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Health Assessment Questionnaire
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About Health Assessment Questionnaire
Scale Name
Health Assessment Questionnaire
Author Details
James F. Fries
Translation Availability
English
Background/Description
The Health Assessment Questionnaire (HAQ), developed by James F. Fries in 1980, is a 20-item self-administered or interviewer-administered scale designed to assess functional disability and discomfort in adults with arthritis, though widely used for other chronic conditions. Published in Arthritis & Rheumatism, it is based on a hierarchical model with five dimensions: death, disability, discomfort, treatment side effects, and medical costs. This review focuses on the disability (Functional Disability Index) and discomfort (pain) dimensions, collectively called the “Short HAQ” or “2-Page HAQ.” The disability dimension covers eight components: Dressing and Grooming, Arising, Eating, Walking, Hygiene, Reach, Grip, and Outdoor Activities. The discomfort dimension uses a single 15-cm visual analogue scale (VAS) for pain.
Each of the 20 disability items is rated on a 4-point scale (0 = without difficulty, 3 = unable to do), with adjustments for aids/assistance. The highest score in each component is summed (0–24) and divided by 8 to yield the Functional Disability Index (0–3). Pain is scored from 0–3 (VAS cm × 0.2). The HAQ was validated with arthritis patients (N ≈ 100–200, mean age ≈ 50–70 years, mixed gender, U.S.-based), with scores interpreted as: 0.0–0.5 (fully self-sufficient), 0.5–1.25 (minor/major difficulties), 1.25–2.0 (major problems), 2.0–3.0 (severely handicapped). It correlates with the Barthel Index (r ≈ 0.60–0.80) and Arthritis Impact Measurement Scales (r ≈ 0.50–0.70). The HAQ is used in rheumatology, clinical psychology, and chronic disease research to assess functional status and evaluate treatment outcomes. It is public domain but requires permission for standardization (see aramis.stanford.edu).
Administration, Scoring and Interpretation
- Obtain the HAQ from Fries et al. (1980) or the Stanford ARAMIS website (aramis.stanford.edu), ensuring ethical permissions.
- Explain to participants (adults with arthritis or chronic conditions) that the questionnaire assesses daily functioning and pain, emphasizing confidentiality and voluntary participation.
- Administer the 20-item disability and single-item pain scale via self-report, telephone, or interview in clinical or community settings, covering performance over the past week.
- Estimated completion time is 5–8 minutes (scoring <1 minute).
- Ensure a private, supportive environment; provide arthritis or mental health resources (e.g., support groups) and adapt for accessibility (e.g., large print) if needed.
Reliability and Validity
The HAQ demonstrates robust psychometric properties (Fries et al., 1980; Pincus et al., 1989). Internal consistency is high (Cronbach’s alpha = 0.71–0.89 per component, 0.94 overall, N = 100–200). Inter-rater reliability between self-administered and interview formats (N = 20) shows a Spearman correlation of 0.85 for the disability index, with component correlations of 0.56–0.85. Test-retest reliability over two weeks (N = 37) is strong (r = 0.87).
Convergent validity is supported by correlations with the Barthel Index (r ≈ 0.60–0.80), Arthritis Impact Measurement Scales (r ≈ 0.50–0.70), and physician ratings (r ≈ 0.40–0.60). Factor analysis confirms eight disability components. Criterion validity is evidenced by sensitivity to treatment changes (e.g., post-therapy improvements) and prediction of work disability. Discriminant validity is shown by lower correlations across dimensions (e.g., disability vs. pain, r < 0.50). Rasch analysis indicates non-interval scaling, suggesting caution in summing scores. Pairing with the Mini-Mental State Examination or Functional Status Index enhances comprehensive assessment.
Available Versions
20-Items
Reference
Jf, F. (1980). Measurement of patient outcome in arthritis. Arthritis rheum, 23, 137-145.
Important Link
Scale File:
Frequently Asked Questions
What does the Health Assessment Questionnaire measure?
It measures functional disability and pain in daily activities, primarily for arthritis patients.
Who is the target population?
Adults with arthritis or chronic conditions in clinical or community settings.
How long does it take to administer?
Approximately 5–8 minutes (scoring <1 minute).
Can it inform interventions?
Yes, it assesses functional status to guide treatment and rehabilitation planning.
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