Abstract
Cognitive interviewing is a qualitative research method for improving the validity of quantitative surveys, which has been underused by academic researchers and monitoring and evaluation teams in global health. Draft survey questions are administered to participants drawn from the same population as the respondent group for the survey itself. The interviewer facilitates a detailed discussion with the participant to assess how the participant interpreted each question and how they formulated their response. Draft survey questions are revised and undergo additional rounds of cognitive interviewing until they achieve high comprehension and cognitive match between the research team’s intent and the target population’s interpretation. This methodology is particularly important in global health when surveys involve translation or are developed by researchers who differ from the population being surveyed in terms of socio-demographic characteristics, worldview, or other aspects of identity. Without cognitive interviewing, surveys risk measurement error by including questions that respondents find incomprehensible, that respondents are unable to accurately answer, or that respondents interpret in unintended ways. This methodological musing seeks to encourage a wider uptake of cognitive interviewing in global public health research, provide practical guidance on its application, and prompt discussion on its value and practice. To this end, we define cognitive interviewing, discuss how cognitive interviewing compares to other forms of survey tool development and validation, and present practical steps for its application. These steps cover defining the scope of cognitive interviews, selecting and training researchers to conduct cognitive interviews, sampling participants, collecting data, debriefing, analysing the emerging findings, and ultimately generating revised, validated survey questions. We close by presenting recommendations to ensure quality in cognitive interviewing.
Highlights
This methodological musing calls attention to cognitive interviewing, a qualitative research methodology for improving the validity of quantitative surveys that has often been overlooked in global public health
We argue that cognitive interviewing should be an essential step in the development of quantitative survey tools used in global public health and call attention to the detailed steps of applying this method in the field
Our research has found reasonable evidence of saturation with a total of 20–25 participants over three rounds, which broadly aligns with recommendations from high-income countries, such as the US Center for Disease Control and Prevention’s guidance of 20–50 respondents (CDC/National Center for Health Statistics, 2014) and lead American cognitive interviewing methodologist Gordon Willis’s 8–12 subjects per round, multiplied by 1–3 rounds (Willis, 2014)
Summary
This methodological musing calls attention to cognitive interviewing, a qualitative research methodology for improving the validity of quantitative surveys that has often been overlooked in global public health. If a respondent said that a baby should be breastfed 3 hours after birth, and we knew from other questions in the survey that the respondent had a caesarean delivery, the interviewer had to probe to determine whether the participant experienced delayed breastfeeding due to her post-operation recovery and whether her reply on when babies should breastfeed was her description of when her baby was breastfed For another example, if a participant said she had not heard of condoms when directly asked in the knowledge section and later said that she had used condoms when asked about her use of birth control, the researcher had to have the insight to circle back to the initial knowledge question about condoms to determine if the initial response was driven by low comprehension (maybe we used an unfamiliar word for condom) or discomfort (shyness) or another factor. Training, including topic lecture and discussion on IYCF and detailed review of the IYCF cognitive interview guide
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