Development of a ‘universal-reporter’ outcome measure (UROM) for patient and healthcare professional completion: a mixed methods study demonstrating a novel concept for optimal questionnaire design

Abstract

ObjectivesTo describe the novel concept of, and methods for developing, a ‘universal-reporter’ outcome measure (UROM); a single questionnaire for completion by patients and/or healthcare professionals (HCPs) when views on the same subject are required.DesignA mixed methods study with three phases—phase I: identification of relevant content domains from existing clinical tools, patient questionnaires and in-depth interviews with multistakeholders; phase II: item development using a novel approach that considered plain language in conjunction with medical terminology; and phase III: pretesting with multistakeholders using cognitive interviews.SettingA case study in surgical wound assessment undertaken in two UK hospital trusts and one university setting.ParticipantsPatients who had recently undergone general abdominal surgery and healthcare professionals involved in post-surgical wound care.ResultsPhase I: In the example case study, 19 relevant content domains were identified from two clinical tools, two patient questionnaires and 19 multistakeholder interviews (nine patients, 10 HCPs). Phase II: Domains were operationalised into items and subitems (secondary components to collect further information, if relevant). The version after pretesting had 16 items, five of which included further subitems. Plain language in conjunction with medical terminology was applicable in nine (27%) items/subitems. Phase III: Pretesting with 28 patients and 14 HCPs found that the UROM was acceptable to both respondent groups. An unanticipated secondary finding of the study was that the combined use of plain language and medical terminology during questionnaire development may be a useful, novel technique for evaluating item interpretation and thereby identifying items with inadequate content validity.ConclusionUROMs are a novel approach to outcome assessment that are acceptable to both patients and HCPs. Combining plain language and medical terminology during item development is a recommended technique to improve accuracy of item interpretation and content validity during questionnaire design. More work is needed to further validate this novel approach and explore the application of UROMs to other settings.

Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries

“…The WHQ was originally developed and validated in the UK (English language) to assess post-discharge infections after abdominal surgery 22 , 23 . The WHQ was designed to be completed either by healthcare professionals or patients 24 , and, as such, has been described as a ‘universal-reporter’ outcome measure (‘UROM’) 25 . In a UK validation study, the WHQ demonstrated good reliability and high sensitivity and specificity when discriminating between SSI and no SSI in comparison with an in-person US CDC assessment 22 , 23 .…”

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

“…The WHQ includes 19 items (18 items and 1 subitem) related to the construct of surgical wound healing, with 11 items (10 items and 1 conditional subitem) related to symptoms of SSI, and 8 items related to interaction with the treatment pathway for SSI. It was designed so that it could either be administered by a healthcare professional, or self-reported by patients 27 (a universal-reporter outcome measure 28 ). Two developers of the WHQ were collaborating members of the Study Management Group.…”

Willingness to use acupuncture: Knowledge, attitudes, beliefs, and practices among allergic rhinitis patients

“…We designed a questionnaire based on a literature review. [24][25][26][27][28][29][30][31][32][33] We applied knowledge, attitudes, beliefs, and practices (KABP) theory, which holds that changes in human behavior involve 3 consecutive processes: acquiring knowledge, generating belief, and forming behavior. [34,35] Therefore, 3 consecutive elements constituted the main body of the questionnaire:…”