Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis
Authors:   NIHR Global Health Research Unit on Global Surgery, Glasbey James , Ademuyiwa Adesoji , Bhatt Alisha , Biccard Bruce , Blazeby Jane , Brocklehurst Peter , Chakrabortee Sohini , Ingabire JC Allen , Dossou Francis Moïse , Durán Irani , Dutta Rohini , Ghosh Dhruva , Gyamfi Frank , Haque Parvez , Hardy Pollyanna , Horton Mike , Hyman Gabriella , Jain Ritu , Ladipo-Ajayi Oluwaseun , Lawani Ismail , Lawani Souliath , Kachapila Mwayi , Lillywhite Rachel , Macefield Rhiannon , Magill Laura , Martin Janet , Mathers Jonathan , McLean Kenneth , Mistry Punam , Mittal Rohin , Monahan Mark , Moore Rachel , Morton Dion , Ojo Moyo , Ntirenganya Faustin , Ofori Emmanuel , Pearse Rupert , Peón Alberto , Pinkney Thomas , de la Medina Antonio Ramos , Ronald Tubasiime , Roman David , Runingamugabo Emmy , Sitch Alice , Slade Anita , Smith Donna , Tabiri Stephen , Bhangu Aneel , Glasbey James , Slade Anita , Horton Mike , Macefield Rhiannon , Bhangu Aneel , Hardy Pollyanna , Ademuyiwa Adesoji O , Ismail Lawani , Ghosh Dhruva , de la Medina Antonio Ramos , Moore Rachel , Ntirenganya Faustin , Tabiri Stephen , Runingamugabo Emmy , Patrawala Simin , Prah Angela , Oko Christian , Kroese Karolin , Lawani Ismaïl , Dossou Francis Moïse , Dzemta Corinne , Kandokponou Covalic Melic Bokossa , Lawani Souliath , Behanzin Hulrich , Kpangon Cyrile , Ofori Bernard Appiah , Tabiri Stephen , Saba Abdul-Hafiz , Limann Gbana , Acquah Daniel Kwesi , Alhassan Shamudeen Mohammed , Mohammed Sheriff , Emmanuel Owusu Abem , Musah Yakubu , Edwin Yenli , Kunfah Sheba , Mustapha Yakubu , Francis Abantanga Atindaana , Ayingayure Emmanuel , Limann Gbana , Amponsah-Manu Forster , Agyemang Eric , Agyekum Vera , Adjei-Acquah Esther , Twerefour Emmanuel Yaw , Koomson Barbra , Boateng Ruby Acheampong , Acquah Ato Oppong , Ofosu-Akromah Richard , Adam-Zakariah Leslie Issa , Adu-Aryee Nii Armah , Wordui Theodore , Larbi Coomson Christian , Enoch Akosa Appiah , Elijah Mensah , Christian Kyeremeh , Kwame Addo Gyambibi , Percy Boakye , Bismark Kontor Effah , Brian Gyamfi , Ruth Manu , Hussey Romeo , Dadzie Samuel , Appiah Akosua Dwamena , Yeboah Grace , Yeboah Cynthia , Amoako James , Acquah Regina , Sowah Naa Anyekaa , Kusiwaa Atta , Asabre Esther , Ballu Cletus , Barimah Charles Gyamfi , Owusu Frank , Sie-Broni Clement , Adobea Vivian , Owusu Prince Yeboah , Zume Marshall , Labaran Abdul-Hamid , Adu-Brobbey Raphael , Morna Martin Tangnaa , Debrah Samuel A , Maison Patrick Opoku Manu , Nortey Michael , Enti Donald , Amoako-Boateng Mabel Pokuah , Appiah Anthony Baffour , Ofori Emmanuel Owusu , Kpankpari Richard , Boakye Benedict , Quartson Elizabert Mercy , Koggoh Patience , Agbeko Anita Eseenam , Gyamfi Frank Enoch , Arthur Joshua , Yorke Joseph , Gyasi-Sarpong Christian Kofi , Dally Charles , Lovi Agbenya Kobla , Amoah Michael , Nimako Boateng , Sagoe Robert , Davor Anthony , Galley Fareeda , Adinku Michael , Boakye-Yiadom Jonathan , Acquaye Jane , Appiah Juliana , Acheampong Dorcas Otuo , Haruna Iddrisu , Boateng Edward Amoah , Ayodeji Emmanuel Kafui , Tuffuor Samuel , Kwarley Naa , Tufuor Yaa , Abdulai Ramatu Darling , Dankwah Fred , Armah Ralph , Ofosuhene Doris , Osei-Poku Dorcas , Temitope Arkorful Ebenezer , Gakpetor Delali Akosua , Gawu Victoria Sena , Asare Christopher , Tackie Enoch , Ankomah James , Nyarko Isaac Omane , Robertson Zelda , Godwin Serbeh , Boakye Appiah Anthony , Fosu Godfred , Assah-Adjei Frank , Haque Parvez , Jain Ritu , Bhatt Alisha , Dhiman Jyoti , Dutta Rohini , Ghosh Dhruva , Daniel Esther , Priyadarshini K , Madankumar Latha , Mittal Rohin , Nagomy Ida , Prasad Soosan , Mathew Arpit Jacob , Prakash Danita , Jacob Priya , Anachy Jeremiah P , Mathew Amy , Thomas Josy , Alexander Philip V , Zechariah Pradeep , Aruldas Neerav D , Mehraj Asif , Ahmed Hafsa Imtiyaz , Wani Rauf A , Parray Fazl Q , Chowdri Nisar A , De la Medina Antonio Ramos , Maldonado Laura Martinez Perez , Vazquez Diana S Gonzalez , Durán Sánchez Iran I , Martínez Lara Maria J , de la Fuente Alejandra Nayen Sainz , Cortes Flores Ana O , Barreto Gallo Mariana E , Ojeda Alejandro Gonzalez , Jimenez Velasco Monica E , Miguelena Luis Hernández , Cervantes Ortiz Reyes J , Hernandez Gonzalez Gonzalo I , Romero Marco Hurtado , Hernandez Krauss Rosa I , Dominguez Sansores Luis A , Cuevas Avendaño Alejandro , Cuellar Aguirre Celina , Baltazar Gomez Isaac , Ortiz Mejia Hector , González Ojeda Alejandro , Olvera Flores Oscar E , González García de Rojas Erick A , Pintor Belmontes Kevin J , Barbosa Camacho Francisco J , Bernal Hernández Aldo , Aguirre Laura Reyes , Morán Galaviz Rubén E , Orozco Clotilde Fuentes , Ángeles Bueno Wenceslao G , Ramirez Marbello Fernando S , Luna Acevedo Diego E , Valadez Michel Hernández , Bogurin Arellano Ana L , Ramírez-González Luis R , Guzmán Ramírez Bertha G , Robles Eduardo Valtierra , Rojas García Ramona I , Pérez Navarro José V , Cortes Torres Edgar J , Dominguez Solano David R , Peón Alberto N , Lincona Menindez Roque D , Gamez Rozana Reyes , Paz Muñoz Maria C , Belie Orimisan , Adeleye Victoria , Ademuyiwa Adesoji , Adeniyi Oluwafunmilayo , Akinajo Opeyemi , Akinboyewa David , Alakaloko Felix , Atoyebi Oluwole , Balogun Olanrewaju , Bode Christopher , Elebute Olumide , Ezenwankwo Francis , Adedotun Adesiyakan , Ihediwa George , Kuku Jubril , Ladipo-Ajayi Oluwaseun , Makanjuola Ayomide , Nwokocha Samuel , Ogein Olubunmi , Ojewola Rufus , Oladimeji Abraham , Olajide Thomas , Alasi Iyabo , Oluseye Oluwaseun , Seyi-Olajide Justina , Soibi-Harry Adaiah , Williams Emmanuel , Vincent Agbulu Moses , Duru Nnamdi Jonathan , Onyekachi Kenneth Uche , Ashley Christiana , Mgbemena Chinelo Victoria , Ojo Moyosoluwa , Oluyemisi Olowu , Ikuewunmi Iyabode , Adebunmi Adeoluwa , Bassey Edet Glory , Ohazurike Ephraim Okwudiri , Amao Olayide Michael , Oluwaseun Osunwusi Benedetto , Doris Emily , Stephen Olutola , Gbenga-Oke Christianah , Olayioye Olawunmi , Oluyemisi Olowu , Oluremi Kayode , Abunimye Esther , Oyegbola Christianah , Kayode Olayade , Orowale Adeola Ayoola , Williams Omolara M , Omisanjo Olufunmilade A , Faboya Omolara M , Imam Zainab O , Oshodi Olabode A , Oshodi Yusuf A , Ogunyemi Ayokunle A , Ajai Olalekan T , Nwaenyi Francisca C , Adisa Adewale O , Aderounmu Adewale A , Wuraola Funmilola O , Sowande Oludayo , Abdur-Rahman Lukman Olajide , Bello Jibril Oyekunle , Raji Hadijat Olaide , Adeleke Nurudeen Abiola , Lawal Saheed Abolade , Afolabi Rafiat Tinuola , Lawal Abdulwahab , Ekwunife Okechukwu Hyginus , Egwuonwu Ochomma Amobi , Uche Chisom Faith , Muhammad Abubakar Bala AB , Muhammad Saminu S , Takai Idris Usman IU , Aliyu Salele Mohammed AS , Ukata Onyekachi G , Magashi Mahmoud Kawu MK , Abdullahi Lawal Barau LB , Muideen Bello Abodunde BA , Ado Khadija A , Anyawu Lofty-John Chukwuemeka LJC , Olori Samson , Sani Samuel A , Osagie Olabisi O , Mbajiekwe Ndubuisi , Aisuodionoe-Shadrach Oseremen , Akaba Godwin O , Ameh Lazarus , Ameh Lazarus , Adebayo Francis o , Uanikhoba Martins , Ogbo Felix O , Tabuanu Nancy O , Lawal Taiwo A , Abdus-Salam Rukiyat A , Ajao Akinlabi E , Takure Augustine O , Ayandipo Omobolaji O , Ekwuazi Hyginus O , Abayomi Olukayode , Lawal Olatunji O , Olagunju Solomon , Egbuchulem Kelvin I , Adebayo Sikiru Adekola , Elemile Peter , Usang Usang E , Udosen Joseph E , Edet Expo E , Inyang Akan W , Olory Edima M , Udie Gabriel U , Chiejina Godwin O , Marwa Adams D , Iseh Faith J , Ogbeche Sunday A , Isa Mary O , Ezomike Uchechukwu O , Ekenze Sebastian O , Eze Matthew I , Izuka Emmanuel O , Ede Jude K , Enemuo Vincent C , Mbadiwe Okezie M , Mbah Ngozi G , Imanishimwe Alphonsine , Habumuremyi Sosthene , Ntirenganya Faustin , Ingabire JC Allen , Ncogoza Isaie , Munyaneza Emmanuel , de Dieu Haragirimana Jean , Urimubabo Christian Jean , Mukanyange Violette , Nyirahabimana Jeannette , Mutabazi Emmanuel , Mpirimbanyi Christophe , Mwenedata Olivier , Maniraguha Hope Lydia , Izabiriza Emelyne , Dusabe Moses , Zirikana Job , Uwizeyimana Francine , Mutuyimana Josiane , Rwagahirima Elisee , Imanishimwe Alphonsine , Tubasiime Ronald , Munyaneza Aphrodis , Habumuremyi Sosthene , Kanyarukiko Salathiel , Ndegamiye Gibert , Mukaneza Francine , Uwimana Jean Claude , Nyirangeri Pierrine , Mukantibaziyaremye Deborah , Hirwa Aime Dieudonne , Mbonimpaye Salomee , Muroruhirwe Piolette , Mukakomite Christine , Kabanda Elysee , Moore Rachel , Nhlabathi Ncamsile Anthea , Fourtounas Maria , Adams Mary Augusta , Hyman Gabriella , Nxumalo Hlengiwe Samkelisiwe , Sentholang Nnosa , Sethoana Mmule Evelyn , Mathe Mpho Nosipho , Ally Zain , Flint Margot , Biccard Bruce , Ademuyiwa Adesoji O , Adisa Adewale O , Bhangu Aneel , Brocklehurst Peter , Chakrabortee Sohini , Hardy Pollyanna , Harrison Ewen , Ingabire JC Allen , Haque Parvez D , Ismail Lawani , Glasbey James , Ghosh Dhruva , Gyamfi Frank Enoch , Li Elizabeth , Lillywhite Rachel , de la Medina Antonio Ramos , Moore Rachel , Magill Laura , Morton Dion , Nepogodiev Dmitri , Ntirenganya Faustin , Pinkney Thomas , Omar Omar , Simoes Joana , Smith Donna , Tabiri Stephen , Ademuyiwa Adesoji O , Ismail Lawani , Ghosh Dhruva , de la Medina Antonio Ramos , Moore Rachel , Ntirenganya Faustin , Tabiri Stephen , Ademuyiwa Adesoji , Bhangu Aneel , Brant Felicity , Brocklehurst Peter , Chakrabortee Sohini , Ghosh Dhruva , Glasbey James , Hardy Pollyanna , Harrison Ewen , Heritage Emily , Ismail Lawani , Kroese Karolin , Lapitan Carmela , Lillywhite Rachel , Lissauer David , Magill Laura , de la Medina Antonio Ramos , Mistry Punam , Monahan Mark , Moore Rachel , Morton Dion , Nepogodiev Dmitri , Ntirenganya Faustin , Omar Omar , Pinkney Thomas , Roberts Tracy , Smith Donna , Tabiri Stephen , Winkles Neil , Hardy Pollyanna , Omar Omar , Runigamugabo Emmy , Verjee Azmina , Sodonougbo Pierre , Assouto Pamphile , Fiogbe Michel , Koco Houenoukpo , Metchinhoungbe Serge , Sogbo Hodonou , Behanzin Hulrich , Seto Djifid Morel , Tandje Yannick , Kangni Sosthène , Kpangon Cyrile , Akpla Marcelin , Chobli Hugues Herve , Kovohouande Blaise , Agboton Gérard , Ahossi Rene , Ngabo Raoul Baderha , Bisimwa Nathan , Kandokponou Covalic Melic Bokossa , Dokponou Mireille , Dossou Francis Moïse , Dzemta Corinne , Gaou Antoine , Goudou Roland , Hedefoun Emmanuel , Houtoukpe Sunday , Kamga Felix , Kiki-Migan Eric , Lawani Souliath , Lawani Ismaïl , Loko René , Moutaïrou Afissatou , Ogouyemi Pencome , Soumanou Fouad , Tamadaho Pia , Zounon Mack-Arthur , Adagrah Luke Aniakwo , Alhassan Bin Baaba Alhaji , Amoako-Boateng Mabel Pokuah , Appiah Anthony Baffour , Asante-Asamani Alvin , Boakye Benedict , Debrah Samuel A , Enti Donald , Ganiyu Rahman Adebisi , Koggoh Patience , Kpankpari Richard , Opandoh Isabella Naa M , Manu Meshach Agyemang , Manu Maison Patrick Opoku , Mensah Samuel , Morna Martin Tangnaa , Nkrumah John , Nortey Michael , Ofori Emmanuel Owusu , Quartson Elizaberth Mercy , Adjei-Acquah Esther , Agyekum Vera , Agyemang Eric , Akesseh Rebecca Adjeibah , Amponsah-Manu Forster , Ofosu-Akromah Richard , Acquah Ato Oppong , Adam-Zakariah Leslie Issa , Asabre Esther , Boateng Ruby Acheampong , Koomson Barbara , Kusiwaa Ataa , Twerefour Emmanuel Yaw , Ankomah James , Assah-Adjei Frank , Boakye Anthony Appiah , Fosu Godfred , Serbeh Godwin , Gyan Kofi Yeboah , Nyarko Isaac Omane , Robertson Zelda , Armah Ralph , Asare Christopher , Gakpetor Delali Akosua , Gawu Victoria Sena , Obbeng Ambe , Ofosuhene Doris , Osei-Poku Dorcas , Puozaa Diana , Tackie Enoch , Temitope Arkorful Ebenezer , Acquah Regina , Amoako James , Appiah Akosua Dwamena , Aseti Mark , Banka Charles , Dadzie Samuel , Essien Derick , Gyamfi Frank Enoch , Hussey Romeo , Kwarteng Jemima , Sowah Naa Anyekaa , Yeboah Grace , Yeboah Cynthia , Addo Kwame Gyambibi , Akosa Enoch Appiah , Boakye Percy , Coompson Christian Larbi , Gyamfi Brian , Kontor Bismark Effah , Kyeremeh Christian , Manu Ruth , Mensah Elijah , Solae Friko Ibrahim , Toffah Gideon Kwasi , Acheampong Dorcas Otuo , Acquaye Jane , Adinku Michael , Agbedinu Kwabena , Agbeko Anita Eseenam , Amankwa Emmanuel Gyimah , Amoah Michael , Amoah George , Appiah Juliana , Arthur Joshua , Ayim Alex , Ayodeji Emmanuel Kafui , Boakye-Yiadom Jonathan , Boateng Edward Amoah , Dally Charles , Davor Anthony , Gyasi-Sarpong Christian Kofi , Hamidu Naabo Nuhu Noel , Haruna Iddrisu , Kwarley Naa , Lovi Agbenya Kobla , Nimako Boateng , Nyadu Bertina Beauty , Opoku Dominic , Osabutey Anita , Sagoe Robert , Tuffour Samuel , Tufour Yaa , Yamoah Francis Akwaw , Yefieye Abiboye Cheduko , Yorke Joseph , Adu-Aryee Nii Armah , Adjei Faisal , Akoto Erica , Ametefe Elikem , Amoako Joachim Kwaku , Attepor Godsway Solomon , Brown George Darko , Fenu Benjamin , Kumassah Philemon Kwame , Olayiwola David Olatayo , Wordui Theodore , Agboadoh Nelson , Abubakari Fatao , Ballu Cletus , Barimah Charles Gyamfi , Boateng Guy Casskey , Luri Prosper Tonwisi , Titigah Abraham , Owusu Frank , Adu-Brobbey Raphael , Coompson Christian Larbi , Labaran Abdul-Hamid , Owusu Junior Atta , Adobea Vivian , Bennin Amos , Dankwah Fred , Doe Stanley , Kantanka Ruth Sarfo , Kobby Ephraim , Larnyor Kennedy Kofi Korankye Hanson , Osei Edwin , Owusu Prince Yeboah , Sie-Broni Clement Ayum , Zume Marshall , Abantanga Francis Atindaana , Abdulai Darling Ramatu , Acquah Daniel Kwesi , Ayingayure Emmanuel , Osman Imoro , Kunfah Sheba , Limann Gbana , Mohammed Shamudeen Alhassan , Mohammed Sheriff , Musah Yakubu , Ofori Bernard , Owusu Emmanuel Abem , Saba Abdul-Hafiz , Seidu Anwar Sadat , Tabiri Stephen , Yakubu Mustapha , Yenli Edwin Mwintiereh Taang , Gautham Arun , Hepzibah Alice , Mary Grace , Singh Deepak , Bhatti Dimple , Bhatti William , Bir Karan , Daniel Swati , Dhar Tapasya , Dhiman Jyoti , Ghosh Dhruva , Goyal Sunita , Goyal Ankush , Hans Monika , Haque Parvez , Konda Samuel , Luther Anil , Mahajan Amit , Makkar Shalini , Mandrelle Kavita , Michael Vishal , Mukherjee Partho , Rajappa Reuben , Singh Prashant , Suroy Atul , Thind Ravinder , Thomas Alen , Tuli Arti , Veetil Sreejith , Jesudason Esther Daniel Mark , Priyadarshini K , Madankumar Latha , Mittal Rohin , Nagomy Ida , Selvakumar Rajesh , Shankar Bharat , Sivakumar Moonish , Sridhar Rajeevan , Thomas Cecil , Titus Devabalan , Aggarwal Manisha , Dhamija Parth , Gupta Himani , Kanna Vinoth , Kumar Ashwani , Singh Gurtaj , Alexander Philip , Thomas Josy , Zechariah Pradeep , Dasari Amos , Jacob Priya , Kurien Elizabeth , Mathew Arpit , Prakash Danita , Susan Anju , Varghese Rose , Alpheus Rahul , Choudhrie Ashish , Kumar Hemanth , Peters Nitin , Raul Subrat , Sharma Rajeev , Vakil Rakesh , Bueno Wenceslao Ángeles , Camacho Francisco Barbosa , Hernández Aldo Bernal , Arellano Ana Bogurin , Torres Edgar Cortes , Orozco Clotilde Fuentes , de Rojas Erick González García , Ojeda Alejandro González , Ramírez Bertha Guzmán , Valadez Michel Hernández , Acevedo Diego Luna , Galaviz Rubén Morán , Flores Oscar Olvera , Navarro José Pérez , Belmontes Kevin Pintor , Marbello Fernando Ramirez , Ramírez-González Luis , Aguirre Laura Reyes , García Ramona Rojas , Robles Eduardo Valtierra , Cervantes Reyes Ortiz , Gonzalez Gonzalo Hernandez , Krauss Rosa Hernandez , Miguelena Luis Hernández , Romero Marco Hurtado , Gomez Isaac Baltazar , Aguirre Celina Cuellar , Avendaño Alejandro Cuevas , Sansores Luis Dominguez , Mejia Hector Ortiz , del Campo Laura Urdapilleta Gomez , Cerdan Claudia Caballero , Solano David Dominguez , Garcia Rafael Toriz , Gallo Mariana Barreto , Flores Ana Cortes , Ojeda Alejandro Gonzalez , Velasco Monica Jimenez , Gamez Rozana Reyes , Menindez Roque Lincona , Peón Alberto Navarrete , Muñoz Maria Paz , Sánchez Irán Irani Durán , Vázquez Diana Samantha González , Lara María José Martínez , Maldonado Laura Martinez Perez , de la Fuente Alejandra Nayen Sainz , De la Medina Antonio Ramos , Abdullahi Lawal , Ado Khadija , Aliyu Mohammed , Anyanwu Lofty-John , Magashi Mahmoud , Muhammad Abubakar , Muhammad Saminu , Muideen Bello , Takai Idris , Ukata Onyekachi , Adesanya Opeoluwa , Awonuga David , Fasiku Olushola , Ogo Chidiebere , Abdulsalam Moruf , Adeniran Abimbola , Ajai Olalekan , Akande Olukemi , Atobatele Kazeem , Eke Grace , Faboya Omolara , Imam Zainab , Momson Esther , Nwaenyi Francisca , Ogunyemi Ayokunle , Oludara Mobolaji , Omisanjo Olufunmilade , Oshodi Olabode , Oshodi Yusuf , Oyewole Yemisi , Salami Omotade , Williams Omolara , Adeleye Victoria , Ademuyiwa Adesoji , Adeniyi Oluwafunmilayo , Akinajo Opeyemi , Akinboyewa David , Alasi Iyabo , Alakaloko Felix , Atoyebi Oluwole , Balogun Olanrewaju , Belie Orimisan , Bode Christopher , Ekwesianya Andrew , Elebute Olumide , Ezenwankwo Francis , Fatuga Adedeji , Ihediwa George , Jimoh Adesola , Kuku Jubril , LadipoAjayi Oluwaseun , Makanjuola Ayomide , Mokwenyei Olayanju , Nwokocha Samuel , Ogein Olubunmi , Ojewola Rufus , Oladimeji Abraham , Olajide Thomas , Oluseye Oluwaseun , Seyi-Olajide Justina , Soibi-Harry Adaiah , Ugwu Aloy , Williams Emmanuel , Egwuonwu Ochomma , Ekwunife Okechukwu , Modekwe Victor , Okoro Chukwuemeka , Uche Chisom , Ugwuanyi Kenneth , Ugwunne Chuka , Adeleke Akeem , Adenikinju Wilson , Adeniyi Olumide , Adepiti Akinfolarin , Aderounmu Adewale , Adesunkanmi Abdulhafiz , Adisa Adewale , Ajekwu Samuel , Ajenjfuja Olusegun , Akindojutimi Jerrie , Akinkuolie Akinbolaji , Alatise Olusegun , Allen Olubukola , Amosu Lukmon , Archibong Micheal , Arowolo Olukayode , Ayantona Deborah , Ayinde Ademola , Badejoko Olusegun , Badmus Tajudeen , Etonyeaku Amarachukwu , Igbodike Emeka , Ijarotimi Omotade , Lawal Adedayo , Nana Fayowole , Oduanafolabi Tunde , Olasehinde Olalekan , Olayemi Olaniyi , Omitinde Stephen , Oni Owolabi , Onyeze Chigozie , Orji Ernest , Rotimi Adewale , Salako Abdulkadir , Solaja Olufemi , Sowemimo Oluwaseun , Talabi Ademola , Tajudeen Mohammed , Wuraola Funmilola , Adebayo Francis , Aisuodionoe-Shadrach Oseremen , Akaba Godwin , Ameh Lazarus , Mbajiekwe Ndubuisi , Ogbo Felix , Olori Samson , Osagie Olabisi , Sadiq Abu , Sani Samuel , Tabuanu Nancy , Uanikhoba Martins , Chiejina Godwin , Edet Ekpo , Inyang Akan , Isa Mary , Iseh Faith , Marwa Adams , Ogbeche Sunday , Olory Edima , Udie Gabriel , Udosen Joseph , Usang Usang , Abayomi Olukayode , Abdus-Salam Rukiyat , Adebayo Sikiru , Ajao Akinlabi , Amusat Olanrewaju , Ayandipo Omobolaji , Egbuchulem Kelvin , Ekwuazi Hyginus , Elemile Peter , Lawal Taiwo , Lawal Olatunji , Olagunju Solomon , Osuala Peter , Suleman Bamidele , Takure Augustine , Abdur-Rahman Lukman , Adeleke Nurudeen , Adesola Muideen , Afolabi Rafiat , Agodirin Sulaiman , Aremu Isiaka , Bello Jibril , Lawal Saheed , Lawal Abdulwahab , Raji Hadijat , Sayomi Olayinka , Shittu Asimiyu , Ede Jude , Ekenze Sebastian , Enemuo Vincent , Eze Matthew , Ezomike Uchechukwu , Izuka Emmanuel , Mbadiwe Okezie , Mbah Ngozi , Ezinne Uba , Francis Matthew , Ikechukwu Iweha , Nnyonno Okoi , Okoro Philemon , Patrick Igwe , Raphael John , Vaduneme Oriji , Victor Abhulimen , Kanyarukiko Salathiel , Mukaneza Francine , Mukantibaziyaremye Deborah , Munyaneza Aphrodis , Ndegamiye Gibert , Tubasiime Ronald , Dusabe Moses , Izabiriza Emelyne , Maniraguha Hope Lydia , Mpirimbanyi Christophe , Mutuyimana Josiane , Mwenedata Olivier , Rwagahirima Elisee , Uwizeyimana Francine , Zirikana Job , Hirwa Aime Dieudonne , Kabanda Elysee , Mbonimpaye Salomee , Mukakomite Christine , Muroruhirwe Piolette , Bucyibaruta Georges , Bunogerane Gisele Juru , Habumuremyi Sosthene , de Dieu Haragirimana Jean , Imanishimwe Alphonsine , Ingabire JC Allen , Mukanyange Violette , Munyaneza Emmanuel , Mutabazi Emmanuel , Ncogoza Isaie , Ntirenganya Faustin , Nyirahabimana Jeannette , Urimubabo Christian , Adams Mary Augusta , Crawford Richard , Ede Chikwendu Jeffrey , Fourtounas Maria , Hyman Gabriella , Khan Zafar , Kwati Morapedi , Mathe Mpho Nosipho , Moore Rachel , Nhlabathi Ncamsile Anthea , Nxumalo Hlengiwe Samkelisiwe , Pattinson Paddy , Sentholang Nnosa , Sethoana Mmule Evelyn , Stassen Maria Elizabeth , Thornley Laura , Hospital Paul Wondoh Edenvale , Birtles Cheryl , Ivy Mathete , Mbavhalelo Cynthia , Ally Zain , Adewunmi Abdus-sami , Cook Jonathan , Jayne David , Laurberg Soren , Brown Julia , Cousens Simon , Smart Neil 
Published: April 2023

Abstract

Background
The Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.

Methods
This was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.

Results
In the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach’s α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).

Conclusion
This study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways.