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

James Glasbey, Jane Blazeby, Francis Moïse Dossou, Irani Durán, Rohini Dutta, Frank Gyamfi, Mike Horton, Souliath Lawani, Mwayi Kachapila, Rhiannon Macefield, Janet Martin, Jonathan Mathers, Kenneth Mclean, Moyo Ojo, Emmanuel Ofori, Rupert Pearse, Alberto Peón, Tubasiime Ronald, David Roman, Emmy RuningamugaboAlice Sitch, Anita Slade, Simin Patrawala, Angela Prah, Christian Oko, Ismaïl Lawani, Bernard Appiah Ofori, Abdul Hafiz Saba, Gbana Limann, Daniel Kwesi Acquah, Shamudeen Mohammed Alhassan, Sheriff Mohammed, Owusu Abem Emmanuel, Yakubu Musah, Yenli Edwin, Sheba Kunfah, Yakubu Mustapha, Abantanga Atindaana Francis, Emmanuel Ayingayure, Emmanuel Yaw Twerefour, Barbra Koomson, Ruby Acheampong Boateng, Leslie Issa Adam-Zakariah, Nii Armah Adu-Aryee, Theodore Wordui, Coomson Christian Larbi, Akosa Appiah Enoch, Mensah Elijah, Kyeremeh Christian, Addo Gyambibi Kwame, Boakye Percy, Kontor Effah Bismark, Gyamfi Brian, Manu Ruth, Romeo Hussey, Samuel Dadzie, Akosua Dwamena Appiah, Grace Yeboah, Cynthia Yeboah, James Amoako, Regina Acquah, Naa Anyekaa Sowah, Atta Kusiwaa, Esther Asabre, Cletus Ballu, Charles Gyamfi Barimah, Frank Owusu, Clement Sie-Broni, Vivian Adobea, Prince Yeboah Owusu, Marshall Zume, Abdul Hamid Labaran, Raphael Adu-Brobbey, Patrick Opoku Manu Maison, Elizabert Mercy Quartson, Anita Eseenam Agbeko, Joshua Arthur, Joseph Yorke, Christian Kofi Gyasi-Sarpong, Charles Dally, Agbenya Kobla Lovi, Michael Amoah, Boateng Nimako, Robert Sagoe, Anthony Davor, Fareeda Galley, Michael Adinku, Jonathan Boakye-Yiadom, Jane Acquaye, Juliana Appiah, Dorcas Otuo Acheampong, Iddrisu Haruna, Edward Amoah Boateng, Emmanuel Kafui Ayodeji, Samuel Tuffuor, Naa Kwarley, Yaa Tufuor, Ramatu Darling Abdulai, Fred Dankwah, Ralph Armah, Doris Ofosuhene, Dorcas Osei-Poku, Arkorful Ebenezer Temitope, Delali Akosua Gakpetor, Victoria Sena Gawu, Christopher Asare, Enoch Tackie, James Ankomah, Isaac Omane Nyarko, Zelda Robertson, Serbeh Godwin, Appiah Anthony Boakye, Godfred Fosu, Frank Assah-Adjei, Parvez Haque, Ritu Jain, Alisha Bhatt, Jyoti Dhiman, Esther Daniel, K. Priyadarshini, Latha Madankumar, Rohin Mittal, Ida Nagomy, Soosan Prasad, Arpit Jacob Mathew, Danita Prakash, Priya Jacob, Jeremiah P. Anachy, Amy Mathew, Josy Thomas, Philip V. Alexander, Pradeep Zechariah, Neerav D. Aruldas, Asif Mehraj, Hafsa Imtiyaz Ahmed, Rauf A. Wani, Fazl Q. Parray, Nisar A. Chowdri, Laura Martinez Perez Maldonado, Diana S.Gonzalez Vazquez, Iran I. Durán Sánchez, Maria J. Martínez Lara, Alejandra Nayen Sainz De La Fuente, Ana O. Cortes Flores, Mariana E. Barreto Gallo, Alejandro Gonzalez Ojeda, Monica E. Jimenez Velasco, Luis Hernández Miguelena, Reyes J. Cervantes Ortiz, Gonzalo I. Hernandez Gonzalez, Marco Hurtado Romero, Rosa I. Hernandez Krauss, Luis A. Dominguez Sansores, Alejandro Cuevas Avendaño, Celina Cuellar Aguirre, Isaac Baltazar Gomez, Hector Ortiz Mejia, Alejandro González Ojeda, Oscar E. Olvera Flores, Erick A. González García De Rojas, Kevin J. Pintor Belmontes, Francisco J. Barbosa Camacho, Aldo Bernal Hernández, Laura Reyes Aguirre, Rubén E. Morán Galaviz, Clotilde Fuentes Orozco, Wenceslao G. Ángeles Bueno, Fernando S. Ramirez Marbello, Diego E. Luna Acevedo, Michel Hernández Valadez, Ana L. Bogurin Arellano, Luis R. Ramírez-González, Bertha G. Guzmán Ramírez, Eduardo Valtierra Robles, Ramona I. Rojas García, José V. Pérez Navarro, Edgar J. Cortes Torres, David R. Dominguez Solano, Alberto N. Peón, Roque D. Lincona Menindez, Rozana Reyes Gamez, Maria C. Paz Muñoz, Orimisan Belie, Victoria Adeleye, Adesoji Ademuyiwa, Oluwafunmilayo Adeniyi, Opeyemi Akinajo, David Akinboyewa, Felix Alakaloko, Oluwole Atoyebi, Olanrewaju Balogun, Christopher Bode, Olumide Elebute, Francis Ezenwankwo, Adesiyakan Adedotun, George Ihediwa, Jubril Kuku, Oluwaseun Ladipo-Ajayi, Ayomide Makanjuola, Samuel Nwokocha, Olubunmi Ogein, Rufus Ojewola, Abraham Oladimeji, Thomas Olajide, Iyabo Alasi, Oluwaseun Oluseye, Justina Seyi-Olajide, Adaiah Soibi-Harry, Emmanuel Williams, Agbulu Moses Vincent, Nnamdi Jonathan Duru, Kenneth Uche Onyekachi, Christiana Ashley, Chinelo Victoria Mgbemena, Moyosoluwa Ojo, Olowu Oluyemisi, Iyabode Ikuewunmi, Adeoluwa Adebunmi, Edet Glory Bassey, Ephraim Okwudiri Ohazurike, Olayide Michael Amao, Osunwusi Benedetto Oluwaseun, Emily Doris, Olutola Stephen, Christianah Gbenga-Oke, Olawunmi Olayioye, Kayode Oluremi, Esther Abunimye, Christianah Oyegbola, Olayade Kayode, Adeola Ayoola Orowale, Omolara M. Williams, Olufunmilade A. Omisanjo, Omolara M. Faboya, Zainab O. Imam, Olabode A. Oshodi, Yusuf A. Oshodi, Ayokunle A. Ogunyemi, Olalekan T. Ajai, Francisca C. Nwaenyi, Adewale A. Aderounmu, Funmilola O. Wuraola, Oludayo Sowande, Lukman Olajide Abdur-Rahman, Jibril Oyekunle Bello, Hadijat Olaide Raji, Nurudeen Abiola Adeleke, Saheed Abolade Lawal, Rafiat Tinuola Afolabi, Abdulwahab Lawal, Okechukwu Hyginus Ekwunife, Ochomma Amobi Egwuonwu, Chisom Faith Uche, Abubakar Bala A.B. Muhammad, Saminu S. Muhammad, Idris Usman I.U. Takai, Mohammed A.S. Aliyu Salele, Onyekachi G. Ukata, Mahmoud Kawu M.K. Magashi, Lawal Barau L.B. Abdullahi, Bello Abodunde B.A. Muideen, Khadija A. Ado, Lofty John Chukwuemeka L.J.C. Anyawu, Samson Olori, Samuel A. Sani, Olabisi O. Osagie, Ndubuisi Mbajiekwe, Oseremen Aisuodionoe-Shadrach, Godwin O. Akaba, Lazarus Ameh, Francis O. Adebayo, Martins Uanikhoba, Felix O. Ogbo, Nancy O. Tabuanu, Taiwo A. Lawal, Rukiyat A. Abdus-Salam, Akinlabi E. Ajao, Augustine O. Takure, Omobolaji O. Ayandipo, Hyginus O. Ekwuazi, Olukayode Abayomi, Olatunji O. Lawal, Solomon Olagunju, Kelvin I. Egbuchulem, Sikiru Adekola Adebayo, Peter Elemile, Usang E. Usang, Joseph E. Udosen, Expo E. Edet, Akan W. Inyang, Edima M. Olory, Gabriel U. Udie, Godwin O. Chiejina, Adams D. Marwa, Faith J. Iseh, Sunday A. Ogbeche, Mary O. Isa, Uchechukwu O. Ezomike, Sebastian O. Ekenze, Matthew I. Eze, Emmanuel O. Izuka, Jude K. Ede, Vincent C. Enemuo, Okezie M. Mbadiwe, Ngozi G. Mbah, Faustin Ntirenganya, Isaie Ncogoza, Emmanuel Munyaneza, Jean De Dieu Haragirimana, Christian Jean Urimubabo, Violette Mukanyange, Jeannette Nyirahabimana, Emmanuel Mutabazi, Christophe Mpirimbanyi, Olivier Mwenedata, Hope Lydia Maniraguha, Emelyne Izabiriza, Moses Dusabe, Job Zirikana, Francine Uwizeyimana, Josiane Mutuyimana, Elisee Rwagahirima, Alphonsine Imanishimwe, Ronald Tubasiime, Aphrodis Munyaneza, Sosthene Habumuremyi, Salathiel Kanyarukiko, Gibert Ndegamiye, Francine Mukaneza, Jean Claude Uwimana, Pierrine Nyirangeri, Deborah Mukantibaziyaremye, Aime Dieudonne Hirwa, Salomee Mbonimpaye, Piolette Muroruhirwe, Christine Mukakomite, Elysee Kabanda, Ncamsile Anthea Nhlabathi, Maria Fourtounas, Mary Augusta Adams, Hlengiwe Samkelisiwe Nxumalo, Nnosa Sentholang, Mmule Evelyn Sethoana, Margot Flint, Bruce Biccard, Adesoji O. Ademuyiwa, Adewale O. Adisa, Aneel Bhangu, Peter Brocklehurst, Sohini Chakrabortee, Pollyanna Hardy, Ewen Harrison, J. C.Allen Ingabire, Parvez D. Haque, Lawani Ismail, Frank Enoch Gyamfi, Elizabeth Li, Rachel Lillywhite, Laura Magill, Dion Morton, Dmitri Nepogodiev, Thomas Pinkney, Omar Omar, Joana Simoes, Donna Smith, Antonio Ramos De La Medina, Rachel Moore, Felicity Brant, Emily Heritage, Karolin Kroese, Carmela Lapitan, David Lissauer, Punam Mistry, Mark Monahan, Tracy Roberts, Neil Winkles, Emmy Runigamugabo, Azmina Verjee, Pierre Sodonougbo, Pamphile Assouto, Michel Fiogbe, Houenoukpo Koco, Serge Metchinhoungbe, Hodonou Sogbo, Hulrich Behanzin, Djifid Morel Seto, Yannick Tandje, Sosthène Kangni, Cyrile Kpangon, Marcelin Akpla, Hugues Herve Chobli, Blaise Kovohouande, Gérard Agboton, Rene Ahossi, Raoul Baderha Ngabo, Nathan Bisimwa, Covalic Melic Bokossa Kandokponou, Mireille Dokponou, Corinne Dzemta, Antoine Gaou, Roland Goudou, Emmanuel Hedefoun, Sunday Houtoukpe, Felix Kamga, Eric Kiki-Migan, René Loko, Afissatou Moutaïrou, Pencome Ogouyemi, Fouad Soumanou, Pia Tamadaho, Mack Arthur Zounon, Luke Aniakwo Adagrah, Bin Baaba Alhaji Alhassan, Mabel Pokuah Amoako-Boateng, Anthony Baffour Appiah, Alvin Asante-Asamani, Benedict Boakye, Samuel A. Debrah, Donald Enti, Rahman Adebisi Ganiyu, Patience Koggoh, Richard Kpankpari, Isabella Naa M. Opandoh, Meshach Agyemang Manu, Maison Patrick Opoku Manu, Samuel Mensah, Martin Tangnaa Morna, John Nkrumah, Michael Nortey, Emmanuel Owusu Ofori, Elizaberth Mercy Quartson, Esther Adjei-Acquah, Vera Agyekum, Eric Agyemang, Rebecca Adjeibah Akesseh, Forster Amponsah-Manu, Richard Ofosu-Akromah, Ato Oppong Acquah, Barbara Koomson, Ataa Kusiwaa, Anthony Appiah Boakye, Godwin Serbeh, Kofi Yeboah Gyan, Ambe Obbeng, Diana Puozaa, Mark Aseti, Charles Banka, Derick Essien, Jemima Kwarteng, Kwame Gyambibi Addo, Enoch Appiah Akosa, Percy Boakye, Brian Gyamfi, Bismark Effah Kontor, Christian Kyeremeh, Ruth Manu, Elijah Mensah, Friko Ibrahim Solae, Gideon Kwasi Toffah, Kwabena Agbedinu, Emmanuel Gyimah Amankwa, George Amoah, Alex Ayim, Naabo Nuhu Noel Hamidu, Bertina Beauty Nyadu, Dominic Opoku, Anita Osabutey, Samuel Tuffour, Yaa Tufour, Francis Akwaw Yamoah, Abiboye Cheduko Yefieye, Faisal Adjei, Erica Akoto, Elikem Ametefe, Joachim Kwaku Amoako, Godsway Solomon Attepor, George Darko Brown, Benjamin Fenu, Philemon Kwame Kumassah, David Olatayo Olayiwola, Nelson Agboadoh, Fatao Abubakari, Guy Casskey Boateng, Prosper Tonwisi Luri, Abraham Titigah, Christian Larbi Coompson, Amos Bennin, Stanley Doe, Ruth Sarfo Kantanka, Ephraim Kobby, Kennedy Kofi Korankye Hanson Larnyor, Edwin Osei, Clement Ayum Sie-Broni, Francis Atindaana Abantanga, Darling Ramatu Abdulai, Imoro Osman, Shamudeen Alhassan Mohammed, Emmanuel Abem Owusu, Anwar Sadat Seidu, Stephen Tabiri, Mustapha Yakubu, Edwin Mwintiereh Taang Yenli, Arun Gautham, Alice Hepzibah, Grace Mary, Deepak Singh, Dimple Bhatti, William Bhatti, Karan Bir, Swati Daniel, Tapasya Dhar, Sunita Goyal, Ankush Goyal, Monika Hans, Samuel Konda, Anil Luther, Amit Mahajan, Shalini Makkar, Kavita Mandrelle, Vishal Michael, Partho Mukherjee, Reuben Rajappa, Prashant Singh, Atul Suroy, Ravinder Thind, Alen Thomas, Arti Tuli, Sreejith Veetil, Esther Daniel Mark Jesudason, Rajesh Selvakumar, Bharat Shankar, Moonish Sivakumar, Rajeevan Sridhar, Cecil Thomas, Devabalan Titus, Manisha Aggarwal, Parth Dhamija, Himani Gupta, Vinoth Kanna, Ashwani Kumar, Gurtaj Singh, Amos Dasari, Elizabeth Kurien, Anju Susan, Rose Varghese, Rahul Alpheus, Ashish Choudhrie, Hemanth Kumar, Nitin Peters, Subrat Raul, Rajeev Sharma, Rakesh Vakil, Wenceslao Ángeles Bueno, Francisco Barbosa Camacho, Aldo Bernal Hernández, Ana Bogurin Arellano, Edgar Cortes Torres, Diego Luna Acevedo, Rubén Morán Galaviz, Oscar Olvera Flores, José Pérez Navarro, Kevin Pintor Belmontes, Luis Ramírez-González, Ramona Rojas García, Reyes Ortiz Cervantes, Gonzalo Hernandez Gonzalez, Rosa Hernandez Krauss, Isaac Baltazar Gomez, Celina Cuellar Aguirre, Alejandro Cuevas Avendaño, Luis Dominguez Sansores, Hector Ortiz Mejia, Laura Urdapilleta Gomez Del Campo, Claudia Caballero Cerdan, David Dominguez Solano, Rafael Toriz Garcia, Mariana Barreto Gallo, Ana Cortes Flores, Monica Jimenez Velasco, Roque Lincona Menindez, Alberto Navarrete Peón, Maria Paz Muñoz, Irán Irani Durán Sánchez, María José Martínez Lara, Mohammed Aliyu, Opeoluwa Adesanya, David Awonuga, Olushola Fasiku, Chidiebere Ogo, Moruf Abdulsalam, Olukemi Akande, Kazeem Atobatele, Esther Momson, Mobolaji Oludara, Yemisi Oyewole, Omotade Salami, Adedeji Fatuga, Adesola Jimoh, Oluwaseun Ladipoajayi, Olayanju Mokwenyei, Aloy Ugwu, Victor Modekwe, Chukwuemeka Okoro, Kenneth Ugwuanyi, Chuka Ugwunne, Akeem Adeleke, Wilson Adenikinju, Olumide Adeniyi, Akinfolarin Adepiti, Abdulhafiz Adesunkanmi, Samuel Ajekwu, Olusegun Ajenjfuja, Jerrie Akindojutimi, Akinbolaji Akinkuolie, Olusegun Alatise, Olubukola Allen, Lukmon Amosu, Micheal Archibong, Olukayode Arowolo, Deborah Ayantona, Ademola Ayinde, Olusegun Badejoko, Tajudeen Badmus, Amarachukwu Etonyeaku, Emeka Igbodike, Omotade Ijarotimi, Adedayo Lawal, Fayowole Nana, Tunde Oduanafolabi, Olalekan Olasehinde, Olaniyi Olayemi, Stephen Omitinde, Owolabi Oni, Chigozie Onyeze, Ernest Orji, Adewale Rotimi, Abdulkadir Salako, Olufemi Solaja, Oluwaseun Sowemimo, Ademola Talabi, Mohammed Tajudeen, Abu Sadiq, Ekpo Edet, Olanrewaju Amusat, Peter Osuala, Bamidele Suleman, Muideen Adesola, Sulaiman Agodirin, Isiaka Aremu, Olayinka Sayomi, Asimiyu Shittu, Uba Ezinne, Matthew Francis, Iweha Ikechukwu, Okoi Nnyonno, Philemon Okoro, Igwe Patrick, John Raphael, Oriji Vaduneme, Abhulimen Victor, Georges Bucyibaruta, Gisele Juru Bunogerane, Richard Crawford, Chikwendu Jeffrey Ede, Gabriella Hyman, Zafar Khan, Morapedi Kwati, Mpho Nosipho Mathe, Paddy Pattinson, Maria Elizabeth Stassen, Laura Thornley, Paul Wondoh Edenvale Hospital, Cheryl Birtles, Mathete Ivy, Cynthia Mbavhalelo, Zain Ally, Abdus Sami Adewunmi, Jonathan Cook, David Jayne, Soren Laurberg, Julia Brown, Simon Cousens, Neil Smart

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)685-700
Number of pages16
JournalBritish Journal of Surgery
Volume110
Issue number6
DOIs
Publication statusPublished - 1 Jun 2023

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