Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries

作者：Nirali M. Chakraborty, Kenzo Fry, Rasika Behl, Kim Longfield · 发表于：Global Health Science and Practice · 年份：2016 · DOI：10.9745/ghsp-d-15-00384 · 被引用次数：139 · 研究领域：Innovation and Socioeconomic Development、Community Development and Social Impact、Public-Private Partnership Projects

BACKGROUND: Social franchising programs in low- and middle-income countries have tried using the standard wealth index, based on the Demographic and Health Survey (DHS) questionnaire, in client exit interviews to assess clients' relative wealth compared with the national wealth distribution to ensure equity in service delivery. The large number of survey questions required to capture the wealth index variables have proved cumbersome for programs. METHODS: Using an adaptation of the Delphi method, we developed shortened wealth indices and in February 2015 consulted 15 stakeholders in equity measurement. Together, we selected the best of 5 alternative indices, accompanied by 2 measures of agreement (percent agreement and Cohen's kappa statistic) comparing wealth quintile assignment in the new indices to the full DHS index. The panel agreed that reducing the number of assets was more important than standardization across countries because a short index would provide strong indication of client wealth and be easier to collect and use in the field. Additionally, the panel agreed that the simplified index should be highly correlated with the DHS for each country (kappa ≥ 0.75) for both national and urban-specific samples. We then revised indices for 16 countries and selected the minimum number of questions and question options required to achieve a kappa statistic ≥ 0.75 for both national and urban populations. FINDINGS: After combining the 5 wealth quintiles into 3 groups, which t...