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PubMed2000

Management of the nontoxic multinodular goitre: a European questionnaire study.

BACKGROUND AND OBJECTIVE: The optimum management strategy for the patient with a multinodular nontoxic goitre is still a matter of debate. Our aim was to assess the attitudes towards management of such patients throughout Europe by means of a questionnaire. DESIGN: The questionnaire was circulated to all clinician members of the European Thyroid Association (ETA). A case report was followed by diagnostic investigations and choice of therapy in the index case (a 42-year-old woman with an irregular nontender bilaterally enlarged thyroid of 50-80 g and no clinical suspicion of malignancy). Eleven variations of the basic case report were proposed in order to evaluate the impact on management of each alteration. SUBJECTS AND METHODS: One hundred and sixty-seven members replied to the letter, and 120 individuals from 22 countries completed the questionnaire (corresponding to approximately two-thirds of the clinical members of the ETA). RESULTS: Based on the index case, serum TSH was the routine choice of 100%, and serum free T4/T4-index was included by 74%. Serum TPO autoantibodies, Tg autoantibodies and calcitonin were measured by 65%, 49% and 32%, respectively. The median number of blood tests used was four (range 1-11). Considerable intercountry variations were seen in the preferred imaging methods. Ninety-one percent of the clinicians would use at least one imaging modality. Ultrasound (US) was used by 84%, thyroid scintigraphy by 76%, and both methods by 69%. US had first priority (53% vs. 19% for scintigraphy). If scintigraphy was performed, fine-needle aspiration cytology was routinely used by 17% (inhomogeneous uptake) and 95% (dominant 'cold' area), and 63% used US-guidance. L-T4 treatment was supported by 52% of the clinicians, iodine supplementation by 4%, radioiodine by 6% and surgery by 10%. In the case of a suppressed serum TSH, radioiodine treatment was preferred by 44%, while surgery was the favoured recommendation in four clinical variations with a large goitre or suspicion of malignancy. Marked differences between the countries were suggested by L-T4 therapy being the dominant treatment in Italy, France and Germany in contrast to the prevailing use of radioiodine in Denmark and a wait and see policy in the UK. CONCLUSIONS: Fundamental differences between European countries exist as regards diagnosis and treatment of the multinodular nontoxic goitre suggesting difficulties in reaching a consensus.

Biomarkers↗
PubMed1990

Sociodemographic and motivational characteristics of parents who volunteer their children for clinical research: a controlled study.

OBJECTIVE: To determine the sociodemographic and motivational characteristics of parents who volunteer their children for clinical research. DESIGN: A questionnaire was administered to parents who volunteered their children for a randomised, double blind, placebo controlled trial of a drug to treat asthma and to a control group of parents whose children were eligible for the trial but had refused the invitation. SETTING: A children's hospital in Australia. SUBJECTS: 68 Parents who had volunteered their children and 42 who had not; a response rate of 94% and 70%, respectively. MAIN OUTCOME MEASURES: Responses of parents to questionnaire designed to assess their perceptions, attitudes, and health seeking behaviour as well as sociodemographic data. RESULTS: Volunteering parents were less well educated with only 15% (10/68) of mothers and 16% (11/68) and of fathers having had a tertiary or university education compared with 26% (11/42) of mothers and 45% (19/42) in the non-volunteering group. Fewer volunteering parents had professional or administrative jobs than did non-volunteering parents (mothers 6% (4/68); fathers 9% (6/68) v mothers 14% (6/42); fathers 31% (13/42)). Volunteering parents had less social support, and they displayed greater health seeking behaviour and consumed more habit forming substances. They were motivated by a desire to help others and to contribute to medical research, but they were also searching for more information and better ways to help their own children. CONCLUSION: Parents who volunteer their children for medical research are significantly more socially disadvantaged and emotionally vulnerable.

Adult↗
PubMed1993

Safe sex? Misconceptions, gender differences and barriers among injection drug users: a focus group approach.

Heterosexual transmission is one factor involved in the spread of the human immunodeficiency virus (HIV) within the injection drug use (IDU) population and between IDU and non-IDU individuals. Insufficient information is currently available to reduce this heterosexual transmission. As a basis for designing a questionnaire aimed at the IDU population, we conducted 5 focus groups to collect information on knowledge of and attitudes toward safe sex as held by male and female IDUs in methadone treatment. We identified misconceptions related to HIV infection, condoms, and sexual behavior. We also found gender-based differences in knowledge and learning style. Also, while individuals felt a responsibility to prevent HIV transmission, they lacked sufficient control to do so. The wide range of responses on questions concerning sexually transmitted diseases (STDs), condoms, reproductive decisions, and methods of promoting safe sex provides a basis for developing a questionnaire designed to identify and target specific subgroups for educational intervention.

Adult↗
PubMed1984

Assessment of change-agent expectations in reversal-to-baseline designs.

Questionnaires similar to those used in previous research to assess behavioral expectations produced by differing reversal-to-baseline rationales were presented to 160 male and female parents in rural South Dakota. Given two case histories, respondents were asked to predict, as simulated change agents, the frequency of problem behavior during reversal in an ABAB design intervention. The five rationales for reversal were: (a) withdrawal, (b) withdrawal and counter-expectancy, (c) problem switch and counter-expectancy, (d) fade and counter-expectancy and (e) inert treatment and counter-expectancy. While obtained means were close to those of a previous study, there were no significant sex or treatment effects. This fails to confirm the earlier results obtained from university undergraduates. Implications for internal validity of ABAB designs are discussed.

Adult↗
PubMed2005

A new questionnaire specifically designed for patients affected by chronic obstructive pulmonary disease; The Italian Health Status Questionnaire.

The aim of this study was to develop a specific and valid questionnaire for Italian COPD patients, living on the north or the south of Italy-which are two culturally distinct areas. The project consisted in three steps: (1) initial item set generation to identify items relevant to both genders, all ages and both regions; (2) item reduction including tests of regional specificity; (3) tests of internal validity using item-response theory using Rasch one-parameter modelling. Ninty-six COPD patients (mean aged 69 yr; 78 Male) completed the original set of 124 items of the Italian Health Status Questionnaire (IHSQ). Item reduction was carried out using an established standardised approach employing classical psychometric test theory. The internal construct validity of the 47 items that survived this process were tested to determine whether they constituted a unidimensional construct "impaired health due to COPD" using Rasch analysis. This showed that the questionnaire had very good psychometric properties, with an excellent Person Separation Index of 0.95 and no evidence of bias due to item-trait interaction (chi104(2)=127.1, P=n.s.). The combination of classical test theory and modern item-response methodology has produced a questionnaire with excellent measurement properties suitable for COPD patients whether from the north or south of Italy.

Adult↗
PubMed1985

Developing effective questionnaires.

Many research questions are effectively answered by collecting data about the opinions, beliefs, and perceptions of large numbers of persons in widely dispersed areas. The questionnaire is an economical means of gathering such information. Properly designed questionnaires can collect valid and reliable data for analyzing a research problem. This article reviews fundamental principles of questionnaire design and presents a matrix to guide the construction of a questionnaire. Methods to avoid common problems and pitfalls in developing a questionnaire are also presented. Field testing is recommended to ensure validity and reliability.

Data Collection↗
PubMed2002

Validation of an instrument to assess patient attitudes towards prescribing of pharmaceuticals by doctors.

OBJECTIVES: To establish the reliability and validity of a questionnaire designed to assess Chinese patients' attitudes towards pharmaceuticals that may influence the prescribing behaviours of their doctors. STUDY DESIGN: A draft questionnaire of 48 items was designed in English, translated into Chinese, and then back-translated into English. After establishing for content and face validity, it was administered to a convenience sample of patients. Responses were factor analysed to establish construct validity and to reduce the questionnaire's length. POPULATION: Hong Kong Chinese patients (n = 387) who visited one of 24 primary care doctors. OUTCOMES MEASURED: Derived factor score means were compared among various age, gender and education groupings. RESULTS: A final 21-item questionnaire was produced. Spearman's rank correlations indicated the instrument was relatively stable over repeated applications. Patients' attitudes were found to be multidimensional. The three-factor solution achieved a simple structure and accounted for 40% of the variance among the 21 items. Items loading heavily on each construct were internally consistent. Nine items measured patients' attitudes towards careful use of medications. Six questions measured a preference for information exchanges between patients and doctors. Six items measured patients' scepticism concerning the need for pharmaceuticals to hasten recovery from most illnesses. The three factors yielded factor score means that discriminated among the patients as expected. CONCLUSIONS: The questionnaire met adequate standards for reliability and validity. It is suitable for further use in investigating Chinese patients' attitudes concerning pharmaceuticals and how these attitudes might influence their physicians' prescribing behaviours.

Adolescent↗
PubMed2006

[Pediatric disability of the upper extremity and quality of life questionnaire: reliability, validity, and sensitivity to change].

OBJECTIVE: The aim of this study was to develop a specific questionnaire, designed to evaluate health-related quality of life of children and adolescents with congenital or acquired anomalies of the upper extremity. MATERIAL AND METHODS: Children who underwent operative or conservative treatment of the upper extremity at Kaunas University of Medicine Hospital and Kaunas Red Cross Hospital or conservative treatment at Kaunas Sanatorium "Zibute" and Druskininkai Sanatorium "Saulute" participated in the study. A total of 99 parents and 56 adolescents with congenital or acquired anomalies of the upper extremity filled out the questionnaires. The data were analyzed by the program SPSS 12.0.1 for Windows. RESULTS: Two versions of questionnaire were developed: one for parents of children and adolescents aged 5-18 years and another - for adolescents aged 11-18 years. Both versions consist of seven scales: self-care, daily activities, sports activities and hobby, self-image, emotional, social health, and patient's satisfaction with treatment. The testing of questionnaire reliability was performed by estimating a Cronbach alfa coefficient which varied from 0.80 to 0.97 for different scales of questionnaire designed for parents. The item-scale correlation was from 0.44 to 0.89. There was a statistically significant difference among separate items for all scales (p<0.001). The intraclass correlation coefficient ranged from 0.84 to 0.89 for all scales. Cronbach alfa coefficients of scales of questionnaire designed for children varied from 0.83 to 0.95, and item-scale correlation was moderate to strong. A statistically significant difference among separate items for all scales was obtained (p<0.001). The intraclass correlation coefficient varied from 0.79 to 0.86. The Pearson's correlation coefficient between questionnaires developed for parents and children was calculated, and strong correlation between corresponding scales was found. Sensitivity to changes was tested, and t-test was performed. A statistically significant difference in all scales was found (p<0.001).

Adolescent↗
PubMed1979

Techniques to increase the response rate in follow-up studies: results of a pilot test.

As a part of the design and implementation of a caseload weighting system, Arkansas Rehabilitation Services is adopting a revised client data system. To assess the validity of the data collected in the new system a follow-up survey for recently closed clients has been designed; and to insure the adequacy of the survey design several issues were considered. These included overall survey and questionnaire design. The process, designed to maximize useful information collected with limited resources, resulted in a telephone survey augmented by mail and personal interviews. The survey procedures and instrumentation were pilot tested for two months with 629 clients. This resulted in major modifications in questionnaire design and brought to light easily adopted procedural improvements resulting in less ambiguity, improved readibility, increased response rate and reduced response bias. Using the described survey methods the investigators observed an overall response rate of 50.8% which compares very favorably with that reported in other studies similar in nature.

Arkansas↗
PubMed2002

Increasing response rates to postal questionnaires: systematic review.

OBJECTIVE: To identify methods to increase response to postal questionnaires. DESIGN: Systematic review of randomised controlled trials of any method to influence response to postal questionnaires. STUDIES REVIEWED: 292 randomised controlled trials including 258 315 participants INTERVENTION REVIEWED: 75 strategies for influencing response to postal questionnaires. MAIN OUTCOME MEASURE: The proportion of completed or partially completed questionnaires returned. RESULTS: The odds of response were more than doubled when a monetary incentive was used (odds ratio 2.02; 95% confidence interval 1.79 to 2.27) and almost doubled when incentives were not conditional on response (1.71; 1.29 to 2.26). Response was more likely when short questionnaires were used (1.86; 1.55 to 2.24). Personalised questionnaires and letters increased response (1.16; 1.06 to 1.28), as did the use of coloured ink (1.39; 1.16 to 1.67). The odds of response were more than doubled when the questionnaires were sent by recorded delivery (2.21; 1.51 to 3.25) and increased when stamped return envelopes were used (1.26; 1.13 to 1.41) and questionnaires were sent by first class post (1.12; 1.02 to 1.23). Contacting participants before sending questionnaires increased response (1.54; 1.24 to 1.92), as did follow up contact (1.44; 1.22 to 1.70) and providing non-respondents with a second copy of the questionnaire (1.41; 1.02 to 1.94). Questionnaires designed to be of more interest to participants were more likely to be returned (2.44; 1.99 to 3.01), but questionnaires containing questions of a sensitive nature were less likely to be returned (0.92; 0.87 to 0.98). Questionnaires originating from universities were more likely to be returned than were questionnaires from other sources, such as commercial organisations (1.31; 1.11 to 1.54). CONCLUSIONS: Health researchers using postal questionnaires can improve the quality of their research by using the strategies shown to be effective in this systematic review.

Data Collection↗
PubMed1991

Why are we weighting? A critical examination of the use of item weights in a health status measure.

There is currently much interest in the measurement of self reported health status. A number of health status measures have been designed. However, such questionnaires are often long and complicated, or are disease specific. The most famous generic British health status instrument is the Nottingham Health Profile (NHP) which is a short questionnaire designed for ease of completion. However, this paper addresses a number of related issues concerning the weights attached to particular items on this questionnaire. It is argued that the weighting of items by Thurstone's method of paired comparisons is inappropriate and can lead to logically inconsistent results.

Health Status Indicators↗
PubMed2002

Delphi type methodology to develop consensus on the future design of EMS systems in the United Kingdom.

OBJECTIVE: To develop consensus opinion on future design characteristics of Emergency Medical Services (EMS) systems in the UK with particular regard to advanced life support skills (ALS). DESIGN: A Delphi questionnaire design with two rounds to gain a consensus of opinion. Investigation of four aspects of EMS design is reported-type of response to a priority based dispatch category, transportation options, enhancement of paramedic skills, and structure of a first responder system. SUBJECTS: Chief executives, directors of operations, and medical directors of Ambulance Trusts in the United Kingdom. OUTCOME MEASURES: Likert scales (0-9) to score opinion on a series of statements with achievement of inter-round consistency. A median score of 0-4 was classified as disagreement and 6-9 as agreement. RESULTS: A 65% response to the first questionnaire and with iteration, 52% response to the second questionnaire was attained. A tiered response (paramedics, technicians, and basic life support first responders) with technicians responding to selected category A and B calls and all category C calls (median score (MS) 7.5, interquartile range (IQR) 4), was recommended. Inter-unit handover of selected calls to maintain paramedic availablity ( MS 7.5, IQR 3.75) and enhancement of paramedic skills (MS 7.0, IQR 4.0) was also proposed. Finally, the development of a first responder system fully integrated into the EMS (MS 8.0, IQR 2.75) involving other agencies including the police force, fire service, and trained members of the local community was agreed. CONCLUSIONS: Senior expert staff from Ambulance Trusts in the UK achieved consensus on certain design characteristics of EMS systems. These are significantly different from the present EMS model.

Administrative Personnel↗
PubMed2006

Measuring safety climate in health care.

AIM: To review quantitative studies of safety climate in health care to examine the psychometric properties of the questionnaires designed to measure this construct. METHOD: A systematic literature review was undertaken to study sample and questionnaire design characteristics (source, no of items, scale type), construct validity (content validity, factor structure and internal reliability, concurrent validity), within group agreement, and level of analysis. RESULTS: Twelve studies were examined. There was a lack of explicit theoretical underpinning for most questionnaires and some instruments did not report standard psychometric criteria. Where this information was available, several questionnaires appeared to have limitations. CONCLUSIONS: More consideration should be given to psychometric factors in the design of healthcare safety climate instruments, especially as these are beginning to be used in large scale surveys across healthcare organisations.

Attitude of Health Personnel↗
PubMed2006

Factors related to truth-telling practice of physicians treating patients with cancer in Turkey.

BACKGROUND: In the practice of oncology, effective communication between physician and patient is very important. Although many studies have indicated that a large majority of physicians, especially from Western countries, tell the truth about diagnosis and prognosis, little is known about attitudes of physicians in Turkey toward truth-telling. OBJECTIVE: In this study, we tried to determine the truth-telling practice of physicians and explore potential related factors with a self-reported questionnaire. DESIGN: Using a questionnaire, 131 cancer specialists were interviewed during the 15th National Oncology Meeting in April 2003. RESULTS: The percentage of physicians who never, rarely, generally, and always prefer truthtelling about a cancer diagnosis were 9%, 39%, 45%, and 7%, respectively. In univariate logistic regression analysis for the truth-telling practice, significant variables included "do not tell" requests from family, experiences from medical training and clinical practice, and medical specialty. In the multivariate analysis, "do not tell" requests from relatives and medical training factors retained their significance. CONCLUSION: Professional training in breaking bad news is important and is associated with the self-reported truth-telling practices of physicians.

Female↗
PubMed2005

Attitudes and predictive factors for live kidney donation: a comparison of live kidney donors versus nondonors.

BACKGROUND: Live donor kidney transplantation (LDKT), although far from risk free, is a reasonably safe procedure for medically suitable donors. We hypothesized that both potential recipients and donors have identifiable and modifiable factors that contribute to the likelihood of LDKT. The objectives of this study were to describe and quantify these factors using anonymous, confidential questionnaires. METHODS: Specifically designed questionnaires addressing personal characteristics, knowledge, and beliefs about LDKT were mailed to 127 previous donors and 387 relatives of patients newly listed on the cadaver transplant wait-list. Ninety-eight (77%) and 243 (63%) responses were returned by donors and nondonors, respectively. RESULTS: There were significant differences between groups in gender, ethnicity, hours worked per week, and annual income. Significant differences were seen in both knowledge and beliefs about LDKT. Most donors indicated they made their decisions without lengthy deliberation or research about kidney donation. Only 20% of nondonors feel they are well informed about LDKT. CONCLUSION: It is likely possible to improve knowledge about LDKT among friends and relations of patients with renal failure, but it is not certain that this will lead to increased donation because most donors don't appear to deliberate or research organ donation before making a commitment to donate. Strategies to educate potential donors should initially focus on the recipient.

Adult↗
PubMed2005

The Child Dental Control Assessment (CDCA) in youth: reliability, validity and cross-cultural differences.

AIM: The Child Dental Control Assessment (CDCA) measures children's preferred control strategies in the dental situation. Three studies are reported, assessing aspects of this instrument in youths from the USA, Japan and Australia. In particular, measurements were made as to the reliability and validity of this instrument in this age group in the three cultures, as well as comparing some results across cultures. STUDY DESIGN: These studies used a questionnaire design. METHODS: Questionnaires (including the CDCA and other measures) were given to youths aged 11-15 in the three cultures. In one culture, youths received the questionnaire twice, to compute test-retest reliability. RESULTS: The measure's reliability and validity were similar to those of other measures. The CDCA behaves similarly to the Revised Iowa Dental Control Index (R-IDCI). Youths in all three cultures showed similar responses, although the Japanese were less likely to endorse items. STATISTICS: Internal reliability of the scale ranged from 0.74 to 0.85. Test- retest reliability was 0.74. Participants in the High Desire/Low Predicted classification on the R-IDCI scored higher on the CDCA (t (73) = 2.9, p < .01). In the Japanese and Australian samples the correlation between CDCA and dental fear was 0.29-0.33 (p < .001). The Australian and USA samples scored significantly higher than the Japanese sample (overall F(2,1544) = 383.98, p < .001, followed by Tukey's HSD, p < .001). CONCLUSIONS: These results provide evidence for the reliability and validity of the CDCA in youth. It appears to measure the discrepancy between Desired and Predicted Control identified in the Revised Iowa Dental Control Index (R-IDCI). Responses of the youth in all three cultures were similar, indicating common dental control preferences for individuals of this age. However, consistent with cultural values, Japanese youth were less likely to endorse the control strategies. These results underline the need to develop culturally-specific, as well as situationally-specific control measures.

Adolescent↗