Use of cognitive interviewing in the development of culturally and linguistically appropriate healthcare measurement instruments

With a current population of 40.5 million people, Hispanics represent the largest and fastest growing minority in the US. Members of the Hispanic community experience high rates of disparities in healthcare. The development and evaluation of public health programs designed to address these disparities must be guided by instruments that support accurate assessment of health related constructs. Crucial to the development of such instruments is sensitivity to cultural and linguistic variations among members of the US Hispanic population.

Cognitive interviewing is valuable for item refinement and examination of content validity during the development of healthcare instruments. In this presentation, the process of cognitive interviewing used in the development of a Spanish-language instrument to measure genomic knowledge will be described. Three phases of cognitive interviews were conducted with Hispanics of Mexican, Central and South American, and Cuban heritage to field test 44 instrument items. Thirty-six Hispanics, with twelve persons representative of each cultural group, participated. Text narratives from transcriptions of audiotaped interviews were qualitatively analyzed. Interethnic and intraethnic themes associated with item interpretation, comprehension, and structure were identified. Patterns of difficulties and suggested improvements that emerged through data analysis conducted at the conclusion of each interview wave guided item revisions. The result was the development of a 38-item instrument. Of the original 44 items, 32 were retained, 89% of which were revised. Six items reflecting cultural knowledge were constructed.

Methodological considerations in the use of cognitive interviewing for a comparative investigation of sources of response error across cultural groups will be discussed. The contribution of the methodology in examining cultural and linguistic equivalency of instrument items and in revealing culture-specific concepts as indicators of knowledge will be presented within the context of the current study.