A questionnaire is a tool for systematically collecting information from study participants.

1. PHC215
By Dr. Khaled Ouanes Ph.D.
E-mail: k.ouanes@seu.edu.sa
Twitter: @khaled_ouanes
INTRODUCTION TO
HEALTHCARE RESEARCH
METHODS

2. Primary Studies:
Developing a Questionnaire

3. 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.

4. Questionnaire Design Plan

5. 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

6. 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).

7. 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

8. 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

9. 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

10. 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

11. Examples
of Types
of
Questions

12. 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?...)

13. 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.

14. 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.

15.  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

16. Examples of Responses for
Ranked Questions

17. 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.

18. 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?

19. 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

20. Problems to Avoid

21. 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.

22. 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.

23. Example of a Self-Reported
Questionnaire

24. Example of a Telephone Interview Script

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.)

30. 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.

31. Primary Studies:
Surveys and Interviews

32. 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.

33. Examples of Methods for Collecting
Data

34. 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.

35. Examples of
Methods for
Contacting
Members of the
Sample Population

36. 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

37. 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

38. Methods for Collecting and
Recording Survey Data

39. 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.

40. Characteristics
of Well-Trained
Interviewers

41. Primary Studies:
Additional Assessments

42. Supplementing Self-Reported
Information
 Anthropometric 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

43. 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