Department of Community Health Sciences and Psychiatry, University of Calgary, Calgary, AB, Canada.
J Urban Health. 2012 Feb;89(1):36-52. doi: 10.1007/s11524-011-9632-z.
In this study, cognitive interviewing methods were used to test targeted questionnaire items from a battery of quantitative instruments selected for a large multisite trial of supported housing interventions for homeless individuals with mental disorders. Most of the instruments had no published psychometrics in this population. Participants were 30 homeless adults with mental disorders (including substance use disorders) recruited from service agencies in Vancouver, Winnipeg, and Toronto, Canada. Six interviewers, trained in cognitive interviewing methods and using standard interview schedules, conducted the interviews. Questions and, in some cases, instructions, for testing were selected from existing instruments according to a priori criteria. Items on physical and mental health status, housing quality and living situation, substance use, health and justice system service use, and community integration were tested. The focus of testing was on relevance, comprehension, and recall, and on sensitivity/acceptability for this population. Findings were collated across items by site and conclusions validated by interviewers. There was both variation and similarity of responses for identified topics of interest. With respect to relevance, many items on the questionnaires were not applicable to homeless people. Comprehension varied considerably; thus, both checks on understanding and methods to assist comprehension and recall are recommended, particularly for participants with acute symptoms of mental illness and those with cognitive impairment. The acceptability of items ranged widely across the sample, but findings were consistent with previous literature, which indicates that "how you ask" is as important as "what you ask." Cognitive interviewing methods worked well and elicited information crucial to effective measurement in this unique population. Pretesting study instruments, including standard instruments, for use in special populations such as homeless individuals with mental disorders is important for training interviewers and improving measurement, as well as interpreting findings.
在这项研究中，使用认知访谈方法测试了从一系列定量工具中选择的针对特定目标的问卷项目，这些工具被用于一项针对无家可归的精神障碍患者的支持性住房干预措施的大型多地点试验。这些工具中的大多数在该人群中都没有已发表的心理计量学研究。参与者是 30 名来自加拿大温哥华、温尼伯和多伦多的服务机构的无家可归的精神障碍（包括物质使用障碍）成年人。6 名访谈员接受了认知访谈方法的培训，并使用标准访谈时间表进行了访谈。根据事先确定的标准，从现有工具中选择了用于测试的问题和（在某些情况下）说明。对身体和心理健康状况、住房质量和生活状况、物质使用、卫生和司法系统服务使用以及社区融合进行了测试。测试的重点是相关性、理解和回忆，以及针对该人群的敏感性/可接受性。根据地点对测试项目进行了整理，并通过访谈员验证了结论。对于确定的感兴趣的主题，存在不同的反应和相似的反应。关于相关性，问卷上的许多项目都不适用于无家可归者。理解程度差异很大；因此，建议同时进行理解检查和提供帮助理解和回忆的方法，特别是对于有急性精神疾病症状和认知障碍的参与者。项目的可接受性在整个样本中差异很大，但研究结果与之前的文献一致，这表明“如何提问”与“问什么”一样重要。认知访谈方法效果很好，在这个独特的人群中获得了对有效测量至关重要的信息。对针对无家可归的精神障碍等特殊人群使用的研究工具（包括标准工具）进行预测试，对于培训访谈员和改进测量以及解释研究结果非常重要。
