Questioning the Questionnaire: Methodological Challenges in Measuring Subjective Quality of Life in Nursing Homes Using Cognitive Interviewing Techniques
Restricted accessResearch articleFirst published online June, 2019
Questioning the Questionnaire: Methodological Challenges in Measuring Subjective Quality of Life in Nursing Homes Using Cognitive Interviewing Techniques
Although the concept of subjective quality of life in the nursing home setting is seen as a promising approach to discovering opportunities for improvement from the resident’s perspective, it appears problematic in classical surveys that self-reported quality ratings on the basis of satisfaction questions tend to turn out overly positive. The aim of this article is to analyze how people in residential care facilities interpret and process response stimuli received from a questionnaire on subjective quality of life. In this analysis, we aim to gain methodological insights into the way a survey instrument on subjective quality of life can adequately represent individual ratings, as well as expectations regarding different aspects of quality of life. To test the feasibility of the proposed approach, we employed a range of probing techniques from the cognitive interviewing approach. The result is a promising design principle for constructing survey instruments to measure subjective quality of life.
American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: American Educational Research Association.
2.
ArlingG.KaneR.LewisT.MuellerC. (2005). Future development of nursing home quality indicators. The Gerontologist, 45, 147–156. doi:10.1093/geront/45.2.147
3.
BeckerS.KruseA.SchröderJ.SeidlU. (2005). Das Heidelberger Instrument zur Erfassung von Lebensqualität bei Demenz (H.I. L.DE.). Dimensionen von Lebensqualität und deren Operationalisierung [The Heidelberg instrument for the assessment of quality of life in dementia (H. I. L. DE). Dimensions of quality of life and methods of organization]. Zeitschrift Für Gerontologie Und Geriatrie, 38, 108–121. doi:10.1007/s00391-005-0297-7
4.
BlairJ.ConradF. G. (2011). Sample size for cognitive interview pretesting. Public Opinion Quarterly, 75, 636–658. doi:10.1093/poq/nfr035
5.
BoeijeH.WillisG. (2013). The cognitive interviewing reporting framework (CIRF): Towards the harmonization of cognitive testing reports. Methodology, 9(3), 87–95. doi:10.1027/1614-2241/a000075
6.
BonomiA.PatrickD.BushnellD.MartinM. (2000). Quality of life measurement: Will we ever be satisfied?Journal of Clinical Epidemiology, 53, 19–23. doi:10.1016/s0895-4356(99)00121-3
7.
BowlingA.GabrielZ.DykesJ.DowdingL.EvansO.FleissigA.. . . SuttonS. (2003). Let’s ask them: A national survey of definitions of quality of life and its enhancement among people aged 65 and over. The International Journal of Aging & Human Development, 56, 269–306. doi:10.2190/bf8g-5j8l-ytrf-6404
8.
BrühlA. (Ed.). (2012). Pflegebedürftigkeit messen? Herausforderungen bei der Entwicklung pflegerischer Messinstrumente am Beispiel des Neuen Begutachtungsassessments (NBA) [Measuring care needs? Challenges for the development of care assessment instruments using the example of the New Review Assessment] (With contributions from S. Bensch, K. Planer, G. Franken, C, Grebe, & A. Brühl). Retrieved from http://opus.bsz-bw.de/kidoks/volltexte/2012/71/pdf/Bruehl_Pflegebeduerftigkeit_messen_2012.pdf
9.
BuersC.TriemstraM.BloemendalE.ZwijnenbergN.HendriksM.DelnoijD. (2014). The value of cognitive interviewing for optimizing a patient experience survey. International Journal of Social Research Methodology, 17, 325–340. doi:10.1080/13645579.2012.750830
10.
CarmodyJ.TraynorV.MarchettiE. (2015). Barriers to qualitative dementia research: The elephant in the room. Qualitative Health Research, 25, 1013–1019. doi:10.1177/1049732314554099
11.
CheppV.GrayC. (2014). Foundations and new directions. In MillerK.WillsonS.CheppV.PadillaJ.-L. (Eds.), Cognitive interviewing methodology (pp. 7–14). Hoboken, NJ: John Wiley. doi:10.1002/9781118838860.ch2
12.
CollinsD. (2003). Pretesting survey instruments: An overview of cognitive methods. Quality of Life Research, 12, 229–238. doi:10.1023/a:1023254226592
13.
ConradF. G. (2011). Response 2 to Miller’s chapter: Cognitive interviewing. In MadansJ.MillerK.MaitlandA.WillisG. (Eds.), Question evaluation methods: Question evaluation methods (pp. 93–102). Hoboken, NJ: John Wiley. doi:10.1002/9781118037003.ch7
14.
CooneyA.MurphyK.O’SheaE. (2009). Resident perspectives of the determinants of quality of life in residential care in Ireland. Journal of Advanced Nursing, 65, 1029–1038. doi:10.1111/j.1365-2648.2008.04960.x
15.
CridlandE. K.PhillipsonL.Brennan-HorleyC.SwafferK. (2016). Reflections and recommendations for conducting in-depth interviews with people with dementia. Qualitative Health Research, 26(13), 1774-1786. doi:10.1177/1049732316637065Curyto
16.
CurytoK.Van HaitsmaK. S.TowsleyG. L. (2016). Cognitive interviewing: Revising the preferences for everyday living inventory for use in the nursing home. Research in Gerontological Nursing, 9, 24–34. doi:10.3928/19404921-20150522-04
17.
DavesonB. A.Bechinger-EnglishD.BauseweinC.SimonS. T.HardingR.HigginsonI. J.GomesB. (2011). Constructing understandings of end-of-life care in Europe: A qualitative study involving cognitive interviewing with implications for cross-national surveys. Journal of Palliative Medicine, 14, 343–349. doi:10.1089/jpm.2010.0348
18.
DichterM. N.HalekM.DortmannO.MeyerG.BartholomeyczikS. (2013). Measuring the quality of life of people with dementia in nursing homes in Germany—The study protocol for the Qol-Dem Project. Psycho-Social Medicine, 10, Doc06. doi:10.3205/psm000096
19.
EstermannJ.KneubühlerH.-U. (2008). Why the quality of life in nursing homes is important, and how it can be measured. Swiss Journal of Sociology, 34, 187–210.
20.
Federal Statistics Office (2015). Pflegestatistik: Pflege im Rahmen der Pflegeversicherung. - Deutschlandergebnisse. [Care statistics: Care within the framework of statutory care insurance - Germany-wide results]. Bonn: Statistisches Bundesamt.
21.
FisherS.BurgioL.ThornB.HardinJ. (2006). Obtaining self-report data from cognitively impaired elders: Methodological issues and clinical implications for nursing home pain assessment. The Gerontologist, 46, 81–88. doi:10.1093/geront/46.1.81
22.
GerritsenD.SteverinkN.OomsM.RibbeM. (2004). Finding a useful conceptual basis for enhancing the quality of life of nursing home residents. Quality of Life Research, 13, 611–624. doi:10.1023/b:qure.0000021314.17605.40
23.
GoffmanE. (1961). Asylums. New York: Anchor Books.
24.
GubriumJ. (1997). Living and dying at Murray Manor (1st ed.). Charlottesville: The University of Virginia Press.
25.
HallW. A.LongB. C.BermbachN.JordanS.PattersonK. (2005). Qualitative teamwork issues and strategies: Coordination through mutual adjustment. Qualitative Health Research, 15, 394–410.
26.
HartigJ.FreyA.JudeN. (2012). Validität [Validity]. In MoosbruggerH.KelavaA. (Eds.), Testtheorie und Fragebogenkonstruktion [Test theory and questionnaire design] (pp. 143–173). Heidelberg, Germany: Springer.
27.
Herold-MajumdarA.BehrensJ. (2012). Lebensqualität im Fokus des Qualitätsaudits in der Langzeitpflege [Quality of life in the focus of quality audits in long-term care]. Das Gesundheitswesen, 74, 806–811. doi:10.1055/s-0031-1301272
28.
HorwoodJ.SuttonE.CoastJ. (2014). Evaluating the face validity of the ICECAP-O capabilities measure: A “think aloud” study with hip and knee arthroplasty patients. Applied Research in Quality of Life, 9, 667–682. doi:10.1007/s11482-013-9264-4
29.
HousenP.ShannonG.SimonB.EdelenM.CadoganM.SohnL.. . . SalibaD. (2008). What the resident meant to say: Use of cognitive interviewing techniques to develop questionnaires for nursing home residents. The Gerontologist, 48, 158–169. doi:10.1093/geront/48.2.158
30.
KelleU.NiggemannC.MetjeB. (2014). Datenerhebung in totalen Institutionen als Forschungsgegenstand einer kritischen gerontologischen Sozialforschung [Data survey in total institutions as a research subject in critical gerontological social research]. In AmannA.KollandF. (Eds.), Das erzwungene Paradies des Alters? [The forced paradise of old age] (1st ed., pp. 163–193). Wiesbaden, Germany: VS Verlag für Sozialwissenschaften.
31.
Kelley-GillespieN. (2012). A secondary analysis of perceptions of quality of life of older adults residing in a nursing home and assisted living setting using an integrated conceptual model of measurement. Applied Research in Quality of Life, 7, 137–154. doi:10.1007/s11482-011-9154-6
32.
LangG.LögerB.AmannA. (2007). Well-being in the nursing home—A methodological approach towards the quality of life. Journal of Public Health, 15, 109–120. doi:10.1007/s10389-006-0082-0
33.
Lundgrén-LaineH.SalanteräS. (2010). Think-aloud technique and protocol analysis in clinical decision-making research. Qualitative Health Research, 20, 565–575. doi:10.1177/1049732309354278
34.
MakaiP.BrouwerW.KoopmanschapM.StolkE.NieboerA. (2014). Quality of life instruments for economic evaluations in health and social care for older people: A systematic review. Social Science & Medicine, 102, 83–93. doi:10.1016/j.socscimed.2013.11.050
35.
MallinsonS. (2002). Listening to respondents: a qualitative assessment of the Short-Form 36 Health Status Questionnaire. Social Science & Medicine, 54, 11–21.
36.
McDowellI. (2006). Measuring health: A guide to rating scales and questionnaires (3rd ed.). Oxford, UK: Oxford University Press.
37.
MillerK. (2011). Cognitive interviewing. In MadansJ.MillerK.MaitlandA.WillisG. (Eds.), Question evaluation methods: Question evaluation methods (pp. 49–75). Hoboken, NJ: John Wiley. doi:10.1002/9781118037003.ch5
38.
MonroeT.CarterM. (2012). Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research. European Journal of Ageing, 9, 265–274. doi:10.1007/s10433-012-0234-8
39.
MurtaghF. E. M.Addington-HallJ. M.HigginsonI. J. (2007). The value of cognitive interviewing techniques in palliative care research. Palliative Medicine, 21, 87–93. doi:10.1177/0269216306075367
40.
O’BrienK. K.BereketT.SwintonM.SolomonP. (2013). Using qualitative methods to assess the measurement property of a new HIV disability questionnaire. International Journal of Qualitative Methods, 12, 1–19. doi:10.1177/160940691301200101
41.
PadillaJ.-L.LeightonJ. P. (2017). Cognitive interviewing and think aloud methods. In ZumboB. D.HubleyA. M. (Eds.), Social Indicators Research Series, Vol. 69: Understanding and investigating response processes in validation research (1st ed., pp. 211–228). Cham, Switzerland: Springer. doi:10.1007/978-3-319-56129-5_12
42.
PatersonC. (2004). Seeking the patient’s perspective: A qualitative assessment of EuroQol, COOP-WONCA charts and MYMOP. Quality of Life Research, 13, 871–881. doi:10.1023/b:qure.0000025586.51955.78
43.
PolitD.BeckC. (2004). Nursing research. Philadelphia: Lippincott Williams & Wilkins.
44.
PriceB. (2002). Laddered questions and qualitative data research interviews. Journal of Advanced Nursing, 37, 273–281.
45.
RamirezM.TeresiJ. A.OgedegbeG.WilliamsO. (2016). Using qualitative methods to assess the conceptual equivalence of the Spanish and English Stroke Action Test (STAT). Qualitative Health Research, 26(13), 1812-1822.doi:10.1177/1049732316636362
46.
RamirezM.WatkinsB.TeresiJ. A.SilverS.SukhaG.BortagisG.. . . PillemerK. (2013). Using qualitative methods to develop a measure of resident-to-resident elder mistreatment in nursing homes. International Psychogeriatrics, 25, 1245–1256. doi:10.1017/S1041610213000264
47.
SaksK.TiitE.MuurinenS.MukkilaS.FrommeltM.HammondM. (2008). Quality of life in institutional care. In VaaramaM.PieperR.SixsmithA. (Eds.), Care-related quality of life in old age (1st ed., pp. 196–216). New York: Springer.
48.
SchenkL.MeyerR.BehrA.KuhlmeyA.HolzhausenM. (2013). Quality of life in nursing homes: Results of a qualitative resident survey. Quality of Life Research, 22, 2929–2938. doi:10.1007/s11136-013-0400-2
49.
SchwarzN.KnäuperB. (2000). Cognition, aging, and self-reports. In ParkD.SchwarzN. (Eds.), Cognitive aging: A primer (1st ed., pp. 233–252). Philadelphia, PA: Psychology Press.
50.
ShippeeT.Henning-SmithC.KaneR.LewisT. (2013). Resident-and facility-level predictors of quality of life in long-term care. The Gerontologist, 55, 643–655. doi:10.1093/geront/gnt148
51.
ShulrufB.HattieJ.DixonR. (2008). Factors affecting responses to Likert type questionnaires: Introduction of the ImpExp, a new comprehensive model. Social Psychology of Education, 11, 59–78. doi:10.1007/s11218-007-9035-x
52.
TabaliM.OstermannT.JeschkeE.DassenT.HeinzeC. (2013). Does the care dependency of nursing home residents influence their health-related quality of life? A cross-sectional study. Health and Quality of Life Outcomes, 11(1), Article 41. doi:10.1186/1477-7525-11-41
53.
TourangeauR.RipsL.RasinskiK. (2012). The psychology of survey response. Cambridge, UK: Cambridge University Press.
54.
WillisG. B. (2005). Cognitive interviewing: A tool for improving questionnaire design. Thousand Oaks, CA: Sage.
55.
WillisG. B. (2011). Response 1 to Miller’s chapter: Cognitive interviewing. In MadansJ.MillerK.MaitlandA.WillisG. (Eds.), Question evaluation methods: Question evaluation methods (pp. 77–91). Hoboken, NJ: John Wiley. doi:10.1002/9781118037003.ch6
ZumboB. D.ChanE. K.H. (2014). Validity and Validation in Social, Behavioral, and Health Sciences (Vol. 54). Cham: Springer International Publishing.
58.
ZumboB. D.HubleyA. M. (Eds.). (2017). Social Indicators Research Series, Vol. 69: Understanding and investigating response processes in validation research (1st ed.). Cham, Switzerland: Springer.
