Conversion of standard retrospective patient-reported outcomes to momentary versions: cognitive interviewing reveals varying degrees of momentary compatibility
The purpose of this study was to adapt different domains of an existing retrospective questionnaire to momentary versions, to use and assess cognitive interviewing for evaluating the new versions, and to compare momentary compatibility (i.e. an item’s potential to be validly converted to a momentary version) across different scales.
Initial momentary versions of retrospective patient-reported outcomes were produced by converting present perfect tense wording to present tense wording. Cognitive interviews were conducted iteratively with 21 patients to determine which reference period they actually employed, and to identify problems with new, revised versions. A think-aloud interview protocol was supplemented with non-specific concurrent and specific retrospective probing. The momentary compatibility of each item was evaluated by calculating the proportion of interviews wherein momentary reference periods were identified; problems were categorized according to cognitive aspects of survey methodology taxonomy. The efficiency of various cognitive interviewing techniques was determined by evaluating whether applied reference periods were identified by think-aloud alone or by supplementary probes.
The momentary compatibility varied from 5 to 100% across items. Cognitive interviews revealed potential problems of various severities in the majority of items. Think-aloud alone was sufficient at determining the applied reference period in one-third of the cases, and the efficiency of additional concurrent and retrospective probing was 50 and 94%, respectively.
Cognitive interviewing techniques proved useful for developing and evaluating momentary items. Researchers should be aware of the applied reference period and of emerging problems when evaluating adapted momentary items, since not all concepts are suitable. We recommend the proposed method in future adaptations of existing instruments.
KeywordsEcological momentary assessments Cognitive interviewing Patient-reported outcomes Thyroid diseases Quality-of-life measurement
The authors would like to thank Bo Kehlet Watt (Kehlet IT) for designing and programming the smartphone app. LH is supported by an unrestricted grant from the Novo Nordisk Foundation.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was performed in compliance with the Declarations of Helsinki. The study protocol was reviewed by the local Ethical Committee (reg. # H-A-2009-FSP23). According to Danish law, questionnaire studies do not require and thus cannot obtain approval by ethical committees.
Informed consent was obtained from all individual participants included in the study.
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