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Using the ‘Think Aloud’ Technique to Explore Quality of Life Issues During Standard Quality-of-Life Questionnaires in Patients With Atrial Fibrillation

Zhang, Ling; Gallagher, Robyn; Lowres, Nicole; Orchard, Jessica; Freedman, S Ben; Neubeck, Lis


Ling Zhang

Robyn Gallagher

Nicole Lowres

Jessica Orchard

S Ben Freedman


Aims and Objectives: to investigate whether using the ‘think aloud’ technique during standard quality of life surveys provides useful additional information about patients’ experiences of living with atrial fibrillation (AF) and health related quality of life (HRQoL).
Background: atrial fibrillation is the most common cardiac arrhythmia and has serious health consequences, particularly ischaemic stroke, high rates of morbidity and mortality and poor HRQoL. Standard quality-of-life questionnaires are often used but may not provide sufficient detail of patients’ experiences living with AF.
Design: a qualitative interpretative study based on semi-structured interviews.
Methods: patients with AF (n = 12) were recruited from the Choice of Health Options in Prevention of Cardiovascular Events-in Atrial Fibrillation (CHOICE-AF), a risk factor management program. Participants were interviewed using a ‘think aloud’ technique with questions guided by the AF Effects on Quality Of Life Questionnaire
(AFEQT) and the Short Form-12 (SF-12). Interviews were audio-recorded, transcribed and analysed thematically.
Results: participants had a median age of 71 years (interquartile range 52 to 77 years), and included four women and eight men. Four themes were identified related to experiences of living with AF and HRQoL including: (1) the adverse impact of atrial fibrillation symptoms, treatments, and related knowledge; (2) loss of function or independence; (3) the influence of age; and (4) approach to life.
Conclusions: atrial fibrillation, especially in older adults, creates an additional layer of requirements for self-management onto existing self-care needs. Even for patients with relatively high HRQoL, the ‘think aloud’ technique together with standard HRQoL questionnaires can help identify additional issues that can be addressed by health professionals to improve the HRQoL of these patients.


Zhang, L., Gallagher, R., Lowres, N., Orchard, J., Freedman, S. B., & Neubeck, L. (2016). Using the ‘Think Aloud’ Technique to Explore Quality of Life Issues During Standard Quality-of-Life Questionnaires in Patients With Atrial Fibrillation. Heart, Lung and Circulation, 26(2), 150-156.

Journal Article Type Article
Acceptance Date May 25, 2016
Online Publication Date Jul 14, 2016
Publication Date 2016-07
Deposit Date Sep 30, 2016
Journal Heart, Lung and Circulation
Print ISSN 1443-9506
Electronic ISSN 1444-2892
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 26
Issue 2
Pages 150-156
Keywords Atrial fibrillation; AF, health related quality of life, HRQoL, patient experience,
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