Overall Software Preference The results of this small feasibility study

are illustrated in figure 5.11. Of the 16 women who participated, 62.5% (n=10) indicated that the overall preference was for AFC. Average overall score (/10) was 8.36 and 7.8 for AFC and SS, respectively.

5.3.4.6 Additional Feedback

There was largely a positive response to the feasibility testing (Figure 5.12). Mothers were very willing to provide feedback about the usability, format, and design of the questionnaire in addition to expressing their views on the survey software. This valuable feedback resulted in changes to both the questionnaire wording and format in addition to a few minor amendments to the study itself.

62%

38% Adobe _FormsCentral

Select Survey

Figure 5 11: Overall Software Preference

Figure 5.12: Additional Feedback from Mothers

• Mothers felt their responses weren’t needed if their baby was

symptomless.

• Some mothers felt happier to take part in the study after reading

more information.

• Many mothers did not notice the ‘read more information’ option. • Mothers liked the descriptions below the questions as opposed to

the help buttons, particularly for wheeze and rattly chest definitions.

• Positive feedback for the colourful children at base of questionnaire-

indicated topic and brightened questionnaire design.

• Mother’s felt more reassured and more likely to participate having

seen the LWH FT logo.

• Mothers wanted to understand the benefit of the study and what it is

hoping to achieve – happy if other children would benefit and not their own child.

• Mothers prefer not to receive the postcard with the bounty pack –too

many leaflets so many unread.

5.4

Discussion

The aims of this study were to test the feasibility and acceptability of the web-based LRBCS questionnaire, and to explore any differences between two questionnaires developed by different survey software options. Results from this small feasibility study provided researchers with necessary results to choose the most appropriate questionnaire software and to develop an appealing and practical questionnaire. They also concluded that the finalised questionnaire is a feasible and acceptable tool for use in the prospective LRBCS population.

A clear overall preference was found for AFC software over SS software, with 62.5% (n=10) of mothers preferring the former. In addition, the 56% of mothers also preferred AFC on first impression, although 25% of mothers had no preference. Encouragingly, 100% of mothers understood each question and were able to complete the questionnaire with minimal

direction, maintaining that the questionnaire is suitable and comprehensible. Previous studies have emphasised the importance of questionnaire design for participation, response rates and attrition, particularly with regards to the format of questions247-249, 261. The format of the online questionnaire also affects it’s perceived length, in addition to the time taken for completion. Dropdown and matrix questions were identified as the most appropriate method for presenting the LRSQ questions. Feasibility testing demonstrated that dropdown style questions were marginally more popular than matrix style questions. Concerns over the validity of data collected using matrix style questions prompted researchers to proceed with the dropdown question design232. Results from previous studies and feedback from mothers suggested that matrix style questions might compromise data collection as answers may be given quickly, preventing the need for respondents to read the questionnaire properly.

Progression through the questionnaire and flow are also important factors to consider. Of the mothers who indicated a preference towards a particular survey software, the majority expressed a preference towards the AFC questionnaire (73% flow and 52% progress). Mothers also highlighted the clear, percentage progress bar on AFC as a particularly useful featured and also felt that the AFC questionnaire was quicker to complete. Results from this study emphasise the importance of skip logic that obviates need to complete irrelevant questions and reduces the time needed to complete the questionnaire, an important factor with regards to response rates. AFC enables skip logic preventing unnecessary questions from being asked unless the ‘trigger’ question selected. This means only relevant questions are asked thus reducing the overall time taken to complete the

questionnaire, improving flow through the questionnaire.

AFC questionnaires are able to provide “help” buttons, headers and footers to give extra information to guide participants through the questionnaire without cluttering the page. However these must be used with caution as some mothers preferred help text to appear directly below the question. During interviews it must be noted that mothers who appeared more computer literate were more comfortable using the ‘help’ buttons. Is important to make the questionnaires as accessible as possible and in a format that appeals the cohort of interest.

Feedback from mothers during interviews was used to further develop the questionnaire following the previous PPI work. This additional feedback prompted researchers to amend the phrasing of the demographic and exposure questions. The LRSQ questions were not edited, as these have been pre-validated in this particular cohort. These small, but necessary revisions are listed in the box below (figure 5.13).

Results regarding QR code usage were not encouraging. Although 60% of mothers recognised QR codes and were aware of their use, they would be unlikely to use the codes to sign up. However, considering the ever-

developing field of technology, this method will be used alongside personal recruitment, rather than replacing it. Study postcards and posters will

include the sign-up QR codes, with instructions on their use. This method of recruitment may then be assessed alongside personal recruitment.

Figure 5.13: Revisions to Demographic and Exposure Questions • Mothers felt their responses weren’t needed if their baby was

symptomless.

• Some mothers felt happier to take part in the study after reading more information.

• Many mothers did not notice the ‘read more information’ option at the beginning of the questionnaire.

• Mothers liked the descriptions below the questions as opposed to the help buttons, particularly for wheeze and rattly chest definitions.

• The term ‘child’ confused mothers and felt questionnaires should be changed to reflect the age of the child of interest. • Confusion over the asthma/allergy question – need to clarify

that this is regarding a 1st degree relative only. • Clarify DOB question is child’s DOB not mothers.

• The ‘save’ button confused mothers so was subsequently removed

• Breastfeeding question was clarified to include expressed milk. • Unsubscribe button must clarify that this is only selected if

participants do not want to take part in the study

• Smoking question was edited- both now refer to smoking anywhere

• Clarify difference between smoking questions –one during pregnancy and the other is at any time.

• Question asking for ‘mobile telephone number’ has been changed to ‘main telephone number’

• Drop down style questions decided for the LRSQ section of the questionnaire.

Additional revisions to the study and other material given to mothers were made following the feedback listed below (figure 5.14). Mothers felt that it was particularly important for recruitment material to clearly explain the study’s purpose, both on the recruitment postcards and questionnaire. The colourful children at the footer were appealing to the majority of mothers interviewed so will be included on more study documentation. One issue raised was that mothers were unsure that their babies might be included despite being symptomless. This prompted researchers to clarify in the initial information presented to mothers, that all babies may be included in the study regardless of whether they experience respiratory symptoms or not.

5.5

Conclusion

This feasibility study concluded that the majority of participants preferred AFC to SS (n=10 in comparison to n=6, respectively). This supports the decision to conduct the online LRBCS, particularly using AFC survey software. The questionnaire design has been further edited following

feedback from mothers to ensure it appeals to the population of interest and the final version of the initial version may be accessed at

http://goo.gl/mm565. QR code recruitment will be used to potentially facilitate recruitment but will certainly not replace the postcard recruitment method.

Figure 5.14: Additional Revisions Following the Feasibility Study

• Clearly explain what the study is hoping to achieve on

postcard and questionnaire.

• Include colourful children in more study documents. • Clarify on all documents and during recruitment that all

babies are being recruited and included into the study, not simply those with symptoms.

5.6

Limitations

Limitations of this small feasibility study must be considered when appraising the quality of data. Observer bias must be taken into account with these results as researchers involved with the LRBCS conducted the interviews. This may have introduced an element of observer bias in the collection and interpretation of the information provided by parents.

However, this could be an advantage in some respects as researchers were able to take every bit of feedback into account. Results of interviews are subjective and may be interpreted differently. All mothers completed

alternated versions of each questionnaire. However this may have affected mothers overall preference. This study targeted a specific population group, thus inferences made may not represent the whole population.

Furthermore, results may have been more reliable and of more significance with a larger sample size.