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Cognitive testing of a survey instrument for self-assessed menstrual cycle characteristics and androgen excess.

ABSTRACT: Background: In large population-based studies, there is a lack of existing survey instruments designed to ascertain menstrual cycle characteristics and androgen excess status including hirsutism, alopecia, and acne. Our objective was to cognitively test a survey instrument for self-assessed menstrual cycle characteristics androgen excess.

Methods: Questions to assess menstrual characteristics and health were designed using existing surveys and clinical experience. Pictorial self-assessment tools for androgen excess were also developed with an experienced medical illustrator to include the modified Ferrimen-Galway, acne and androgenic alopecia. These were combined into an online survey instrument using REDCap. Of the 219 questions, 120 were selected for cognitive testing to assess question comprehension in a population representative of the future study population.

Results: Cognitive testing identified questions and concepts not easily comprehended, recalled, or had problematic response choices. Comprehension examples included simplifying the definition for polycystic ovary syndrome and revising questions on historic menstrual regularity and bleeding duration. Recall and answer formation examples include issues with recalling waist size, beverage consumption, and interpretation of questions using symbols (> or <). The survey was revised based on feedback and subsequently used in the Ovulation and Menstruation (OM) Health Pilot study.

Conclusion: We present a cognitively tested, novel survey instrument to assess menstrual cycle characteristics and androgen excess.

SUBMITTER: Mahalingaiah S

PROVIDER: S-EPMC7650203 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Cognitive testing of a survey instrument for self-assessed menstrual cycle characteristics and androgen excess.

Mahalingaiah Shruthi S Cosenza Carol C Cheng J Jojo JJ Rodriguez Erika E Aschengrau Ann A

Fertility research and practice 20201109 1

<h4>Background</h4>In large population-based studies, there is a lack of existing survey instruments designed to ascertain menstrual cycle characteristics and androgen excess status including hirsutism, alopecia, and acne. Our objective was to cognitively test a survey instrument for self-assessed menstrual cycle characteristics androgen excess.<h4>Methods</h4>Questions to assess menstrual characteristics and health were designed using existing surveys and clinical experience. Pictorial self-ass ...[more]

PMID: 33292647

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Project description:BackgroundPopulation level data on sexual practices, behaviours and health-related outcomes can ensure that responsive, relevant health services are available for all people of all ages. However, while billions of dollars have been invested in attempting to improve sexual and reproductive health (including HIV) outcomes, far less is understood about associated sexual practices and behaviours. Therefore, the World Health Organization embarked on a global consultative process to develop a short survey instrument to assess sexual health practices, behaviours and health outcomes. In order for the resulting draft survey instrument to be published as a 'global' standard instrument, it is important to first determine that the proposed measures are globally comprehensible and applicable. This paper describes a multi-country study protocol to assess the interpretability and comparability of the survey instrument in a number of diverse countries.MethodsThis study will use cognitive interviewing, a qualitative data collection method that uses semi-structured interviews to explore how participants process and respond to survey instruments. We aim to include study sites in up to 20 countries. The study procedures consist of: (1) localizing the instrument using forward and back-translation; (2) using a series of cognitive interviews to understand how participants engage with each survey question; (3) revising the core instrument based on interview findings; and (4) conducting an optional second round of cognitive interviews. Data generated from interviews will be summarised into a predeveloped analysis matrix. The entire process (a 'wave' of data collection) will be completed simultaneously by 5+ countries, with a total of three waves. This stepwise approach facilitates iterative improvements and sharing across countries.DiscussionAn important output from this research will be a revised survey instrument, which when subsequently published, can contribute to improving the comparability across contexts of measures of sexual practices, behaviours and health-related outcomes. Site-specific results of the feasibility of conducting this research may help shift perceptions of who and what can be included in sexual health-related research.

Project description:Menstrual cycle characteristics are markers of endocrine milieu. However, associations between age at menarche and adulthood sex steroid hormone levels have been inconsistent, and data on menstrual characteristics and non-sex steroid hormones are sparse.We assessed the relations of menstrual characteristics with premenopausal plasma sex steroid hormones, sex hormone binding globulin (SHBG), prolactin, and growth factors among 2,745 premenopausal women (age 32-52) from the Nurses' Health Study II. Geometric means and tests for trend were calculated using multivariable general linear models.Early age at menarche was associated with higher premenopausal early-follicular free estradiol (percent difference <?12 vs.?>?13 years?=?11%), early-follicular estrone (7%), luteal estrone (7%), and free testosterone (8%) (all p trend?<?0.05). Short menstrual cycle length at age 18-22 was associated with higher early-follicular total (<?26 vs.?>?39 days?=?18%) and free estradiol (16%), early-follicular estrone (9%), SHBG (7%), lower luteal free estradiol (-?14%), total (-?6%), and free testosterone (-?15%) (all p trend?<?0.05). Short adult menstrual length was associated with higher early-follicular total estradiol (<?26 vs.?>?31 days?=?14%), SHBG (10%), lower luteal estrone (-?8%), progesterone (-?9%), total (-?11%) and free testosterone (-?25%), and androstenedione (-?14%) (all p trend?<?0.05). Irregularity of menses at 18-22 was associated with lower early-follicular total (irregular vs. very regular?=?-?14%) and free estradiol (-?14%), and early-follicular estrone (-?8%) (All p trend?<?0.05). Irregularity of adult menstrual cycle was associated with lower luteal total estradiol (irregular vs. very regular?=?-?8%), SHBG (-?3%), higher total (8%), and free testosterone (11%) (all p trend?<?0.05).Early-life and adulthood menstrual characteristics are moderately associated with mid-to-late reproductive year's hormone concentrations. These relations of menstrual characteristics with endogenous hormone levels could partially account for associations between menstrual characteristics and reproductive cancers or other chronic diseases.

Project description:IntroductionEmergency Department (ED)-based HIV counseling and testing (HCT) has had a significant impact on improving rates of HIV diagnosis and linkage to care. Unfortunately, expansion of this strategy to low- and middle-income countries has been limited. Successful implementation of ED-based HCT is dependent on patient and provider acceptance of the intervention, and their attitudes and pre-existing biases towards the disease. This study sought to develop validated survey instruments to assess attitudes towards ED-based HCT.MethodsThis cross-sectional study surveyed patients and providers in three EDs in the Eastern Cape province, South Africa. A convenience sample of patients and providers in the ED were surveyed. Exploratory factor analysis was conducted using questions on attitudes to HIV testing to develop validated survey instruments. An ANOVA test assessed variance in attitudes towards HCT based on demographic variables collected.ResultsA total of 104 patient and 132 provider surveys were completed. Exploratory factor analysis resulted in a 17- and 7-question attitudes survey for patients and providers, respectively. Overall, 92.3% of patients and 70.7% of providers supported ED-based HCT, however, both groups displayed only mildly positive attitudes. Questions representing 'confidentiality' and 'stigma around HIV testing' had the least positive influence on patients' overall attitudes. Questions representing 'comfort with HIV testing' had the least positive influence on providers' overall attitudes.ConclusionOur study demonstrated ED patients and providers are generally supportive of ED-based HCT. A validated survey instrument was able to provide a standardized approach to identify barriers to HCT implementation in an ED setting, across contexts. For successful implementation, behavioral interventions must focus on strengthening patient beliefs around confidentiality and the consent process, and providers' comfort levels with providing HIV testing services in the ED.

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Cognitive testing of a survey instrument for self-assessed menstrual cycle characteristics and androgen excess.

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Cognitive testing of a survey instrument for self-assessed menstrual cycle characteristics and androgen excess.

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