Validation of diabetes health-related quality-of-life instruments using cognitive interviewing with older African Americans.

The reliability and validity of two diabetes-specific quality-of-life instruments were examined with aging African Americans with limited literacy. Cognitive interviews with 15 persons and content analysis were conducted. Participants' mean age was 72 years, and 40% had less than a high school education. Most observed problems with the surveys related to comprehension and response categories. Respondents had difficulty distinguishing between certain functional limitations and/or level of satisfaction as being associated with chronic illness or aging. This study underscores the need for research with special populations on the appropriateness of instruments previously validated and shown reliable for more general populations. While cognitive interviewing is resource intensive, ignoring this investment may result in inappropriate interpretations about the effectiveness of interventions to improve care and outcomes, understand differences, and eliminate disparities.