1. Survey Methodology EPID 626 Survey Instruments Manya Magnus, Ph.D. Fall 2001

2. Lecture Outline Getting started Types of questions Group exercise

3. What is a survey instrument? For interviews: A script for interviewers, including introductions, instructions, and questions For self-administered surveys: A questionnaire

4. What is the worst thing you can do? Jump in without thinking about purpose of study, objectives, analysis plan! Think first, start slowly!

5. Essential steps in developing a survey instrument Statement of purposes –What do you want to accomplish with the survey? Research questions, objectives List of the variables to be measured –Group into logical categories Draft analysis plan –What are your dependent, independent variables? What are potential confounders?

6. Design/variable grid Research question Dependent variables Independent variables Potential confounders Are clients satisfied with ancillary services? Satisfaction with individual services (yes/no) Gender Race Ethnicity Age Disease status Pregnancy Children Need for services at baseline CD4 count Viral load Medication status Satisfaction with individual services (scale) Etc..

7. Preliminary question design steps Interdisciplinary research group –What are the research questions/ objectives/hypotheses? Focus groups Draft questions Cognitive laboratory interviews Pilot/pre-test

8. Focus groups (1) Objective: To compare the reality about which respondents will be answering questions with the abstract concepts embedded in the study objectives Usually 6-8 people per group; have a couple of groups

9. Focus groups (2) Try to get participants who are similar to your survey population Talk about perceptions, experiences, and feelings related to survey subject Get people who are experts in focus group leadership

10. Drafting questions Look for standard questions from other surveys –Benefit from their experience –Enhance comparability of your survey with previous surveys Write good questions Don’t remake the wheel!

11. Cognitive laboratory interviews Respondents are brought into a laboratory setting –May be videotaped –Interviews conducted by cognitive psychologist or experienced investigator Goal: To get information about how the respondent understood the questions and about the way they answered them

12. Layout of survey instrument Make it clear and simple Usually begin with straightforward questions, put complicated or sensitive questions in the middle or at the end

13. Interviews Should have everything scripted, including introductions, instructions, transitions, definitions, and explanations Be very explicit about skip instructions Differentiate instructions and optional wording from questions –Usually done with all caps and parentheses, respectively

14. Example Interviewer instructions: … read aloud all sentences that are in bold. Italics indicate instructions for interviewer that are not to be read aloud… Have you been pregnant in the last three (3) months?  1—yes [if yes, skip to question 4]  2—no [if no, skip to question 5]

15. Self-administered Questionnaire should be self- explanatory (minimal instructions needed) Limit to closed questions Use short questions with consistent formats Minimize skips; make them very clear

16. Example Instructions: Please make a check (  ) in the box which best reflects your answer. Have you been pregnant in the last three (3) months?  1—yes  Did you take a prenatal vitamin?  1—yes  2—no  2—no  Did you take a multi-vitamin?  1—yes  2—no *Note problems with these questions!

17. Field pre-testing Goal: Find out how well the data collection protocols and survey instruments work under realistic conditions

18. Interviews Usually interview 20-50 respondents who are similar to your survey population Interviewers note ways to improve survey instruments

19. Quantitative methods for pre-testing (1) Ask interviewers to fill out a rating for each question –Is it easy to read as worded? –Do respondents understand the question in a consistent way? –Can respondents answer the question accurately? Note problems possible in interpreting if that survey isn’t good…

20. Taping and behavior coding –Trained coders review the recordings and evaluate the question and answer process in a consistent way Do the interviewers read the question as worded? Do the respondents ask for clarification? Do the respondents initially give an inadequate answer that requires interviewer probing? Quantitative methods for pre-testing (2)

21. Self-administered Have respondents (who are similar to your survey population) fill out the survey and then discuss –Were the instructions clear? –Were the questions clear? –Were there any problems understanding what kind of answers were expected?

22. Validity and reliability If you are developing this tool, find ways to undertake testing of validity and reliability (crude  sophisticated) Note difficulties with this, and benefits to using already-validated tool

23. Open-ended questions Short, specific –What is your current age? Long, narrative –Why did you choose to come to this clinic? Problems: –Illegible handwriting –Inappropriate detail Usually avoid-the rest of the lecture is devoted to closed-ended questions

24. Yes/No and checklist questions Yes/No Checklist –From a list of alternatives, check those that apply –Problematic because you can’t distinguish a “No” from a skip –Yes/No may be better because it forces thought

25. Multiple-choice questions Response alternatives should be mutually exclusive and exhaustive Think about whether you want respondents to just check one response or to be able to check multiple responses – Multiple responses may complicate analysis –Think about presenting alternatives as a checklist

26. Multiple-choice questions (2) Include “Other” as an alternative? –What does it tell you? About the respondent? About your question? –Use open-ended “Specify”________ –May be useful during pretesting or if you are planning on revising the survey instrument

27. Semantic differential questions Two opposite adjectives at the ends Best Worst 1 2 34567 Sometimes ask the question for two scenarios, ex: current situation and ideal situation, and look at the differential

28. Ranking questions Present alternatives and ask respondents to rank them –Ex: rank from the most important to the least important Think about whether you want to allow tie rankings –How will that affect your analysis?

29. Two common formats 1 __ Eating fruit __ Exercising __ Meditating __ Being happy __ Sleeping enough 2 Eating fruit 1 2 3 4 5 Exercising 1 2 3 4 5 Meditating 1 2 3 4 5 Being happy 1 2 3 4 5 Sleep enough 1 2 3 4 5 Number 2 is usually preferable. Why?

30. Rating Scales Present a respondent with a question or statement and a range of responses Ex. How would you rate your relationship with your physician? Excellent Very good Good Fair Poor

31. Rating scales (2) Likert scale: Ex. Patients should have the right to sue Health Maintenance Organizations Strongly Agree Unsure Disagree Strongly agree disagree

32. Rating scales (3) Psychological distance –Distance between alternatives should be equal Number of response alternatives –Usually 3 to 7 are recommended –What might affect your choice? –Think about your research question –Think about the complexity of the issue

33. Rating scales (4) Order of response alternatives –Should be monotonically increasing or decreasing –Should all be ordered in a column or row –Within a survey, may want to mix up increasing and decreasing by section, but never within a section

34. Rating scales (5) Unipolar response alternatives –Range from “nothing” to “a great deal” Excellent Very good Good Fair Poor Bipolar response alternatives –Range from “large negative” through “zero” to “large positive” Strongly Disagree Unsure Agree Strongly disagree agree

35. Rating scales (6) Odd or even number of alternatives? –Odd numbers create a midpoint This midpoint should be a neutral response Many respondents really like midpoints and will use them a lot!!! –Even numbers force people to make a decision –Depends on your research question

36. Rating scales (7) –For very complex, emotional issues, you may want to have 2 middle points Ex. Slightly agree and Slightly disagree Balanced scales –Should have equal numbers on either side of neutral –Unbalanced scales will lead to bias

37. Rating scales (8) “Don’t know” as an alternative –Usually necessary for knowledge questions –For attitude questions, “don’t know” usually means “unsure”. Adding more middle categories may be a better solution –Sometimes use a screen question then initiate a skip sequence

38. Rating scales (9) Example of a screening question: 1. Are you familiar with the proposed legislation regarding universal healthcare? (circle one) Yes Go to question 2. No Go to question 17.

39. Rating scales (10) Behaviorally anchored scales –Objective, quantitative –Compare to subjective scales

40. Ex: How often do you exercise in a week? Subjective: Often Sometimes Never Behaviorally anchored: 5 times 3-4 times 1-2 times Never Which one to use? –Depends on your research question

41. General Recommendations Write brief questions Write clear questions –Define ambiguous terms –Avoid jargon –Avoid double negatives –Avoid unclear pronouns –For open-ended questions, avoid adverbial constructions such as how, why, when, where

42. General Recommendations (2) Be careful with: –Intentions –Hypotheticals –Assumptions: commonplace is not universal Write unidimensional questions Write mutually exclusive and exhaustive response alternatives

43. General Recommendations (3) Generally avoid loaded questions –Special case for questions that may involve social desirability –When might we want to ask loaded questions?

44. “Most people have times when they drink too much and feel tipsy. How often has this happened to you in the last month?” “Most people feel that smoking marijuana is harmful. How do you feel?” “Marijuana has been shown to be an effective treatment for people with some symptoms of AIDS. How do you feel about legalizing marijuana?”