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Table 3 General Design Issues and Revisions

From: Cognitive testing of the Colon Cancer Screening Behaviours Survey with South Asian immigrants in Canada

General Design
Issue & Survey Description Revisions
Skip pattern Knowledge Item: “Before this test was described, had you ever heard of a home stool test?” Two participants, one in each group indicated that while they had not heard of the home stool test and perhaps did not recognize it, they had the procedure at some time. This was uncovered later in the survey after they had already responded to the first item. Cognitive interviewer instructions were inserted after this item: “If participant states NOT HEARD but states they HAD the test, go to question that asks if they had the test and revise.”
Urdu language
English language
Format and position of item in survey Colon Cancer Practice Item: “Do you plan to go for any other type of colon cancer screening test in the future?” was problematic for a number of participants (Urdu, n = 3) because at this point in the survey, colonoscopy had not been explained. These participants provided comments that they did not know about any other tests. Additionally, during joint collaborative analysis, it was determined that participants provided the rationale that they would only do a test with physician recommendation. Given that the test requires a doctor’s order in Canada, it was noted that additional information regarding this would be important to include. This item was relocated after the description of colonoscopy and related items. Modification of the item was also indicated to include doctor advice. “Do you plan to go for any other type of colon cancer screening test if your doctor ordered the test (for example, a colonoscopy)?”
Urdu language
Missing response category Socio-demographic Item: “In your household, tell us the individuals who make up your family: Mark all that apply.” Most participants in both groups stated they also lived with children. This was not included in the response categories for the socio-demographic item on household. During the interview, the cognitive interviewer added this with written notes. An additional response category was added: “Living with own children”.
Urdu language
English language
Response category 3 Scale Items (Percieved barriers): “Having a colonoscopy is painful.” “Having to follow a special diet and taking a laxative would keep you from having a colonoscopy.” “You are afraid to have colonoscopy because of the possibility there may be bleeding or tearing of the colon.” English language participants who lacked knowledge provided additional comments that they “did not know”. Responses were in line with what was expected in these items, which was “I neither agree or disagree”. No revisions were indicated. The rationale was that participant’s responses were in line with the goals of testing the items. Only English language participants and no Urdu language participants had this issue related to their not having had a colonoscopy.
English language
Item relevance 2 Scale Item (Perceived barriers): “The cost would keep you from having a home stool test.” “The cost would keep you from having a colonoscopy.” The cost were clear for all participants. One issue arose for both Urdu and English language participants; their general knowledge of the test was that it was paid for by the Ontario Health Insurance Plan (Round 1 English, n = 3; Round 2 Urdu, n = 3 and English, n = 2). During joint collaborative analysis discussions, it was felt that some participants’ may be confused and not know if there was a cost, especially if they lacked knowledge. No revisions indicated. Further discussion was undertaken and it was decided to retain these items so that further testing could be done through pilot testing with a larger population.
Urdu language
English language