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PHC215
By Dr. Khaled Ouanes Ph.D.
E-mail: [email protected]
Twitter: @khaled_ouanes
INTRODUCTION TO
HEALTHCARE RESEARCH
METHODS
Primary Studies:Developing a Questionnaire
Overview
A questionnaire is a tool for systematically gathering information from study participants.
Questionnaires can be designed for self-reporting or as scripts for interviews.
Questionnaire Design Plan
Questionnaire Content
It is often helpful to start with a list of the main categories of questions to be asked, and then to add
detail about the specific topics to be covered.
Question areas
Questionnaire Content
The questionnaire must include questions confirming
that participants meet the eligibility criteria for the
study.
The questionnaire must also be able to accurately
place participants into key categories, such
confirming that all cases in a case-control study
meet the case definition.
A survey should be neither too short nor too long
(Depending on the audience too).
Types of Questions
After determining the broad categories of questions
and the specific topics to be addressed in each
section, each question topic should be assigned a
specific type of question.
Close-ended questions allow a limited number of
possible answers
Open-ended questions allow participants to give
free-response answers
Open-Ended Questions
Open-ended questions allow participants to:
explain their selections and qualify their responses
give multiple answers
provide responses not anticipated by the researcher
However:
they take longer to ask and answer
they may result in irrelevant answers
recoding for statistical analysis is often difficult
Close-Ended Questions
Close-ended questions come in a variety of
formats, including:
Date and time variables
Numeric variables
Categorical variables
Paired-comparison variables
Rank-order variables
Categorical variables come in a variety of formats:
Dichotomous variables have only two
response options (like yes/no)
Ordinal variables are ranked based on an
inherent order
Nominal variables are have no built-in order
Close-Ended Questions
Examples
of Types
of
Questions
ALL THE QUESTIONS, REGARDLESS OF THEIR
TYPES, SHOULD BE ELABORATED AND
DESIGNED ACCORDINGLY TO THE TARGET
AUDIENCE.
(Length, language, Use of technical/Savvy jargon, Open-
ended or close-ended?...)
Anonymity
Many questions can be asked in more than one
valid way, and the researcher must decide
which question type is most appropriate and will
best protect participants’ anonymity.
If a name, an address, a birthdate, or other
information could link a participant to the study,
then there must be a solid plan in place for
protecting the privacy of participants and the
confidentiality of the information they share.
Types of Responses
Once the types of questions have been
selected and clearly determined, a decision
must be made about the kinds of responses
that are appropriate and suitable for the
asked questions.
For numeric responses, the question should state
exactly how specific the answers should be.
For categorical questions, consider all possible
responses for each question, and include as many
as needed (including, perhaps, “other”, N/A and “I
do not know”).
For ranked questions, decide how many entries to
include on the scale and whether there will be a
neutral option.
Types of Responses
Examples of Responses for
Ranked Questions
Wording of Questions
One of the major difficulties in writing good survey
questions is getting the wording and the phrasing
right. Even minor wording differences and slight
phrasing variations can confuse the respondent or
lead to incorrect interpretations of the question.
As usual, we should always keep the targeted audience in
mind.
Wording of Questions
After drafting the questionnaire, check each question
for clarity:
Does each question ask what it is intended to ask?
Is the language of each question clear and neutral?
Will members of the study population understand the
language?
Is the question sensitive to potential cultural issues
related to language?
Check to be sure that the responses are carefully
worded:
Is the choice of response clear?
For scaled questions, is the rank order clear? (For
example, is it clear that 1 is “strongly disagree” and
5 is “strongly agree”?)
For questions with unranked categories, is the order
of possible responses alphabetical or otherwise
neutral?
Wording of Questions
Problems to Avoid
Order of Questions
Many questionnaires start with easy or at least general questions before moving to more difficult or sensitive questions.
The questions should be in an order that flow naturally from one topic to another, and similar questions should be grouped.
Think carefully about how previous questions could taint the answers to later ones.
Layout and Formatting
The layout of the survey instrument will vary depending
on the mechanism of data collection used.
A self-report survey, either paper-based or computer-based,
may require instructions about how to indicate answers.
For an oral survey, the interview script requires an opening
statement, transitions between sections of the survey, closing
sentences, spaces for recording responses to questions, and
other instructions.
Example of a Self-Reported
Questionnaire
Example of a Telephone Interview Script
Validation
A valid questionnaire measures what it was intended to measure in the population being
assessed.
One way to seek validity is to include survey questions or modules that are identical to the ones used in previous research projects, but access to survey questions is often not possible in the health sciences.
Pilot testing of the new questionnaire is essential for the development of a valid and useful tool.
Commercial Research Tools
A number of widely used and validated tests, primarily
from the social sciences, are available to researchers
as commercial products.
Some of these tools are free of charge, but most
require payment for use.
Some tests provide the instrument for free but require
researchers to pay to have the results scored and
validated against previous users of the survey
instrument.
Translation
Translation of the survey instrument into one or
more additional languages may be necessary.
Check to be sure that the translated version
expresses the same meaning as the original
survey.
Accuracy may require the rephrasing of
whole sentences, not just direct word-for-
word translations.
Pilot Testing
A pilot test (pretest) of the questionnaire is helpful for
checking content, clarity, layout, timing, and other
factors.
Volunteers from the target population (but not the
sample population) should be asked to complete
the preliminary survey and provide feedback on it.
The survey instrument should be revised based on
these observations.
Several rounds of pilot testing may be required.
Pilot Testing
Here are a few things to keep in mind when
conducting a pilot test:
Keep it practicable by testing your survey on a small group of
people
Test your survey on individuals that are similar to your actual
survey population
After completing the survey, ask participants to provide
feedback on the intelligibility of questions and response options,
as well as the length of time it took them to complete the survey.
Assess if the questionnaire has issues (too long, too complex, too
ambiguous etc.)
Pilot Testing
Review the test responses to the survey, looking for
any inconsistencies or unexpected answers.
Make any necessary changes to the survey before
implementing it on a large scale. Consider
conducting a second pilot test if extensive changes
have been made to the original survey.
Primary Studies:Surveys and Interviews
Surveys vs. Interviews
Most primary studies collect data from individual participants using an interview method or a self-administered questionnaire.
Self-reported surveys are usually the least costly and least time-consuming way to gather information, and they may be the best way to get honest answers to sensitive questions.
Interviews may allow for more detailed information to be gathered and can be accompanied by laboratory and other tests.
Examples of Methods for Collecting
Data
Recruiting Methods
Once a data collection method has been selected, the next step is to decide on an effective method for recruiting
members of the sample population to be participants in the study.
The best method for initiating contact with potential participants is often related to the intended data collection
method.
Examples of
Methods for
Contacting
Members of the
Sample Population
Recruiting Methods
Participation rates will likely be higher if:
Recruits understand the importance and value of the
research project
Researchers provide multiple invitations and
opportunities to participate, and make participation
as easy as possible
Incentives (such as small gifts) are offered
Data Recording Methods
A decision must also be made about how responses
will be recorded and when they will be entered into a
computer database. There are two basic options:
Record the responses on paper and to enter them
into a computer database later
Have interviewers or participants enter responses
directly into a database
Methods for Collecting and
Recording Survey Data
Training Interviewers
The interview process should be the same for all participants in a study, whether they are being interviewed in-person or by telephone interview.
Uniformity is easiest to accomplish when all interviewers attend training sessions where they have an opportunity to practice their interview skills.
Characteristics
of Well-Trained
Interviewers
Primary Studies:Additional Assessments
Supplementing Self-Reported
InformationAnthropometric Measures (Height, weight, Waist….)
Vital Signs (temperature, blood pressure, heart rate…)
Clinical Examination (Heart sounds, Mental status, Bowel sounds…)
Tests of Physiological Function (EEG, ECG…)
Laboratory Analysis of Biological Specimens
Medical Imaging (X-Rays, CT-Scans, MRI…)
Physical Fitness Tests (Muscle strength, cardiorespiratory fitness…)
Environmental Assessment (Exposure to sources of pollution …)
GIS (Geographic Information Systems) – Spatial Analysis
PHC215
By Dr. Khaled Ouanes Ph.D.
E-mail: [email protected]
Twitter: @khaled_ouanes
HEALTHCARE RESEARCH METHODS
Based on the textbook of introduction to health research methods – K.H. Jacobsen