Value of cognitive interviewing in the development of the weight stigma in healthcare inventory.

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DOI: 10.1016/j.pec.2023.107767


BACKGROUND: Despite the detrimental effects of weight stigma in healthcare, there is no widely validated measure comprehensively examining such experiences.

OBJECTIVE: We aimed to develop and pilot test an inventory to measure patient experiences of weight stigma in healthcare, and to ensure our items were easily understood.

PATIENT INVOLVEMENT: During our iterative design process, patients assessed whether our inventory items were easy to understand and we included an open-ended comments question.

METHODS: We compiled items from pre-existing tools assessing experiences of weight stigma in healthcare, and developed our own novel items. We conducted field pre-testing with a convenience sample of 48 patients at a Midwest academic internal medicine clinic. We utilized an iterative design process whereby respondents provided feedback on our inventory, we analyzed the data and made revisions, and then repeated the cycle.

RESULTS: Respondents found some of the language in our items confusing; expressed reluctance to speculate on the motivations of healthcare providers; had difficulty with "double-barreled" questions; found some questions vague; and expressed the desire to have weight addressed in clinical encounters neither too much nor too infrequently. We altered items appropriately, and in subsequent rounds of data collection they were easier to understand.

DISCUSSION: Patients found many common weight stigma survey items and some of our novel items confusing. Our modified inventory reduces patient confusion and enhances data quality.

PRACTICAL VALUE: Our study demonstrates the value of cognitive interviewing. Furthermore, the WSHCI will be a useful tool for clinicians and research teams seeking to measure weight stigma in healthcare but first needs to be validated in a larger sample.

FUNDING: This study was supported by the Physician Scientist Training Program, Diabetes Center T32 (DK112751), and the Clinical and Translational Science Award grant funded from the National Institutes of Health (UL1TR002537).

Journal Title

Patient education and counseling



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MeSH Keywords

Humans; Weight Prejudice; Delivery of Health Care; Surveys and Questionnaires; Motivation; Cognition


Cognitive interviewing; Survey design; Weight stigma

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