Cognitive Interviewing during Pretesting of the Prefinal Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand Questionnaire following Translation and Cross-Cultural Adaptation.
Susan de Klerk, Christina Jerosch-Herold, Helen Buchanan and 1 others
PMID 33100934WHAT IT FOUND
Patients with low literacy and vision problems struggled with the Afrikaans DASH questionnaire.
Changing the format to use words instead of numbers and providing reading glasses fixed these issues, making the test usable in busy public clinics.
Key findings
01Participants struggled with the original numeric response options (1-5) because they had to look back at the column headers, causing them to lose their place and mark multiple answers.
02Replacing the numbers with written response choices and increasing the font size resolved the completion errors and improved understanding of the instructions.
03Practical barriers like lack of reading glasses and poor lighting were addressed by the interviewer providing non-prescription reading glasses, which four participants used.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The principal interviewer had no prior experience with cognitive interviews. The study was conducted in specific public health settings in South Africa, so the findings about literacy and vision barriers may not apply to all populations. The sample size was small (30 participants total).
Declared interests
The paper does not report any specific funding sources or conflicts of interest.
The easy way to misread this
Do not assume the revised Afrikaans DASH is clinically validated for measuring outcomes. This study only confirms that the questions are understood and answerable (content validity); it does not prove the test accurately measures disability or change over time.