Coleman S, Nixon J, Keen J, Muir D, Wilson L, McGinnis E, Stubbs N, Dealey C, Nelson E A
Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
BMC Med Res Methodol. 2016 Nov 16;16(1):158. doi: 10.1186/s12874-016-0257-5.
Variation in development methods of Pressure Ulcer Risk Assessment Instruments has led to inconsistent inclusion of risk factors and concerns about content validity. A new evidenced-based Risk Assessment Instrument, the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool - PURPOSE-T was developed as part of a National Institute for Health Research (NIHR) funded Pressure Ulcer Research Programme (PURPOSE: RP-PG-0407-10056). This paper reports the pre-test phase to assess and improve PURPOSE-T acceptability, usability and confirm content validity.
A descriptive study incorporating cognitive pre-testing methods and integration of service user views was undertaken over 3 cycles comprising PURPOSE-T training, a focus group and one-to-one think-aloud interviews. Clinical nurses from 2 acute and 2 community NHS Trusts, were grouped according to job role. Focus group participants used 3 vignettes to complete PURPOSE-T assessments and then participated in the focus group. Think-aloud participants were interviewed during their completion of PURPOSE-T. After each pre-test cycle analysis was undertaken and adjustment/improvements made to PURPOSE-T in an iterative process. This incorporated the use of descriptive statistics for data completeness and decision rule compliance and directed content analysis for interview and focus group data. Data were collected April 2012-June 2012.
Thirty-four nurses participated in 3 pre-test cycles. Data from 3 focus groups, 12 think-aloud interviews incorporating 101 PURPOSE-T assessments led to changes to improve instrument content and design, flow and format, decision support and item-specific wording. Acceptability and usability were demonstrated by improved data completion and appropriate risk pathway allocation. The pre-test also confirmed content validity with clinical nurses.
The pre-test was an important step in the development of the preliminary PURPOSE-T and the methods used may have wider instrument development application. PURPOSE-T proposes a new approach to pressure ulcer risk assessment, incorporating a screening stage, the inclusion of skin status to distinguish between those who require primary prevention and those who require secondary prevention/treatment and the use of colour to support pathway allocation and decision making. Further clinical evaluation is planned to assess the reliability and validity of PURPOSE-T and it's impact on care processes and patient outcomes.
压疮风险评估工具的开发方法存在差异，导致风险因素的纳入不一致，且对内容效度存在担忧。作为国家卫生研究院（NIHR）资助的压疮研究项目（项目编号：RP - PG - 0407 - 10056）的一部分，开发了一种新的循证风险评估工具——压疮风险一级或二级评估工具 - PURPOSE - T。本文报告了预测试阶段，以评估和改进PURPOSE - T的可接受性、可用性并确认内容效度。
进行了一项描述性研究，纳入认知预测试方法并整合服务使用者的观点，该研究分3个周期进行，包括PURPOSE - T培训、焦点小组和一对一的出声思考访谈。来自2家急症和2家社区国民保健服务信托机构的临床护士按工作角色分组。焦点小组参与者使用3个案例 vignettes 完成PURPOSE - T评估，然后参加焦点小组。出声思考参与者在完成PURPOSE - T评估时接受访谈。在每个预测试周期后进行分析，并以迭代方式对PURPOSE - T进行调整/改进。这包括使用描述性统计来评估数据完整性和决策规则的遵守情况，并对访谈和焦点小组数据进行定向内容分析。数据收集于2012年4月至2012年6月。
34名护士参与了3个预测试周期。来自3个焦点小组、12次出声思考访谈（包含101次PURPOSE - T评估）的数据促使对工具内容和设计、流程和格式、决策支持以及特定项目措辞进行了改进。数据完整性的提高和适当的风险路径分配证明了可接受性和可用性。预测试还证实了该工具在临床护士中的内容效度。
预测试是初步的PURPOSE - T开发过程中的重要一步，所使用的方法可能在更广泛的工具开发中具有应用价值。PURPOSE - T提出了一种新的压疮风险评估方法，包括一个筛查阶段，纳入皮肤状况以区分需要一级预防者和需要二级预防/治疗者，并使用颜色来支持路径分配和决策制定。计划进行进一步的临床评估，以评估PURPOSE - T的可靠性和效度及其对护理过程和患者结局的影响。
