18 Chapter 1 for that purpose: ‘What do we want to measure?’, ‘In which target population?’, and ‘For which purpose?’ Answers to these questions describe the construct and the framework for the OQUA. This was a cross-sectional study divided in two phases. In phase 1 in-depth interviews were done to identify relevant types of ear complaints and to formulate items. A pilot study of the first and second draft of the OQUA were part of phase 1 as well. In phase 2 the OQUA was field-tested, and item reduction was performed. The result is the OQUA consisting of 34 items. It covers eight types of ear complaints and consists of two constructs: complaints and impact. The development of the OQUA was based on the guidelines provided in Measurement in medicine20 and the COSMIN checklist15. In chapter 5 the construct validity, reliability and responsiveness of the Otology Questionnaire Amsterdam were examined. A new cohort of 194 patients visiting the ENT surgeons were recruited for the assessment of the responsiveness. A second prospective cohort of 50 consecutive patients undergoing ear surgery was recruited surgery for test-retest reliability of the OQUA. Additionally, a scoring system was developed to calculate subscale scores for all 8 ear complaints and impact of these complaints on Quality of Life. Chapter 6 describes the process of gathering insights in ear complaints in the general population in the Netherlands. OQUA data of 500 healthy adults, stratified on categorized age groups and gender were used to calculate normative data. These data can be valuable in a shared decision-making consultation, providing better understanding of the patient’s ear complaints as compared to the general population. In chapter 7 a prospective and qualitative analysis using focus groups and interviews with ENT professionals (n=15) and patients (n=25) with ear complaints of one tertiary referral hospital and two regional hospitals was performed. The barriers and enablers of using the OQUA as perceived by ENT surgeons and patients are presented and form the fundamentals for recommendations of an implementation strategy.
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