6 Questionaire Design 1

7/29/2019 6 Questionaire Design 1

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QUESTIONNAIRE

DESIGNPatrick S. Romano, MD, MPH

Professor of Medicine and Pediatrics


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Questionnaire Design

1. List variablesSources include patients/subjects (focus groups,key informant interviews), clinical observation,theory or conceptual framework, prior research,

and expert opinion.2. Borrow from other instruments Save development effort (reinventing the wheel)

Borrow reliability, validity, variance estimates Facilitate comparison with previous studies3. Solicit input from colleagues and friends


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4. Prepare a draft5. Circulate and revise6. Pretest7. Shorten and revise again

Questionnaire Design (cont)


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Method of Administration

Advantages of verbal interview:Interviewer can clarify unclear questions

Literacy is not required

Interviewer can collect more complexanswers and observations

Interviewer can minimize missing andinappropriate responses

Interviewer can prevent respondentfrom answering out of sequence


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Method of Administration (cont)

Advantages of written questionnaire:

Much less staff time is required, with no deadtime waiting for potential participants

Less potential for observer bias

Anonymity may minimize social desirabilitybias, and encourage more honest responses tosensitive questions

Computer-assisted telephone interviewing(CATI) by random-digit dialing (RDD) combinesadvantages of both verbal and written methods.


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Questionnaire Design:

General Principles

Open-ended vs closed-ended questions: Open-ended questions generate

answers that are more nuancedand information-rich

Open-ended questions generateanswers that are more difficult tocategorize and analyze


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Questionnaire Design:General Principles (cont)

Closed-ended questions are easierto interpret, with lower respondentburden.

Developing a sufficiently specific butexhaustive list of response optionsmay be very difficult.

Closed-ended questions may lead

the respondent in an inappropriatedirection.


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General Principles (cont)Length: No longer than absolutely necessary (24

pages) Use branching questions and skip patterns

to reduce length

Avoid deceptively short questions with

high respondent burden (complex tables,rank ordering, mental calculations, check

all that apply)


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Visual design: Attractive, uncluttered format with a professional

appearance and consistent graphic design Consider light pastel colors, illustrations, 2 columns Avoid excessively small or unusual fonts Number and carefully align (vertically) questions

and response options

Avoid loose pages; booklet format if possible.

Avoid splitting questions across columns/pages. Minimize the number and abruptness of format

changes; use transitional sentences.


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Sequence: Frame the survey briefly but carefully

Place instructions where needed, not just at

the beginning Start with benign, easy, salient questions

(consistent with cover letter)

Bury most sensitive questions about personal

behaviors Threatening demographic questions near end

End with thank you and follow-upinformation


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General Principles (cont)

Facilitating response:

Design survey form to fold on itself or includeenvelope

Self-addressed, stamped (not metered) return Prepaid incentive ($5-10 cash best)

Signed endorsement/cover letter(s)

Prenotification letter, reminder postcard, follow-up mailings and/or telephone calls


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General Principles (cont)

Facilitating data entry and follow-up:Precode closed-ended questions

(avoid negative scale values)

Number questions consecutively

Identification number


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Phrasing Questions1. Clarity/specificity

Avoid nonspecific response options, but alsoavoid seeking unachievable specificity.

Often? Sometimes? Regularly?

2. Simplicity Avoid complex or technical phrasing.

Use complete but short sentences (avoidingdouble negatives and redundancy between

question stem and response options)3. Neutrality

Avoid loaded questions, arguable prefatorystatements, and judgmental words/phrases


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Phrasing Questions (cont)

4. Sensitivity Encourage unorthodox and socially

undesirable" responses (depersonalization):

Everybody does itHow many timesMany experts say

Discourage over reporting ofsocially desirableresponsesDid you happen toMany people have trouble remembering

Allow for either agreement or disagreement inquestion stem

Funnelling questions to introduce sensitive topics


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5. One topic per question Avoid double-barreled questions

Do African-Americans and Latinos suffer fromdiscrimination

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


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8. Mutually exclusive and exhaustiveresponse options

Use ofother fields

9. Consider question polarity andsequence (survey as conversation)

Avoid yea-saying patterns and

carryover effects, but maintainconsistency when possible

10. Check for technical accuracy


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Scaling Responses

Visual analogue (thermometer)scales

Frequency-weighted multi-symptom indices I-PSS score

Multi-symptom checklists Charlson/Elixhauser comorbidity lists

Grading or ranking


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Scaling Responses (cont)

Likert (summative) scales Add ordinal scores for multiple items

measuring agreement or disagreement withstated attitudes or beliefs.

Number of symmetric categories (4-10) Include or omit middle category (or put no

opinion at end of response options)

Consider ceiling and floor effects

Watch for over-endorsement of labeledboxes


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Scaling Responses (cont)

Adjectival scale (variation of Likert) Semantic differential scale

Anchoring the extremes is usuallydesirable to increase variation

Labeling intermediate points encouragesendorsement of those points

Guttman (cumulative) scales

Add the number of ordered statementseliciting agreement by the respondent

Ordering errors may be problematic(coefficient of scalability)


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Thank You !

6 Questionaire Design 1

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