CHAPTER SIX
STRUCTURED QUESTIONNAIRES
This chapter focuses on structured questionnaires and how they can
be used in drug use studies. It begins with a brief overview of the
questionnaire method and indicates the types of study questions for
which it is most suited. The greater part of the chapter is devoted
to a discussion of the steps involved in using the method to study a
particular drug use problem.
6.10: Overview
6.11: What is a Structured Questionnaire?
A questionnaire is a group or sequence of questions designed to elicit information from an
informant or respondent when asked by an interviewer or completed unaided by the respondent.
When an interviewer is involved, the questionnaire is sometimes referred to as an interview.
An unstructured questionnaire is an instrument or guide used by an interviewer who asks
questions about a particular topic or issue. Although a question guide is provided for the
interviewer to direct the interview, the specific questions and the sequence in which they are
asked are not precisely determined in advance.
A structured questionnaire, on the other hand, is one in which the questions asked are precisely
decided in advance. When used as an interviewing method, the questions are asked exactly as
they are written, in the same sequence, using the same style, for all interviews. Nonetheless, the
structured questionnaire can sometimes be left a bit open for the interviewer to amend to suit a
specific context.
A semi-structured questionnaire is a mix of unstructured and structured questionnaires. Some
of the questions and their sequence are determined in advance, while others evolve as the
interview proceeds.
The focus of this chapter is on structured questionnaires.
The list of questions that make up a structured questionnaire may be open ended or close ended,
depending on how the questions are framed and asked An open-ended question is one in which
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possible responses are not supplied in advance. Each respondent=s statements should be
recorded as fully as possible and in the respondent's own words. Open-ended questions are very
useful for exploring sensitive issues and investigating topics concerning beliefs, attitudes, and
practices.
A close-ended question usually provides a set of responses or options from which a respondent
indicates his/her choice. Where the study topic concerns factual issues, or is a familiar one with
a limited range of responses, close-ended questions are particularly useful.
6.12: Use of Structured Questionnaire in Drug Use Studies
The structured questionnaire method can be used to study various aspects of drug use behavior
involving providers and consumers. The method is appropriate to use where the study is aimed
at:
!
Estimating the prevalence of existing beliefs or attitudes as a means of confirming
data obtained with either unstructured interview or other qualitative methods.
!
Finding out more information to complement or follow up a previous exploratory study.
The purpose of this may be to check the validity of previously collected data or
observations to enrich the overall results of a study.
!
Comparing responses in subgroups of a large population, such as knowledge about
different drugs, the type of drugs used, how much they cost, and so on.
6.20: Steps for Using Structured Questionnaires
Drug use studies that employ the structured questionnaire method share some of the
characteristics of other methods. Several steps are involved; these are outlined and described
below.
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Table 6.1:
Key Steps in Using a Structured Questionnaire in Drug Use Studies
Step 1: Plan how to carry out the study.
Step 2: Define and identify the target group for the study.
Step 3: Develop the questionnaire(s) and guides.
Step 4: Select interviewers and other field team personnel.
Step 5: Train field personnel and pilot test the questionnaire.
Step 6: Prepare and conduct the field work.
Step 7: Analyze and interpret the data.
6.21. STEP 1: Plan How to Carry out the Study
a. Why is Planning Necessary?
When planning a questionnaire study, you must first make a number of decisions regarding
various aspects of the study and how it will proceed. These decisions will all have a major
impact on the implementation and success of the study.
During the planning you must decide which target group will answer your questionnaire, how to
select a sample, design the questionnaire, and select and train interviewers.
In addition, you need to plan study logistics and equipment. These include stationery, forms,
transport and whether incentives will be offered to respondents. Field allowance for interviewers
must also be decided at this stage. These issues are addressed in the rest of this chapter.
b. Is there the Need for a Resource Person?
Planning and implementing a questionnaire study is an interesting but demanding task. Whether
or not it is necessary to find a resource person to assist in planning and implementing the study
will depend upon factors such as the scope of the study, available resources, and your own
experience and confidence in applying the technique.
Of all the methods described in this manual, questionnaires are the most familiar to many health
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professionals, and the one technique with which many people have had experience. An
investigator with some experience may be able to manage a small study by merely following the
steps described here, since the skills required to design and implement a structured questionnaire
are not as demanding as other methods. For a large study, you may consider the assistance of a
social scientist who is experienced in questionnaire design and survey research.
6.22. STEP 2: Identify the Target Group
One important decision is to identify the study population (the target groups of respondents who
can best provide the information you need). The following steps provide a guide to the issue of
sampling.
a.
Determine Type of Sampling
Probability sampling methods are most commonly used in structured questionnaire studies. The
purpose for using the questionnaire method usually involves confirming a hypothesis or
generalizing the results of a study so relatively larger samples selected by probability methods are
appropriate. The common probability sampling methods include:
!
simple random sampling
!
systematic sampling
!
stratified sampling
!
cluster sampling
!
multi-stage sampling
These methods are described briefly in Annex A.
The basic principle underlying probability sampling is that the selection of any respondent or unit
in the study population is based on a known (usually equal) probability. The most appropriate
method for a particular study depends on the size of the target population, what lists of members
are available, and whether the population is organized in natural clusters like villages or health
centers. [See also How to investigate drug use in health facilities: selected drug use indicators
(WHO/DAP/93.1) for a more detailed discussion on sampling procedures.]
Sometimes, because of logistical constraints, the sample for studies of the knowledge, attitudes,
or satisfaction of patients attending health facilities, or of patients with specific health problems,
will not be selected randomly, but in the order in which they present for treatment (a convenience
sample). In such samples, we must assume that patients in general, or patients with specific
problems, present Arandomly@ from the underlying pool in the community, and that
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generalization to the larger underlying population is justified. Sometimes surveys will avoid
sampling patients who attend early in the morning (more likely to be emergencies), or those who
attend on market days (more likely to have no specific complaint) in order to avoid bias.
b.
Who should be Selected?
The target population for a questionnaire survey will be chosen based on the drug use problem,
the study objectives, and how the results are to be used. For example, you might be interested in
inappropriate diarrhea treatment in the community. Previous research may have shown that most
patients are treated without prescription in private pharmacies and drug retail outlets. A
questionnaire survey of provider knowledge and beliefs may target all counter attendants in
licensed pharmacies if that is an identifiable group for whom an intervention might be mounted.
The most important principle is to ensure that all segments of the target population are well
represented.
Sometimes questionnaire surveys will include Aproxy@ cases; if so, criteria for who can be
included must be clearly specified at the beginning. For example, in studying the use of
antibiotics for treating ARI, an investigator is likely to talk to mothers with children who report
with an episode of ARI. In cases where patients are accompanied by other relatives such as an
aunt or neighbor, instead of the mother, the study should specify whether these persons can be
interviewed or not.
c.
Number to Interview
Sample size depends upon the aim of your study, and in particular how precise the sample
estimates must be. Using the antibiotic example, if the purpose is simply to explore beliefs and
attitudes about antibiotics in the treatment of cough in children, a small sample may be sufficient.
However, if the purpose of a study is to estimate specific knowledge deficits in a population of
paramedics in order to design a curriculum, a larger sample might be necessary. Generally, if the
goal of the study is to test a hypothesis or generalize the findings to a large population, then an
adequate representative sample -- usually a large one -- must be taken to achieve a reliable result.
d.
Contacting Respondents
Respondents to a study may be contacted by mail, telephone, or personal contact; the latter is
usually the most feasible in developing countries.
It is wise to contact the community or institution where the sample will be drawn in advance of
the study. Depending on the focus of the study, contact people may include the chief or
community head, health center officer-in-charge, or local government representative. Such
influential people can later assist with field organization and logistics, and especially with
providing an up-to-date list of the members of the target population (a sample frame).
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During the initial contact, the aim of the study, when and for how long it will take place, and how
it will benefit them should be explained to the agencies involved. Such information may
encourage greater cooperation.
6.23. STEP 3: Develop the Questionnaire(s) and Guides
The design of a questionnaire and how questions are worded can greatly influence the reliability
of the data collected. Developing a structured questionnaire is a relatively familiar activity, since
questionnaires are so commonly used. Despite this, creating a good questionnaire is not a simple
task, but one which requires careful testing and retesting. The suggested sequence of steps to
assemble a questionnaire is:
a.
1.
Determine the contents of the questionnaire.
2.
Formulate the questions.
3.
Order the questions.
4.
Arrange the questionnaire.
5.
Translate the questionnaire (if necessary).
Determine the Contents of the Questionnaire
The first task is to determine which topics the questionnaire will cover and how it will be
administered. The number of topics will depend on the objectives of the study, and on the length
of time it is reasonable to expect respondents to cooperate. Remember that the information
collected should be relevant to the design of an intervention. The most frequent problem in
questionnaire design is asking too many questions that are not directly useful or relevant. You
can organize your work as follows:
!
Outline the most important objectives of the study.
!
List under each objective the types of information directly relevant and
necessary in meeting these objectives.
!
Rearrange and organize the lists into separate sub-themes or sections of
the questionnaire.
!
Decide how the questionnaire will be administered; i.e., whether it will be
filled in by respondents themselves or by an interviewer (which is more
common in developing countries).
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b.
Formulate the Questions
After identifying the sections of the questionnaire, you must formulate individual questions to
gather the specific pieces of information needed.
Wording questions so that they are uniformly understood and tap into the desired category of
response requires patience, practice, and, above all, pre-testing. Some general guidelines on
good question formulation include:
1.
Each question must be clear, simple, and specific
For example, a question such as "Where do you normally seek treatment when your child falls
ill?" may be perceived differently by different respondents. AIllness@ can include many different
types of health problems, and varying degrees of severity. AWhere@ can be interpreted as a
physical location or a type of practitioner. ANormally@ is an imprecise word that means different
things to different people. ASeek treatment@ may exclude self-medication in the minds of some
respondents.
To overcome this problem, it is best to specify questions in clear, short and simple language.
You may for instance break the question into pieces to assist respondents, for example, by asking
specifically about ARI. Further limiting the duration to the last two weeks preceding the study or
the last episode of illness will also enhance recall of respondent. You can further ask them to
mention specifically the various actions they took since the illness was noticed. These may
involve the following questions:
Has your child been ill with cough within the past two weeks?
(If the answer is yes): Did you visit anyone for advice or treatment? Did you give the
child any medicines?
(If the respondent indicates medicine(s) were given): Would you please list any
medication(s) that the child has used since the illness started?
2.
Each question must measure one thing at a time
Questions which measure two or more different things should be avoided. For example, the
question "How do you and your staff normally treat children who present with cough?" should
be divided into several questions to enable the respondent to give separate answers for different
types of prescribers in the facility, since they may each have a preferred way of treating cough.
3.
Questions should not be biased
Leading questions can lead to biased responses. A leading question is one which suggests the
expected answer. For example, the question: "When a child presents with ARI, do you prescribe
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an antibiotic?" is a leading one because it mentions antibiotic. An alternative would be to ask
"What do you do when a child presents with ARI?"
Leading questions may also arise when presumptions are made about the respondents. For
example, the question: "What additional fluids did you give your child when he was last ill with
cough?" is biased because of the presumption that when the child has had an attack of cough, the
respondent would give the child extra fluids.
A better set of questions might be: "Has your child had cough within the last two weeks?" (If
yes): "Did you take any action?" (If yes): "What action did you take?"
4.
Questions must be free from ambiguity
Words which are vaguely defined or have double meanings should be avoided. The question:
"What kind of patient was he?" may lead to different types of responses such as `"poor" or "rich,"
"simple" or "complex," "cooperative" or "un-cooperative," and so on.
Also, "double barreled" questions, such as: "Do you think ampicillin and tetracycline are
effective for treating cough?" are not good questions since a respondent could like one and not
the other. In this case, a Yes or No response would not truly reflect the respondent's opinion.
Divide such questions into two, each containing a single idea.
c.
Sequence the Questions
After framing the questions, they must be organized in a sequence that is helpful for respondents.
Following is a useful approach:
!
Ensure a logical order of topics, and of questions within a topic. Ideas should
flow smoothly from one question to another, moving from more general questions
to more specific ones within each topic.
!
Begin with relatively non-controversial and interesting questions, e.g., How many
years have you worked at this health post?"
!
Place sensitive questions concerning personal information such as age, education,
occupation, and income at the end of the questionnaire since respondents may be
unwilling to answer them if they are asked early, before a relationship of trust has
been established.
!
If the response to one question is likely to influence the response to another
question, these questions should be separated.
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!
d.
Any instructions for skipping one or more questions should be clearly indicated
and, if possible, written in a different font or typeface.
Arrange the Questionnaire
Finalizing the draft questionnaire involves planning the layout to make it both "consumer" and
"user" friendly. This involves the following:
e.
!
Provide necessary headings and spaces for labeling and identifying all
questionnaires, ie., identifying information for respondent, date and place of
interview, as well as name of interviewer.
!
Provide necessary instructions at the start of each section of the questionnaire.
Give guidance and reminders at relevant sections to the interviewers.
!
Provide sufficient space between questions.
!
Be consistent with codes or boxes for pre-categorized answers.
!
Provide enough space for writing down answers to open-ended questions.
Translate the Questionnaire (if necessary)
Most interviews involving patients in developing countries are conducted in local languages. To
ensure consistency in the use of words and meanings, questionnaires must be thoroughly
translated before the field work begins.
One effective way of checking the accuracy of translations is to have a different translator do a
back translation into the original language in which the questionnaire was written. The two
versions can then be compared to iron out any differences. Table 6.2. is an example of a
questionnaire.
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Table 6.2.:
Example of A Structured Questionnaire
DRUG USE STUDIES IN ACUTE RESPIRATORY INFECTION (ARI)
Client Intercept Questionnaire
Name of District..........................................................................
Date of Interview..............................................
Name of Town.............................................................................
Name of Interviewer.........................................
Name of Facility..........................................................................
Name of Patient...........................................................................
DIAGNOSIS
1.
Can you tell me in your own words what the problem is with your child?
2.
Why did you choose to come to this facility today for treatment?
3.
Have you ever been to this facility before?
Yes________
No________
4.
Did you try any other kind of treatment before you came here?
Yes________
No________
If yes: What kind of treatment was that?
DRUG USE
5.
Could you please show me the drugs you were given here today? Examine drugs to be able to later fill
in the questions on drug labeling on the dispensing form.
Did anyone here tell you how to use these drugs?
Yes________
No________
Did you understand what they explained to you?
Yes________
No________
b. The drugs you were given?
No
If yes: Who was it that explained this to you?
Yes
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3.
Can you explain why you were not satisfied, or in what ways might you have been more satisfied?
4.
If your child's cough does not improve after taking these drugs, what do you plan to do?
d)
8.
Socio-Demographic characteristics
Sex of Respondent
Male
9.
Highest level of education
a. Primary
b. Secondary
c. University
d. Other Tertiary
e. Other(Specialties)
f. No formal education
Table 6.2.
6.
Female
(Continued)
Could you please explain the use of each drug to me? Hold each drug in turn for the adult to see.
Drug
Described Use
a.
b.
c.
d.
e.
SATISFACTION WITH CARE
7.
Are you satisfied with the treatment obtained?
Yes________
No________
The way the child was examined?
Yes________
No________
The drugs you were given?
Yes________
No________
8.
If you could change one thing about the care here to make it better, what would that be?
9.
If your child=s cough does not improve after taking these drugs, what do you plan to do?
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SOCIO-DEMOGRAPHIC CHARACTERISTICS
10.
Sex of Respondent
Male_______
11.
Highest level of education (Check one):
Female________
Primary
______________________
Other Tertiary
Secondary
______________________
Other (Specialties)____________________
University
______________________
No formal education __________________
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____________________
6.24.
STEP 4: Select Field Personnel
The calibre of field personnel who administer the questionnaire have a great influence on the
quality of data. In structured questionnaire interviews, the field team personnel usually include
interviewers and supervisors.
a.
Selecting Interviewers
The interviewer is the one who "sells" the aims, objectives, and intended use of the information
to the respondents. The following are qualities to consider when recruiting interviewers.
1.
Educational qualifications
Administering a structured questionnaire does not necessarily require high qualifications. Usually
people with high school or second cycle education who can read and write well would be
appropriate. In fact, using personnel with high qualifications may even prove risky since such
people have a greater tendency to get bored with repetitive work.
2.
Personal qualities
The following are useful personal qualities in an interviewer:
!
ability to develop rapport with people;
!
ability to speak all languages, if multiple languages are being used;
!
fluency in local language where this is essential;
!
ability to work alone and under difficult conditions;
!
honest and with a strong motivation to work;
!
previous experience in conducting interviews;
!
good communication skills.
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Someone who is shy, aggressive, or has an unpleasant appearance
is not likely to be a good interviewer
6-14
b.
Selecting Supervisors
A supervisor is responsible for seeing that the field work is done properly. In addition to the
personal qualities listed under Interviewer (above), the role of the supervisor demands the
following additional qualities:
!
ability to work with an motivate people;
!
highly motivated and intelligent;
!
considerable field experience is most preferable;
In general the duties of a supervisor include:
!
consulting relevant authorities when a team enters a community or an institution
for the necessary permission;
!
checking the progress of the interviewers in the field;
!
acting as point of contact between interviewers in the field;
!
maintaining schedules and coordinating work in the field;
!
solving any problems or difficulties that need to be resolved in the field;
!
reviewing and editing completed interview schedules on a daily basis to avoid or
minimize any problems during the analysis;
!
re-interviewing small samples of respondents on important aspects of the
interview to provide some measure of quality control in the data obtained.
You may decide to select your personnel through interview, or written test (for language
competency). It is advisable to make the selection provisional, subject to good performance
during training and field testing.
6.25. STEP 5: Train Field Personnel and Pilot-test Questionnaire
The purpose of training is to impart the needed skills to the field team before they embark upon
the field work. The training curriculum must cover both the technical aspects of questionnaire
surveys, as well as practical training in how to implement them effectively.
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a.
Technical Background on Structured Questionnaires
Provide interviewers with adequate background knowledge on structured questionnaires and the
survey process. This theoretical aspect of the training must include the following:
b.
!
an overview of structured questionnaires;
!
how questionnaires will be used in this drug use study;
!
the role of field personnel, including interviewers and supervisors;
!
how to sample and locate respondents in the field;
!
how to gain rapport with respondents and conduct a successful interview;
!
how to record, process, or edit data in the field;
!
how the data will be analyzed.
Relevant Background Knowledge about the Study
Inform the team about the problem, purpose and objectives of the study so that they can
understand it in context. Provide information about the study community and target population.
Discuss the possible problems that could be encountered with respondents on the field. Explain
any anticipated sensitivities on the part of community leaders, facility administrators, or
respondents. This is especially important if it is possible that the questionnaire is seen as
evaluating or judging knowledge or performance.
c.
Instructions for Recording Responses
Much of a structured questionnaire is completed by an interviewer marking or circling the
appropriate response. In order to avoid inconcsistency, it should be made clear exactly how the
interviewer is to complete each item. For multiple response lists, indicate whether the
interviewer is to read the list to respondents, and also whether multiple responses are possible. If
the interviewer makes a mistake filling in a question, explain how the mistake is to be corrected (
e.g., by blocking out, erasing, circling with an X, etc.).
Each respondent has to answer open-ended questions in his or her own way. The interviewer
therefore needs to be cautious in recording open-ended responses. Such responses should be
written in full. However sometimes this is impractical, and interviewers must learn to extract the
key information. The respondent can be asked politely to repeat a response if it is not well
understood.
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Interviewers must not spend a lot of time writing since this can interrupt the flow of the
session. Abbreviations are very useful, but interviewers should avoid those that are difficult to
read later. Introducing a common set of abbreviations for vocabulary that will be frequently
used is very helpful.
d.
Role Play Sessions
The practical sessions of training consist of two parts. First are the role plays in which
interviewers and other field staff practice among themselves in artificially created situations.
Interviews should play the part of both interviewers and respondents.
The trainer and other experienced interviewers can observe and comment on the performance of
interviewers in order to improve both the interviewers' style and the questionnaire.
e.
Pilot Tests
As with all applied qualitative methods, it is important to pilot test the questionnaire and the field
procedures. This involves trying out the prepared questionnaire in a group and an environment
similar to that expected in the actual study situation. It affords interviewers the opportunity to
practice all the activities that they are expected to carry out in the field. Functionally, pilot tests
serve to:
!
assist interviewers in becoming familiar with the questionnaire;
!
help improve and sharpen interviewing skills;
!
afford a means of checking, revising, and finalizing the questionnaire by
improving the clarity and order of questions and removing ambiguous and
unnecessary questions;
!
enable the investigator to learn about possible problems that lie ahead, thereby
providing an opportunity to make changes in the study organization before
embarking on the field work.
6.26. STEP 6: Prepare for the Field Work
Once the training and pilot testing and over, you are almost ready to move into the field.
Preliminary preparations do, however, need to be made to ensure that the field work proceeds
successfully.
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a.
Review and Revise the Questionnaire
After the pilot test, review and revise the questionnaire and the guidelines for the actual field
work. This review should take into account all issues related to the successful administration of
the questionnaire. These will include the following:
!
interviewer's approach to respondents;
!
target response rates;
!
what to do about partial or irrelevant responses;
!
mistakes in following instructions on the questionnaires;
!
time required for completing the interview.
Before printing the final questionnaire, have it thoroughly proof read to correct any hidden
mistakes.
b.
Prepare a Work Plan
As part of your preparation for the field work, you need a work plan and a time-table of how you
will proceed with the field interviews. Particularly if the study is a large one with several
interviewers and other staff, your work schedule will involve:
c.
!
composition of various teams of interviewers and supervisors;
!
assignment of teams to specific locations or delineated areas;
!
transportation and accommodation arrangements;
!
schedule of work.
Plan for Supporting Materials
Before you finally move into the field, ensure that instruments and other interviewing materials
and logistics for the field work are ready. Your checklist should include:
!
introductory letters;
!
sufficient questionnaires for the interviews;
!
waterproof folders for the questionnaires in case of rain (if needed);
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!
instruction list for interviewers and supervisors;
!
pens/pencils and note books for interviewers and supervisors;
!
bags for carrying interviews and materials.
6.27. STEP 7: Administer the Questionnaire
a.
The Interview Process
Interviews are best conducted with respondents alone in a place that offers reasonable comfort
and privacy. Providers and patients/clients may be interviewed in a health facility or drug retail
outlet. Community members can also be interviewed in their homes which is where they are
most likely to stock and take their medicines.
The interview session can be divided in three stages: introduction and rapport building;
interviewing; and closing the interview.
1.
Introduction and Rapport Building
The opening part of the interview is aimed at introducing the respondent to the topic and making
him/her relaxed for the interview. The interviewer seeks to do the following:
.
2.
!
greet the respondent, keeping with local custom;
!
introduce himself/herself;
!
briefly explain the purpose of the interview;
!
assure respondent that responses will be anonymous and confidential;
!
politely ask respondent to introduce himself/herself;
!
seek respondent's consent to start interview
Interviewing
After establishing rapport, the most important aspect of the interview is asking questions in a
standardized way. Following are interviewing techniques to guide the interviewer:
!
Questions should be asked without changing the wording, order, or emphasis.
Rationale: All respondents should be given the same information and asked the
same questions, under similar conditions.
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3.
!
Instructions which introduce sections of the questionnaire must be read out clearly
and distinctly.
Rationale: These instructions help respondents think about and prepare their
answers.
!
Interviewers must read out questions at a reasonable pace.
Rationale: If the interview is rushed, respondents may give answers that tend to
come to mind first instead of thinking about questions; if the pace is too slow, the
interview can drag along and tire respondents.
!
If a question is not understood, the interviewer must repeat the question in the
same words, with the same emphasis and the same instructions.
Rationale: Putting questions in different words can easily change the meaning
and emphasis.
!
Interviewers must avoid returning to questions which could previously not be
answered.
Rationale: Repeating questions this way can expose the intent and influence the
responses.
!
The interviewer must show neutrality as much as possible.
Rationale: Certain reactions by an interviewer can change the attitude of a
respondent.
Examples are: frowning or irritated voice, smiling or laughing suspiciously,
winking an eye, or raising eyebrows.
Closing the Interview
Before the interview is brought to an end, the interviewer must politely thank the respondent,
explain that the interview is now completed, and ask if the respondent has any comments or
questions. It is a good idea to ask respondents if they felt that the interview captured all of their
opinions about the subject matter. Often respondents will offer useful opinions that may not
have been covered in any of the questions.
In the final wrap-up, the interviewer must remember to:
!
repeat the value placed on the respondent=s opinions and their likely benefits;
!
reassure the respondent of confidentiality;
!
express goodwill or polite farewell.
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Remember: the interview does not end until the interviewer has said
Athank you@ to the respondent.
b. Anticipating and Managing Possible Problems
There are some problems that are commonly encountered during interview surveys. Sometimes
these can be anticipated and prevented. Common problems and suggested ways to deal with
them include:
!
A respondent refuses an interview altogether:
The best way to guard against refusals is by polite introduction, explaining the
intended benefits of the study, and assuring the potential respondent that the interview
will be brief. When refusals occur, note any reasons for the refusal and leave the
respondent.
!
A respondent abandons the interview halfway:
Keeping interviews on track and moving along at a good pace will decrease
abandoned interviews. Well-designed questionnaires also help by maintaining the
respondent=s interest. When interviews are abandoned, record any comments as to why
this occurred.
!
Respondent gives careless answers:
Well-trained interviewers are always alert for respondents who do not seem to be
responding seriously or thoughtfully. Sometimes the respondent is temporarily
distracted or hurried, and the interview can be re-scheduled for completion at
another time. In any case, record any doubts and suspicions, and indicate
obviously suspicious answers.
!
Noisy environment:
Queues of patients, curious onlookers, and young children can all distract
respondents. Finding a more private place for the interview is the best solution.
If this is impossible, carry on as best as you can; find out from the respondent
whether something can be done about the problem.
!
Others present try to intrude in respondent's answers:
Any unusual activity in a health facility or home tends to attract interest.
Onlookers can bias responses not only by directly answering questions, but also
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because respondents may not be able to give honest answers in their presence.
Politely ask helpful onlookers to stop; at the extreme, suspend and re-schedule the
interview with the consent of the respondent.
!
Aggressive and other unacceptable behavior change in respondents:
Sometimes a particular question or simply an overly lengthy interview can trigger
hostility in a respondent. In these situations, end the interview with a polite
excuse; record the actual details of the closure on the questionnaire.
6.28. STEP 8: Analyze and Interpret the Data
After the field work, data from the questionnaires must be processed, analyzed, and presented in
the form of a report. The process involves the following activities:
a.
Processing Questionnaire Data
1.
Check and Edit Questionnaires
For purposes of easy identification, all questionnaires must be numbered separately after they
have been completed. Field supervisors should maintain a log of the number of completed
questionnaires received from interviewers each day. This helps to prevent lost questionnaires,
and also can be used to check interviewer productivity.
Interviewers should routinely edit questionnaires under the supervision of the field supervisor to
correct errors, omissions, or logical inconsistencies in filling them. The process is particularly
useful at the early stages of data collection, as it allows errors to be fed back to the interviewers
in order to avoid further mistakes.
Before the data process begins, a complete re-check and editing is necessary to clean the data.
2.
Categorize Responses
The first stage of data processing involves categorizing the responses. This is the process of
listing all responses to a question under clearly defined options. In structured questionnaire,
categorization is necessary for open-ended questions. For example, an answer to the question:
"Why did you choose to come here today for treatment?", could contain possible categories such
as "accessibility", "faith in treatment", "treatment is scientific", and "referred".
The process begins by first examining the raw data to draw up a list of clearly defined responses
for each question. Each category should be precisely described in a few words. Again, the list of
categories for each question should not be too long as this can make the analysis difficult. For
each question, place similar responses under one category. The process takes the analysis a step
on to coding.
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3.
Code Data
Coding involves assigning symbols to categories. Commonly, numbers are used. Coding makes
data processing easier, particularly where the analysis involves the use of a computer. Codes are
written on each questionnaire next to the responses. It is ideal to maintain consistency in coding
by writing the codes on one side, i.e., either left or right margin of the questionnaire, since this
facilitates speed and helps minimize errors in data entry.
For each question, if the number of categories does not exceed 9, which may be the case in most
situations, assign A1" to the first category, A2" to the second category, and so on. If the number
of categories exceeds 9, assign "01" to the first group, "02" to the second group, "03" to the third
group, and so on.
When developing a coding list, it is advisable to give the same code to common responses,
irrespective of the question, to minimize mistakes by coders.
Example:
No = Ш
Yes = 1
There are no common types of missing values that must be assigned codes. Sometimes a
response is missing because the respondent did not know the answer; this is sometimes assigned
the code A8" or A88" in numerically coded questions or ADK@ in categorical systems. A
response can also be missing if the respondent refuses to answer, the interview was not finished,
the item was skipped, or for other reasons; these missing values are after assigned A9" or A99"
codes in numeric systems, or ANA@ if categories are used. When you have finished developing
your codes, compile them into a code book and ensure that there are enough copies for all coders.
During coding a supervisor must periodically review a sample of each coder's work to ensure
that coding is being done correctly.
4.
Analyzing Data
After coding, the stages of analysis will vary depending upon whether it is manual or involves a
computer. If the analysis is manual, the use of dummy tables or a master sheet is very helpful.
1.
Using data master sheets
When data are to be analyzed manually, you will need tools for organizing the coded data from
the questionnaires and aggregating them into summary tables. The data master sheet is one tool
for organizing data. This technique is particularly helpful for small samples. Basically, it is a
sheet containing the various coded responses on the questionnaire that makes it easier to tally the
individual responses by hand.
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The advantage of using a master sheet is that direct counts can be done easily for coded
responses, e.g., for socio-economic and other background characteristics. It may not be feasible
to use master sheets if the questionnaire involves many open-ended responses. In such cases,
hand compilation may be more useful in order to capture the whole range of responses. Table
6.3. is an example of part of a master sheet.
Table 6.3. Example of a Data Master Sheet
Respondent ID
Sex
Age
Diagnosis
Prescriber
Drugs
No. Prescribed
Satisfaction
Antibiotic?
Injection?
With
drugs
Knowledge
With
care
About
diagnosis
About
drugs
1
2
3
Etc.
TOTAL
2.
Using Tally Sheets
After data have been organized on master sheets, it is easier to compute totals for individual
variables. However, the other advantage is that more complex data presentations can be
developed easily from the master sheets, such as two-way and three-way tables.
To develop a complex data presentation, it is first necessary to lay out a dummy table that will
contrast totals within categories. An example of a dummy table contrasting level of satisfaction
for patients who received or did not receive an injection by diagnosis is shown in Table 6.4.
Table 6.4. Example of a Dummy Table
Received Injection
Satisfied
No Injection
Not satisfied
ARI
Diarrhea
Malaria
Other Diagnoses
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Satisfied
Not Satisfied
Once a dummy table has been laid down, each respondent=s data from the master sheet can be
recorded as a tick mark in the appropriate cell of the table. After all respondents= data are
entered, tallying the tick marks gives the totals for the sample as a whole.
3.
Using a microcomputer for analysis
If a study involves a large volume of data, it is generally easier if a computer is used for the
analysis. This will, however, also depend upon the resources available. The following steps
provide guidance on how computerized analysis would be conducted.
4.
Choose appropriate software
Various computer software programs are available for use in processing data. For most drug use
studies some of the common ones include the following:
!
Epi Info version 5 or 6.
!
spreadsheet LOTUS 123 program
!
dBase or other database management program
!
Statistical Package for Social Sciences (SPSS) or other statistical package
Before you decide on what program to use, however, it is advisable to consult an expert in the
area. In fact such a person ought to be consulted at the planning stage of writing the
questionnaire in order to pre-plan how questions should be framed, and what kind of analysis
could be done. This has the advantage of preventing or minimizing difficulties in analysis.
5.
Enter data
For the data to be entered into a computer, a data entry format must first be developed. This is a
screen containing the questions in the questionnaire with a space provided for entering
appropriate responses. Epi Info 6 is especially well-suited for developing data entry routines
directly from the wordprocessing files used to print the questionnaire. When this has been done,
the data are then entered into the computer in their coded form. It is fastest to have specially
trained data entry clerks do the data entry.
6.
Edit data
After all data have been entered into the computer, a verification must be done to correct errors
and omissions made in the process. Examples of such obvious mistakes may involve wrong
codes such as entering 6 as code for sex when the allowable codes for sex in most cases are 0 or
1, and so on.
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To avoid or minimize such mistakes, it is sometimes possible to build checks into the program to
detect and refuse such data entry mistakes. Another option is to enter data twice and have the
computer check the equivalence of both entries.
7.
Carry Out Analyses
The great advantage of using a computer lies in its ability to do several kinds of analysis in a
relatively short time. After the data have been cleaned, you can run the analysis to obtain the
needed output. Results can be produced in the form of graphs, tables, charts, and a range of
statistical tests. You need to decide the most appropriate and useful but also interesting way of
making this presentation.
c.
Presenting and Interpreting Data
Two basic approaches are involved in the presentation and interpretation of data from structured
questionnaires. The approach is determined by the nature of the questions asked; ie., whether
they are close-ended or open-ended.
The analysis of close-ended questions, which are more or less quantitative, involves:
!
First summarizing the information in a tabular or statistical form, and then
!
Describing in words or text the information presented.
The presentation can be descriptive or analytical depending upon the purpose of the study and the
intended use of the results. Simple statistical procedures that are used in most studies include
calculating averages, percentages, proportions and ratios. As already mentioned, presentations
can be in the form of tables, graphs, pie charts and several others as best as the investigator can
manage.
Open-ended questions may also be reported as percentages if categorized and coded, but the
content of each response or categories of any particular question may also be analyzed in more
depth. As much as possible, responses that ask for knowledge, attitudes, and practices should be
described as well as quantified.
The last stage of the data presentation is interpretation. It involves explaining the underlying
reasons for the findings, and drawing implications from them. The discussion can highlight the
significance of the main findings by contrasting them with other studies on the subject.
Based on the findings and discussion, recommendations for further action can be made. This
may involve the introduction of interventions such as health education, targeted at the community
people, or policy changes to streamline the managerial capacity of the institution(s) involved.
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d.
Writing the Report
Findings from a questionnaire study are presented in the form of a report. An outline of the final
report should ideally be developed at the initial stage of the study and reviewed after the pilot
test. The components of the final report should consist of the following:
Introduction:
Statement of problem, research objectives, rationale, scope, operational
definition, outline of the chapter.
Methodology: Research approach and method, instruments, study setting, sampling, personnel,
field work organization and supervision, mode of data analysis.
Findings:
This embodies tabulating and describing the study results.
Discussion:
Underlying reasons and explanations of the main findings.
Conclusion and
Recommendations: Inferences, suggestions, and likely follow-up interventions.
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