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Dr Keith Meadows

About Me

I am a Clinical Outcome Assessment (COA) and questionnaire development specialist with experience across questionnaire design and review, cognitive interviewing, translation and linguistic validation.

My Work

My work focuses on understanding how questionnaires perform from both a methodological and respondent perspective — from the concepts and items being measured through to how respondents interpret, process and answer questions.

I am particularly interested in the practical challenges that can influence questionnaire quality, including conceptual clarity, item wording, recall periods, response options, cognitive burden and cross-cultural interpretation.

I provide practical training and consultancy to help researchers and professionals apply these principles confidently to their own work.

 

 

Questionnaire Design Masterclass

From questionnaire design to respondent experience.

A well-designed questionnaire is more than a collection of clearly worded questions. Each item needs to capture the intended concept, be relevant and meaningful to the target population, and enable respondents to arrive at an answer in a way that is consistent with the developer’s intent.

The Questionnaire Design Masterclass provides practical, applied guidance on the principles that underpin effective questionnaire development.

The masterclass explores:

  • Defining concepts and ensuring conceptual alignment
  • Developing clear, relevant and meaningful questionnaire items
  • Identifying ambiguity, assumptions and potential sources of bias
  • Considering recall periods and respondent cognitive burden
  • Designing appropriate response options and scales
  • Structuring questionnaires to support the respondent
  • Avoiding redundancy and unnecessary complexity
  • Considering population, context of use and intended application
  • Recognising potential issues before formal testing
  • Applying practical approaches to reviewing and improving questionnaire items

The emphasis is on practical application rather than theory alone, using examples and discussion to consider how seemingly simple design decisions can influence how respondents understand and answer a questionnaire.

Who is it for?

The masterclass is designed for professionals involved in: Questionnaire development · Clinical Outcome Assessment · Patient-Reported Outcomes · Health Outcomes Research · Qualitative Research · Linguistic Validation.

Interested in developing better questionnaires? Find out more.

 

 

Cognitive Interviewing Masterclass

From respondent understanding to meaningful insight

The Cognitive Interviewing Masterclass provides practical guidance on designing, conducting, analysing and reporting cognitive interviews, with a focus on applying the approach effectively within questionnaire and COA development.

The masterclass explores:

  • Selecting an appropriate cognitive interviewing approach
  • Developing an effective interview schedule
  • Exploring respondent understanding and interpretation
  • Investigating recall, judgement and response processes
  • Identifying ambiguity and potential questionnaire issues
  • Conducting effective cognitive interviews
  • Analysing and interpreting qualitative findings
  • Considering sample size and recruitment
  • Determining when findings may warrant questionnaire modification
  • Reporting and documenting findings clearly
  • Practical considerations for multilingual and cross-cultural studies

The masterclass looks beyond the question Did the respondent understand the item? to explore what the respondent actually thought the question meant, what they considered when answering it and how they selected their response.

Who is it for?

Each masterclass is suitable for researchers and professionals working in questionnaire development, COA development, patient-reported outcomes, cognitive interviewing, qualitative research and linguistic validation.

Want to strengthen your cognitive interviewing approach? Find out more.

 

 

Expert review. Better questions. Stronger evidence.

QuestReview™ was created to help developers look beyond whether a questionnaire simply appears clear and understandable. QuestReview™ provides an independent perspective on your questionnaire or COA, combining COA-specific methodological design expertise with AI-supported analysis.

How does QuestReviewTM work?

QuestReview™ is benchmarked against 32 evidence-based questionnaire design parameters, aligned with FDA, EMA and ISPOR guidance and industry best practice.

QuestReview™ can support developers at different stages of questionnaire and COA development, including:

  • New measure development — identify potential issues early in the design process
  • Review of an existing measure — provide an independent assessment of potential areas for improvement
  • Pre-cognitive interviewing — identify issues that may warrant exploration before qualitative testing
  • Pre-field testing — provide an additional structured review before moving into larger-scale testing
  • Measure refinement — assess revised items and recommendations following earlier development work

A focused route forward

Following the QuestReview™ assessment, clients receive a structured Feedback Report summarising key findings and areas for consideration.

The report provides an independent perspective on the questionnaire, highlighting potential issues, explaining why they may matter and offering practical recommendations to support informed development decisions.

Want to see what QuestReview™ could uncover? Email: info@questreview.co.uk

The Diabetes Health Profile (DHP-18)

Capturing meaningful diabetes outcomes that HbA1c alone cannot measure

I am also the author of the Diabetes Health Profile-18 (DHP-18) which is a scientifically validated, 18-item patient-reported outcome measure (PROM) designed to assess the psychological and behavioral impacts of living with Type 1 or Type 2 diabetes. It uniquely measures three core areas of diabetes management: Psychological Distress, Barriers to Activity, and Eating Behaviour.

Completed by more than 15,000 people with Type 1 and Type 2 diabetes, the DHP-18 is designed specifically to capture the “patient’s voice” without relying on hypothetical or out-of-touch questions.

Why Healthcare Providers and Researchers Choose the DHP-18:

  • Measures Eating Dysfunction: Unlike many standard quality-of-life scales, it explicitly measures disinhibited eating—an essential component of diabetes care
  • Rigorous Psychometric Integrity: Demonstrates strong reliability with Cronbach’s alpha ranges of 0.70 to 0.88 across its sub-domains and confirmed construct and convergent validity
  • Fast and Convenient: Taking only 5–6 minutes to complete, it features excellent patient acceptability with completion rates over 90%
  • FDA-Compliant Framework: The conceptual framework conforms to the FDA’s Guidance for Industry on patient-reported outcomes, making it ideal for rigorous clinical trials
  • Globally Trusted: Officially adapted and validated in over 32 languages, making it a reliable tool for international research and clinical care

The tool can be quickly implemented into your clinical trial or clinical care via the Oxford University Innovation Click-to-Licence Portal. For deeper, evidence-based details on its metrics and methodology, you can contact me at: info@healthoutinsights.com

Key References

Meadows K, Steen N, McColl E, Eccles M, Shiels C, Hewison J, Hutchinson A. (1996). The Diabetes Health Profile (DHP): a new instrument for assessing the psychosocial profile of insulin requiring patients—development and psychometric evaluation. Quality of Life Research, 5(2), 242–254. doi:10.1007/BF00434746. https://pubmed.ncbi.nlm.nih.gov/8998493/

Meadows KA, Abrams C, Sandbaek A. (2000). Adaptation of the Diabetes Health Profile (DHP-1) for use with patients with Type 2 diabetes mellitus: psychometric evaluation and cross-cultural comparison. Diabetic Medicine, 17(8), 572–580. doi:10.1046/j.1464-5491.2000.00322.x. https://pubmed.ncbi.nlm.nih.gov/11073178/

Mulhern, B., & Meadows, K. (2011). Estimating the minimally important difference (MID) of the diabetes health profile-18 (DHP-18) for type 1 and type 2 diabetes mellitus. https://eprints.whiterose.ac.uk/id/eprint/43132/

Mulhern B, Meadows K. (2013) Investigating the minimally important difference of the Diabetes Health Profile and the EQ-5D and SF-6D in a diabetes mellitus population. Health, 2013; 5(6) https://www.scirp.org/journal/paperinformation?paperid=33263

Mulhern B, Meadows K. (2014). The construct validity and responsiveness of the EQ-5D, SF-6D and Diabetes Health Profile-18 in type 2 diabetes. Health and Quality of Life Outcomes, 12, 42. https://pubmed.ncbi.nlm.nih.gov/24661350/

 

 

Some of my recent peer reviewed publications

Meadows, K. (2026). Focus Group-Based Cognitive Interviews: A Valid Method in the Development and Evaluation of Clinical Outcome Assessment Measures? K. Meadows. The Patient-Patient-Centered Outcomes Research, 19(3), 353-354. https://link.springer.com/article/10.1007/s40271-026-00802-9

Meadows, K. A., & Reaney, M. (2025). Understanding the unique patient—causal singularism and patient reported outcomes. Quality of Life Research, 34(5), 1221-1231. https://doi.org/10.1007/s11136-025-03905-2

Meadows, K. A., Ferrante, N., & Geršić, T. (2025). Cognitive Interviews: Recommendations for Best Practices in Clinical Outcome Assessment (COA) Measure Development and Validation: KA Meadows et al. The Patient-Patient-Centered Outcomes Research, 18(6), 609-621. https://pubmed.ncbi.nlm.nih.gov/40705225/

Meadows, K. (2024). Phenomenology: A method for the interpretation of patient-reported outcomes. Clinical Nursing Research, 33(4), 262-270. https://doi.org/10.1177/10547738241240032

Meadows, K. A. (2024). The Role of Philosophical Tools in Nursing Research. Clinical Nursing Research, 33(7), 581-588. https://doi.org/10.1177/10547738241267159

Meadows, K. A., & Reaney, M. (2024). Story completion (SC) – an epistemological approach to the interpretation of patient-reported outcomes?. Expert review of pharmacoeconomics & outcomes research, 24(1), 49–56. https://doi.org/10.1080/14737167.2023.2268833

Meadows, K. A., & Reaney, M. (2023). Bringing the patient’s perspectives forward in drug development and health-care evaluation. Expert review of pharmacoeconomics & outcomes research, 23(3), 267–271. https://doi.org/10.1080/14737167.2023.2166492

Meadows K. (2022). Do Patient-Reported Outcome Measures Tell Us the Full Story? Guest Editor. Clinical Nursing Research. 31(2):159-162. https://doi.org/10.1177/10547738221078335

Meadows, K. (2021). Cognitive interviewing methodologies. Clinical Nursing Research, 30(4), 375-379. https://doi.org/10.1177/10547738211014099

 

 

 

Please get in touch if you would like to know more. You can reach me at: keith@healthoutinsights.com

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