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Table 5 Coding framework for cognitive interviews and frequency of issues

From: Development of a measure for patients preparing to start dialysis and their partners: The Starting Dialysis Questionnaire (SDQ)

Aspects of information processing Definition Examples Questions
Difficult item Delay in comprehending question meaning and difficulty answering Q17: Dialysis affects patients’ lives in various ways and in early dialysis it is unlikely they could manage many tasks (2/10) Q7, 8, 11, 12, 17
Wording Issue with wording or phrasing of the question Q9: ‘Normal life’ discussed and ‘daily life’ suggested (3/10) Q3, 7, 9, 12, 15, 20, 32
Need for clarification Participant needed more information to answer question Q29: Patients asked if it included time on dialysis or just when they were off it (4/10) Q1, 2, 29
Misinterpretation Question not interpreted the way it was intended Q21: Both patients and partners thought question asked about their own positivity (3/10) Q21, 22, 29
Multiple interpretations There are two or more possible interpretations Q27: Talked about communication in regard to wider context rather than within couple and did not like phrasing (5/10) Q10, 13, 16, 27, 31
Semantic difficulties The meaning of a word or phrase is not understood Q1: Definition of QOL questioned and noted that everyone may define it differently (1/10) Q1
Hesitation Excessive pausing or re-reading while comprehending the question Q26: Re-read question two times but confidently marked answer (1/10) Q26
Incomprehension The meaning of the question is not understood NA  
Lack of information Participants did not have knowledge that could inform question Q3: Partners stated they had no or low expectations (3/10) Q1, 3, 5, 16
Relevance The extent to which the question is relevant to their experience Q23: Partners commented that during early dialysis they did not express their feelings because they were focusing on being positive or still learning about dialysis (2/10) Q1, 13, 14, 15, 21, 22, 23, 28
Repetition A question has the same meaning as a previous one Q7: Question similar to other Q9, Q16, Q17 (3/10) Q7, 8, 11, 24, 25, 26
Time frame Refers to the reference point for answering the question Q1: Patient considered question in reference to QOL before chronic kidney disease rather than last 2 weeks (1/10) Q1, 2, 9, 34
Hesitation Excessive pausing or hesitation Q10: Partner thought about patient’s engagement in overall treatment (1/10) Q3, 8, 10, 12, 25
Response scale confusion Difficulty when marking response on the scale Q22: Selected 1 when verbal reasoning indicated a score of 5 (1/10) Q7, 22, 31, 33
Missed question Question not answered, either intentionally or accidentally Q13: Spoke about the question but could not select a response (1/10) Q3, 12, 13
Response scale wording Issues with wording of the response scale Q32: Difficult to differentiate between 4 = A great deal and 5 = Completely (1/10) Q1, 7, 32
Response scale scoring Issues with the scoring of the response scale Q12: Noticed the scoring was different from previous questions (reverse scored) and recommended changing it to prevent mistakes (1/10) Q2, 12, 25
Formatting Changes to format recommended Q9: Recommended moving it after Q6 (1/10) Q4, 5, 9
Positive feedback    
Important question** Question highlighted as important Q6: Patient said it was key to adapting to dialysis (1/10) Q6, 33, 34
Good question Participant states that a question is good Q12: Patient stated they liked it because it asked about an often-overlooked topic (1/10) Q12, 20, 21, 22
Straight-forward question** Participant states a question is straight-forward Q11: Patients stated it was a clear question (2/10) Q11
  1. The question numbers match the item tested during the cognitive interviews (the developing versions of the Patient-Dialysis version of the Starting Dialysis Questionnaire, see Additional file 2). Adapted from [9]
  2. *Retrieval was added to the framework and adapted from [8], p. 38
  3. **Codes added by the research team
  4. Italic question numbers indicate deleted questions