Enhancing validity through cognitive interviewing. A methodological example using the Epilepsy Monitoring Unit...

Area of Science:

• Neurology
• Patient Experience Research

Background:

• The Epilepsy Monitoring Unit Comfort Questionnaire (EMUCQ) is a new instrument designed to assess patient comfort.
• Ensuring the questionnaire's validity and user-friendliness is crucial for accurate data collection.

Purpose of the Study:

• To refine the EMUCQ by identifying problematic items.
• To evaluate the questionnaire's completeness and user-friendliness.
• To enhance the face validity of the EMUCQ through modifications.

Main Methods:

• A qualitative-descriptive cross-sectional study was conducted.
• Five iterative rounds of cognitive interviewing, utilizing think-aloud, verbal probing, and observation, were performed with the target population.
• Data analysis employed the framework method with an eight-column matrix.

Main Results:

• Twenty-five interviews revealed issues with item completeness, comprehension, information retrieval, judgment, and response reporting.
• Modifications included rewording 11 items, adding 6 new items, and reworking the instructions section.
• Twenty-seven items remained unchanged following the iterative process.

Conclusions:

• Cognitive interviewing is an effective, albeit time-consuming, method for uncovering hidden instrument flaws.
• Addressing identified problems significantly enhances the validity and usability of patient-reported outcome measures.
• The refined EMUCQ demonstrates improved face validity and user-friendliness.