| Objectives:This study focuses on the urgent need for a screening index system in the development of external treatment techniques with Miao medical characteristics.Under the framework of mixed methods research,by virtue of a “three-stage” design thought including qualitative exploration,tool research and development,and quantitative research in exploratory sequential design,this study integrates qualitative and quantitative research methods as well as data,and establishes a scientific,systematic,and comprehensive screening index system for the external treatment techniques with Miao medical characteristics.In addition,it explores the application of the screening index system with practical examples to provide screening tools and application methods for follow-up studies and to help the inheritance and development of external treatment techniques with Miao medical characteristics.Method:1 Screening Index System Establishment1.1 Qualitative Exploration Stage Through semi-structured interviews,the three-level code of grounded theory,and literature research,an item pool of screening index elements for the external treatment techniques with Miao medical characteristics was drawn up.(1)Snowball sampling was adopted to conduct semi-structured interviews with experts who were engaged in the clinical diagnosis and treatment based on the external treatment techniques with Miao medical characteristics,and to obtain the experience,viewpoints,and opinions from these experts when they chose to use external treatment techniques with Miao medical characteristics.This formed a database that helped construct an item pool of the screening index elements for the external treatment techniques with Miao medical characteristics.(2)Based on the grounded theory,the text materials in the database were processed with the three-level code of open coding,axial coding,and selective coding from bottom to top.Elements and keywords related to the screening of the external treatment techniques with Miao medical characteristics were extracted and distilled into general concepts and categories to form a codebook of screening index elements at all levels,which was then arranged to create the first draft of the item pool of screening index elements for the external treatment techniques with Miao medical characteristics.(3)Through a literature search,information about screening indexes and name,content,and specific meaning of the elements in relevant literature published over the past decade were analyzed and extracted,and the first draft of the item pool was revised and completed.Thus,the item pool of screening index elements for the external treatment techniques with Miao medical characteristics was finalized.1.2 Tool Research and Development Stage Entries in the item pool were organized to write a consultation questionnaire for experts.Experts on Miao medicine were invited to conduct the expert consultation using the Delphi method.The screening indexes at all levels were revised according to the consultation results until the experts reached a consensus.In this way,the screening index system for the external treatment techniques with Miao medical characteristics was established.1.3 Quantitative Research Stage This process employs the analytic hierarchy process and the percentage weight method.Senior experts who have participated in the Delphi consultation during the tool research and development stage are invited to assess the importance of each index in the screening index system and to determine the weight of each index,which offers a basis for the further application of this screening index system in the future.2 Application of the Screening Index System Based on the screening index system for the external treatment techniques with Miao medical characteristics established in this study,the screening questionnaire and scoring criteria were created accordingly.In addition,front-line doctors engaged in clinical diagnosis and treatment with treatment techniques with Miao medical characteristics,along with the working group,completed the example screening of three typical techniques,verified the operability and practicability of the screening index system,and provided application methods for the follow-up studies.Results:1 Establishment of the Screening Index System1.1 Qualitative Exploration Stage(1)This study conducted a total of 720 minutes of semi-structured interviews with 20 experts and obtained 163000 words of interview transcripts,which served as the database for the item pool of screening index for the external treatment techniques with Miao characteristics.(2)Based on the textual materials grounded in the database,this study labeled1793 reference points through open coding,which could be summarized as 369 initial concepts,and 56 initial categories were abstracted.Then,the axial coding narrowed down the 56 initial categories to 25 subsidiary categories.The selective coding further analyzed and sorted the 25 subsidiary categories into eight fundamental categories.The index element code book at all levels was sorted to form the first draft of the item pool of the screening index elements for the external treatment techniques with Miao medical characteristics including eight first-level screening index element entries,25 secondary screening index element entries,and 56 tertiary screening index element entries.(3)This study compared the screening indexes and relevant information of elements extracted from the literature retrieval with the first draft of the item pool, deleted three secondary screening index element entries,four tertiary screening index element entries,adjusted four tertiary screening index element entries,modified three tertiary screening index element entries,and added one secondary screening index element entry as well as four tertiary screening index element entries.Finally,the item pool of the screening index elements for the external treatment techniques with Miao medical characteristics,consisting of eight first-level screening index element entries,23 secondary screening index element entries,and 54 tertiary screening index element entries,was drafted.1.2 Stage of Tool Development Through two rounds of Delphi expert consultation with 45 experts,based on the item pool of the screening index elements for the external treatment techniques with Miao medical characteristics,after the first round of expert consultation,one first-level screening index,one secondary screening index,and six tertiary screening indexes were deleted.Besides,two secondary screening indexes were adjusted and 14 tertiary screening indexes were modified.After the second round of expert consultation,two tertiary screening indexes were deleted,and two tertiary screening indexes were modified.Finally,the screening index system for the external treatment techniques with Miao medical characteristics,consisting of seven first-level screening indexes,18 secondary screening indexes,and 47 tertiary screening indexes,was established.The positive coefficients of the two rounds of expert consultation were 100%.The expert authority coefficients were 0.86 and 0.89,respectively.In the first round of consultation,Kendall’s W of the importance score of screening indexes at all levels was 0.252(χ~2=79.406,P<0.001),0.242(χ~2=240.063,P<0.001),0.169(χ~2=402.403,P<0.001)respectively.Coefficient of variation(CV)was 0.14,0.16 and 0.21 respectively.Kendall’s W of operability score was 0.195(χ~2=61.361,P<0.001),0.141(χ~2=139.305,P<0.001),0.132(χ~2=314.132,P<0.001)respectively.CV was 0.15,0.16 and 0.22 respectively.In the second round of expert consultation,Kendall’s W of the importance score of screening indexes at all levels was 0.338(χ~2=91.370,P<0.001), 0.244(χ~2=240.078,P<0.001)、0.187(χ~2=413.501,P<0.001)respectively.CV was 0.14,0.16 and 0.20 respectively.Kendall’s W of operability score was 0.241(χ~2=65.127,P<0.001),0.152(χ~2=145.125,P<0.001),0.135(χ~2=317.240,P<0.001)respectively;CV was 0.15,0.16 and 0.20 respectively.1.3 Quantitative Research Stage According to the judgment of the importance degree of each screening index by15 senior experts,the weight and combined weight of each index were determined.Finally,the screening index system for the external treatment techniques with Miao medical characteristics and the weight and combined weight of each index were respectively constructed as follows: 7 first-level screening indexes(weight): A safety(0.30),B efficacy(0.36),C operability(0.10),D economy(0.06),E maturity(0.08),F universality(0.04),G demand(0.06);18 secondary screening indexes(weight/combined weight): A1 adverse reaction(0.58/0.174),A2 trauma of the technique(0.42/0.126),B1 clinical efficacy(0.60/0.216),B2 levels of evidence(0.40/0.144),C1 ease of operation(0.31/0.031),C2 difficulty in operation(0.25/0.025),C3 operator’s qualification(0.12/0.012),C4 technical operation specification(0.32/0.032),D1 patient-borne costs(0.62/0.037)D2 medical institution costs and benefits(0.38/0.023),E1 clinical applications(0.45/0.036),E2 scientific research(0.36/0.029),E3 folk inheritance(0.19/0.015),F1 requirements for techniques(0.46/0.018),F2 requirements for medical institution level(0.31/0.012),F3 requirements for region(0.23/0.009),G1 applicable illnesses or diseases(0.60/0.036),G2 applicable population(0.40/0.024);47 tertiary screening indexes(weight/combined weight): A11 adverse reaction rate(0.36/0.063),A12 adverse reaction intensity(0.32/0.056),A13 adverse reaction reversibility(0.32/0.056),A21 trauma rate(0.36/0.045),A22 trauma intensity(0.32/0.040),A23 trauma reversibility(0.32/0.040),B11 clinical effectiveness rate(0.32/0.069),B12 recurrence rate of illnesses or diseases(0.14/0.030),B13 objective index change(0.17/0.037)B14techniques onset time(0.18/0.039),B15 life quality improvement(0.19/0.041),B21 randomized controlled trials(0.38/0.055),B22 case series(0.27/0.039),B23 case report(0.24/0.035),B24 expert ideas,editorials,opinions(0.11/0.016),C11 personnel required for treatment(0.59/0.018),C12 time required for treatment(0.41/0.013),C21 use as you learn(0.54/0.014),C22 necessity of passing the formal training and examination for use(0.46/0.012),C31 doctors(0.45/0.005),C32 nurses(0.30/0.004),C33 patients themselves(0.25/0.003),C41 technical operation specifications reported in literature(0.48/0.015),C42 technical operation procedure reported in literature,but no technical operation specification(0.32/0.010),C43 technical operation specification without any form of literature(0.20/0.006),D11 cost difference with similar traditional Chinese medicine techniques(0.46/0.017)D12 medical insurance(0.54/0.020),D21 operation costs and benefits of techniques(0.49/0.011),D22 costs and benefits of time invested by medical staff(0.51/0.012),E11 clinical application time(0.47/0.017),E12 clinical application cases(0.53/0.019),E21 subject level(0.40/0.012),E22 paper publication(0.60/0.017),E31 folk inheritance time(0.60/0.009),E32 folk inheritance range(0.40/0.006),F11 sustainable availability of technical consumables and appliances(0.37/0.007),F12 difficulty in processing and manufacturing of technical consumables and instruments(0.29/0.005),F13 techniques substitutability(0.34/0.006),F21 provincial hospital(0.32/0.004),F22 city,county-level hospital(0.36/0.004),F23 township health center(0.33/0.004),G11sub-health conditioning(0.22/0.008),G12 common diseases,frequently-occurring diseases(0.36/0.013),G13 chronic disease(0.25/0.009)G14 difficult and miscellaneous diseases(0.17/0.006),G21 applicable gender(0.50/0.012),G22 applicable age(0.50/0.012).2 Application of the Screening Index System The screening results were as follows: 82.15 points for crossbow needle therapy of the Miao ethnic minority group,72.37 points for paper fire moxibustion therapy of the Miao ethnic minority group,and 68.67 points for needle pricking therapy of the Miao ethnic minority group.In the case screening application,the data required for each screening index was simple and reasonable,and the index weight was appropriate,which could accurately and quickly screen the external treatment techniques of Miao medical characteristics.With specific operability,certain practicability,precise entries and complete content,the screening index system can comprehensively present the characteristics and existing problems of current clinical research and application of external treatment techniques with Miao medical characteristics,and has a specific guiding effect on the future development of the screened techniques.Conclusion:1 This study has established a dedicated screening index system for external treatment techniques with Miao medical characteristics with the following indexes and their weights: 7 primary screening indexes,including efficacy,safety,operability,maturity,economy,demand,and universality;18 secondary screening indexes,including technical operation specification,folk inheritance,and requirements for techniques;47 tertiary screening indexes including techniques onset time,clinical application cases,and techniques substitutability.In short,such a system brings a reference tool to the follow-up screening research on the external treatment techniques with Miao medical characteristics.2 The development of screening questionnaires and scoring standards in support of applying the screening index system for external treatment techniques with Miao medical characteristics is practicable and it provides a reference method for the follow-up screening research on the external treatment techniques with Miao medical characteristics.3 This study has successfully introduced mixed methods research into establishment of a screening index system for external treatment techniques with Miao medical characteristics,thereby becoming a reference case for employing mixed methods research in the study of ethnic minority medicine. |
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