title: Cognitive testing of human papillomavirus vaccine survey items for parents of adolescent girls.
abstract: OBJECTIVE
  Many studies have been conducted to understand what factors are associated with human papillomavirus (HPV) vaccine acceptability and completion of the 3-dose vaccination series, but few have examined whether people understand the survey items used to assess these relationships. Through a multisite collaborative effort, we developed and cognitively tested survey items that represent constructs known to affect vaccine acceptability and completion.
  
  
  METHODS
  Investigators from 7 research centers in the United States used cognitive interviewing techniques and in-person and telephone interviews to test 21 items. Four rounds of testing, revising, and retesting were conducted among racially and ethnically diverse parents (n = 62) of girls between the ages of 9 and 17 years.
  
  
  RESULTS
  The final survey contained 20 items on attitudes and beliefs relevant to HPV vaccine. Some parents misinterpreted statements about hypothetical vaccine harms as statements of fact. Others were unwilling to answer items about perceived disease likelihood and perceived vaccine effectiveness, because they said the items seemed to have a "right" answer that they did not know. On the basis of these and other findings from cognitive testing, we revised the wording of 14 questions to improve clarity and comprehension. We also revised instructions, response options, and item order.
  
  
  CONCLUSIONS
  Cognitive testing of HPV vaccine survey items revealed important differences between intended and ascribed item meaning by participants. Use of the tested survey questions presented here may increase measurement validity and researchers' ability to compare findings across studies and populations. Additional testing using quantitative methods can help to further validate these items.
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. richmana@ecu.edu
authors.forename: Alice R
authors.initials: AR
authors.lastname: Richman
authors.forename: Gloria D
authors.initials: GD
authors.lastname: Coronado
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Arnold
authors.forename: Maria E
authors.initials: ME
authors.lastname: Fernandez
authors.forename: Beth A
authors.initials: BA
authors.lastname: Glenn
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Allen
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Wilson
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003071:Cognition; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014611:Vaccination / Q000523:psychology
chemical_list: D053918:Papillomavirus Vaccines