title: A promising method for identifying cross-cultural differences in patient perspective: the use of Internet-based focus groups for content validation of new patient reported outcome assessments.
abstract: OBJECTIVE
  This proof of concept (POC) study was designed to evaluate the use of an Internet-based bulletin board technology to aid parallel cross-cultural development of thematic content for a new set of patient-reported outcome measures (PROs).
  
  
  METHODS
  The POC study, conducted in Germany and the United States, utilized Internet Focus Groups (IFGs) to assure the validity of new PRO items across the two cultures--all items were designed to assess the impact of excess facial oil on individuals' lives. The on-line IFG activities were modeled after traditional face-to-face focus groups and organized by a common 'Topic' Guide designed with input from thought leaders in dermatology and health outcomes research. The two sets of IFGs were professionally moderated in the native language of each country. IFG moderators coded the thematic content of transcripts, and a frequency analysis of code endorsement was used to identify areas of content similarity and difference between the two countries. Based on this information, draft PRO items were designed and a majority (80%) of the original participants returned to rate the relative importance of the newly designed questions.
  
  
  RESULTS
  The use of parallel cross-cultural content analysis of IFG transcripts permitted identification of the major content themes in each country as well as exploration of the possible reasons for any observed differences between the countries. Results from coded frequency counts and transcript reviews informed the design and wording of the test questions for the future PRO instrument(s). Subsequent ratings of item importance also deepened our understanding of potential areas of cross-cultural difference, differences that would be explored over the course of future validation studies involving these PROs.
  
  
  CONCLUSIONS
  The use of IFGs for cross-cultural content development received positive reviews from participants and was found to be both cost and time effective. The novel thematic coding methodology provided an empirical platform on which to develop culturally sensitive questionnaire content using the natural language of participants. Overall, the IFG responses and thematic analyses provided a thorough evaluation of similarities and differences in cross-cultural themes, which in turn acted as a sound base for the development of new PRO questionnaires.
authors.affiliation: Worldwide Health Outcomes Research, La Jolla Laboratories, Pfizer Inc,, San Diego, CA 92121, USA. mjatkinson@ucsd.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Atkinson
authors.forename: Jan
authors.initials: J
authors.lastname: Lohs
authors.forename: Ilka
authors.initials: I
authors.lastname: Kuhagen
authors.forename: Julie
authors.initials: J
authors.lastname: Kaufman
authors.forename: Shamsu
authors.initials: S
authors.lastname: Bhaidani
mesh_terms: D001294:Attitude to Health; D003431:Cross-Cultural Comparison; D003880:Dermatology / Q000295:instrumentation*; D005145:Face / Q000473:pathology; D017144:Focus Groups; D005858:Germany; D006801:Humans; D020407:Internet; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011594:Psychometrics / Q000379:methods*; D012535:Scalp / Q000473:pathology; D012629:Sebum; D012871:Skin Diseases / Q000208:ethnology / Q000523:psychology*; D014481:United States