Methods for pre-testing and piloting survey questions: illustrations from the KENQOL survey of health-related quality of life

Black box no more: A cross-sectional multi-disciplinary survey for exploring governance and guiding adoption of AI in medical imaging and radiotherapy in the UK

BACKGROUND

Medical Imaging and radiotherapy (MIRT) are at the forefront of artificial intelligence applications. The exponential increase of these applications has made governance frameworks necessary to uphold safe and effective clinical adoption. There is little information about how healthcare practitioners in MIRT in the UK use AI tools, their governance and associated challenges, opportunities and priorities for the future.

METHODS

This cross-sectional survey was open from November to December 2022 to MIRT professionals who had knowledge or made use of AI tools, as an attempt to map out current policy and practice and to identify future needs. The survey was electronically distributed to the participants. Statistical analysis included descriptive statistics and inferential statistics on the SPSS statistical software. Content analysis was employed for the open-ended questions.

RESULTS

Among the 245 responses, the following were emphasised as central to AI adoption: governance frameworks, practitioner training, leadership, and teamwork within the AI ecosystem. Prior training was strongly correlated with increased knowledge about AI tools and frameworks. However, knowledge of related frameworks remained low, with different professionals showing different affinity to certain frameworks related to their respective roles. Common challenges and opportunities of AI adoption were also highlighted, with recommendations for future practice.

Factors influencing the intention to use the ICD-11 among medical record officers (MROs) and assistant medical record officers (AMROs) in Ministry of Health, Malaysia

The transition of ICD has never been a straightforward initiative. As nations transition to ICD-11, ensuring its acceptance among the users is essential. To our knowledge, there are limited studies about the instrument and ICD-11 adoption. Therefore, the purpose of this study was to design an instrument and investigate the factors influencing the intention to use the ICD-11 among medical record officers (MROs) and assistant medical record officers (AMROs) at Ministry of Health (MOH) Malaysia facilities. Based on the current literature, a model based on the decomposed theory of planned behaviour (DTPB) was proposed. The model consisted of 13 dimensions and 12 hypotheses identified from previous studies. Using PLS-SEM, 185 survey data points were analysed. The study findings showed that ten factors have a significant impact on the suggested model. Users' subjective norm was the most influential factor in their intention to use ICD-11. Unexpectedly, perceived usefulness and was found to have no significant influence. This study is important for policymakers in strategising ICD-11 implementation efforts. This study's novelty lies in applying a DTPB theory model in the context of the intention to use ICD-11.

Knowledge and attitudes on attention deficit hyperactivity disorder (ADHD) among school teachers in Anuradhapura district, Sri Lanka: a descriptive cross-sectional study

OBJECTIVE

This study aimed to assess the knowledge and attitude of school teachers from a rural district in a developing country towards children with attention deficit hyperactivity disorder (ADHD).

DESIGN

A population-based descriptive cross-sectional study was conducted using probability proportionate to size cluster sampling.

SETTING

This study was conducted in 21 government schools in Anuradhapura district, Sri Lanka.

PARTICIPANTS

The study sample consisted of 458 teachers with a mean age of 41 completed years ranging from 24 to 59 years.

MAIN OUTCOME MEASUREMENTS

We assessed knowledge, attitudes and sources of information on ADHD using the self-administered, validated Knowledge of Attention Deficit Disorder Scale (KADD), Teacher Attitudes Towards Inclusion Scale (TAIS) and the Perceived and Actual Sources of Information questionnaires.

RESULTS

The median KADD score was 11 (IQR 8-14) and 45.5% (n=208) of participants lacked sufficient knowledge. Percentages of the correct answers, misconceptions and 'don't know' responses were 28.2%, 24.5% and 45.5%, respectively. The majority of teachers believed that the children with ADHD generally experience more problems in novel situations than in familiar situations (63.5%), a diagnosis of ADHD by itself makes a child eligible for placement in special education (61.1%), and children with ADHD do not often have difficulties organising tasks and activities (61.1%). Some participants (12%) stated that punishment would improve the outcome of the children with ADHD. The attitudes were positive with TAIS 1 and 2 median scores of 46 (IQR 36-58) and 49 (IQR 40-59). The majority of participants relied on informal knowledge gained through their personal experience in the classroom on ADHD (n=337, 76%). The majority of teachers (n=300, 67.7%) preferred to be educated through seminars.

CONCLUSIONS

School teachers possess a positive attitude. However, they have poor knowledge and significant misconceptions regarding ADHD which may affect the identification and management.

Vaccine hesitancy among healthcare workers in low- and middle-income countries during the COVID-19 pandemic: Results from facility surveys across six countries

BACKGROUND

Vaccine hesitancy remains a critical barrier in mitigating the effects of the ongoing COVID-19 pandemic. The willingness of health care workers (HCWs) to be vaccinated, and, in turn, recommend the COVID-19 vaccine for their patient population is an important strategy. This study aims to understand the uptake of COVID-19 vaccines and the reasoning for vaccine hesitancy among facility-based health care workers (HCWs) in LMICs.

METHODS

We conducted nationally representative phone-based rapid-cycle surveys across facilities in six LMICs to better understand COVID-19 vaccine hesitancy. We gathered data on vaccine uptake among facility managers, their perceptions of vaccine uptake and hesitancy among the HCWs operating in their facilities, and their perception of vaccine hesitancy among the patient population served by the facility.

RESULTS

1,148 unique public health facilities participated in the study, with vaccines being almost universally offered to facility-based respondents across five out of six countries. Among facility respondents who have been offered the vaccine, more than 9 in 10 survey respondents had already been vaccinated at the time of data collection. Vaccine uptake among other HCWs at the facility was similarly high. Over 90% of facilities in Bangladesh, Liberia, Malawi, and Nigeria reported that all or most staff had already received the COVID-19 vaccine when the survey was conducted. Concerns about side effects predominantly drive vaccine hesitancy in both HCWs and the patient population.

CONCLUSION

Our findings indicate that the opportunity to get vaccinated in participating public facilities is almost universal. We find vaccine hesitancy among facility-based HCWs, as reported by respondents, to be very low. This suggests that a potentially effective effort to increase vaccine uptake equitably would be to channel promotional activities through health facilities and HCWs.However, reasons for hesitancy, even if limited, are far from uniform across countries, highlighting the need for audience-specific messaging.

Perceived Nexus Between Non-Invigilated Summative Assessment and Mental Health Difficulties: A Cross Sectional Studies

The COVID-19 pandemic rapidly led to changes in the mode of teaching, learning and assessments in most tertiary institutions worldwide. Notably, non-invigilated summative assessments became predominant. These changes heightened anxiety and depression, especially among individuals with less resilient coping mechanism. We explored the perceptions and experiences of mental health difficulties of students in tertiary education regarding non-invigilated alternative assessments in comparison to invigilated assessments. A pragmatic, mixed method cross sectional design was conducted online via Qualtrics. Thematic analysis of text was carried out using NVivo 12. In the quantitative analysis, univariable and multivariable ordinal logistic models were used to examine the potential factors for preference among students in higher education. A total of 380 Nursing and Social Science students responded to the survey. Approximately 77% of students perceived non-invigilated assessments to be less stressful compared to invigilated exams. Age, course of study, stage of studies, and number of units enrolled per semester were identified as significant drivers for students' perceived preference for non-invigilated assessments. There was an inverse relationship between the perception of stress associated with invigilated exams and the age of students. For instance, students aged between 18-24 were 5 times more likely to prefer non-invigilated exams compared to those aged 55 or more. Comparatively, students in early stages of studies had higher preference for non-invigilated assessments. However, there was a preference reversal for students enrolled in 2 or less units per semester. Social sciences students were two times more likely to prefer non-invigilated examinations to invigilated examinations compared to nursing students. The findings reinforce the use of alternative assessments in higher education as a mitigating agency to lessen the mental health burden of tertiary students in post COVID-19 era.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10805-023-09472-w.

Costs and Benefits of Undergraduates Revealing Depression to Online Science Instructors

Depression is one of the leading mental health concerns among science undergraduates, and rates of student depression increased during the COVID-19 pandemic. Revealing one's depression in an academic science environment can be helpful, because it can result in increased support from others. However, depression is considered a concealable stigmatized identity, meaning that it can be kept hidden and may carry a stigma. A national pivot to online learning owing to COVID-19 not only increased the need to bolster student mental health, but also presented a novel learning environment. However, it is unclear to what extent students revealed their depression in science courses and why. We surveyed 1179 undergraduates with depression at a research-intensive institution about whether they had revealed their depression to an online college science instructor. Very few undergraduates (5.9%) had revealed their depression to online science instructors; students who identify as LGBTQ+, have lower grade point averages, or experience more severe depression were more likely to reveal their depression to an instructor. Undergraduates reported potential benefits from doing so, including building a connection with the instructor and receiving accommodations. This work provides insight into steps science instructors can take to foster inclusive course environments for students with depression.

Using machine learning and qualitative interviews to design a five-question survey module for women's agency

Open-ended interview questions elicit rich information about people's lives, but in large-scale surveys, social scientists often need to measure complex concepts using only a few close-ended questions. We propose a new method to design a short survey measure for such cases by combining mixed-methods data collection and machine learning. We identify the best survey questions based on how well they predict a benchmark measure of the concept derived from qualitative interviews. We apply the method to create a survey module and index for women's agency. We measure agency for 209 married women in Haryana, India, first, through a semi-structured interview and, second, through a large set of close-ended questions. We use qualitative coding methods to score each woman's agency based on the interview, which we use as a benchmark measure of agency. To determine the close-ended questions most predictive of the benchmark, we apply statistical algorithms that build on LASSO and random forest but constrain how many variables are selected for the model (five in our case). The resulting five-question index is as strongly correlated with the coded qualitative interview as is an index that uses all of the candidate questions. This approach of selecting survey questions based on their statistical correspondence to coded qualitative interviews could be used to design short survey modules for many other latent constructs.

Estimating the recreational use value of Tis-Abay Waterfall in the upstream of the Blue Nile River, North-West Ethiopia

Tis-Abay Waterfall is a famous tourist destination in northern Ethiopia, attracting both domestic and international visitors. Although the site's recreation and tourism potential are enormous, the value of the waterfall remains underestimated; an application of economic valuation methods can provide information to better utilize the resource. This study estimates the recreational value of Tis-Abay Waterfall and analyzes the consumer characteristics associated with recreational demand. Drawing on data from 1044 on-site surveys, the study uses the Individual Travel Cost Method (ITCM) with a Zero-Truncated Poisson (ZTP) regression model. Results of the ZTP regression suggest that visitors' age, monthly income, and interest in alternative recreation sites like Lake Tana and Gondar Fasiledes Royal Castle are variables significantly and positively related with recreational demand for the Tis-Abay Waterfall. However, visitors' recreational demand is negatively associated with respondents' distance from the site, leisure time, and total cost of site access. The appraisal suggests that the Tis-Abay Waterfall has a significant annual recreational value of $9.5 million. But it also shows that the waterfall's value would increase significantly, up to $17.3 million, with hypothetical quality improvements in the waterfall settings. The value attachment suggests that estimating the recreation value for Tis-Abay Waterfall is a central component in the sustainable use and management of the resource. However, the presence of unfavorable trade-offs with the electric power plant and the inadequate infrastructure and services for reaching the site are major concerns that require immediate attention to make better use of Tis-Abay Waterfall's recreational services.

Aspects of online college science courses that alleviate and exacerbate undergraduate depression

Depression is a top mental health concern among college students, yet there is a lack of research exploring how online college science courses can exacerbate or alleviate their depression. We surveyed 2,175 undergraduates at a large research-intensive institution about the severity of their depression in large-enrollment online science courses. The survey also explored aspects of online science courses that exacerbate or alleviate depression and we used regression analyses to assess whether demographics predicted responses. Over 50% of undergraduates reported experiencing depression and LGBTQ+ students, financially unstable students, and lower division students were more likely to experience severe rather than mild depression compared to their counterparts. Students reported difficulty building relationships and struggling to perform well online as aspects of online science courses that exacerbated their depression and the flexible nature of online courses and caring instructors as aspects of online courses that alleviated their depression. This study provides insight into how instructors can create more inclusive online learning environments for students with depression.

Determinants of Physical Activity and Dietary Habits among Adults in Ghana: A Cross-Sectional Study

A critical understanding of the interrelationship between two behavioral decisions—participating in physical activity, and eating healthily—is lacking in Ghana. This study aimed to determine which factors affect each of the two behavioral decisions, jointly and separately, among adults aged 18 years or older in three metropolises (Kumasi, Accra, and Tamale) of Ghana. The data from the Ghana Obesity Survey 2021 were used. A bivariate probit model was fitted to estimate nonlinear models that indicate an individual’s joint decision to participate in physical activity and consume a healthy diet. A positive correlation (r = 0.085; p < 0.05) was found between these two decisions, indicating a relationship between these two behavioral decisions. The common correlates between these decisions were self-reported good health status, high income, and attitudes toward being overweight. Men were more likely to be physically active but less likely to eat well. Both religion and culture determined participation in physical activity, but not the consumption of a healthy diet. Marital status determined diet, but not physical activity. The new knowledge gained from this analysis around the nature and the extent of the interconnectedness between physical activity and diet is critical to devising targeted interventions for obesity prevention in Ghana.

The determinants of Mobile government services adoption: The moderating effect of perceived government support (PGS)

This study holds the view that the m-government success depends on the adequate intervention and support of government. Given this, the study seeks to investigate the role that government support can play on m-government services acceptance. Particularly the study examines the moderating influence of perceived government support (PGS) on m-government services usage. A structural equation model (SEM) method was deployed with Smart PLS 3.0. Analysis from the data captured using a comprehensive Unified Theory of Acceptance and Use of Technology (UTAUT) model, demonstrated that contrary to the initial held view, performance expectancy (PE) did not impact the acceptance behavior of m-government services. Facilitating conditions, security and privacy, trust in m-government and quality of information had a direct positive influence on m-government services adoption. The findings also revealed that PGS had a significant moderating influence on PE, facilitation conditions, and trust towards the adoption of mobile government services. However, perceived government support had no significant moderating effect on security and privacy and information quality on the adoption of m-government services. These results guide researchers and practitioners in respect of the role government support plays in making m-government a success and how government aid should be designed to have the maximum impact on changing the adoption behavior of citizens.

Supportive supervision from a roving nurse mentor in a community health worker programme: a process evaluation in South Africa

BACKGROUND

Many low and middle- income countries (LMICs) are repositioning community health worker (CHW) programmes to provide a more comprehensive range of promotive and preventive services and referrals to the formal health service. However, insufficient supervision, fragmented programmes, and the low literacy levels of CHWs often result in the under-performance of the programmes. We evaluate the impact of a roving nurse mentor working with CHW teams proving supportive supervision in a semi-rural area of South Africa.

METHODS

We conducted a longitudinal process evaluation, using in-depth interviews, focus groups and observations prior to the intervention, during the intervention, and 6 months post-intervention to assess how the effects of the intervention were generated and sustained. Our participants were CHWs, their supervisors, clients and facility staff members and community representatives.

RESULTS

The nurse mentor operated in an environment of resource shortages, conflicts between CHWs and facility staff, and an active CHW labour union. Over 15 months, the mentor was able to (1) support and train CHWs and their supervisors to gain and practice new skills, (2) address their fears of failing and (3) establish operational systems to address inefficiencies in the CHWs' activities, resulting in improved service provision. Towards the end of the intervention the direct employment of the CHWs by the Department of Health and an increase in their stipend added to their motivation and integration into the local primary care clinic team. However, given the communities' focus on accessing government housing, rather than better healthcare, and volatile nature of the communities, the nurse mentor was not able to establish a collaboration with local structures.

CONCLUSIONS

A roving nurse mentor overseeing several CHW teams within a district healthcare system is a feasible option, particularly in a context where there is a shortage of qualified supervisors to support CHWs activities. A roving nurse mentor can contribute to the knowledge and skills development of the CHWs and enhance the capacity of junior supervisors. However, the long-term sustainability of the effects of intervention is dependent on CHWs' formal employment by the Department of Health.

Measuring and valuing broader impacts in public health: Development of a sanitation-related quality of life instrument in Maputo, Mozambique

Two billion people globally lack access to a basic toilet. While improving sanitation reduces infectious disease, toilet users often identify privacy, safety and dignity as more important. However, these outcomes have not been incorporated in sanitation-related economic evaluations. This illustrates the general challenge of outcome measurement and valuation in the economic evaluation of public health interventions, and risks misallocating the US$ 20 billion invested in sanitation in low- and middle-income countries every year. In this study in urban Mozambique, we develop an instrument to measure sanitation-related quality of life (SanQoL). Applying methods from health economics and the capability approach, we develop a descriptive system to measure five attributes identified in prior qualitative research: disgust, health, shame, safety and privacy. Sampling individuals from the intervention and control groups of a sanitation intervention trial, we elicit attribute ranks to value a SanQoL index and assess its validity and reliability. In combination with a measure of time using a sanitation service, SanQoL can quantify incremental benefits in a sanitation-focused cost-effectiveness analysis. After monetary valuation based on willingness to pay, QoL benefits could be summed with health gains in cost-benefit analysis, the most common method in sanitation economic evaluations.

Gender differences in nutritional status and determinants among infants (6–11 m): a cross-sectional study in two regions in Ethiopia

Background

A limited number of studies suggest that boys may have a higher risk of stunting than girls in low-income countries. Little is known about the causes of these gender differences. The objective of the study was to assess gender differences in nutritional status and its determinants among infants in Ethiopia.

Methods

We analyzed data for 2036 children (6–11 months old) collected as the baseline for a multiple micronutrient powders effectiveness study in two regions of Ethiopia in March–April 2015. Child, mother, and household characteristics were investigated as determinants of stunting and wasting. Multiple logistic regression models were used separately for boys and girls to check for gender differences while adjusting for confounders. The study is registered at http://www.clinicaltrials.gov/ with the clinical trials identifier of NCT02479815.

Results

Stunting and wasting prevalence is significantly higher among boys compared to girls, 18.7 vs 10.7% and 7.9 vs 5.4%, respectively. Untimely initiation of breastfeeding, not-exclusive breastfeeding at the age of 6 months, region of residence, and low maternal education are significant predictors of stunting in boys. Untimely introduction to complementary food and low consumption of legumes/nuts are significant predictors of stunting in both boys and girls, and low egg consumption only in girls. Region of residence and age of the mother are significant determinants of wasting in both sexes. Analysis of interaction terms for stunting, however, shows no differences in predictors between boys and girls; only for untimely initiation of breastfeeding do the results for boys (OR 1.46; 95%CI 1.02,2.08) and girls (OR 0.88; 95%CI 0.55,1.41) tend to be different (p = 0.12).

Conclusion

In Ethiopia, boys are more malnourished than girls. Exclusive breastfeeding and adequate dietary diversity of complementary feeding are important determinants of stunting in boys and girls. There are no clear gender interactions for the main determinants of stunting and wasting. These findings suggest that appropriate gender-sensitive guidance on optimum infant and young child feeding practices is needed.

Aspects of Large-Enrollment Online College Science Courses That Exacerbate and Alleviate Student Anxiety

Anxiety is the top mental health concern for undergraduates. While researchers have identified ways that in-person science courses can affect anxiety, little is known about how online science courses affect anxiety. In this study, 2111 undergraduates at a large research-intensive institution completed survey questions about their anxiety in large-enrollment online science courses. Specifically, we assessed students' anxiety in the context of online science courses and asked what aspects of online science courses increase and decrease their anxiety. Students also identified what instructors can do to lessen anxiety in online classrooms. We used open coding and logistic regression to analyze student responses. More than 50% of students reported at least moderate anxiety in the context of online college science courses. Students commonly reported that the potential for personal technology issues (69.8%) and proctored exams (68.0%) increased their anxiety, while being able to access content at a later time (79.0%) and attending class from where they want (74.2%) decreased their anxiety. The most common ways that students suggested that instructors could decrease student anxiety is to increase test-taking flexibility (25.0%) and be understanding (23.1%). This study provides insight into how instructors can create more inclusive online learning environments for students with anxiety.

A Survey of Speech-Language Pathologists' Experience With Clinical Cough Assessment

PURPOSE

The purpose of this study was to determine if students (clinicians-intraining) and clinicians of speech-language pathology assess cough during clinical swallow evaluations. We also sought to determine if participants received background education and training regarding implementation of clinical cough assessment. Finally, we aimed to identify participant interest in a cough assessment training program.

METHOD

A clinician-researcher panel developed a 20-question survey to address specific aims. The final survey was distributed via social media and a clinical dysphagia website after two phases of revision.

RESULTS

A percentage (84.6%) of the survey participants reported that they assess cough in clinical swallow evaluations, mainly using subjective measures. The majority of clinicians reported no background education or skilled training to implement cough assessment. Background education and training was higher for participants outside the United States, although the total sample size of that group was small. Almost all participants (97.8%) were interested in a cough training program.

CONCLUSIONS

Many practicing clinicians in this survey reported that they complete cough assessments, despite limited education and training to do so. However, they also reported high interest in participating in a clinical cough assessment training program, which would support the field of speech-language pathology and patients at risk of airway protective dysfunction.

COVID-19 complications and entrepreneurial intention among the entrepreneurs of Pakistan: evidence from the second wave of the pandemic

Purpose

At present, nearly the whole globe is facing a severe threat of COVID-19. This study aims to examine the COVID-19 complications and entrepreneurial intention among the entrepreneurs of Pakistan.

Design/methodology/approach

The study used a deductive approach. An online survey is conducted to collect cross-sectional data from entrepreneurs of Pakistan. Convenience sampling is applied to target the respondents. In total, 278 usable answers proceed for final analysis. The structural equation model (SEM) is used to infer the results.

Findings

The findings of the study highlight a significant negative effect of fear of COVID-19 (FO19), perceived susceptibility (PSU) and perceived severity (PSE) on entrepreneurial intention (EI) among the entrepreneurs.

Practical implications

The study would provide the guidelines for policymakers and planners to combat the barriers of fear, PSU and PSE during a pandemic. The findings of the second wave of COVID-19 may provide a warning to the government to take preventive measures to face the severe effect of the pandemic. Finally, the outcomes of the study may enrich the depth of COVID-19 literature globally.

Originality/value

This study is the first study highlighting factors such as fear, PSU and PSE toward EI in COVID-19 second wave.

Without Assumptions: Development of a Socio-Emotional Learning Framework That Reflects Community Values in Cameroon

Socioemotional learning (SEL) skills are the competencies that children need to be successful and accepted members of society. In this study, we built a SEL framework and a SEL measurement tool from the ground up that assess children's development of skills with communities of the Baka ethnic group in Cameroon. We conducted a participatory and interactive study to develop a SEL framework and measurement tool that is specific to the context of indigenous Baka communities in Cameroon. Using a quick ethnography methodology and an emic approach, a researcher team comprised mainly of Baka community members engaged parents, teachers, and others in iterative cycles of data collection, analysis, and reflection to develop the framework and assessments. The resulting Baka SEL framework includes skills and domains distinct from predominant SEL frameworks, underscoring the importance of drawing SEL priorities from communities themselves. Shared foundational constructs underlying the Baka SEL framework and other frameworks indicate possible universal human expectations for emotional and relational skills. Two SEL measurement tools were produced: a caregiver tool and a teacher tool, each using storytelling to elicit specific, honest, and detailed information about child behavior. These tools allow us to capture child behavior in the school and the home, and to collect data on all participating children within a specific time period. The described approach is a simple, practical, and culturally appropriate strategy for collaborating with rural communities to articulate their understanding of SEL. The resulting framework and tools illustrate the importance of rooting SEL in local culture, while the approach to developing them serves as a model for other early childhood care and education organizations and programs.

Perceptions on respectful maternity care in Sri Lanka: Study protocol for a mixed-methods study of patients and providers

BACKGROUND

Over the past few decades, interest in providing and measuring Respectful Maternity Care (RMC) has increased markedly. Sri Lanka is reportedly shown to have better maternal health statistics and studies on quality improvement are lacking in this unique population. We aim to describe healthcare providers' perceptions and women's expectations, perceptions and their gaps in service provision regarding RMC in Sri Lanka.

METHODS

A descriptive cross-sectional study with a mixed-methods approach comprising of qualitative component followed by a quantitative component will be conducted in Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW), Colombo, Sri Lanka. Healthcare providers (HCP- doctors, nurses and midwives) and vaginally delivered postnatal women (in postnatal wards and postnatal well-baby clinics) will be recruited through convenience sampling. In-depth interviews will be conducted with each of the four categories. Thematic analysis will be adopted to analyze qualitative data and the findings will further be used to improve the quantitative phase questionnaires. Self-administered questionnaire will be administered to a 378 vaginally delivered postnatal women [quota sampling across ten wards], exploring demographic details, and maternal opinion on various aspects of RMC. Locally validated Women's Perceptions of RMC tool (WP-RMC) will also be used to measure the level of RMC among these postnatal women along with the questionnaire 01. Qualitative findings will be used for cognitive validation of the WP-RMC into the Sri Lankan setting.

DISCUSSION

This study will explore HCP's and women's expectations, perceptions and their gaps in service provision regarding RMC in two maternity hospitals in Sri Lanka. Assessment of the quality of care with regards to RMC have not been reported previously in this setting.

Effectiveness of a 595-nm Pulsed Dye Laser for the Treatment of Basal Cell Carcinoma Using One Double-Stacked Pulse Session: A Randomized, Double-Blinded Controlled Trial

BACKGROUND

Surgical and nonsurgical methods are used for treating basal cell carcinoma (BCC). Few randomized controlled trials exist on the effectiveness of the pulsed dye laser (PDL) on BCC treatment.

OBJECTIVE

We investigated the effectiveness of PDL treatment in a single session for the management of nodular and superficial BCCs on the trunk and extremities of adults using a randomized, double-blind, controlled technique.

METHODS

We used settings of fluence 7.5 J/cm2, 3-ms pulse duration, no dynamic cooling, 10-mm spot size, 10% overlap between pulses, and 2 stacked pulses on a 595-nm wavelength laser. Histopathologic clearance on excision of tumor with 4-mm margins was the primary outcome measure.

RESULTS

Twenty-four patients were included in the study, with 14 in the laser treatment group and 10 patients in the sham/control group. In total, 10/14 (71.4%) of the tumors in the treatment group were successfully treated with no residual tumor on excisional specimen histology, compared with 3/10 (30.0%) of the control group (p = .045).

CONCLUSION

Our study shows that PDL may be an effective treatment for low-risk BCCs of the trunk and extremities, but the cure rate is lower than those of other treatments for BCC. Thus, PDL under the current settings cannot be recommended.

A self-applied valid scale for rapid tracking of household food insecurity among pregnant women in Sri Lanka

Rapid household food insecurity (HFI) tracking has been identified as a priority in the context of the COVID-19 pandemic and its aftermath. We report the validation of the Latin American and Caribbean Food Security Scale (Escala Latinoamericana y Caribena de Seguridad Alimentaria [ELCSA]) among pregnant women in Sri Lanka. The eight-item adult version of the ELCSA was translated from English to Sinhala and Tamil. Cognitive testing (on 10 pregnant women and five local experts) and psychometric validation of the self-administered HFI tool were conducted among pregnant women (n = 269) attending the special clinics of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura in February 2020. We assessed the psychometric properties and fit using a one parameter logistic model (Rasch model analysis) using STATA Version 14 and WINSTEP software Version 4.3.4. Concurrent validity was tested using psychological distress. The scale was internally consistent (Cronbach's alpha = 0.79) and had a good model fit (Rasch items infit statistic range: 0.85 to 1.07). Item 8 ('did not eat for the whole day') was removed from the model fit analysis, as it was not affirmed by respondent. Item severity scores ranged from -2.15 for 'not eating a diverse diet' to 4.43 for 'not eating during the whole day'. Concurrent validity between HFI and psychological distress was confirmed (r = 0.15, p < 0.05). The self-applied version of ELCSA-pregnancy in Sri Lanka (ELCSA-P-SL) is a valid and feasible valid tool. We recommend it to track HFI among pregnant women in lower income countries during the COVID-19 pandemic.

Call on me! Undergraduates' perceptions of voluntarily asking and answering questions in front of large-enrollment science classes

Allowing students to voluntarily ask and answer questions in front of the whole class are common teaching practices used in college science courses. However, few studies have examined college science students’ perceptions of these practices, the extent to which students choose to engage in these practices, and what discourages students from participating. In this study, we surveyed 417 undergraduates at a research-intensive institution about their experiences asking and answering questions in large-enrollment college science courses. Specifically, students answered questions about to what extent they perceive voluntarily asking and answering questions in large-enrollment science courses is helpful to them and why. They also answered questions about to what extent they engage in asking and answering questions in large-enrollment college science courses and what factors could discourage them from participating. Using binary logistic regression, we examined whether there were differences among students of different demographic groups regarding their opinions about asking and answering questions. We found that overwhelmingly students reported that other students voluntarily asking and answering instructor questions is helpful to them. Notably, compared to continuing generation students, first-generation students were more likely to perceive other students asking questions to be helpful. Despite perceiving asking and answering questions to be helpful, over half of students reported that they never ask or answer questions in large-enrollment college science courses during a semester, and women were more likely than men to report never asking questions. We identified fear of negative evaluation, or students’ sense of dread associated with being unfavorably evaluated, as a primary factor influencing their decision to answer instructor questions. This work adds to a growing body of literature on student participation in large-enrollment college science courses and begins to uncover underlying factors influencing student participation.

Gender Differences in Student Comfort Voluntarily Asking and Answering Questions in Large-Enrollment College Science Courses

Allowing students to ask and answer questions is a common practice employed by college science instructors. However, recent literature has identified that women participate in whole-class discussions less often than men. One hypothesized reason for this gender gap is that women may be less comfortable participating. However, no studies have examined students' comfort with asking and answering questions in large-enrollment science courses, identified what about these practices might make students uncomfortable, or explored whether there are gender differences with regard to student comfort. To answer these questions, we surveyed 417 undergraduates at an R1 institution about their experiences asking and answering questions in large-enrollment college science courses. Students answered questions about the extent to which they felt comfortable both asking and answering questions and selected possible factors that could make them uncomfortable participating. Using binary logistic regression, we tested whether student demographics predicted their opinions about these practices. Over half of students reported feeling uncomfortable both asking and answering questions in front of college science classes, and women were significantly less comfortable than men both asking and answering questions. Furthermore, we identified student confidence regarding their knowledge of the material and a concern that other students would judge them as some of the primary factors that could cause students to feel uncomfortable asking and answering questions in front of the whole class. This work highlights factors that instructors can target in hopes of maximizing student comfort participating in large-enrollment college science courses.

Survey Development: Community Involvement in the Design and Implementation Process

Documenting Tribal health priorities is needed to inform research agendas, policy efforts, advocacy, and funding. However, published literature rarely documents the methods used to develop surveys in Indigenous communities. This methods paper includes two objectives: (1) increase knowledge and understanding about the importance of community involvement in public health activities; and (2) provide an example of how the Rocky Mountain Tribal Leaders Council Epidemiology Center (RMTEC) worked with one Tribal community to develop a health priorities survey. This paper describes how the RMTEC worked with a Tribal community and Tribal College students to develop, pilot, and revise a health priorities survey. Recommendations focus on the need for more culturally-responsive survey methods, the importance of building Tribal capacity for health research, and the value of piloting surveys in communities prior to implementation.

Ambulatory Assessment for Physical Activity Research: State of the Science, Best Practices and Future Directions

Technological and digital progress benefits physical activity (PA) research. Here we compiled expert knowledge on how Ambulatory Assessment (AA) is utilized to advance PA research, i.e., we present results of the 2nd International CAPA Workshop 2019 "Physical Activity Assessment - State of the Science, Best Practices, Future Directions" where invited researchers with experience in PA assessment, evaluation, technology and application participated. First, we provide readers with the state of the AA science, then we give best practice recommendations on how to measure PA via AA and shed light on methodological frontiers, and we furthermore discuss future directions. AA encompasses a class of methods that allows the study of PA and its behavioral, biological and physiological correlates as they unfold in everyday life. AA includes monitoring of movement (e.g., via accelerometry), physiological function (e.g., via mobile electrocardiogram), contextual information (e.g., via geolocation-tracking), and ecological momentary assessment (EMA; e.g., electronic diaries) to capture self-reported information. The strengths of AA are data assessment that near realtime, which minimizes retrospective biases in real-world settings, consequentially enabling ecological valid findings. Importantly, AA enables multiple assessments across time within subjects resulting in intensive longitudinal data (ILD), which allows unraveling within-person determinants of PA in everyday life. In this paper, we show how AA methods such as triggered e-diaries and geolocation-tracking can be used to measure PA and its correlates, and furthermore how these findings may translate into real-life interventions. In sum, AA provides numerous possibilities for PA research, especially the opportunity to tackle within- subject antecedents, concomitants, and consequences of PA as they unfold in everyday life. In-depth insights on determinants of PA could help us design and deliver impactful interventions in real-world contexts, thus enabling us to solve critical health issues in the 21st century such as insufficient PA and high levels of sedentary behavior.

The Quality of Data on Participation in Adult Education and Training. An Analysis of Varying Participation Rates and Patterns Under Consideration of Survey Design and Measurement Effects

Statistics on adult education and training (AET) are often considered as insufficient because they fail to deliver a comprehensive and consistent picture of this field of education. This study addresses a specific problem in AET statistics that is varying participation rates of adults in AET depending on underlying data sources. We elaborate potential causes for deviations in survey design and the measurement of participation in sample based AET statistics with reference to the Total Survey Error (TSE) approach. Our analysis compares AET participation rates and patterns from four representative German surveys and reveals substantial differences in participation rates and mixed results for patterns of participation in AET. We find similar relationships for the influence of employment and educational attainment. The relationship with region, gender, and age shows to some extent deviations that conclude in contradictory statements on probabilities of participation. The discussion addresses consequences for the interpretation of survey results on AET participations and draws conclusions for the further development of AET statistics.

Factors that predict life sciences student persistence in undergraduate research experiences

Undergraduate research experiences (UREs) have the potential to benefit undergraduates and longer UREs have been shown to lead to greater benefits for students. However, no studies have examined what causes students to stay in or consider leaving their UREs. In this study, we examined what factors cause students to stay in their UREs, what factors cause students to consider leaving their UREs, and what factors cause students to leave their UREs. We sampled from 25 research-intensive (R1) public universities across the United States and surveyed 768 life sciences undergraduates who were currently participating in or had previously participated in a URE. Students answered closed-ended and open-ended questions about factors that they perceived influenced their persistence in UREs. We used logistic regression to explore to what extent student demographics predicted what factors influenced students to stay in or consider leaving their UREs. We applied open-coding methods to probe the student-reported reasons why students chose to stay in and leave their UREs. Fifty percent of survey respondents considered leaving their URE, and 53.1% of those students actually left their URE. Students who reported having a positive lab environment and students who indicated enjoying their everyday research tasks were more likely to not consider leaving their UREs. In contrast, students who reported a negative lab environment or that they were not gaining important knowledge or skills were more likely to leave their UREs. Further, we identified that gender, race/ethnicity, college generation status, and GPA predicted which factors influenced students' decisions to persist in their UREs. This research provides important insight into how research mentors can create UREs that undergraduates are willing and able to participate in for as long as possible.

Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH)

OBJECTIVES

Social capital which implies 'features of social organisation, such as trust, norms and networks that can improve the efficiency of society by facilitating coordinated actions' is rarely assessed in relation to maternal health in low/middle-income countries (LMICs). A main reason for this research gap could be the unavailability of a specific tool to measure social capital in pregnancy. The study developed and validated an instrument to measure social capital among pregnant women.

SETTING

We developed the tool based on World Bank Social Capital Assessment Tool and its adaptations identified as applicable to LMIC from an initial systematic review. The study was conducted in Anuradhapura district in the North Central Province of Sri Lanka. Validation process was conducted in urban, rural and resettled communities.

PARTICIPANTS

Study participants of the cognitive validation included pregnant women from the three communities, and an expert panel including a social scientist, methodological expert, subject expert, public health officers. The psychometric validation was performed on 439 pregnant women permanently residing in the three communities.

RESULTS

The 24-item Low and middle income countries Social Capital Assessment Tool for Maternal Health (LSCAT-MH) demonstrated high internal consistency (Cronbach's α=0.94). Factor analytical methods suggested a four-factor model of (1) neighbourhood networks (structural bonding), (2) domestic and neighbourhood cohesion (cognitive bonding), (3) social contribution and (4) social participation (structural bridging). Concurrent validity with antenatal mental ill health was confirmed through a negative correlation with the Edinburgh Postpartum Depression Scale. Test-retest reliability was high with intraclass correlation of 0.71 and a Pearson correlation of 0.83.

CONCLUSION

The LSCAT-MH is a psychometrically valid and reliable tool to measure social capital in pregnancy. Predictive validity was not tested as the study was not a longitudinal follow-up.

On-line Crowdsourcing: Motives of Customers to Participate in Online Collaborative Innovation Processes

The large-scale adoption of the Internet and social media make transactions and interactions between businesses and customers easy, inexpensive, and highly efficient. Online crowdsourcing and co-creation with customers are developments increasingly seen as attractive alternatives to traditional forms of innovation management. Online customers are willing to spend time and effort on collaborative innovation trajectories and so have a say in the development of new products and services. Identifying and recruiting capable and innovation-minded co-creation partners online is one of the main challenges of such collaborative innovation-focused processes; understanding the attitudes and motives of innovation-minded customers are the first steps in enticing and recruit these as innovation partners. In this study, we identify and classify customer motives for participating in online co-creation processes in two European countries: Spain and The Netherlands. More than a quarter of online customers are active co-creators and two co-creator profiles were identified in both countries, based the levels of motivation predisposition; Spanish online customers are more involved and enthusiastic co-creators than Dutch customers. The study confirms that financial motives are not the main reason for co-creation; highly motivated customers are motivated by product-related benefits, while hedonic benefits are the most important triggers for less motivated co-creators.

The Role of Frontline Leaders in Building Health Professional Support for a New Patient Portal: Survey Study

Background

Effective leadership and change management are thought to contribute to the successful implementation of health information technology innovations. However, limited attention has been paid to the role of frontline leaders in building health professional support for new technical innovations.

Objective

First, we examined whether frontline leaders’ positive expectations of a patient portal and perceptions of its implementation were associated with their support for the portal. Second, we explored whether leaders’ positive perceptions influenced the same unit’s health professional support for the portal.

Methods

Data were collected through an online survey of 2067 health professionals and 401 frontline leaders working in 44 units from 14 health organizations in Finland. The participating organizations run a joint self-care and digital value services project developing a new patient portal for self-management. The survey was conducted before the piloting and implementation of the patient portal.

Results

The frontline leaders’ perception of vision clarity had the strongest association with their own support for the portal (ß=.40, P<.001). Results also showed an association between leaders’ view of organizational readiness and their support (ß=.15, P=.04). The leaders’ positive perceptions of the quality of informing about the patient portal was associated with both leaders’ own (ß=.16, P=.02) and subordinate health professionals’ support for the portal (ß=.08, P<.001). Furthermore, professional participation in the planning of the portal was positively associated with their support (ß=.57, P<.001).

Conclusions

Findings suggest that assuring good informing, communicating a clear vision to frontline leaders, and acknowledging organizational readiness for change can increase health professional support for electronic health (eHealth) services in the pre-implementation phase. Results highlight the role of frontline leaders in engaging professionals in the planning and implementation of eHealth services and in building health professionals’ positive attitudes toward the implementation of eHealth services.

Ability to understand and correctly follow HIV self-test kit instructions for use: applying the cognitive interview technique in Malawi and Zambia

INTRODUCTION

The ability to achieve an accurate test result and interpret it correctly is critical to the impact and effectiveness of HIV self-testing (HIVST). Simple and easy-to-use devices, instructions for use (IFU) and other support tools have been shown to be key to good performance in sub-Saharan Africa and may be highly contextual. The objective of this study was to explore the utility of cognitive interviewing in optimizing the local understanding of manufacturers' IFUs to achieve an accurate HIVST result.

METHODS

Functionally literate and antiretroviral therapy-naive participants were purposefully selected between May 2016 and June 2017 to represent intended users of HIV self-tests from urban and rural areas in Malawi and Zambia. Participants were asked to follow IFUs for HIVST. We then conducted cognitive interviews and observed participants while they attempted to complete the HIVST steps using a structured guide, which mirrored the steps in the IFU. Qualitative data were analysed using a thematic approach.

RESULTS

Of a total of 61 participants, many successfully performed most steps in the IFU. Some had difficulties in understanding these and made errors, which could have led to incorrect test results, such as incorrect use of buffer and reading the results prematurely. Participants with lower levels of literacy and inexperience with standard pictorial images were more likely to struggle with IFUs. Difficulties tended to be more pronounced among those in rural settings. Ambiguous terms and translations in the IFU, unfamiliar images and symbols, and unclear order of the steps to be followed were most commonly linked to errors and lower comprehension among participants. Feedback was provided to the manufacturer on the findings, which resulted in further optimization of IFUs.

CONCLUSIONS

Cognitive interviewing identifies local difficulties in conducting HIVST from manufacturer-translated IFUs. It is a useful and practical methodology to optimize IFUs and make them more understandable.

Lower Limb Prosthetic Rehabilitation in Canada: A Survey Study

Purpose: This study describes prosthetic rehabilitation services provided to individuals who have had a lower limb amputation in Canada. Method: This cross-sectional survey study used an online survey to collect data from facilities that provide lower limb prosthetic rehabilitation; it included questions about approaches and types of service, therapies, focus of service, and health care providers. One representative from each facility was asked to complete the survey. Results: Of the 65 identified eligible facilities, 59 completed the survey (response rate = 90.8%). The majority of facilities (n = 39; 66.1%) indicated that they provided both in-patient and outpatient prosthetic rehabilitation services. All facilities provided balance, coordination, and gait training as well as prosthetic fit education. Most facilities indicated that they had a physical therapist (n = 58; 93.8%), an occupational therapist (n = 52; 88.1%), and a prosthetist (n = 52; 88.1%) on their team. Conclusions: The majority of the facilities surveyed provided both in-patient and outpatient services and had specialized health care provider teams. Future surveys are required to collect more specific information about prosthetic rehabilitation in Canada.

A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment

PURPOSE

Speech-language pathologists (SLPs) are the primary providers of dysphagia management; however, this role has been criticized with assertions that SLPs are inadequately trained in swallowing physiology (Campbell-Taylor, 2008). To date, diagnostic acuity and treatment planning for swallowing impairments by practicing SLPs have not been examined. We conducted a survey to examine how clinician demographics and swallowing complexity influence decision making for swallowing impairments in videofluoroscopic images. Our goal was to determine whether SLPs' judgments of swallowing timing impairments align with impairment thresholds available in the research literature and whether or not there is agreement among SLPs regarding therapeutic recommendations.

METHOD

The survey included 3 videofluoroscopic swallows ranging in complexity (easy, moderate, and complex). Three hundred three practicing SLPs in dysphagia management participated in the survey in a web-based format (Qualtrics, 2005) with frame-by-frame viewing capabilities. SLPs' judgments of impairment were compared against impairment thresholds for swallowing timing measures based on 95% confidence intervals from healthy swallows reported in the literature.

RESULTS

The primary impairment in swallowing physiology was identified 67% of the time for the easy swallow, 6% for the moderate swallow, and 6% for the complex swallow. On average, practicing clinicians mislabeled 8 or more swallowing events as impaired that were within the normal physiologic range compared with healthy normative data available in the literature. Agreement was higher among clinicians who report using frame-by-frame analysis 80% of the time. A range of 19-21 different treatments was recommended for each video, regardless of complexity.

CONCLUSIONS

Poor to modest agreement in swallowing impairment identification, frequent false positives, and wide variability in treatment planning recommendations suggest that additional research and training in healthy and disordered swallowing are needed to increase accurate dysphagia diagnosis and treatment among clinicians.

Evaluating Surgical Coaching: A Mixed Methods Approach Reveals More Than Surveys Alone

OBJECTIVE

Traditionally, surgical educators have relied upon participant survey data for the evaluation of educational interventions. However, the ability of such subjective data to completely evaluate an intervention is limited. Our objective was to compare resident and attending surgeons' self-assessments of coaching sessions from surveys with independent observations from analysis of intraoperative and postoperative coaching transcripts.

DESIGN

Senior residents were video-recorded operating. Each was then coached by the operative attending in a 1:1 video review session. Teaching points made in the operating room (OR) and in post-OR coaching sessions were coded by independent observers using dialogue analysis then compared using t-tests. Participants were surveyed regarding the degree of teaching dedicated to specific topics and perceived changes in teaching level, resident comfort, educational assessments, and feedback provision between the OR and the post-OR coaching sessions.

SETTING

A single, large, urban, tertiary-care academic institution.

PARTICIPANTS

Ten PGY4 to 5 general surgery residents and 10 attending surgeons.

RESULTS

Although the reported experiences of teaching and coaching sessions by residents and faculty were similar (Pearson correlation coefficient = 0.88), these differed significantly from independent observations. Observers found that residents initiated a greater proportion of teaching points and had more educational needs assessments during coaching, compared to the OR. However, neither residents nor attendings reported a change between the 2 environments with regard to needs assessments nor comfort with asking questions or making suggestions. The only metric on which residents, attendings, and observers agreed was the provision of feedback.

CONCLUSIONS

Participants' perspectives, although considered highly reliable by traditional metrics, rarely aligned with analysis of the associated transcripts from independent observers. Independent observation showed a distinct benefit of coaching in terms of frequency and type of learning points. These findings highlight the importance of seeking different perspectives, data sources, and methodologies when evaluating clinical education interventions. Surgical education can benefit from increased use of dialogue analyses performed by independent observers, which may represent a viewpoint distinct from that obtained by survey methodology.

Naturopathy Special Interest Group Research Capacity and Needs Assessment Survey

Objectives: Despite recent shifts in regulation and recognition of the role that naturopathy plays in health care delivery in Canada, comparatively little research has been conducted regarding individuals who conduct naturopathy-related research. A survey was undertaken to better understand the needs and capacity of these individuals to conduct more research.

Design, Setting, and Subjects: The Naturopathy Special Interest Group (N-SIG) of the Interdisciplinary Network of Complementary and Alternative Medicine (INCAM) Researchers created and distributed a survey of individuals interested in naturopathy-related research to assess gaps between current and desired research activity and needs for further participation.

Outcome measures: Results from a previous pilot study (2014; n = 58) were used to inform the design and distribution. This study received approval and oversight from the Research Ethics Board of the Canadian College of Naturopathic Medicine.

Results: The survey was completed by 201 individuals (∼5%–10% of all naturopathic doctors and naturopathy researchers in Canada). The majority (70%) had no peer-reviewed publication experience; however, 63% reported having published in a nonpeer-reviewed medium. Respondents reported differing levels of confidence in completing various components of a research project. Frequently selected obstacles included lack of time due to professional and personal obligations, as well as insufficient training, funding, and mentorship. The greatest identified needs for participation in research were mentorship/support, access to a wider degree of scientific journals, and targeted funding opportunities for CAM research. Overall, the results of this survey suggest that there is interest in further conducting naturopathy-related research in Canada. There are individuals who are already involved and have expressed skills in the area of evidence-based medicine. Mentorship, research training, resources, and critical appraisal and writing skills may be important leverage points.

Conclusion: Findings from this investigation will be used to inform an agenda for naturopathy-related research and activities of the N-SIG with respect to enhancing research capacity. Other CAM groups or geographic regions could consider using similar methodology to assess capacity and needs for research participation.

To be funny or not to be funny: Gender differences in student perceptions of instructor humor in college science courses

For over 50 years instructor humor has been recognized as a way to positively impact student cognitive and affective learning. However, no study has explored humor exclusively in the context of college science courses, which have the reputation of being difficult and boring. The majority of studies that explore humor have assumed that students perceive instructor humor to be funny, yet students likely perceive some instructor humor as unfunny or offensive. Further, evidence suggests that women perceive certain subjects to be more offensive than men, yet we do not know what impact this may have on the experience of women in the classroom. To address these gaps in the literature, we surveyed students across 25 different college science courses about their perceptions of instructor humor in college science classes, which yielded 1637 student responses. Open-coding methods were used to analyze student responses to a question about why students appreciate humor. Multinomial regression was used to identify whether there are gender differences in the extent to which funny, unfunny, and offensive humor influenced student attention to course content, instructor relatability, and student sense of belonging. Logistic regression was used to examine gender differences in what subjects students find funny and offensive when joked about by college science instructors. Nearly 99% of students reported that they appreciate instructor humor and reported that it positively changes the classroom atmosphere, improves student experiences during class, and enhances the student-instructor relationship. We found that funny humor tends to increase student attention to course content, instructor relatability, and student sense of belonging. Conversely, offensive humor tends to decrease instructor relatability and student sense of belonging. Lastly, we identified subjects that males were more likely to find funny and females were more likely to find offensive if a college science instructor were to joke about them.

Health professionals' expectations of a national patient portal for self-management

OBJECTIVE

Patient portals have the potential to support patient empowerment, self-care, and management, but their adoption and use have reported to be limited. Patients' more active role creates tension, as health professionals need to change their traditional expert role and share control with patients. Professionals may also have other expectations and concerns that influence the acceptance of patient portals supporting patient empowerment. This study explores the health professionals' expectations influencing their support for a new patient portal for self-management prior to implementation.

DESIGN

The study empirically evaluates the impact of several variables on health professionals' support for a new patient portal for self-management. The study variables include 1) expected influences on professionals' work, 2) expected influences on patients, 3) usability, 4) professional autonomy, 5) informing, 6) implementation practices, and 7) user participation.

METHODS

Data was collected through an online survey of 2943 health professionals working in 14 health organizations in Finland. The participating organizations run a joint Self-Care and Digital Value Services (ODA) project, developing a national patient portal for self-management. Three main services of the patient portal are well-being coaching, diagnostic tool, and a health care plan.

RESULTS AND CONCLUSIONS

The results show that health professionals' positive expectations about the new patient portal, adequate informing of professionals ahead of time, and the organization's good implementation practices had a positive impact on their support for the patient portal. Perceived threat to professional autonomy had a negative impact on professionals' support for the portal. Age, gender, and user participation did not influence support. Professionals' concerns were related especially to patients' willingness and capability to use the patient portal. The findings can guide health care providers to facilitate professionals' support and remove obstacles to introduce patient portals already in the pre-implementation phase.

Resident Wellness and Social Support: Development and Cognitive Validation of a Resident Social Capital Assessment Tool

OBJECTIVE

The purpose of this study is to develop and generate validity evidence for an instrument to measure social capital in residents.

DESIGN

Mixed-methods, phased approach utilizing a modified Delphi technique, focus groups, and cognitive interviews.

SETTING

Four residency training institutions in Washington state between February 2016 and March 2017.

PARTICIPANTS

General surgery, anesthesia, and internal medicine residents ranging from PGY-1 to PGY-6.

RESULTS

The initial resident-focused instrument underwent revision via Delphi process with 6 experts; 100% expert consensus was achieved after 4 cycles. Three focus groups were conducted with 19 total residents. Focus groups identified 6 of 11 instrument items with mean quality ratings ≤4.0 on a 1-5 scale. The composite instrument rating of the draft version was 4.1 ± 0.5. After refining the instrument, cognitive interviews with the final version were completed with 22 residents. All items in the final version had quality ratings >4.0; the composite instrument rating was 4.8 ± 0.1.

CONCLUSIONS

Social capital may be an important factor in resident wellness as residents rely upon each other and external social support to withstand fatigue, burnout, and other negative sequelae of rigorous training. This instrument for assessment of social capital in residents may provide an avenue for data collection and potentially, identification of residents at-risk for wellness degradation.

Characterizing Intervention Strategies Used in Community-Based Mental Health Care for Infants and Their Families

Mental health interventions for infants typically target high-risk groups and can prevent long-term negative outcomes. Despite federal initiatives promoting early intervention, minimal research has examined usual care services for infants, which is important to improve routine care. The current study characterized usual care practices in infant mental health through the adaptation and administration of a provider survey. Providers (n = 126) reported using a wide range of intervention strategies and few intervention programs with varied evidence. Findings can inform future research to identify quality improvement targets of usual mental health care for high-risk infants and their families.

Development, Validity, and Reliability of the Women's Capabilities Index

We report the results of a series of validity and reliability tests performed during the development of the Women's Capabilities Index (WCI) in Malawi. The WCI is a multidimensional measure based on Sen's capability framework for assessing women's quality of life. Construct validity was assessed by investigating the expected relationships of the dimensions with key socioeconomic characteristics. The majority of hypothesized associations were found to be statistically significant in the expected direction. This provides evidence that the index is measuring quality of life as intended in the conceptual model. Further evidence in support of the index's validity was given by the high degree of correlation between the WCI and another scale measuring comparable (but not identical) domains of quality of life. The results from the internal consistency and the test-retest repeatability also offered encouraging evidence on the reliability of the instrument. This is the first study to rigorously and comprehensively test for validity and reliability a capabilities index for a low-income setting. The results of the validity and reliability tests provide supportive evidence that a locally developed measure of capabilities can be used as a robust tool for the assessment of women's quality of life.

Validating an Agency-based Tool for Measuring Women's Empowerment in a Complex Public Health Trial in Rural Nepal

Despite the rising popularity of indicators of women's empowerment in global development programmes, little work has been done on the validity of existing measures of such a complex concept. We present a mixed methods validation of the use of the Relative Autonomy Index for measuring Amartya Sen's notion of agency freedom in rural Nepal. Analysis of think-aloud interviews (n = 7) indicated adequate respondent understanding of questionnaire items, but multiple problems of interpretation including difficulties with the four-point Likert scale, questionnaire item ambiguity and difficulties with translation. Exploratory Factor Analysis of a calibration sample (n = 511) suggested two positively correlated factors (r = 0.64) loading on internally and externally motivated behaviour. Both factors increased with decreasing education and decision-making power on large expenditures and food preparation. Confirmatory Factor Analysis on a validation sample (n = 509) revealed good fit (Root Mean Square Error of Approximation 0.05-0.08, Comparative Fit Index 0.91-0.99). In conclusion, we caution against uncritical use of agency-based quantification of women's empowerment. While qualitative and quantitative analysis revealed overall satisfactory construct and content validity, the positive correlation between external and internal motivations suggests the existence of adaptive preferences. High scores on internally motivated behaviour may reflect internalized oppression rather than agency freedom.

Appropriateness of unscheduled hospital admissions from care homes

Unscheduled hospital admissions from care homes are common and potentially avoidable but little guidance is available as to what constitutes an appropriate hospital admission. We surveyed healthcare professionals' opinions on a range of common scenarios affecting care-home residents. We developed seven clinical vignettes and an accompanying questionnaire. We used purposive sampling to obtain opinions from relevant primary care and secondary care teams. We asked assessors to comment on whether they would favour hospital admission and to justify their response using pre-selected options and/or free text. Admission to hospital was judged inappropriate in 54.6% of responses. Opinion on admission varied according to the case, with fewer than half of respondents agreeing for three of the seven cases. Recurring themes were uncertainty around services available to care homes and anticipatory care planning. The lack of consensus suggests that concepts surrounding inappropriate care-home admission are not shared by staff who provide care for this patient group.

Validating the measurement of social capital in Bangladesh: a cognitive approach

Despite the growing evidence linking social capital to improvements in health and health behaviors, reliable measures of social capital are lacking in low-income countries. To accurately measure social capital in new contexts, there is a need to validate social capital survey questions in each new cultural setting. In this article, we examine the content validity of the measurement of social capital in Bangladesh using qualitative methods. In December 2012, we conducted four focus group discussions and 32 cognitive interviews in one rural subdistrict (Durgapur) and one urban slum (Mirpur). We used the findings from the focus groups and cognitive interviews to create a new social capital survey instrument that can be used by health and development organizations in Bangladesh. Furthermore, in this article, we provide insight into social capital survey research in general, including suggestions for the measurement of group membership, social support, collective action, and social trust.

Constructing and pre-testing an instrument to assess smoking cessation services within the Brazilian public health system

RATIONALE, AIMS AND OBJECTIVES

Assessing public health interventions is crucial for the development of public policies. Currently, there is no instrument to assess the inputs, activities and short-term outcomes of the smoking cessation programme in the Brazilian public health system. This study reports the development of a questionnaire for that purpose and assesses its suitability.

METHODS

A multidimensional self-administered questionnaire was constructed. Questions were compiled from three Brazilian governmental acts that define the standards and requirements for smoking cessation services. A panel of experts familiar with tobacco control programmes reviewed the instrument. A pre-test was conducted to assess its suitability, with 18 health professionals working in eight different multidisciplinary teams, which treat smokers in two different Brazilian cities. Descriptive statistics were computed. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 21; IBM, São Paulo, Brazil). This study was approved by the Committee on Ethics and Research of the Brazilian National Cancer Institute.

RESULTS

A self-administered multidimensional questionnaire comprising 30 questions was developed in Portuguese. The instrument had a high level of acceptance, and was considered clear and covering all parameters necessary to assess the treatment for smoking cessation by 100% of the pre-test participants. The mean time spent to complete the questionnaire varied between 15 and 30 minutes.

CONCLUSION

An understandable and easy-to-use questionnaire was developed with suitable content and it was well accepted by health professionals. Pre-testing provided a substantial enhancement of the questionnaire, minimizing difficulties in understanding the questions and perfecting the response options. This instrument will contribute to the process of assessing smoking cessation services.

Development and validation of a cross-cultural knowledge, attitudes, and practices survey instrument for chronic kidney disease in a Swahili-speaking population

Introduction

Non-communicable diseases are a growing global burden, and structured surveys can identify critical gaps to address this epidemic. In sub-Saharan Africa, there are very few well-tested survey instruments measuring population attributes related to non-communicable diseases. To meet this need, we have developed and validated the first instrument evaluating knowledge, attitudes and practices pertaining to chronic kidney disease in a Swahili-speaking population.

Methods and Results

Between December 2013 and June 2014, we conducted a four-stage, mixed-methods study among adults from the general population of northern Tanzania. In stage 1, the survey instrument was constructed in English by a group of cross-cultural experts from multiple disciplines and through content analysis of focus group discussions to ensure local significance. Following translation, in stage 2, we piloted the survey through cognitive and structured interviews, and in stage 3, in order to obtain initial evidence of reliability and construct validity, we recruited and then administered the instrument to a random sample of 606 adults. In stage 4, we conducted analyses to establish test-retest reliability and known-groups validity which was informed by thematic analysis of the qualitative data in stages 1 and 2. The final version consisted of 25 items divided into three conceptual domains: knowledge, attitudes and practices. Each item demonstrated excellent test-retest reliability with established content and construct validity.

Conclusions

We have developed a reliable and valid cross-cultural survey instrument designed to measure knowledge, attitudes and practices of chronic kidney disease in a Swahili-speaking population of Northern Tanzania. This instrument may be valuable for addressing gaps in non-communicable diseases care by understanding preferences regarding healthcare, formulating educational initiatives, and directing development of chronic disease management programs that incorporate chronic kidney disease across sub-Saharan Africa.

Pretesting Qualitative Data Collection Procedures to Facilitate Methodological Adherence and Team Building in Nigeria

Qualitative methods are becoming widely used and increasingly accepted in biomedical research involving teams formed by experts from developing and developed practice environments. Resources are rare in offering guidance on how to surmount challenges of team integration and resolution of complicated logistical issues in a global setting. In this article we present a critical reflection of lessons learned and necessary steps taken to achieve methodological coherence and international team synergy. A series of 10 pretest interviews were conducted to assess instrumentation rigor and formulate measures to address any limitations or threats to bias and management procedures before carrying out the formal phase of qualitative research, contributing to an evidence-based stroke-preventive care clinical trial study. The experience of pretesting notably helped to identify obstacles and thus increase the methodological and social reliability central to conducting credible qualitative research, while also ensuring both personal and professional fulfillment of our team members.

Self-rated quality of life of city-dwelling elderly people benefitting from social help: results of a cross-sectional study

Background

The percentage of people aged 65 or older living in Poland is 13.6%, but 17.2% in Łódź. The aim of the study was to identify factors correlating with the self-rated quality of life of elderly inhabitants of cities applying for social help, on the basis of a cross-sectional study.

Methods

The study was conducted in Łódź, a large Polish city, between September 2011 and February 2012 in a group of people applying for help in the Municipal Social Welfare Centre. Four hundred and sixty-six respondents aged 65 or older were included in the study. The tool used in the study was an interview questionnaire. The respondents answered questions on their demographic situation, living conditions, financial, health and social situation. The authors also applied the WHOQOL-BREF Questionnaire, the Activities of Daily Living Scale (ADL) and the Geriatric Depression Scale (GSOD). For statistical purposes, the authors used single- and multiple-factor regression and the Statistica 9.0 Program. The results were presented as an odds ratio (OR) with a 95% confidence interval (CI); the adopted significance level was p < 0.05. The authors applied the Pearson’s x² test in order to evaluate the structure of the studied group and the subpopulation, who were aged 65 or older and using social help, throughout the city.

Results

Logistic regression confirmed that a high quality of life depends on the following variables: university education (OR = 2.31; p < 0.05), an income which is sufficient to live (OR = 1.63; p < 0.05), no heart palpitations (OR = 2.32; p < 0.05), stable blood pressure (OR = 2.32; p < 0.05), no headaches (OR = 1.55; p < 0.05), no pain in the chest (OR = 1.51; p < 0.01), no shortness of breath (OR = 1.51; p < 0.01), no tiredness (OR = 2.08; p < 0.05), a score on the Geriatric Depression Scale pointing to a lack of suspected depression (OR = 9.88; p < 0.001 if the person does not suffer from depression and OR = 6.33; p < 0.001 if there is uncertain depression) as well as not using nursing services, a score on the ADL Scale confirming the person’s fitness and participation in family gatherings.

Conclusions

A subjective evaluation of the quality of life of the elderly depends on many factors. An identification of these factors might be helpful in implementing steps aimed at improving the quality of life of elderly people who, as a consequence, will need less social help: particularly nursing services.