ePRO – electronic Patient-Reported Outcome measures

ePROMs have been adopted by researchers seeking to benefit from the significant advantages associated with their use. As ePROMs continue to be more widely used, HPR will help users by providing clear instructions for the migration of our questionnaires from traditional paper and pen to electronic versions suitable for completion on different types of devices.

If you wish to use an electronic version of a questionnaire licensed by HPR, you will need to send the adaptation you produce to cjg@healthpsychologyresearch.com for review. This step will help preserve equivalence between the original paper version of the questionnaire and the electronic adaptation. You can enable access via a link (so the reviewer can complete the questionnaire as a participant would) or via screenshots. Please send a link, if possible. Also, if sending a link, please just provide access to the adapted HPR questionnaire or enable skipping of other parts of your electronic study (e.g. sociodemographic questionnaire).

If the adaptation meets our basic requirements (see below), then the adaptation will probably be approved immediately and you can use it in your study. However, please be aware that passing the adaptation review is no guarantee of equivalence. The only means to establish equivalence is to measure the psychometric properties of the questionnaire using data you collect with the adaptation and compare your findings to the psychometric properties reported previously for the original questionnaire.

Below is a brief list of HPR’s essential requirements for electronic adaptations that are often inappropriately implemented. Please adhere to these guidelines to increase the chances of your adaptation passing adaptation review quickly, and reduce the risk that the adaption is not psychometrically equivalent to the original questionnaire:

1) Keep Guidance Statements / Instructions the same

  • These are an integral part of the questionnaire and should be included as much as the items themselves.

2) Keep Copyright information

  • The copyright information must be included, but it should be in smaller font so that it does not catch the eye of someone who is not looking for it.
  • Ideally, it should be presented at the bottom of each page/view.

3) Keep all Response Options the same and in the same order

  • If the response options are arranged left to right, all integers from ‘6’ to ‘0’, then this is what should appear in any adapted version.
  • In some cases, it may be necessary to change horizontal alignment of the scales to vertical alignment but it is essential that the options available do not change.

4) Change wording as appropriate for the electronic format

  • Slight changes in the wording might be needed for the questionnaire to make sense in the context of its new format.
  • For example, ‘Please put a ‘X’…’ or ‘Please… by circling…’, should be changed to ‘Please select…’ or ‘Please…by selecting…’.
  • Make sure this is implemented for all language versions, if applicable.

5) Do not add unnecessary words or characters

  • Keep the appearance and layout the same as the original version of the questionnaire as much as possible.

6) Keep font formatting the same

  • If there are words underlined or in bold etc in the original, then they should be rendered the same in the adaptation.

7) Participants need to have the option NOT to respond

  • It is often the case that electronic questionnaires have mandatory fields, which mean participants do not have the option not to respond. We consider this to be unethical.
  • We suggest the following options for enabling participants not to respond if that is their preference (without losing the benefit of avoiding accidentally missed responses):
    1. Make all responses for HPR questionnaires optional (i.e. enable participants to submit their digital form having left some items in the HPR questionnaires unanswered). HPR questionnaires have good face validity, which makes missing responses far fewer and therefore far less problematic.
    2. Make all responses mandatory but include an additional response option for each item with the label “Prefer not to respond”.
    3. If the form-building tool enables this, we encourage you to consider prompting participants to complete items with missing responses when they press ‘next page’ or ‘submit’, but it is essential that the form allows them the option to submit an incomplete questionnaire if they choose to. This option avoids the need for a ‘Prefer not to respond’ response option.