Applying cognitive design principles to formatting HRQOL instruments

Researchers developing or using health-related quality of life (HRQOL) inst ruments can benefit from knowledge of state-of-the-art formatting methods f or self-administered questionnaires. Three objectives in formatting design are: (1) to reduce errors in respondent navigation through the questionnair e that lead to item non-response and question misinterpretation; (2) to red uce respondent and administrative burden; and (3) to enhance respondent mot ivation in question answering and compliance with the request to participat e. Based on an extensive literature review to identify techniques that have been shown to meet these objectives, we developed specific guidelines for HRQOL instruments concerning all aspects of questionnaire formatting. These guidelines represent well-motivated recommendations for improving HRQOL in struments, although their overall impact has not been empirically tested. W e applied the guidelines to several HRQOL instruments that are widely used internationally, and obtained approval from the developers for all formatti ng changes to their instruments. Applying cognitive design principles and e mpirically substantiated formatting techniques produces an HRQOL instrument formatting with six critical attributes: simple, consistent, organized, na tural, clear and attractive. The present paper contributes to the emerging research literature on the cognitive processes by which respondents answer HRQOL questions and demonstrates how 'cognitive aspects of survey methodolo gy' research can improve HRQOL data collection efforts.