Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention

Macefield, Rhiannon, Mandefield, Laura, Blazeby, Jane M., Fairhurst, Caroline, Baird, Kalpita, Arundel, Catherine, Chetter, Ian, Martin, Belen Corbacho, Hewitt, Catherine, Gkekas, Athanasios, Mott, Andrew, Saramago Goncalves, Dr Pedro, Swan, Samantha, Torgerson, David, Wilkinson, Jacqueline, Zahra, Sabeen, Dixon, Stephen, Hatfield, Josie, Oswald, Angela, Dumville, Jo, Lee, Mr Matthew, Pinkney, Thomas, Stubbs, Nikki, Wilson, Lyn, Clothier, A., Bosanquet, D., Blow, M., Price, C., Todd, J., Munro, T., Pillay, W., Pradhan, A., Garnham, A., Wall, M., Powezka, K., Syed, A., Gerrard, D., Croucher, A., Hadjievangelou, N., Firth, A., Roe, T., Smith, G., Bicknell, C., Carr, C., Negbenose, E., Tarusan, L., Vesey, A., Wilson, D., Bell, D., Fletcher, J., Greenwood, C., Wallace, T., Vallabhaneni, S., Holder, S., Williams, J., Sim, S., Tambyraja, A. L., Kerray, F., Ng, A., Sylvester, M., Slater, L., Rashid, S. T., Palacios, A., Feld, K., Nandhra, S., Stansby, G., Parr, N., Jones, L., Milne, J., Stubbs, C., Hinchliffe, R., Twine, C., Antoniou, G. A., Corbett, C., Munt, S., Warran, S., Fletcher, R., Al-Jundi, W., Burrows, M., Stather, P. ORCID: https://orcid.org/0000-0002-3585-6728, Barnes, R., Woodrow, T., Adams, B., Agu, O., Gleeson, Y., D'Souza, R., Erete, L., Jones, S., Checketts, C., Bajic, D., Matravers, R., Loftus, I., Budge, J., Azhar, B., Juszczak, M., Syed, A., Hancox, R., Pearce, C., Suggett, N., Whitehouse, A., Kuhan, G., Premnath, S., Dattani, N., Hollings, V., Khasawneh, F., AlShakarchi, J. and Packer, E. (2025) Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention. Journal of Tissue Viability, 34 (3). ISSN 0965-206X

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Abstract

Background: Surgical wounds healing by secondary intention are common. Healing is often complicated by surgical site infection (SSI). SSI assessment is important to guide treatment but existing methods generally require in-person assessment, making them resource intensive. A validated patient-reported SSI outcome measure may be useful to overcome this limitation. Aim: To modify and validate the Bluebelle Wound Healing Questionnaire (WHQ) for wounds healing by secondary intention.  Methods: The 18-item Bluebelle WHQ developed for wounds healing by primary intention was modified to make it applicable to secondary healing wounds. Testing was performed as part of the SWHSI-2 randomised trial assessing negative pressure wound dressings versus standard care. Participants completed the WHQ at five timepoints; in-person (baseline, post-healing) and by post (3, 6, 12 months). A reference SSI assessment was performed by a research nurse at the time of wound healing. Acceptability and criterion validity (ability of the Bluebelle WHQ to discriminate between SSI/no SSI) were explored by examining questionnaire return rates, levels of missing data and total score sensitivity/specificity values (receiver operating characteristic curve (ROC)).  Results: Baseline in-person questionnaire return rates were highest (672/686; 98 %), with postal return rates of 428/615 (68.5 %), 274/416 (65.9 %) and 186/296 (62.8 %) at follow up points. Overall, low levels of item-missing data were observed with few problems completing the questionnaire reported. Ability to discriminate between SSI/no SSI was good (Area under ROC = 0.796).  Conclusion: The modified Bluebelle WHQ is a valuable tool for post-discharge assessment of wounds healing by secondary intention. It is recommended for use in research and clinical practice.

Item Type:	Article
Additional Information:	Availability of data and materials: Anonymised datasets generated and analysed during the current study will be stored in a publicly available open research repository (https://osf.io/echxv). Data is anticipated to be available via this repository by end 2024, following completion of analysis and subsequent publication. Sharing of this anonymised data is covered by original participant consent for the SWHSI-2 trial which permits sharing of data to support future research via sharing anonymously.
Uncontrolled Keywords:	patient reported outcome (pro),secondary intention healing,surgical site infection,surgical wounds,wound assessment,pathology and forensic medicine,dermatology ,/dk/atira/pure/subjectarea/asjc/2700/2734
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
Related URLs:	https://www.scopus.com/pages/publication...
Depositing User:	LivePure Connector
Date Deposited:	25 Aug 2026 15:56
Last Modified:	27 Aug 2026 14:37
URI:	https://ueaeprints.uea.ac.uk/id/eprint/104351
DOI:	10.1016/j.jtv.2025.100889

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