Qualitative Interviewing: Testing Health Surveys Among Vietnam War Veterans at the Age of 70 Years

April S Fales,Victoria J Davey,Marsha E Dunn,Aaron I Schneiderman,Yasmin S Cypel,Ann L Truelove,Erick K Ishii

doi:10.1177/2158244019832690

April S Fales, Victoria J Davey + Show 5 more

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https://doi.org/10.1177/2158244019832690

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Abstract

The Vietnam Era Health Retrospective Observational Study (VE-HEROeS) is a nationwide study designed to compare the health of U.S. Vietnam era veterans to age- and sex-matched U.S. residents. Two self-administered mail questionnaires, one for veterans and the other for the U.S. nonmilitary population, were developed using already validated and newly developed items. A pretest was conducted to evaluate item recall and comprehension, new-item response validity, and the overall survey experience (usability of survey materials including the screener questionnaire for nonveterans). Subject recruitment was completed using convenience sampling and a $50 incentive. Cognitive interviewing and usability interviewing, two qualitative research methods, were implemented. Interviews were conducted in two stages (Stage 1, cognitive interviewing, n = 12; Stage 2, usability testing, n = 8) by three experienced methodologists. Concurrent probing techniques, unscripted probes, and retroactive probing were used to elicit response from 14 veterans and six nonveterans (mostly male, White, and aged 65-70 years). Information about the overall survey process was also obtained through observation during usability testing. Results signify that qualitative research is an important part of questionnaire development targeting older veterans due to issues involving comprehension, interpretability, and recall.

Highlights

The Vietnam Era Health Retrospective Observational Study (VE-HEROeS) is a large nationwide study designed to assess and compare the current health and well-being of U.S Vietnam era veterans with the health of age- and sex-matched U.S residents who never served in the military (Vietnam era veterans comprise all individuals who served in Vietnam, Cambodia, or Laos, or other areas of the world during the Vietnam War)
This is the case for major studies conducted by the U.S Centers for Disease Control and Prevention (CDC) between 1984 and 1988 that examined morbidity and mortality in Army Vietnam War veterans (CDC, 1987; CDC Vietnam Experience Study, 1988a, 1988b, 1988c; The Selected Cancers Cooperative Study Group, 1990); other major Vietnam War veteran studies such as the National Survey of the Vietnam Generation, one of three components of the National Vietnam Veterans Readjustment Study (Kulka et al, 1988; Kulka et al, 1990); the 2012-2013 National Vietnam Veterans Longitudinal Study (Schlenger et al, 2015); and the 2013-2015 HealthViEWS focused on women Vietnam War veterans (Magruder et al, 2015)
Questionnaires were reviewed by a research study steering committee that was composed primarily of Vietnam theater veterans, clinicians who treat Vietnam War veterans, survey research experts, and representatives of veteran’s service organizations (VSOs)

Summary

Introduction

The Vietnam Era Health Retrospective Observational Study (VE-HEROeS) is a large nationwide study designed to assess and compare the current health and well-being of U.S Vietnam era veterans with the health of age- and sex-matched U.S residents who never served in the military (Vietnam era veterans comprise all individuals who served in Vietnam, Cambodia, or Laos, or other areas of the world during the Vietnam War). Large surveys of Vietnam era veterans have been conducted in the past, there has been limited published research that discusses any qualitative testing of the survey questionnaires used. Much of the qualitative testing of large-scale survey questionnaires has been conducted on the U.S general population (National Center for Health Statistics, CDC, 2017, 2018; U.S Census Bureau, 2014). Veterans, those veterans who lived through the “Vietnam experience” (Boyle, Decouflé, & O’Brien, 1989), may differ from nonveterans in their approach to surveys. Changes to questionnaires made after qualitative testing can improve question wording, recall, and overall response quality and quantity

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