OTC labeling risk perceptions in the elderly: Questionnaire development

Background: Questionnaires should be pretested in age-specific groups to evaluate respondents' understanding prior to actual field distribution to decrease response errors. Objective: To identify challenges in developing a health vignette-based questionnaire with risk information manipulations to be mailed out to elderly respondents. Methods: The questionnaire examined how the elderly utilizes risk information on hypothetical OTC drug package labels to form their perceived risk of using those products. Employing a 2x2x2x2 factorial design, perceived risk was manipulated in four ways, each at two levels (low vs. high risk): (1) cold product vs. pain reliever; (2) 2 vs. 4 side effects on label; (3) dry skin vs. diabetes as pre-existing health problem; (4) absence vs. presence of those problems as contraindication on label. Sixteen questionnaire versions were pretested in 39 elderly participants. They were asked to imagine having a pre-existing health problem, to read an OTC label to treat a minor condition, and to use that scenario to answer questions on their perceived risk of using that product. In-depth interviewing was used to assess readability and identify problematic questions. Results: The questionnaire needed to be redesigned because participants had difficulty in (1) imagining themselves in the scenarios; (2) recalling information; (3) distinguishing between different risk manipulations; (4) understanding labeling terminology which is not consistent with words used by health care professionals. Conclusions: It is critical to design valid questionnaires that can test experimentally manipulated information in elderly respondents with diminished cognitive functioning. Implications include redesigning OTC labels to address the elderly's needs.