Table 1.
Summary of qualitative feedback and proposed changes to CHAI items
| Item | Issue / Comments from Cognitive Interviews | Illustrative Quotes | Proposed Changes |
|---|---|---|---|
| Q1 It is very important that I treat my health as my top priority. | No major concerns; seen as straightforward. Experts deemed it relevant for emphasizing health prioritization. | “That’s [a] clear [question], I should put health first.” (Lay participant) | No change. Item was clear and well-received. |
| Q2 I always know what steps to take when I have a health problem. | Generally easy to understand; participants felt it covered basic self-management steps. One expert noted that “steps to take” could be broad but still acceptable. | “I know to see a doctor or take medicine, but sometimes not exactly which steps.” (Expert) | No change. Participants generally felt the wording was clear. |
| Q3 I always know how to make myself feel better. | Unclear whether “feel better” refers to physical or mental well-being. Some experts found it vague and wondered if it was deliberately so. | “I wasn’t sure if it’s physical or emotional. Maybe they should say ‘improve my well-being’?” (Expert) | Revise to “I always know how to improve my well-being.” |
| Q4 I always know where to look for information before making decisions about my health. | Generally easy to understand. One expert noted it potentially combines two concepts (finding information versus making decisions). Most participants understood it as knowing where to get health information. | “I’m clear on where to find details, but not sure about the ‘making decisions’ part.” (Expert) | Possible split or clarify scope, “I always know where to look for reliable health information.” |
| Q5 I can always take care of myself. | Vague and overly broad (item-level agreement was low). Some experts questioned the relevance of the question and were unsure if it referred to daily self-care, mental health, or managing chronic issues. | “It’s too general, I don’t know if it means daily chores or serious health issues… And no one can always take care of themselves.” (Expert) | Remove or refine to specify context, e.g. “I can always handle my own health needs.” |
| Q6 It is very easy for me to understand my doctor’s instructions. | Item-level agreement relatively low; some experts felt this question related more to “literacy” or knowing rather than doing. Some also preferred the broader term “healthcare provider” rather than “doctor”. Clarity concerns if instructions come from nurses, pharmacists, etc. | “The doctor’s instruction is okay, but we have a multidisciplinary healthcare team today, with nurses, pharmacists, etc.” (Expert) | Revise to “It is very easy to understand instructions from my healthcare provider.” |
| Q7 It is very easy for me to make changes to my daily life to improve my health. | Two experts felt “to my daily life” was unnecessary. Others generally found it implied lifestyle changes appropriately. | “We already know it’s about daily habits. The question can be shortened.” (Expert) | Revise to “It is very easy for me to make changes to improve my health.” |
| Q8 It is very easy for me to follow my doctor’s instructions. | Similar to Q6, clarifying that instructions may come from multiple professionals. Overall clarity was acceptable, but “doctor’s instructions” could be replaced with “healthcare provider.” | “Same as Q6—the instructions don’t always come from a doctor.” (Expert) | Revise to “It is very easy for me to follow instructions from my healthcare provider.” |
| Q9 I always attend all of my doctor’s appointments. | Generally clear; perceived as measuring adherence to recommended appointments. Some experts suggested further specifying “health-related appointments.” | “To me, if you’re serious about health, you won’t no show [miss] for your appointments.” (Lay participant) | Revise to “I always attend all of my health-related appointments.” |
| Q10 I always make the health changes I should even if I do not feel well. | Ambiguity around “health changes” (lifestyle versus medication changes or others? ) Some confusion about persisting with changes despite “not feeling well.” |
“What are health changes? Could you give me some examples?” (Lay participant) “Do they mean not seeing benefits right away or feeling sick from the changes advised but still continuing to do so?” (Lay participant) “If I am running a fever, should I still run because it is a healthy activity otherwise? What is the intention of this question?” (Expert) |
Revise for simplicity and to clarify scope, e.g. “I always make the necessary changes I should (e.g., lifestyle, behaviors, medications).” |
Abbreviations: CHAI, Consumer Health Activation Index