JMIR Publications

ABSTRACT

Background:

Hospital healthcare is facing major challenges, including ageing, multimorbidity, rising costs, and staff shortages. This puts the delivery of high-quality healthcare under pressure. Hybrid healthcare can help alleviate current pressure on healthcare systems. Once implemented, it is essential to monitor and evaluate hybrid care. Through concept-mapping, the HHQA-model was created which covers and connects all the important aspects high-quality hybrid care needs to address. Based on the items and clusters within the model, a corresponding questionnaire has been developed. To implement the questionnaire in practice, its content should be validated.

Objective:

This study aimed to iteratively refine the HHQA-questionnaire by evaluating and improving its content validity, focusing on comprehensibility, relevance, and comprehensiveness from the perspective of hospital employees and client representatives.

Methods:

This qualitative study was iterative in nature and was performed within Zuyderland Medical Center, located in Heerlen, the Netherlands. Four group-based think-aloud sessions were organized. During these sessions, participants verbally reflected while progressing through half of the questionnaire. This was audio recorded and transcribed verbatim. Transcripts were coded and analyzed using the Framework Method, with feedback from each session returned to the questionnaire’s developer to inform iterative refinement.

Results:

The four think-aloud sessions contained a total number of thirty-one participants. Comprehensibility was refined by improving clarity through better language use and terminology ensuring each item measures a single aspect, and clarifying scope and improving item applicability. Relevance was improved by enhancing wording and clarifying the target audience of items. Comprehensiveness was generally regarded as adequate, although it was only partially assessable. Some items required rewording to better align with the cluster. Alternatives were suggested for items that did not fit their cluster. Additionally, changes to cluster titles were suggested for some clusters as they were potentially unclear or misleading. The answer options were substantially revised to bring them more in line with the item they belong to and their audience.

Conclusions:

Relevance and comprehensiveness were assessed as reasonably good and were further improved. Even after four iterations, the comprehensibility of the questionnaire can be improved further. This is evident for both items and answer options. The reliability of the HHQA-questionnaire should be tested before implementing and testing the questionnaire in another Dutch hospital, filtering could be used to facilitate easier answering, and patients should stay part of the audience of the HHQA-questionnaire.