Development Of A Patient-Reported Outcome Measure For Recovery After Major Abdominal Surgery: Stage 2 Cognitive Interview Study

This study is the second qualitative stage in developing a patient-reported outcome measure (PROM) for adults recovering after major abdominal surgery (MAS). Stage 2 focuses on cognitive evaluation of the draft questionnaire content produced from Stage 1 concept elicitation. The objective is to assess whether participants understand the questionnaire instructions, items, response options, and recall period as intended, and to identify item-level problems that require revision, deletion, or retesting. Semi-structured cognitive interviews are conducted remotely using concurrent verbal probing, informed by Tourangeau’s cognitive model of survey response and problem-coding approaches for identifying comprehension, retrieval, judgement, and response-mapping issues. Iterative cycles of testing and revision continue until cognitive saturation criteria are met and a finalised item pool is produced. Outputs include an auditable item-tracking matrix documenting all changes and the final item pool for subsequent drafting and further PROM testing.