Comparative study of pencil-and-paper and electronic formats of GHQ-12, WHO-5 and PHQ-9 questionnaires.

INTRODUCTION: The increase in telemedicine in the mental health field has led to psychometric instruments changing from paper-and-pencil administration to an electronic format. A study is performed to determine if both formats are equivalent for well-known questionnaires such as GHQ-12, WHO-5, and PHQ-9.

MATERIAL AND METHODS: Forty-seven volunteers completed GHQ-12, WHO-5 and PHQ-9 questionnaires in paper-and-pencil format, and in the following 24h they completed their electronic versions via the web site www.memind.net. An electronic-Likert format was used by 24 participants, and 23 used an electronic-slider format. Internal consistency was measured by α-Cronbach index and omega coefficient, and test-retest was measured by the intraclass correlation coefficient (ICC). Agreement between individual items was compared using Weighted Kappa coefficients, and dimensional structure between formats using the Comparative Fit Index (CFI).

RESULTS: Internal consistency was higher than 0.8 for GHQ-12 and WHO-5. The ICC ranged between 0.655 for PHQ-9 paper-and-pencil/electronic-slider and 0.901 for GHQ-12 paper-and-pencil/electronic- slider. Agreement for individual items in paper-and-pencil and electronic-Likert versions was variable, ranging from low agreement in PHQ-1 (weighted κ=0.143; P=.384) to high agreement in PHQ-5 (weighted κ=0.769; P=.000). The CFI results showed an adequate equivalence between formats.

CONCLUSIONS: Except for the PHQ-9 electronic-Likert, questionnaires keep their structure in electronic formats. Discrepancies were found in items agreement. This study supports previous works indicating that the change from paper-and-pencil to electronic formats is not an immediate process, and needs a proper adaptation.