Interpretation of the Avoidance-Endurance Fast-Screen Questionnaire

OBJECTIVES: This study examined how patients with high-impact chronic pain interpreted and responded to the Danish version of the Avoidance-Endurance Fast-Screen (AE-FS) to identify potential problematic items that did not correspond with item intention and causes for this. METHODS: Participants were recruited from patients referred to treatment in an interdisciplinary pain center to partake in cognitive interviews following the Three-Step Test-Interview protocol. Interview transcripts were analyzed in 2 steps. First, a coding analysis was used to code responses in relation to item intention using 4 predefined codes (congruent, incongruent, ambiguous, or confused) to identify potential problematic items (≤50% congruent responses). Second, a reflexive thematic analysis was used to uncover causes of incongruency in the problematic items as well as elements of confusion across all items. RESULTS: Thirty-four participants were included. Three items (1, 4, and 6) were identified as being problematic with items 1 and 4 having many incongruent responses. The most common causes of incongruency were related to formulations of items, and 7 elements of confusion were uncovered across all items. DISCUSSION: The current study identified potential issues with participants' interpretation of 3 items of the AE-FS. However, as interviews may be prone to the influence of social desirability bias, the interpretation of the results for item 4, where the most frequent noncongruent interpretation of making a fuss was equal to lack of pain validation, is done with caution. Therefore, a revision is suggested with reformulation of item 6 and removal of item 1, which, however, will require validation in future research.