After developing the preliminary PROM, a cognitive validation study was conducted to evaluate whether the questions of the SOS-SAH were interpreted in the way they were intended (step 4 of the PROM-cycle: testing of the PROM). This enabled the evaluation of whether the selected (domains of) existing PROMs were suitable for use in patients with aSAH, and to assess the comprehensibility of any newly formulated items. Patients with a successfully treated aSAH who attended the outpatient clinic were asked to participate. During the interview, the patients completed the SOS-SAH and shared their thoughts about the purpose and phrasing of the questions and about the comprehensiveness of the SOS-SAH [24]. An interview guide was used for all the interviews, which were transcribed verbatim. The analysis was performed based on a topic list and any new issues that emerged during the analysis were added to this topic list. Based on the results, the working group made the final decision about the removal or adaptation of unclear items, leading to the final version of the SOS-SAH.

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