Lessons Learned: Adapting a Health Impact Assessment Tool Using Cognitive Interviews

<div class="OutlineElement Ltr SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;"> <p class="Paragraph SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px -2px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW179010292 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.5042px; font-family: 'Times New Roman', 'Times New Roman_EmbeddedFont', 'Times New Roman_MSFontService', serif;" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">Introduction: The National Institutes of Health (NIH) supported the Rapid Acceleration of Diagnostics-Underserved Populations (</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">RADx</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">-UP) program, which aims to ensure that all Americans have access to COVID-19 testing and promotes health equity, especially in underserved communities. Under </span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">RADx</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">-UP, there are two pilot programs &mdash; Community Collaboration Grants (C2G) and Rapid Research Pilot Program (RP2) &mdash; that fund projects to conduct community-engaged outreach and research to address COVID-19 testing disparities. Our evaluation team used cognitive interviews with project representatives to revise an existing Health Impact Assessment tool to measure health equity </span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">impacts</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;"> within these community-centered programs. We highlight our process of adapting the original tool and share lessons learned that other evaluators may apply to their work.</span></span><span class="EOP SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.5042px; font-family: 'Times New Roman', 'Times New Roman_EmbeddedFont', 'Times New Roman_MSFontService', serif;" data-ccp-props="{&quot;335559685&quot;:-20,&quot;335559737&quot;:-20}">&nbsp;</span> </div> <div class="OutlineElement Ltr SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;"> <p class="Paragraph SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px -2px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW179010292 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.5042px; font-family: 'Times New Roman', 'Times New Roman_EmbeddedFont', 'Times New Roman_MSFontService', serif;" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">Methods: From August to September 2023, we conducted online cognitive interviews among</span><span class="NormalTextRun CommentStart SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;"> six representatives purposively sampled from 3 C2G and 3 RP2 projects.</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;"> We developed a semi-structured interview guide to assess participants' opinions about an equity measurement tool developed by Heller et al. (2014). During interviews, we asked participants to use a think-aloud approach to elicit feedback related to comprehension, clarity, structure, and difficulty level on the items and response options within the original tool. A team of three coders deductively developed a codebook and analyzed data using </span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">Dedoose</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">, a mixed-methods web application. After analysis, we revised the original tool based on the summarized feedback. We re-engaged participants to provide </span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">additional</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;"> feedback on how the tool improved from the original to the revised version. Once </span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">finalized</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">, the </span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">final version</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;"> will be administered to assess the pilot programs&rsquo; health equity impacts.</span></span><span class="EOP SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.5042px; font-family: 'Times New Roman', 'Times New Roman_EmbeddedFont', 'Times New Roman_MSFontService', serif;" data-ccp-props="{&quot;335559685&quot;:-20,&quot;335559737&quot;:-20}">&nbsp;</span> </div> <div class="OutlineElement Ltr SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;"> <p class="Paragraph SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px -2px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW179010292 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.5042px; font-family: 'Times New Roman', 'Times New Roman_EmbeddedFont', 'Times New Roman_MSFontService', serif;" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">Result: All participants provided feedback on the tool </span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;">indicating</span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text;"> that we should make changes to improve the tool&rsquo;s suitability for measuring pilot projects&rsquo; health equity impacts. For example, participants </span><span class="NormalTextRun SCXW179010292 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-selec