Cognitive testing of the STAR-Q: insights in activity and sedentary time reporting.

PURPOSE The qualitative attributes and quantitative measurement properties of physical activity questionnaires are equally important considerations in questionnaire appraisal, yet fundamental aspects such as question comprehension are not often described in the literature. Here we describe the use of cognitive interviewing to evaluate the Sedentary Time and Activity Reporting Questionnaire (STAR-Q), a self-administered questionnaire designed to assess overall activity energy expenditure and sedentary behavior. METHODS Several rounds of one-on-one interviews were conducted by an interviewer trained in qualitative research methods. Interviewees included a convenience sample of volunteers and participants in the Tomorrow Project, a large cohort study in Alberta, Canada. Following each round of interviews the STAR-Q was revised and cognitively tested until saturation was achieved. RESULTS Six rounds of cognitive interviewing in 22 adults (5 males, 17 females) age 23-74 years, led to revisions involving 1) use of recall aids; 2) ambiguous terms; and 3) specific tasks, such as averaging across multiple routines, reporting time asleep and self-care, and reporting by activity domain. CONCLUSIONS Cognitive interviewing is a critical step in questionnaire development. Knowledge gained in this study led to revisions that improved respondent acceptability and comprehension of the STAR-Q and will complement ongoing validity testing.

[1]  Heather K. Neilson,et al.  Estimating activity energy expenditure: how valid are physical activity questionnaires? , 2008, The American journal of clinical nutrition.

[2]  J. Last,et al.  Making the Dictionary of Epidemiology. , 1996, International journal of epidemiology.

[3]  Michael J Thun,et al.  American Journal of Epidemiology Original Contribution Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of Us Adults , 2022 .

[4]  Felix Ehrlenspiel,et al.  Cognitive Interviewing: A Qualitative Tool for Improving Questionnaires in Sport Science , 2010 .

[5]  J. Sallis,et al.  Physical activity assessment methodology in the Five-City Project. , 1985, American journal of epidemiology.

[6]  Heather K. Neilson,et al.  Practice of Epidemiology Reliability and Validity of the Past Year Total Physical Activity Questionnaire , 2005 .

[7]  Walter C Willett,et al.  Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. , 2003, JAMA.

[8]  S. Hooker,et al.  The effect of question order on reporting physical activity and walking behavior. , 2008, Journal of physical activity & health.

[9]  D. Nieman,et al.  Sedentary Activity Associated With Metabolic Syndrome Independent of Physical Activity , 2012 .

[10]  P. Robson,et al.  Population-based cohort development in Alberta, Canada: a feasibility study. , 2006, Chronic diseases in Canada.

[11]  M. Pratt,et al.  Lessons learned after 10 years of IPAQ use in Brazil and Colombia. , 2010, Journal of physical activity & health.

[12]  D. Collins.  Pretesting survey instruments: An overview of cognitive methods , 2003, Quality of Life Research.

[13]  B E Ainsworth,et al.  The recall of physical activity: using a cognitive model of the question-answering process. , 1996, Medicine and science in sports and exercise.

[14]  D. Casey,et al.  Issues in using methodological triangulation in research. , 2009, Nurse researcher.

[15]  G. Willis,et al.  Research Synthesis: The Practice of Cognitive Interviewing , 2007 .

[16]  Caroline B. Terwee,et al.  Physical Activity Questionnaires for Adults , 2010, Sports medicine.

[17]  Robert L. Hill,et al.  What do IPAQ questions mean to older adults? Lessons from cognitive interviews , 2010, The international journal of behavioral nutrition and physical activity.

[18]  Schofield Wn,et al.  Predicting basal metabolic rate, new standards and review of previous work , 1985 .

[19]  Miquel Porta,et al.  A Dictionary of Epidemiology , 2008 .

[20]  D. Berrigan,et al.  Cognitive testing of physical activity and acculturation questions in recent and long-term Latino immigrants , 2010, BMC public health.

[21]  J. S. Stevenson,et al.  Triangulation: Operational Definitions , 1991, Nursing research.

[22]  W. Mechelen,et al.  Self-Administered Physical Activity Questionnaires for the Elderly , 2010, Sports medicine.

[23]  B E Ainsworth,et al.  Compendium of physical activities: an update of activity codes and MET intensities. , 2000, Medicine and science in sports and exercise.

[24]  Frederick Conrad,et al.  FROM IMPRESSIONS TO DATA: INCREASING THE OBJECTIVITY OF COGNITIVE INTERVIEWS , 1996 .

[25]  W. Mechelen,et al.  Physical Activity Questionnaires for Youth , 2010, Sports medicine.

[26]  C. Matthews,et al.  Too much sitting: the population health science of sedentary behavior. , 2010, Exercise and sport sciences reviews.

[27]  Tamara B Harris,et al.  Daily activity energy expenditure and mortality among older adults. , 2006, JAMA.

[28]  D. Warburton,et al.  A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults , 2010, The international journal of behavioral nutrition and physical activity.

[29]  Brigid M Lynch,et al.  Sedentary Behavior and Cancer: A Systematic Review of the Literature and Proposed Biological Mechanisms , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[30]  B. Sternfeld,et al.  Physical activity questionnaire comprehension: lessons from cognitive interviews. , 2009, Medicine and science in sports and exercise.

[31]  H. Sesso.  Invited commentary: a challenge for physical activity epidemiology. , 2007, American journal of epidemiology.

[32]  D. Mignault,et al.  Relationship between the metabolic syndrome and physical activity energy expenditure: a MONET study. , 2008, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[33]  Caroline B. Terwee,et al.  Qualitative Attributes and Measurement Properties of Physical Activity Questionnaires , 2010, Sports medicine.

[34]  E. McColl.  Cognitive Interviewing. A Tool for Improving Questionnaire Design , 2006, Quality of Life Research.

[35]  Gregory J Welk,et al.  Differences in Daily Energy Expenditure in Lean and Obese Women: The Role of Posture Allocation , 2008, Obesity.

[36]  M. Clark,et al.  Interindividual Variation in Posture Allocation: Possible Role in Human Obesity , 2005, Science.

[37]  C. Bouchard,et al.  Sitting time and mortality from all causes, cardiovascular disease, and cancer. , 2009, Medicine and science in sports and exercise.

[38]  Lewis H Kuller,et al.  Development of Questionnaire to Examine Relationship of Physical Activity and Diabetes in Pima Indians , 1990, Diabetes Care.

[39]  T. Jørgensen,et al.  Construct validity of a revised Physical Activity Scale and testing by cognitive interviewing , 2010, Scandinavian journal of public health.