The ATA Chronicle - November/December 2021 - 22

voice to come through in
the translated content and
ensures that the correct
terminology is used. Some
companies encourage the
cognitive interviewer to
use a visual analog scale to
assess how well the target
group comprehends the
translated response options.
For example, a visual scale
ranging from 0 to 100%, in
which 0 represents Not at
all and 100 represents Very
much, would enable the
respondent to better express
the value (e.g., intensity) to
each option by pointing at
a place on the scale. Using a
card ranking game is another
useful strategy. A respondent
is asked to arrange the
selected response options in
an order that makes sense
to them (e.g., Not at all at the
top of the page, Very much at
the bottom, and other terms
in a continuum).
Recruiting Participants
Before cognitive debriefing
can begin, you or your
project manager must
recruit in-country for
both investigators and
respondents, which can
prove challenging. Some
projects require the
recruitment of five healthy
adult patients, which is
generally easy to do. Other
projects are more difficult
because they may require
five patients with a specific
diagnosed condition. For
example, I've had to find five
patients with gastroenteritis,
and a recent project required
me to recruit 10 patients with
blood cancer, ideally chronic
myeloid leukemia.
As a general rule, the
selected participants
within the target countries
should be diverse in terms
education level, gender,
and age. In most cases, the
primary selection criterion
is to find patients with the
required medical condition
being studied.
The project manager
usually allows up to four
weeks for the recruitment
process. I typically need
to report the status of the
recruitment on a weekly
basis. I'm encouraged to
use chat rooms, message
boards, networking sites,
national support groups,
patient associations,
professional websites,
hospitals, doctors, and
private practices as resources
to find participants.
Treatment doctors who
know the patient well also
serve as good contacts,
but they're often busy and
sometimes hard to contact.
In recent years, I've found
that cancer support groups
and clubs (e.g., Gilda's Club)
are excellent resources for
potential recruitment, and
there's one in most big
cities. The club's chair can
be the first point of contact,
as they often have a good
relationship with members.
Members usually trust the
chair and can be open to
being interviewed if the chair
encourages them.
From my experience,
successful recruitment also
depends on how well the
company communicates to
potential participants. One
company I've worked with
prepares excellent recruiting
forms, including patient
consent and privacy notice
forms that clearly state
the project's purpose, the
specific things participants
are expected to do, tangible
benefits and potential risks,
and how privacy will be
22 The ATA Chronicle | November/December 2021
protected. All forms should
be written in plain language
and be translated into the
target language.
Companies have different
policies regarding payment
for participants. As a
recruiter, I've learned that
companies who are willing
to reimburse participants,
doctors, medical personnel,
or the heads of patient
associations for their
efforts have higher rates
of success compared to
those who don't. If I receive
a request for cognitive
debriefing from companies
that don't at least mention
payment for the patients,
I ask the project manager
if there's the possibility
for compensation. Though
many patients don't need
it, offering a small sum is
something the company can
do to express appreciation
for their participation. I also
tell the project manager I'm
uncomfortable contacting
patients with a chronic
disease to ask them to
spend 30-45 minutes for an
interview without payment.
In many cases, the project
manager will talk to the
project lead and perhaps
spend a portion of the
project budget to compensate
participants.
Conducting Cognitive
Interviews
Companies normally provide
the recruiter and interviewer
with some training for
cognitive debriefing. Before
conducting real interviews
with selected patients,
companies usually ask me to
complete a practice interview
and record the data on a
data collection form (DCF)
to be sent back to the project
manager. This will enable the
project manager to confirm
that I'm on the right track
and approve the DCF before
I proceed to interview the
selected patients.
There are many good tips
for cognitive debriefing
interviewing available
online.2
is that interviewers need
to do everything possible
to ensure that participants
feel comfortable before and
during the interview.
As I mentioned previously,
face-to-face interviews
are ideal for cognitive
debriefing. However, during
the pandemic face-to-face
interviews have proven
difficult, so interviews
can be done via phone or
remote video conferencing.
Remote interviews can allow
the interviewer to conduct
the job without being in
the country where the
participants live. This has
been good for me. When I
was stuck outside my home
country due to the pandemic,
I was still able to call to set
up interviews with people
there. For virtual interviews,
the interviewer needs to
make sure participants
receive the questionnaire,
ideally in printed form, to
use during the interview. If
the questionnaire is online,
participants are encouraged
to open it using a laptop
or an iPad rather than a
smartphone. (I did have
problems with participants
who weren't able to see the
questionnaire well because
of the tiny screen on their
smartphones.) Additionally,
for virtual interviews, visual
analog scales or card ranking
games originally designed
for use during face-to-face
meetings may need to be
www.atanet.org
The general principle
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