Using Cognitive Interviews to Evaluate and Improve a Danish Translation of a Compiled Questionnaire on Existential and Spiritual Constructs

This paper presents how structured iterative rounds of qualitative cognitive interviews can be used to evaluate and improve a compiled questionnaire on existential and spiritual constructs intended for digital use in a cohort setting in Denmark. Translation and cultural adaptation were done according to World Health Organization guidelines. 14 individuals with various demographic background and disease states underwent cognitive interviews according to an interview guide. Interviews were conducted through four iterative rounds with adjustments to the questionnaire in between. Data was analyzed through a deductively driven directed content analysis with a predefined theoretical framework. The method was successful in providing evidence for improvement of the questionnaire. Issues identified during interviews decreased in iterative rounds of testing as hypothesized, and the comprehension and feasibility of the questionnaire was increasing over test rounds. Cognitive interviewing is a useful and warranted qualitative approach in survey methodology. For the field, more transparent reporting of methodology and analysis will strengthen the method for future practice.