Cognitive Interviewing to Assess a New Measure of Attitudes and Beliefs Held by Candidates for Bariatric Surgery

Increases in the obese population of the United States have subsequently led to increases in the numbers of bariatric surgeries pursued. However, despite increases in the number of surgeries performed, the success rate of the surgeries still remains acutely tied in with adherence to lifestyle modifications post-surgery, which are products of individuated attitudes and beliefs. Identification of these variables pre-surgery may enable health-care professionals to brainstorm preemptive intervention techniques aimed at providing support to bariatric patients post-surgery. However, no measures to identify such attitudes and beliefs exist. This qualitative study utilized Cognitive Interviewing to assess sources of response error in two new measures designed to identify attitudes and beliefs of candidates for bariatric surgery. Our hypothesis was that the newly created measures would be easy to understand and answer. METHODS: Twenty patients attending a bariatric clinic were offered $20 gift cards to answer questions on The Eating Behaviors Self-Efficacy Measure and The Perceived Barriers to Exercise Measure. A standardized instruction script asking participants to “thinkaloud” while answering questions was read before each interview. Interviews were audio recorded and transcribed to assess similarities in sources of response error. RESULTS: The majority of participants (90%) struggled with understanding/executing instructions of the measures. In addition, several specific items were identified as sources of confusion. Recommendations to reduce sources of response error were made to the test-makers. CONCLUSION: Although the hypothesis was not supported, future adaptation of recommendations could decrease most sources of response error. Additional Cognitive Interviewing after instrument refinement was recommended. After revision, The Eating Behavior Efficacy Measure and The Perceived Barriers to Exercise Measure should receive pilot testing in a longitudinal investigation of the scales’ validity and reliability for clinical use.