Using cognitive interviewing to bridge the intent‐interpretation gap for nutrition coverage survey questions in India

Abstract

Designing survey questions that clearly and precisely communicate the question's intent and elicit responses based on the intended interpretation is critical but often undervalued. We used cognitive interviewing to qualitatively assess respondents' interpretation of and responses to questions pertaining to maternal and child nutrition intervention coverage. We conducted interviews to cognitively test 25 survey questions with mothers (N = 21) with children less than 1 year in Madhya Pradesh, India. Each question was followed by probes to capture information on four cognitive stages—comprehension, retrieval, judgement, and response. Data were analysed for common and unique patterns across the survey questions. We identified four types of cognitive challenges: (1) retention of multiple concepts in long questions: difficulty in comprehending and retaining questions with three or more key concepts; (2) temporal confusion: difficulty in conceptualizing recall periods such as “in the last 6 months” as compared to life stages such as pregnancy; (3) interpretation of concepts: mismatch of information being asked, meaning of certain terms and intervention scope; and (4) understanding of technical terms: difficulty in understanding commonly used technical words such as “breastfeeding” and “antenatal care” and requiring use of simple alternative language. Findings from this study will be useful for stakeholders involved in survey design and implementation, especially those conducting large‐scale household surveys to measure coverage of essential nutrition interventions.

Adolescents’ understanding of the Nepalese version of HLS-CHILD-Q15: qualitative pre-testing in ninth-graders

“…The findings of the study conducted by Domanska et al (2018) support the conclusion that adolescents lacked familiarity with certain terms in the questionnaire and required additional practical experience in healthcare interaction and disease prevention tasks [ 29 ]. Another comparable study concluded that using technical words in survey questionnaires could result in issues with understanding [ 42 ], although to a lesser extent than in this study. Identifying and addressing these issues related to questionnaires and respondents is recognized as crucial for increasing the accuracy and reliability of survey instruments.…”

Exploring women’s interpretations of survey questions on pregnancy and pregnancy outcomes: cognitive interviews in Iganga Mayuge, Uganda

“…A previous nutrition coverage study in India reported that surveys noted challenges with long questions that had multiple concepts, with respondents missing the intention of the question [ 29 ]. Similarly in our study, long questions with multiple concepts or with two or more questions within the same sentence caused difficulty to some participants.…”

Gap between the concerns of healthcare professionals and parents’ perceptions regarding dietary habits for 18-month- and 3-year-old children in Japan

“…Previous studies that have noted the contrast between parents’ and professionals’ concerns have indicated the difficulty of getting parents to understand the concepts and terminology related to child nutrition as used by professionals [ 12 , 32 , 34 ]; for example, understanding growth through height and weight measurements [ 38 ] and the importance of continuous life care from beginning before childbirth to childhood. [ 39 ] It should be noted that although many parents obtain childcare support information from the Internet, they may not be receiving it from childcare professionals [ 40 ]. Parents may not recognize how many sweet beverages their children are drinking because they have insufficient knowledge of nutritional balance.…”