After winnowing, each domain group had a set of items to carry forward for review
by researchers and by potential respondents. This item set included items with a
range of styles in phrasing, time frame of recall, response options, and literacy
demands. Because of these variations, the items would be difficult to administer
as a coherent test or on a CAT administration in their current form. PROMIS investigators
made a substantial effort to create and use items that were accessible for a variety
of literacy levels and that had little ambiguity or cognitive difficulty. As part
of this effort, PROMIS favored uniformity in format when evidence did not suggest
that diversity is better. The next phase of QIR involved item review and revision
to provide consistency of style of questions, ease the literacy requirements of
respondents, and apply a consistent set of response options and time frames. Network
PRO experts worked to reach consensus on the item guidelines to be used across domains,
including response options and time frame.
Items retained after the binning and winnowing process had numerous styles of language,
instructions, recall periods, and response options. The Network recognized that
most items would need some level of revision to adhere to the PROMIS format and
to incorporate the PROMIS response option and recall period conventions. We also
recognized that this was the opportunity to clarify vague or multibarreled questions
before taking them to the field. Many questions also used language that was outdated,
difficult to translate, or unnecessarily complex and could also be corrected during
the item revision process. Items were revised by Network experts in the specific
domain. When revising the items, writers made the following assumptions:
- items would need to stand alone, as only 1 item would be administered at a time
on a computer screen;
- all items would have similar context statements (eg, "In the past 7 days,");
- all else being equal, items should be as concise and simply worded as possible;
- items should be worded to use one of the preferred response options if possible.
The text above is an excerpt from the DeWalt et al, 2007 Medical Care manuscript.
For a full summary of the process please reference the following manuscript: DeWalt,
D.A., Rothrock, N., Yount S., Stone, A., on behalf of the PROMIS Cooperative Group.
Evaluation of Item Candidates
– The PROMIS Qualitative Item Review. Med Care 2007; 45: S12–S21.