Gale, V. orcid.org/0000-0001-7472-2039, Powell, P.A. and Carlton, J. (2025) Young children (6–7 years) can meaningfully participate in cognitive interviews assessing comprehensibility in health-related quality of life domains: a qualitative study. Quality of Life Research. ISSN 0962-9343
Abstract
Purpose
Establishing the comprehensibility of patient reported outcome measures (PROMs) in quality of life research is essential. Cognitive interviews are recommended as a ‘gold standard’ for evaluating comprehensibility among adult populations but are not routinely used with young children (≤ 7 years). The current study therefore aimed to evaluate the feasibility of cognitive interviewing using traditional and adapted methods with children aged 6–7 years to evaluate PROM item comprehensibility.
Methods
Fourteen children (6–7 years) with a range of diagnosed health conditions participated in individual cognitive interviews. Each child answered six mock PROM items (physical, psychological, and social health-related quality of life domains) and concurrent verbal probes were used to evaluate item comprehensibility. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed using a novel Comprehensibility Continuum which coded the extent of alignment between children’s explanations of items and intended meanings.
Results
Cognitive interviews were successful; extent of comprehensibility could be determined for 83/84 (99%) item discussions. Most items were comprehensible, with children describing the intended item meaning for 74/84 (88%) items evidenced by contextual examples and/or de-contextual definitions in children’s responses to verbal probes. Three items (‘walk’, ‘sad’, and ‘made fun of’) were identified as requiring further testing and/or refinement, where a lower percentage of discussions contained evidence of intended item meaning.
Conclusion
Despite previous uncertainty, this study demonstrates how methodological challenges can be addressed to enable young children’s participation in cognitive interviews evaluating item comprehensibility, ultimately contributing to the accurate measurement of young children’s health outcomes in healthcare and research.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2025. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
Keywords: | Patient reported outcome measures; Cognitive interview; Young children; Comprehensibility; Content validity |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 07 Mar 2025 10:34 |
Last Modified: | 07 Mar 2025 10:34 |
Status: | Published online |
Publisher: | Springer |
Refereed: | Yes |
Identification Number: | 10.1007/s11136-025-03940-z |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:223794 |