Testing and adapting dietary habits and food security questions for a national nutrition survey using cognitive interviews and expert consultation

Abstract

Objective: To cognitively test questions for inclusion in a national nutrition survey, ensuring the questions are interpreted as intended and to inform further improvements.

Design: A draft nutrition survey questionnaire was developed based on existing questionnaires and expert input. Twelve questions on dietary habits and food security were selected for cognitive testing as these were newly developed, amended from existing questions, or identified to no longer reflect the current food environment or concepts. Cognitive interviews were conducted using both think-aloud and probing techniques to capture respondents’ thought processes used to arrive at an answer. Interviews were audio recorded and transcribed verbatim. Qualitative data were analysed for recurring patterns and unique discoveries across the survey questions.

Setting: New Zealand.

Participants: Sixty-eight participants aged 11 years and older representing diverse sociodemographics including gender, ethnicity, and education level.

Results: Three main cognitive challenges were identified: 1) interpreting ambiguous terms, 2) understanding of dietary or technical terms, and 3) following complex or unclear instructions. Questions were refined based on the study findings and further advice from experts in nutrition and survey design to enhance participant understanding and accuracy.

Conclusion: The cognitive testing findings and expert input led to the refinement and potential improvement of selected questions for inclusion in a national nutrition survey. Changes included simplified terminology, clearer instructions, improved examples, and better question order. Our methodological approach and findings may be valuable for those designing similar questions for dietary surveys.