I have noticed that quite a few respondents react negatively when you ask them to explain how they understand certain generic concepts such as “satisfied with treatment,” “to control life,” “everyday activities,” and “social life.” A typical response would be: “I do not understand what ‘everyday activities’ means. That’s not how people talk! No, really, what do you mean by ‘everyday activities’? It makes no sense to me at all. Explain to me what you mean here by everyday activities.” But when you ask more specific questions – for instance, you ask the respondent to try to think of some examples of “everyday activities,” the respondent’s answers show that they understand the concept perfectly well.
What does this mean for translators of questionnaires? How do we interpret the results meaningfully and how do we avoid making misleading conclusions? Importantly, the respondent’s first reaction does not actually show how they understand the translated item. It shows that the respondent feels uncomfortable having to explain a word/ expression that means different things to different people. Indeed, interpretation of generic concepts depends entirely on the respondent’s personal experience. Also, these concepts might be difficult to rephrase. So I think it is not necessary to record verbatim what such a respondent says during a Cognitive Debriefing report; it is not informative for the developer. I think it is enough to record only the evidence of respondents’ actual understanding of a word/expression, for instance, the examples they provide.