Development, content validation and reliability assessment of the Bowel Irrigation Questionnaire, a Patient-Reported Experience Measure for Transanal Irrigation: a multi-methods study
- 1Cardiff University
Abstract
Objective To develop the Bowel Irrigation Questionnaire (BIQ), a patient-reported experience measure (PREM) designed to assess the users experience of transanal irrigation (TAI) and conduct preliminary evaluation of its content validity and temporal stability. Design A four-stage multi-methods study comprising: (1) item generation through literature review and qualitative interviews; (2) international three-round Delphi survey and consensus meeting; (3) content validity assessment through cognitive interviews and the Questionnaire on Questionnaires (QQ-10); (4) temporal stability assessment. Settings Item generation and the Delphi survey were conducted online with healthcare professionals (HCPs) and TAI users from the UK, Denmark, Sweden, Ireland and the Netherlands. Participants in content validity and temporal stability assessment were recruited from a UK site. Participants HCPs and TAI users were involved throughout development: (1) nine completed qualitative interviews (6 HCPs, 3 TAI users; 4 male, 5 female); (2) 20 completed the Delphi survey (12 HCPs, 8 TAI users; 7 male, 13 female) and (3) six TAI users completed cognitive interviews. Thirty-two TAI users (30 female, 93.8%; median age 52 years, IQR 34-54) completed the BIQ, followed by QQ-10 and repeated BIQ. Results Multi-disciplinary qualitative interviews and literature review generated 215 statements across 20 sub-domains, refined to 73 statements for Delphi survey. Following Delphi survey and cognitive interviews, the 16-item BIQ addressed training and support (one item); usability (five items), and user experience (10 items). Median QQ-10 value and burden scores were 21 (IQR 19-22.5) and 0 (IQR 0-2.3) respectively, supporting acceptability and face validity. Test-retest exact agreement ranged from 83.9% to 100% across items, with 100% agreement within one response category for every item. Conclusions The Bowel Irrigation Questionnaire is a PREM assessing the user experience of TAI. In preliminary assessment, the BIQ demonstrates good measurement properties; however, further psychometric evaluation is required before it can be recommended in clinical practice.
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BibTeX
@misc{farrow2026development,
title = {{Development, content validation and reliability assessment of the Bowel Irrigation Questionnaire, a Patient-Reported Experience Measure for Transanal Irrigation: a multi-methods study}},
author = {E. Farrow and R. Balachandran and R. Embleton and K. Krogh and P. F. Vollebregt and J. Cornish and P. Christensen},
howpublished = {medRxiv},
year = {2026},
month = jul,
doi = {10.64898/2026.07.16.26358225},
url = {https://www.medrxiv.org/content/10.64898/2026.07.16.26358225v2},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Development, content validation and reliability assessment of the Bowel Irrigation Questionnaire, a Patient-Reported Experience Measure for Transanal Irrigation: a multi-methods study
AU - E. Farrow
AU - R. Balachandran
AU - R. Embleton
AU - K. Krogh
AU - P. F. Vollebregt
AU - J. Cornish
AU - P. Christensen
PY - 2026
DA - 2026/07/16
PB - medRxiv
DO - 10.64898/2026.07.16.26358225
UR - https://www.medrxiv.org/content/10.64898/2026.07.16.26358225v2
AB - Objective To develop the Bowel Irrigation Questionnaire (BIQ), a patient-reported experience measure (PREM) designed to assess the users experience of transanal irrigation (TAI) and conduct preliminary evaluation of its content validity and temporal stability. Design A four-stage multi-methods study comprising: (1) item generation through literature review and qualitative interviews; (2) international three-round Delphi survey and consensus meeting; (3) content validity assessment through cognitive interviews and the Questionnaire on Questionnaires (QQ-10); (4) temporal stability assessment. Settings Item generation and the Delphi survey were conducted online with healthcare professionals (HCPs) and TAI users from the UK, Denmark, Sweden, Ireland and the Netherlands. Participants in content validity and temporal stability assessment were recruited from a UK site. Participants HCPs and TAI users were involved throughout development: (1) nine completed qualitative interviews (6 HCPs, 3 TAI users; 4 male, 5 female); (2) 20 completed the Delphi survey (12 HCPs, 8 TAI users; 7 male, 13 female) and (3) six TAI users completed cognitive interviews. Thirty-two TAI users (30 female, 93.8%; median age 52 years, IQR 34-54) completed the BIQ, followed by QQ-10 and repeated BIQ. Results Multi-disciplinary qualitative interviews and literature review generated 215 statements across 20 sub-domains, refined to 73 statements for Delphi survey. Following Delphi survey and cognitive interviews, the 16-item BIQ addressed training and support (one item); usability (five items), and user experience (10 items). Median QQ-10 value and burden scores were 21 (IQR 19-22.5) and 0 (IQR 0-2.3) respectively, supporting acceptability and face validity. Test-retest exact agreement ranged from 83.9% to 100% across items, with 100% agreement within one response category for every item. Conclusions The Bowel Irrigation Questionnaire is a PREM assessing the user experience of TAI. In preliminary assessment, the BIQ demonstrates good measurement properties; however, further psychometric evaluation is required before it can be recommended in clinical practice.
ER -