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

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine

Publication Date


Document Type



Aged; Aged, 80 and over; Caribbean Region; *Cognition; Depression; Diabetes Mellitus, Type 2; Educational Status; Female; Hispanic Americans; Humans; Interviews as Topic; Male; Massachusetts; Middle Aged; Needs Assessment; Patient Education as Topic; Psychometrics; Qualitative Research; Quality of Life; Questionnaires; Self Care; Semantics


Behavioral Disciplines and Activities | Behavior and Behavior Mechanisms | Community Health and Preventive Medicine | Preventive Medicine


PURPOSE: Cognitive interviewing techniques were used to adapt existing measures for use with a population of low-literate Spanish-speaking people with diabetes.

METHODS: 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 handwritten 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.


Diabetes Educ. 2003 Nov-Dec;29(6):1006-17.

Journal/Book/Conference Title

The Diabetes educator

Related Resources

Link to Article in PubMed

PubMed ID