Cognitive interviewing in the development of PRO measures – The HSSQ-Test

Cognitive interviewing in the PRO development - TheHSSQ-TestPatient reported outcomes (PROs) such as well-being, perceptions of health, functioning, symptoms and satisfaction are increasingly used in outcome based healthcare as both primary and secondary endpoints. Critical however, to the notion of outcome based healthcare is that the data collected through their use is reliable and valid and respondents are able to understand the questions being asked. However, traditional pretesting of the questionnaire will not uncover interpretation issues as often this is a passive activity with respondents answering a question irrespective as to whether it is complex to answer or not.

The HSSQ-Test™ has been developed by HealthSurveySolutions to identify and describe features of a questionnaire that are likely to interfere with respondents’ ability to provide reliable and valid responses to patient reported outcomes and health survey questionnaires.

The HSSQ-Test comprises a number of stages, but in addition brings together both quantitative and qualitative methodology combined with a problem classification scheme in the analysis of the cognitive interview across each of the stages of the question-answer cognitive model. As a result the HSSQ-Test provides a detailed breakdown in terms of frequency and description as to where respondents are experiencing problems across the process of answering the question, e.g. comprehension, recall and responding. Based on the quantitative and descriptive data, the required changes can be graded in accordance with ISPOR’s recommendations.

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mmendations as minor, moderate and substantial and whether further psychometric testing is required.

Categories: Patient reported outcomes, Questionnaire design

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1 reply


  1. Cognitive interviewing in the development of PRO measures – The HSSQ-Test | DHP Research thepatientoutcomesblog

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