Questionnaires and Interviews Steven R. Cummings, MD Director, S.F. Coordinating Center

SFSFCoordinating CenterCoordinating Center

Questionnaires and Interviews

Steven R. Cummings, MDSteven R. Cummings, MD

Director, S.F. Coordinating CenterDirector, S.F. Coordinating Center


Where we left my story…

• Resveratrol increases speed, Resveratrol increases speed, endurance & strength & lifespanendurance & strength & lifespan

• My hypothesis: Those who My hypothesis: Those who consume resveratrol have longer consume resveratrol have longer healthy lifehealthy life

• A randomized trial for mortality A randomized trial for mortality was too big and NIA didn’t fund was too big and NIA didn’t fund my small trial of resveratrol and my small trial of resveratrol and gait speedgait speed

• So…So…


An opportunity to piggy back

• A SFCC study about aging is A SFCC study about aging is planning a new visitplanning a new visit Men ≥ age 75 years oldMen ≥ age 75 years old

• I could add questions about I could add questions about intake of resveratrol intake of resveratrol

• I could test subsequent I could test subsequent mortality or cross-sectional mortality or cross-sectional associations with healthassociations with health

• ……cheaplycheaply

• But additions must be shortBut additions must be short


Measurements I need to test my hypothesis

• ““Resveratrol intake”Resveratrol intake”

• ““Healthy”Healthy”

• ““Lower mortality”Lower mortality”


Measurements I need to test my hypothesis


• ““Healthy”Healthy”

• ““Lower mortality”Lower mortality” But insufficient number of men taking But insufficient number of men taking

resveratrol and too few deaths to test resveratrol and too few deaths to test whether resveratrol is associated with whether resveratrol is associated with mortalitymortality


Measurements I need to test my revised hypothesis


• ““Health”Health”


I need questions to assess


• ““Health”Health”


1st step

• Are there standard questionnaires?Are there standard questionnaires?

• Must I make my own?Must I make my own?


Where to find questionnaires

• Experts and articles in the area of researchExperts and articles in the area of research

• Search the webSearch the web

• e.g. QualityMetrics: e.g. QualityMetrics: www.qualitymetric.com General health status (SF36)General health status (SF36) A few disease-specific measurementsA few disease-specific measurements Must get a licenseMust get a license

• SF Coordinating CenterSF Coordinating Center


Resveratrol intake comes mainly from red wine and supplements

• I need to quantify the I need to quantify the average amount of average amount of resveratrol the participant resveratrol the participant takestakes

• Add questions about red Add questions about red wine intakewine intake

• Add questions about use of Add questions about use of resveratrol supplements resveratrol supplements


The Coordinating Center has a standard questionnaire on alcohol use

• Basic questionsBasic questions Have you drunk at least 12 ‘drinks’ of Have you drunk at least 12 ‘drinks’ of

alcohol in past 12 months? alcohol in past 12 months?

If yes If yes Average drinks per week.Average drinks per week.

• Easily modified to substitute ‘red wine’ Easily modified to substitute ‘red wine’ for ‘alcohol’for ‘alcohol’


The Coordinating Center also has a standard questionnaire on medication use

• Do you currently take ____?Do you currently take ____?

__ No (skip to X)__ No (skip to X)

__ Yes__ Yes

• How often?How often? __ daily __ weekly __ less often__ daily __ weekly __ less often What dose? ___What dose? ___


I must adapt the questionnaire to measure resveratrol intake

• Do you currently take ____?Do you currently take ____?

__ No (skip to X)__ No (skip to X)

__ Yes__ Yes

• How often?How often? __ daily __ weekly __ less often__ daily __ weekly __ less often What dose? ___What dose? ___


Quantifying resveratrol intake from supplements

• Do you currently take tablets or Do you currently take tablets or capsules containing resveratrol?capsules containing resveratrol?

• YesYes No (skip to X)No (skip to X)

• How often?How often? __ daily __ weekly __ less often__ daily __ weekly __ less often What dose? _____What dose? _____

• X…X…






What’s wrong with this question?What’s wrong with this question?






These problems might be These problems might be discovered by pretesting with discovered by pretesting with people who take resveratrolpeople who take resveratrol

““Or” can be Or” can be confusingconfusing

It is also sold It is also sold as a liquidas a liquid Some are not Some are not

called ‘resveratrol’called ‘resveratrol’

May not know; May not know; not on labelnot on label


Clarified the question…but

• Do you currently take supplements Do you currently take supplements containing resveratrol?containing resveratrol?



Some are not Some are not called ‘resveratrol’called ‘resveratrol’



Clarified the question…but

• Do you currently take supplements Do you currently take supplements containing resveratrol?containing resveratrol?


• How often?How often? __ daily __ weekly __ less often__ daily __ weekly __ less often What dose? _____What dose? _____ What brand? _____What brand? _____

Some are not Some are not called ‘resveratrol’called ‘resveratrol’


Only few brandsOnly few brandsare absorbedare absorbed


Assessing intake by interview

• Please bring all of the medications or Please bring all of the medications or supplements that you have taken in the supplements that you have taken in the past monthpast month

• Frequency of useFrequency of use __ daily __ weekly __ less often__ daily __ weekly __ less often

• Dose __ __ __ mgDose __ __ __ mg

• Brand _________Brand _________

Open endedOpen endedMust be coded Must be coded with a dictionarywith a dictionary


Some assessments are difficult and inherently imperfect

• IntakesIntakes

• ActivityActivity

• SleepSleep

PreferPrefer

• Direct measurementsDirect measurements


Some assessments are difficult and inherently imperfect

• IntakesIntakes Blood or urine levelsBlood or urine levels

• ActivityActivity MonitorsMonitors

• SleepSleep Actigraphy; home Actigraphy; home devices devices

PreferPrefer

• Direct measurementsDirect measurements


“Health”

• MrOS uses the SF-12 to assess health MrOS uses the SF-12 to assess health statusstatus

• It is extensively validatedIt is extensively validated For example, large differences between For example, large differences between

patients with and without chronic diseasepatients with and without chronic disease Changes in response to interventions, Changes in response to interventions,

such as exercise or medical treatmentssuch as exercise or medical treatments


‘Standard’ or ‘validated’ instruments

• Usually the best choiceUsually the best choice Probably free(er) of bugsProbably free(er) of bugs Looks better in papers and grantsLooks better in papers and grants

• However, However, May not measure what you wantMay not measure what you want May not apply to your populationMay not apply to your population May be longer than you needMay be longer than you need


Questions in the SF-12(for patients > 70-95)


Questions in the SF-12(for patients > 70-95)

Some men >75 Some men >75 might not do thesemight not do these

This might be discovered This might be discovered by pretesting men >75by pretesting men >75


Questions in the SF-12



Does resveratrol Does resveratrol improve mood?improve mood?





There is no reason to believeThere is no reason to believethat resveratrol would relieve painthat resveratrol would relieve pain


The ‘validated’ SF-12

• A good choice becauseA good choice because Extensively tested, few/no bugsExtensively tested, few/no bugs Would look better in papers and grantsWould look better in papers and grants

• However, However, Does not measure ‘health’ related to Does not measure ‘health’ related to

speed, strength, endurancespeed, strength, endurance Many questions about mood and pain Many questions about mood and pain May not apply to men > age 75 yearsMay not apply to men > age 75 years


What do I want to measure?

• Walking speedWalking speed Already to be measured in MrOsAlready to be measured in MrOs

• General health question General health question

• Physical quality of lifePhysical quality of life Just the ‘physical’ components of SF-12Just the ‘physical’ components of SF-12


Pretest, pretest, pretest

• Start with a few friends or colleaguesStart with a few friends or colleagues

• Try it on 2 or 3 like subjects in your studyTry it on 2 or 3 like subjects in your study Men over age 75; extremes (age, education…)Men over age 75; extremes (age, education…)

• Discuss the answers with the volunteersDiscuss the answers with the volunteers

• Revise and retestRevise and retest

• Test the ‘final’ in more and diverse subjectsTest the ‘final’ in more and diverse subjects Potential goals: clarity, time, frequency of Potential goals: clarity, time, frequency of

answersanswers

• Bigger efforts: test reliability and validityBigger efforts: test reliability and validity


Administering questions

• Questionnaires are more efficient than interviewsQuestionnaires are more efficient than interviews If needed, follow-up review of questionsIf needed, follow-up review of questions

• Sometimes, interviews are the only waySometimes, interviews are the only way Make sure they are asked verbatimMake sure they are asked verbatim

• Use electronic methods as much as possibleUse electronic methods as much as possible Online tools (mix of free & pay service)Online tools (mix of free & pay service)

www.surveymonkey.com www.zoomerang.com

11 reviewed at 11 reviewed at www.techsoup.org/learningcenter/software

(search “online survey tools”)(search “online survey tools”)


Summary

• Carefully define what you want to measureCarefully define what you want to measure

• Search for ‘standard’ instrumentsSearch for ‘standard’ instruments Do they measure what you want?Do they measure what you want?

• If you make your own: avoid pitfallsIf you make your own: avoid pitfalls Clarity; avoid “and,” “or”Clarity; avoid “and,” “or”

• Pretest, pretest, pretest…Pretest, pretest, pretest…

Documents

Questionnaires and Interviews Steven R. Cummings, MD Director, S.F. Coordinating Center