Health Research Methods, Evidence, and Impact

Elizabeth Juniper

MSc (McMaster)

Professor Emeritus, Department of Health Research Methods, Evidence, and Impact


Measurement of Health-Related Quality of Life





Liz trained as a physiotherapist in London and later, while at the Royal Postgraduate Medical School, took a degree in Medical Physics and Physiological Measurement. In 1973, she emigrated to McMaster University in Canada. After four years in exercise physiology and control of breathing research, she moved to asthma and rhinitis research. Over the next decade, she was the first author of a number of classic methods papers on the measurement of airway hyperresponsiveness and she designed, conducted and published a large number of clinical trials both in asthma and rhinoconjunctivitis. 

In 1989 she joined the faculty in the Department of Clinical Epidemiology and Biostatistics at McMaster University and her interests turned to the newly developing area of the assessment of health-related quality of life (HRQL). She has developed and validated disease-specific instruments for adults and children with asthma, and for adults, adolescents and children with rhinoconjunctivitis. The Asthma Quality of Life Questionnaire alone has been translated into more than 90 languages and her questionnaires are being used worldwide both in clinical trials and clinical practice. Her Asthma Control Questionnaire (over 80 languages) is advocated for use in clinical practice by international guidelines.  She has developed a number of new technologies in the health measurement field, has published 3 books, 16 book chapters and is the author of more than 120 papers in peer-reviewed journals. She has established an international reputation for developing methods for measuring health status and interpreting the results and is a consultant to many groups wishing to develop their own instruments. In 2000, she ‘retired’ from McMaster and returned to her home in Bosham, on the south coast of England, where she has a small office and continues her work on questionnaire development, validation and distribution. She is currently working on the methods for adapting and validating health status questionnaires for electronic data capture  by a range of different devices and the internet.

Selected Publications

  1. Juniper EF, Daniel EE, Roberts RS, Kline PA, Hargreave FE, Newhouse MT. Improvement in airway responsiveness and asthma severity during pregnancy..  Am Rev Respir Dis 1989; 140: 924-31.
  2. Juniper EF, Kline PA, Vanzeileghem MA, Ramsdale EH, O'Byrne PM, Hargreave FE.  Effect of long-term treatment with an inhaled corticostero­id (budesonide) on airway hyper­responsiveness and clinical asthma in nonsteroid-dependent asthmatics.  Am Rev Respir Dis 1990; 142: 832-836.
  3. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE.  Measuring quality of life in asthma.  Am Rev Respir Dis 1993; 147: 832-838.
  4. Juniper EF, Guyatt GH, Willan A, Griffith LE.  Determining a minimal important change in a disease-specific quality of life instrument.  J Clin Epidemiol 1994; 47: 81-87.
  5. Juniper EF, O’Byrne PM, Guyatt GH, Ferrie PJ, King DR.  Development and validation of a questionnaire to measure asthma control. Eur Respir J 1999; 14: 902-7.
  6. Juniper EF, Wisniewski ME, Cox FM, Emmett AH, Nielsen KE, O’Byrne PM.  Relationship between quality of life and measures of clinical status in asthma: a factor analysis.  Eur Respir J 2004; 23: 287-291.
  7. Juniper EF, Bousquet J, Abetz L, Bateman ED. Identifying ‘well-controlled’ and ‘not well-controlled’ asthma using the Asthma Control Questionnaire.  Respir Med 2006; 100: 616- 621.
  8. Juniper EF, Langlands JM, Juniper BA.  Patients may respond differently to paper and electronic versions of the same questionnaires.  Respir Med 2009; 103: 932-4.
  9. Juniper EF. Medical questionnaires are copyrighted to ensure that validity is maintained. Chest 2009; 136:951-952. (Editorial)
  10. Juniper EF. Validated questionnaires should not be modified. Eur Respir J 2009; 34: 1015 - 1017. (Editorial)

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