Interpretation of the Avoidance-Endurance Fast-Screen Questionnaire: A Qualitative Study Using Cognitive Interviews...

This study examined how patients with high-impact chronic pain interpreted and responded to the Danish version of the Avoidance-Endurance Fast-Screen (AE-FS) to identify potential problematic items that did not correspond with item intention and causes for this.

Participants were recruited from patients referred to treatment in an interdisciplinary pain center to partake in cognitive interviews following the Three-Step Test-Interview protocol. Interview transcripts were analyzed in 2 steps. First, a coding analysis was used to code responses in relation to item intention using 4 predefined codes (congruent, incongruent, ambiguous, or confused) to identify potential problematic items (≤50% congruent responses). Second, a reflexive thematic analysis was used to uncover causes of incongruency in the problematic items as well as elements of confusion across all items.

Thirty-four participants were included. Three items (1, 4, and 6) were identified as being problematic with items 1 and 4 having many incongruent responses. The most common causes of incongruency were related to formulations of items, and 7 elements of confusion were uncovered across all items.

The current study identified potential issues with participants' interpretation of 3 items of the AE-FS. However, as interviews may be prone to the influence of social desirability bias, the interpretation of the results for item 4, where the most frequent noncongruent interpretation of making a fuss was equal to lack of pain validation, is done with caution. Therefore, a revision is suggested with reformulation of item 6 and removal of item 1, which, however, will require validation in future research.