Table 1 Operational definitions, measurement instrument, and available metric properties of primary and secondary outcomes of interest

Functional Health

Elicited in T₀ questionnaire using the SF-12v2 (13 items).

The questions generate a physical and mental component, each with a theoretical range of 0 to 100. A difference of 5 points between persons or over time is considered clinically significant. The instrument has solid psychometric properties and was validated for French Canadian subjects [60, 61].

Number and Severity of Chronic Conditions

1. Hypertension

2. Elevated cholesterol

3. Asthma

4. Pulmonary problem

5. Diabetes

6. Thyroid disorder

7. Osteoarthritis

8. Rheumatoid arthritis

9. Back pain or sciatic pain

10. Osteoporosis

11. Other illness that affects the members or the articulations

12. Reflux, peptic ulcer or pyrosis

13. Intestine problem

14. Overweight

15. Hearing problem

16. Vision problem

17. Cardiac illnesses

18. CVA

19. Heart failure

20. Cancer (past 5 years)

21. Depression or anxiety problems

22. Other chronic health problems not mentioned above

Disease Burden Morbidity Assessment [64] (22 items).

Subject is asked to report whether a health professional has diagnosed the listed condition and to estimate the extent to which it interferes with his daily activities on a Likert scale ranging from "not at all" (1) to "a lot" (5). 0 = condition not diagnosed.

Though theoretically scores range from 0 to 125, in practice the maximum is 50 [64]. Compared to chart reviews, self reports of conditions have a median sensitivity of 75% and specificity of 92%. Self-reported scores correlate more closely to functional health than chart measures of multi-morbidity [64].

No population norm exists but in elderly persons the average score was 13.9 with a maximum of 51 [64]. Multi-morbid individuals are those with a score of ≥10.

Compared to chart reviews, self reports of conditions have a median sensitivity of 75% and specificity of 92%. The score correlates more closely to functional health than chart measures of multi-morbidity [64].

Health Behaviours

Body Mass Index: BMI

Height, weight (2 items).

Normal Body Mass Index (BMI) = 19-24.9 kg/m².

Scoring ranges from 1 (ideal weight for height) to -3 (morbidly obese BMI > 35 kg/m²).

Among those above ideal weight: intention to engage in weight change over the next 6 months. [68, 72] (1 item).

Fruit and vegetable consumption

Enquête Saguenay-Lac-St-Jean 2007 [66]and other regional surveys (3 items).

Intention to consume at least 3 daily servings of fruit and vegetables over the next 6 months [68, 72] (1 item).

Smoking: status, age-onset of daily smoking, current intensity, nicotine dependency

CCHS 3.1, Daily smoking, daily number (same as CCHS p. 110-116). Found to be highly reliable and valid [84] (2 items).

Scoring ranges from 1 (< 100 cigarettes in lifetime) to -3 (daily smoking ≥ 20 cigarettes).

Enquête Saguenay-Lac-St-Jean 2007 [66]and other regional surveys: ever smoke (1 item).

Among smokers: intention to quit smoking over the next 6 months [68, 72] (1 item).

   Quit history, attempts and intentions

CCHS p.117 (2 items).

   Receipt of smoking cessation advice and aid from health professional

CCHS p. 120 (3 items).

   Second-hand smoke exposure

CCHS p.124 (2 items).

Physical activity

Enquête Saguenay-Lac-St-Jean 2007 [66]and other regional surveys (4 items): Practice of regular physical activity.

Intention to engage in regular active exercise (at least 3 times per week for 20 minutes per time) over the next 6 months [68, 72] (1 item).

Alcohol use-frequency, problem drinking

Enquête Saguenay-Lac-St-Jean 2007 [66]and other regional surveys (4 items).

Adapted from CCHS 3.1 (driving under the influence) (1 item).

Among problem drinkers: intention to reduce alcohol consumption over the next 6 months [68, 72] (1 item).

Psychological distress: the general concept of maladaptive psychological functioning in the face of stressful life events

K6 [85] -Frequency of feelings of tiredness, nervousness, hopelessness, restlessness, depression on a Likert scale from 1 (all of the time) to 5 (none of the time). CCHS p. 181 (6 items).

Though not specific to any particular psychiatric disorder" most psychiatric patients score high on these measures and it discriminates well between mental illness severity [85, 86] α = 0.89.

Use of specialists and specialty testing for common conditions

Administrative database.

Hospital emergency room use

Administrative database.