What the Resident Meant to Say

Use of Cognitive Interviewing Techniques to Develop Questionnaires for Nursing Home Residents

Published in: The Gerontologist, v. 48, no. 2, Apr. 2008, p. 158-169

Posted on RAND.org on January 01, 2008

by Patricia Housen, George R. Shannon, Barbara Simon, Maria Orlando Edelen, Mary P. Cadogan, Linda Sohn, Malia Jones, Joan L. Buchanan, Debra Saliba

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PURPOSE: Emphasis on consumer-centered care for frail and institutionalized older adults has increased the development and adaptation of surveys for this population. Conventional methods used to pretest survey items fail to investigate underlying sources of measurement error. However, the use of the cognitive interview (CI), a method for studying how respondents answer survey items, is not well established or documented in this population. This study demonstrates how CIs can be used to improve questionnaires intended for nursing home residents. DESIGN AND METHODS: CIs were conducted with 29 nursing home residents in order to identify potential problems with prospective survey items. The authors scripted probes to standardize the interviews and adapted the Question Appraisal System to enumerate and classify the problems discovered. RESULTS: The authors fielded between one and five versions of each item in an iterative process that identified 61 item-specific problems. Additionally, residents' cognitive responses suggested that some screened their answers on the basis of perceived physical and environmental limitations, and some had difficulty answering items about preferences that fluctuate day to day. These findings led us to modify the items and response set to simplify the respondents' cognitive task. IMPLICATIONS: This study illustrates how CI techniques can be used to understand residents' comprehension of and response to survey items.

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