Cognitive Interview Study Research Articles

Parents' online coaching in the early intervention home program for toddlers with autism spectrum disorder during the COVID-19 pandemic: Manual development and feasibility study.

Early intervention improves the developmental progress among toddlers with ASD. Family involvement enhances the intervention outcome. This study aimed to develop and test the feasibility of an early intervention home program manual for toddlers with ASD. Method: This study involved three phases: (I) formulation of manual concept and content design (II) manual development through focus group discussion (n = 10) and content validation by experts (n = 9); (III) cognitive interview (n = 6) and feasibility study (n = 8). Result: Content Validity Index (I-CVI) for the developed manual ranged from .78-1.0, S-CVI/Ave .96, and S-CVI/UA .79. Cognitive interview among six parents reported that the manual was easy to understand. The feasibility study reported all eight parents benefitted from coaching sessions. Approximately 87.5% of the respondents found the program benefited their children and could easily implement the activities in their daily routines. Approximately 75% of respondents reported having greater confidence in managing their child's behaviors at home. Parent coaching using the developed home program is feasible and accepted by parents of a toddler with ASD. Further study should be developed to explore the effectiveness of parent coaching using the manual.

Does adapting a self-report instrument to improve its cognitive accessibility for people with intellectual disability result in a better measure? − A cognitive interview study

Background and aimsWe investigated whether improving the cognitive accessibility of a widely used self-report measure leads to better understanding and more accurate answers in a sample of adults with mild intellectual disability and borderline intellectual functioning. Methods and proceduresWe undertook a series of cognitive interviews before and after adaptation of the instructions and selected items of an existing self-report measure of adaptive functioning. Interview results and participant feedback were supplemented with quantitative comparisons between participant and carer scores. Outcomes and resultsAdaptation based on participant experiences and preferences combined with evidence-informed guidelines improved understanding and accuracy. Self-report and carer-report scores showed greater convergence after adaptation; this occurred because people with intellectual disabilities appeared to understand the self-report measure more effectively. Conclusions and implicationsThe results show that adaptation of the self-report instrument to suit the needs and preferences of people with mild intellectual disability or borderline intellectual functioning leads to a more accessible measure and more reliable and valid results. Results also highlight the importance of complementing proxy reports with a first-person perspective in assessment as clients and informants may differ in their assessment of behavior and skills.

Evaluation of perinatal anxiety assessment measures: a cognitive interview study

BackgroundAnxiety in pregnancy and postpartum is highly prevalent but under-recognised. To identify perinatal anxiety, assessment tools must be acceptable, relevant, and easy to use for women in the perinatal period.MethodsTo determine the acceptability and ease of use of anxiety measures to pregnant or postpartum women (n = 41) we examined five versions of four measures: the Generalised Anxiety Disorder scale (GAD) 2-item and 7-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS). Cognitive interviews were used to examine ease of comprehension, judgement, retrieval and responding.ResultsAll measures were acceptable. Some items were deemed less relevant to the perinatal period e.g., difficulties sleeping. Ease of comprehension, judgement, retrieval and responding varied, with all measures having strengths and weaknesses. The SAAS and CORE-10 had the lowest mean number of problematic components. The GAD had the highest mean number of problematic components​. Non-binary response options were preferred. Preferences for time frames (e.g. one week, one month) varied. Qualitative data provides in-depth information on responses to each measure.ConclusionsFindings can be used to inform clinical guidelines and research on acceptable anxiety assessment in pregnancy and after birth.

Cognitive testing of the Children’s Palliative Outcome Scale (C-POS) with children, young people and their parents/carers

Background: The Children’s Palliative Outcome Scale (C-POS) is being developed using best methodological guidance on outcome measure development, This recommends cognitive testing, an established method of item improvement, prior to psychometric testing. Aim: To cognitively test C-POS within the target population to establish comprehensibility, comprehensiveness, relevance and acceptability. Design: Cross-sectional cognitive interview study following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology and Rothrock guidance on outcome measure development. Cognitive interviews were conducted using ‘think aloud’ and verbal probing techniques. Setting/participants: Children 5–⩽17 years old with life-limiting conditions and parents/carers of children with life-limiting conditions were recruited from 14 UK sites. Results: Forty-eight individuals participated (36 parents; 12 children) in cognitively testing the five versions of C-POS over two to seven rounds. Content and length were acceptable, and all questions were considered important. Refinements were made to parent/carer versions to be inclusive of non-verbal children such as changing ‘share’ to ‘express’ feelings; and ‘being able to ask questions’ to ‘having the appropriate information’. Changes to improve comprehensibility of items such as ‘living life to the fullest’ were also made. Parents reported that completing an outcome measure can be distressing but this is anticipated and that being asked is important. Conclusion: Cognitive interviewing has facilitated refinement of the C-POS, especially for non-verbal children who represent a large proportion of those with a life-limiting condition. This study has enhanced the face and content validity of the measure and provided preliminary evidence for acceptability for use in routine practice.

Arabic translation and cultural adaptation of a training load and player monitoring in high-level football questionnaire: A cognitive interview study.

Understanding the current practice and the associated challenges in applying monitoring tools is essential to improving football performance in the Middle East, thus the purpose was to translate and culturally adapt a published questionnaire that assessed the practice and perception of High-Level football teams toward Training Load and Player Monitoring to be used in the Arabic context, aiming to contribute to the enhancement of football performance, player welfare, and training quality in the region. A total of 15 Arabic-speaking coaches (mean age 42.6 ± 9.9 years; mean experience 10.9 ± 5.7 years; 53.3% football coaches and 46.7% strength & conditioning coaches) were conveniently selected to participate in this study. The current research followed a systematic cross-cultural adaptation process, which included forward translation, synthesis, back-translation, expert panel review, and pre-testing through cognitive interviewing. Three rounds of cognitive interviews were conducted with the 15 participants. Descriptive statistics, including means with standard deviations and frequencies with percentages, were reported for the participants' characteristics. With some minor linguistic modifications to the questionnaire by the expert committee (i.e., adjustments such as Sport Scientist to Sport Science Specialist), the instrument was translated and culturally adapted into Arabic. All participants confirmed that the resulting Arabic versions of the training load and player monitoring in high-level football questionnaires were appropriate and fully understandable for Arabic speakers in conveying the intended meanings of the items in each. The training load and player monitoring in the high-level football questionnaire was successfully translated and culturally adapted into Arabic and are now ready for use in the Arabic context, offering an opportunity for comprehensive research and enabling tailored performance optimization strategies, which could ultimately lead to advancements in player development and welfare within Arabic-speaking football communities.

Development and adaptation of the Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) for the Australian osteopathic profession - A cognitive interview study

BackgroundThe Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The Osteo-TAQ has the potential to measure multiple domains of osteopaths' practice including their therapeutic approach, clinical decision-making and therapeutic relationship with patients. It is unknown how well the items in the Osteo-TAQ relate to the practice of Australian osteopaths. ObjectivesTo assess and improve the quality of the Osteo-TAQ survey items prior to utilising the Osteo-TAQ amongst the Australian osteopathic profession. MethodsCognitive interviews with six Australian registered osteopaths (n = 6) were used to generate data on how participants interpreted and understood the Osteo-TAQ items. Interviews were transcribed verbatim and content analysis was used to identify issues of comprehension and problem areas relating to the Osteo-TAQ. ResultsThree areas for improvement were identified in relation to the core aspects of clinical practice (the patient, examination, treatment and management), use of possessive pronouns and Likert scale frequency response options. ConclusionThese problems may reflect the similarities in osteopathic practice in the UK and Australia, but also indicate subtle differences in the terminology utilised by osteopaths to describe and communicate areas of their clinical practice.

How patients with insomnia interpret and respond to the consensus sleep diary: a cognitive interview study

Objective/BackgroundThe Consensus Sleep Diary (CSD) is widely used to assess subjective sleep. Psychometric evaluations and focus-groups support its validity and clinical usefulness, but further research into its validity is needed. The aim of the study was to evaluate a Swedish translation of the CSD regarding test content and response processes in patients with insomnia.Patients/MethodsIn connection with translating the CSD into Swedish, we used cognitive interviewing to evaluate test content and the response process, that is, how people make decisions when responding to survey items. Cognitive interviews were conducted with 13 primary health care patients with insomnia disorder (mean age, 49 years; SD 15.5). Iterative, reparative analysis was used to investigate test content. Descriptive deductive analysis was used to investigate interview transcripts for the themes of the cognitive model: comprehension, retrieval, decision process, and judgement. Together, the themes explain the response process when responding to a patient-reported outcome measure.ResultsThe overall comprehension of the CSD could be affected by poor adherence to the instructions (comprehension). Patients had difficulty with recall if they did not complete the diary immediately in the morning and just before bedtime (retrieval). They could have problems deciding how to respond to certain items because they imbued sleep-related concepts with extra meaning (decision process), and had trouble finding response alternatives nuanced enough to describe their experience of sleep and tiredness (judgement).ConclusionsThis study contributes knowledge on how the instrument is perceived and used by care-seeking patients with insomnia. In this context, the CSD exhibits known flaws such as memory lapses if the diary is not filled in directly in the morning. To increase the accuracy of patients’ responses, therapists should support patients in reading the instructions.

"Postponing it Any Later Would not be so Great": A Cognitive Interview Study of How Physicians Decide to Initiate Goals of Care Discussions in the Hospital.

There are missed opportunities to discuss goals and preferences for care with seriously ill patients in the acute care setting. It is unknown which factors most influence clinician decision-making about communication at the point of care. This study utilized a cognitive-interviewing technique to better understand what leads clinicians to decide to have a goals of care (GOC) discussion in the acute care setting. A convenience sample of 15 oncologists, intensivists and hospitalists were recruited from a single academic medical center in a large urban area. Participants completed a cognitive interview describing their thought process when deciding whether to engage in GOC discussions in clinical vignettes. 6 interconnected factors emerged as important in determining how likely the physician was to consider engaging in GOC at that time; (1) the participants' mental model of GOC, (2) timing of GOC related to stability, acuity and reversibility of the patient's condition, (3) clinical factors such as uncertainty, prognosis and recency of diagnosis, (4) patient factors including age and emotional state, (5) participants' role on the care team, and (6) clinician factors such as emotion and communication skill level. Participants were hesitant to commit to the present moment as the right time for GOC discussions based on variations in clinical presentation. Clinical decision support systems that include more targeted information about risk of clinical deterioration and likelihood of reversal of the acute condition may prompt physicians to discuss GOC, but more support for managing discomfort with uncertainty is also needed.

Understanding the impact of tuberous sclerosis complex: development and validation of the TSC-PROM

BackgroundTuberous sclerosis complex (TSC) is a rare and complex genetic disorder, associated with tumor growth in various organ systems, epilepsy, and a range of neuropsychiatric manifestations including intellectual disability. With improving patient-centered care and targeted therapies, patient-reported outcome measures (PROMs) are needed to measure the impact of TSC manifestations on daily functioning. The aim of this study was to develop a TSC-specific PROM for adults that captures the impact of TSC on physical functions, mental functions, activity and participation, and the social support individuals with TSC receive, called the TSC-PROM.MethodsCOSMIN methodology was used to develop a self-reported and proxy-reported version. Development and validation consisted of the following studies: PROM development, content validity, structural validity, internal consistency, and construct validity. The International Classification of Functioning and Disability was used as a framework. Content validity was examined by a multidisciplinary expert group and cognitive interview study. Structural and construct validity, and internal consistency were examined in a large cohort, using confirmatory factor analysis, hypotheses testing, and Cronbach’s alpha.ResultsThe study resulted in an 82-item self version and 75-item proxy version of the TSC-PROM with four subscales (physical functions 18 and 19 items, mental functions 37 and 28 items, activities and participation 13 and 14 items, social support 13 items, for self version and proxy version respectively). Sufficient results were found for structural validity with sufficient unidimensionality for each subscale. With regard to construct validity, 82% of the hypotheses were met for the self version and 59% for the proxy version. The PROM showed good internal consistency (Cronbach’s alpha 0.78–0.97).ConclusionsWe developed a PROM for adults with TSC, named TSC-PROM, showing sufficient evidence for reliability and validity that can be used in clinical and research settings to systematically gain insight into their experiences. It is the first PROM in TSC that addresses the impact of specific TSC manifestations on functioning, providing a valuable, patient-centered addition to the current clinical outcomes.

Arabic translation and cultural adaptation of sedentary behavior, dietary habits, and preclinical mobility limitation questionnaires: A cognitive interview study.

Developing global evidence on the influence of health-related behaviors (e.g., sedentary behavior, diet) and mobility limitations on health requires global consortia from diverse sets of countries. Thus, the purpose was to translate and culturally adapt (i) the Sedentary Behavior Questionnaire (SBQ); (ii) the Dietary Habits Questionnaire adapted from the Survey of Health, Aging and Retirement in Europe (SHARE) study; (iii) the Preclinical Mobility Limitation questionnaire for use in the Saudi Arabian context. 50 adult Saudi participants (mean age 41.7±9.6, 48% female) participated in this study. We followed a systematic cross-cultural adaptation process that involved forward translation, synthesis, back-translation, expert panel, and pre-testing (cognitive interviewing). Four rounds of cognitive interviews were held with 40 participants for the SBQ, SHARE questionnaire, and the Preclinical Mobility Limitation questionnaire, an additional round was needed for the Preclinical Mobility Limitation questionnaire. Descriptive data (means ± standard deviations and frequencies with percentages) were reported for characteristics. With some minor changes to the questionnaires, the SBQ, Dietary Habits, and Preclinical Mobility Limitation questionnaires were translated and cross-culturally adapted into Arabic. 100% of the participants confirmed that the resulting Arabic versions of the SBQ, Dietary Habits questionnaire, and Preclinical Mobility Limitation questionnaires were appropriate and fully understandable for Arabic speakers in communicating the intended meanings of the items in each. For example, item SBQ1, 'Watching television (including videos on VCR/DVD)' was changed to 'Sitting and watching television or videos (including smartphones, tablets)'. The SBQ, Dietary Habits questionnaire, and Preclinical Mobility Limitation questionnaire were successfully cross-culturally adapted into Arabic and are now ready for use in Saudi Arabian.

"How about me giving blood for the COVID vaccine and not being able to get vaccinated?" A cognitive interview study on understanding of and agreement with broad consent for future use of data and samples in Colombia and Nicaragua.

Broad consent for future use, wherein researchers ask participants for permission to share participant-level data and samples collected within the study for purposes loosely related to the study objectives, is central to enabling ethical data and sample reuse. Ensuring that participants understand broad consent-related language is key to maintaining trust in the study and public health research. We conducted 52 cognitive interviews to explore cohort research participants' and their parents' understanding of the broad consent-related language in the University of California at Berkeley template informed consent (IC) form for biomedical research. Participants and their parents were recruited from long-standing infectious disease cohort studies in Nicaragua and Colombia and interviewed during the COVID-19 pandemic. We conducted semi-structured interviews to assess participants' agreement with the key concepts in the IC after clarifying them through the cognitive interview. Participants did not understand abstract concepts, including collecting and reusing genetic data. Participants wanted to learn about incidental findings, future users and uses. Trust in the research team and the belief that sharing could lead to new vaccines or treatments were critical to participant support for data and sample sharing. Participants highlighted the importance of data and sample sharing for COVID-19 response and equitable access to vaccines and treatments developed through sharing. Our findings on participants' understanding of broad consent and preferences for data and sample sharing can help inform researchers and ethics review committees working to enable ethical and equitable data and sample sharing.

Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study

BackgroundDiagnostic excellence encompasses both receiving an accurate and timely explanation of a health problem that was communicated well, and the process it took to get to the correct diagnosis. Directly eliciting patients’ perceptions of their diagnostic experience and outcomes after emergency visits is a promising method of assessing diagnostic excellence. However, little is known about how patients interpret and respond to questions about their diagnostic experiences and outcomes. ObjectiveTo analyze patient and care partners’ interpretation of questions capturing patient-reported diagnostic excellence in emergency settings. DesignCognitive interviews using think-aloud and probing methods. Setting(s)Interviews were conducted virtually and via phone calls. Participants were patients or care partners of patients recently discharged from three emergency departments within a single academic health system in the Mid-Atlantic region of the US. Participants15 patients and care partners, 18 years or older, with recent emergency department experiences. MethodsQualitative analysis using a deductive approach was used to code transcripts and analyze participant responses to Patient-Report to Improve Diagnostic Excellence in Emergency Department (PRIME-ED) questionnaire items. Themes of patient and care partners’ questionnaire interpretations are presented descriptively. Results80% of participants were female, 47% were between the ages of 18–24 years, 47% of participants were White, and 7% were Hispanic/Latino. Participants shared their interpretations of diagnostic excellence following PRIME-ED domains: diagnostic accuracy and care team skills, their comprehension of the diagnosis, provider communication of uncertainty, and quality of diagnostic communication, including whether they felt the care team communicated well, adapted communication to their needs, listened and took concerns seriously, treated them as an equal, and provided clear, sufficient, and functional communication about follow-up steps. Responses indicated that patients and care partners can identify diagnostic errors, rationalize why their diagnosis was inaccurate, and assess whether diagnostic excellence was achieved. Respondents identified factors that contributed to their assessments of diagnostic accuracy and the quality of diagnostic communication. The quality of diagnostic communication contributed to patient perception of diagnostic accuracy and understanding of the diagnosis. ConclusionsPatient report is a useful tool for assessing diagnostic excellence in emergency settings. Our patient and care partners describe how they assess diagnostic excellence in the emergency department.Registration: N/A.Tweetable abstract: Patients and care partners provide accessible and useful information to assess diagnostic practices and diagnostic excellence in emergency departments.

Designing Game-Based Learning for High School Artificial Intelligence Education

Artificial Intelligence (AI) permeates every aspect of our daily lives and is no longer a subject reserved for a select few in higher education but is essential knowledge that our youth need for the future. Much is unknown about the level of AI knowledge that is age and developmentally appropriate for high school, let alone about how to teach AI to even younger learners. In this theoretical paper, we discuss the design of a game-based learning environment for high school AI education, drawing upon insights gained from a prior cognitive interview study at a STEM focused private high school. We argue that game-based learning is an excellent fit for AI education due to the commonality of problem solving in both game playing and AI.

Asking the Experts: Using Cognitive Interview Techniques to Explore the Face Validity of the Mental Wellness Measure for Adolescents Living with HIV.

There has been an increased focus on the mental health of adolescents living with HIV (ALHIV), because evidence shows that poor mental health outcomes are associated with lower rates of adherence and retention in HIV care. However, the research to date has predominantly focused on addressing mental health problems and reducing symptoms of mental illness rather than strengthening mental wellness [positive mental health]. Consequently, little is known about the critical mental wellness indicators that should be targeted in services for ALHIV. There is a need for valid and appropriate measures of mental wellness to drive research and provide evidence on the mental wellness needs of ALHIV that would inform service delivery as well as the monitoring and evaluation of treatment outcomes. To this end, we developed the Mental Wellness Measure for Adolescents Living with HIV (MWM-ALHIV) for ALHIV in the South African context. In this paper, we report on the findings from a cognitive interview study with nine ALHIV aged 15-19 years receiving treatment at a public healthcare facility in the Cape Metropole, South Africa. Through interviews, participants identified key issues related to the wording, relevance and understanding of the items and provided suggestions to improve the instrument's overall face validity.

Exploring the contributions of expert review and cognitive interviewing to evaluating the content validity of items for anew measure of adolescent social communication, the Transition Pragmatics Interview

ABSTRACT Interventions to facilitate improvement in adolescent social communication are more effective when they are tailored to adolescents’ individual profiles of ability. Current social communication assessments for adolescents are not designed to identify their profiles of ability for settings beyond compulsory education. To address this gap, we developed the Transition Pragmatics Interview (TPI). The purpose of these studies was to evaluate the content validity of items developed for the TPI using expert review and cognitive interviewing. Cognitive interviewing is recommended in health-related measurement standards but is not widely reported for assessments of developmental language disorders. Six speech-language pathologists participated in the expert review, rating how well TPI items represented facets of social communication ability. All questions were rated as representative of their intended construct. Eight adolescents (age 14–21) of varied social communication abilities participated in the cognitive interview study to explore whether items were understood as intended by the developers. Participants responded to each item while aresearcher observed their response process and asked questions to identify the respondents’ thinking about the items. Transcribed responses were classified based on whether they indicated aconstruct-irrelevant difficulty with the item. Nine of 52 items were identified with recall difficulties, ambiguous wording or potential sources of bias. Cognitive interviewing complemented expert review by identifying issues with content validity not identified by expert review. Items with construct-irrelevant barriers to response will be modified and re-evaluated prior to field testing.

Content validity of the Recap of atopic eczema (RECAP) instrument in Dutch, English and German to measure eczema control in young people with atopic eczema: a cognitive interview study.

Recap of atopic eczema (RECAP) is a patient-reported outcome measure assessing eczema control. This instrument has been developed and validated in the UK. There are self-reported and proxy-reported versions in English, Dutch and German. However, it is unclear whether the self-reported version shows adequate content validity when completed by young people (8-16 years) in these languages. To assess the content validity (comprehensibility, relevance and comprehensiveness) of the English, German and Dutch versions of the self-reported RECAP in young people with atopic eczema and to identify the most appropriate age cutoff for self-completion. We conducted 23 semistructured cognitive interviews with young people aged 8-16 years, using the 'think-aloud' method. In Germany and the Netherlands, participants were recruited in dermatology clinics and in the UK through social media and existing mailing lists. Interviews were audio recorded, transcribed verbatim and analysed in the three languages, using a problem-focused coding manual. Transcripts were coded by two independent reviewers in each country. Themes were translated into English and compared across the three countries. Significant age-related comprehensibility issues with the last three items of the questionnaire occurred with young people aged 8-11 years, causing difficulties completing RECAP without help. However, older children had only minor problems and were able to complete the questionnaire by themselves. The self-reported version of RECAP has sufficient content validity for self-completion in young people aged 12 years and above. However, the German version with some translational adaptations may be appropriate for children from the age of 8 years. There may be some situations where the proxy version is needed for older children too. The self-reported version of RECAP is appropriate for use from the age of 12 years. The proxy version can be used in children younger than 12 years. Other measurement properties should be further investigated. What is already known about this topic? Recap of atopic eczema (RECAP) is an instrument recommended by the Harmonising Outcome Measures for Eczema initiative for the core outcome domain of long-term control of atopic eczema. Content validity of RECAP for self-completion by adults and of the proxy version has been assessed. What does this study add? In this study, content validity (comprehensibility, relevance and comprehensiveness) of the self-reported version of RECAP among young people (aged 8-16 years) with atopic eczema across the UK, Germany and the Netherlands is assessed. Based on these findings, key recommendations on how to measure eczema control in young people with atopic eczema are formulated. What are the clinical implications of this work? The Dutch, English and German self-completion versions of RECAP are recommended for use in adolescents from the age of 12 years. The proxy version could be used in children younger than 12 years or where children are cognitively or physically incapable of reporting their experience of eczema control. Caregivers should be encouraged to complete RECAP together with their child where possible.

Validating a Self-Reported Medication Nonadherence Measure in the Context of Multiple Chronic Diseases and Routes of Medication Administration Among Patients with Type 2 Diabetes.

Patients with diabetes may take oral and injectable medications and often have comorbid chronic diseases. It is unclear whether to assess nonadherence for oral and injectable medications separately or combined and for comorbid conditions separately or combined. We conducted two cognitive interview studies among patients with type 2 diabetes who were prescribed medications for oral or injectable diabetes medications (Study 1) or at least one diabetes, blood pressure, and cholesterol medication (Study 2). Participants completed the two-domain DOSE-Nonadherence measure, which assesses extent of nonadherence and reasons for nonadherence. We asked about interpretation of instructions and items, recall period, ability to respond accurately with separate versus combined versions, and comprehensiveness of reasons for nonadherence to injectable medications. Based on Study 1 (n=14), nonadherence to injectable and oral medications should be assessed separately. Participants believe they can respond accurately to 7-day recall period for daily medications and a one-month recall period for weekly injectable medications. New reasons for nonadherence to injectable medications were perceived as relevant. Based on Study 2 (n-12), nonadherence to medications for diabetes, blood pressure, and cholesterol should be assessed separately. Although separate versions increase response time, it may improve accuracy. Responses to the measure can facilitate conversations about nonadherence between providers and patients to inform clinical decision-making.

Cross-Cultural Adaptation and Validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL-SR) for Diabetic Patients in Serbia.

Thoroughly validated instruments can provide a more accurate and reliable picture of how the instrument works and of the level of health literacy in people with type 2 diabetes mellitus (T2DM). The present work aimed at cross-cultural adaptation and validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL) in patients with T2DM in Serbia. After translation and back-translation, views from an expert group, one cognitive interview study (n = 10) and one survey study (n = 130) were conducted among samples of diabetic patients. Item analysis, internal consistency, content validity, confirmatory factor analysis (CFA) and reliability testing were performed. When all 14 items were analyzed, loading factors were above 0.55, but without adequate model fit. After removing two items with the lowest loadings FHL1 and IHL2 the fit indexes indicated a reasonable normed χ2 (SB scaled χ2/df = 1.90). CFI was 0.916 with SRMR = 0.0676 and RMSEA = 0.0831. To determine internal consistency, Cronbach’s alpha coefficient was 0.796 for the whole FCCHL-SR12. With only minor modifications compared to the English version, the 12-item FCCHL instrument is valid and reliable and can be used to measure health literacy among Serbian diabetic patients. However, future research on a larger population in Serbia is necessary for measuring the levels of HL and their relationship with other determinants in this country.

Improving abortion underreporting in the USA: a cognitive interview study

Abortion is a difficult-to-measure behaviour with extensive underreporting in surveys, which compromises the ability to study and monitor it. We aimed to improve understanding of how women interpret and respond to survey items asking if they have had an abortion. We developed new questions hypothesised to improve abortion reporting, using approaches that aim to clarify which experiences to report; reduce the stigma and sensitivity of abortion; reduce the sense of intrusiveness of asking about abortion; and increase respondent motivation to report. We conducted cognitive interviews with cisgender women aged 18–49 in two US states (N = 64) to assess these new approaches and questions for improving abortion reporting. Our findings suggest that including abortion as part of a list of other sexual and reproductive health services, asking a yes/no question about lifetime experience of abortion instead of asking about number of abortions, and developing an improved introduction to abortion questions may help to elicit more accurate survey reports. Opportunities exist to improve survey measurement of abortion. Reducing the underreporting of abortion in surveys has the potential to improve sexual and reproductive health research that relies on pregnancy histories.

Applicability of the AO Spine Patient Reported Outcome Spine Trauma (PROST) in people with motor-complete spinal cord injury: a cognitive interview study.

Study designThis is a cognitive interview study.ObjectivesTo examine the applicability of the Patient Reported Outcome Spine Trauma (AO Spine PROST) in people with motor-complete traumatic or non-traumatic spinal cord injury (SCI).SettingTwo rehabilitation centers in The Netherlands.MethodSemi-structured cognitive interviews were conducted with 29 adults with a motor-complete SCI (AISA Impairment Scale A or B). Participants were asked to complete the AO Spine PROST and four additional evaluation questions rated on a 1–5-point Likert scale (5 most positive), while verbalizing their thoughts about their answers. Interviews were audio-recorded and transcribed. Codes were identified and linked to a coding scheme. Qualitative data were used to interpret the quantitative results.ResultsAlmost three-quarters of the participants (71.4%) had a traumatic SCI. Positive ratings of the measure were obtained regards comprehensibility (mean 4.0), non-offensiveness (4.6), relevance (4.2), and completeness (3.6). A question about the emotional impact of SCI was indicated to be missing. How using an assistive device should weigh in the score was a recurring topic. The use of multiple examples per item raised uncertainty, mostly solved by averaging their score. Some individuals indicated that the possibility to express even better function compared to before the onset of injury would be valuable.ConclusionsOverall, the AO Spine PROST appears applicable in adults with a motor-complete traumatic or non-traumatic SCI. Recommendations are made for improvement in instructions, terminology, and examples used in the tool. This study contributes to the further development of the AO Spine PROST in spine trauma care and research.