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Background  Self-reported outcome instruments in health research have become increasingly important over the last decades. Occupational therapy interventions often focus on occupational balance. However, instruments to measure occupational balance are scarce. The aim of the study was therefore to develop a generic self-reported outcome instrument to assess occupational balance based on the experiences of patients and healthy people including an examination of its psychometric properties.    Methods  We conducted a qualitative analysis of the life stories of 90 people with and without chronic autoimmune diseases to identify components of occupational balance. Based on these components, the  Occupational Balance-Questionnaire  ( OB-Quest ) was developed. Construct validity and internal consistency of the  OB-Quest  were examined in quantitative data. We used Rasch analyses to determine overall fit of the items to the Rasch model, person separation index and potential differential item functioning. Dimensionality testing was conducted by the use of t-tests and Cronbach’s alpha.    Results  The following components emerged from the qualitative analyses:  challenging and relaxing activities ,  activities with acknowledgement by the individual and by the sociocultural context ,  impact of health condition on activities ,  involvement in stressful activities and fewer stressing activities ,  rest and sleep ,  variety of activities ,  adaptation of activities according to changed living conditions  and  activities intended to care for oneself and for others . Based on these, the seven items of the questionnaire (OB-Quest) were developed. 251 people (132 with rheumatoid arthritis, 43 with systematic lupus erythematous and 76 healthy) filled in the  OB-Quest . Dimensionality testing indicated multidimensionality of the questionnaire (t = 0.58, and 1.66 after item reduction, non-significant). The item on the component  rest and sleep  showed differential item functioning (health condition and age). Person separation index was 0.51. Cronbach’s alpha changed from 0.38 to 0.57 after deleting two items.    Conclusions  This questionnaire includes new items addressing components of occupational balance meaningful to patients and healthy people which have not been measured so far. The reduction of two items of the  OB-Quest  showed improved internal consistency. The multidimensionality of the questionnaire indicates the need for a summary of several components into subscales.

health and quality of life outcomes

Development of a new occupational balance-questionnaire: incorporating the perspectives of patients and healthy people in the design of a self-reported occupational balance outcome instrument