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The responsible researcher invites the clinicians to comment on the clinical applicability of the items and to suggest alternative items or wording.
The clarity, relevance and applicability of the items and domains have been significantly strengthened by the ratings and qualitative inputs of 131 multi-disciplinary stakeholders from 16 countries, including 18% of patients and patient representatives.
Items of the BFNE (e.g., I am often afraid that people will notice my shortcomings) are rated on a 5-point scale (0 4) indicating the self-reported applicability of the items.
To ensure applicability of the items to Palawan, each item was reviewed and modified by each health program manager in the Provincial Health Office and a public health nurse in one RHU in Palawan.
With regard to the term "things" no changes were made as a replacement of the word with a description of an activity was considered to limit the applicability of the items considerably.
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Nurses generally suggested changes to improve the applicability of the item in a healthcare setting.
Also, the EORTC project has a strong focus on cross-cultural applicability of the item bank and consequently includes collaborators and patients from various countries in all development stages.
Given the applicability of the item in the current hospital setting, the question related to hand washing, "As far as you know, did doctors/nurses wash or clean their hands in between touching patients?" was removed but may be reviewed at a later date.
To further establish the face-validity, comprehensibility and applicability of the interview items, six pilot ORACLe interviews were undertaken in three Australian health policy agencies followed by pilot testing of the SPIRIT intervention and the associated measurement tools (including ORACLe) in one policy agency.
The selected guidelines were scored using the AGREE instrument, which uses 4-point scales for each item: scope and purpose (3 items), stakeholder involvement (4 items), rigour of development (7 items), clarity and presentation of the recommendations (4 items), applicability of the guideline (3 items), and editorial independence (2 items).
The discussion guide was structured to concentrate on the following key areas to determine face and content validity: 1) design of survey (layout, order, length); 2) language (translation, clarity, vocabulary, brevity and focus); 3) applicability and specificity of the items.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com