Abstract
BackgroundThe evaluation of patient-reported outcomes (PROs) in health care has seen greater use in recent years, and methods to improve the reliability and validity of PRO instruments are advancing. This paper discusses the cognitive interviewing procedures employed by the Patient Reported Outcomes Measurement Information System (PROMIS) pediatrics group for the purpose of developing a dynamic, electronic item bank for field testing with children and adolescents using novel computer technology. The primary objective of this study was to conduct cognitive interviews with children and adolescents to gain feedback on items measuring physical functioning, emotional health, social health, fatigue, pain, and asthma-specific symptoms.MethodsA total of 88 cognitive interviews were conducted with 77 children and adolescents across two sites on 318 items. From this initial item bank, 25 items were deleted and 35 were revised and underwent a second round of cognitive interviews. A total of 293 items were retained for field testing.ResultsChildren as young as 8 years of age were able to comprehend the majority of items, response options, directions, recall period, and identify problems with language that was difficult for them to understand. Cognitive interviews indicated issues with item comprehension on several items which led to alternative wording for these items.ConclusionChildren ages 8–17 years were able to comprehend most item stems and response options in the present study. Field testing with the resulting items and response options is presently being conducted as part of the PROMIS Pediatric Item Bank development process.
Highlights
The evaluation of patient-reported outcomes (PROs) in health care has seen greater use in recent years, and methods to improve the reliability and validity of PRO instruments are advancing
The pediatric cognitive interviewing methodology followed the general principles of the Patient Reported Outcomes Measurement Information System (PROMIS) Network [3], with the necessary adaptations required for children as young as 8 years of age, relying in part on the cognitive interviewing methodology utilized in the development of the PedsQLTM instruments [8] and the work of Willis [9]
PROMIS focused on the measurement of generic health domains that are important across a variety of illnesses, including physical function, pain, fatigue, emotional distress, and social function [2]
Summary
The evaluation of patient-reported outcomes (PROs) in health care has seen greater use in recent years, and methods to improve the reliability and validity of PRO instruments are advancing. This paper discusses the cognitive interviewing procedures employed by the Patient Reported Outcomes Measurement Information System (PROMIS) pediatrics group for the purpose of developing a dynamic, electronic item bank for field testing with children and adolescents using novel computer technology. Cognitive interviewing allows direct input from respondents on the item content, format, and understandability. This method has emerged as an essential component in the development of a number of standardized measures [5,6,7]. The cognitive interviewing methodology for PROMIS was designed to elicit input from respondents on all items under consideration for the PROMIS item bank [3]. The intent of cognitive interviewing is to determine what the respondent thinks or comprehends a particular item is asking (what do specific words and phrases in the item stem mean to the respondent); the processes used by the respondent to retrieve relevant information from autobiographical memory; the decision or judgment processes used to conceive an answer; and the process of formulating a response to the item stem [10,11,12,13]
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