Attitudes to Disease Prevention: Development of an International Patient Questionnaire

Objectives: Develop a validated questionnaire for international use to investigate Patient Attitudes to Prevention: PAPOH-1 within Europe.
Methods: As part of a larger study; ADVOCATE, (Horizon 2020 project across six countries: Netherlands, Hungary, Denmark, Ireland, Germany, UK, investigating factors contributing to a safe, effective patient-centred, prevention-oriented healthcare model. A stepwise mixed-methods approach established data-focused profiles on each ADVOCATE oral healthcare system from published literature. Profiles were refined through panel discussions in all countries (n=7) by commissioners/policy makers, dental professionals, patients and insurers. Profiles included system demographics, dental workforce, provision of oral care, oral health status, economics/political aspects. A systematic literature review on barriers and facilitators to oral healthcare prevention enabled focus group topic guide development. Focus groups conducted in each country identified patient barriers/facilitators to oral healthcare prevention.
A questionnaire investigating patient’s attitudes to prevention (oral health) was developed and piloted in each country via snowballing. Validation and rationalisation of the questions was achieved using exploratory factor analysis (EFA).
Results: Barriers/facilitators to prevention identified were: appropriate level of care/ feeling valued, cost, level of motivation/priority, not feeling informed, knowledge and skill mix. These were used to develop the questionnaire. The EFA on the pilot questionnaire enabled 2 questions to be removed from the tool. The final questionnaire consisted of 34 items and was used to collect attitudinal patient data in all ADVOCATE countries.
Conclusions: Effective oral disease prevention is a common goal across health care systems. Transnational research is important in identifying and understanding international variation in attitudes to disease prevention and supporting the development of nationally appropriate services. This stepwise mixed-methods approach enabled the development of the PAPOH-1 oral health questionnaire for patients. It was developed from research literature, refined by patients and EFA to produce a tool which will allow valid and relevant international comparisons of attitudes to oral disease prevention.