Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic
Abstract
:1. Introduction
2. Materials and Methods
2.1. Theoretical Framework
2.2. Literature Search
2.3. Assessment of Content Validity
3. Results
3.1. Item Generation
3.2. Quantitative Assessment of Content Validity by CVI Evaluation
3.3. Qualitative Assessment of the Content Validity by Cognitive Interviews
4. Discussion
4.1. Strengths and Limitations
4.2. Implications for Research and Practice
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Appendix A
Survey Instrument
- 1.
- Date of birth
- 2.
- Physician diagnosed asthma (yes, no)
- 3.
- Age at diagnosis
- 4.
- Type of asthma (allergic, non-allergic, asthma with COPD, exercise-induced asthma, do not know, another type)
- 5.
- Chronic disease comorbidity (diabetes, bowel, liver, kidney, hypertension, COPD, cancer, another, no other)
- 6.
- Medication
- 7–11.
- Asthma control test
- During the last 4 weeks, how much of the time has your asthma kept you from getting as much done at work, school, or home? (all the time, most of the time, some of the time, a little of the time, none of the time)
- During the last 4 weeks, how often have you had shortness of breath? (more than once a day, once a day, 3 to 6 times a week, once or twice a week, not at all)
- During the last 4 weeks, how often have your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) woken you up at night or earlier than usual in the morning? (4 or more nights a week, 2 to 3 nights a week, once a week, once or twice, not at all)
- During the last 4 weeks, how often have you used your rescue inhaler or nebuliser medication (such as Salbutamol)? (3 or more times per day, once or twice per day, 2 or 3 times per day, once a week or less, not at all)
- How would you rate your asthma control during the last 4 weeks? (not controlled at all, poorly controlled, somewhat controlled, well controlled, completely controlled)
- 12.
- Smoking status and frequency of consumption (cigarettes, cigars, e-cigarettes)
- 13.
- Please rate your present health status (very good, good, moderate, poor, very poor)
- 14.
- Please indicate which statement you agree with most (cannot answer, do not agree at all, do not agree, agree to some extent, agree)
- I am well informed about my asthma condition
- I am familiar with the use of my inhaler and the inhaler medication
- I am familiar with the use of a peak-flow meter (lung capacity)
- I know which asthma medication I have to take and why
- I know the triggers for asthma attacks and exacerbations
- In order to understand what my doctor tells me I ask questions if necessary
- Before making decisions about my treatment I critically assess the situation
- 15.
- How much does your asthma impair your life? (6-point Likert scale from not at all to very strongly)
- 16.
- COVID-19 disease status (symptoms, test status) if negatively tested and/or no symptoms continue with item 16
- Ever since I had COVID-19 my asthma symptoms have become (less severe, unchanged, somehow more severe, a lot more severe)
- 17.
- How harmful or dangerous would a COVID-19 infection be for you? (completely harmless, harmless, rather dangerous, very dangerous, do not know)
- 18.
- Attitude towards PCR test (cannot answer, do not agree at all, do not agree, agree to some extent, agree)
- Getting tested requires a lot of effort and time
- The PCR test is reliable
- I would get tested if I had been in contact with a person that tested positive even if I myself had no symptoms
- 19.
- The following statements are (correct, incorrect, do not know)
- COVID-19′s main transmission route is human to human
- Main symptoms are fever, dry cough as well as loss of smell and taste
- The coronavirus does not exist
- The coronavirus can be caught by touching door handles or railings in trams
- There are drugs for the treatment of COVID-19
- 20.
- Prevention measures (yes, no, do not know)
- Adhere to hygiene rules (e.g., washing one’s hands for 20–30 s)
- Keep a distance of 1.5–2 m to other people
- Use the corona alert app
- Regularly airing indoor areas
- Wearing a facemask (e.g., when shopping or using public transport)
- Regular gargling with a mouth rinse
- 21.
- How well do you think you are you informed about the coronavirus? (6-point Likert scale from no knowledge at all to a lot of knowledge)
- 22.
- About asthma and the coronavirus or the COVID-19 disease I feel (very well informed, well informed, poorly informed, very poorly informed, cannot say)
- 23.
- Do you feel confused about coronavirus information? (very confused, somewhat confused, very little confused, cannot say)
- 24.
- Compared to the time before the COVID-19 pandemic, these days how often do you seek information about your asthma condition? (less often, unchanged, more often, do not know)
- 25.
- What sources for information do you access to find information about your asthma condition in relation to the pandemic and how reliable do you think these sources are? (tick box and then judge reliability (cannot judge, not reliable, rather not reliable, rather reliable, very reliable))
- Telephone hotlines
- Health insurance organisations
- GP
- Specialist physician
- Pharmacist
- Family/Friends/Acquaintances
- Health-related websites
- Social media
- Printed health publications
- Public broadcasting services
- Private broadcasting services
- Other (name)
- 26.
- HLS-COVID-Q22: How easy or difficult is it for you to:
- Find information about the coronavirus on the internet?
- Find information on the internet about protective behaviours that can help to prevent infection with the coronavirus?
- Find information in newspapers, magazines, and on TV about behaviours that can help to prevent infection with the coronavirus?
- Find information on how to recognise if I have likely become infected with the coronavirus?
- Find information on how to find professional help in case of coronavirus infection?
- Find information on how I much I am at risk for being infected with the coronavirus?
- Understand your doctor’s, pharmacist’s, or nurse’s instructions on protective measures against coronavirus infection?
- Understand recommendations of authorities regarding protective measures against coronavirus infection?
- Understand advice from family members or friends regarding protective measures against coronavirus infection?
- Understand information in the media on how to protect myself against coronavirus infection?
- Understand risks of the coronavirus that I find on the internet?
- Understand risks of the coronavirus that I find in newspapers, magazines, or on TV?
- Judge if information on the coronavirus and the coronavirus epidemic in the media is reliable?
- Judge which behaviours are associated with a higher risk of coronavirus infection?
- Judge what protective measures you can apply to prevent a coronavirus infection?
- Judge how much I am at risk for a coronavirus infection?
- Judge if I have been infected with coronavirus?
- Decide how you can protect yourself from coronavirus infection based on information in the media?
- Follow instructions from your doctor or pharmacist regarding how to handle the coronavirus situation?
- Use information the doctor gives you to decide how to handle an infection with the coronavirus?
- Use media information to decide how to handle an infection with the coronavirus?
- To behave in a way to avoid infecting others?
- 27.
- Please indicate whether the following statements are correct or incorrect (correct, incorrect, do not know)
- It is sufficient that the facemask covers only the mouth
- Medical masks, e.g., FFP-2 masks are more effective than ordinary masks
- Single use masks have to be disposed of after 8 h or when it has become moist
- Before putting on the mask and before removal of the mask one should wash one’s hands with soap
- 28.
- Please indicate how much you agree with the following statements (cannot answer, do not agree at all, do not agree, agree to some extent, agree)
- I am confident about how to use a facemask correctly
- Because of my asthma I find it very difficult to wear a facemask because of breathing difficulty
- Wearing a facemask protects me sufficiently from infection
- 29.
- Since March 2020 have you postponed appointments with your GP or specialist physician because of the pandemic? (yes; no, I attended as scheduled; no, I had no appointments; no, appointment(s) were cancelled)
- 30.
- Have there been changes in your asthma treatment since March 2020? (yes, no, do not know)
- Because of the pandemic, I am more careful in making sure to take my medication regularly
- Because of the pandemic, I have or intend to interrupt my asthma treatment/medication intake
- Because of the pandemic, I now take different asthma medication(s)
- 31.
- I think that (cannot answer, do not agree at all, do not agree, agree to some extent, agree)
- I am perfectly able to distinguish my asthma symptoms from those of a COVID-19 infection
- I am more vulnerable to COVID-19 because of my asthma
- Should I get COVID-19 the course of the disease could be more severe because of my asthma
- 32.
- Please indicate how much you agree with the following statements (cannot answer, do not agree at all, do not agree, agree to some extent, agree)
- When I cough more, I worry that I might have been infected with COVID-19
- I worry that my asthma will get worse after a COVID-19 infection
- I worry about other things (name)
- 33.
- The coronavirus is (semantic differential from −3 to +3)
- I hardly ever think about it–I think about it a lot
- It makes me feel helpless–I can do something about it
- Not scary–scary
- Not stressful–stressful
- 34.
- Whose help or advice would you use or have used?
- Telephone hotlines
- Health insurance organisations
- Medical personnel
- Public health departments
- Social media
- Self-help groups
- Patient societies
- Counselling services
- Other (name)
- I would not use any help or advice
- 35.
- What helps you in coming to terms with your asthma condition and the COVID-19 pandemic? (cannot answer, do not agree at all, do not agree, agree to some extent, agree)
- Talking to friends/family/acquaintances
- Exercising, going for walks, or other physical activities
- Other (name)
- 36.
- Please indicate how much you agree with the following statement (cannot answer, do not agree at all, do not agree, agree to some extent, agree)
- There is sufficient information about asthma and the coronavirus available that I find comprehensible and helpful
- 37.
- What information would you like about asthma and COVID-19? (text box)
- 38.
- Sociodemographic information
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WHO Survey Tool and Guidance [43] | Adapted Survey Instrument | |||||||
---|---|---|---|---|---|---|---|---|
Categories | Categories and Subcategories | Theoretical Framework Level | Item # in Final Version | References | Number of Items in Respective Versions | |||
1st | 2nd | 3rd | Final | |||||
Socio-demography | Sociodemographic determinants | Sociodemographic determinants | 1, 38–48 | [55,56] | 12 | 12 | 12 | 12 |
COVID-19 personal experience | Personal experiences with COVID-19 | Other control variable (experience) | 16, 16a | [57,58] | 6 | 4 | 4 | 2 |
Health literacy (HL) | COVID-19-related health information management | HL (subjective) | 26 | [2,7] | 22 | 22 | 22 | 22 |
Knowledge about COVID-19 | HL (objective) | 19, 20, 21, 27 | [7,57,58,59,60] | 54 | 29 | 21 | 16 | |
COVID-19 risk perception: Probability and severity | Risk perceptions (vulnerability and severity) | Other control variable (perception) | 17, 31 | [57] | 8 | 6 | 6 | 4 |
Preparedness and perceived self-efficacy | Self-efficacy | Mediator | [57,60] | 3 | 0 | 0 | 0 | |
Prevention—own behaviours | Health behaviour (COVID-19 and asthma-related) | Health outcome (health behaviour) | 30 | [61] | 53 | 12 | 5 | 3 |
Affect | Affective perceptions | Other control variable (psychosocial impact) | 28, 32, 33 | [57,60] | 37 | 15 | 12 | 8 |
Stressors | 28, 33 | 30 | 3 | 3 | 2 | |||
Psychological state | 5 | 7 | 0 | 0 | ||||
Trust in sources of information | Dealing with COVID-19-related health information: Trust in sources of information | Other control variable (attitudes) | 22, 23 | [2,7] | 2 | 2 | 2 | 2 |
Use of sources of information | Utilisation and assessment of information sources | Health outcome (health information behaviour) | 24, 25, 36, 37 | [2,7,57] | 30 | 19 | 18 | 16 |
Frequency of information | ||||||||
Trust in institutions | Trust in authorities/institutions | Other control variable (attitudes) | [57,58] | 14 | 0 | 0 | 0 | |
Policies, interventions | Acceptance of and reactance to the preventive measures | Other control variable (attitudes) | [58] | 16 | 0 | 0 | 0 | |
Conspiracies | Belief that COVID-19 does not exist | Other control variable (perceptions) | 19 | [7] | 1 | 1 | 1 | 1 |
Resilience | Coping and resilience | Mediator | 35 | [58] | 16 | 8 | 5 | 3 |
Testing and tracing | Barriers and drivers to getting tested | Other control variable (perceptions) | 18 | 7 | 4 | 3 | 3 | |
Fairness | Acceptance and reactance | Other control variable (perceptions) | [58] | 4 | 0 | 0 | 0 | |
Lifting restrictions | Not adopted | |||||||
Unwanted behaviour | Not adopted | |||||||
Well-being | Well-being | Other control variable (psychosocial impact) | [58] | 6 | 0 | 0 | 0 | |
COVID-19 vaccine | Vaccination intention | Other control variable (attitude) | [58] | 13 | 2 | 0 | 0 | |
Additional categories | ||||||||
Health care utilisation | Health outcome (health system utilisation) | 29, 34 | [53,62] | 15 | 12 | 12 | 2 | |
Asthma-related health outcomes | Health outcome (health status) | 02–11, 14 | [63,64] | 17 | 18 | 21 | 17 | |
General health status | Health outcome (health status) | 12, 13, 15 | [56,61,65,66] | 27 | 22 | 3 | 3 | |
Total number of items | 398 | 198 | 150 | 116 |
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Hasenpusch, C.; Matterne, U.; Tischer, C.; Hrudey, I.; Apfelbacher, C. Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2022, 19, 1923. https://doi.org/10.3390/ijerph19041923
Hasenpusch C, Matterne U, Tischer C, Hrudey I, Apfelbacher C. Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2022; 19(4):1923. https://doi.org/10.3390/ijerph19041923
Chicago/Turabian StyleHasenpusch, Claudia, Uwe Matterne, Christina Tischer, Ilona Hrudey, and Christian Apfelbacher. 2022. "Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic" International Journal of Environmental Research and Public Health 19, no. 4: 1923. https://doi.org/10.3390/ijerph19041923