How do people with acquired brain injury interpret the Valued Living Questionnaire? A cognitive interviewing study

Background: The accurate evaluation of valued living in people with acquired brain injury (ABI) is important for measuring the outcome of interventions targeting valued living. The Valued Living Questionnaire (VLQ) is one of the most widely used measures, however its validity in an ABI cohort may be affected by the cognitive demands associated with evaluating the value-consistency of actions in the past week. Objectives: We aimed to systematically identify common difficulties or errors associated with the comprehension and completion of the VLQ in people with ABI in order to guide a potential adaptation of the measure. Methods: Adults with an ABI (traumatic brain injury, stroke, tumour), experiencing cognitive difficulties and/or emotional distress impacting participation in valued activities, were invited to participate in a cognitive interview which probed their understanding of the VLQ. Concurrent verbal probing was used, whereby scripted verbal probes were asked alongside each questionnaire item as it was being rated by participants. Interviews were transcribed and analysed by combining data pertaining to each item and aggregating these across interviews to highlight common comprehension errors or difficulties. Results: There were 11 participants (mean age = 59.55 years, SD = 12.84; mean education = 14.73 years, SD = 2.87) with a range of ABI aetiologies (7 stroke, 2 TBI, 2 tumour). Common difficulties with the VLQ included confusion caused by question phrasing and structure of the measure, errors due to the cognitive demands associated with rating the importance of abstract values and value-consistency of actions in the last week, and problems with the rating scale. Conclusions: Key problems with the validity of the VLQ within an ABI sample were identified due to comprehension errors relating to its structure and content. Findings will inform an adapted version, suited to the needs of individuals with ABI-associated cognitive difficulties.