104 Chapter 4 General presence of reflexivity The MCSQ starts with items about the general presence of reflexivity in the work setting of professionals. These are categorized into two types: general statements and frequencyitems. These items can be viewed as (some) preconditions for moral craftsmanship. For example, if a professional does not experience support, from colleagues or supervisors, in doing their job well, this could explain (lower) scores in other domains. These items are not comprehensive. Additionally, some items address possible ‘risk factors’ for elements of MCS, i.e., scores on these items can reduce positive scores on other MCS items. For example, whether or not it is allowed to make mistakes in your job. Or if the job mainly consists of routines, one would likely experience less room for personal moral reflections. Finally, some items are based on ‘moral distress’-related items of DeTienne et al. (2012), since moral distress could also impact other items of MCS. Results on these items could be considered when investigating the responses in the other domains of the MCSQ. Adaptations after ‘think aloud interviews’ In the ‘think aloud interviews’ with seven prison staffers, we learned more about the usability of the MCSQ. The tests took approximately forty-five minutes. On average, respondents stated it would have taken fifteen to twenty minutes to fill in the questionnaire without verbalizing their thoughts. Often the researcher encouraged prison staff to actively think-aloud by asking ‘Can you elaborate on how you came to this answer?’ (Shi, 2008). One of the respondents – a manager – had dyslexia, which was even more useful for the usability-test of the MCSQ for all types of professionals. The tests helped to identify items that took too long or too much effort to answer, items that were unclear or confusing, and therefore did not meet their intended purpose. The insights gained resulted in three new rounds of adaptations of the MCSQ. We did not need to adapt the domains, but changes were made on the item-level. Besides adjusting items to make them easier to understand, there were other reasons we made changes. Most participants struggled with the questionnaire; they needed time to understand the items. Everyone who experienced this mentioned it was because the MCSQ opened with the ‘frequency-items’, which were difficult to start with. So, we changed the order (see Table 1), with the ‘general statements’ opening the MCQS, followed by the ‘frequencyitems’ and then the other domains (see Appendix 6). We tested the new order with the last three participants of the think-aloud interviews, and they did not experience problems with the order nor understanding the ‘frequency-items’.