The value of cognitive interviewing for optimizing a patient experience survey

Abstract

This mixed-methods study uses both cognitive interviewing and a quantitative field test to provide empirical evidence on the value of cognitive interviewing for questionnaire development. Ten interviews were conducted with a questionnaire on patient experiences with cataract surgery (75-item consumer quality index cataract), using both thinking-aloud and probing techniques. Interviews were recorded and transcribed verbatim, problems were coded with the commonly used systems of Levine et al. and Willis, and results were compared with item non-response in a field test. The coding systems revealed similar numbers and type of problems: 55 items showed a total of 174 problems. However, most problematic items (67%) had an adequate response in the field test. Results stress the importance of cognitive interviewing as a pre-survey evaluation method to early identification of questionnaire problems, and it is recommended to use the coding system of Willis for it provides specific directions for questionnaire optimization.

Keywords:

• cognitive interviewing
• questionnaire pretesting
• validity
• self-report
• patient experiences
• mixed methods

Acknowledgements

The authors would like to thank those who participated in the cognitive interviews and the staff of the Rotterdam Eye Hospital who helped to recruit the participants and who facilitated the interviews by providing an interview room. Financial support for this study was provided by the Dutch Centre for consumer experience in health care.