227830 An innovative approach to cognitive interviewing to culturally adapt epidemiologic questionnaires

Sunday, November 7, 2010

Fikri Yucel, MA , Public Health Research, Social & Scientific Systems, Durham, NC
Mwenda Kudumu, BS , Public Health Research, Social & Scientific Systems, Durham, NC
Janet Archer, BSc, Msc , Public Health Research, Social & Scientific Systems, Durham, NC, Afghanistan
Riana Bornman, MBChB DSc MD , Department of Urology, University of Pretoria, Pretoria, South Africa
Pamela Schwingl, PhD , Public Health Research, Social & Scientific Systems, Inc., Durham, NC
Social and Scientific Systems (SSS) adapted four epidemiologic questionnaires for a study of DDT exposure and pregnancy loss in rural South Africa. To ensure an accurate translation into Tshivenda, we faced two challenges: (1) assessing the questions for clarity and comprehensibility; and (2) evaluating the content for relevance to the local culture. To accomplish this we adapted cognitive interviewing techniques for use with members of the local population who are bilingual in Tshivenda and English.

Typically, in cognitive interviewing the interviewer asks the question, and then debriefs subjects on how they answered to assess how well they understood the intended meaning. This process usually involves audio recording and transcription, and can be time consuming and costly. We replaced this practice with a more direct, structured, and simplified pen-and-paper method of recording subjects' feedback, allowing us to evaluate and revise the questionnaires more quickly.

English-speaking, supervisory field staff were trained to use this modified method with local bilingual field interviewers as subjects to evaluate over 400 questions and response categories. Approximately half of the questions generated comments from one or more of the subjects; about half of these comments revealed areas requiring significant clarification or revision for cultural relevance. Bilingual interviewers then pre-tested revised English questionnaires on local, bilingual volunteers, yielding additional feedback and further revisions. In the final step bilingual interviewers pre-test Tshivenda instruments with Tshivenda-speaking volunteers. Utilizing this innovative approach, SSS is able to collect epidemiologic data with clear, culturally-relevant instruments regardless of the population's primary language.

Learning Areas:
Environmental health sciences
Social and behavioral sciences

Learning Objectives:
1. Evaluate standard cognitive interviewing as a means of culturally adapting and preparing questionnaires for translation. 2. Discuss the rationale for a modified approach and describe how it differs from the standard. 3. Assess the results of the process (categorize types of feedback leading to revisions, and quantify how many questions were revised as a result). 4. Identify factors that contribute to the success of this approach, and its limitations.

Keywords: Epidemiology, Survey

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 12 years of experience conducting survey research for environmental epidemiology studies.
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.