Open Access Research article

Quality assessment of expert answers to lay questions about cystic fibrosis from various language zones in Europe: the ECORN-CF project

Daniela d'Alquen1*, Kris De Boeck2, Judy Bradley3, Věra Vávrová4, Birgit Dembski5, Thomas OF Wagner6, Annette Pfalz6 and Helge Hebestreit1

Author Affiliations

1 Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany

2 Pediatric Pulmonology, Department of Pediatrics, University Hospital of Leuven, Herestraat 49, 3000 Leuven, Belgium

3 Health and Rehabilitation Sciences Research Institute, University of Ulster and Adult CF Centre, Belfast Health and Social Care Trust, Shore Road, Newtownabbey BT37 0QB, Northern Ireland

4 Cystic Fibrosis Centre, Charles University, 2nd School of Medicine, V Uvalu 84, 15006 Prague 5, Czech Republic

5 CF Europe, Bonn, and CF Association, Mukoviszidose e.V., In den Dauen 6, 53117 Bonn, Germany

6 Department of Pneumology, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany

For all author emails, please log on.

BMC Medical Research Methodology 2012, 12:11  doi:10.1186/1471-2288-12-11

Published: 6 February 2012



The European Centres of Reference Network for Cystic Fibrosis (ECORN-CF) established an Internet forum which provides the opportunity for CF patients and other interested people to ask experts questions about CF in their mother language. The objectives of this study were to: 1) develop a detailed quality assessment tool to analyze quality of expert answers, 2) evaluate the intra- and inter-rater agreement of this tool, and 3) explore changes in the quality of expert answers over the time frame of the project.


The quality assessment tool was developed by an expert panel. Five experts within the ECORN-CF project used the quality assessment tool to analyze the quality of 108 expert answers published on ECORN-CF from six language zones. 25 expert answers were scored at two time points, one year apart. Quality of answers was also assessed at an early and later period of the project. Individual rater scores and group mean scores were analyzed for each expert answer.


A scoring system and training manual were developed analyzing two quality categories of answers: content and formal quality. For content quality, the grades based on group mean scores for all raters showed substantial agreement between two time points, however this was not the case for the grades based on individual rater scores. For formal quality the grades based on group mean scores showed only slight agreement between two time points and there was also poor agreement between time points for the individual grades. The inter-rater agreement for content quality was fair (mean kappa value 0.232 ± 0.036, p < 0.001) while only slight agreement was observed for the grades of the formal quality (mean kappa value 0.105 ± 0.024, p < 0.001). The quality of expert answers was rated high (four language zones) or satisfactory (two language zones) and did not change over time.


The quality assessment tool described in this study was feasible and reliable when content quality was assessed by a group of raters. Within ECORN-CF, the tool will help ensure that CF patients all over Europe have equal possibility of access to high quality expert advice on their illness.