs efficiently.

Specific research has focused on the Duke-PH’s utility in identifying anxiety and depressive symptoms in primary care populations, highlighting its diagnostic and screening validity. Its structure, which separates positive health measures (like self-esteem) from negative dysfunction measures (like anxiety and depression), contributes to its differentiated validity across various subscales.

Reliability

The Duke Health Profile exhibits acceptable to high internal consistency and test-retest reliability, supporting its use as a consistent measure of health status. The rigorous development process, which led to the refinement of the 17-item version from the original Duke-UNC Health Profile, emphasized maximizing reliability across its subscales, including physical, mental, and social health indices.

Due to its application across diverse populations and clinical settings, the scale’s reliability has been scrutinized in multiple studies, confirming that the short, focused item sets maintain adequate internal coherence, making them reliable indicators of the health domains they are designed to capture.

Factor Analysis

Factor analytic studies were crucial in the development and refinement of the Duke-PH, particularly in establishing the dimensionality of the 17-item version. These analyses support the separation of the instrument into distinct factors corresponding to Physical Health, Mental Health, and Social Health, as well as the specific dysfunction scales (Anxiety and Depression).

The scoring methodology, which groups items into multiple scales (e.g., 5 health scales and 5 dysfunction scales in the 17-item version), reflects the underlying factor structure identified through empirical testing. This structure confirms that the Duke-PH is a truly multidimensional measure, capable of yielding independent scores for distinct aspects of health and illness.

Instrument

Test Type: Self-report Questionnaire / Health Status Measure

Format: Multiple versions available, including 17-item, 15-item, and 8-item formats. Items typically use a 3-point Likert scale response format (e.g., Yes/Somewhat/No, or None/Some/A Lot).

Language Available: English (likely translated into numerous languages for international use, though specific list not provided in source).

Population Group: General adult population, particularly primary care patients.

Age Group: Adults.

Population Details: Originally developed using adult populations seeking care at Duke University Medical Center and primary care clinics.

Test Methodology: Pencil-and-paper or electronic administration. Scoring involves summing or averaging raw scores, often after reversing certain items, and multiplying by a constant to standardize scores (typically scaled 0 to 100, where higher scores generally indicate better health/function, or worse dysfunction, depending on the subscale).

Keywords

Duke-UNC Health Profile, health measurement, 17-item scale, functional status, chronic illness, behavioral health, primary care assessment, self-report

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: Not provided in source.

Correspondence Address: Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina.

Permissions & Fee and Test Year

The original development of the precursor, the Duke-UNC Health Profile, began in 1981. The 17-item Duke Health Profile (Duke-PH) was formalized around 1990–1991. The instrument is generally considered part of the Duke Health Measures suite. Detailed information regarding current licensing, permissions, and fees should be sought directly from the Department of Community and Family Medicine at the Duke University Medical Center, as indicated in the user guides.

Reference’s

The original PDF detailing the instrument and scoring can be downloaded here: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf

• Parkerson‚ G.R.‚ Jr.‚ Gehlbach‚ S.H.‚ Wagner‚ E.H.‚ et al. (1981). The Duke-UNC Health Profile: an adult health status instrument for primary care. Med Care‚ 19:806–828.
• Parkerson‚ G.R.‚ Jr.‚ Broadhead‚ W.E.‚ Tse‚ C.K.J. (1990). The Duke Health Profile: a 17-item measure of health and dysfunction. Med Care‚ 28(11):1056–1072.
• Parkerson‚ G.R Jr.‚ Broadhead‚ W.E.‚ Tse C-K.J. (1991). Development of the 17-item Duke Health Profile. Family Practice‚ 8(4); 396-401.
• Parkerson‚ G.R.‚ Jr.‚ Broadhead‚ W.E‚ Tse‚ C.K.J. (1991). Comparison of the Duke Health Profile and the MOS Short-Form in healthy young adults. Med Care‚ 29:679–683.
• Parkerson‚ G.R.‚ Jr.‚ Broadhead‚ W.E.‚ Tse‚ C.K.J. (1992). Quality of life and functional health of primary care patients. J Clin Epidemiol‚ 45:1303–1313.
• Parkerson‚ G.R.‚ Jr. (1994). User’s guide for the Duke Health Profile (DUKE). Durham‚ North Carolina: Duke University Medical Center.
• Parkerson‚ G.R.‚ Jr.‚ Broadhead‚ W.E.‚ Tse‚ C.K. (1995). Health status and severity of illness as predictors of outcomes in primary care. Med Care‚ 33:53–66.
• Parkerson‚ G.R.‚ Jr.‚ Broadhead. W‚E.‚ Tse‚ C.K.J. (1996). Anxiety and depressive symptom identification using the Duke Health Profile. J Clin Epidemiol‚ 49(1):85–93.
• Parkerson‚ G.R.‚ Jr. (2002). Users guide for Duke health measures. Durham‚ N.C.: Department of Community and Family Medicine‚ Duke University Medical Center.
• McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS.

Items of the Duke Health Profile (Duke-PH)

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