Validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessment of surgical site infection in closed primary wounds after hospital discharge

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Accurate assessment of surgical site infection (SSI) is crucial for surveillance andresearch. Self-report patient measures are needed because current SSI tools arelimited for assessing patients after leaving hospital. The Bluebelle Wound Healing Questionnaire (WHQ) was developed for patient or observer completion and thisstudy tested its acceptability, scale structure, reliability and validity in patients with closed primary wounds after abdominal surgery .


Patients completed the WHQ (self-assessment) within 30 days after leaving hospitaland returned it by post. Healthcare professionals (HCPs) completed the WHQ (observer assessment) by telephone or face-to-face. Questionnaire response rates and patient acceptability were assessed. Factor analysis and Cronbach’s alpha examined scale structure and internal consistency. Test-retest and self- versus observer reliability assessments were performed. Sensitivity and specificity for SSI discrimination against a face-to-face reference diagnosis (using Centres for Disease Control and Prevention (CDC) criteria) was examined.


591/792 (70.8%) self-assessments and 597/791 (74.4%) observer assessments were completed with few missing data and problems reported. Data supported a single scale structure with strong internal consistency (alpha >0.8). Reliability between test-retest and self- versus observer assessments was good (kappa > 0.6 for the majority of items). Sensitivity and specificity for SSI discrimination was high (area under the receiver operating characteristic (ROC) curve=0.9056).


The Bluebelle WHQ is acceptable, reliable and valid with a single scale structure for post-discharge patient or observer assessment of SSI in closed primary wounds. It is now ready for use in trials and routine practice.


Original languageEnglish
Pages (from-to)226-235
JournalBritish Journal of Surgery
Early online date17 Dec 2018
Publication statusE-pub ahead of print - 17 Dec 2018


  • surgical site infection, wound healing, questionnaire validation, outcome measure, wound assessment