223072 Cognitive Testing of Human Papillomavirus (HPV) Survey Items

Monday, November 8, 2010

Alice R. Richman, PhD, MPH , Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
Gloria Coronado, PhD , Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Lauren D. Arnold, PhD, MPH , School of Public Health, Department of Epidemiology, St. Louis University, St. Louis, MO
María E. Fernández, PhD , Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX
Beth Glenn, PhD , UCLA School of Public Health, Department of Health Services, Jonsson Comprehensive Cancer Center, Division of Cancer Prevention and Control Research, Los Angeles, CA
Jennifer D. Allen, RN, MPH, ScD , School of Nursing, Boston College, Chestnut Hill, MA
Katherine M. Wilson, PhD, MPH, CHES , Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
Noel T. Brewer, PhD , Health Behavior and Health Education, UNC-Chapel Hill, School of Public Health, Chapel Hill, NC
Purpose: Cervical cancer can be prevented by a vaccine against types of HPV that cause most of these cancers. Many studies have assessed factors associated with HPV vaccine acceptability and uptake, but few have examined whether people understand survey items that assess these potential correlates. We sought to develop and cognitively test survey items assessing constructs deemed important to vaccine acceptability.

Methods: Investigators from seven research centers across the US worked collaboratively to develop and cognitively test survey items among racially and ethnically diverse parents (n=62) of girls between ages 9-17. We used a think-aloud protocol and semi-structured verbal probing in qualitative in-person and telephone interviews. We cognitively tested items through a series of iterative phases, initially testing items with a small sample of parents, utilizing feedback to revise and re-administer to a new sample four times.

Results: The final survey contained 20 items on attitudes and beliefs relevant to HPV vaccine. Some parents misinterpreted statements about hypothetical vaccine harms as statements of fact. Some were unwilling to answer items about perceived disease likelihood and perceived vaccine effectiveness, because they said the items appeared to have a “right” answer that they did not know. Cognitive testing results led us to revise 14 questions to improve clarity and comprehension.

Conclusions: Cognitive testing of HPV vaccine survey items revealed important differences between our intended meaning and meaning ascribed to items by participants. Employing cognitive testing in an integrated strategy for instrument development can identify problems with measures and may increase measurement validity.

Learning Areas:
Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Describe the general process of cognitive testing. 2. Discuss how our research group developed and cognitively tested survey items assessing constructs deemed important to HPV vaccine acceptability. 3. Formulate ideas on how you can use cognitive interviewing in your own testing of survey items around cancer prevention research.

Keywords: Cervical Cancer, Survey

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I co-lead this project and work in the area of HPV and cervical cancer prevention.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.