PA25 Developing an online diagnostic criteria questionnaire for psoriasis in children (< 18 years) using framework analysis from think-aloud cognitive interviews (DIPSOC-QI study)

Abstract Psoriasis can be challenging to diagnose in children and young adults. The original DIPSOC study was a UK multicentre case–control diagnostic accuracy study that identified seven best predictive criteria for diagnosing psoriasis in patients aged < 18 years [Burden-Teh E, Murphy R, Gran S et al. Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study). Br J Dermatol 2022; 186: 341–51]. Using these criteria, we developed a pilot online diagnostic criteria questionnaire for the intention of use by health professionals, researchers, young people and parents. The aim of this study was to ascertain whether young people and parents could easily complete the questionnaire. The questionnaire included questions about the seven diagnostic criteria, demographics, other diagnoses and feedback. Dermatological terms were modified into plain and inclusive language guided by a patient advisor, the Young Person’s Advisory Group for Research and an expert in skin of colour. The objectives were to understand difficulties experienced when filling out the questionnaire, to understand what individuals were thinking and to collect suggestions for improvements. Ethical approval was granted (Faculty of Medicine and Health Sciences 107-1020). Cognitive telephone interviews in two rounds were undertaken by one interviewer with seven parents of children (0–13 years) and one young person (14–17 years) with a skin disease while they completed the questionnaire. The cognitive interviews followed a think-aloud technique with verbal prompts and used a semistructured interview guide. All interviews were conducted over the telephone, audio recorded and transcribed. In round 1, prompts and probes were used after each individual question and the data were used to improve the wording and design of the questionnaire before round 2. In round 2, interviewees were asked to complete sections of the questionnaire and feedback was sought at the end. Framework analysis was performed focusing on the following themes: (i) understanding and interpretation, (ii) ease and ability to answer, (iii) decision making, (iv) appeal and acceptability and (v) suggestions for improvement. The overall feedback was positive. Changes implemented included layout adaptation, clearer instructions, allowing dropdown answers to contain ‘other’ and a free-text box, utilizing bullet points, providing ‘top tips’, revising and explaining terminology, and considering how the questionnaire will be administered. Interviewees asked for further clarification on words such as ‘hairline’. Recall was a limitation, particularly for young people (14–17 years) answering without parents. The usability and comprehension of the DIPSOC online diagnostic criteria questionnaire have been assessed and improved through think-aloud cognitive interviews. Further studies are required to test the diagnostic accuracy and validity of the questionnaire, which may enable earlier detection and treatment of psoriasis.