Using cognitive interviews to enhance measurement in empirical bioethics: Developing a measure of the preventive misconception in biomedical HIV prevention trials

Abstract

Background: We describe our use of cognitive interviews in developing a measure of “preventive misconception” to demonstrate the importance of this approach to researchers developing surveys in empirical bioethics. The preventive misconception involves research participants' false beliefs about a prevention trial, including beliefs that the interventions being tested will certainly be effective. Methods: We developed and refined a measure of the preventive misconception using qualitative interviews that focused on cognitive testing of proposed survey items with HIV prevention trial participants. Results: Two main problems emerged during initial interviews. First, the phrase “reduce your risk,” used to elicit beliefs about risk reduction from the use of study medications, was interpreted as relating to a reduction of risky behaviors. Second, the phrase “participating in this study,” intended to elicit beliefs about trial group assignment, was interpreted as relating to personal behavior changes associated with study participation. Additional interviews using a revised measure were no longer problematic in these ways, and participants felt the response options were appropriate for conveying their answers. Conclusions: These findings underscore the importance of cognitive testing in developing surveys for empirical bioethics.