At a preliminary meeting of the ‘IMPALA’ International Partnership (www.lstmed.ac.uk/impala ), representing expertise in asthma, COPD, air quality, smoking and occupational lung disease, we identified existing validated tools, including the World Health Organization household energy use survey and questions on nutrition developed by experts from the Global Asthma Network. After consultation with the original authors and developers, we held structured discussions with in-country colleagues to identify areas in which existing questionnaires were inadequate, improperly focussed or unsuitable for direct deployment in sub Saharan Africa. The agreed targets were context-appropriate tools to assess lung disease symptoms, smoking, nutrition, household energy use, history of tuberculosis, and wider lifetime exposures to risk factors for lung disease, including occupation (see Table 1 ).
New questionnaires were collaboratively created on a shared online platform (Kobo toolbox). Where possible we adapted existing tools: others were developed de novo. Insights from external advisors with specific expertise (e.g., dietary contributors to lung health) and situational knowledge relating to the Malawian context were sought and used to refine questionnaire scope and design. A single co-ordinating team ensured coherence and completeness across the tools with collaborative meetings, both remotely and in person, held throughout the process to share insights and progress updates. Prior to any further processes, the questionnaires’ content validity (the extent to which the tool measures the complete spectrum of the construct) and criterion validity (in comparison to a ‘gold standard’ or proxy) were considered by an expert panel with broad previous field research experience. The questionnaires were translated into Chichewa by two Malawian translators, with two independent parallel translations in most cases. Subsequent discussions were held between translators and a research coordinator to resolve areas of difficulty or discord.
Original and translated versions were then taken forward for consultation in a series of meetings with pre-established lay focus groups, locally known as community advisory groups [11 (link)]. Separate meetings, each of approximately nine people from urban Blantyre and from rural Chikwawa, gave feedback on the comprehensibility and contextual relevance of the questionnaires, within a pre-agreed consultation framework. Meetings were conducted in a combination of English and Chichewa, with fieldworkers and community advisory group coordinators in key positions as linguistic intermediaries. Lay members were organised into subgroups of three, each with a bilingual member of staff with prior understanding of the questionnaire content in a coordinating position. This allowed for guided debate where all voices could be heard, before consensus opinion was sought amongst the wider group. In terms of participant selection, purposive sampling was used to allow fuller representation by age, gender and occupation.
The consultation meetings were part of ongoing work within the science communication group, with specific Research Ethics Committee approval granted for the testing of the questionnaires in Malawi (College of Medicine Research Ethics Committee P.02/18/2349) and planned for other sites.
Questionnaires with more original content and those with significant anticipated context-sensitive elements were fully considered by focus groups from both urban and rural areas. Others, based on established sources were only put to one group, although members considered how the questions might be understood and applicable more broadly (detailed inTable 1 ).
The resulting questionnaires, including flow and skip-logic were circulated, first to key researchers in the team, then to the wider expert group for feedback. Suggested changes were discussed and agreed on amongst coordinators before incorporation to the final questionnaire set. Partners responsible for each individual tool also nominated key questions to be taken forward to form a composite ‘screening questionnaire’. The new questionnaires are being used by members of the wider collaboration in pilot projects, initially in Malawi and subsequently, after iterative adaptation processes, in other sites across sub Saharan Africa.
New questionnaires were collaboratively created on a shared online platform (Kobo toolbox). Where possible we adapted existing tools: others were developed de novo. Insights from external advisors with specific expertise (e.g., dietary contributors to lung health) and situational knowledge relating to the Malawian context were sought and used to refine questionnaire scope and design. A single co-ordinating team ensured coherence and completeness across the tools with collaborative meetings, both remotely and in person, held throughout the process to share insights and progress updates. Prior to any further processes, the questionnaires’ content validity (the extent to which the tool measures the complete spectrum of the construct) and criterion validity (in comparison to a ‘gold standard’ or proxy) were considered by an expert panel with broad previous field research experience. The questionnaires were translated into Chichewa by two Malawian translators, with two independent parallel translations in most cases. Subsequent discussions were held between translators and a research coordinator to resolve areas of difficulty or discord.
Original and translated versions were then taken forward for consultation in a series of meetings with pre-established lay focus groups, locally known as community advisory groups [11 (link)]. Separate meetings, each of approximately nine people from urban Blantyre and from rural Chikwawa, gave feedback on the comprehensibility and contextual relevance of the questionnaires, within a pre-agreed consultation framework. Meetings were conducted in a combination of English and Chichewa, with fieldworkers and community advisory group coordinators in key positions as linguistic intermediaries. Lay members were organised into subgroups of three, each with a bilingual member of staff with prior understanding of the questionnaire content in a coordinating position. This allowed for guided debate where all voices could be heard, before consensus opinion was sought amongst the wider group. In terms of participant selection, purposive sampling was used to allow fuller representation by age, gender and occupation.
The consultation meetings were part of ongoing work within the science communication group, with specific Research Ethics Committee approval granted for the testing of the questionnaires in Malawi (College of Medicine Research Ethics Committee P.02/18/2349) and planned for other sites.
Questionnaires with more original content and those with significant anticipated context-sensitive elements were fully considered by focus groups from both urban and rural areas. Others, based on established sources were only put to one group, although members considered how the questions might be understood and applicable more broadly (detailed in
The resulting questionnaires, including flow and skip-logic were circulated, first to key researchers in the team, then to the wider expert group for feedback. Suggested changes were discussed and agreed on amongst coordinators before incorporation to the final questionnaire set. Partners responsible for each individual tool also nominated key questions to be taken forward to form a composite ‘screening questionnaire’. The new questionnaires are being used by members of the wider collaboration in pilot projects, initially in Malawi and subsequently, after iterative adaptation processes, in other sites across sub Saharan Africa.
Full text: Click here