Table 2.

Examples of items revised during cognitive interviewing based on: participant think aloud and interviewer probing.

Sample revised items (with intended diagnostic domain)	Reason for revision
Original item: I felt anxious. Revised item: I had anxiety. (Anxiety)	Participants, particularly those in the South, sometimes defined anxious in the context of “I felt anxious” as excited or eager (eg, “I was anxious to go to the fair”). The noun form, however, did not have the same additional connotation; therefore, the item was revised to use the noun form of anxiety.
Original item: I thought I might be God’s personal messenger on Earth. Revised Item: I am the only person who can do God's work on Earth. (Psychotic disorders-religious delusions )	The original item produced a high base rate of endorsement among devoutly religious participants. The revised item is distinct from the notion that all people are God’s children or messengers.
Original instructions: Now I’m going to ask you about things you thought you might have seen while you were fully awake and it was light . Revised instructions: Now I’m going to ask you about things you might have seen while you were fully awake and there was enough light to see clearly. (Psychotic disorders-visual hallucinations)	Participant thinks aloud and interviewer probing responses indicated high endorsement because of the appearance of shadows due to dim light. The revised instructions clarify that visual hallucinations were present when enough light was present to see clearly (ie, eliminate shadows).