DESIGNING SURVEYS September 18, 2012 1:00 – 2:15 pm WORKSHOP OBJECTIVES By the end of this session you will: Know the major strengths and weaknesses of alternative methods for measuring key public health variables using survey questionnaires Be able to write clear, specific survey questions Be able to independently design a questionnaire for a small-scale survey 2 PREPARING FOR A SURVEY Defining the survey purpose Identifying survey recipients Defining key concepts Designing the survey instrument Putting it all together (structure) 3 WHY USE A SURVEY? Target large amount of people Use to describe, compare or explain Can cover activities and behavior, knowledge, attitudes, preferences Specific objectives, standardized and highly structured questions Used to collect quantitative data – information that can be counted or measured 4 STRENGTHS Reach respondents in widely dispersed locations Can be relatively low cost in time and money Relatively easy to get information from people quickly Standardized questions Analysis can be straight-forward and responses pre-coded Low pressure for respondents LIMITATIONS Low response rate and consequent bias and confidence in results Seeks information only by asking, can we trust what people say? e.g. issues with over-reporting Question wording can have major effect on answers 5 BIASES THAT MUST BE UNDERSTOOD The selection of questions reflect the biases and perspectives of the researchers The questions being posed often include inherent biases Answers to survey questions reflect the perspective of the respondent Multiple respondents may answer differently The selected sample may not necessarily reflect the general population Difficulty in getting “accurate” responses from different populations 6 DEFINING THE SURVEY PURPOSE 7 DEVELOP THE PURPOSE Write a couple of sentences about the purpose of the survey- what is the general thing you want to find out? Write down ideas about the kinds of questions you could ask Brainstorm the data you could collect related to the purpose you have chosen Write down the users for the questionnaire Group your ideas into three or four key areas to investigate and write down what these are Why will this be important to the person who wants the questionnaire written? Think about the overall purpose for your questionnaire and what data you want to get out of it 8 THINGS TO THINK ABOUT: Kind of information: What do you want to know? Is the information already available? What do you NEED to know vs. “would like to know” Who will complete the questionnaire - when? (think about readability, length, interest in the topic, etc) 9 IDENTIFYING SURVEY RECIPIENTS 10 WHO DO YOU WANT TO FIND OUT INFORMATION ABOUT? This is the target population. WHO WILL YOU GIVE THE QUESTIONNAIRE TO? This is called the sample. COMBINE WITH PREVIOUS SAMPLING Population Good Sample Poor Sample 12 WHAT IS A RESPONSE RATE? The proportion of people who respond: # that answered = response rate # you contacted Example: If you distribute 50 questionnaires and you get 25 questionnaires back, your response rate is 50%. High response rate promotes confidence in results. Lower response rate increases the likelihood of biased results. 13 WHICH TYPE OF SURVEY SHOULD I CHOOSE? 14 5 ALTERNATIVE INTERVIEW METHODS Interview type Advantages Disadvantages Personal interview •Stronger commitment to completing •More costly •Greater potential for creating a non-representative sample the interview. •Greater confidence in finding the right recipient •Longer interviews tolerated Telephone surveys •Quicker turn-around •Wide availability of telephone numbers •Availability of CATI to address complex questions •Role skilled interviewers to elicit more complete answers • Negative perception of surveyors as “telemarketers” •Challenges of getting past “gatekeepers” (e.g., administrative assistants, caller ID) Mail surveys •Relative expense per response •Ability to use only names and address to reach respondent •Can use photos •Answer at respondent’s leisure •Viewed as less intrusive •Survey takes longer •Response rates lower •Respondents are more likely to have “something to say” •Less ability to correct “misunderstanding” of questions 15 5 ALTERNATIVE INTERVIEW METHODS (CONTINUED) Interview type Advantages Disadvantages Email surveys •Inexpensive with quick turnaround •Simple •Allows attachments •Cannot handle complex logic •Requires having email addresses •Perceptions about viruses and spam •Potential missed messages due to “junk” mail filters •Difficult to manage sample due to ease of forwarding •Loss of anonymity •Response bias/inability to generalize Web surveys •High speed in getting responses •Low cost •Use of email to generate responses •Flexibility in creating complex logic •More responsive to ‘sensitive’ questions •Greater ability to use open-ended questions •Respondent inputs data •Increase survey “quitting” •Restricting response to the “sample” •Even greater difficulty in generalizing results 16 WHICH TYPE OF SURVEY SHOULD I CHOOSE? “It depends”… upon What you want to know – how complex or sensitive the information is Who the respondents are – their characteristics and which type of survey will be most appropriate Your timeline Available resources 17 WILL USING A SURVEY BE CULTURALLY APPROPRIATE? Literacy level Tradition of reading, writing Setting Not best choice for people with oral tradition Translation (demands more than just literal translation) How cultural traits affect response How to sequence the questions Pretesting the questionnaire when it may be viewed as intrusive Computer access and use if an electronic survey 18 IDENTIFYING CHARACTERISTICS OF THE RESPONDENTS IS IMPORTANT BECAUSE: Their educational backgrounds determine the most effective wording Their ages and writing abilities will affect the type of question you use Their potential interest in the topic affects what you need to do to ensure they respond Physical and ability levels may affect how the questionnaire is administered 19 DEFINING KEY CONCEPTS 20 DEFINE THE VARIABLES TO BE COLLECTED Write a detailed list of the information to be collected and the concepts to be measured in the study. Are you trying to identify: Attitudes Needs Behavior Demographics Some combination of these concepts Translate these concepts into variables that can be measured. Define the role of each variable in the statistical analysis: Predictor Confounder Outcome 21 DESIGNING A SURVEY INSTRUMENT 22 Creating and aggregating information about a large number of respondents STUDY PROTOCOL AND QUESTIONNAIRE Study protocol Questionnaire Definition of objectives Design questions questions must relate to objectives List of variables to collect Analysis plan Control and reading collect appropriate information for analyses Pilot test 23 QUESTIONNAIRE DESIGN Design individual questions: Good questionnaires are difficult to construct; bad questionnaires are difficult to analyze. Adopt questions used in other questionnaires Adapt questions used in other questionnaires (search the literature) Develop your own questions (may want to use focus groups or key informant interviews) 24 REVIEW THE LITERATURE Review current literature to identify related surveys and data collection instruments that have measured concepts similar to those related to your study’s aims. Saves development time and allows for comparison with other studies if used appropriately. Proceed with caution if using only a subset of an existing questionnaire as this may change the meaning of the scores. Contact the authors of the questionnaire to determine if a smaller version of the instrument exists that has also been validated. 25 QUESTIONNAIRE NEEDS TO BE ADAPTED TO STUDY POPULATION Know the respondents language education occupation ethnic group sensitive issues 26 5 MINUTE BREAK QUESTIONS 1. 2. 3. 4. 5. 6. 7. Type of information Type of questions Types of response Common wording problems Problems with response Validity Reliability 28 TYPE OF INFORMATION Knowledge - what people know What is the recommended interval between eye checks for patients with uncomplicated diabetes? o 6 months o 1 year o 2 years o Not sure 29 TYPE OF INFORMATION Knowledge - what people know Opinions, attitudes, beliefs, values - what people think about an issue What do you think are the major issues affecting general practice physicians at the moment? ___________________________________________________ ___________________________________________________ 30 TYPE OF INFORMATION Knowledge - what people know Opinions, attitudes, beliefs, values - what people think about an issue Behavior - what people do Have you developed a care plan for any of your patients? o o Yes No 31 TYPE OF INFORMATION Knowledge - what people know Opinions, attitudes, beliefs, values - what people think about an issue Behavior - what people do Attributes – who people are (characteristics) When did you graduate from college? _______ 32 QUESTIONS 1. 2. 3. 4. 5. 6. 7. Type of information Type of questions Types of response Common wording problems Problems with response Validity Reliability 33 OPEN AND CLOSED QUESTIONS (FROM OPPENHEIM, 1992) OPEN CLOSED Strength Limitation Freedom & spontaneity of answer Time-consuming Opportunity to probe Coding more problematic Useful for testing hypothesis about ideas or awareness More effort from respondents Requires little time Loss of spontaneous responses No extended writing Bias in answer categories Low costs Sometimes too crude Easy to process May irritate respondents Make group comparisons easy Useful for testing specific hypothesis 34 CLOSED-ENDED QUESTIONS Typically used in quantitative studies. Assumption is researcher has knowledge to prespecify response categories. Data can be pre-coded and therefore in a form amenable for use with statistical packages (e.g., SPSS, SAS) – data capture therefore easier. More difficult to design but simplifies analysis. Used in studies involving large samples. Limited range of response options. 35 BRANCHING QUESTIONS Are used to direct respondents to answer the right questions as well as questions in the proper sequence ‘Skips’ in telephone questionnaires more easily managed if these are computer-assisted Consider including ‘not applicable’ category: In the past week, how often have you used MEDLINE: Not at all o At least once o More than once o I do not have access to MEDLINE o 36 SCREENING OR FILTER QUESTIONS Are used to ensure respondents in the study are those that meet the pre-determined criteria of the target population. “Tonight we are talking with individuals who are 18 years of age or older and have 50 percent or more of the responsibility for healthcare decisions in your household. Are you that person?” __ Yes __ No 37 QUESTIONS 1. 2. 3. 4. 5. 6. 7. Type of information Type of questions Types of response Common wording problems Problems with response Validity Reliability 38 RESPONSE – WORDING THE ANSWER Wording the response is as important as clear wording in the question. Make the answer options clear, logical, comparable and mutually exclusive. 39 RESPONSES Closed ended questions are usually followed by a set of responses Limited choices of responses, lack of consistency in what a yes/no, agree/disagree response means Do you have trouble climbing stairs? Attitudes and behaviors lie on a continuum To what extent do you experience difficulty when climbing stairs in your house? o None o A little o Quite a bit o A lot o I do not have stairs in my house 40 RESPONSES Choose type of scale: Nominal Are you: o Male o Female What is your marital status? o Single o Married o Widowed o Divorced o Separated o Other, specify __________ 41 RESPONSES Choose type of scale: Nominal Ordinal What is your current stage of cancer? o Localized o Regional o Metastatic What is the highest level of education you have reached? o Did not complete high school o High school diploma/GED o Some college o Bachelor’s degree o Post-graduate education 42 RESPONSES Choose type of scale: Nominal Ordinal Continuous o Numerical How severe was your pain after you were stung? (please circle) 1 2 3 4 5 6 7 Not painful at all Very painful Analogue How severe is your pain (put the tick on the line) o 0 10 43 HOW MANY TIMES HAVE YOU PARTICIPATED IN THE HEALTH FAIR? Poor spacing and logic 0−1 1−3 3−6 7−12 More than 12 times Better 0 times (never) 1−3 times 4−6 times 7- 9 times 10 or more times Vertical order of answer choice options 44 EXHAUSTIVE AND MUTUALLY EXCLUSIVE RESPONSE OPTIONS From which one of these sources did you first learn about the health clinic? o A friend o A neighbor o A relative o An advertisement o At school What is your age ? o 16-20 o 20-25 o 25-30 o 35-40 o Over 40? • Mutually exclusive: In the above example, I might have first learned about the health clinic through a friend who is also a neighbor – which would I check? Also, the choices include both sources and locations. • Exhaustive: make sure the options include all possible, important answers. Use ‘other’ fields. 45 INCLUDE BOTH POSITIVE AND NEGATIVE SIDES IN THE QUESTION STEM AND ALL POSSIBLE ANSWER OPTIONS Poor: Do you agree that our planning committee needs to meet once per month? o Agree o Disagree Better: Do you agree or disagree that our planning committee needs to meet once per month? o Agree o Disagree o No opinion Another option: How often do you think our planning committee should meet? o More than once a month o Once a month o Less than once a month 46 RATING SCALES 47 FIVE TYPES OF ORDINAL RATING SCALES Endorsement Definitely true, true, don’t know, false, definitely false Frequency Always, very often, fairly often, sometimes, almost never, never Intensity None, very mild, mild, moderate, severe Influence Big problem, moderate problem, small problem, very small problem, no problem Comparison Much more than others, somewhat more than others, about the same as others, somewhat less than others, much less than others 48 PROVIDE BALANCED SCALES WITH CATEGORIES THAT ARE EVENLY SPACED CONCEPTUALLY Poor Overall, how would you rate your experience as a nurse? o Excellent o Very good o Good o Fair o Poor Better Overall, how would you rate your experience as a nurse? o Very good o Good o Fair o Poor o Very poor Balance the scale with an equal number of positive and negative options. 49 MAKE SURE THE RESPONSE SCALE MATCHES THE QUESTION Poor To what extent do you think the health leadership project helped you develop your leadership skills? o Excellent o Very good o Good o Fair o Poor Better To what extent do you think the health leadership project helped you develop your leadership skills? o Very great extent o o o o Great extent Some extent Little extent Very little extent 50 KEEP THE SCALE CONSISTENT Poor o o o o Not worth my time Very little interest Somewhat interested Very interested Better o o o o Not at all interested Very little interest Somewhat interested Very interested The left column includes two concepts – “worth” and “interest level.” 51 ALWAYS INCLUDE LABELS FOR YOUR NUMBERED SCALE CATEGORIES TO AVOID MISINTERPRETATION Incomplete labels: To what extent have you increased your triage skills as a result of this program? A great deal Not at all 1 2 3 4 Fully labeled: To what extent have you increased your triage skills as a result of this program? A great deal Somewhat Not much Not at all 1 2 3 4 52 LIKERT SCALE Rate agreement with a series of statements. To what extent do you agree or disagree with each of the following statements… o o o o o Strongly Agree Agree Neither Disagree Strongly disagree 53 CHECKLIST Which of the following issues are barriers to Tibetans’ overall tuberculosis (TB) care? Language Yes No Don´t know Immigration Yes No Don´t know Misconceptions about TB Yes No Don´t know Lack of insurance Yes No Don´t know Patient’s work schedule Yes No Don´t know Which of the following issues are barriers to Tibetans’ overall tuberculosis (TB) care? Language Immigration Misconceptions about TB Lack of insurance Patient’s work schedule 54 QUESTIONS 1. 2. 3. 4. 5. 6. 7. Type of information Type of questions Types of response Common wording problems Problems with response Validity Reliability 55 QUESTION WORDING 1. Clarity/specificity “Have you seen a doctor during the past year?” “In the last 12 months, have you visited a general practitioner?” Yes No “How long has it been since you last visited a general practitioner? o within the last month, o between 1 and 12 months ago o more than 12 months ago 56 QUESTION WORDING 2. Simplicity Avoid complex or technical phrasing. Use complete but short sentences (avoiding double negatives and redundancy between question stem and response options) Avoid “deceptively short” questions with high respondent burden (complex tables, rank ordering, mental calculations, “check all that apply”) 57 QUESTION WORDING 3. Neutrality Avoid loaded questions, arguable prefatory statements, and judgmental words/phrases “Do you prefer being examined by a doctor of your own sex?” Would you rather be examined by a: o Male doctor o Female doctor o Either/doesn’t matter 58 QUESTION WORDING 4. Sensitivity Encourage ‘unorthodox’ and “socially undesirable" responses (depersonalization): “Everybody does it…” “How many times…” “Many experts say…” Discourage over reporting of ‘socially desirable’ responses “Did you happen to…” “Many people have trouble remembering…” Allow for either agreement or disagreement in question stem Funneling questions to introduce sensitive topics 59 QUESTION WORDING 5. One topic per question Avoid ‘double-barreled’ questions “Do African-Americans and Latinos suffer from discrimination” 6. Specify an appropriate time frame Typical/usual versus maximal/minimal Depends on salience of topic 7. Improving recall Aided recall (memory cues, prompts) Bounded recall (time window) Records or diaries 60 QUESTION WORDING 8. Consider question polarity and sequence (survey as conversation) Avoid ‘yea-saying’ patterns and carryover effects, but maintain consistency when possible 9. Check for technical accuracy 61 QUESTION ORDER Decide on the order of items/questions easy difficult general particular factual abstract most salient least salient Questions should be ordered so as to seem logical to the respondent Group questions Be aware of ordering effects/position bias Don’t put the most important items last 62 QUESTION ORDER To avoid wasting time, qualify early To boost response rate, put innocuous questions first, personal questions last Start with questions that are easy to answer and relevant to the stated purpose of the survey To boost response rate, put demographic questions last To increase accuracy, keep similar questions together 63 QUESTION WORDING – THINGS TO AVOID Abbreviations Alternative meanings Negatives, words with negative prefixes Inappropriate categories Asking same question twice Jargon Leading questions Typographical errors Threatening questions Being condescending 64 THE GOAL OF WRITING A GOOD QUESTION… is to develop a question that every potential respondent will: 1. interpret in the same way, 2. be able to respond to accurately, and 3. be willing to answer. 65 QUESTIONS 1. 2. 3. 4. 5. 6. 7. Type of information Type of questions Common wording problems Types of response Problems with response Validity Reliability 66 PROBLEMS WITH RESPONSE Fatigue/boredom/disinterest agree with everything just say ‘don’t know’ always choose first response ‘randomly’ respond without considering the question (Christmas treeing) Social desirability instruct that it is ok not to know something Aversion to extreme ends of the scale Ceiling effects Halo effects Framing effects 67 PROBLEMS WITH RESPONSE Minimizing fatigue/boredom Keep task simple e.g. easier to recall more recent events Keep words short and easy to understand Maintain motivation of participants Ensure task is relevant Ask people to justify their responses Position Bias May be more likely to endorse first or last response option Preceding questions may influence responses to questions that follow 68 AVOID POSITION BIAS Position Bias “How important are flexible hours in evaluating job alternatives?” “What factors are important in evaluating job alternatives?” No Position Bias “What factors are important in evaluating job alternatives?” “How important are flexible hours in evaluating job alternatives?” 69 QUESTIONS 1. 2. 3. 4. 5. 6. 7. Type of information Type of questions Types of response Common wording problems Problems with response Validity Reliability 70 VALIDITY Does the question measure what you claim it measures? Problems with self-report People don’t know the causes of their own behavior People’s memories are inaccurate People are not good at predicting their future behavior People are not telling you what they know because of Social desirability bias Demand characteristics Response sets 71 QUESTIONS 1. 2. 3. 4. 5. 6. 7. Type of information Type of questions Common wording problems Types of response Problems with response Validity Reliability 72 RELIABILITY Results are reproducible or consistent with similar groups of respondents, over time and when other people administer the questionnaire Questions measure consistently Test-retest Inter-rater Internal consistency 73 FOR EACH QUESTION GIVEN, IDENTIFY WHICH TYPE OF QUESTION IT IS, IDENTIFY ANY ISSUES WITH THE QUESTION, AND EXPLAIN HOW YOU MIGHT IMPROVE THE QUESTION AND WHY. Identify issues with questions and discuss improvements Question One Is there normally an adult at home during the day?’ Identify which type of question it is Identify any issues with the question Explain how you might improve the question and why. 75 Question Two How much money would you be prepared to spend on a burglar alarm?’ $500 $1000 $1500 LO: Identify issues with questions and discuss Identify improvement which type of s question it is Identify any issues with the question Explain how you might improve the question and why. 76 Question Three How much television did you watch last year? LO: Identify issues with questions and discuss Identify improvement which type of s question it is Identify any issues with the question Explain how you might improve the question and why. 77 Question Four Do you agree that trains and buses and taxis are kept clean enough? Identify which type of question it is Identify any issues with the question Explain how you might improve the question and why. 78 Question Five Do you think nurses are: very kind fairly kind not very kind? Identify which type of question it is Identify any issues with the question Explain how you might improve the question and why. 79 PUTTING IT ALL TOGETHER Structure of a questionnaire STRUCTURE OF A QUESTIONNAIRE 1. 2. 3. 4. 5. Identification Introduction Instructions on how to answer Questions Conclusion 81 ANONYMITY AND CONFIDENTIALITY Anonymous means that NO ONE can identify who provided the information Difficult to assure if there is a need to follow-up with non-respondents or when the survey is administered online (internet or intranet)- Don’t promise anonymity! Confidentiality means that you are able to identify the person, but you guarantee that the information will not be identified with the person All aspects of data collection, analysis and reporting When reporting and communicating, ensure that no names or other identifying information is used 82 ALWAYS PILOT TEST THE QUESTIONNAIRE By experts- your colleagues, others who are knowledgeable about writing questions or your program By potential respondents- or people as similar to respondents as possible Do they understand the questions? The instructions? Do questions mean the same thing to all? Do questions elicit the information you want? How long does it take? 83 SUMMARY A well designed survey instrument: collects appropriate data to answer your research question minimizes potential sources of bias increases the validity of the replies will much more likely be completed 84 CONTACT INFORMATION Kelleigh Trepanier KSU Center (West Entrance) Burruss.kennesaw.edu ktrepani@kennesaw.edu 770-423-6464 85 THANK YOU RESOURCES www.aapor.org “Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients”, Health Technology Assessment, 2001. Vol.5, No. 31. De Vaus, D.A. (1990) Surveys in Social Research. Allen and Unwin, London. Dillman, D., Smyth, J., Christian, LM. 2009. Internet, Mail and Mixed-Mode Surveys: The tailored design method. John Wiley and Sons. Fink, A. (Ed.)(1995) The Survey Kit. Sage, London. Foddy W (1993). Constructing questions for interviews and questionnaires: Theory and practice in social research. Cambridge University Press, Melbourne. Fowler, Floyd J. (2002) Survey Research Methods. Sage, 87 London. RESOURCES Hoinville, G and Jowell, R. (1982) Survey Research Practice. Heinemann, London. Moser, C. and Kalton, G. (2001) Survey Methods in Social Investigation. Ashgate, Aldershot. Oppenheim AN (1992). Questionnaire design, interviewing and attitude measurement. Pinter Publishers, London Scheuren, F. What is a survey. American Statistical Association. Free download at http://www.whatisasurvey.info/ Schuman H, Presser S (1996). Questions and answers in attitude surveys: experiments on question form, wording, and context. Sage Publications, San Diego. Streiner DL, Norman GF (1995). Health Measurement Scales: a practical guide to their development and use, 88 Oxford University Press, Oxford, 1995. LARGE SCALE SURVEYS Converse, Philip E., Jean D. Dotson, Wendy J. Hoag, and William H. McGee III (eds.), American Social Attitudes Data Sourcebook 1947-1978 (Cambridge, MA: Harvard University Press, 1980). Gallup, Alec, George Gallup, The Gallup Poll Cumulative Index: Public Opinion1935-1997 (Wilmington, DE: Scholarly Resources, Inc., 1999). Hastings, Philip K. and Jessie C. Southwick (eds.), Survey Data for Trend Analysis: An Index to Repeated Questions in U.S. National Surveys Held by the Roper Public Opinion Research Center (Roper Public Opinion Research Center, 1974). 89 Martin, Elizabeth, Diana McDuffee, and Stanley Presser, Sourcebook of Harris National Surveys: Repeated Questions 1963-1976 (Chapel Hill: Institute for Research in Social Science, University of North Carolina Press, 1981). Miller, Warren E., Arthur H. Miller, and Edward J. Schneider, American National Election Studies Data Sourcebook 1951-1978 (Cambridge, MA: Harvard University Press, 1980). National Opinion Research Center, General Social Surveys 1972-2008: Cumulative Code Book (Chicago: NORC, 2009). Robinson, John P., Robert Athanasiou, and Kendra B. Head, Measures of Occupational Attitudes and Occupational Characteristics (Ann Arbor, MI: Institute for Social Research, 1969). 90 Robinson, John P., Phillip R. Shaver, and Lawrence S. Wrightsman, Measures of Political Attitudes (San Diego, CA: Academic Press, 1999). Robinson, John P., and Phillip R. Shaver, Measures of Social-Psychological Attitudes (Ann Arbor, MI: Institute for Social Research, 1980, rev. ed.). Converse, Jean M., and Stanley Presser, Survey Questions: Handcrafting the Standardized Questionnaire (Thousand Oaks, CA Sage Publications, 1986). Inter-university Consortium for Political and Social Research (ICPSR) www.icpsr.umich.edu 91 TOP TEN STRATEGIES TO MAXIMIZE RESPONSE RATES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. More interesting better than less interesting Certified or priority delivery better than regular mail Incentive (especially money) better than no incentive Short better than long Incentive with questionnaire better than on return Pre-contact better than no pre-contact Colored ink better than standard ink User friendly better than standard questionnaire Follow-up better than no follow up Request explanation for not completing better than no request Edwards, Roberts, Clarke et al BMJ 2002; 324: 1183 92