Use of cognitive interviewing to adapt measurement instruments for low-literate Hispanics

PURPOSE Cognitive interviewing techniques were used to adapt existing measures for use with a population of low-literate Spanish-speaking people with diabetes. METHOD'S Five individuals of Caribbean origin with diabetes participated in cognitive interviews for 4 instruments (measuring diabetes knowledge, quality of life, self-management, and depression) adapted for oral administration to low-literate individuals. Audiotaped interviews and bandwritten notes were subjected to content analysis to identify problems across the 4 instruments as well as specific to a given instrument. RESULTS The following key problems were identified. general instructions were not helpful, items that were not specific enough generated a variety of interpretations, some wording was confusing, abstract concepts were difficult to understand, some terminology was unfamiliar, and interpretation of certain words was incorrect. CONCLUSIONS The data illustrate the usefulness of cognitive interviewing as a first step in the process of adapting measurement instruments.