The validity of instruments to measure knowledge in population-based cancer screening targeting individuals at average risk - A systematic review.

OBJECTIVES: Relevant knowledge is essential for informed choices about (non)participation in population-based cancer screening. Many instruments have been proposed to assess residents' knowledge about cancer screening programmes but their measurement properties are unknown. This systematic review aims to identify and critically evaluate the measurement properties of instruments to measure knowledge about cancer screening in individuals eligible for population-based screening. METHODS: A literature search was undertaken in PubMed, PsycINFO, Embase, CINAHL, Scopus and Web of Science in August 2023. The review included any study reporting one or more measurement properties of the questionnaire or sub-scale used measuring knowledge of cancer screening including breast, colorectal and/or cervical cancer screening. Studies including males aged 45 or older and females aged 20 or older were included. Two independent reviewers screened the articles and assessed the included articles using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN). RESULTS: We included 24 instruments, which varied in number and characteristics of items. All instruments were assessed as having an inadequate instrument development. The results of structural validity, internal consistency, criterion validity and reliability were assessed as indeterminate, while construct validity and responsiveness were assessed as sufficient. CONCLUSION: This systematic review identified no instruments to measure knowledge about cancer screening where the measurement properties were sufficiently evaluated. There is a lack of focus on content validity and structural validity, and further validation of the instruments is needed. The results indicate a lack of shared understanding or agreement of what constitutes relevant knowledge about cancer screening.

The GLA:D BACK self-management adherence and competence checklist (SMAC Checklist)-Development, content validity and feasibility.

OBJECTIVES: To unpack the complexity and impact of self-management interventions targeting musculoskeletal health conditions, we need to learn more about treatment delivery in clinical settings. Fidelity evaluation can illuminate how complex treatments are delivered and help understand the elements that lead to the effect. The objective of this study was to develop a checklist for the evaluation of the clinicians' delivery of structured patient education and exercise intervention for people with persistent back pain, the GLA:D Back intervention. The intent was to provide a checklist adaptable for the general delivery of self-management interventions for musculoskeletal pain. METHODS: We derived items for the treatment delivery fidelity checklist from behaviour change techniques and theory about communication style. We applied a three-step developmental process covering developing a preliminary fidelity intervention framework, validating checklist content and piloting and refining the checklist. RESULTS: We developed the adaptable fidelity checklist, The GLA:D BACK Self-management Adherence and Competence Checklist (SMAC Checklist). Evaluation of clinical practice using the checklist was feasible and acceptable by clinicians. Preliminary results indicate satisfactory observer agreement during pilot testing of the checklist. CONCLUSION: The GLA:D BACK Self-management Adherence and Competence Checklist is a fidelity measurement tool for the assessment of the delivery of a self-management supportive intervention for people with persistent back pain. The intention is that it can be useful as an adaptable tool for use across self-management interventions for musculoskeletal pain.

Diagnostic Screening for Lumbar Spinal Stenosis.

PURPOSE: To develop a self-administered diagnostic screening questionnaire for lumbar spinal stenosis (LSS) consisting of items with high content validity and to investigate the diagnostic value of the questionnaire and the items. PATIENTS AND METHODS: A self-reported diagnostic LSS screening questionnaire was developed based on items from the existing literature describing key symptoms of LSS. The screening questionnaire (index test) was to be tested in a cohort of patients with persistent lumbar and/or leg pain recruited from a Danish publicly funded outpatient secondary care spine clinic with clinicians performing the reference test. However, to avoid unnecessary collection of data if the screening questionnaire proved to be of limited value, a case-control design was incorporated into the cohort design including an interim analysis. Additional cases for the case-control study were recruited at two Danish publicly funded spine surgery departments. Prevalence, sensitivity, specificity and diagnostic odds ratio (OR) were calculated for each individual item, and AUC (area under the curve) was calculated to examine the performance of the full questionnaire. RESULTS: A 13-item Danish questionnaire was developed and tested in 153 cases and 230 controls. The interim analysis was not in favour of continuing the cohort study, and therefore, only results from the case-control study are reported. There was a positive association for all items except the presence of back pain. However, the association was only moderate with ORs up to 3.3. When testing the performance of the whole questionnaire, an AUC of 0.72 was reached with a specificity of 20% for a fixed sensitivity of 95%. CONCLUSION: The items were associated with LSS and therefore have some potential to identify LSS patients. However, the association was not strong enough to provide sufficient accuracy for a diagnostic tool. Additional dimensions of symptoms of LSS need identification to obtain a reliable questionnaire for screening purposes.

Quality-of-Life Differences among Diagnostic Subgroups of Children Receiving Ventilating Tubes for Otitis Media.

OBJECTIVE: The pathological picture may differ considerably between diagnostic subgroups of children with otitis media receiving ventilating tubes. The aims of this study are to investigate differences in quality of life among diagnostic subgroups of children treated with ventilating tubes and to investigate possible predictors for clinical success. STUDY DESIGN: Longitudinal observational study. SETTING: Secondary care units. METHODS: Four hundred ninety-one families were enrolled in the study. The Otitis Media-6 questionnaire was applied in the assessment of child quality of life. Caregivers completed questionnaires at 7 time points from before treatment to 18-month follow-up. Logistic regression analysis was used to investigate possible predictors for clinical success. RESULTS: Response rates ranged from 96% to 81%; diagnostic distribution: 15% recurrent acute otitis media (rAOM), 47% otitis media with effusion (OME), and 38% mixed diagnosis of rAOM and OME (rAOM/OME). There were no significant differences between children diagnosed with rAOM and children diagnosed with rAOM/OME. However, these children had a significantly poorer quality of life at baseline compared with children diagnosed with only OME. Factors associated with clinical success included a diagnosis of rAOM, number of interrupted nights, physician visits, and canceled social activities due to OM. CONCLUSIONS: Results highlight the importance of distinguishing between diagnostic subgroups of children having ventilating tube treatment. A diagnosis of rAOM was found to predict baseline quality of life. Children with rAOM with or without OME were found to suffer significantly more than children with only OME before treatment. Factors associated with disease severity were found to predict clinical success.

Caregiver Quality of Life and Daily Functioning in Relation to Ventilating Tube Treatment.

OBJECTIVE: Caregiver quality of life and daily functioning may improve after ventilating tube treatment in children with otitis media. The aims of this study are to assess possible changes in caregiver quality of life and daily functioning in relation to ventilating tube treatment and to investigate possible predictors for clinical success. STUDY DESIGN: Longitudinal observational study. SETTING: Secondary care units. METHODS: Four hundred ninety-one families were enrolled in the study. The Caregiver Impact Questionnaire was applied in the assessment of caregiver quality of life. Caregivers completed questionnaires at baseline and at 1, 3, 6, 12, and 18 months' follow-up. Variables on caregiver daily functioning comprised 4 weeks' history of number of interrupted nights, absenteeism, cancelled social activities, and doctor visits as a result of otitis media in the child. RESULTS: Response rates ranged from 96% to 79%. Significant improvements in disease-specific quality of life were seen after treatment. The poorest baseline quality of life was found in caregivers of children with recurrent acute otitis media. Significant improvements were found on all variables on daily functioning. Predictors for caregiver-perceived clinical success included child sex, number of interrupted nights, doctor visits, absenteeism, and cancelled social activities. CONCLUSION: Results of this study support the notion that caregivers of children with otitis media with defined surgical indications improve their quality of life and daily functioning after ventilating tube treatment. Factors related to caregiver functioning and disease severity were found to be associated with caregivers experiencing important improvements after treatment.

Otitis Media and Caregiver Quality of Life: Psychometric Properties of the Modified Danish Version of the Caregiver Impact Questionnaire.

OBJECTIVE: Otitis media in children may have a considerable impact on caregiver quality of life. The disease-specific Caregiver Impact Questionnaire is designed to assess caregiver quality of life in relation to child otitis media. Assessment of the psychometric properties of this instrument is limited. This study assesses the psychometric properties of this instrument including validity, reproducibility, responsiveness, and interpretability. STUDY DESIGN: Longitudinal validation study. SETTING: Secondary care units. METHODS: Analyses were based on data from 435 families. Validity was assessed using confirmatory factor analysis, internal consistency, and hypothesis testing. Test-retest reliability and measures of smallest detectable change were investigated in the assessment of reproducibility. Responsiveness was investigated by means of hypothesis testing and receiver operating characteristic analysis. An anchor-based distribution method was applied for determining minimal important change as perceived by the respondent. RESULTS: Factor analysis confirmed the hypothesized 1-factor structure with an acceptable fit. Cronbach's alpha was .90. In the analysis of construct validity, 88.9% of the hypothesized correlations were correctly predicted. Intraclass correlation coefficient was 0.87 and smallest detectable change corresponded to approximately one-fourth of the scale. Responsiveness was found to be good and a change score of 13.8 represented minimal important change. CONCLUSION: The modified Danish version of the Caregiver Impact Questionnaire is a valid and reproducible measurement tool that is also sensitive to measuring change in the current setting. A change score representing minimal important change as perceived by the respondent is proposed. Results of this study support the use of this instrument.