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PubMed2000

Management of the nontoxic multinodular goitre: a European questionnaire study.

BACKGROUND AND OBJECTIVE: The optimum management strategy for the patient with a multinodular nontoxic goitre is still a matter of debate. Our aim was to assess the attitudes towards management of such patients throughout Europe by means of a questionnaire. DESIGN: The questionnaire was circulated to all clinician members of the European Thyroid Association (ETA). A case report was followed by diagnostic investigations and choice of therapy in the index case (a 42-year-old woman with an irregular nontender bilaterally enlarged thyroid of 50-80 g and no clinical suspicion of malignancy). Eleven variations of the basic case report were proposed in order to evaluate the impact on management of each alteration. SUBJECTS AND METHODS: One hundred and sixty-seven members replied to the letter, and 120 individuals from 22 countries completed the questionnaire (corresponding to approximately two-thirds of the clinical members of the ETA). RESULTS: Based on the index case, serum TSH was the routine choice of 100%, and serum free T4/T4-index was included by 74%. Serum TPO autoantibodies, Tg autoantibodies and calcitonin were measured by 65%, 49% and 32%, respectively. The median number of blood tests used was four (range 1-11). Considerable intercountry variations were seen in the preferred imaging methods. Ninety-one percent of the clinicians would use at least one imaging modality. Ultrasound (US) was used by 84%, thyroid scintigraphy by 76%, and both methods by 69%. US had first priority (53% vs. 19% for scintigraphy). If scintigraphy was performed, fine-needle aspiration cytology was routinely used by 17% (inhomogeneous uptake) and 95% (dominant 'cold' area), and 63% used US-guidance. L-T4 treatment was supported by 52% of the clinicians, iodine supplementation by 4%, radioiodine by 6% and surgery by 10%. In the case of a suppressed serum TSH, radioiodine treatment was preferred by 44%, while surgery was the favoured recommendation in four clinical variations with a large goitre or suspicion of malignancy. Marked differences between the countries were suggested by L-T4 therapy being the dominant treatment in Italy, France and Germany in contrast to the prevailing use of radioiodine in Denmark and a wait and see policy in the UK. CONCLUSIONS: Fundamental differences between European countries exist as regards diagnosis and treatment of the multinodular nontoxic goitre suggesting difficulties in reaching a consensus.

Biomarkers↗
PubMed1990

Sociodemographic and motivational characteristics of parents who volunteer their children for clinical research: a controlled study.

OBJECTIVE: To determine the sociodemographic and motivational characteristics of parents who volunteer their children for clinical research. DESIGN: A questionnaire was administered to parents who volunteered their children for a randomised, double blind, placebo controlled trial of a drug to treat asthma and to a control group of parents whose children were eligible for the trial but had refused the invitation. SETTING: A children's hospital in Australia. SUBJECTS: 68 Parents who had volunteered their children and 42 who had not; a response rate of 94% and 70%, respectively. MAIN OUTCOME MEASURES: Responses of parents to questionnaire designed to assess their perceptions, attitudes, and health seeking behaviour as well as sociodemographic data. RESULTS: Volunteering parents were less well educated with only 15% (10/68) of mothers and 16% (11/68) and of fathers having had a tertiary or university education compared with 26% (11/42) of mothers and 45% (19/42) in the non-volunteering group. Fewer volunteering parents had professional or administrative jobs than did non-volunteering parents (mothers 6% (4/68); fathers 9% (6/68) v mothers 14% (6/42); fathers 31% (13/42)). Volunteering parents had less social support, and they displayed greater health seeking behaviour and consumed more habit forming substances. They were motivated by a desire to help others and to contribute to medical research, but they were also searching for more information and better ways to help their own children. CONCLUSION: Parents who volunteer their children for medical research are significantly more socially disadvantaged and emotionally vulnerable.

Adult↗
PubMed1993

Safe sex? Misconceptions, gender differences and barriers among injection drug users: a focus group approach.

Heterosexual transmission is one factor involved in the spread of the human immunodeficiency virus (HIV) within the injection drug use (IDU) population and between IDU and non-IDU individuals. Insufficient information is currently available to reduce this heterosexual transmission. As a basis for designing a questionnaire aimed at the IDU population, we conducted 5 focus groups to collect information on knowledge of and attitudes toward safe sex as held by male and female IDUs in methadone treatment. We identified misconceptions related to HIV infection, condoms, and sexual behavior. We also found gender-based differences in knowledge and learning style. Also, while individuals felt a responsibility to prevent HIV transmission, they lacked sufficient control to do so. The wide range of responses on questions concerning sexually transmitted diseases (STDs), condoms, reproductive decisions, and methods of promoting safe sex provides a basis for developing a questionnaire designed to identify and target specific subgroups for educational intervention.

Adult↗
PubMed1984

Assessment of change-agent expectations in reversal-to-baseline designs.

Questionnaires similar to those used in previous research to assess behavioral expectations produced by differing reversal-to-baseline rationales were presented to 160 male and female parents in rural South Dakota. Given two case histories, respondents were asked to predict, as simulated change agents, the frequency of problem behavior during reversal in an ABAB design intervention. The five rationales for reversal were: (a) withdrawal, (b) withdrawal and counter-expectancy, (c) problem switch and counter-expectancy, (d) fade and counter-expectancy and (e) inert treatment and counter-expectancy. While obtained means were close to those of a previous study, there were no significant sex or treatment effects. This fails to confirm the earlier results obtained from university undergraduates. Implications for internal validity of ABAB designs are discussed.

Adult↗
PubMed1985

Developing effective questionnaires.

Many research questions are effectively answered by collecting data about the opinions, beliefs, and perceptions of large numbers of persons in widely dispersed areas. The questionnaire is an economical means of gathering such information. Properly designed questionnaires can collect valid and reliable data for analyzing a research problem. This article reviews fundamental principles of questionnaire design and presents a matrix to guide the construction of a questionnaire. Methods to avoid common problems and pitfalls in developing a questionnaire are also presented. Field testing is recommended to ensure validity and reliability.

Data Collection↗
PubMed2002

Validation of an instrument to assess patient attitudes towards prescribing of pharmaceuticals by doctors.

OBJECTIVES: To establish the reliability and validity of a questionnaire designed to assess Chinese patients' attitudes towards pharmaceuticals that may influence the prescribing behaviours of their doctors. STUDY DESIGN: A draft questionnaire of 48 items was designed in English, translated into Chinese, and then back-translated into English. After establishing for content and face validity, it was administered to a convenience sample of patients. Responses were factor analysed to establish construct validity and to reduce the questionnaire's length. POPULATION: Hong Kong Chinese patients (n = 387) who visited one of 24 primary care doctors. OUTCOMES MEASURED: Derived factor score means were compared among various age, gender and education groupings. RESULTS: A final 21-item questionnaire was produced. Spearman's rank correlations indicated the instrument was relatively stable over repeated applications. Patients' attitudes were found to be multidimensional. The three-factor solution achieved a simple structure and accounted for 40% of the variance among the 21 items. Items loading heavily on each construct were internally consistent. Nine items measured patients' attitudes towards careful use of medications. Six questions measured a preference for information exchanges between patients and doctors. Six items measured patients' scepticism concerning the need for pharmaceuticals to hasten recovery from most illnesses. The three factors yielded factor score means that discriminated among the patients as expected. CONCLUSIONS: The questionnaire met adequate standards for reliability and validity. It is suitable for further use in investigating Chinese patients' attitudes concerning pharmaceuticals and how these attitudes might influence their physicians' prescribing behaviours.

Adolescent↗
PubMed1979

Techniques to increase the response rate in follow-up studies: results of a pilot test.

As a part of the design and implementation of a caseload weighting system, Arkansas Rehabilitation Services is adopting a revised client data system. To assess the validity of the data collected in the new system a follow-up survey for recently closed clients has been designed; and to insure the adequacy of the survey design several issues were considered. These included overall survey and questionnaire design. The process, designed to maximize useful information collected with limited resources, resulted in a telephone survey augmented by mail and personal interviews. The survey procedures and instrumentation were pilot tested for two months with 629 clients. This resulted in major modifications in questionnaire design and brought to light easily adopted procedural improvements resulting in less ambiguity, improved readibility, increased response rate and reduced response bias. Using the described survey methods the investigators observed an overall response rate of 50.8% which compares very favorably with that reported in other studies similar in nature.

Arkansas↗
PubMed2002

Increasing response rates to postal questionnaires: systematic review.

OBJECTIVE: To identify methods to increase response to postal questionnaires. DESIGN: Systematic review of randomised controlled trials of any method to influence response to postal questionnaires. STUDIES REVIEWED: 292 randomised controlled trials including 258 315 participants INTERVENTION REVIEWED: 75 strategies for influencing response to postal questionnaires. MAIN OUTCOME MEASURE: The proportion of completed or partially completed questionnaires returned. RESULTS: The odds of response were more than doubled when a monetary incentive was used (odds ratio 2.02; 95% confidence interval 1.79 to 2.27) and almost doubled when incentives were not conditional on response (1.71; 1.29 to 2.26). Response was more likely when short questionnaires were used (1.86; 1.55 to 2.24). Personalised questionnaires and letters increased response (1.16; 1.06 to 1.28), as did the use of coloured ink (1.39; 1.16 to 1.67). The odds of response were more than doubled when the questionnaires were sent by recorded delivery (2.21; 1.51 to 3.25) and increased when stamped return envelopes were used (1.26; 1.13 to 1.41) and questionnaires were sent by first class post (1.12; 1.02 to 1.23). Contacting participants before sending questionnaires increased response (1.54; 1.24 to 1.92), as did follow up contact (1.44; 1.22 to 1.70) and providing non-respondents with a second copy of the questionnaire (1.41; 1.02 to 1.94). Questionnaires designed to be of more interest to participants were more likely to be returned (2.44; 1.99 to 3.01), but questionnaires containing questions of a sensitive nature were less likely to be returned (0.92; 0.87 to 0.98). Questionnaires originating from universities were more likely to be returned than were questionnaires from other sources, such as commercial organisations (1.31; 1.11 to 1.54). CONCLUSIONS: Health researchers using postal questionnaires can improve the quality of their research by using the strategies shown to be effective in this systematic review.

Data Collection↗
PubMed1991

Why are we weighting? A critical examination of the use of item weights in a health status measure.

There is currently much interest in the measurement of self reported health status. A number of health status measures have been designed. However, such questionnaires are often long and complicated, or are disease specific. The most famous generic British health status instrument is the Nottingham Health Profile (NHP) which is a short questionnaire designed for ease of completion. However, this paper addresses a number of related issues concerning the weights attached to particular items on this questionnaire. It is argued that the weighting of items by Thurstone's method of paired comparisons is inappropriate and can lead to logically inconsistent results.

Health Status Indicators↗
PubMed2002

Delphi type methodology to develop consensus on the future design of EMS systems in the United Kingdom.

OBJECTIVE: To develop consensus opinion on future design characteristics of Emergency Medical Services (EMS) systems in the UK with particular regard to advanced life support skills (ALS). DESIGN: A Delphi questionnaire design with two rounds to gain a consensus of opinion. Investigation of four aspects of EMS design is reported-type of response to a priority based dispatch category, transportation options, enhancement of paramedic skills, and structure of a first responder system. SUBJECTS: Chief executives, directors of operations, and medical directors of Ambulance Trusts in the United Kingdom. OUTCOME MEASURES: Likert scales (0-9) to score opinion on a series of statements with achievement of inter-round consistency. A median score of 0-4 was classified as disagreement and 6-9 as agreement. RESULTS: A 65% response to the first questionnaire and with iteration, 52% response to the second questionnaire was attained. A tiered response (paramedics, technicians, and basic life support first responders) with technicians responding to selected category A and B calls and all category C calls (median score (MS) 7.5, interquartile range (IQR) 4), was recommended. Inter-unit handover of selected calls to maintain paramedic availablity ( MS 7.5, IQR 3.75) and enhancement of paramedic skills (MS 7.0, IQR 4.0) was also proposed. Finally, the development of a first responder system fully integrated into the EMS (MS 8.0, IQR 2.75) involving other agencies including the police force, fire service, and trained members of the local community was agreed. CONCLUSIONS: Senior expert staff from Ambulance Trusts in the UK achieved consensus on certain design characteristics of EMS systems. These are significantly different from the present EMS model.

Administrative Personnel↗
PubMed1988

Malignant hyperpyrexia and sudden infant death syndrome.

This paper reports three investigations of the suggested relationship between sudden infant death syndrome (SIDS) and malignant hyperpyrexia (MH). In the first study 151 MH-susceptible families completed a questionnaire designed to identify the incidence of SIDS within their own pedigree. In the second study 106 SIDS families completed a questionnaire designed to identify the incidence of anaesthetic related problems. In the third study, 14 SIDS parents were subjected to muscle biopsy and in vitro halothane contracture and caffeine contracture screening for susceptibility to MH. From the results of the three studies it can be concluded that there is no association between SIDS and MH.

Disease Susceptibility↗
PubMed1999

PTSD symptoms, response to intrusive memories and coping in ambulance service workers.

OBJECTIVES: To examine the relationship of coping strategies and responses to intrusive memories with post-traumatic stress disorder (PTSD) and other psychiatric symptoms in ambulance service workers. METHOD: Fifty-six ambulance service workers describe the most distressing aspects of their work and completed questionnaires designed to measure their coping strategies in dealing with distressing incidents. They also described their intrusive memories of particularly distressing incidents and completed a questionnaire designed to measure their interpretation of these intrusions and their responses to them. In addition, they completed the Post-traumatic Stress Symptom Scale (PSS; Foa, Riggs, Dancu & Rothbaum, 1993) and the General Health Questionnaire (GHQ; Goldberg & Hiller, 1979). RESULTS: Of the participants, 21% met DSM-III-R criteria for PTSD, and 22% met GHQ screening criteria for psychiatric symptoms. Wishful thinking and mental disengagement when confronted with critical incidents at work, negative interpretations of intrusive memories, and maladaptive responses to these memories (rumination, suppression and dissociation) correlated with PTSD severity. CONCLUSION: The results are consistent with the hypothesis that coping strategies and responses to intrusive memories that prevent emotional processing of the distressing event maintain PTSD. They also support Ehlers & Steil's (1995) hypotheses about the role of negative interpretations of post-traumatic intrusions in PTSD. A substantial subgroup of emergency service personnel may need support in processing distressing incidents at work and may benefit from information that normalizes post-traumatic symptoms such as intrusions.

Adaptation, Psychological↗
PubMed1999

Studying the careers of nurse diplomates: the importance of branch-specific questionnaires.

Questionnaire design is considered in the context of a longitudinal panel study focusing on the careers of people qualifying from all four branches of the UK nurse diploma course. Separate, but comparable, questionnaires were developed for each branch in order to produce information which reflected the differences between branches, and the experiences of the cohort as a whole. This approach ensured that participants from the smaller branches did not feel their interests and concerns were overshadowed by those of the largest (adult) branch, as is often the case during the diploma course's Common Foundation Programme. The elements that needed to be tailored to each branch emerged during a three-stage piloting process used to develop and test the questionnaires. Differences were found between branches in their use of terminology; in certain issues being more relevant to some branches than others; and in questions which concerned all branches benefiting from the inclusion of branch-specific examples. The effectiveness of this approach to questionnaire design is borne out by the study's high response rates.

Career Choice↗
PubMed2003

Do they practise what we teach? A survey of manual handling practice amongst student nurses.

Experience of training students of nursing in manual handling suggested that they did not practise the techniques they had been taught. A search of the literature revealed that there was indeed a theory-practice gap. The aim of the project was to answer three questions: do students know what they should be doing, do they do what they should be doing, and if not, why not. A survey design was used, with questionnaires designed specifically for the study. Self report questionnaires were distributed to students of nursing (n = 148) on the adult branch in one higher education institution in England. One hundred and thirty-nine completed questionnaires were returned. Results showed that students' knowledge of whether particular techniques were 'recommended' was fair. They indicated however, that they were frequently unable to use recommended techniques in practice. The most frequent explanation given was the influence of other nurses. Results of this small study indicated that male students and younger students were more susceptible to socialization into poor ward practice than others. Other reasons for not using recommended techniques were unavailability of manual handling aids, lack of time and patient needs. The complexity of relationships within the nursing team emerged, with students ever aware of the impression they were making with regard to their assessment of practice, and their need to be accepted as a member of the team. Changes to training are suggested, to help reduce the theory-practice gap.

Adult↗
PubMed2000

Factorial validity and invariance of questionnaires measuring social-cognitive determinants of physical activity among adolescent girls.

BACKGROUND: There are few theoretically derived questionnaires of physical activity determinants among youth, and the existing questionnaires have not been subjected to tests of factorial validity and invariance. The present study employed confirmatory factor analysis (CFA) to test the factorial validity and invariance of questionnaires designed to be unidimensional measures of attitudes, subjective norms, perceived behavioral control, and self-efficacy about physical activity. METHODS: Adolescent girls in eighth grade from two cohorts (N = 955 and 1,797) completed the questionnaires at baseline; participants from cohort 1 (N = 845) also completed the questionnaires in ninth grade (i.e., 1-year follow-up). Factorial validity and invariance were tested using CFA with full-information maximum likelihood estimation in AMOS 4.0. Initially, baseline data from cohort 1 were employed to test the fit and, when necessary, to modify the unidimensional models. The models were cross-validated using a multigroup analysis of factorial invariance on baseline data from cohorts 1 and 2. The models then were subjected to a longitudinal analysis of factorial invariance using baseline and follow-up data from cohort 1. RESULTS: The CFAs supported the fit of unidimensional models to the four questionnaires, and the models were cross-validated, as indicated by evidence of multigroup factorial invariance. The models also possessed evidence of longitudinal factorial invariance. CONCLUSIONS: Evidence was provided for the factorial validity and the invariance of the questionnaires designed to be unidimensional measures of attitudes, subjective norms, perceived behavioral control, and self-efficacy about physical activity among adolescent girls.

Adolescent↗
PubMed1997

The Estonian study of Chernobyl cleanup workers: I. Design and questionnaire data.

Nearly 2% of the male population of Estonia aged 20-39 years were sent to Chernobyl to assist in the cleanup activities after the reactor accident. A cohort of 4,833 cleanup workers was assembled based on multiple and independent sources of information. Information obtained from 3,704 responses to a detailed questionnaire indicated that 63% of the workers were sent to Chernobyl in 1986; 54% were of Estonian and 35% of Russian ethnicity; 72% were married, and 1,164 of their 5,392 children were conceived after the Chernobyl disaster. The workers were less educated than their counterparts in the general population of Estonia, and only 8.5% had attended university. Based on doses entered in worker records, the mean dose was 11 cGy, with only 1.4% over 25 cGy. Nearly 85% of the workers were sent as part of military training activities, and more than half spent in excess of 3 months in the Chernobyl area. Thirty-six percent of the workers reported having worked within the immediate vicinity of the accident site; 11.5% worked on the roofs near the damaged reactor, clearing the highly radioactive debris. The most commonly performed task was the removal and burial of topsoil (55% of the workers). Potassium iodide was given to over 18% of the men. The study design also incorporates biological indicators of exposure based on the glycophorin A mutational assay of red blood cells and chromosome translocation analyses of lymphocytes; record linkage with national cancer registry and mortality registry files to determine cancer incidence and cause-specific mortality; thyroid screening examinations with ultrasound and fine-needle biopsy; and cryopreserved white blood cells and plasma for future molecular studies. Comprehensive studies of Chernobyl cleanup workers have potential to provide new information about cancer risks due to protracted exposures to ionizing radiation.

Alcohol Drinking↗