Cognitive interviewing for cross-cultural adaptation of pediatric antiretroviral therapy adherence measurement items

Rachel Vreeman, Winstone M. Nyandiko, Samuel O. Ayaya, Eunice G. Walumbe, Thomas Inui

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: There are 2.3 million children living with HIV worldwide, almost 90 % of whom live in sub-Saharan Africa. Access to antiretroviral therapy (ART) for HIV treatment has dramatically increased in resource-limited settings in recent years and allows more HIV-infected children to survive into adolescence and adulthood. Purpose: Our objective was to improve the understandability of pediatric antiretroviral adherence measurement items for use in resource-limited settings through cognitive interviewingwith pediatric caregivers and HIV-infected adolescents in Kenya. Methods: We compiled adherence measurement items through a systematic literature review and qualitative work. We conducted cognitive interviews assessing the items with caregivers of HIV-infected children enrolled in HIV care in Kenya and conducted group cognitive assessments with HIV-infected adolescents. We used verbal probing and guided "thinking aloud" to evaluate relevance, comprehension, recall, and sensitivity/acceptability. Analysis followed a systematic sequence of review, compiling data by item, and coding responses. Results: We interviewed 21Kenyan parents and guardians and 10 adolescents (mean age 15 years, SD 1.8) on antiretroviral therapy for a mean of 3.6 years. Cognitive interviews optimized item-response options, wording, and content. Some participants demonstrated difficulty with "think aloud" processes, but verbal probes were easily answered. Comprehension problems were found for key language concepts such "missed doses" and "having side effects." Key findings for response options included differences among responses to various recall periods, with preferences for the shortest (one 24-hday) and longest recall periods (1 month); difficulty describing specific drug information; benefits for including normalizing statements before asking for sensitive information; and challenges processing categorical frequency scales. Important content areas for inclusion included dose timing, disclosure, stigma, and food insecurity. Conclusions: Cognitive interviewing is a productive strategy for increasing the face validity and understandability of adherencemeasurement items, particularly across cultures. Interviews in Kenya suggested adherence measurement modifications of relevance for other resource-limited settings.

Original languageEnglish
Pages (from-to)186-196
Number of pages11
JournalInternational Journal of Behavioral Medicine
Volume21
Issue number1
DOIs
StatePublished - 2014

Fingerprint

HIV
Pediatrics
Kenya
Interviews
Therapeutics
Caregivers
Food Supply
Africa South of the Sahara
Disclosure
Reproducibility of Results
Language
Parents
Pharmaceutical Preparations

Keywords

  • Adherence
  • Cognitive interviewing
  • HIV
  • Measurement
  • Resource-limited setting

ASJC Scopus subject areas

  • Applied Psychology

Cite this

Cognitive interviewing for cross-cultural adaptation of pediatric antiretroviral therapy adherence measurement items. / Vreeman, Rachel; Nyandiko, Winstone M.; Ayaya, Samuel O.; Walumbe, Eunice G.; Inui, Thomas.

In: International Journal of Behavioral Medicine, Vol. 21, No. 1, 2014, p. 186-196.

Research output: Contribution to journalArticle

Vreeman, Rachel ; Nyandiko, Winstone M. ; Ayaya, Samuel O. ; Walumbe, Eunice G. ; Inui, Thomas. / Cognitive interviewing for cross-cultural adaptation of pediatric antiretroviral therapy adherence measurement items. In: International Journal of Behavioral Medicine. 2014 ; Vol. 21, No. 1. pp. 186-196.
@article{f8bd0dd85acf473cb6718765d2e8b803,
title = "Cognitive interviewing for cross-cultural adaptation of pediatric antiretroviral therapy adherence measurement items",
abstract = "Background: There are 2.3 million children living with HIV worldwide, almost 90 {\%} of whom live in sub-Saharan Africa. Access to antiretroviral therapy (ART) for HIV treatment has dramatically increased in resource-limited settings in recent years and allows more HIV-infected children to survive into adolescence and adulthood. Purpose: Our objective was to improve the understandability of pediatric antiretroviral adherence measurement items for use in resource-limited settings through cognitive interviewingwith pediatric caregivers and HIV-infected adolescents in Kenya. Methods: We compiled adherence measurement items through a systematic literature review and qualitative work. We conducted cognitive interviews assessing the items with caregivers of HIV-infected children enrolled in HIV care in Kenya and conducted group cognitive assessments with HIV-infected adolescents. We used verbal probing and guided {"}thinking aloud{"} to evaluate relevance, comprehension, recall, and sensitivity/acceptability. Analysis followed a systematic sequence of review, compiling data by item, and coding responses. Results: We interviewed 21Kenyan parents and guardians and 10 adolescents (mean age 15 years, SD 1.8) on antiretroviral therapy for a mean of 3.6 years. Cognitive interviews optimized item-response options, wording, and content. Some participants demonstrated difficulty with {"}think aloud{"} processes, but verbal probes were easily answered. Comprehension problems were found for key language concepts such {"}missed doses{"} and {"}having side effects.{"} Key findings for response options included differences among responses to various recall periods, with preferences for the shortest (one 24-hday) and longest recall periods (1 month); difficulty describing specific drug information; benefits for including normalizing statements before asking for sensitive information; and challenges processing categorical frequency scales. Important content areas for inclusion included dose timing, disclosure, stigma, and food insecurity. Conclusions: Cognitive interviewing is a productive strategy for increasing the face validity and understandability of adherencemeasurement items, particularly across cultures. Interviews in Kenya suggested adherence measurement modifications of relevance for other resource-limited settings.",
keywords = "Adherence, Cognitive interviewing, HIV, Measurement, Resource-limited setting",
author = "Rachel Vreeman and Nyandiko, {Winstone M.} and Ayaya, {Samuel O.} and Walumbe, {Eunice G.} and Thomas Inui",
year = "2014",
doi = "10.1007/s12529-012-9283-9",
language = "English",
volume = "21",
pages = "186--196",
journal = "International Journal of Behavioral Medicine",
issn = "1070-5503",
publisher = "Routledge",
number = "1",

}

TY - JOUR

T1 - Cognitive interviewing for cross-cultural adaptation of pediatric antiretroviral therapy adherence measurement items

AU - Vreeman, Rachel

AU - Nyandiko, Winstone M.

AU - Ayaya, Samuel O.

AU - Walumbe, Eunice G.

AU - Inui, Thomas

PY - 2014

Y1 - 2014

N2 - Background: There are 2.3 million children living with HIV worldwide, almost 90 % of whom live in sub-Saharan Africa. Access to antiretroviral therapy (ART) for HIV treatment has dramatically increased in resource-limited settings in recent years and allows more HIV-infected children to survive into adolescence and adulthood. Purpose: Our objective was to improve the understandability of pediatric antiretroviral adherence measurement items for use in resource-limited settings through cognitive interviewingwith pediatric caregivers and HIV-infected adolescents in Kenya. Methods: We compiled adherence measurement items through a systematic literature review and qualitative work. We conducted cognitive interviews assessing the items with caregivers of HIV-infected children enrolled in HIV care in Kenya and conducted group cognitive assessments with HIV-infected adolescents. We used verbal probing and guided "thinking aloud" to evaluate relevance, comprehension, recall, and sensitivity/acceptability. Analysis followed a systematic sequence of review, compiling data by item, and coding responses. Results: We interviewed 21Kenyan parents and guardians and 10 adolescents (mean age 15 years, SD 1.8) on antiretroviral therapy for a mean of 3.6 years. Cognitive interviews optimized item-response options, wording, and content. Some participants demonstrated difficulty with "think aloud" processes, but verbal probes were easily answered. Comprehension problems were found for key language concepts such "missed doses" and "having side effects." Key findings for response options included differences among responses to various recall periods, with preferences for the shortest (one 24-hday) and longest recall periods (1 month); difficulty describing specific drug information; benefits for including normalizing statements before asking for sensitive information; and challenges processing categorical frequency scales. Important content areas for inclusion included dose timing, disclosure, stigma, and food insecurity. Conclusions: Cognitive interviewing is a productive strategy for increasing the face validity and understandability of adherencemeasurement items, particularly across cultures. Interviews in Kenya suggested adherence measurement modifications of relevance for other resource-limited settings.

AB - Background: There are 2.3 million children living with HIV worldwide, almost 90 % of whom live in sub-Saharan Africa. Access to antiretroviral therapy (ART) for HIV treatment has dramatically increased in resource-limited settings in recent years and allows more HIV-infected children to survive into adolescence and adulthood. Purpose: Our objective was to improve the understandability of pediatric antiretroviral adherence measurement items for use in resource-limited settings through cognitive interviewingwith pediatric caregivers and HIV-infected adolescents in Kenya. Methods: We compiled adherence measurement items through a systematic literature review and qualitative work. We conducted cognitive interviews assessing the items with caregivers of HIV-infected children enrolled in HIV care in Kenya and conducted group cognitive assessments with HIV-infected adolescents. We used verbal probing and guided "thinking aloud" to evaluate relevance, comprehension, recall, and sensitivity/acceptability. Analysis followed a systematic sequence of review, compiling data by item, and coding responses. Results: We interviewed 21Kenyan parents and guardians and 10 adolescents (mean age 15 years, SD 1.8) on antiretroviral therapy for a mean of 3.6 years. Cognitive interviews optimized item-response options, wording, and content. Some participants demonstrated difficulty with "think aloud" processes, but verbal probes were easily answered. Comprehension problems were found for key language concepts such "missed doses" and "having side effects." Key findings for response options included differences among responses to various recall periods, with preferences for the shortest (one 24-hday) and longest recall periods (1 month); difficulty describing specific drug information; benefits for including normalizing statements before asking for sensitive information; and challenges processing categorical frequency scales. Important content areas for inclusion included dose timing, disclosure, stigma, and food insecurity. Conclusions: Cognitive interviewing is a productive strategy for increasing the face validity and understandability of adherencemeasurement items, particularly across cultures. Interviews in Kenya suggested adherence measurement modifications of relevance for other resource-limited settings.

KW - Adherence

KW - Cognitive interviewing

KW - HIV

KW - Measurement

KW - Resource-limited setting

UR - http://www.scopus.com/inward/record.url?scp=84898990758&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898990758&partnerID=8YFLogxK

U2 - 10.1007/s12529-012-9283-9

DO - 10.1007/s12529-012-9283-9

M3 - Article

C2 - 23188670

AN - SCOPUS:84898990758

VL - 21

SP - 186

EP - 196

JO - International Journal of Behavioral Medicine

JF - International Journal of Behavioral Medicine

SN - 1070-5503

IS - 1

ER -