The contribution of lexical analyses of the wording in cognitive interviews during the Cf-EQ-5D Italian translation

Objective: As a part of the CF-EQ-5D harmonization project, descriptive and statistically based lexical analyses of the semi-directive cognitive have been performed within the translation procedure. The main goal is to identify potential problems of comprehensibility and ambiguity in the First Final Forward Translation (FFT1) of the Italian CF-EQ-5D, in order to contribute to the formulation of comprehensible, unambiguous, and reliable items in the final version of the CF-EQ-5D. Methods: After the completion of the FFT1, cognitive interviews based on paraphrasing approach have been collected from a group of Italian native speakers children/adolescents (aged 8-15; resident in different parts of Italy) and their mothers. First of all, a content analysis of participants’ paraphrases of each sentence of the EQ-5D has been performed; answers and have been coded into different categories that differentiate paraphrases on the basis of their congruence with the intended meaning of the sentence. Subsequently, transcripts of the cognitive interviews have been analysed with descriptive and multivariate statistical methodologies fit for textual data, in order to: a) detect the semantic fields associated to each item of the pilot CF-EQ-5D; b) verify whether multiple semantic fields are associated to the same item. Results: Results show that the overall the formulation of the Italian CF-EQ-5D and of three of the five dimensions is clearly understood by the young respondents and their mothers, so that no modification are suggested. Ambiguities appear concerning one domain of the questionnaire and two response sets. Also the VAS instructions appear to be understood with some difficulty. Recommendations for possible improvements in the Second Final Forward Translation of the CF-EQ-5D are provided.