Use of cognitive interview techniques in the development of nutrition surveys and interactive nutrition messages for low-income populations

The effectiveness of dietary surveys and educational messages is dependent in part on how well the target audience's information processing needs and abilities are addressed. Use of pilot testing is helpful; however, problems with wording and language are often not revealed. Cognitive interview techniques offer 1 approach to assist dietitians in understanding how audiences process information. With this method, respondents are led through a survey or message and asked to paraphrase items; discuss thoughts, feelings, and ideas that come to mind; and suggest alternative wording. As part of a US Department of Agriculture-funded nutrition education project, 23 cognitive interviews were conducted among technical community college students in North Carolina. Interview findings informed the development of tailored computer messages and survey questions. Better understanding of respondents' cognitive processes significantly improved the language and approach used in this intervention. Inter-view data indicated 4 problem areas: vague or ineffective instructions, confusing questions and response options, variable interpretation of terms, and misinterpretation of dietary recommendations. Interviews also provided insight into the meaning of diet-related stages of change. These findings concur with previous research suggesting that cognitive interview techniques are a valuable tool in the formative evaluation and development of nutrition surveys and materials.