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Table 6 Examples of actions taken based on results of cognitive review and focus groups, 2012

From: Development of the adult and child complementary medicine questionnaires fielded on the National Health Interview Survey

Question Action taken Justification
Did you see a practitioner for/use [therapy] because it was recommended by a medical doctor? Accept original question Cognitive testing confirmed that respondents were primarily thinking of “Western,” “mainstream” medical doctors when they responded to this question, as intended.
Original question: Did you do breathing exercises as part of [certain therapies]? Accept original question with minor edits Testing revealed that respondents understood “breathing exercises” differently so that some thought it included merely taking a deep breath whereas others thought it was a more formal technique. Therefore, a definition was included in the text of the question.
Final question: Did you do breathing exercises as part of [certain therapies]? Breathing exercises may involve actively controlling the way air is drawn in, or the rate or depth of breathing.
Original question: During the past 12 months, did you see practitioner for/use [therapy] for any of these reasons…” Accept original question with major edits This question was divided into two questions and re-worded so that only respondents using medical treatments were asked whether experiences with medical treatments influenced their use of complementary therapies, and the type of medical treatment is explicit. Cognitive testing of the original question revealed that respondents found the reference to “medical treatments” unclear. For respondents who were not receiving or using any medical treatments, these questions appeared not to be applicable. In fact, a number of respondents specifically commented that these questions were not relevant to their circumstances.
…Medical treatments were not helping you?
…Medical treatments were too expensive?
…[modality] combined with medical treatments would help you?
Revised and restructured into 2 new questions:
Did you receive any of the following medical treatments for
[condition using complementary therapy for]…”
Prescription medications?
Over-the-counter medications?
Physical therapy?
Mental health counseling?
[next question asked for respondents who said yes to any items in question above]?
DURING THE PAST 12 MONTHS, did you see a practitioner for/use [modality] for any of these reasons…
These medical treatments do not work for the health problem you want to treat or prevent?
[next question asked for respondents using prescription medications and/or over the counter medications]
Prescription medications/Over the counter medications cause side effects?
Do you currently see a practitioner for [therapy] more, less or about the same as you did one year ago? Question dropped Question was problematic for respondents who see a practitioner only sporadically or on an “as needed” basis. For instance, one respondent who had used homeopathic treatment in the past 12 months said she only uses it when she has a flare up and therefore found it difficult to compare her current use to her use 1 year ago. Similarly, a respondent who did not practice yoga with any regularity had difficultly answering.
Original question: During the past 12 months, did you see a practitioner for/use [therapy] because it is how you were raised? New question written Although the meaning is similar, this item was re-worded to better capture the way some respondents are influenced to use complementary therapies by cultural factors. When hearing the original question, several respondents hesitated and seemed to find the original wording awkward, evidenced by one respondent who said, “That sounds very odd.” The phrasing “how you were raised” suggested a more deliberate action than merely being exposed to complementary therapies at an early age. “It was part of your upbringing” better captured unintentional or cultural exposure which was the intent of the item.
Final item: During the past 12 months, did you see a practitioner for/use [therapy] because it was part of your upbringing?
General wording of "disease or health problem" found in many questions Modified Changing wording to "health problems, symptoms, or conditions" is more comprehensive and inclusive
DURING THE PAST 12 MONTHS, did you or another family member get information about [fill1: modality] from any of the following sources? Question written (didn’t exist previously) Information sources about complementary therapies was identified as an important and missing topic during focus groups
The internet?
Books, magazines, or newspapers?
Television or radio?
Scientific articles?
Health food stores?
[fill1: Not including the practitioner [fill: S.C. name] saw for [fill2: modality] DURING THE PAST 12 MONTHS, did you let [fill S.C. name]’s personal health care provider know about [fill: his/her] use of [fill3: modality]? Question written (didn’t exist previously) Communication about complementary medicine use with other health care providers was identified as an important and missing topic during focus groups
If no, why not:…
[fill: S.C. name] was not using it at the time?
They discouraged use of it in the past?
You were worried they would discourage it?
You were concerned about a negative reaction?
You didn’t think they needed to know?
They didn’t ask?
You don’t think they know as much about it as you do?
They didn’t give you enough time to tell them?