PHI survey for rural health issue

There are several healthcare related discrepancies between urban and rural populations in the United States.  1 of these includes lower rates of cancer screening in rural populations.  Colorectal cancer is the third most commonly diagnosed cancer in the United States, and 1 of the leading causes of cancer related deaths among men and women.  There are a few options to screen for this potentially preventable cancer.  These include endoscopic evaluation by a physician, but this service may not be available in under-served regions.  Another option is a CT evaluation, which requires access to an imaging center that tend to be more prevalent.  And finally, a mail-in kit that tests stool sample that a patient may send from home.

My survey questions will help establish patients’ general attitudes toward screening.  In addition, my survey will determine how far a patient is willing to travel for colon cancer screening.

The survey I develop will help determine the best screening option for the people in Richmond County, VA.  I asked 3 volunteers to take my survey, and provide feedback.  The volunteers are patients who would part of the sampled population in Richmond County, VA although geographically in Fairfax County, VA.  Some questions were modified, and the modified questions will be disseminated.  This would be disseminated via mail with paper and electronic options, and a target of 200 responders.  I would avoid disseminating in a healthcare facility as this may self-select responders who are already engaged in the healthcare system and potentially adding bias to the data.

 

I asked 3 volunteers to take my survey, and provide feedback.  The volunteers are patients who would part of the sampled population in Richmond County, VA although geographically in Fairfax County, VA which is not a rural county.  Some questions were modified, and the modified questions will be disseminated.  Modifications included shortening question length as some details confused the responders, and some of the response options are edited to be less technical.  Redundant questions are omitted and/or condensed, thus shortening the survey. The survey will be disseminated via mail with paper and electronic options, and a target of 200 responders.  I would avoid disseminating in a healthcare facility as this may self-select responders who are already engaged in the healthcare system and potentially adding bias to the data.

Survey link https://nadianadia325482.typeform.com/to/RU3zho

 

Content validity is relevant in a survey.  Content validity is the extent that survey items accurately measure aspects of a construct that were designed to evaluate.  A group of people that are familiar with the construct may be tasked with evaluating content validity, this should be at least 3 people.  In the case of my survey, the evaluators will ensure  my survey questions are easy to understand and will not confuse those responding to the survey.  Evaluators of content validity will also ensure that I have not excluded questions that are relevant in the survey that regarding preferences of colon cancer screening.

Face validity, related to content validity,  is the degree to with survey items appear to measure what the are intended to measure, which may be judged by the respondents.  However, this is a weak form of validation.

 

External validity relates broadening the survey, and “to what populations, settings, and variables can this effect be generalized?” (Campbell, 1957 Pg 297.)  External validity is important in public health because it is useful to know if a program could be effective in other environments as research findings are applied beyond the original model.  The formal way to establish external validity would repeat the survey in the desired county.  However, with trained health officials and valid data, one may reasonable interferences about external validity.

 

 

Richmond County is a rural county in Virginia.  There is a hospital located 8-30 miles from various points in the county.  This hospital provided screening services.  Based on the results of the survey I would create a public health education campaign for direct mail.  A direct mail campaign improved screening rates in a rural Iowa (The Journal of the American Board of Family Medicine September 2013, 26 (5) 486-497). The education campaign would target specific zip codes in the county that would be better suited for screening at a healthcare facility versus the “at home” screening test that involves sending in a stool sample.  This data would be shared with healthcare providers.

 

References:

Khorsan, R., & Crawford, C. (2014). How to assess the external validity and model validity of therapeutic trials: a conceptual approach to systematic review methodology. Evidence-based complementary and alternative medicine : eCAM, 2014, 694804. doi:10.1155/2014/694804

 

Tsang, S., Royse, C. F., & Terkawi, A. S. (2017). Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi journal of anaesthesia, 11(Suppl 1), S80–S89. doi:10.4103/sja.SJA_203_17rnative medicine : eCAM, 2014, 694804. doi:10.1155/2014/694804