Development of a factorial survey for use in an international study examining clinicians’ likelihood to support the decision to initiate invasive long-term ventilation for a child (the TechChild study)

Background: The decision to initiate invasive long-term ventilation for a child with complex medical needs can  be extremely challenging. TechChild is a research programme that aims to explore the liminal space between initial  consideration of such technology dependence and the fnal decision. This paper presents a best practice example of  the development of a unique use of the factorial survey method to identify the main infuencing factors in this critical  juncture in a child’s care. 

Methods: We developed a within-subjects design factorial survey. In phase 1 (design) we defned the survey goal  (dependent variable, mode and sample). We defned and constructed the factors and factor levels (independent  variables) using previous qualitative research and existing scientifc literature. We further refned these factors based  on expert feedback from expert clinicians and a statistician. In phase two (pretesting), we subjected the survey tool  to several iterations (cognitive interviewing, face validity testing, statistical review, usability testing). In phase three  (piloting) testing focused on feasibility testing with members of the target population (n=18). Ethical approval was  obtained from the then host institution’s Health Sciences Ethics Committee. 

Results: Initial refnement of factors was guided by literature and interviews with clinicians and grouped into four  broad categories: Clinical, Child and Family, Organisational, and Professional characteristics. Extensive iterative con?sultations with clinical and statistical experts, including analysis of cognitive interviews, identifed best practice in  terms of appropriate: inclusion and order of clinical content; cognitive load and number of factors; as well as language  used to suit an international audience. The pilot study confrmed feasibility of the survey. The fnal survey comprised  a 43-item online tool including two age-based sets of clinical vignettes, eight of which were randomly presented to  each participant from a total vignette population of 480.

Conclusions: This paper clearly explains the processes involved in the development of a factorial survey for the  online environment that is internationally appropriate, relevant, and useful to research an increasingly important  subject in modern healthcare. This paper provides a framework for researchers to apply a factorial survey approach in  wider health research, making this underutilised approach more accessible to a wider audience.