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Nelsen LM, Kosinski M, Rizio AA, Jacques L, Schatz M, Stanford RH, Svedsater H. A structured review evaluating content validity of the Asthma Control Test, and its consistency with U.S. guidelines and patient expectations for asthma control. J Asthma 2020; 59:628-637. [PMID: 33377411 DOI: 10.1080/02770903.2020.1861624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess whether the content of the Asthma Control Test (ACT) served as a valid measure of asthma control (i.e., content validity) by mapping ACT items to the National Heart, Lung and Blood Institute (NHLBI) guideline asthma control definitions, and to language used by patients to describe their asthma. DATA SOURCES PubMed and EMBASE databases were used for a structured literature analysis. STUDY SELECTIONS Full-text, English-language articles that reported findings from qualitative studies conducted in adults, focusing on patient descriptors of asthma symptoms, impacts, or severity, were included. Pediatric studies, studies conducted in patients without asthma, and studies that did not contain qualitative data were excluded. RESULTS ACT items reflected all domains of asthma impairment described in the NHLBI guidelines, except pulmonary function. Following the literature review, 28 full-text publications were identified that included patient descriptors that could be mapped to ACT items. For example, per ACT Item 1, patients described having trouble at work, school, and completing household chores; and, per ACT Item 2, patients used the phrase "short of breath" to describe asthma-associated symptoms. CONCLUSION ACT item content corresponded well with the NHLBI guideline definitions of the impairment domain of asthma control (focused on asthma symptoms and impact), and we identified numerous examples in the literature indicating that ACT concepts and item content mirror the language patients use when discussing asthma symptoms and impact, and their degree of asthma control. This provides further evidence to support content validity of the ACT as a measure of asthma control.
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Affiliation(s)
- Linda M Nelsen
- Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA
| | | | | | | | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, CA, USA
| | - Richard H Stanford
- US Value Evidence and Outcomes, GlaxoSmithKline plc., Research Triangle Park, NC, USA (at the time of study)
| | - Henrik Svedsater
- Value Evidence and Outcomes, GlaxoSmithKline plc., Brentford, MDX, UK
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Ludden T, Shade L, Welch M, Halladay J, Donahue KE, Coyne-Beasley T, Bray P, Tapp H. What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis. BMJ Open 2020; 10:e030883. [PMID: 32152153 PMCID: PMC7064133 DOI: 10.1136/bmjopen-2019-030883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To qualitatively analyse different types of dissemination of information during monthly group calls between researchers, providers and clinical staff used to establish best practices for implementing an asthma shared decision-making (SDM) intervention. Evaluating dissemination of information can provide a better understanding of how best practices are shared, informing implementation approaches to improve the uptake of new evidence and overcome barriers. SETTING 10 primary care practices in North Carolina. PARTICIPANTS Providers and clinical staff participated in monthly group phone calls with researchers to share best practices during implementation of a SDM intervention for asthma patients. DESIGN The research team transcribed and coded statements using content analysis into three different knowledge types: Knowledge Position, Knowledge Form and Knowledge Object. Knowledge Objects were further classified using directed content analysis where the research team interpreted the content objects through a classification process of identifying themes or patterns to describe three different types of dissemination of information: (A) Confirmation of Existing Knowledge, (B) Generation of New Knowledge and (C) Spreading of New Knowledge. RESULTS Across the 8 transcripts, 4 Knowledge Positions, 7 Knowledge Forms and 18 types of Knowledge Objects were identified. From the Knowledge Objects, Confirmation of Existing Knowledge occurred during the training of participating practices. The review also identified Generation of New Knowledge by providers and clinical staff raised in these calls. This Generation of New Knowledge was later documented being used by other practices with the identification of Spreading of New Knowledge. CONCLUSION The research team described the types of dissemination of information that occurred between researchers, providers and clinical staff during implementation of an asthma SDM intervention. Both Confirmation of Existing Knowledge and Generation of New Knowledge in response to barriers occurred. These exploratory dissemination of information results provide additional mechanisms for evaluating implementation science. TRIAL REGISTRATION NUMBER NCT02047929; Post-results.
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Affiliation(s)
- Thomas Ludden
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Lindsay Shade
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Madelyn Welch
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jacqueline Halladay
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katrina E Donahue
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tamera Coyne-Beasley
- Department of Pediatrics and Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Bray
- Community Based Care, Vidant Medical Center, Greenville, North Carolina, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
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Arcia A, George M, Lor M, Mangal S, Bruzzese JM. Design and Comprehension Testing of Tailored Asthma Control Infographics for Adults with Persistent Asthma. Appl Clin Inform 2019; 10:643-654. [PMID: 31486056 PMCID: PMC6727064 DOI: 10.1055/s-0039-1693713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adherence to daily inhaled corticosteroid medication is important for asthma control but low health literacy is a barrier to comprehension of control status and may contribute to medication nonadherence. Infographics tailored with patients' own data can support comprehension of health status, but these have not been applied to asthma successfully. OBJECTIVES This two-phased study developed and tested tailored infographics of (1) scores on the Asthma Control Questionnaire (ACQ), a self-report measure of symptom burden, and (2) pulmonary function test (PFT) results. The infographics are intended for use as communication and adherence-promotion tools in clinical interactions. METHODS For both phases, participants (18+ years, English- or Spanish-speaking, persistent asthma) were recruited through two primary care clinics. In Phase I, we used a hybrid iterative participatory design process to refine prototype designs. In Phase II, we conducted individual comprehension assessment interviews with the finalized designs. Infographics were hand-tailored for each participant using their ACQ score and PFT results collected at the start of the interview. Two independent raters scored interview transcripts for gist and verbatim comprehension based on a predetermined rubric. RESULTS The five Phase I design sessions led to final prototypes that participants (n = 21) considered appealing and easy to comprehend. All Phase II participants (n = 10) demonstrated complete gist and verbatim comprehension. Participants reacted favorably to receiving their information via infographics and expressed intentions to engage in self-management behaviors (e.g., medication adherence, smoking cessation, weight loss, and review of their care plan) in response to the information. CONCLUSION This study provides preliminary evidence that infographics can support comprehension of asthma control status and promote self-management intentions among adults with persistent asthma. Infographics can be programmed into electronic health records and/or standalone applications to allow for instant tailoring at the point of care.
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Affiliation(s)
- Adriana Arcia
- Columbia University School of Nursing, New York, New York, United States
| | - Maureen George
- Columbia University School of Nursing, New York, New York, United States
| | - Maichou Lor
- Columbia University School of Nursing, New York, New York, United States
| | - Sabrina Mangal
- Columbia University School of Nursing, New York, New York, United States
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Ware JE, Richardson MM, Meyer KB, Gandek B. Improving CKD-Specific Patient-Reported Measures of Health-Related Quality of Life. J Am Soc Nephrol 2019; 30:664-677. [PMID: 30898870 DOI: 10.1681/asn.2018080814] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/30/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures that are more practical and clinically useful are needed for patients with CKD. We compared a new CKD-specific quality-of-life impact scale (CKD-QOL) with currently used measures. METHODS Patients (n=485) in different treatment groups (nondialysis stages 3-5, on dialysis, or post-transplant) completed the kidney-specific CKD-QOL and Kidney Disease Quality of Life-36 (KDQOL-36) forms and the generic SF-12 Health Survey at baseline and 3 months. New items summarizing quality of life (QOL) impact attributed to CKD across six QOL domains yielded single impact scores from a six-item static (fixed-length) form and from computerized adaptive tests (CATs) with three to six items. Validity tests compared the CKD-QOL, KDQOL-36 (Burden, Effects, and Symptoms/Problems subscales), and generic SF-12 measures across groups in four tests of clinical status and clinician assessment of change (CKD-specific tests), and number of comorbidities. ANOVA was used to test for group mean differences, variances in each measure explained by groups, and relative validity (RV) in comparison with the referent KDQOL-36 Burden subscale. RESULTS KDQOL-36 and CKD-QOL measures generally discriminated better than generic SF-12v2 measures. The pattern of variances across CKD-specific tests comparing validity favored CKD-QOL two-fold over KDQOL-36. Two RV test results confirmed CKD-QOL improvements over the referent KDQOL scale. Results for static and CAT CKD-QOL forms were similar. SF-12 Physical and KDQOL-36 Symptoms scores worsened with increasing comorbid condition counts. CONCLUSIONS Overall, compared with the KDQOL-36, the new approach to summarizing CKD-specific QOL impact performed better across multiple tests of validity. CAT surveys were more efficient than static surveys.
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Affiliation(s)
- John E Ware
- John Ware Research Group, Outcomes Measurement Department, Watertown, Massachusetts; .,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Michelle M Richardson
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; and.,Dialysis Clinic, Inc., Outcomes Monitoring Program, Boston, Massachusetts
| | - Klemens B Meyer
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; and.,Dialysis Clinic, Inc., Outcomes Monitoring Program, Boston, Massachusetts
| | - Barbara Gandek
- John Ware Research Group, Outcomes Measurement Department, Watertown, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Welch M, Ludden T, Mottus K, Bray P, Hendrickson L, Rees J, Halladay J, Tapp H. Patient and provider perspectives on uptake of a shared decision making intervention for asthma in primary care practices. J Asthma 2018; 56:562-572. [PMID: 29927661 DOI: 10.1080/02770903.2018.1471703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Poor outcomes and health disparities related to asthma result in part from difficulty disseminating new evidence such as shared decision making (SDM) into clinical practice. As part of a three-arm cluster randomized dissemination study, evaluation of the impact of different dissemination methods was studied. Here we evaluate themes from patient and provider focus groups to assess the impact of a facilitated, traditional dissemination approach, or no intervention, on patient and provider perspectives of asthma care. METHODS Using semi-structured questions, twenty-four pre- and post-intervention focus groups with patients and providers took place across primary care practices. Discussions were held in all three arms both before and after the time of intervention rollout. Audio recordings were transcribed and analyzed for themes. RESULTS Across all sites patients and providers discussed themes of communication, asthma self-management, barriers, education, and patient awareness. After the intervention, compared to traditional sites, facilitated practices were more likely to discuss themes related to SDM, such as patient-centered communication, patient-provider negotiation on treatment plan, planning, goal-setting, and solutions to barriers. CONCLUSIONS Emergent themes allowed for further understanding of how the SDM implementation was perceived at the patient and provider level. The facilitated implementation was associated with higher adoption of the SDM intervention. These themes and supporting quotes add to knowledge of best practices associated with implementing an evidence-based SDM intervention for asthma into primary care and will inform researchers, practices, and providers as they work to improve adoption of evidence-based interventions into practice.
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Affiliation(s)
- Madelyn Welch
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
| | - Thomas Ludden
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
| | - Kathleen Mottus
- b University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Paul Bray
- c Vidant Medical Group , Greenville , NC , USA
| | | | - Jennifer Rees
- b University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | - Hazel Tapp
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
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Ware JE, Gandek B, Guyer R, Deng N. Standardizing disease-specific quality of life measures across multiple chronic conditions: development and initial evaluation of the QOL Disease Impact Scale (QDIS®). Health Qual Life Outcomes 2016; 14:84. [PMID: 27255462 PMCID: PMC4890258 DOI: 10.1186/s12955-016-0483-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/06/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To document the development and evaluation of the Quality of life Disease Impact Scale (QDIS®), a measure that standardizes item content and scoring across chronic conditions and provides a summary, norm-based QOL impact score for each disease. METHODS A bank of 49 disease impact items was constructed from previously-used descriptions of health impact to represent ten frequently-measured quality of life (QOL) content areas and operational definitions successfully utilized in generic QOL surveys. In contrast to health in general, all items were administered with attribution to a specific disease (osteoarthritis, rheumatoid arthritis, angina, myocardial infarction, congestive heart failure, chronic kidney disease (CKD), diabetes, asthma, or COPD). Responses from 5418 adults were analyzed as five disease groups: arthritis, cardiovascular, CKD, diabetes, and respiratory. Unidimensionality, item parameter and scale-level invariance, reliability, validity and responsiveness to change during 9-month follow-up were evaluated by disease group and for all groups combined using multi-group confirmatory factor analysis (MGCFA), item response theory (IRT) and analysis of variance methods. QDIS was normed in an independent chronically ill US population sample (N = 4120). RESULTS MGCFA confirmed a 1-factor model, justifying a summary score estimated using equal parameters for each item across disease groups. In support of standardized IRT-based scoring, correlations were very high between disease-specific and standardized IRT item slopes (r = 0.88-0.96), thresholds (r = 0.93-0.99) and person-level scores (r ≥ 0.99). Internal consistency, test-retest and person-level IRT reliability were consistently satisfactory across groups. In support of interpreting QDIS as a disease-specific measure, in comparison with generic measures, QDIS consistently discriminated markedly better across disease severity levels, correlated higher with other disease-specific measures in cross-sectional tests, and was more responsive in comparisons of groups with better, same or worse evaluations of disease-specific outcomes at the 9-month follow-up. CONCLUSIONS Standardization of content and scoring across diseases was shown to be justified psychometrically and enabled the first summary measure of disease-specific QOL impact normed in the chronically ill population. This disease-specific approach substantially improves discriminant validity and responsiveness over generic measures and provides a basis for better understanding the relative QOL impact of multiple chronic conditions in research and clinical practice.
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Affiliation(s)
- John E. Ware
- />John Ware Research Group, 10 Wheeler Court, Watertown, MA 02472 USA
- />Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA USA
| | - Barbara Gandek
- />John Ware Research Group, 10 Wheeler Court, Watertown, MA 02472 USA
- />Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA USA
| | - Rick Guyer
- />John Ware Research Group, 10 Wheeler Court, Watertown, MA 02472 USA
| | - Nina Deng
- />Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA USA
- />Measured Progress, Dover, NH USA
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Gater A, Nelsen L, Fleming S, Lundy JJ, Bonner N, Hall R, Marshall C, Staunton H, Krishnan JA, Stoloff S, Schatz M, Haughney J. Assessing Asthma Symptoms in Adolescents and Adults: Qualitative Research Supporting Development of the Asthma Daily Symptom Diary. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:440-450. [PMID: 27325336 DOI: 10.1016/j.jval.2016.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/08/2015] [Accepted: 01/17/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite the widespread availability of patient-reported asthma questionnaires, instruments developed in accordance with present regulatory expectations are lacking. To address this gap, the Patient-Reported Outcome (PRO) Consortium's Asthma Working Group has developed a patient-reported asthma daily symptom diary (ADSD) for use in clinical research to assess outcomes and support medical product labeling claims in adults and adolescents with asthma. OBJECTIVES To summarize the qualitative research conducted to inform the initial development of the ADSD and to provide evidence for content validity of the instrument in accordance with the Food and Drug Administration's PRO Guidance. METHODS Research informing the initial development and confirming the content validity of the ADSD is summarized. This comprised a review of published qualitative research, semi-structured concept elicitation interviews (n = 55), and cognitive interviews (n = 65) with a diverse and representative sample of adults and adolescents with a clinician-confirmed diagnosis of asthma in the United States to understand the asthma symptom experience and to assess the relevance and understanding of the newly developed ADSD. RESULTS From the qualitative literature review and concept elicitation interviews, eight core asthma symptoms emerged. These were broadly categorized as breathing symptoms (difficulty breathing, shortness of breath, and wheezing), chest symptoms (chest tightness, chest pain, and pressure/weight on chest), and cough symptoms (cough and the presence of mucus/phlegm). Conceptual saturation was achieved and differences in the experience of participants according to socio-demographic or clinical characteristics were not observed. Subsequent testing of the ADSD confirmed participant relevance and understanding. CONCLUSIONS The ADSD is a new patient-reported asthma symptom diary developed in accordance with the Food and Drug Administration's PRO Guidance. Evidence to date supports the content validity of the instrument. Item performance, reliability, and construct validity will be assessed in future quantitative research.
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Affiliation(s)
- Adam Gater
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK.
| | | | | | | | - Nicola Bonner
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | - Rebecca Hall
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | - Chris Marshall
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | | | - Jerry A Krishnan
- University of Illinois Hospital and Health Sciences System, Medical Center Administration, Chicago, IL, USA
| | | | - Michael Schatz
- Kaiser Permanente Medical Center/Kaiser Foundation Hospital, San Diego, CA, USA
| | - John Haughney
- University of Aberdeen, King's College, Aberdeen, UK
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Blasi F, Bettoncelli G, Canonica GW, Centanni S, Crimi N, DiMaria G, Gasparini S, Gentili G, Girbino G, Mereu C, Minghetti P, Nardini S, Paggiaro P, Papi A, Pistolesi M, Rossi A. The management of asthma in the phenotype and biomarker era: The proposal of a new diagnostic-therapeutic model. J Asthma 2016; 53:665-7. [PMID: 27050723 DOI: 10.3109/02770903.2016.1140774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treatment goals in asthma patients are the achievement of a good control of symptoms and the reduction of the risk of exacerbation. However, a "one-size-fits-all" therapeutic strategy is no longer appropriate to effectively pursue these goals, due to the heterogeneity of asthma. To make the treatment scenario even more complex, asthma patients often present comorbidities that may alter response to therapy. In addition, adherence to asthma treatment is poor. Given this complex and heterogeneous picture, the management of asthma is highly challenging. A clear diagnostic-therapeutic model of patients' care and the definition of the specific responsibilities of different healthcare providers appear necessary to improve clinical outcomes and better allocate healthcare resources. We present here a proposal for this model.
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Affiliation(s)
- Francesco Blasi
- a Department of Pathophysiology and Transplantation University of Milan , IRCCS Fondazione Cà Granda Milano , Milan , Italy
| | | | | | | | | | | | | | | | | | - Carlo Mereu
- j Pneumology Unit, Santa Corona Hospital , Savona , Italy
| | | | | | - Pierluigi Paggiaro
- l Cardio-Thoracic and Vascular Department , University of Pisa , Pisa , Italy
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Mowrer JL, Tapp H, Ludden T, Kuhn L, Taylor Y, Courtlandt C, Alkhazraji T, Reeves K, Steuerwald M, Andrew M, Dulin M. Patients' and providers' perceptions of asthma and asthma care: a qualitative study. J Asthma 2015; 52:949-56. [PMID: 25975701 DOI: 10.3109/02770903.2015.1010731] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Differences in patients' and providers' perceptions of asthma and asthma care can create barriers to successful treatment. The primary goal of this qualitative study was to further explore patient and provider perceptions of asthma and asthma care as part of a larger Asthma Comparative Effectiveness Study. METHODS Focus groups held every 6 months for 3 years were designed to have a mix of both patients and providers allowing for unique understanding around asthma care. RESULTS The discussion centered on goal setting, asthma action plans and prevention strategies for asthma exacerbations. Three overarching themes, with a variety of subthemes, emerged as the main findings of this study. The three main themes were Cost/Economic Barriers/Process, Self-Governance/Adherence and Education. CONCLUSIONS These themes indicated a strong need for patient educational interventions around asthma as well as education for providers around cost, insurance coverage and patient-centered communication. Specifically, education on learning to use inhalers properly, avoiding triggers and understanding the importance of a controller medication will benefit patients in the long-term management of asthma.
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Affiliation(s)
- J Lauren Mowrer
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
| | - Hazel Tapp
- b Family Medicine Research, Carolinas HealthCare System , Charlotte , NC , USA
| | - Thomas Ludden
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
| | - Lindsay Kuhn
- b Family Medicine Research, Carolinas HealthCare System , Charlotte , NC , USA
| | - Yhenneko Taylor
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
| | - Cheryl Courtlandt
- c Department of Pediatrics , Carolinas HealthCare System , Charlotte , NC , USA , and
| | - Tami Alkhazraji
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
| | - Kelly Reeves
- b Family Medicine Research, Carolinas HealthCare System , Charlotte , NC , USA
| | | | - McWilliams Andrew
- b Family Medicine Research, Carolinas HealthCare System , Charlotte , NC , USA
| | - Michael Dulin
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
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Qualitative approaches to understanding patient preferences. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 5:215-23. [PMID: 23006055 DOI: 10.1007/bf03262494] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Achieving patient-centered care depends on a thorough understanding of patient preferences at all stages of their journeys through healthcare. Qualitative research methods provide the means to systematically collect and analyze these preferences. Qualitative approaches to research are diverse in character, but many such approaches have a long history and strong disciplinary roots. Despite variation, most qualitative approaches work inductively from the 'ground up', and seek to build knowledge and understanding rather than test hypotheses. Their use to explore patient pathways through care has offered insight into reasons why people become patients in the first instance, their preferences for treatment options and degree of involvement in decisions, and their preferences for healthcare delivery. Qualitative approaches are sometimes used alongside 'quantitative' in mixed methods designs, requiring solid expertise and resourcing. Expertise is also crucial in the assessment of quality in qualitative research, and efforts to develop checklists to assess quality are challenged by evidence about the importance of expertise-based judgments. Recent developments in health research include an upsurge in patient involvement activities in design of research and healthcare services; these may seem similar to qualitative research, but are in fact very different. While an important part of the research landscape, patient involvement activities are not intended to provide robust research-based evidence about patients' preferences or experiences. There is pressing need to bridge the gap between qualitative research evidence and patient involvement in the design of research and services. Participatory research methods that harness qualitative approaches may be a way to achieve this.
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Turner-Bowker DM, Saris-Baglama RN, Derosa MA, Paulsen CA. Cognitive testing and readability of an item bank for measuring the impact of headache on health-related quality of life. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2012; 5:89-99. [PMID: 22510051 DOI: 10.2165/11592170-000000000-00000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Patient-reported outcomes (PRO) measures should be valid and accessible to a wide audience. OBJECTIVE Cognitive item testing and readability studies were conducted to evaluate how adult headache sufferers (N = 9) understood and responded to the Headache Impact Test (HIT™) item bank, a PRO measure for headache that serves as the source of item content for the HIT-6™ (a widely used six-item short-form measure of headache impact with more than 30 language translations), and the Dynamic Health Assessment Headache Impact Test (DYNHA® HIT™) [a computerized adaptive test (CAT) of headache impact]. METHODS During cognitive interviews, participants were asked to 'think aloud' as they read survey instructions, completed items, and formulated responses. Data analyses evaluated item comprehension, memory recall of relevant information, and decision and response processes; compared various item attributes; and tested shortened item versions. RESULTS Survey readability was at the seventh-grade level. Respondents understood most revised items as intended, and found shorter items comparable to longer items with some exceptions. When recall period was included in instructions but not within the items themselves, respondents often expanded the recall period to answer the item. Some response scales (e.g. "Never" to "Always") were more readily understood than others (e.g. "Definitely true" to "Definitely false"). CONCLUSION Qualitative research can improve the validity and accessibility of PRO measures that are used to monitor health conditions and aid patient-provider communication.
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Turner-Bowker DM, DeRosa MA, Saris-Baglama RN, Bjorner JB. Development of a computerized adaptive test to assess health-related quality of life in adults with asthma. J Asthma 2011; 49:190-200. [PMID: 22115275 DOI: 10.3109/02770903.2011.633674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this research was to calibrate an item bank for a computerized adaptive test (CAT) of asthma impact on health-related quality of life (HRQOL), test CAT versions of varying lengths, conduct preliminary validity testing, and evaluate item bank readability. METHODS Asthma Impact Survey (AIS) bank items that passed focus group, cognitive testing, and clinical and psychometric reviews were administered to adults with varied levels of asthma control. Adults self-reporting asthma (N = 1106) completed an Internet survey including 88 AIS items, the Asthma Control Test, and other HRQOL outcome measures. Data were analyzed using classical and modern psychometric methods, real-data CAT simulations, and known groups validity testing. RESULTS A bi-factor model with a general factor (asthma impact) and several group factors (cognitive function, fatigue, mental health, physical function, role function, sexual function, self-consciousness/stigma, sleep, and social function) was tested. Loadings on the general factor were above 0.5 and were substantially larger than group factor loadings, and fit statistics were acceptable. Item functioning for most items and fit to the model was acceptable. CAT simulations demonstrated several options for administration and stopping rules. AIS distinguished between respondents with differing levels of asthma control. CONCLUSIONS The new 50-item AIS item bank demonstrated favorable psychometric characteristics, preliminary evidence of validity, and accessibility at moderate reading levels. Developing item banks for CAT can improve the precise, efficient, and comprehensive monitoring of asthma outcomes and may facilitate patient-centered care.
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Turner-Bowker DM, Saris-Baglama RN, Smith KJ, DeRosa MA, Paulsen CA, Hogue SJ. Heuristic evaluation and usability testing of a computerized patient-reported outcomes survey for headache sufferers. Telemed J E Health 2011; 17:40-5. [PMID: 21214341 DOI: 10.1089/tmj.2010.0114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate usability of a prototype tablet PC-administered computerized adaptive test (CAT) of headache impact and patient feedback report, referred to as HEADACHE-CAT. MATERIALS AND METHODS Heuristic evaluation specialists (n = 2) formed a consensus opinion on the application's strengths and areas for improvement based on general usability principles and human factors research. Usability testing involved structured interviews with headache sufferers (n = 9) to assess how they interacted with and navigated through the application, and to gather input on the survey and report interface, content, visual design, navigation, instructions, and user preferences. RESULTS Specialists identified the need for improved instructions and text formatting, increased font size, page setup that avoids scrolling, and simplified presentation of feedback reports. Participants found the tool useful, and indicated a willingness to complete it again and recommend it to their healthcare provider. However, some had difficulty using the onscreen keyboard and autoadvance option; understanding the difference between generic and headache-specific questions; and interpreting score reports. CONCLUSIONS Heuristic evaluation and user testing can help identify usability problems in the early stages of application development, and improve the construct validity of electronic assessments such as the HEADACHE-CAT. An improved computerized HEADACHE-CAT measure can offer headache sufferers an efficient tool to increase patient self-awareness, monitor headaches over time, aid patient-provider communications, and improve quality of life.
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Anatchkova MD, Bjorner JB. Health and role functioning: the use of focus groups in the development of an item bank. Qual Life Res 2010; 19:111-23. [PMID: 20047086 DOI: 10.1007/s11136-009-9570-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Role functioning is an important part of health-related quality of life. However, assessment of role functioning is complicated by the wide definition of roles and by fluctuations in role participation across the life-span. The aim of this study is to explore variations in role functioning across the lifespan using qualitative approaches, to inform the development of a role functioning item bank and to pilot test sample items from the bank. METHODS Eight focus groups were conducted with a convenience sample of 38 English-speaking adults recruited in Rhode Island. Participants were stratified by gender and four age groups. Focus groups were taped, transcribed, and analyzed for thematic content. RESULTS Participants of all ages identified family roles as the most important. There was age variation in the importance of social life roles, with younger and older adults rating them as more important. Occupational roles were identified as important by younger and middle-aged participants. The potential of health problems to affect role participation was recognized. Participants found the sample items easy to understand, response options identical in meaning and preferred five response choices. CONCLUSIONS Participants identified key aspects of role functioning and provided insights on their perception of the impact of health on their role participation. These results will inform item bank generation.
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Affiliation(s)
- Milena D Anatchkova
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Journal Watch. Pharmaceut Med 2009; 23. [PMCID: PMC7100411 DOI: 10.1007/bf03256789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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