50 Chapter 3 complaint, were not known to have a learning disability or cognitive impairment and had a good written understanding of the Dutch language, which was the dominant used language in the research setting. Study design This cross-sectional study consisted of two phases: formulation and selection of items based on qualitative analyses (phase 1) and selecting the definite set of items based on quantitative psychometric analyses (phase 2). The development of the OQUA was based on the guidelines provided in ‘Measurement in medicine’.6 All statistical analyses were performed using SPSS Statistics v.22.0. Phase 1: formulation and selection of items. A. Interviews: Semi-structured interviews (N = 16) were conducted to generate content and to identify relevant types of ear complaints. Patients were asked to describe their ear complaints and how these affected their daily lives. Qualitative content analysis was used to extract meaning units. Based on these meaning units, items were formulated (OQUA-v1).7 OQUA-v1 contained 34 items about several ear complaints. B. Pilot study 1: The first draft of a measurement instrument needs to be tested in a small sample of patients (i.e. 15-30 persons) of the target population to test the acceptability and relevance of all items of the questionnaire.6 Therefore, the OQUA-v1 was pilot-tested (N = 32) to identify which ear complaints were rated relevant to patients and to select descriptions of ear complaints that best described the complaints as experienced by patients. Each item contained different descriptions of a specific ear complaint, which were all formulated based on patients’ descriptions that were collected during patient interviews. For each item, the description that was selected most frequently was identified. Items were formulated based on these most selected descriptions. This resulted in OQUA-v2. C. Expert opinion: An expert panel including specialists in ear and hearing (N = 4) critically examined the content of OQUAv2. Based on their input, adaptations were made. They also discussed the feasibility in the outpatient clinic and decided on adequate response scales that should be used. Visual analogue scales (VAS) and Likert scales were chosen. A VAS is a continuous line of variables with a clear begin and end point, like ranging from ‘no pain’ to ‘extreme pain’. The patient has to drag or click the line to the point that resembles their complaint the most. This scale was chosen to measure the severity of complaints because it allows a precise measurement.8 A 5-point Likert scale is a 5-answer multiple-choice scale that measures a discrete
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