Challenges Conducting Cognitive Interviews in Low and Middle Income Countries - A Case Study with Older Adults in Lebanon - Survey Methods: Insights from the Field - Volume 3 - Issue 2 (2025)

Sep 4, 2026

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The global increase in population ageing, especially in Low and Middle Income Countries (LMICs), creates a stronger need for population-based surveys that capture older adults’ health and social requirements in context. Many survey questions are adapted from High Income Countries, requiring pretesting for interpretability and cultural appropriateness through cognitive interviewing. Based on 58 interviews in Lebanon’s pretest of a new ageing survey, the study identifies population- and ageing-specific challenges and proposes recommendations and best practices.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

Introduction

Cognitive interviewing as a survey pretesting method

Knowledge gaps in LMIC ageing and dementia research

Case study context: Lebanon Study on Aging and HeAlth (LSAHA)

Challenges Conducting Cognitive Interviews in Low and Middle Income Countries: A Case Study with Older Adults in Lebanon Survey Methods: Insights from the Field, Volume 3, issue 2 (2025) Alexandra Abi Nassif | Mayssan Kabalan | Carlos Mendes de Leon | Julie de Jong | Frederick Conrad * | | * Corresponding author | Note: A. Abi Nassif & M. Kabalan contributed equally to this work. How to cite this article : Abi Nassif, A. , Kabalan M. , de Jong J. , Mendes de Leon C. & Conrad F. (2025) . Challenges Conducting Cognitive Interviews in Low and Middle Income Countries: A Case Study with Older Adults in Lebanon. Survey Methods: Insights from the Field. Retrieved from [https://surveyinsights.org/?p=21128](https://surveyinsights.org/?p=21128) DOI : 10. 13094/SMIF-2025-00009 Copyright : © the authors 2025. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4. 0) Abstract : The global increase in population ageing, especially in Low and Middle Income Countries (LMICs), has created greater need for population-based surveys that document the health and social requirements of older adults in this context. The surveys ﬁelded in response to this need ask questions adapted from ongoing surveys in High Income Countries; hence it is important to pretest the adapted questions for interpretability and cultural appropriateness using methods such as cognitive interviewing. The aim of this paper is to highlight challenges in the administration of cognitive interviews in LMICs with older adults, based on our pretest of a new population survey study in Lebanon. We analysed 58 cognitive interviews conducted with older adults, and identiﬁed two sets of challenges: population-speciﬁc and ageing-speciﬁc challenges. The ﬁrst set includes trouble understanding the purpose of cognitive interviewing, respondents’ suspicion of institutions, reluctance to disclose sensitive information, and problems arising from diglossia, i.e. , languages whose oﬃcial, written form diﬀers substantially from the colloquial, spoken form. The second set concerns age-related attributes such as hearing problems, fatigue, and decline in cognitive abilities. Based on our ﬁndings and experience, we oﬀer recommendations and best practices for conducting cognitive interviews in LMICs with older adults. 1. Introduction The population of older adults is growing worldwide, especially in low- and middle-income countries (LMICs) (Sudharsanan & Bloom, 2018; UNDESA, 2020) . To document the health and social needs in these populations, an increasing number of population-level survey studies has been established, modelled after the Health and Retirement Study (HRS) in the United States, and connected with one another in the network of the Health and Retirement Studies Around the World (HRS Around the World , n. d. ) . One such survey is a new population-based study of ageing and dementia in Lebanon: the Lebanon Study on Aging and HeAlth (LSAHA) . Many of the questions and instruments in the LSAHA survey have been adapted from HRS, making it necessary to assess the interpretability and cultural appropriateness of the draft questionnaire for this population (Willis, 2015) . To that end, LSAHA designed and implemented cognitive interviews. Cognitive interviewing is one of the most widely used survey pretesting methods, helping researchers evaluate the extent to which respondents understand the questions as intended and are able to carry out the response tasks required by each question (Beatty & Willis, 2007; Willis, 2004) . However, application of cognitive interviewing in LMICs has been limited to a narrow range of topics, such as nutrition and program participation (Andrew et al. , 2022; Ashok et al. , 2022; Namaste et al. , 2024), and studies have noted the need for careful cultural adaptation of the cognitive interviewing process to ensure the task is well-understood among populations in LMICs (Martin et al. , 2017; Melgar

FAQs

Why are cognitive interviews important when adapting survey questions for LMIC older adults?

Because adapted questions need to be pretested for how well respondents understand the intended meaning and can perform the response tasks, especially when cultural and interpretive differences may affect interpretability and appropriateness.

What population-specific challenges were identified in the Lebanon case study?

Challenges included difficulty understanding the purpose of cognitive interviewing, suspicion of institutions, reluctance to disclose sensitive information, and issues linked to diglossia between official and colloquial languages.

What ageing-specific challenges affected cognitive interview administration?

Age-related factors included hearing problems, fatigue, and declines in cognitive abilities that can interfere with participation and comprehension during the interviews.

Sep 4, 2026

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