The CoTSIS Study  - Cognitive testing of a survey instrument to assess sexual practices, behaviours, and health-related outcomes – was a multi-country study coordinated by HRP and implemented by research partners in 19 countries.

CoTSIS was a qualitative study that used cognitive interviewing to pre-test and refine various iterations of the draft SHAPE questionnaire. Cognitive testing assesses the willingness of individuals to answer questions of a sensitive nature, determines item comprehensibility, and evaluates whether the questionnaire assesses the intended 

CoTSIS was a qualitative study that used cognitive interviewing to pre-test and refine various iterations of the draft SHAPE questionnaire. Cognitive testing assesses the willingness of individuals to answer questions of a sensitive nature, determines item comprehensibility, and evaluates whether the questionnaire assesses the intended constructs consistently and accurately when translated and implemented in diverse settings.
The CoTSIS Study core protocol was published online on World Sexual Health Day in September 2020 as part of a request for proposals, issued by WHO/HRP and the HRP Alliance. Researchers from around the world were invited to partake. Institutions or principal investigators whose primary affiliation was an institution in a low- or middle-income country could apply to receive a small research grant (up to US$20 000) to support study implementation. The open call ran until the end of December 2020, and 35 applications were received.

Nineteen research collaborators were selected and worked with WHO/HRP through 2021 to adapt the protocol for their settings and obtain local ethics approval. The CoTSIS Study was ultimately implemented in a mixture of high-, middle- and low-income countries representing all WHO regions.

Participating study sites were divided into three consecutive waves, allowing for iterative data collection and refinement of the draft questionnaire after each wave. Training began for the first wave of the CoTSIS Study in March 2022, and data collection finished for the final wave in March 2023. In total, CoTSIS researchers interviewed 636 individuals across the following 19 countries: Australia, Bangladesh, Botswana, Brazil, Canada, Colombia, Ghana, Guinea, Indonesia, Italy, Kenya, Malaysia, Mali, Myanmar, Nigeria, Pakistan, Thailand, Uganda and Uruguay.