title: Patients' needs in asthma treatment: development and initial validation of the NEAT questionnaire.
abstract: OBJECTIVE
  We aimed to develop and tentatively validate an instrument assessing patients' needs related to asthma treatment.
  
  
  METHODS
  Patients were recruited through various approaches (e.g. physicians, pharmacies and patient organizations). Utilizing a mixed methods design, we first conducted five focus groups to explore needs among patients. Next, we devised an item pool which was revised, reduced and evaluated by patients. Finally, data from a survey (n = 362) were used to further reduce the item pool and to examine the questionnaire's psychometric properties and validity.
  
  
  RESULTS
  Four broad needs categories emerged from the focus groups: (1) information needs; (2) consideration of patient views in diagnosis; (3) consideration of patient views in treatment planning; and (4) addressing patients' fears. We devised 45 items, which were reduced to 22 items based on patient feedback. The survey data suggested a 13-item scale with four subscales ("patient expertise", "drug effects", "handling drugs" and "exacerbations"). Cronbach's alpha was acceptable for those subscales (>0.7) and for the total score (0.9). Increasing scores on subscales and the total score (implying more unmet needs) showed close and consistent associations with poor asthma control, reduced quality of life and low treatment satisfaction.
  
  
  CONCLUSIONS
  The development process of the Needs in Asthma Treatment (NEAT) questionnaire ensured that needs of asthma patient are captured with high validity. The NEAT questionnaire has been shown to be valid, thereby representing a promising tool for research and delivery of patient-centered care.
authors.affiliation: a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany .|b Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University , Mannheim , Germany .
authors.forename: Adrian
authors.initials: A
authors.lastname: Loerbroks
authors.affiliation: a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany .
authors.forename: Verena
authors.initials: V
authors.lastname: Leucht
authors.affiliation: c Faculty of Philosophy, Social Sciences Institute, University of Düsseldorf , Düsseldorf , Germany .
authors.forename: Susanne
authors.initials: S
authors.lastname: Keuneke
authors.affiliation: d Division of Medical Sociology, Department of Epidemiology and Preventive Medicine , University of Regensburg , Regensburg , Germany .|e Division of Public Health and Primary Care , Brighton and Sussex Medical School, University of Brighton , Falmer , UK .
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Apfelbacher
authors.affiliation: f Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Centre of Medical Informatics, The University of Edinburgh, Medical School , Edinburgh , UK .|g Division of General Internal Medicine and Primary Care , Brigham and Women's Hospital , Boston , MA , USA , and.|h Department of Medicine , Harvard Medical School , Boston , MA , USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany .
authors.forename: Peter
authors.initials: P
authors.lastname: Angerer
mesh_terms: D000328:Adult; D001249:Asthma / Q000628:therapy*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: Asthma; mixed methods; needs; patient-reported outcome measures; questionnaire design; validation