Content validation of the HeartRunner questionnaire to volunteer responders dispatched to out-of-hospital cardiac arrests: A qualitative study

Aim

To increase survival after out-of-hospital cardiac arrest (OHCA) in Denmark, volunteer responders are activated through a smartphone application (HeartRunner app) to quickly locate an automated external defibrillator (AED) and assist with cardiopulmonary resuscitation (CPR). All dispatched volunteer responders who have been activated by the app receive a follow-up questionnaire to evaluate their participation in the programme. The content of the questionnaire has never been thoroughly evaluated. We therefore aimed to validate the content of the questionnaire.

Methods

Content validity was evaluated qualitatively. It was based on individual interviews with three experts, along with three focus group interviews and five individual interviews using cognitive interview technique, with a total of 19 volunteer responders. The interviews were also used to inform refinements of the questionnaire to reach improvements in content validity.

Results

The initial questionnaire consisted of 23 items. After the content validation process, the questionnaire consisted of 32 items; with the addition of 9 new items. Specifically, some original items were merged into one item or divided into separate items. Moreover, we revised the order of items, some sentences were rephrased or reworded, an introduction and headlines to different sections were added, and skip logic were incorporated to hide non-relevant items.

Conclusion

Our findings support the importance of validating questionnaires to ensure accuracy of survey instruments. Validation led to modifications of the questionnaire, and we propose a new version of the HeartRunner questionnaire. Our findings support the content validity of the final HeartRunner questionnaire. The questionnaire may allow the collection of quality data to evaluate and improve volunteer responder programmes.

Social disparities in the use of ART treatment: a national register-based cross-sectional study among women in Denmark

STUDY QUESTION

How are educational level, labor market attachment and income associated with receiving a first ART treatment in either the public or private healthcare sector among women in Denmark?

SUMMARY ANSWER

Higher educational level and income as well as labor market attachment were associated with higher probability of initiating ART treatment at public and private fertility clinics among women in Denmark.

WHAT IS KNOWN ALREADY

Infertility is common in populations worldwide, and the approach to this issue differs between societies and healthcare systems. In the public Danish healthcare system, ART treatment is free of charge, and the direct cost for patients is therefore low. In the private healthcare sector in Denmark, ART treatment is self-financed. There is limited knowledge about the association between socioeconomic factors and seeking ART treatment, although previous studies have indicated that higher socioeconomic status is associated with seeking ART treatment.

STUDY DESIGN, SIZE, DURATION

Women undergoing ART treatment during 1994-2016 registered in the Danish IVF register were individually linked with data from sociodemographic population registers using the Danish Personal Identification number. The study population consisted of 69 018 women treated with ART and 670 713 age-matched comparison women from the background population with no previous history of ART treatment.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The women included in the analyses were aged 18-45 years. The associations between attained educational level, labor market attachment and income and receiving a first ART treatment attempt were investigated for women either initiating treatment in the public sector or in the private sector, respectively. Information on age and origin was included as potential confounders, and odds ratios (ORs) were estimated in logistic regression models. In addition, analyses were stratified by age group to investigate potential differences across the age span.

MAIN RESULTS AND THE ROLE OF CHANCE

Adjusted results showed increased odds of receiving a first ART treatment in either the public or private sector among women with a higher educational level. Furthermore, women in employment were more likely to receive a first ART treatment in the public or private sector compared to women outside the workforce. The odds of receiving a first ART treatment increased with increasing income level. Surprisingly, income level had a greater impact on the odds of receiving a first ART treatment in the public sector than in the private sector. Women in the highest income group had 10 times higher odds of receiving a first ART treatment in the public sector (OR: 10.53 95% CI: 10.13, 10.95) compared to women in the lowest income group. Sub-analyses in different age groups showed significant associations between ART treatment and income level and labor market attachment in all age groups.

LIMITATIONS, REASONS FOR CAUTION

Our study does not include non-ART treatments, as the national IVF register did not register these types of fertility treatments before 2007.

WIDER IMPLICATIONS OF THE FINDINGS

In Denmark, there is equal access to medically assisted reproduction treatment in the publicly funded healthcare system, and since there is no social inequality in the prevalence of infertility, social inequality in the use of ART treatment would not be expected as such. However, our results show that social inequality is found for a first ART treatment attempt across publicly and privately funded ART treatment across the socioeconomic indicators, educational level, labor market attachment and income.

STUDY FUNDING/COMPETING INTEREST(S)

The funding for the establishment of the Danish National ART-Couple II Cohort (DANAC II Cohort) was obtained from the Rosa Ebba Hansen Foundation. The authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Using Intervention Mapping to develop an intervention to promote healthy child weight development

Background

Clear documentation of the understanding of the problem, development process, and content of interventions is essential to understand why interventions succeed or fail. Transparent reporting will enable future researchers to build on previous evidence and replicate or adapt interventions for new contexts. This paper describes the theory- and evidence-based systematic development of the Bloom Trial - a home-based intervention to promote healthy weight development among infants and children in Denmark.

Methods

Development of the intervention is guided by the six-step planning tool the Intervention Mapping protocol. Step 1: Needs assessment including identification of risk factors in infancy and existing interventions, interviews with parents, and an organizational capacity assessment. Step 2: Development of program theory and matrices. Step 3: Selection of theoretical methods and practical applications for modifying personal and environmental determinants. Step 4: Development of intervention tools. Step 5: Planning of program adoption, implementation, and sustainability. Step 6: Generation of an evaluation plan.

Results

The Bloom intervention is universal but with a strong focus on families with low socio-economic position and non-Danish ethnic background. It is aimed at first-time parents and addresses early risk factors for child overweight such as parental skills and healthy habits related to food and meals, movement, screen time and sleep, and introduce a new theme: sense of security in the family. It will be integrated in existing services delivered by community health nurses supplemented with extra elements such as telephone consultations, family groups and a video library.

Conclusions

The transparency of the developmental process and theoretical, empirical, and contextual foundation of the Bloom Trial may enable future studies to build on our findings and accumulate knowledge to promote healthy weight development among infants and children.

Key messages

Parents’ perceptions of barriers & facilitators for adhering to advice from community health nurses

Background

Childhood obesity is a global health problem and infancy is an important window of opportunity for promoting healthy weight development. In Denmark, community health nurses cover most families with a new-born child leaving a huge potential for promoting healthy weight development. This study examines parents’ perceptions of barriers and facilitators for adhering to advice from the health nurse regarding healthy weight development of their child.

Methods

Sixteen interviews with parents (children aged 0- 2 years) living in Denmark were conducted. Parents were strategically sampled representing variations across child age, family socioeconomic position, ethnicity, and geography. All interviews were based on a semi-structured interview guide, recorded, and transcribed verbatim and analysed using a thematic analysis.

Findings

Parents generally experience visits from their health nurse positively. Health nurses are emphasized as a confident and trustful relation and the key informant about children's’ health. Variations in how parents adhere to advice favouring healthy weight development of their child were found. Generally, parents adopted a positive attitude towards the health nurse, also when she addressed behaviour or practice of the parents, but parents expressed the importance of doing so in a non-stigmatising or finger pointing manner. The degree to which parents follow the advice from their health nurse depend on cultural background, advice from family and friends, and use of online information.

Conclusions

Parents generally have a confident and trustful relation to the health nurse, and she constitutes the key informant on child health. This leaves a potential for the structure of Danish health nurses for future interventions promoting healthy weight development. Adaptation of the future intervention program to the needs of parents will increase the chances of developing a relevant, successful, and sustainable intervention.

Key messages

• Health nurses are emphasized as a trustful relation and the key informant about children’s’ health, but parents expressed the importance of addressing behaviours in a non-stigmatising manner.

• Adapting information gained from parents in development of the trial will increase the chances of a relevant, successful, and sustainable intervention promoting healthy child weight development.

Adaptation, Student Participation and Gradual Withdrawal by Researchers as Sustainability Strategies in the High School-Based Young and Active Intervention: School Coordinators' Perspectives

Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&A) intervention used peer-led workshops to promote movement and strengthen students' sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&A, focusing on school coordinators' reflections on the intervention's fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.