Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention—Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions.
Background: In clinical practice, nurses’ attitudes regarding older patients are important in relation to quality of care. The Older People in Acute Care Survey (OPACS) is an instrument measuring hospital nurses attitudes regarding older patients and is validated in Australia and the USA. The OPACS is translated in Dutch language and content validity of this translation is previously assessed, presenting questionable results. Measurement instruments, however, cannot be “validated” based on content validity evidence alone. Judgmental evidence and statistical analysis should be combined to fully evaluate content domain definition and representation and guide further development. Objective: Assess structural validity and reliability to fully evaluate the OPACS for use in the Netherlands, complementing previous conducted content validity results. Design: Cross-sectional. Setting: Three general hospitals in the Netherlands. Participants: 201 registered nurses. Methods: Confirmatory factor analysis was used to assess the structural validity. Reliability was assessed with Cronbach’s alpha. Results: OPACS Section A (measuring practice experiences) demonstrated to have acceptable structural validity- and good reliability outcomes after exclusion of two items (model fit: x² [df=537]=8475.40, p <0.001, CFI=0.96, TLI=0.96, RMSEA=0.21; Cronbach’s alpha=0.82). Section B (measuring general opinion) demonstrated to have inadequate structural validity outcomes (model fit: x² [df=1127]=9200.29, p<0.001, CFI=0.68, TLI=0.67, RMSEA=0.15). None of the items contributed significant to the factor and therefore no further analysis could be performed (range p(>|z|)= 0.551 -0 .788). Conclusion: Even though structural validity for section A was acceptable, content validity scores of a majority of items in this subscale were low, resulting in questionable use of this subscale for the Dutch context. The findings of this study, in relation to the earlier findings regarding content validity, justify the conclusion that use of the Dutch OPACS in clinical practice and research is not recommended. Given these findings, future research should pursue the development or (cross-cultural) validation of other instruments measuring hospital nurses attitudes towards older patients for the Dutch cultural context. Furthermore, this study demonstrated the influence of cultural differences on measurement instruments and the need for rigorous research before using a measurement instrument in a new culture or context.
BackgroundWe report development of the SPQ (School Participation Questionnaire) a teacher-completed measure of participation related constructs for schools. The SPQ was developed to support participation-related assessment, interventions, and research in the inclusive school context.MethodsSeveral iterative steps were undertaken. An international panel of experts reviewed content validity. A 66-item pilot questionnaire was administered in schools. Mokken and Rasch model analysis were applied. Internal consistency was assessed using Cronbach’s alpha. Analyses were conducted on associations with teacher and child demographic variables. Feedback was sourced from users. Participants were teachers of 101 children (5−12 years old) with a range of disabilities, including intellectual disability, autism spectrum disorder and learning difficulties.ResultsFour participation-related dimensions of the SPQ were confirmed. Rasch person and item reliability were good, and 2–4 strata were confirmed per scale. Internal consistency was good (all scales, Cronbach α > 0.8). Mean administration time was 11.7 min. Mean SPQ scores were independent of teacher characteristics. A significant effect of school support level, eligibility for free school meals and gender was found. Through synthesising analytic results and feedback, a new 46-item tool was obtained.ConclusionThe results of this study provide evidence of acceptability, practicality and validity. The SPQ is the first tool developed to assess participation related constructs in schools, and it contains novel information not given by other assessments. The SPQ may be used by practitioners and researchers to understand and improve the participation of children with a range of disabilities in schools.
MULTIFILE
