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      Validity of Internet-Based Longitudinal Study Data: The Elephant in the Virtual Room

      research-article
      , BSc (Hons), MSc 1 , , , BSc (Hons), PhD 1 , , BVSc, PhD 1 , , BVSc, PhD 2 , , BVSc, PhD 2
      (Reviewer), (Reviewer)
      Journal of Medical Internet Research
      JMIR Publications Inc.
      epidemiology, validation studies as topic, Internet, questionnaires, longitudinal studies, health, canine

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          Abstract

          Background

          Internet-based data collection relies on well-designed and validated questionnaires. The theory behind designing and validating questionnaires is well described, but few practical examples of how to approach validation are available in the literature.

          Objective

          We aimed to validate data collected in an ongoing Internet-based longitudinal health study through direct visits to participants and recall of their health records. We demonstrate that despite extensive pre-planning, social desirability can still affect data in unexpected ways and that anticipation of poor quality data may be confounded by positive validation.

          Methods

          Dogslife is a large-scale, Web-based longitudinal study of canine health, in which owners of Labrador Retrievers were recruited and questioned at regular intervals about the lifestyle and health of their dogs using an Internet-based questionnaire. The Dogslife questionnaire predominantly consists of closed-answer questions. In our work, two separate validation methodologies were used: (1) direct interviews with 43 participants during visits to their households and (2) comparison of owner-entered health reports with 139 historical health records.

          Results

          Our results indicate that user-derived measures should not be regarded as a single category; instead, each measurement should be considered separately as each presents its own challenge to participants. We recommend trying to ascertain the extent of recall decay within a study and, if necessary, using this to guide data collection timepoints and analyses. Finally, we recommend that multiple methods of communication facilitate validation studies and aid cohort engagement.

          Conclusions

          Our study highlighted how the theory underpinning online questionnaire design and validation translates into practical data issues when applied to Internet-based studies. Validation should be regarded as an extension of questionnaire design, and that validation work should commence as soon as sufficient data are available. We believe that validation is a crucial step and hope our suggested guidelines will help facilitate validation of other Internet-based cohort studies.

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          Most cited references21

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          A concordance correlation coefficient to evaluate reproducibility.

          L Lin (1989)
          A new reproducibility index is developed and studied. This index is the correlation between the two readings that fall on the 45 degree line through the origin. It is simple to use and possesses desirable properties. The statistical properties of this estimate can be satisfactorily evaluated using an inverse hyperbolic tangent transformation. A Monte Carlo experiment with 5,000 runs was performed to confirm the estimate's validity. An application using actual data is given.
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            Validity of Web-Based Self-Reported Weight and Height: Results of the Nutrinet-Santé Study

            Background With the growing scientific appeal of e-epidemiology, concerns arise regarding validity and reliability of Web-based self-reported data. Objective The objectives of the present study were to assess the validity of Web-based self-reported weight, height, and resulting body mass index (BMI) compared with standardized clinical measurements and to evaluate the concordance between Web-based self-reported anthropometrics and face-to-face declarations. Methods A total of 2513 participants of the NutriNet-Santé study in France completed a Web-based anthropometric questionnaire 3 days before a clinical examination (validation sample) of whom 815 participants also responded to a face-to-face anthropometric interview (concordance sample). Several indicators were computed to compare data: paired t test of the difference, intraclass correlation coefficient (ICC), and Bland–Altman limits of agreement for weight, height, and BMI as continuous variables; and kappa statistics and percent agreement for validity, sensitivity, and specificity of BMI categories (normal, overweight, obese). Results Compared with clinical data, validity was high with ICC ranging from 0.94 for height to 0.99 for weight. BMI classification was correct in 93% of cases; kappa was 0.89. Of 2513 participants, 23.5% were classified overweight (BMI≥25) with Web-based self-report vs 25.7% with measured data, leading to a sensitivity of 88% and a specificity of 99%. For obesity, 9.1% vs 10.7% were classified obese (BMI≥30), respectively, leading to sensitivity and specificity of 83% and 100%. However, the Web-based self-report exhibited slight underreporting of weight and overreporting of height leading to significant underreporting of BMI (P<.05) for both men and women: –0.32 kg/m2 (SD 0.66) and –0.34 kg/m2 (SD 1.67), respectively. Mean BMI underreporting was –0.16, –0.36, and –0.63 kg/m2 in the normal, overweight, and obese categories, respectively. Almost perfect agreement (ie, concordance) was observed between Web-based and face-to-face report (ICC ranged from 0.96 to 1.00, classification agreement was 98.5%, and kappa 0.97). Conclusions Web-based self-reported weight and height data from the NutriNet-Santé study can be considered as valid enough to be used when studying associations of nutritional factors with anthropometrics and health outcomes. Although self-reported anthropometrics are inherently prone to biases, the magnitude of such biases can be considered comparable to face-to-face interview. Web-based self-reported data appear to be an accurate and useful tool to assess anthropometric data.
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              Evaluation of the optimal recall period for disease symptoms in home-based morbidity surveillance in rural and urban Kenya

              Background In African settings with poor access to health care, surveillance and surveys of disease burden are often done through home visits. The optimal recall period to capture data on symptoms and health utilization is unknown. Methods We collected illness data among 53 000 people during fortnightly home visits in rural and urban Kenya. Dates of cough, fever and diarrhoea in the past 2 weeks and health-seeking behaviour were recorded. Incidence rates were modelled using Poisson regression for data collected from 1 July 2006 to 30 June 2007. Results Incidence rates were higher in days 0–6 before the home visit than in days 7–13 before the home visit for all three symptoms, for the rural and urban sites, for children and adults, for self- and proxy-reported symptoms and for severe and non-severe illness in children. Recall decay was steeper in the rural than the urban sites, and for proxy- than self-reported symptoms. The daily prevalence of symptoms fell 3 days before the home visit for children and >4 days for persons ≥5 years of age. Recall of previously documented clinic visits, and prescriptions of antimalarials and antibiotics also declined by ∼7, 15 and 23% per week, respectively, in children aged <5 years, and 6, 20 and 16%, respectively, in older persons (P < 0.0001 for each decline). Conclusions A 2-week recall period underestimates true disease rates and health-care utilization. Shorter recall periods of 3 days in children and 4 days in adults would likely yield more accurate data.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                April 2015
                16 April 2015
                : 17
                : 4
                : e96
                Affiliations
                [1] 1The Roslin Institute and Royal (Dick) School of Veterinary Studies University of Edinburgh EdinburghUnited Kingdom
                [2] 2Royal (Dick) School of Veterinary Studies and The Roslin Institute University of Edinburgh EdinburghUnited Kingdom
                Author notes
                Corresponding Author: Carys A Pugh Carys.Pugh@ 123456roslin.ed.ac.uk
                Author information
                http://orcid.org/0000-0002-6548-0311
                http://orcid.org/0000-0002-7084-4386
                http://orcid.org/0000-0002-2541-6219
                http://orcid.org/0000-0001-6407-4963
                http://orcid.org/0000-0002-0596-1885
                Article
                v17i4e96
                10.2196/jmir.3530
                4416133
                25887101
                468ca0c8-87de-44e0-941a-4a656d4bcec6
                ©Carys A Pugh, Kim M Summers, B Mark C Bronsvoort, Ian G Handel, Dylan N Clements. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.04.2015.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 09 May 2014
                : 17 November 2014
                : 06 January 2015
                : 03 February 2015
                Categories
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                Medicine
                epidemiology,validation studies as topic,internet,questionnaires,longitudinal studies,health,canine

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