It is intended that such a draft questionnaire, once further developed, could be used to further our understanding about help-seeking and patients in the general population, as well as those presenting with cardiac symptoms. Studies in the literature have raised MEK162 mechanism concerns over the validity of existing generic help-seeking instruments, especially for women.1 2 27 The full development and testing of this questionnaire (comprehensive reliability and validity testing) is beyond of the scope of this study. However, the initial stages of development

and preliminary testing will be undertaken by the researchers including item generation and selection, establishing content validity, and testing comprehensibility to patients. Questionnaire items will each have five participant response options: ‘strongly agree’, ‘agree’, ‘neither agree or disagree’, ‘disagree’

and ‘strongly disagree’ for each item.53 Items will be scored ranging from a value of five at the positive end, to a value of one at the negative end. It is envisaged that the questionnaire will comprise 10–16 questions, providing for a maximum score of 50–80. A high score will denote highly proactive help-seeking intentions and practices, a midrange score moderately proactive help-seeking and a low score suggesting the likelihood of delayed help-seeking help for critical symptoms which could negatively affect long-term outcomes. Establishing content validity To ensure all help-seeking practices for non-emergency cardiac symptoms are identified by the questionnaire, its content validity will be measured. This determines the extent to which the questionnaire represents all aspects of the given social construct it aims to measure.54 The study will use Lawshe’s (1975) methods for confirming content validity. The advice of a panel of experts—including cardiology experts, behaviour experts and a questionnaire construction expert—will be sought. The panellists will grade the relevance of each item (question) and the Lawshe (1975) formula (Content Validity Ratio) will Dacomitinib be applied to the grading to determine

the overall relevance of each item. Items with weak relevance can then be reworded or excluded from the questionnaire.54 In addition, a review by supervisors and professional colleagues will be undertaken to ensure questions are grammatically correct, make sense and thus have good face validity.54 Testing comprehensibility to patients The draft instrument will then be piloted on a sample of the interview patients (10–15 patients) to assess the comprehensibility. The participants will be invited to participate in this second phase of the research when consent is taken initially. The questionnaire will be emailed or posted to participants (with stamped addressed envelopes for return to the researcher) as per patient preference.