Verbal Probing Research Articles

Cognitive interviewing validation of the Chinese version of the neurogenic bladder symptom score

BackgroundThe neurogenic bladder symptom score (NBSS) has been widely used to specifically measure symptoms and consequences of neurogenic bladder (NB). The cognitive interviewing (CI) is effective in assessing item clarity and identifying key issues related to the comprehension of the instrument. We aim to translate the NBSS into Chinese and use the CI approach to explore the thought processes of patients with NB in responding the Chinese Version of the NBSS, identify and modify the factors hinder the thought processes to enhance the face validity of the NBSS. MethodsThe translation of the NBSS into Chinese was conducted with the guidance of the recommended frameworks. Patients with NB were recruited by purpose sampling. CI with the combination of thinking aloud and verbal probing techniques were used to explore thought processes. The interviews were transcribed and analyzed based on Tourangeau four-stage response model. ResultsTwo rounds of CI were carried out. The problems of comprehension, judgement and response mapping were identified in 8 items. Four items were revised based on the results of the interview. The revised items were verified and eventually integrated into the final version. ConclusionThe Chinese Version of the NBSS was easy to comprehend and use. The use of CI methodologies can increase the comprehensibility and cultural applicability of the NBSS, providing the evidence for the development of a clearer and more appropriate questionnaire.

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.

Adolescents’ understanding of the Nepalese version of HLS-CHILD-Q15: qualitative pre-testing in ninth-graders

IntroductionResearch on health literacy is still at an early stage, lacking a dedicated measurement instrument for assessing children’s and adolescents’ health literacy. Such tools are necessary to generate the evidence required for informed intervention development. This study translated the validated German HLS-Child-Q15 into the Nepalese context, creating the HLS-Child-Q22-NEP.MethodsThe research team initially created the HLS-Child-Q22-NEP using an additional item pool. We conducted thirteen one-on-one cognitive interviews with adolescent students from community schools in three districts of Nepal during the pre-test. We employed verbal probing techniques and deductively analysed the interviews based on Tourneau’s model, uncovering four main themes: (1) comprehension (with the two sub-categories: a) item comprehension and b) word comprehension); (2) retrieval; (3) judgement; and (4) response.ResultsOverall, participants responded positively to the HLS-Child-Q22-NEP. However, this study revealed comprehension challenges such as unfamiliarity, misunderstandings, and translation issues. Additionally, the study identified retrieval challenges and poor judgement, indicating limitations in the assessment. Participants experienced varying levels of difficulty with some items, emphasising the need for revised instructions. Subsequent revisions, guided by pretest insights, led to the development of the HLS-Child-Q24-NEP.ConclusionThe development of the HLS-Child-Q22-NEP is a significant step in addressing Nepali adolescents’ lack of health literacy measurement. Despite its generally positive reception, this study encountered challenges in comprehending the scale, prompting enhancements, and developing the HLS-Child-Q24-NEP. Further research, both qualitative and quantitative, is necessary to evaluate the validity and reliability of the modified items.

Exploring women’s interpretations of survey questions on pregnancy and pregnancy outcomes: cognitive interviews in Iganga Mayuge, Uganda

BackgroundIn 2021, Uganda’s neonatal mortality rate was approximately 19 deaths per 1000 live births, with an estimated stillbirth rate of 15.1 per 1000 total births. Data are critical for indicating areas where deaths occur and why, hence driving improvements. Many countries rely on surveys like Demographic and Health Surveys (DHS), which face challenges with respondents’ misinterpretation of questions. However, little is documented about this in Uganda. Cognitive interviews aim to improve questionnaires and assess participants’ comprehension of items. Through cognitive interviews we explored women’s interpretations of questions on pregnancy and pregnancy outcomes.MethodsIn November 2021, we conducted cognitive interviews with 20 women in Iganga Mayuge health and demographic surveillance system site in eastern Uganda. We adapted the reproductive section of the DHS VIII women’s questionnaire, purposively selected questions and used concurrent verbal probing. Participants had secondary school education and were English speaking. Cognition was measured through comparing instructions in the DHS interviewers’ manual to participants’ responses and researcher’s knowledge. A qualitative descriptive approach to analysis was undertaken.ResultsWe report findings under the cognitive aspect of comprehension. Some questions were correctly understood, especially those with less technical terms or without multiple sections. Most participants struggled with questions asking whether the woman has her living biological children residing with her or not. Indeed, some thought it referred to how many living children they had. There were comprehension difficulties with long questions like 210 that asks about miscarriages, newborn deaths, and stillbirths together. Participants had varying meanings for miscarriages, while many misinterpreted stillbirth, not linking it to gestational age. Furthermore, even amongst educated women some survey questions were misunderstood.ConclusionsPopulation surveys may misclassify, over or under report events around pregnancy and pregnancy outcomes. Interviewers should begin with a standard definition of key terms and ensure respondents understand these. Questions can be simplified through breaking up long sentences, while interviewer training should be modified to ensure they thoroughly understand key terms. We recommend cognitive interviews while developing survey tools, beyond basic pre-testing. Improving respondents’ comprehension and thus response accuracy will increase reporting and data quality.

Psychometric evaluation of Maastricht clinical teaching questionnaire based on the cognitive apprenticeship model.

The Maastricht Clinical Teaching Questionnaire is a valid and reliable instrument for measuring the quality of clinical teaching. This study was aimed at translation and psychometric evaluation of the Persian version of this questionnaire to evaluate clinical teaching based on the cognitive apprenticeship model. The translation of the questionnaire was performed according to Guillemins framework. Reliability was examined by calculating Cronbach's alpha coefficient. Confirmatory factor analysis was studied among 120 medical students. Content validity was assessed by calculating the content validity index and content validity ratio. Face validity was evaluated by conducting interviews with students using concurrent verbal probing and thinking aloud. Cronbach's alpha coefficient for the whole scale was 0.95. The content validity index was 0.92, and the content validity ratio was 0.82. Confirmatory factor analysis resulted in a seven-factor model and demonstrated an adequate fit with the data. The Persian version of the Maastricht Clinical Teaching Questionnaire with seven factors including modeling, coaching, scaffolding, articulation, reflection, exploration, and learning environment appears to be a valid and reliable instrument for the evaluation of clinical teaching in Iranian universities of medical sciences.

First-nation Australian children’s interpretation of a pictorial questionnaire designed to assess physical literacy

ABSTRACT Background The Physical Literacy in Children Questionnaire (PL-C Quest) is a pictorial tool designed to measure children’s self-reported physical literacy. It measures 30 elements within the four domains (physical, psychological, cognitive, and social) of the Australian Physical Literacy Framework (APLF). The development study of the PL-C Quest only included children from non-Indigenous backgrounds living in a metropolitan city. Hence, little is known about how Indigenous children living in regional and rural areas understand and engage with the items. Purpose The study aims to determine if Indigenous children living in regional and rural areas in Australia understand the items in the PL-C Quest (test content) and if they cognitively engaged with the items (response processes) as intended by the APLF definitions. Methods The study followed a qualitative descriptive approach. The PL-C Quest includes an orange cartoon bunny carrying out 30 scenarios with accompanying statements. Each scenario has one bunny rabbit doing the activity well and the other bunny not so well. Cognitive interviews were conducted based on verbal probing using Tourangeau’s four-stage cognitive model (comprehension, retrieval, judgment, and response). In the regional town, nine Indigenous children were interviewed one on one in after-school sessions. In the rural town, 12 Indigenous children enrolled in the school programme of a sports provider were interviewed in pairs or small groups. All individual and group interviews were audio recorded and transcribed verbatim. All transcripts were coded using the NVivo12 software. Each cognitive action of Tourangeau’s model, comprehension, retrieval, judgment, and response, became a coding category. Responses coded into each category were further categorised into sub-categories. For instance, ‘Understood as intended’, ‘Partially understood’, and ‘Misunderstood’ were subcategories for comprehension; ‘skills’ and ‘past events and experiences’ were for retrieval; ‘confident and unconfident’ were for judgement; and ‘justify’ and ‘unable to justify’ were subcategories for response category. Once the first author completed the analysis of the children’s responses to items, the other two authors’ part of the data collection confirmed the accuracy of the coding. Findings Overall, children in both sites understood most of the content of the items as intended. In addition, they could retrieve relevant information when responding to the items. For example, a few children reflected on their ability to play a ball-throwing Indigenous game and carry younger siblings when responding to the items, ‘Object Manipulation’ and ‘Strength’, respectively. Also, most children confidently selected the bunny that represented them more in all 30 items and were able to justify their responses. Conclusion The study is the first to generate validity evidence for the PL-C Quest when used with Indigenous children in regional and rural Australia. The findings demonstrate that this pictorial scale may be a suitable tool to collect data about the physical literacy of Indigenous children living in regional and rural areas – subject to further testing with a larger population. Future research may provide evidence on other sources of validity. For instance, whether these domains uphold the measured construct, physical literacy (internal structure), with Indigenous children.

Translation and cultural adaptation of the Greek integrated palliative care outcome scale (IPOS): challenges in a six-phase process

AimTo translate and culturally adapt IPOS to the Greek population.MethodsA four phases- sequential study, which included verification of conceptual equivalence, double forward- backward translations and conceptual cognitive debriefing. Focus group interviews used ‘think aloud’ and ‘verbal probing’ techniques. Interviews were audio-recorded, transcribed verbatim and thematically analyzed using predefined categories. Purposely sampled from two oncology and palliative care units in Athens.ResultsThe Integrated Palliative Care Outcome Scale was well accepted by both patients and health professionals. Overall comprehension and acceptability of the scale were good. The comprehension and judgement challenges identified in the pre-final version were successfully resolved in the cognitive interviewing phase. Five out of the seventeen translated items of the scale were modified after cognitive debriefing. Comprehension difficulties were identified with specific terms (e.g., energy/feeling depressed) and with some answer options. Severity of symptoms and not their impact was a common difficulty. A judgement challenge was reported in relation to 7-days recall and fluctuation of symptoms. Layout concerns in relation to length of questions were also stated. All questions were considered important and none as inappropriate.ConclusionThis study demonstrated face and content validity and acceptability of the Integrated Palliative Care Outcome Scale in the Greek context. Cognitive Interviewing proved valuable in refining concepts within the specific cultural context.Clinical implicationsThe IPOS outcome measure tool is now being used routinely in a palliative care service in Athens and is currently used to evaluate service outcomes.

How do older adults receiving aged care services understand and respond to the EQ-5D-5L? A think-aloud study in residential care

PurposeThe EQ-5D-5L is a preference-based instrument for measuring and valuing health-related quality of life (HRQoL). The EQ-5D-5L has been used extensively in economic evaluation, including in aged care. However, older adults’ understanding of the EQ-5D-5L has not been comprehensively investigated to date. This research aimed to assess older adults’ understanding of the EQ-5D-5L using a think-aloud protocol with two cognition groups: no cognitive impairment and mild/moderate cognitive impairment.MethodsParticipants’ cognition was assessed using the Standardised Mini-Mental State Examination (SMMSE). Face-to face interviews were conducted with concurrent and retrospective think-aloud encouraged through verbal probing. Audio recordings were transcribed, and qualitative analysis, informed by the Tourangeau four-stage Response Model (comprehension, retrieval, decision process, response process) was conducted in NVivo.ResultsIn total, 46 older adults (age 65 +) were recruited from 10 residential care facilities across South Australia (n = 25 no cognitive impairment, n = 21 mild/moderate cognitive impairment). Comprehension, retrieval, judgement and response mapping issues were common across all cognition levels and EQ-5D-5L dimensions. The two dimensions resulting in the most response issues were usual activities and personal care.ConclusionOlder adults may bring a different understanding to the EQ-5D-5L descriptive system than that expected given testing with general population samples. Dimension descriptors that are more relevant to this population may facilitate responses that better align with the underlying EQ-5D-5L concept model.

Content validation of the SF-36v2® Health Survey Acute for use in hypoparathyroidism

PurposeThe purpose of this study was to conduct cognitive debriefing (CD) interviews with adults diagnosed with chronic hypoparathyroidism (HP) to assess the content validity of the SF-36v2® Health Survey Acute (SF-36v2) measure in this population.MethodsCD interviews were conducted with adults with HP in the United States (US). Interviews were conducted by a trained moderator using a semi-structured interview guide, employing a think-aloud method in conjunction with verbal probing. Participants were asked whether each item was understandable, relevant, important, and sensitive to change in relation to HP. Additionally, comprehension of instructions, response options, and the appropriateness of a 1-week recall period was assessed.ResultsSixteen adults with HP participated in individual CD telephone interviews. All items in the SF-36v2 were reported to be understood, relevant, important, and sensitive to change by at least half, and in most cases, by a strong majority of study participants. Most of the study sample confirmed comprehension of the instructions and the entire sample understood all response options.ConclusionThe study findings show that the items in the SF-36v2® are applicable to adults with HP. The overall high levels of endorsement of items provide strong evidence of the measure’s content validity for this population. The SF-36v2 is therefore recommended for usage in clinical trials examining adults with HP, although it is recommended that this generic measure be supplemented with disease-specific instruments such as the recently developed Hypoparathyroidism Patient Experience Scale—Symptom (HPES-Symptom) and Hypoparathyroidism Patient Experience Scale—Impact (HPES-Impact) measures.

Cognitive interviewing as a method to inform questionnaire design and validity - Immersive Technology Evaluation Measure (ITEM) for healthcare education

Research of immersive technology in education is rapidly expanding with potential to educate future students in healthcare disciplines. Despite increasing literature there is a lack of validated instruments to investigate the effects of these technologies. Cognitive interviewing is a valuable evaluation method to check comprehension of a measure and was applied to a new measure of user experience of immersive technology for healthcare education (ITEM). A 5 domain self-reported measure of: immersion, intrinsic motivation, cognitive load, system usability, and debrief. Prior to the interview 9 participants were allocated to augmented reality and virtual reality educational activities. Verbal probing and think aloud techniques through semi-structured cognitive interviews were conducted. The ITEM was found to have high content validity index scores and relationships between domains were further explored through qualitative analysis. The results indicate high clarity of understanding for those completing the ITEM and supports future research as part of an ongoing validation process.

Knowledge, Attitude and Perceptions on Pictorial Warnings on Tobacco Packaging in Relation to Age, Gender and Socio-economic Status among Patients Visiting a Dental Hospital in Mysuru City

Objectives: The objectives of the study were to assess knowledge, attitude and perceptions on pictorial warnings on tobacco packaging in relation to age, gender and socio-economic status (SES) among patients visiting a dental hospital in Mysuru city. Materials and Methods: This cross-sectional study was conducted among patients visiting a dental college and hospital in Mysuru. Initial questionnaire development was done using synthesis of inputs from subject experts and literature review. This questionnaire was then validated by three subject experts. Cognitive interview using concurrent verbal probing technique was undertaken on three prospective participants to elicit response process validity. Known group validity was assessed by distributing the questionnaire among three public health dentists and three 3rd year BDS students. Questionnaire was then subjected to reliability assessment on five participants using test retest method. Final questionnaire having 30 items was used on 400 participants aged more than 18 years visiting dental college hospital. Census enumeration of all eligible adult participants was done till the required sample size was reached. Results: Mean knowledge score on warning signs on tobacco packaging was significantly higher among those aged <40 years (7.47 ± 2.47) compared to those aged 40 years and above (6.59 ± 2.47). It was also significantly higher among those from the upper classes (7.55 ± 2.41) compared to those from the lower classes (6.52 ± 2.52) with no significant difference in relation to gender and smoking status. Conclusion: Knowledge on pictorial health warning labels was higher among younger individuals and those from the upper socio-economic classes with no significant difference in the attitude and perception in relation to age, gender, SES and smoking status.

Development and Content Validity of the Bilateral Vestibulopathy Questionnaire

BackgroundTo date, the burden and severity of the full spectrum of bilateral vestibulopathy (BVP) symptoms has not yet been measured in a standardized manner. Since therapeutic interventions aiming to improve BVP symptoms are emerging, the need for a new standardized assessment tool that encompasses the specific aspects of BVP arises. Therefore, the aim of this study was to develop a multi-item Patient Reported Outcome Measure (PROM) that captures the clinically important symptoms of BVP and assesses its impact on daily life.MethodsThe development of the Bilateral Vestibulopathy Questionnaire (BVQ) consisted of two phases: (I) initial item generation and (II) face and content validity testing. Items were derived from a literature review and individual semi-structured interviews focusing on the full spectrum of reported BVP symptoms (I). Subsequently (IIa), individual patient interviews were conducted using “thinking aloud” and concurrent verbal probing techniques to assess the comprehensibility of the instructions, questions and response options, and the relevance, missing domains, or missing items. Interviews continued until saturation of input was reached. Finally, international experts with experience in the field of the physical, emotional, and cognitive symptoms of BVP participated in an online focus group to assess the relevance and comprehensiveness of the BVQ (IIb).ResultsThe BVQ consisted of two sections. The first section included 50 items scored on a six-point Likert scale arranged into seven constructs (i.e., imbalance, oscillopsia, other physical symptoms, cognitive symptoms, emotional symptoms, limitations and behavioral changes and social life). The second section consisted of four items, scored on a visual analog scale from 0 to 100, to inquire about limitations in daily life, perceived health and expectations regarding future recovery. Interviews with BVP patients [n = 8, 50% female, mean age 56 years (range 24–88 years)] and the expert meeting confirmed face and content validity of the developed BVQ.ConclusionThe BVQ, which was developed to assess the spectrum of BVP symptoms and its impact on daily life, proved to have good face and content validity. It can be used to characterize current self-reported symptoms and disability and to evaluate symptom burden before and after therapeutic interventions in future research and clinical practice.

How do people with acquired brain injury interpret the Valued Living Questionnaire? A cognitive interviewing study

BackgroundThe accurate evaluation of valued living in people with acquired brain injury (ABI) is important for measuring the outcome of interventions targeting valued living. The Valued Living Questionnaire (VLQ) is one of the most widely used measures, however its validity in an ABI cohort may be affected by the cognitive demands associated with evaluating the value-consistency of actions in the past week. ObjectivesWe aimed to systematically identify common difficulties or errors associated with the comprehension and completion of the VLQ in people with ABI in order to guide a potential adaptation of the measure. MethodsAdults with an ABI (traumatic brain injury, stroke, tumour), experiencing cognitive difficulties and/or emotional distress impacting participation in valued activities, were invited to participate in a cognitive interview which probed their understanding of the VLQ. Concurrent verbal probing was used, whereby scripted verbal probes were asked alongside each questionnaire item as it was being rated by participants. Interviews were transcribed and analysed by combining data pertaining to each item and aggregating these across interviews to highlight common comprehension errors or difficulties. ResultsThere were 11 participants (mean age = 59.55 years, SD = 12.84; mean education = 14.73 years, SD = 2.87) with a range of ABI aetiologies (7 stroke, 2 TBI, 2 tumour). Common difficulties with the VLQ included confusion caused by question phrasing and structure of the measure, errors due to the cognitive demands associated with rating the importance of abstract values and value-consistency of actions in the last week, and problems with the rating scale. ConclusionsKey problems with the validity of the VLQ within an ABI sample were identified due to comprehension errors relating to its structure and content. Findings will inform an adapted version, suited to the needs of individuals with ABI-associated cognitive difficulties.

Progressing the development of a food literacy questionnaire using cognitive interviews.

Food literacy is the knowledge, skills and behaviours needed to meet food needs and determine intake and is conceptualised as eleven components under four domains of planning and managing, selecting, preparing, and eating. Previous measures of food literacy vary in their adherence to the conceptualisation and ability to capture totality of eating. This study aimed to determine items for inclusion and exclusion in a food literacy item pool and capture the general public's interpretation of everyday food literacy practices. Beginning with an item pool from previous studies, cognitive interviews were conducted using think-aloud and verbal probing methods. Data were first analysed for applicability, clarity, ambiguity and logic, then for emergent themes to ensure items captured the totality of the participant's eating. Australia. Australian residents over 18 years of age recruited via Facebook residential groups (n 20). Of the original 116 items, 11 items had limited applicability; 13 items had unclear references; 32 items had lexical problems and 11 items had logical problems. In total, 29 items were deleted, 31 retained and 56 revised. Thematic analysis revealed participants limited their responses to consider only conventional practices such as grocery shopping, cooking and planned meals rather than the totality of their eating. An additional eighty-four items were developed to address eating out, incidental eating occasions and inconsistencies between participants assumed correct knowledge and that of public health guidelines. This resulted in a refined 171-item pool. This study progresses the development towards a comprehensive, validated food literacy questionnaire.

Prognostic value of a brief loneliness questionnaire for patients with coronary heart disease: Proposal for a prediction model.

In patients with coronary heart disease (CHD), loneliness is associated with increased risk of morbidity and mortality. No predictive tool is available to detect patients who are influenced by loneliness to a degree that impacts mortality. To: (i) propose a prediction model that detects patients influenced by loneliness to a degree that increases one-year all-cause mortality, (ii) evaluate model classification performance of the prediction model, and (iii) investigate potential questionnaire response errors. A cohort of patients with CHD (n=7169) responded to a national cross-sectional survey, including two questions on loneliness. Information on cohabitation and follow-up information on one-year all-cause mortality were obtained from national registers. Prediction model development was based on the prognostic values of item responses in the questionnaire on loneliness and of cohabitation, evaluated with Cox-proportional Hazards Ratio (HR). Item responses which significantly predicted one-year mortality were included in the high-risk loneliness (HiRL) prediction model. Sensitivity, specificity and likelihood ratio were calculated to evaluate model classification performance. Sources of response errors were evaluated using verbal probing technique in an additional cohort (n=7). The TRIPOD checklist has been used to ensure transparent reporting. Two item responses significantly predicted one-year mortality HR=2.24 (95%CI=1.24-4.03) and HR=2.65 (95%CI=1.32-5.32) and were thus included in the model. Model classification performance showed a likelihood ratio of 1.89. Response error was evaluated as low. Based on the prognostic value in a loneliness questionnaire, a prediction model suitable to screen patients with CHD for high-risk loneliness was suggested. The HiRL prediction model is a short and easy-to-use screening tool that offers clinical staff to identify patients with CHD who are influenced by loneliness to a degree that impacts mortality. However, further evaluation of model performance and questionnaire validation is recommended before integrating the model into clinical practice.

Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data

BackgroundPalliative care phases (stable, unstable, deteriorating, terminal and bereavement) are routinely used in Australia and the UK to describe the clinical situation of patients and their families and to evaluate the associated care plan. In addition, it serves as a benchmark developed by the Australian Palliative Care Outcome Collaboration (PCOC) and is used nationwide for comparisons between services. In Germany, the concept is not used consistently due to various translations. Furthermore, there is no nationwide systematic approach to routinely assess clinical outcomes in palliative care.The study aims to develop a German version of the palliative care phase definitions by adapting them culturally, and to examine the inter-rater reliability of the adjusted definitions with healthcare professionals.MethodsMixed-methods approach: Cognitive interview study using ‘think aloud’ and verbal probing techniques and a consecutive multi-center cross-sectional study with two clinicians independently assigning the phase definitions. Interviewees/participants were selected through convenience and purposive sampling in specialist palliative care inpatient units, advisory and community services and in three specialist palliative care units with doctors, nursing staff and allied health professionals.ResultsFifteen interviews were conducted. Identified difficulties were: Some translated terms were 1) not self-explanatory (e.g. ‘family/carer’ or ‘care plan’) and (2) too limited to the medical dimension neglecting the holistic approach of palliative care. (3) Problems of comprehension regarding the concept in general occurred, e.g. in differentiating between the ‘unstable’ and ‘deteriorating’ phase. Inter-rater reliability was moderate (kappa = 0.44; 95% CI = 0.39–0.52). The assignment of the phase ‘deteriorating’ has caused the most difficulties.ConclusionOverall, the adapted palliative care phases are suitable to use in the German specialist palliative care setting. However, the concept of the phases is not self-explanatory. To implement it nationwide for outcome measurement/benchmarking, it requires further education, on-the-job training and experience as well as the involvement of healthcare professionals in implementation process. For the use of international concepts in different healthcare systems, a deeper discussion and cultural adaptation is necessary besides the formal translation.

Using rapid cycle tests of change to develop the Carers Assistive Technology Experience Questionnaire: a cognitive interview study in the UK

We describe the use of rapid cycle tests of change to pretest and develop a Carers Assistive Technology Experience Questionnaire for a survey of informal carers of persons with dementia....

Wykorzystanie wywiadów kognitywnych w projektowaniu kwestionariusza wywiadu na przykładzie badania uczenia się osób dorosłych

Artykuł przedstawia analizę wywiadów kognitywnych, które stanowiły pierwszy etap pilotażu kwestionariusza wywiadu w ramach badania „Uczenie się dorosłych Polaków”. Dostępne wyniki badań międzynarodowych wskazują na relatywnie niski poziom uczestnictwa osób dorosłych w edukacji w Polsce, a zarazem różnice w wartości wskaźników w poszczególnych badaniach. Na podstawie przeglądu literatury wnioskować można, że rozbieżności te wynikają z różnic w operacjonalizacji, sposobie agregacji kategorii, jak również innych czynników. Założono, że wykorzystanie wywiadów kognitywnych, w tym technik thinking aloud i verbal probing, umożliwi dotarcie do sposobów interpretacji pojęć i rozumienia pytań przez respondentów, a także pozwoli badaczom na identyfikację zagadnień o wysokim poziomie drażliwości. Na podstawie wyników obserwacji prowadzonej w trakcie wywiadów oraz analizy zgromadzonego materiału empirycznego omówiono rozbieżne od pierwotnie założonych przez badaczy sposoby konceptualizacji terminów przez badanych, a także kwestie wywołujące dyskomfort respondentów. Zaprezentowano zaproponowane modyfikacje kwestionariusza wywiadu, których celem jest redukcja ryzyka uzyskania wyników nietrafnych, obarczonych wysokim ryzykiem błędu pomiaru oraz troska o dobrostan respondentów związany z sytuacją badania. Przedstawiono również wnioski dotyczące zastosowania techniki wywiadów kognitywnych jako elementu pilotażu badań sondażowych oraz konkluzje o charakterze metodologicznym dotyczące techniki wywiadów kognitywnych.

Adaptation of the barriers to help-seeking for trauma (BHS-TR) scale: a cross-cultural cognitive interview study with female intimate partner violence survivors in Iceland

BackgroundEven though traumatization is linked to substantially reduced health-related quality of life, help-seeking and service utilization among trauma survivors are very low. To date, there has not been available in Iceland a culturally attuned, self-reported measure on help-seeking barriers after trauma. This study aimed to translate and cross-culturally adapt the English version of Barriers to Help-Seeking for Trauma (BHS-TR) scale into the Icelandic language and context.MethodsThe BHS-TR was culturally adapted following well-established and rigorous guidelines, including forward-backward translation, expert committee review, and pretesting through cognitive interviews. Two rounds of interviews with 17 female survivors of intimate partner violence were conducted using a think-aloud technique and verbal probing. Data were analyzed using qualitative content analysis, a combination of deductive and inductive approaches.ResultsIssues with the BHS-TR that were uncovered in the study were classified into four categories related to general design, translation, cultural aspects, and post-trauma context. The trauma-specific issues emerged as a new category identified in this study and included concepts specific to trauma experiences. Therefore, modifications were of great importance—resulting in the scale becoming more trauma-informed. Revisions made to address identified issues improved the scale, and the process led to an Icelandic version, which appears to be semantically and conceptually equivalent to the original version; additionally, the results provided evidence of content validity.ConclusionsAs a cognitive interview study, it adds to the growing cognitive interviewing methodology literature. Furthermore, the results provide essential insights into the self-report response process of trauma survivors, highlighting the significance of making health-related research instruments trauma-informed.

Qualitative evaluation of the Autism Behavior Inventory: use of cognitive interviewing to establish validity of a caregiver report scale for autism spectrum disorder

PurposeThe Autism Behavior Inventory (ABI) is an observer-reported outcome scale measuring core and associated features of autism spectrum disorder (ASD). Extensive scale development (reported elsewhere) took place, in alignment with the Food and Drug Administration’s patient-reported outcome guidance, to address the need for instruments to measure change and severity of ASD symptoms.MethodsCognitive interviewing was used to confirm understanding and content validity of the scale prior to its use in clinical trials. Respondents were caregivers of individuals with ASD (N = 50). Interviews used a hybrid of the “think-aloud” and verbal probing approach to assess ABI’s content validity and participant understanding of the instrument, including: item clarity and relevance; item interpretation; appropriateness of response scales; and clarity of instructions. Audio-recordings of the interviews were transcribed for qualitative data analysis. The scale was revised based on participant feedback and tested in a second round of interviews (round 1 N = 38, round 2 N = 12).ResultsIn total, 67/70 items reached ≥ 90% understandability across participants. Caregivers were able to select an appropriate response from the options available and reported finding the examples helpful. Based on participant feedback, instructions were simplified, 8 items were removed, and 10 items were reworded. The final revised 62-item scale was presented in round 2, where caregivers reported readily understanding the instructions, response options, and 61/62 items reached ≥ 90% understandability.ConclusionsCognitive interviews with caregivers of a diverse sample of individuals with ASD confirm the content validity and relevance of the ABI to assess core and associated symptoms of ASD.