Cognitive interviewing: verbal data in the design and pretesting of questionnaires

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Abstract

The purpose of this paper is to discuss problems that occur in questionnaire responses and how cognitive interviewing can be used to identify problematic questions prior to using the questionnaire in the field. Questionnaire design involves developing wording that is clear, unambiguous and permits respondents successfully to answer the question that is asked. However, a number of problems in relation to respondents' understanding and successfully completing questionnaires have been identified. Cognitive interviewing, an amalgamation of cognitive psychology and survey methodology, has been developed to identify problematic questions that may elicit response error. The overall aim is to use cognitive theory to understand how respondents perceive and interpret questions and to identify potential problems that may arise in prospective survey questionnaires. A literature review is used to examine the process of questionnaire design and how cognitive interviewing can be used to reduce sampling error and increase questionnaire response rates. Cognitive interviewing involves interviewers asking survey respondents to think out loud as they go through a survey questionnaire and tell them everything they are thinking. This allows understanding of the questionnaire from the respondents' perspective rather than that of the researchers. Cognitive interviews have been used in a number of areas in health care research to pretest and validate questionnaires and to ensure high response rates. Interviewing has been found to be highly effective in developing questionnaires for age specific groups (children and adolescents) and in ascertaining respondents' understanding in health surveys prior to distribution. However, cognitive interviews have been criticized for being overly subjective and artificial. Cognitive interviews are a positive addition to current methods of pretesting questionnaires prior to distribution to the sample. They are most valuable in pretesting questions that are complex, where questions are sensitive and intrusive and for specific groups for whom questionnaire completion may pose particular difficulties.

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Most cited references 7

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The Work Limitations Questionnaire

Susan Malspeis, Kathleen Bungay, Diane J Cynn … (2001)

The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment ("work limitations").

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Do short cases elicit different thinking processes than factual knowledge questions do?

L. Schuwirth, H Boshuizen, Timo van den Berg … (2001)

To assess whether case-based questions elicit different thinking processes from factual knowledge-based questions. 20 general practitioners (GPs) and 20 students solved case-based questions and matched factual knowledge-based questions while thinking aloud. Verbatim protocols were analysed. Five indicators were defined: extent of protocols; immediate responses; re-reading of information given in the stem or case after the question had been read; order of re-reading information, and type of consideration, i.e. 'true-false' type or 'vector', that is, a deliberation which has a magnitude and a direction. Cases elicited longer protocols than factual knowledge questions. Students re-read more given information than GPs. GPs gave an immediate response on twice as many occasions as students. GPs re-ordered the case information, whereas students re-read the information in the order it was presented. This ordering difference was not found in the factual knowledge questions. Factual knowledge questions mainly led to 'true-false' considerations, whereas cases elicited mainly 'vector' considerations. Short case-based questions lead to thinking processes which represent problem-solving ability better than those elicited by factual knowledge questions.

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Development of a digestive health status instrument: tests of scaling assumptions, structure and reliability in a primary care population.

Nicholas J. Talley, Christiane I M Healey, S. M Shaw … (1998)

The absence of valid and reliable health status measures for functional gastrointestinal illness has limited research and patient care for this common group of disorders. A self-report survey has been developed. Initial development focused on extensive pre-testing of patients, primary care physicians and gastroenterologists. The disease-specific portion included the Rome criteria for dyspepsia subgroups and the Manning and Rome criteria for irritable bowel syndrome. The Short Form-36 was added. Psychometric analyses included techniques of multitrait scaling, scale internal consistency and criterion validation. Six hundred and ninety patients presenting to their primary care physician for treatment of heartburn, abdominal pain or discomfort completed the 98 question survey. The disease-specific portion revealed five components including reflux, dysmotility, a two-domain bowel dysfunction complex, and a pain index. Internal consistency measures demonstrated good to excellent reliability. Scaling successes were observed on multitrait scaling. The disease-specific portion was reduced to 34 questions. Criterion validity was demonstrated with the correlation of the disease-specific questions to the SF-36. The psychometric analyses lend credence to the concept of stomach and bowel symptom subgrouping as proposed by expert consensus. The psychometric properties of the five summated disease-specific scales compare favourably with standardized health status measures.