Using cognitive interviews to refine a household contacts survey on the epidemiology of community-associated methicillin resistant Staphylococcus aureus

Abstract

Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) infections have become epidemic in many parts of the world and are responsible for significant morbidity and mortality. In preparation for a large longitudinal CA-MRSA Household Contacts Study, we developed a survey of potential CA-MRSA risk factors. To assess the survey’s interpretation, comprehension, and cultural- and age-appropriateness, we conducted cognitive interviews, which prompt respondents to reveal cues to the thought processes involved when responding, among eight patients who represented various demographic criteria and CA-MRSA risks. The interviews used a combination of face-to-face interviews and self-administered surveys. Testing the Household Contacts Study survey instrument using cognitive interviews provided insight into ways to address potentially ambiguous survey items and patient concerns. An unexpected finding that the cognitive interviews uncovered was the emotional impact that diagnosis of MRSA had on respondents. The resulting survey will lead to a better understanding of CA-MRSA pathogenesis and prevention.