Patients’ needs in asthma treatment: development and initial validation of the NEAT questionnaire

Abstract

Objective: We aimed to develop and tentatively validate an instrument assessing patients’ needs related to asthma treatment. Methods: Patients were recruited through various approaches (e.g. physicians, pharmacies and patient organizations). Utilizing a mixed methods design, we first conducted five focus groups to explore needs among patients. Next, we devised an item pool which was revised, reduced and evaluated by patients. Finally, data from a survey (n = 362) were used to further reduce the item pool and to examine the questionnaire’s psychometric properties and validity. Results: Four broad needs categories emerged from the focus groups: (1) information needs; (2) consideration of patient views in diagnosis; (3) consideration of patient views in treatment planning; and (4) addressing patients’ fears. We devised 45 items, which were reduced to 22 items based on patient feedback. The survey data suggested a 13-item scale with four subscales (“patient expertise”, “drug effects”, “handling drugs” and “exacerbations”). Cronbach’s alpha was acceptable for those subscales (>0.7) and for the total score (0.9). Increasing scores on subscales and the total score (implying more unmet needs) showed close and consistent associations with poor asthma control, reduced quality of life and low treatment satisfaction. Conclusions: The development process of the Needs in Asthma Treatment (NEAT) questionnaire ensured that needs of asthma patient are captured with high validity. The NEAT questionnaire has been shown to be valid, thereby representing a promising tool for research and delivery of patient-centered care.

• Asthma
• mixed methods
• needs
• patient-reported outcome measures
• questionnaire design
• validation

Acknowledgements

The funder had no say related to the study design, the collection, analysis and interpretation of data; the writing of the manuscript; and in the decision to submit the manuscript for publication. We are grateful to the Bertelsmann Stiftung for granting permission to edit and use two short movies as introductory material for our focus groups. We are furthermore indebted to the German Allergy and Asthma Foundation [Deutscher Allergie und Asthmabund, DAAB], the German Association for Atopic Eczema [Bundersverband Neurodermitis e.V.], numerous rehabilitation centers, various regional patient organizations and pulmonary sports groups throughout Germany as well as physicians and pharmacists for their invaluable efforts to support the recruitment of study participants. We wish to thank Prof. Stefan Wilm, Director of the Institute of General Practice at the Medical Faculty of the University of Düsseldorf, for his support and advice related to patient recruitment in early stages of this project. We wish to express our gratitude to Mrs Ursula Goldberger, a certified interpreter from the Mannheim Institute of Public Health, Social and Preventive Medicine at the University of Heidelberg, for the translation of the quotes from the focus groups for the current manuscript. Finally, we are grateful to Mrs Bettina Hartmann, Mrs Julia Czechy and Mrs Miriam Engel for their support related to data management, transcription services and patient recruitment.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. This study was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, grant number: LO 1730/2-1) as a project of the Junior Academy in Health Services Research (Nachwuchsakademie Versorgungsforschung 2012).

Supplementary material available online

Notes

¹The item on interactions of asthma drugs with other drugs was not considered here. Respondents were instructed only to respond to that item if it was applicable (i.e. if they took other drugs for other conditions than asthma).