Self-report questionnaires are frequently used in health fields; however, subjective interpretation is often ignored. One way of assessing this is using techniques derived from cognitive interviewing. Of these, ‘think-aloud’, in which respondents speak their thoughts aloud as they complete a questionnaire, is the original paradigm. The thesis focusses on the use of ‘think-aloud’ methodology in the evaluation of questionnaires already in use in the health domain. The current thesis has been prepared in the format of scientific papers. Paper 1 is a systematic review (23 studies) of the appropriateness and usefulness of think-aloud techniques for evaluating health-related questionnaires. A descriptive account is provided of the aims of the studies reviewed; the justification for using think-aloud; populations studied; and methodology; an evaluative account depicts the usefulness of the think-aloud method in addressing researchers’ aims. Think-aloud was successfully used to address researchers’ aims and was effective at elucidating problems with questionnaires. Theoretical and clinical implications are discussed, and recommendations made for future research. Paper 2 is a cross-sectional observational study using think-aloud methods to examine the way in which people with End Stage Renal Disease (N=25) interpret and respond to the Emotion Regulation Questionnaire (ERQ). All questions were found to be problematic to some extent and reappraisal questions yielded the most problems. A tendency to deny or minimise negative emotions and present a positive self-image was also noted. Implications are discussed for use of the ERQ and replication with further samples suggested. Paper 3 is a critical appraisal of the above papers and provides personal reflections on the research process as a whole. The current thesis was a transition from a different study; amended due to time constraints. The journey is also outlined from this original study to the present thesis. Strengths and limitations are considered as well as areas for improvement and future research.

Att presentera information eller påverka användarens upplevelser via ljudsättning av gränssnitt är lågt prioriterat inom systemutveckling. Design av gränssnitt håller den visuella presentationen av information central därtill sammankopplar detta främst med områden som exempelvis användbarhet eller funktionell form. Syftet med denna studie har varit att undersöka hur ljud påverkar upplevelsen samt hur detta skulle kunna implementeras för att förbättra användares upplevelser av internetbaserade gränssnitt. Det vetenskapliga ramverket har sammanställts genom ett artikelunderlag vilket genererat en grundläggande kategorisering. Detta avsåg koppling till ”Estetik”, ”Sonification”, ”Att ljudsätta användardata” samt ”User experience och audio”. Arbetssättet byggde på en metodkombination där ett kvantitativt internetbaserat frågeformulär undersökte områden inom ramverkets kategorisering samt en kvalitativ ”Think-aloud” undersökning där två verksamma systemutvecklare testade en ljudsatt prototyp. Resultatet från den kvalitativa undersökningen visade hur ljudsättning initialt inte värdesatts vid interaktion med ett gränssnitt samtidigt som prototypens ljudsättning inte upplevdes störande eller negativ. Prototypen framkom som ”för” kreativt vinklat vilket återkopplar till ramverkets beskrivning gällande två estetiska huvudspår inom webbdesign. Den kvantitativa analysen framställer hur användbarhet och ordning värdesatts högre än kreativa upplevelser samt att information i gränssnitt inte sågs lämpligt att förmedla via ljud. Slutsatsen inom arbetet ligger vid att ljudsättning av gränssnitt genom ett balanserat formspråk och en bibehållen känsla av kontroll, kan och bör kopplas till användarens interaktion med gränssnittet. Detta kan trots ett viss motstånd användas för att påverka upplevelser, känslor och därtill uppfattad användbarhet inom ett system.

Paramedics are responsible for the care of patients requiring emergency assistance in the out of hospital setting. These health care providers need to make many decisions during the course of an emergency call. This thesis on paramedic clinical decision-making includes two studies, intended to determine which decisions paramedics make that are most important for patient safety and clinical outcome, and what thinking strategies paramedics rely on to make decisions. Forty-two decisions were found to be most important for outcome and safety. The highest decision density of an emergency call is during the on-scene treatment phase. Paramedics use a mix of thinking strategies, including rule out worst scenario, algorithmic, and exhaustive thinking. The results of these studies have implications for future research, paramedic practice and training.

Caring for patients in an acute medical ward occurs in a complex and dynamic environment. Prioritisation of goals and activities represents one element of effective planning and delivery of care. The importance of priority setting has been highlighted in the nursing literature for over twenty-five years; however, there would appear to be no systematic study of this key skill. This thesis explores priority setting within a novice/expert framework, using a mixed methods approach. In addition to using simulation it investigates real-time priority setting within actual clinical practice. Study one used simulation in four groups with a range of nursing experience. This included one group of non-nurses for comparison. Participants were asked to prioritise twelve care activities presented in a simulated case-load. Analysis demonstrated that the simulation evoked priority setting behaviour, and differences in priority setting were seen. Study two combined the simulated case-load with think-aloud method. Semistructured interview completed the data collection. Findings were consistent with Benner’s ovice/expert framework, suggesting that prioritisation is determined by two main characteristics, the views, values and perceptions of the nurse, and key skills, knowledge and experience. Study three used think-aloud method to examine priority setting in clinical practice, comparing junior student nurses with senior staff nurses. This was supplemented by observation and semi-structured interview. Findings from this study identified differences in cognitive processes, and priority setting strategies. Developing critical thinking skills, expert role modelling, and the use of an active apprenticeship model may facilitate skill acquisition. This thesis highlights the complexity of priority setting in caring for patients in an acute medical ward. It explores the development of this skill in learner nurses, and demonstrated a range of methods for studying decision-making in both simulated and clinical settings.

The think aloud method has been used in this research to generate data that reveals the thoughts of participants of a study while they are performing tasks. The pioneers of this method, Simon and Ericsson, have provided a method to analyze the data so as to obtain meaningful results. However, this analysis method is complicated and time consuming. Most researchers use some form of categorization to perform their analysis. Critical incidents were used to categorize the data gathered in the tests conducted as part of this research. This research proposed the use of tenets of Activity Theory while performing data analysis so that the cultural and environmental aspects that influence task performance are identified and addressed as part of the analysis. A data analysis template was created that directs the analyst to follow activity theory while performing the analysis. Sample data was gathered using the Think Aloud Method. The results obtained after analyzing this data using the proposed Activity Theory Based method were compared with those obtained when the same data was analyzed using a representative traditional method of analysis. The research included positive critical incidents, negative critical incidents and level of severity of negative critical incidents as the dependent measures. No significant differences were found between the two methods based on these dependent measures. Task type had a significant effect on the number of positive and negative critical incidents identified. / Master of Science

The aim of this study is to investigate how inside and outside directors differ in their cognition and reasoning in regards to environmental sustainability issues. The theoretical background derives from a cognitive view and Stakeholder theory. The paper is further based on current research regarding insiders’ and outsiders’ relationship to environmental sustainability. In order to capture the cognition and reasoning of insiders and outsiders, a Think-aloud study was conducted, interviewing a total of 20 board members in the food industry. Results from this study showed that, when faced with environmental issues, outsiders are more likely to request, repeat, ponder as well as clarify the information given. Secondly, outsiders are more likely to consider a long-term perspective. Thirdly, outsiders are more likely to consider an environmental view. Lastly, both insiders and outsiders use analogical reasoning when contemplating around environmental issues. However, insiders are more likely to draw experience from their current position or company while outsiders are more likely to draw experience from outside their current position or company when solving environmental issues.

The present study was designed to investigate the effects of divergent production activities with math inquiry and think aloud strategy of students with math difficulty. Multiple baseline across behaviors design was replicated across four participants. This research also investigated relationships between the interventions and creativity scores by employing pretest and posttest design as measured by the Torrance Tests of Creative Thinking (TTCT). The results varied with the participants and the interventions. The overall mean in all three treatments increased a mild degree based on descriptive statistics. All four participants showed a drastic variability in math problem solving. T-test results from the TTCT showed that there were significant differences in both fluency and flexibility scores. Elaboration and originality scores appeared unaffected since the instructions were mean in all three treatments increased to a mild degree based on descriptive statistics. All four primarily involved in fluency and flexibility creativity constructs. Originality was excluded as a measure and elaboration was not instructed intensely enough in the program. Conclusively, 5th grade students with math difficulty improved both think aloud and math inquiry scores based on visual/statistical inspection of Mean+Trend difference analysis. It was found that only math inquiry intervention was effective to a mild degree for three out of four participants. Fluency and flexibility scores increased as a result of divergent production activities, however not enough to say that overall creativity is fostered directly by the program. Issues emerged out of the math problem solving in terms of controlling variability and developing content materials for the instruction. Further research is needed to ascertain the effects of multiple interventions on students with math difficulty. Replications are needed to expand the findings to the development of viable instructions. Future study is also needed to use varied math inquiry skills and think aloud strategy in order to improve both problem solving ability and creativity associated with mathematics.

Detta arbete består av designen av ett gränssnitt för webbplatsen whatismykidplaying.com. Designen var tänkt att ge hög användbarhet för målgruppen och testades av användare i ett think-aloud test. De fick testa och utvärdera hur väl gränssnittet fungerar och  deras feedback utvärderades och resultaten låg till grund för förslag på förändringar i gränssnittet, vissa som sedan blev implementerade. Studien har utgått från de olika stegen i en användarcentrerad utvecklingsmodell, analys - design - utvärdering - återkoppling, och en iteration har genomförts. Som utgångspunkt, för att öka användbarheten i webbplatsens gränssnitt, användes diverse regler och riktlinjer för hur användbarhet bäst kan uppnås, när designen gjordes. Hur väl dessa regler och riktlinjer fungerat tillsammans, i detta projekt och design, blev således en del i think-aloud testest utvärdering. Studien presenterar och analyserar hur användarna upplevt resultatet av den första designen av gränssnittet, och vad som fungerat bra och mindre bra ur användbarhetssynpunkt. / This thesis consists of the design of a user interface for the website whatismykidplaying.com. The design of the user interface was meant to increase usability for the target-group, and was tested by users in a think-aloud test. The users evaluated the usability and their feedback was evaluated and the results were used to produce suggestions for improvements in the user interface, some of which were implemented. The basis for the study is the steps in user-centered-design, analysis - design - evaluation - feedback, and one cycle has been carried out. To enhance usability in the user interface, different rules and guidelines regarding how to design for usability were used for the design. How well these rules played together, in this design, was evaluated in the think-aloud test. The thesis presents and analyses how the users experienced the first design of the user interface and which parts had worked well and those that didn't, from the usability point of view.

The present study was designed to investigate the effects of divergent production activities with math inquiry and think aloud strategy of students with math difficulty. Multiple baseline across behaviors design was replicated across four participants. This research also investigated relationships between the interventions and creativity scores by employing pretest and posttest design as measured by the Torrance Tests of Creative Thinking (TTCT). The results varied with the participants and the interventions. The overall mean in all three treatments increased a mild degree based on descriptive statistics. All four participants showed a drastic variability in math problem solving. T-test results from the TTCT showed that there were significant differences in both fluency and flexibility scores. Elaboration and originality scores appeared unaffected since the instructions were mean in all three treatments increased to a mild degree based on descriptive statistics. All four primarily involved in fluency and flexibility creativity constructs. Originality was excluded as a measure and elaboration was not instructed intensely enough in the program. Conclusively, 5th grade students with math difficulty improved both think aloud and math inquiry scores based on visual/statistical inspection of Mean+Trend difference analysis. It was found that only math inquiry intervention was effective to a mild degree for three out of four participants. Fluency and flexibility scores increased as a result of divergent production activities, however not enough to say that overall creativity is fostered directly by the program. Issues emerged out of the math problem solving in terms of controlling variability and developing content materials for the instruction. Further research is needed to ascertain the effects of multiple interventions on students with math difficulty. Replications are needed to expand the findings to the development of viable instructions. Future study is also needed to use varied math inquiry skills and think aloud strategy in order to improve both problem solving ability and creativity associated with mathematics.

The overall aim of this thesis is to corroborate whether the Situation Awareness (SA) of older drivers is deficient to that of younger driving groups, due to the onset of age-related cognitive decrements. This is important to ascertain due to a presumed linkage between the concept and accident causation. In addition, the research undertaken to date to investigate this linkage has exclusively utilised rather artificial driving simulators and simulations. Thus there is a need for data from more ecologically valid methods. The research studies reported here have sought to preference on-road assessments (of different complexity), and to capture what information was selectively perceived, comprehended and reacted to; rather than, as in previous work, what was recalled. To achieve this, a Think aloud methodology was chosen to produce narratives of a driver s thoughts. This method was advantageously unobtrusiveness, but also flexible - it could additionally be used to compare an individual's SA to a driving performance measure, Hazard Perception. The driving-based studies undertaken found that for a relatively non-taxing route, an older driver group could produce cohesive awareness in parity with a younger driver group. However, the concepts from which that awareness was based upon drew more on general, direction based, concepts, in contrast to the younger group s focus on more specific, action based, concepts, and rearward and safety-related cues. For a more cognitively taxing route, the younger group produced significantly higher (p < 0.024) individual SA-related scores than their older counterparts. But the concepts/cues both groups relied upon remained similar - particularly in regards to the ratio of those indicative of a rearward and/or a safety-related focus. In a video-based study, however, and in contrast, the older driver group s SA scores improved sufficient to outperform a younger group, but, despite this, not for video-based scores indicative of Hazard Perception (HP). In this latter regard, age-related decrements appeared to be more influential, as the older group felt they were under time pressure during a HP test. However, the difficulty this presented appeared to advantageously bring more attention and effort to the task, which were argued as important factors for the uplift in their SA scoring. The thesis also showed that older groups judgement of the actual complexity of a driving task could potentially be deficient to that of younger driver groups. This could cause problems as incorrect perceptions could deflate the relevance and cohesiveness of information being processing. In contrast, the perceived complexity of a task could bring a rise or fall in SA score for both groups. Such results raised questions as to the impact of cognitive decrements, relative to task difficulty and related effort whilst driving. It also provided evidence that Situation Awareness, rather than being uniformly good or bad, could, like any other psychological construct, be prone to change. These aspects were drawn together in a proposed model of driving SA.