Cultural and linguistic validation of the NHQ-2 Questionnaire: a specific instrument for assessing patient’s usability of inhalation devices

Abstract

BackgroundAn increasing number of inhalation devices are presently available in the market. They are differently characterized in terms of their handling and usability, both factors which may affect the outcomes of respiratory treatment.The assessment of the preference and the usability rate of all devices can be carried out by means of specific questionnaires. Before their use, the identification of errors due to the incorrect wording of questions included in the questionnaires, together with the trans-cultural reliability represents the main issues of their cultural and linguistic validation.Methods and resultsThe New Handling Questionnaire - NHQ-2 is a novel specific questionnaire aimed to measure both the preference and the usability of all kinds of inhalation devices. The method used for its validation has been summarized in the first section of the present paper, while the results of the specific validation and translation process have been described in the second section, together with the grading of improvement achieved over the process. The comprehensibility and the reproducibility rates achieved for both the Italian and the English final versions of the NHQ-2 questionnaire were very high, such as >90 % for each question included.ConclusionsThe novel NHQ-2 questionnaire proved very high comprehensibility and reproducibility in both its Italian and English final versions. It can be proposed for the trans-cultural clinical use when the usability, and not only the patients’ preference of devices, should be assessed.Electronic supplementary materialThe online version of this article (doi:10.1186/s40248-016-0067-y) contains supplementary material, which is available to authorized users.

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“…A questionnaire is a widely used, simple, and cheap instrument for research concerning both speci c and generic populations' behaviors, attitudes, and beliefs, and it is crucial that the speci c questionnaire is constructed to produce valid and trustworthy results. The validity of questionnaires in terms of the comprehension of its questions, and the repeatability of the responses, might still be challenged (22). Rigorous (statistical) validation of questionnaires has been recommended for decades, and the inclusion of content validity and cross-cultural adaptation has been internationally recommended and acknowledged at least since the description of the COSMIN guidelines in 2010 (23) .…”

“…Considering the central signi cance of truthfulness in communication (22,23), a likely course of action would be for the respondent to decide his/her answer by choosing the option that he/she considers closest to the truth. In that case, he/she would be observing the rst maxim of Quality to the highest extent possible, given their circumstances.…”

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“…Nevertheless, even if inhalers can differently affect per sé the therapeutic outcomes independently of the drug used, their choice is frequently empiric in real life, and the reasons for possible differences in their performance is often underestimated or neglected in real life [14,21,22].…”