Enhancing validity through cognitive interviewing. A methodological example using the Epilepsy Monitoring Unit Comfort Questionnaire.
Andrea Egger-Rainer
PMID 30289559WHAT IT FOUND
Cognitive interviewing with 25 epilepsy monitoring unit patients showed comfort questionnaire items were often misunderstood or incomplete.
Rewording 11 items and adding six made it clearer, but does not prove the questionnaire measures comfort accurately.
Key findings
01Interviews revealed problems with general questionnaire aspects, item interpretation and missing items; 27 items remained unchanged, 11 were reworded and 6 were added.
02Patients often answered items outside the intended epilepsy monitoring unit context, so wording was changed to specify the ward, current condition, talking to a doctor, and the present moment.
03Five of eight items previously set aside were rated relevant by patients, and an item about faith was added back.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one epilepsy monitoring unit in one German-speaking setting, so the wording problems may not apply to other language or care areas. Only 25 patients took part, and participation was voluntary, so other patients may have identified different problems. Some patients had been sleep-deprived or had had a seizure before the interview, which could have affected how they understood and answered items. The study tested item wording and relevance, but it did not show that the questionnaire reliably measures comfort, detects change, or improves patient care. The authors say further quantitative testing is still needed for construct validity, convergent validity, reliability and responsiveness.
The easy way to misread this
Do not treat the revised questionnaire as proven to measure comfort accurately. It was modified after 25 patients found wording problems, but construct validity, reliability and responsiveness still need further testing.