The usefulness of 'think-aloud' for evaluating questionnaires in use in the health domain

Self-report questionnaires are frequently used in health fields; however, subjective interpretation is often ignored. One way of assessing this is using techniques derived from cognitive interviewing. Of these, ‘think-aloud’, in which respondents speak their thoughts aloud as they complete a questionnaire, is the original paradigm. The thesis focusses on the use of ‘think-aloud’ methodology in the evaluation of questionnaires already in use in the health domain. The current thesis has been prepared in the format of scientific papers. Paper 1 is a systematic review (23 studies) of the appropriateness and usefulness of think-aloud techniques for evaluating health-related questionnaires. A descriptive account is provided of the aims of the studies reviewed; the justification for using think-aloud; populations studied; and methodology; an evaluative account depicts the usefulness of the think-aloud method in addressing researchers’ aims. Think-aloud was successfully used to address researchers’ aims and was effective at elucidating problems with questionnaires. Theoretical and clinical implications are discussed, and recommendations made for future research. Paper 2 is a cross-sectional observational study using think-aloud methods to examine the way in which people with End Stage Renal Disease (N=25) interpret and respond to the Emotion Regulation Questionnaire (ERQ). All questions were found to be problematic to some extent and reappraisal questions yielded the most problems. A tendency to deny or minimise negative emotions and present a positive self-image was also noted. Implications are discussed for use of the ERQ and replication with further samples suggested. Paper 3 is a critical appraisal of the above papers and provides personal reflections on the research process as a whole. The current thesis was a transition from a different study; amended due to time constraints. The journey is also outlined from this original study to the present thesis. Strengths and limitations are considered as well as areas for improvement and future research.