Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis
Glasbey J., Ademuyiwa A., Bhatt A., Biccard B., Blazeby J., Brocklehurst P., Chakrabortee S., Ingabire JCA., Dossou FM., Durán I., Dutta R., Ghosh D., Gyamfi F., Haque P., Hardy P., Horton M., Hyman G., Jain R., Ladipo-Ajayi O., Lawani I., Lawani S., Kachapila M., Lillywhite R., Macefield R., Magill L., Martin J., Mathers J., McLean K., Mistry P., Mittal R., Monahan M., Moore R., Morton D., Ojo M., Ntirenganya F., Ofori E., Pearse R., Peón A., Pinkney T., de la Medina AR., Ronald T., Roman D., Runingamugabo E., Sitch A., Slade A., Smith D., Tabiri S., Bhangu A., Glasbey J., Slade A., Horton M., Macefield R., Bhangu A., Hardy P., Ademuyiwa AO., Ismail L., Ghosh D., de la Medina AR., Moore R., Ntirenganya F., Tabiri S., Runingamugabo E., Patrawala S., Prah A., Oko C., Kroese K., Lawani I., Dossou FM., Dzemta C., Kandokponou CMB., Lawani S., Behanzin H., Kpangon C., Ofori BA., Tabiri S., Saba A-H., Limann G., Acquah DK., Alhassan SM., Mohammed S., Emmanuel OA., Musah Y., Edwin Y., Kunfah 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Haragirimana J., Urimubabo CJ., Mukanyange V., Nyirahabimana J., Mutabazi E., Mpirimbanyi C., Mwenedata O., Maniraguha HL., Izabiriza E., Dusabe M., Zirikana J., Uwizeyimana F., Mutuyimana J., Rwagahirima E., Imanishimwe A., Tubasiime R., Munyaneza A., Habumuremyi S., Kanyarukiko S., Ndegamiye G., Mukaneza F., Uwimana JC., Nyirangeri P., Mukantibaziyaremye D., Hirwa AD., Mbonimpaye S., Muroruhirwe P., Mukakomite C., Kabanda E., Moore R., Nhlabathi NA., Fourtounas M., Adams MA., Hyman G., Nxumalo HS., Sentholang N., Sethoana ME., Mathe MN., Ally Z., Flint M., Biccard B., Ademuyiwa AO., Adisa AO., Bhangu A., Brocklehurst P., Chakrabortee S., Hardy P., Harrison E., Ingabire JCA., Haque PD., Ismail L., Glasbey J., Ghosh D., Gyamfi FE., Li E., Lillywhite R., de la Medina AR., Moore R., Magill L., Morton D., Nepogodiev D., Ntirenganya F., Pinkney T., Omar O., Simoes J., Smith D., Tabiri S., Ademuyiwa AO., Ismail L., Ghosh D., de la Medina AR., Moore R., Ntirenganya F., Tabiri S., Ademuyiwa A., Bhangu A., Brant F., Brocklehurst P., Chakrabortee S., Ghosh D., Glasbey J., Hardy P., Harrison E., Heritage E., Ismail L., Kroese K., Lapitan C., Lillywhite R., Lissauer D., Magill L., de la Medina AR., Mistry P., Monahan M., Moore R., Morton D., Nepogodiev D., Ntirenganya F., Omar O., Pinkney T., Roberts T., Smith D., Tabiri S., Winkles N., Hardy P., Omar O., Runigamugabo E., Verjee A., Sodonougbo P., Assouto P., Fiogbe M., Koco H., Metchinhoungbe S., Sogbo H., Behanzin H., Seto DM., Tandje Y., Kangni S., Kpangon C., Akpla M., Chobli HH., Kovohouande B., Agboton G., Ahossi R., Ngabo RB., Bisimwa N., Kandokponou CMB., Dokponou M., Dossou FM., Dzemta C., Gaou A., Goudou R., Hedefoun E., Houtoukpe S., Kamga F., Kiki-Migan E., Lawani S., Lawani I., Loko R., Moutaïrou A., Ogouyemi P., Soumanou F., Tamadaho P., Zounon M-A., Adagrah LA., Alhassan BBA., Amoako-Boateng MP., Appiah AB., Asante-Asamani A., Boakye B., Debrah SA., Enti D., Ganiyu RA., Koggoh P., Kpankpari R., Opandoh INM., Manu MA., Manu MPO., Mensah S., Morna MT., Nkrumah J., Nortey M., Ofori EO., Quartson EM., Adjei-Acquah E., Agyekum V., Agyemang E., Akesseh RA., Amponsah-Manu F., Ofosu-Akromah R., Acquah AO., Adam-Zakariah LI., Asabre E., Boateng RA., Koomson B., Kusiwaa A., Twerefour EY., Ankomah J., Assah-Adjei F., Boakye AA., Fosu G., Serbeh G., Gyan KY., Nyarko IO., Robertson Z., Armah R., Asare C., Gakpetor DA., Gawu VS., Obbeng A., Ofosuhene D., Osei-Poku D., Puozaa D., Tackie E., Temitope AE., Acquah R., Amoako J., Appiah AD., Aseti M., Banka C., Dadzie S., Essien D., Gyamfi FE., Hussey R., Kwarteng J., Sowah NA., Yeboah G., Yeboah C., Addo KG., Akosa EA., Boakye P., Coompson CL., Gyamfi B., Kontor BE., Kyeremeh C., Manu R., Mensah E., Solae FI., Toffah GK., Acheampong DO., Acquaye J., Adinku M., Agbedinu K., Agbeko AE., Amankwa EG., Amoah M., Amoah G., Appiah J., Arthur J., Ayim A., Ayodeji EK., Boakye-Yiadom J., Boateng EA., Dally C., Davor A., Gyasi-Sarpong CK., Hamidu NNN., Haruna I., Kwarley N., Lovi AK., Nimako B., Nyadu BB., Opoku D., Osabutey A., Sagoe R., Tuffour S., Tufour Y., Yamoah FA., Yefieye AC., Yorke J., Adu-Aryee NA., Adjei F., Akoto E., Ametefe E., Amoako JK., Attepor GS., Brown GD., Fenu B., Kumassah PK., Olayiwola DO., Wordui T., Agboadoh N., Abubakari F., Ballu C., Barimah CG., Boateng GC., Luri PT., Titigah A., Owusu F., Adu-Brobbey R., Coompson CL., Labaran A-H., Owusu JA., Adobea V., Bennin A., Dankwah F., Doe S., Kantanka RS., Kobby E., Larnyor KKKH., Osei E., Owusu PY., Sie-Broni CA., Zume M., Abantanga FA., Abdulai DR., Acquah DK., Ayingayure E., Osman I., Kunfah S., Limann G., Mohammed SA., Mohammed S., Musah Y., Ofori B., Owusu EA., Saba A-H., Seidu AS., Tabiri S., Yakubu M., Yenli EMT., Gautham A., Hepzibah A., Mary G., Singh D., Bhatti D., Bhatti W., Bir K., Daniel S., Dhar T., Dhiman J., Ghosh D., Goyal S., Goyal A., Hans M., Haque P., Konda S., Luther A., Mahajan A., Makkar S., Mandrelle K., Michael V., Mukherjee P., Rajappa R., Singh P., Suroy A., Thind R., Thomas A., Tuli A., Veetil S., Jesudason EDM., Priyadarshini K., Madankumar L., Mittal R., Nagomy I., Selvakumar R., Shankar B., Sivakumar M., Sridhar R., Thomas C., Titus D., Aggarwal M., Dhamija P., Gupta H., Kanna V., Kumar A., Singh G., Alexander P., Thomas J., Zechariah P., Dasari A., Jacob P., Kurien E., Mathew A., Prakash D., Susan A., Varghese R., Alpheus R., Choudhrie A., Kumar H., Peters N., Raul S., Sharma R., Vakil R., Bueno WÁ., Camacho FB., Hernández AB., Arellano AB., Torres EC., Orozco CF., de Rojas EGG., Ojeda AG., Ramírez BG., Valadez MH., Acevedo DL., Galaviz RM., Flores OO., Navarro JP., Belmontes KP., Marbello FR., Ramírez-González L., Aguirre LR., García RR., Robles EV., Cervantes RO., Gonzalez GH., Krauss RH., Miguelena LH., Romero MH., Gomez IB., Aguirre CC., Avendaño AC., Sansores LD., Mejia HO., del Campo LUG., Cerdan CC., Solano DD., Garcia RT., Gallo MB., Flores AC., Ojeda AG., Velasco MJ., Gamez RR., Menindez RL., Peón AN., Muñoz MP., Sánchez IID., Vázquez DSG., Lara MJM., Maldonado LMP., de la Fuente ANS., De la Medina AR., Abdullahi L., Ado K., Aliyu M., Anyanwu L-J., Magashi M., Muhammad A., Muhammad S., Muideen B., Takai I., Ukata O., Adesanya O., Awonuga D., Fasiku O., Ogo C., Abdulsalam M., Adeniran A., Ajai O., Akande O., Atobatele K., Eke G., Faboya O., Imam Z., Momson E., Nwaenyi F., Ogunyemi A., Oludara M., Omisanjo O., Oshodi O., Oshodi Y., Oyewole Y., Salami O., Williams O., Adeleye V., Ademuyiwa A., Adeniyi O., Akinajo O., Akinboyewa D., Alasi I., Alakaloko F., Atoyebi O., Balogun O., Belie O., Bode C., Ekwesianya A., Elebute O., Ezenwankwo F., Fatuga A., Ihediwa G., Jimoh A., Kuku J., LadipoAjayi O., Makanjuola A., Mokwenyei O., Nwokocha S., Ogein O., Ojewola R., Oladimeji A., Olajide T., Oluseye O., Seyi-Olajide J., Soibi-Harry A., Ugwu A., Williams E., Egwuonwu O., Ekwunife O., Modekwe V., Okoro C., Uche C., Ugwuanyi K., Ugwunne C., Adeleke A., Adenikinju W., Adeniyi O., Adepiti A., Aderounmu A., Adesunkanmi A., Adisa A., Ajekwu S., Ajenjfuja O., Akindojutimi J., Akinkuolie A., Alatise O., Allen O., Amosu L., Archibong M., Arowolo O., Ayantona D., Ayinde A., Badejoko O., Badmus T., Etonyeaku A., Igbodike E., Ijarotimi O., Lawal A., Nana F., Oduanafolabi T., Olasehinde O., Olayemi O., Omitinde S., Oni O., Onyeze C., Orji E., Rotimi A., Salako A., Solaja O., Sowemimo O., Talabi A., Tajudeen M., Wuraola F., Adebayo F., Aisuodionoe-Shadrach O., Akaba G., Ameh L., Mbajiekwe N., Ogbo F., Olori S., Osagie O., Sadiq A., Sani S., Tabuanu N., Uanikhoba M., Chiejina G., Edet E., Inyang A., Isa M., Iseh F., Marwa A., Ogbeche S., Olory E., Udie G., Udosen J., Usang U., Abayomi O., Abdus-Salam R., Adebayo S., Ajao A., Amusat O., Ayandipo O., Egbuchulem K., Ekwuazi H., Elemile P., Lawal T., Lawal O., Olagunju S., Osuala P., Suleman B., Takure A., Abdur-Rahman L., Adeleke N., Adesola M., Afolabi R., Agodirin S., Aremu I., Bello J., Lawal S., Lawal A., Raji H., Sayomi O., Shittu A., Ede J., 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Abstract Background The Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation. Methods This was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model. Results In the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach’s α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever). Conclusion This study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways.