PHC215

By Dr. Khaled Ouanes Ph.D.

E-mail: k.ouanes@seu.edu.sa

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: k.ouanes@seu.edu.sa

Twitter: @khaled_ouanes

HEALTHCARE RESEARCH METHODS

Based on the textbook of introduction to health research methods – K.H. Jacobsen