Use of cognitive interviewing in the development of a Spanish language genetic knowledge instrument

Study purpose. Genetic advances are significantly impacting healthcare, yet recent studies of ethnic group participation in genetic services demonstrate low utilization rates by Latinos. Limited genetic knowledge is a major barrier. The purpose of this study was to field test items in a Spanish-language instrument that will be used to measure genetic knowledge relevant to type 2 diabetes among members of the ethnically heterogeneous U.S. Latino community. Accurate genetic knowledge measurement can provide the foundation for interventions to enhance genetic service utilization. ^ Design. Three waves of cognitive interviews were conducted in Spanish to field test 44 instrument items Thirty-six Latinos, with 12 persons representative of Mexican, Central and South American, and Cuban heritage participated, including 7 males and 29 females between 22 and 60 years of age; 17 participants had 12 years or less of education. ^ Methods. Text narratives from transcriptions of audiotaped interviews were qualitatively analyzed using a coding strategy to indicate potential sources of response error. Through an iterative process of instrument refinement, codes that emerged from the data were used to guide item revisions at the conclusion of each phase; revised items were examined in subsequent interview waves. ^ Results. Inter-cultural and cross-cultural themes associated with difficulties in interpretation and grammatical structuring of items were identified; difficulties associated with comprehension reflected variations in educational level. Of the original 44 items, 32 were retained, 89% of which were revised. Six additional items reflective of cultural knowledge were constructed, resulting in a 38-item instrument. ^ Conclusions. Use of cognitive interviewing provided a valuable tool for detecting both potential sources of response error and cultural variations in these sources. Analysis of interview data guided successive instrument revisions leading to improved item interpretability and comprehension. Although testing in a larger sample will be essential to test validity and reliability, the outcome of field testing suggests initial content validity of a Spanish-language instrument to measure genetic knowledge relative to type 2 diabetes. ^ Keywords. Latinos, genetic knowledge, instrument development, cognitive interviewing ^

Exploring self-rated health among adolescents : a think-aloud study

BACKGROUND: Despite extensive use of self-rated health questions in youth studies, little is known about what such questions capture among adolescents. Hence, the aim of this study was to explore how adolescents interpret and reason when answering a question about self-rated health. METHODS: A qualitative study using think-aloud interviews explored the question, "How do you feel most of the time?", using five response options ("Very good", "Rather good", "Neither good, nor bad", "Rather bad", and "Very bad"). The study involved 58 adolescents (29 boys and 29 girls) in lower secondary school (7th grade) and upper secondary school (12th grade) in Sweden. RESULTS: Respondents' interpretations of the question about how they felt included social, mental, and physical aspects. Gender differences were found primarily in that girls emphasized stressors, while age differences were reflected mainly in the older respondents' inclusion of a wider variety of influences on their assessments. The five response options all demonstrated differences in self-rated health, and the respondents' understanding of the middle option, "Neither good, nor bad", varied widely. In the answering of potential sensitive survey questions, rationales for providing honest or biased answers were described. CONCLUSIONS: The use of a self-rated health question including the word 'feel' captured a holistic view of health among adolescents. Differences amongst response options should be acknowledged when analyzing self-rated health questions. If anonymity is not feasible when answering questions on self-rated health, a high level of privacy is recommended to increase the likelihood of reliability.

What do people think about when they answer theory of planned behaviour questionnaires? A 'think aloud' study

Two studies aiming to identify the nature and extent of problems that people have when completing theory of planned behaviour (TPB) questionnaires, using a cognitive interviewing approach are reported. Both studies required participants to 'think aloud' as they completed TPB questionnaires about: (a) increasing physical activity (six general public participants); and (b) binge drinking (13 students). Most people had no identifiable problems with the majority of questions. However, there were problems common to both studies, relating to information retrieval and to participants answering different questions from those intended by researchers. Questions about normative influence were particularly problematic. The standard procedure for developing TPB questionnaires may systematically produce problematic questions. Suggestions are made for improving this procedure. Copyright © 2007 SAGE Publications.

A Randomized Clinical Trial to Examine Enhancing Cognitive-Behavioral Group Therapy for Obsessive-Compulsive Disorder with Motivational Interviewing and Thought Mapping

Background: Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts to control thoughts and actions with rituals. These rituals are used in order to prevent feared or personally distressing outcomes. Cognitive behavioral group therapy (CBGT) has been reported to be effective for treating OCD patients. However, about one-third (30%) of patients do not benefit from CBGT. Some of these patients do not show significant improvement and continue to use rituals following CBGT, partially because they fail to complete the exposure and ritual prevention (ERP) exercises. Consequently, it is important to motivate patients to fully engage in CBGT treatment and complete the ERP exercises. Aims: A randomized behavioral trial examined 12 weeks of manual directed CBGT, with the addition of individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM), and compared treatment outcome to the effectiveness of CBGT group alone. Method: Subjects were randomized (n = 93) into a CBGT group or a CBGT group with MI+TM. Results: When the two groups were compared, both groups reduced OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. Positive outcomes were also maintained, with additional symptom reduction at the 3-month follow-up for the MI TM CBGT group. Conclusions: Adding two individual sessions of MI and TM before CBGT successfully reduced OCD symptoms and was more effective than using CBGT group alone.

Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behaviour therapy in addition to standard care for patients with psychosis and a co-morbid substance use problem. Design Two-centre, open, rater-blind randomised controlled trial Setting UK Secondary Care Participants 327 patients with clinical diagnoses of schizophrenia, schizophreniform or schizoaffective disorder and DSM-IV diagnoses of drug and/or alcohol dependence or abuse Interventions Participants were randomly allocated to integrated motivational interviewing and cognitive behaviour therapy or standard care. Therapy has two phases. Phase one – “motivation building” – concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two –“Action” – supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. Main outcomes The primary outcome was death from any cause or admission to hospital in the 12 months after therapy. Secondary outcomes were frequency and amount of substance use (Timeline Followback), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, global assessment of functioning and deliberate self harm, at 12 and 24 months, with additional Timeline Followback assessments at 6 and 18 months. Analysis was by intention-to-treat with robust treatment effect estimates. Results 327 participants were randomised. 326 (99.7%) were assessed on the primary outcome, 246 (75.2%) on main secondary outcomes at 24 months. Regarding the primary outcome, there was no beneficial treatment effect on hospital admissions/ death during follow-up, with 20.2% (33/163) of controls and 23.3% (38/163) of the therapy group deceased or admitted (adjusted odds-ratio 1.16; P= 0.579; 95% confidence interval 0.68 to 1.99). For secondary outcomes there was no treatment effect on frequency of substance use or perceived negative consequences, but a statistically significant effect of therapy on amount used per substance-using day (adjusted odds-ratios: (a) for main substance 1.50; P=0.016; 1.08 to 2.09, (b) all substances 1.48; P=0.017; 1.07 to 2.05). There was a statistically significant treatment effect on readiness to change use at 12 months (adjusted odds-ratio 2.05; P=0.004; 1.26 to 3.31), not maintained at 24 months. There were no treatment effects on assessed clinical outcomes. Conclusions Integrated motivational interviewing and cognitive behaviour therapy for people with psychosis and substance misuse does not improve outcome in terms of hospitalisation, symptom outcomes or functioning. It does result in a reduction in amount of substance use which is maintained over the year’s follow up. Trial registration Current Controlled Trials: ISRCTN14404480

An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring.

To ensure successful treatment, HIV patients must maintain a high degree of medication adherence over time. Since August 2004, patients who are (or are at risk of) experiencing problems with their HIV antiretroviral therapy (ART) have been referred by their physicians to an interdisciplinary HIV-adherence program. The program consists of a multifactorial intervention along with electronic drug monitoring (MEMS(TM)). The pharmacists organize individualized semi-structured motivational interviews based on cognitive, emotional, behavioral, and social issues. At the end of each session, the patient brings an adherence report to the physician. This enables the physician to use the adherence results to evaluate the treatment plan. The aim of this study was to retrospectively analyze this on-going interdisciplinary HIV-adherence program. All patients who were included between August 2004 and the end of April 2008 were analyzed. One hundred and four patients were included (59% women, median age 39 (31.0, 46.0) years, 42% black ethnicity). Eighty (77%) patients were ART-experienced patients and 59% had a protease inhibitor-based treatment. The retention rate was high (92%) in the program. Patient inclusion in this HIV-adherence program was determined by patient issues for naive patients and by nonadherence or suboptimal clinical outcomes for ART-experienced patients. The median time spent by a subject at the pharmacy was 35 (25.0, 48.0) minutes, half for the medication handling and half for the interview. The adherence results showed a persistence of 87% and an execution of 88%. Proportion of undetectable subjects increased during study. In conclusion, retention and persistence rates were high in this highly selected problematic population.

Protocol for a feasibility study of a self help cognitive behavioural therapy resource for the reduction of dental anxiety in young people

Background Childhood dental anxiety is very common, with 10–20 % of children and young people reporting high levels of dental anxiety. It is distressing and has a negative impact on the quality of life of young people and their parents as well as being associated with poor oral health. Affected individuals may develop a lifelong reliance on general anaesthetic or sedation for necessary dental treatment thus requiring the support of specialist dental services. Children and young people with dental anxiety therefore require additional clinical time and can be costly to treat in the long term. The reduction of dental anxiety through the use of effective psychological techniques is, therefore, of high importance. However, there is a lack of high-quality research investigating the impact of cognitive behavioural therapy (CBT) approaches when applied to young people’s dental anxiety. Methods/design The first part of the study will develop a profile of dentally anxious young people using a prospective questionnaire sent to a consecutive sample of 100 young people referred to the Paediatric Dentistry Department, Charles Clifford Dental Hospital, in Sheffield. The second part will involve interviewing a purposive sample of 15–20 dental team members on their perceptions of a CBT self-help resource for dental anxiety, their opinions on whether they might use such a resource with patients, and their willingness to recruit participants to a future randomised controlled trial (RCT) to evaluate the resource. The third part of the study will investigate the most appropriate outcome measures to include in a trial, the acceptability of the resource, and retention and completion rates of treatment with a sample of 60 dentally anxious young people using the CBT resource. Discussion This study will provide information on the profile of dentally anxious young people who could potentially be helped by a guided self-help CBT resource. It will gain the perceptions of dental care team members of guided self-help CBT for dental anxiety in young people and their willingness to recruit participants to a trial. Acceptability of the resource to participants and retention and completion rates will also be investigated to inform a future RCT.

Testo e memoria tra semiotica e scienze cognitive: una situazione sperimentale intorno al ricordo di un film

The research project presented in this dissertation is about text and memory. The title of the work is "Text and memory between Semiotics and Cognitive Science: an experimental setting about remembering a movie". The object of the research is the relationship between texts or "textuality" - using a more general semiotic term - and memory. The goal is to analyze the link between those semiotic artifacts that a culture defines as autonomous meaningful objects - namely texts - and the cognitive performance of memory that allows to remember them. An active dialogue between Semiotics and Cognitive Science is the theoretical paradigm in which this research is set, the major intend is to establish a productive alignment between the "theory of text" developed in Semiotics and the "theory of memory" outlined in Cognitive Science. In particular the research is an attempt to study how human subjects remember and/or misremember a film, as a specific case study; in semiotics, films are “cinematographic texts”. The research is based on the production of a corpus of data gained through the qualitative method of interviewing. After an initial screening of a fulllength feature film each participant of the experiment has been interviewed twice, according to a pre-established set of questions. The first interview immediately after the screening: the subsequent, follow-up interview three months from screening. The purpose of this design is to elicit two types of recall from the participants. In order to conduce a comparative inquiry, three films have been used in the experimental setting. Each film has been watched by thirteen subjects, that have been interviewed twice. The corpus of data is then made by seventy-eight interviews. The present dissertation displays the results of the investigation of these interviews. It is divided into six main parts. Chapter one presents a theoretical framework about the two main issues: memory and text. The issue of the memory is introduced through many recherches drown up in the field of Cognitive Science and Neuroscience. It is developed, at the same time, a possible relationship with a semiotic approach. The theoretical debate about textuality, characterizing the field of Semiotics, is examined in the same chapter. Chapter two deals with methodology, showing the process of definition of the whole method used for production of the corpus of data. The interview is explored in detail: how it is born, what are the expected results, what are the main underlying hypothesis. In Chapter three the investigation of the answers given by the spectators starts. It is examined the phenomenon of the outstanding details of the process of remembering, trying to define them in a semiotic way. Moreover there is an investigation of the most remembered scenes in the movie. Chapter four considers how the spectators deal with the whole narrative. At the same time it is examined what they think about the global meaning of the film. Chapter five is about affects. It tries to define the role of emotions in the process of comprehension and remembering. Chapter six presents a study of how the spectators account for a single scene of the movie. The complete work offers a broad perspective about the semiotic issue of textuality, using both a semiotic competence and a cognitive one. At the same time it presents a new outlook on the issue of memory, opening several direction of research.

UNDERSTANDING NURSE CREATED COGNITIVE ARTIFACTS: PERSONALLY-CREATED-COGNITIVE-ARTIFACTS AS EXTERNAL REPRESENTATIONS OF DISTRIBUTED COGNITION

Manuscript 1: “Conceptual Analysis: Externalizing Nursing Knowledge” We use concept analysis to establish that the report tool nurses prepare, carry, reference, amend, and use as a temporary data repository are examples of cognitive artifacts. This tool, integrally woven throughout the work and practice of nurses, is important to cognition and clinical decision-making. Establishing the tool as a cognitive artifact will support new dimensions of study. Such studies can characterize how this report tool supports cognition, internal representation of knowledge and skills, and external representation of knowledge of the nurse. Manuscript 2: “Research Methods: Exploring Cognitive Work” The purpose of this paper is to describe a complex, cross-sectional, multi-method approach to study of personal cognitive artifacts in the clinical environment. The complex data arrays present in these cognitive artifacts warrant the use of multiple methods of data collection. Use of a less robust research design may result in an incomplete understanding of the meaning, value, content, and relationships between personal cognitive artifacts in the clinical environment and the cognitive work of the user. Manuscript 3: “Making the Cognitive Work of Registered Nurses Visible” Purpose: Knowledge representations and structures are created and used by registered nurses to guide patient care. Understanding is limited regarding how these knowledge representations, or cognitive artifacts, contribute to working memory, prioritization, organization, cognition, and decision-making. The purpose of this study was to identify and characterize the role a specific cognitive artifact knowledge representation and structure as it contributed to the cognitive work of the registered nurse. Methods: Data collection was completed, using qualitative research methods, by shadowing and interviewing 25 registered nurses. Data analysis employed triangulation and iterative analytic processes. Results: Nurse cognitive artifacts support recall, data evaluation, decision-making, organization, and prioritization. These cognitive artifacts demonstrated spatial, longitudinal, chronologic, visual, and personal cues to support the cognitive work of nurses. Conclusions: Nurse cognitive artifacts are an important adjunct to the cognitive work of nurses, and directly support patient care. Nurses need to be able to configure their cognitive artifact in ways that are meaningful and support their internal knowledge representations.

Interviewing adult witnesses and victims

In this chapter, we discuss the interviewing of adult witnesses and victims with reference to how the extant psychological and linguistic literature has contributed to understanding and informing interview practice over the past 20 years and how it continues to support practical and procedural improvements. We have only scratched the surface of this important and complex topic, but throughout this chapter we have directed readers to many in-depth reviews and some of the most contemporary research literature currently available in this domain. We have introduced the PEACE model and described the Cognitive Interview procedure and its development. We have also discussed rapport building, question types and communication style, all with reference to witness memory and practical interviewing. Finally, we highlight areas that would benefit from research, for example conducting interviews with interpreters, and how new training initiatives are seeking to improve interview procedures and interviewer practice.

To challenge, or not to challenge? Best practice when interviewing vulnerable suspects

This paper examines to what extent police investigators can reliably question a vulnerable suspect’s account when the evidence base for appropriate questioning styles for this particular vulnerable group is limited. We examine a simulated interview to demonstrate how difficult it is to challenge discrepancies in a vulnerable suspect’s account. It is argued from both linguistic and psychological perspectives that certain question formats may lead to acquiescence, cognitive overload and confusion for the suspect. It is suggested that one way of trying to manage these issues is through the provision of alternative narratives (i.e. ‘only one of those stories can be true’) but these too are found to be problematic.

Interviewing strategies in the face of beauty:a psychophysiological investigation into the job negotiation process

After the application form is submitted, the interview is the most important method of human resource allocation. Previous research has shown that the attractiveness of interviewees can significantly bias interview outcome. We have previously shown that female interviewers give attractive male interviewees higher status job packages compared their average looking counterparts. However, it is not known whether male interviewers exhibit such biases. In the present study, participants were asked to take part in a mock job negotiation scenario where they had to allocate either a high- or low-status job package to attractive or average looking ``interviewees.'' Before each decision was made, the participant's anticipatory electrodermal response (EDR) was recorded. The results supported our previous finding in that female participants allocated a greater number of high-status job packages to attractive men. Additionally, male participants uniformly allocated a greater number of low-status job packages to both attractive men and attractive women. Overall, the average looking interviewees incurred a penalty and received a significantly greater number of low-status job packages. In general, the EDR profile for both male and female participants was significantly greater when allocating the low-status packages to the average looking interviewees. However, the male anticipatory EDR profile showed the greatest change when allocating attractive women with low-status job packages. We discuss these findings in terms of the potential biases that may occur at the job interview and place them within an evolutionary psychology framework.

Producing facial composite sketches in remote cognitive interviews:a preliminary investigation

Justice systems around the world are increasingly turning to videoconferencing as a means to reduce delays and reduce costs in legal processes. This preliminary research examined whether interviewing a witness remotely - without physical co-presence of the witness and interviewer - could facilitate the production of quality facial composite sketches of suspects. In Study 1, 42 adults briefly viewed a photograph of a face. The next day they participated in Cognitive Interviews with a forensic artist, conducted either face-to-face or remotely via videoconference. In Study 2, 20 adults participated in videoconferenced interviews, and we manipulated the method by which they viewed the developing sketch. In both studies, independent groups of volunteers rated the likeness of the composites to the original photographs. The data suggest that remote interviews elicited effective composites; however, in Study 1 these composites were considered poorer matches to the photographs than were those produced in face-to-face interviews. The differences were small, but significant. Participants perceived several disadvantages to remote interviewing, but also several advantages including less pressure and better concentration. The results of Study 2 suggested that different sketch presentation methods offered different benefits. We propose that remote interviewing could be a useful tool for investigators in certain circumstances. © 2013 Taylor & Francis.

Confirmation bias in witness interviewing: Can interviewers ignore their preconceptions?

Basic research on expectancy effects suggests that investigative interviewers with pre-conceived notions about a crime may negatively influence the interview process in meaningful ways, yet many interviewing protocols recommend that interviewers review all available information prior to conducting their interviews. Previous research suggests that interviewers with no pre-interview knowledge elicit more detailed and accurate accounts than their informed counterparts (Cantlon, et al., 1996; Rivard et al., under review). The current study investigated whether (a) the benefit of blind versus informed interviewing is moderated by cautionary interviewer instructions to avoid suggestive questions and (b) whether any possible effects of pre-interview information extend beyond the immediate context of the forensic interview. ^ Paired participants (N = 584) were assigned randomly either to the role of interviewer or witness. Witnesses viewed a mock crime video and were interviewed one week later by an interviewer who received either correct, incorrect, or no information about the crime event. Half of the interviewers were assigned randomly to receive additional instructions to avoid suggestive questions. All participants returned 1 week after the interview to recall the crime video (for the witness) or the information recalled by the witness during the interview (for the interviewer). All interviews and delayed recall measures were scored for the quantity and accuracy of information reported. ^ Results replicate earlier findings that blind interviewers elicit more information from witnesses, without a decrease in accuracy rate. However instructions to avoid suggestive questions did not moderate the effect of blind versus informed interviewing on witness recall during the interview. Results further demonstrate that the effects of blind versus non-blind interviewing may extend beyond the immediate context of the interview to a later recall attempt. With instructions to avoid suggestive questions, witnesses of blind interviewers were more accurate than witnesses of incorrectly informed interviewers when recalling the event 1 week later. In addition, blind interviewers had more accurate memories for the witnesses' account of the event during the interview compared to non-blind interviewers.^

Effectiveness of the cognitive interview in a multiple-testing situation

The present study assessed the effectiveness of the Cognitive Interview (CI) in a multiple-testing situation. One-hundred and eighty-two undergraduate psychology students viewed a short film clip depicting an automobile accident. Subsequently, the subjects were interviewed twice using either the CI or standard interviewing technique. In both instances, subjects who received the CI recalled more accurate information (m=32.30 at Time 1 and m=30.51 at Time 2) than subjects who received the standard interview (m=18.14 at Time 1 and m=18.38 at Time 2). There was no effect of type of interview at Time 1 on amount recalled at Time 2. This research has implications not only for judicial fact-finders, but also for further researchers interested in the CI procedure.