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For each instrument, interRAI created a detailed item by item instruction manual, with item definitions, process instructions, and examples.
Rather, it seems likely that the student chose this description as a didactic strategy in an attempt to harmonize the explanation with the expected cognitive level of the intended audience, which was explicitly specified to be "a small child that is not familiar with the appropriate scientific terminology" in the open-ended test item instruction.
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Interviewees are then asked to comment on the questionnaire items, instructions and response format.
Before formal data collection, the four assessors went through all the test items, instructions, and materials with the second author.
Participants completed the ASQOL in the presence of an interviewer and were then invited to comment on the items, instructions and response format.
Results from Stage I were used in the development of candidate items, instructions, recall period, response options, and format for the Flu-PRO instrument.
The second part of the interview involved cognitive debriefing of the draft PRO to assess patient understanding and relevance of questionnaire items, instructions and response options.
When analyzing the cognitive debriefing interviews the focus was on confirming patient understanding and interpretation of items, instructions and response options of the HAE PRO.
To stimulate unambiguous interpretation of items, instructions accompanying a questionnaire should invoke specific content of cognitive processes e.g. a particular frame of reference and reference group [ 25].
These detailed instructions had to be revised as the full-text review of publications progressed and the need for more detailed guidance was noted; for two items, instructions changed substantially between the first and the second reviewers' appraisals.
Finally, cognitive interviews with patients following completion of the measure provided evidence that participants interpreted the items, instructions, and response options as intended, and that the items comprehensively evaluated patient experiences of nighttime symptoms of COPD.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com