1. Cognitive Interviewing for Question Evaluation Kristen Miller, Ph.D. National Center for Health Statistics ksmiller@cdc.gov

2. Why Question Evaluation?  Ensure questions capture intended concept  Identify incomparable survey data Cultural beliefs Response problems for vulnerable populations  Lower socio-economic status  Fewer resources Translation problems  To fix problems

3. Why Question Evaluation?  To identify and document what the question measures Not just what is wrong with the question Identify and describe subtle differences in  Patterns of interpretation  Patterns of calculation To support data users when conducting analysis of survey data

4. Question Evaluation should answer:  How do the respondents understand the survey question?  Do respondents understand the survey question differently?  Does the question mean the same in all the languages that it is asked?  Does the question mean the same in all of the cultures that it is asked?

5. Question Evaluation should answer:  In processing a question, do all respondents recall information and form an answer the same way?  What groups should be considered for comparability?  Country? Language? Age? Education? Income? Gender? Health Status?

6. Presentation Outline  Define tenets of good question design  Describe cognitive interviewing What it is and how to do it Benefits for  Question designer  Data analysts  Outline WG Cognitive Interviewing II

7. A good question is… 1. relevant to the research agenda and 2. relevant to each potential respondent’s experience and knowledge.

8. What to Remember about Respondents  Do not know or understand the research question  Most likely, do not use scientific, abstract concepts  Survey puts them in the position of operating as informants  Reference aspects of their lives

9. When this relationship is broken, error is introduced into the data.relationship  False Positives  False Negatives  An entirely different phenomena is measured than intended by the research agenda  Example: TerrorismTerrorism

10. Cognitive Stages to Survey Question Response 1. Comprehension– the respondent interprets the question 2. Retrieval– the respondent searches memory for relevant information 3. Judgment– the respondent assesses the completeness and relevance of memories, and makes an estimation 4. Response: Maps judgment onto response category; may need to edit response to fit the categoryMaps judgment onto response category

11. Question Response Process Retrieval Comprehension JudgmentResponse Social Factors

12. Cognitive Interviews  Designed to understand how respondents comprehend, retrieve, judge, respond to questions  Through this examination, can identify potential response errors patterns of interpretation  Provide insight into social-cultural factors that impact the response process

13. Cognitive Interviews are Semi-structured  Core Question- interview is organized by the questions that are being tested  Probe Questions- open-ended, spontaneous, not pre-scripted, based on the information that the respondent provides

14. Probing for story  Why did the respondent answer the question the way that they did?  Does this story match with the intent of the question?  video video

15. Cognitive Test  Qualitative  Small sample  Sample selection purposive  Examines thought processes of respondent  How does the question work?  Does the question work as intended? If not, how can it be “fixed”?

16. Data from Cognitive Testing  Collected from semi-structured protocol  Narrative format  Validity tied to rich detail  Findings are grounded  Insight into question interpretation  Insight into patterns of calculation

17. Cognitive Interview Findings  Provide knowledge of question performance  Illustrate what the question measures Varied patterns of interpretation Dimensions of response error

18. Overall, during the past 4 weeks, how much difficulty did you have with thinking clearly and solving daily problems? Respondent 5 Respondent 2 Respondent 6 Respondent 3 Respondent 4 Respondent 1 Alzheimer’s disease Busy Long term, medical problem Specific experience- organizing tenants Remembering detailed list Fiscal functioning

19. Analysis of Cognitive Interviews:  Yields an “inventory” of: Interpretations Patterns of calculation Types of errors  Provides an explanation of inventory Shows if and how patterns are interrelated E.g., does a particular country or group of respondents interpret a question differently than all others? If so, why?

20. Cognitive Interviewing Reports  Methodology (e.g. N and demographics of respondents, recruitment and interviewing protocols)  Analysis summary  Question by question review—details:  interpretations,  calculation processes  types of errors

21. Examples of Cognitive Reports: Q-Bank: Database of question evaluation reports searchable by question Q-Bank Website: http://wwwn.cdc.gov/QBANK/Home.aspx

22. WG Cognitive Interviewing Round II

23. Overall Testing Plan First,  Cognitive interviewing study (traditional) Small purposive samples Qualitative data and analysis To gain detailed insight processes  i.e. interpretations, calculations, errors  January-February, 2009

24. Overall Testing Plan Then,  Field test Larger, non-purposive sample Quantitative data and analysis Questionnaire contains:  WG questions  Issues identified in cognitive interviewing To learn prevalence or scope of problems  March – April, 2009

25. Cognitive Interviewing Project  Novel approach using the best and current knowledge of pre-testing  Utilization of new software for analyzing cognitive interviews  Integrating lessons learned from WG Test Round 1 and other pre-testing studies  Based on group effort and collaboration

26. Cognitive Interviewing Study Timeline  Interviewer Training: January, 2009 – Bangkok  Participating countries each conduct 20 interviews  Preliminary Analysis: Kristen and friends  Analysis Meeting: February, 2009 – Bangkok  Documentation and Report: Kristen and friends

27. Country Invitation: Requirements for Participation One or Two cognitive interviewers  NOT field interviewers  Must understand question-response process  Fluency in both English and language of respondents Attend Bangkok training Conduct 20 interviews Access internet for communication with group Document interviews in the provided template Prepare for & attend Bangkok analysis meeting

28. Questions?