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.

Publisher: Oxford University Press Country of Publication: England NLM ID: 0372553 Publication Model: Print Cited Medium: Internet ISSN: 1365-2168 (Electronic) Linking ISSN: 00071323 NLM ISO Abbreviation: Br J Surg Subsets: MEDLINE

Publication: 2021- : [Oxford] : Oxford University Press
Original Publication: [Bristol, England : Baltimore : John Wright & Sons ; Williams & Wilkins Co.

Translations* ; Wound Healing*; Humans ; Prospective Studies ; Psychometrics ; Reproducibility of Results ; Surveys and Questionnaires

Background: The Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.
Methods: This was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.
Results: In the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).
Conclusion: This study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways.
(© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.)

Erratum in: Br J Surg. 2023 Aug 11;110(9):1246. (PMID: 37463300)

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MR/K025643/1 United Kingdom MRC_ Medical Research Council; United Kingdom DH_ Department of Health

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Date Created: 20230403 Date Completed: 20230519 Latest Revision: 20240228

20240228

PMC10364512

10.1093/bjs/znad058

37005373