What is howRU?
What is howRU
howRU is a short generic tool for measuring patient-reported outcomes (health status) in terms of how you feel physically and mentally, and how much you can do in terms of loss of function and dependence. It is quick and easy to use in routine clinical care and to deliver feedback to patients, clinicians, managers and payers.
The name, howRU, stems from the core question “How are you today?”. We define today as being the previous 24 hours, to cover patients whose condition changes with the time of day or is worse at night.
The howRU questionnaire has four items:
- Pain or discomfort, which relates to physical symptoms and comfort-discomfort
- Feeling low or worried, which relates to emotional symptoms and wellbeing-distress
- Limited in what you can do, which relates to work, home and leisure activities and capability-disability
- Require help from others, which relates to lack of autonomy, activities of daily living an independence-dependence.
The severity of each howRU item is rated using four levels:
- A little
- Quite a lot
Each level is indicated in mutually supporting ways to minimise cognitive effort and reduce the need for training (not all of these need to be used):
- Written labels: None, A little, Quite a lot, Extreme
- Colour: green, yellow, orange and red
- Position: increasing in severity from left to right or top to bottom
- Pictographs based on smiley faces
The combination of four items with four levels each creates a 4x4 matrix with 256 (44) different combinations. This classification is generic (not condition-specific) and can be used by almost all types of patients and citizens, and in all health settings.
The scoring system is a summative score in which a higher score indicates better health. For analysis and reporting, each level is allocated a score on a 0-3 ordinal scale with low being bad and good being a high:
- None = 3
- A little = 2
- Quite a lot = 1
- Extreme = 0
The howRU Score for an individual subject is calculated by adding the scores for each item, giving a range from the floor, 0 (4 x Extreme), to the ceiling, 12 (4 x None). This scoring system is similar to that used by the Apgar, Glasgow Coma and Oxford Hip and Knee scores.
For the populations, we transform the individual scores, for each item into an index score on a 0-100 scale. We use the following population indices:
- Comfort Index for Pain and discomfort
- Wellbeing Index for Feeling low or worried
- Capability Index for Limited in what you can do
- Independence Index for Need help from others
- howRU Index for summative howRU Score
howRU and its scoring schemes are easy to understand and are transparent. Unlike more complex scoring schemes, such as those based on utility estimation (such as EQ-5D) or normal distributions (such as SF-36), the impact of changing a single rating from one level to the next always has the same impact on the overall score. The resulting scale has ordinal properties.
Benson T, Sizmur S, Whatling J, Arikan S, McDonald D, Ingram D. Evaluation of a new short generic measure of health status: howRu. Informatics in Primary Care 2010 Vol 18 No 2, 89-101. Free Full Text Download