Table 8 Examples of General Design Issues Identified from Cognitive Interviews
General design problem | Illustrative example |
|---|---|
Health system differences between countries | Description of issue: In Peru, there is not a formal adverse event and reporting system at every facility. As such, the concept is unfamiliar to many participants. Revision: Addition of a question specific to whether or not the participant is aware of the presence of a formal error reporting system at their respective facility. |
Work environment for physicians is different | Description of issue: In Peru, most physicians work at more than one facility. Also, they are usually employed full-time by the public health system (or semi-public) and then work as contractors in the private health system. Revision: Incorporated a question to capture the number of hours worked at all health facilities in addition to their primary work facility in Peru. |
Professional domains are different or absent | Description of issue: There are many professions in the United States and in Peru which are different. For example, registered nurses are present in both places but respiratory therapists do not exist in Peru. Revision: Reconstruct the questions specific to professional roles and positions in facilities in Peru |
Multiple concepts are different between the public and private health systems | Description of issue: Within Peru, there are differences between the reference terms for areas, departments, and even facilities. Revision: For example, the public sector term for an acute care facility is “hospital” while the private sector term is “clinica.” Additional step: Incorporate changes by crafting two instruments: 1) Instrument specific for public facilities; and 2) Instrument for private facilities but only with changes to distinct descriptions and terminology but without changes to the item meaning. |
Description of issue: Within Peru, there are differences in job titles and descriptions between the public and the private health facilities. Revision: For public system, use the appropriate terms and for the private system use the specific terms. Additional step: Incorporate changes throughout the instrument for public facilities and then throughout the instrument for private facilities. |