Mixed-methods analysis of select issues reported in the 2016 World Health Organization verbal autopsy questionnaire

• Published in: PloS one 2022-10, Vol.17 (10), p.e0274304-e0274304
• Main Authors: Nichols, Erin, Pettrone, Kristen, Vickers, Brent, Gebrehiwet, Hermon, Surek-Clark, Clarissa, Leitao, Jordana, Amouzou, Agbessi, Blau, Dianna M, Bradshaw, Debbie, Abdelilah, El Marnissi, Groenewald, Pamela, Munkombwe, Brian, Mwango, Chomba, Notzon, F. Sam, Biko Odhiambo, Steve, Scanlon, Paul
• Format: Article
• Language: English
• Subjects: Analysis; Autopsies; Autopsy; Biology and Life Sciences; Birth weight; Cognitive ability; Confusion; Data collection; Datasets; Dementia disorders; Design; Diagnosis; Health surveys; Interviews; Medical diagnosis; Medicine and Health Sciences; Methods; Mixed methods research; Mortality; Neonates; Performance evaluation; Qualitative analysis; Qualitative research; Quantitative analysis; Questionnaires; Questions; Redundancy; Research and Analysis Methods; Series (mathematics); Surveillance; Teams; Tobacco; Ulcers; Vaccination; Vomiting
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0274304

Background Use of a standardized verbal autopsy (VA) questionnaire, such as the World Health Organization (WHO) instrument, can improve the consistency and reliability of the data it collects. Systematically revising a questionnaire, however, requires evidence about the performance of its questions. The purpose of this investigation was to use a mixed methods approach to evaluate the performance of questions related to 14 previously reported issues in the 2016 version of the WHO questionnaire, where there were concerns of potential confusion, redundancy, or inability of the respondent to answer the question. The results from this mixed methods analysis are discussed across common themes that may have contributed to the underperformance of questions and have been compiled to inform decisions around the revision of the current VA instrument. Methods Quantitative analysis of 19,150 VAs for neonates, children, and adults from five project teams implementing VAs predominately in Sub-Saharan Africa included frequency distributions and cross-tabulations to evaluate response patterns among related questions. The association of respondent characteristics and response patterns was evaluated using prevalence ratios. Qualitative analysis included results from cognitive interviewing, an approach that provides a detailed understanding of the meanings and processes that respondents use to answer interview questions. Cognitive interviews were conducted among 149 participants in Morocco and Zambia. Findings from the qualitative and quantitative analyses were triangulated to identify common themes. Results Four broad themes contributing to the underperformance or redundancy within the instrument were identified: question sequence, overlap within the question series, questions outside the frame of reference of the respondent, and questions needing clarification. The series of questions associated with one of the 14 identified issues (the series of questions on injuries) related to question sequence; seven (tobacco use, sores, breast swelling, abdominal problem, vomiting, vaccination, and baby size) demonstrated similar response patterns among questions within each series capturing overlapping information. Respondent characteristics, including relationship to the deceased and whether or not the respondent lived with the deceased, were associated with differing frequencies of non-substantive responses in three question series (female health related issues, tobacco use, and bab