Objectives

According to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel, structural validity describes how well Patient-Reported Outcome Measures’ (PROM) scores reflect the dimensions of the measured construct. Reaching structural validity is important for PROMs that reflect unidimensional effect indicators, but not for formative PROMs in which the items are not necessarily correlated. The main purpose of this study was to examine the structural components of the Abilitator, a co-developed self-report questionnaire on work ability and functioning for the population in a weak labour market position.

Methods

We examined to what extent the Abilitator has reflective and formative elements in its five summary scales: “C. Inclusion”, “D. Mind”, “E. Everyday life”, “F. Skills”, and “G. Body”. The Abilitator data sample (n=4555, men 51%, mean age 37 years) was collected in 2017–2022 by the Finnish Institute of Occupational Health in cooperation with the European Social Fund Priority 5 projects in which the participants have multiple challenges to gain employment. For the structural components and validity analysis we implemented both Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA).

Results

Based on the COSMIN criteria for structural validity, the Abilitator reached approximate model fit with CFA when we analysed the different concepts of the questionnaire separately rather than in one unified model. An exception was “E. Everyday life” which was a formative summary scale, and it did not reach approximate fit. EFA showed that the items in the Abilitator’s summary scales loaded on ten factors.

Conclusions

The Abilitator had both reflective and formative elements in its structure. It reached structural validity in those separate concepts that were based on a reflective model. This study revealed interesting connections between different aspects of the Abilitator and produced valuable information for further  modification of the questionnaire.

The Abilitator was co-developed in 2014–2017 at the Finnish Institute of Occupational Health (FIOH) in “The Social Inclusion and the Change of One’s Work Ability and Capacity” (Solmu), a national coordination project funded by the European Social Fund (ESF) Priority 5 programme (2014–2023). One of the main aims of the ESF Priority 5 programme was to improve the social inclusion, work ability, and functioning of those in a weak labour market position. Solmu’s target was to jointly develop a PROM ‘Abilitator’, which would evaluate both the work ability and functioning of those participating in the national Priority 5 projects and detect any changes after the projects. In addition to the ESF projects in Finland, the Abilitator has been used in research and in employment, health, and social services to support primary-level decision-making when large numbers of clients meet professionals with various occupational backgrounds.

The Abilitator contains 84 items under nine domains (sections): “A. Personal details”, “B. Well-being”, “C. Inclusion”, “D. Mind”, “E. Everyday life”, “F. Skills”, “G. Body”, “H. Background information”, and “I. Work and the Future”. Each section contains 4–14 items. The measure of  each of the five reported sections C, D, E, F, and G is a summary scale, transformed into a score of 0% to 100% of the selected items . Qualitative data is gathered from all the questions in sections A, H, I, and in separate questions of C9-C13, F4, G2, G3, G8, G9-G12. These questions are valuable for the respondents to reflect on, but they also provide useful additional information on the respondents’ situation for the service professional.

In this study, we examined the structural components of the summary scales formed from sections C, D, E, F, and G, which contain the dimensions of social functioning and participation, psychological functioning, managing in everyday life, cognitive functioning and basic skills, and physical functioning, respectively. The “Overall situation” score, which is the mean of the sums obtained from these five summary scales, was not included in the analysis. There are no limit values for this score and the obtained data is mainly used to monitor change in the respondent’s overall situation. Also, sections A, H, and I were excluded from the analysis since they were developed to provide background information and do not form a summary scale. Even though the Abilitator is available in 10 different languages, in this study we only examined the original Finnish version.

The entire Abilitator data (n=54464) has been collected in various services and projects aimed mainly for the unemployed.  To ensure that the participants in this study were in a weak labour market position the data sample utilized (n=4555) was collected by FIOH in cooperation only with the European Social Fund Priority 5 projects in 01.10.2017–31.12.2022. Each project (n=150) gave written consent to FIOH to use their Abilitator data in an anonymous format in its research. All the Abilitator respondents in the data were participants in  ESF Priority 5 projects which aim to improve the work ability and functioning of people not in employment to help them proceed on employment paths and to strengthen social inclusion. In each project the participants took part in activities such as cooking, gardening, social interaction, light physical activity, and rehabilitative work tasks. All the respondents of the Abilitator were adults and had been given written information in advance about the Abilitator’s purpose, data security, the possible later research use of the data in anonymous format, and the voluntary nature of answering the questionnaire. They had also all consented to this by responding to the Abilitator questionnaire.  The respondents could choose whether to answer the questionnaire online via the Abilitator online service or in a paper format. In the latter case, the staff of each ESF project transferred the answers to the Abilitator online service with the permission of the respondent.

The data does not include the variable for the identification of specific ESF projects, which is used for clustering the participants in the analyses of the study related to this data. In addition, the data does not include any demographics such as the participants age, sex, or duration of unemployment. Therefore, the analyses cannot be replicated identically to the original study. In questions concerning data availability from more information is available at: Data permits for datasets of the Finnish Institute of Occupational Health | Finnish Institute of Occupational Health (ttl.fi)