222 7 Chapter 7 Method Study 1 Participants Fourteen people participated (see Additional file 1 for demographics). This sample size was deemed sufficient to identify the most important problems (56). Inclusion criteria were able to read and express their thoughts in Dutch, and being 18 years of age or older. The Dutch eHLQ is meant to be used among the general Dutch population. While the ‘general Dutch population’ is an ambiguous definition we used purposive sampling, to ensure a wide variation in terms of demographics, health condition and prior experience with eHealth. Participants were recruited via various channels including posters in public areas of Leiden University Medical Center, various sports clubs in the region, patient organizations and the co-author’s personal network. People interested in participation were contacted by telephone to confirm their interest, to explain the study, and to schedule the interview. The interview was held at a quiet location (mostly the participant’s home). Prior to data collection, written informed consent was collected. Data collection Cognitive interview Cognitive interviews were held to assess the 1) test content and 2) response process. We adopted the validity arguments formulated by Cheng et al. in a validity study on the original eHLQ (41). The validity arguments for test content included themes, wording, format of items, administration and scoring. Assessment of the response process includes assessing whether the items were understood by the respondents as intended by the developers, whether items were understood similarly across subgroups, and whether the number of items, response format and instructions were appropriate. The cognitive interviews were performed by an experienced qualitative researcher (CP) and a research assistant trained in cognitive interviewing, and lasted between 1.5 - 2 hours. The interviews followed a think-aloud approach in which respondents were asked to verbalize their thoughts while completing the questionnaire. This helps to understand the mental processes of respondents as they interpret questions and formulate answers, with minimal interference of the interviewer (57). In addition, problems regarding memory retrieval, ambiguities or unclear perspectives can be elucidated. The think-aloud exercise was complemented by spontaneous and scripted probing (58). Spontaneous probes were used based on a respondent’s response such as signs of hesitation (e.g., responses to certain items taking longer than to other items) and included questions such as ‘I saw you hesitate while answering item [X]. Could you explain why?’. Scripted probing helped to explore items which needed further exploration according to the consensus teams. Scripted probes were ‘what does [word or phrasing] mean to you?’. The subsequent structured part of the interview was guided by a manual containing items and scripted probes. The combination of a respondentdriven approach (think aloud) and an interviewer-driven approach (scripted probing)
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