Figure 1. Description of instrument domains and item revision process.
Domain
Domain Description
Changes
Resulting from
Experts (n=3)a
Changes
Resulting from
Survivors (n=18)b
Remaining
Items (n)
Nutrition &
Health
Brief text adapted from the
American Cancer Society
nutrition recommendations
followed by questions in cloze
procedure format
Multiple choice questions that
require knowledge of foods
containing carbohydrate,
protein, and fat
Food photographs with a
description of the portion size
are presented, and the
individual must decide if the
portion depicted is a
recommended portion.
An example nutrition facts
panel is provided with
questions requiring use of the
example.
A list of commonly consumed
foods is provided, and the
individual must organize the
list into the correct USDA food
categories
Photographs of food or food
packaging are presented, and
individuals must choose
between options based on the
issue in question.
Deleted 1 item,
Modified instructions,
Modified 7 items
Deleted 1 item
Modified 3 items
10
Deleted 2 items
Modified 1 item
Modified instructions
10
Deleted 3 items,
Modified instructions,
Modified 2 items
Modified instructions
9
Deleted 2 items,
Modified 5 questions
Modified 3 items
10
Deleted 1 item
Provided example
None
15
Deleted 2 items,
Modified 3 items
None
10
Macronutrients
Household
Food
Measurements
Food Label &
Numeracy
Food Groups
Consumer
Skills
Experts in breast cancer nutrition ranked each item’s relevance and clarity and whether to
delete. These rankings informed item decisions.
a
b
Breast cancer survivors were interviewed about their thoughts and feelings about the
instrument as they read it aloud, using cognitive interviewing techniques. Responses were used
to inform item decisions.