OBJECTIVES: Questionnaire developers lack evidence to inform basic item construction activities, including the appropriate placement of a recall period. This study evaluated whether participants interpreted items in three English language patient-reported outcome (PRO) questionnaires consistently, regardless of whether the recall period was placed at the beginning or end of the item. METHODS: In three separate studies, cognitive interview participants were assigned to one of two groups. Group A completed an item with the recall period at the end followed by the completion of an alternative version of the item identical in content but with the recall period at the beginning. Group B completed the items in the reverse order. In both groups, participants were asked to provide their interpretations of both versions. An example of a tested item pair is as follows: “Over the past 24 hours, rate your worst stomach pain” and “Rate your worst stomach pain over the past 24 hours.” All interviews were audio-recorded, transcribed, and the qualitative data were entered into ATLAS.TI for analysis.  RESULTS: Of the 97 total participants, 69.1% were female and the mean age was 43.9 years. Eighty-eight participants contributed to the analysis with all participants in Group A (n=8) having a gastrointestinal condition and, in Group B (n=80), 44 participants had a gastrointestinal condition and 36 participants had a dermatological condition. In Group A, 100.0% of participants interpreted the items consistently (i.e., stated that the items were the same). In Group B, 79 of the 80 participants (98.8%) interpreted the items consistently. CONCLUSIONS: This study provided evidence that placement of the recall period at either the beginning or end of PRO questionnaire items does not impact the interpretation of the item content. Additional research will be needed to confirm these findings in other cultures/languages and content areas.