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Public Health Information Network (PHIN) Series II

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Title: Public Health Information Network (PHIN) Series II


1
Public Health Information Network (PHIN) Series
II
  • Outbreak Investigation Methods
  • From Mystery to Mastery

2
(No Transcript)
3
Series IISession IV
  • Designing Questionnaires

4
Series II Sessions
Title Date
Recognizing an Outbreak June 2
Risk Communication July 7
Study Design August 4
Designing Questionnaires September 1
Interviewing Techniques October 6
Data Analysis November 3
Writing and Reviewing Epidemiological Literature December 1
5
Access Series Files Online http//www.vdh.virgini
a.gov/EPR/Training.asp
  • Session slides
  • Session activities (when applicable)
  • Session evaluation forms
  • Speaker biographies
  • Alternate Web site http//www.sph.unc.edu/nccphp/
    phtin/index.htm

6
Site Sign-in Sheet
  • Please submit your site sign-in sheet and
  • session evaluation forms to
  • Suzi Silverstein
  • Director, Education and Training
  • Emergency Preparedness Response Programs
  • FAX (804) 225 - 3888

7
Session Overview
  • The importance of questionnaire design
  • Hypothesis generating versus hypothesis testing
    questionnaires
  • Preparing for questionnaire design
  • Question design
  • Question type
  • Questionnaire format

8
Todays Presenters
  • Sarah Pfau, MPH
  • Consultant
  • NC Center for Public Health Preparedness
  • Aaron Wendelboe, MSPH
  • Doctoral Candidate and
  • Graduate Research Assistant,
  • NC Center for Public Health Preparedness

9
Learning Objectives
  • Upon completion of this session, you will
  • Understand the role of questionnaire design in an
    outbreak investigation
  • Know how to develop a hypothesis generating
    questionnaire
  • Recognize key planning strategies for successful
    questionnaire design

10
Learning Objectives
  • Recognize key characteristics of well-designed
    questions
  • Recognize three broad question types and when to
    use them
  • Understand what different question types measure,
    and the type of data (quantitative versus
    qualitative) they yield

11
Learning Objectives
  • Know how to format questionnaires for interviewer
    administered and self-administered settings

12
Session IV
  • Designing Questionnaires

13
Basic Steps of an Outbreak Investigation
  • Verify the diagnosis and confirm the outbreak
  • Define a case and conduct case finding
  • Tabulate and orient data time, place, person
  • Take immediate control measures
  • Formulate and test hypothesis
  • Plan and execute additional studies
  • Implement and evaluate control measures
  • Communicate findings

14
Why is Questionnaire Design Important?
  • The quality of the data will be no better than
    the most error-prone feature of the survey
    design.
  • - Fowler, F.J. (1993). Survey Research Methods
    Second Edition. Sage Publications Newbury
    Park.

15
Why is Questionnaire Design Important?
  • With an understanding of good questionnaire
    design principles, you will ask only about what
    you need to meet your research objectives.

16
Ask Only About What You Need. . .
  • Example
  • You ask respondents to list all vaccinations
    that their school-aged child has had (difficult
    in terms of respondent recall / accuracy), when
    you really only need to know if the child is
    current on all DTP boosters.

17
Why is Questionnaire Design Important?
  • Survey answers are not of interest
    intrinsically rather, the answers are important
    because of their relationship to what they are
    supposed to help you measure.

18
Why is Questionnaire Design Important?
  • Question type and response option formatting
    impact
  • 1. How you can design an on-screen data entry
    form and / or analyze variables in your software
    program
  • 2. How respondents interpret and respond to the
    questions

19
Hypothesis Generating Questionnaires
20
Which Questionnaire Type Should You Use?
  • Hypothesis Generating?
  • Hypothesis Testing?

21
Hypothesis Generating Questionnaire
  • Person, Place, Time Questions
  • Demographics
  • Clinical details of the illness
  • Health care provider visits
  • Water exposure
  • Exposure to other ill persons
  • Exposure to children in day care
  • Exposure to a farm or farm animals
  • Travel outside of the immediate area

22
Hypothesis Generating Questionnaire
  • If the pathogen can be spread through food or
    beverages, include questions about
  • Food eaten in the home
  • Food eaten in the homes of friends, family
  • Food eaten at any restaurant
  • Dates and times of food consumption and any
    suspicious observations

23
Hypothesis Generating Questionnaire
24
Hypothesis Generating Questionnaire
25
Hypothesis Testing Questionnaires
26
Hypothesis Testing Questionnaire
  • Include detailed questions about the suspected
    source of infection.
  • Example The local bakery is suspected as the
    source of a Hepatitis outbreak in multiple
    counties. The hypothesis testing questionnaire
    is used with both cases and non-cases, and
    includes only a food history for all possible
    items on the bakery menu to pinpoint the exact
    food item that is contaminated.

27
Hypothesis Testing Questionnaire
28
Hypothesis Generating versus Testing Questions
E. coli 0157H7
  • Hypothesis Generating
  • Account for consumption of ground beef, lettuce,
    alfalfa sprouts, un-pasteurized milk or juice,
    and swimming in or drinking sewage-contaminated
    water
  • Hypothesis Testing
  • beef suspected
  • Beef brand, date of purchase, and grocery store
    or restaurant where beef was purchased or eaten

29
Preparing for Questionnaire Design
30
Preparing for Questionnaire Design
  • There is more to questionnaire design than
    writing questions. Ideally, you should first
  • Have a clear purpose and research objectives
  • List variables to be measured
  • Have an analysis plan
  • Consider cost and other logistical aspects

31
Questionnaire Design
  • Have a clear purpose and research objectives.
  • Is the purpose of your outbreak investigation
    survey to generate a hypothesis or to test a
    refined hypothesis?
  • If testing a hypothesis, who is included in your
    study sample?

32
Questionnaire Design
  • List variables to be measured
  • Whether you are generating or testing a
    hypothesis, determine your variables of interest
    before you develop questions. You will avoid
    asking unnecessary questions or asking for
    unnecessary details.

33
Questionnaire Design
  • Go to http//www.cdc.gov
  • Under Health Safety Topics in the left
    margin, click on, Diseases Conditions
  • Select a link to either an alphabetized list of
    all diseases or diseases by topic e.g., if you
    already know that a pathogen is water-borne
    versus food-borne

34
Questionnaire Design
35
Questionnaire Design
  • Have an analysis plan.
  • Guides the question types and response option
    categories used on the questionnaire
  • Helps assure that the data collection leading up
    to analysis yields variable coding that your
    analysis software program can use efficiently.

36
Questionnaire Design
  • Analysis Plan
  • Hypothesis
  • Variables involved
  • Response option coding
  • Continuous versus categorical values

37
Questionnaire Design
  • Consider cost and other logistical aspects
  • What is the survey sample size?
  • What is the geographic distribution of the survey
    sample?
  • Will questionnaires be interviewer administered
    or self-administered?
  • What is your staff capacity to work within the
    parameters of a c above?

38
Question Answer Opportunity
39
Question Design
40
Elements of Good Question Design
  • Reliability
  • Validity
  • Specificity versus ambiguity
  • Simplicity
  • Only one question asked
  • Mutually exclusive answer choices
  • Refers respondents to specific dates / times for
    recall
  • When feasible, make sure data can be compared to
    existing sources of information

41
Question Design
  • 1. A question that is designed to be reliable
    will assure that the words are interpreted the
    same way in any setting, and that respondents
    answer the same way in any setting.

42
Reliable Question Design
  • Question
  • Are you experiencing diarrhea?
  • Interviewer then adds
  • For the purposes of this survey, we consider
    diarrhea to be 3 or more loose bowel movements in
    a 24 hour period.

43
Question Design
  • 2. A question that is designed to be valid will
    always yield information that can be used as a
    true measure of what you, the researcher, are
    looking for.

44
Valid Question Design
  • Less Useful
  • Which is your source of drinking water at home?
  • Tap water
  • Bottled water
  • Better
  • Which is your source of drinking water at home?
  • Municipal tap water
  • Municipal tap water with additional filtration
  • Well water
  • Commercially bottled water

45
Question Design
  • 3. Avoid ambiguity in question wording.
  • Less useful
  • When did you have Disease X?
  • Better
  • How old were you when you had Disease X?

46
Question Design
  • 3. Avoid ambiguity in question wording.
  • Less useful
  • Have you been examined by a physician in the
    past seven days?
  • Better
  • Have you been examined by a physician for these
    symptoms in the past seven days?

47
Question Design
  • 4. Use simple language and keep questions
    short.
  • Less useful
  • Were you exposed to the fomite at the dinner
    party?
  • Better
  • Did you use a shared hand towel at the dinner
    party?

48
Question Design
  • 5. Ask only one question.
  • Two questions in one
  • Did you eat mashed potatoes and giblet gravy?
  • One question at a time
  • Did you eat mashed potatoes? Yes No
  • If Yes, did you eat them
  • a. Plain
  • b. With giblet gravy

49
Question Design
  • 6. For closed-ended questions, make sure that
    response options are mutually exclusive.
  • Not useful
  • What is your age?
  • lt 18 years
  • gt18 years
  • Useful
  • What is your age?
  • 17 years old or younger
  • 18 years old or older

50
Question Design
  • 7. Use specific date / time references to
    improve respondent recall.
  • Less useful
  • Have you been swimming in a public pool
    recently?
  • Better
  • Did you swim in a public pool any time between
    Friday, July 1st and Monday, July 4th?

51
Question Design
  • When feasible, make sure data can be compared to
    existing sources of information.
  • Example
  • Case-patient age
  • Less than 2 years
  • 2 5 years
  • The U.S. Census reports population data for age
    groups
  • less than 1
  • 1 2
  • 3
  • 4
  • 5

52
Question DesignGeneral Guidelines
  • Design clear (unambiguous), specific questions.
  • Use simple language and keep questions short.
  • Ask only one question!

53
Question DesignGeneral Guidelines
  • For closed-ended questions, make sure that
    response options are mutually exclusive.
  • Use specific date / time references to improve
    respondent recall.
  • Make sure data can be compared to existing
    sources of information if you need to compare
    local, state, and national statistics.

54
Question Type
55
Question Type
  • Three broad categories
  • Closed-ended
  • Open-ended
  • Fill-in-the-blank
  • Data collected and analysis options may differ
    by question type.

56
Closed-ended Questions
57
Closed-Ended Questions
  • Provide answer choices in pre-coded categories
    that represent counts, ranges, or demographic
    information.
  • Yield quantitative data.
  • Are preferable for self-administered and
    hypothesis testing questionnaires.

58
Closed-Ended Questions
  • Example Pre-coded demographic information
  • In which of the following categories does your
    age fall? (select only one)
  • 0 20
  • 21 40
  • 41 60
  • 61 - 80
  • 81 100

59
Question Type
  • There are two ways in which categorical
    measurement is carried out in closed-ended
    questions
  • Nominal
  • Ordinal

60
Question Type
  • Nominal response options result in the
    classification of a respondent into a category
    for race, gender, marital status, etc.
  • - Response options can be mutually exclusive
    (Select only one response)

61
Question Type
  • Example Nominal response options in a
    closed-ended question
  • Please select the one response that describes
    your marital status.
  • Single
  • Married
  • Divorced
  • Widowed

62
Question Type
  • Ordinal response options result in
    classification into an ordered category that may
    or may not rank values that are equidistant.
  • - Ordinal responses have a numeric value.

63
Question Type
  • Example Ordinal response options in a
    closed-ended question
  • When you turn off the frozen dairy dessert
    machine at the restaurants closing time, how
    frequently do you sanitize the dispenser?
  • 1 Every time 4 Once a month
  • 2 Every other time 5 Less than once a
    month
  • 3 Once a week

64
Question Type
  • Likert scales contain pre-coded ordinal
    responses with assigned values. You can then
    calculate averages to determine the most
    prevalent response.
  • Example Please rate the severity of your
    abdominal cramp pain (circle one)
  • 1 minimal 3 moderate 5 very painful
  • 2 mild 4 painful

65
Question TypeLikert Scales
3-point scale 5-point scale
Minimal Minimal
Mild
Moderate Moderate
Painful
Very Painful Very Painful
66
Question TypeLikert Scales
  • Example Please rate the severity of your
    abdominal cramp pain
  • 1 minimal 3 moderate 5 very painful
  • 2 mild 4 painful
  • Calculate the average of responses, where N
    35
  • 1 10 people 2 5 people 3 20 people
  • 4 0 5 0
  • 10 x 1 10 2 x 5 10 3 x 20 60
  • 10 10 60 80
  • 80 / 35 people 2.29 (average response of mild
    pain)

67
Question Type
  • Using Dont Know or Not Applicable
  • When you have categorical, dichotomous response
    options such as, Yes and No, you may
    sometimes choose to add a Dont Know option.

68
Skip Patterns
  • 1a. Did you travel outside of River City during
    the week of June 10th through June 17th, 2005?
  • Yes
  • No
  • Skip 1b and 1c if answer to 1a is No.
  • 1b. To where did you travel? _____________
  • 1c. What mode of transportation did you use?
  • Airplane
  • Automobile
  • Chartered bus
  • Cruise ship
  • Train

69
Open-ended Questions
70
Open-ended Questions
  • Allow respondents to provide answers in their own
    words.
  • Yield qualitative data.
  • May yield unanticipated answers that contribute
    to the study.
  • Are most appropriate for hypothesis generating
    versus testing questionnaires.

71
Question Type
  • Example Open-ended questions
  • What restaurants did you patronize in the past
    seven days?
  • Please list the two main symptoms you are having
    with this illness

72
Fill-in-the-blank Questions
73
Fill-in-the-blank Questions
  • Allow respondents to provide short answers in
    their own words.
  • Yield qualitative data.
  • Are most appropriate when possible response
    categories are too numerous to list.
  • Are most appropriate when the question is
    measuring respondent characteristics versus
    attitudes, beliefs, or behaviors.

74
Question Type
  • Example Fill-in-the-blank Questions
  • 1. County of residence _____
  • 2. Age in years ____
  • 3. Number of children under age 18 living in
    your household ____

75
Question and AnswerOpportunity
76
5 minute break
77
Questionnaire Format
78
Questionnaire Format
  • We will now consider layout guidelines
  • In general
  • For interviewer administered questionnaires
  • For self-administered questionnaires

79
General Formatting Guidelines
80
General Guidelines
  • A well-designed questionnaire
  • Minimizes respondent burden
  • Minimal time to think about each response
  • Minimal time to complete entire survey

81
General GuidelinesRespondent Perspective
  1. Format page layout with a vertical flow from
    question to question and from response option to
    response option.
  2. Maintain white space on the page.
  3. Number every question.

82
General GuidelinesRespondent Perspective
  • Use consistent codes for response options.
  • Arrange questions in a logical order even within
    sub-sections if possible.
  • Use differentiating font for questions and
    response options.

83
General GuidelinesRespondent Perspective
  1. Provide clear but brief instructions for survey
    completion.
  2. Indicate units for fill-in-the-blank questions.
  3. Use clear cues (text or arrows) to guide
    respondents through skip patterns.
  4. Use transitional cues for each subsection of
    questions (The next series of questions will
    ask about . . . ).

84
General GuidelinesResearcher Perspective
  • Include unique record identification numbers so
    you can maintain confidentiality and link data
    when applicable (e.g., in Epi Info).
  • Use numbers versus check boxes for coded response
    options so they can be used for data entry and
    analysis (e.g., in Epi Info).

85
General GuidelinesResearcher Perspective
  • To reduce the difficulty of distinguishing
    between missing data and simply all no
    responses to a categorical list of response
    options, consider alternative formatting.
  • Example standard question format
  • Where did you see published information about
    this free HIV screening?
  • Billboard on subway
  • Doctors office
  • Local newspaper

86
General GuidelinesResearcher Perspective
  • Example alternative question format
  • Where did you see published information about
    this free HIV screening?
  • Billboard on subway Yes No
  • Doctors office Yes No
  • Local newspaper Yes No

87
Format Guidelines
  • Interviewer versus
  • Self-Administered Questionnaires

88
Format Guidelines
Interviewer Administered Self-Administered
Format for interviewers navigation Format for respondents navigation
Respondents are not influenced by questionnaires appearance Need eye-appealing format (survey length, font size, white space, and organization)
Include detailed instructions, scripts, definitions, etc. for interviewers Include only essential, succinct instructions or symbols for navigation
Question stems and response options must be succinct and simple Question stems and response options should be simple, but can be longer
89
Supporting DocumentationInterviewers Manual
  • Background
  • Fieldwork
  • Interviewing Techniques
  • Telephone Interviewer Instructions (if
    applicable)
  • Terms and Definitions
  • Details of the Questionnaire
  • Description of the Survey Area

90
Supporting Documentation
  • Standard format for interviewer introductions
    for telephone or face-to-face interviews
  • Interviewers name
  • Health department (or organization) represented
  • One sentence description of the surveys purpose
    (e.g., There has been an outbreak of disease X
    in your county and we are calling you to . . .)
  • A conservative estimate of how long the interview
    will take

91
You are not finished yet. . .

Pilot Test Questionnaires!
92
Pilot Test Questionnaires
  • Are questions yielding the information that they
    are supposed to yield?
  • Do respondents understand all wording?
  • Do respondents interpret the questions the same
    way?
  • Do closed-ended questions have a response option
    that applies to each respondent?
  • Are skip patterns followed correctly?

93
Case Study Example Interviewer
AdministeredQuestionnaire
94
NC Rapid Needs Assessment Hurricane Isabel,
September 2003
Injury and Violence Prevention Branch, NC-DHHS DPH
95
Who was involved in developing the RNA
Questionnaire?
  • Epidemiology Section
  • Public Health Preparedness Response
  • Injury and Violence Prevention Branch
  • Division of Environmental Health
  • Division of Mental Health
  • CDC specialists in mass trauma surveillance
  • PHRST members

Injury and Violence Prevention Branch, NC-DHHS DPH
96
Strategies for Designing the RNA Questionnaire
  • Selected a TEAM leader
  • Identified examples to serve as prototypes
  • Agreed upon goals of data collection

Injury and Violence Prevention Branch, NC-DHHS DPH
97
Strategies for Designing the RNA Questionnaire
  • Limit forms to one-page
  • Number all questions
  • Preference for closed-ended questions
  • Omit extremely sensitive questions
  • Allow for Dont Know as a legitimate answer

Injury and Violence Prevention Branch, NC-DHHS DPH
98
How many forms were needed?
  • 1. Tracking Form
  • 2. Survey Form
  • 3. Referral Form

Injury and Prevention Branch, NC-DHHS DPH
99
Tracking Form
100
Respondent Referral Form
101
Survey Instrument
102
What data needed to be collected for Hurricane
Isabel?
  • The SURVEY FORM
  • Damage to homes
  • Availability of usable utilities
  • Incidence of hurricane related illness / injury
  • Access to medical care
  • Access to food and water
  • Self-identified immediate needs

Injury and Violence Prevention Branch, NC-DHHS DPH
103
Survey Instrument
  • Header
  • Date
  • Interviewer
  • Sampling information
  • Respondent information

Injury and Violence Prevention Branch, NC-DHHS DPH
104
Survey Instrument
  • Household information
  • Type
  • Usual number of residents
  • Residents during the storm
  • persons at increased risk

Injury and Violence Prevention Branch, NC-DHHS DPH
105
Survey Instrument
  • Damage to house from the hurricane
  • Habitability of structure
  • Tarp needed
  • Amount of flood water in the house
  • Missing amount of mud or debris

Injury and Violence Prevention Branch, NC-DHHS DPH
106
Survey Instrument
  • Current status of household utilities
  • Running water
  • Power
  • Toilet
  • Telephone
  • Radio
  • Use of generator
  • Use of charcoal

Injury and Violence Prevention Branch, NC-DHHS DPH
107
What else was needed?
  • Question by Question instructions
  • Standard in formal epidemiologic research
  • Often only form of procedure manual when
    preparation time limited
  • Often deciding factor in complicated analysis
  • Introductory script
  • English and Spanish

Injury and Violence Prevention Branch, NC-DHHS DPH
108
Scripting English Introductory Script
109
Lessons Learned
Injury and Violence Prevention Branch, NC-DHHS DPH
110
Lessons Learned
  • Include representative from a minority community
    during questionnaire development

Injury and Violence Prevention Branch, NC-DHHS DPH
111
Lessons Learned
  • Include question on the presence of mud or debris
    in survey questionnaire
  • Appropriate for mountains and flatlands

112
Lessons Learned
  • Discuss at outset need for including questions on
    current conditions and risk factors for potential
    problems
  • Landslides often occur days after hurricane
  • Floods often occur days or weeks after event

Injury and Violence Prevention Branch, NC-DHHS DPH
113
Lessons Learned
  • Emotional / mental stress is frequent after mass
    trauma how to craft questions that will
    identify stress that is not easily abated
  • e.g., death of family member(s)

114
5 minute break
115
Guest Lecturer
  • Aaron Wendelboe, MSPH
  • NC Center for Public Health Preparedness

116
Lessons Learned in Questionnaire Design
  • Household Transmission of Pertussis Study

August 2005
117
Overview
  • Describe transmission of pertussis study
  • Describe thought process in designing
    questionnaire
  • Highlight weaknesses in questionnaire
  • Highlight lessons learned from other studies

118
Transmission of Pertussis Study Background
  • International, multi-site study
  • Determine who transmits pertussis to young
    infants
  • Enroll infants 6 months of age diagnosed with
    pertussis
  • Enroll family members and other close contacts

119
Questionnaire DesignConsiderations
120
Designing the Questionnaire
  • Target Interviewees
  • Infant index cases
  • Adult household contacts
  • Child household contacts
  • Non-household contacts
  • Data Collected
  • Demographics, clinical history, biologic specimens

121
Designing the Questionnaire
  • Mode of administration?
  • Self vs. Interviewer administered
  • Training of interviewers?
  • One long questionnaire or 4 separate
    questionnaires?
  • One database or 4 separate databases?

122
Ordering the Questions
  • How to order the questions
  • Meet research objective
  • Ease of data entry
  • Always start with inclusion / exclusion criteria
  • Infants less 6 months of age what does this
    mean? (i.e., 6 months and 30 days?)

123
Ordering the Questions
  • Demographics
  • Beginning or end
  • Sensitive questions at end
  • Build rapport
  • Do not end with complicated questions

124
Peer Review and Pilot Test
  • Have colleagues review for
  • Errors
  • Clarity
  • Improvement
  • 10 pairs of eyes may have looked it over, but
    dont assume its enough . . .
  • Pilot test among the target population
  • May not be possible to pilot in real situation,
    but try to simulate as much as possible

125
Lessons Learned
126
CONTACT WITH INDEX CASE (Index case Infant diagnosed with pertussis) CONTACT WITH INDEX CASE (Index case Infant diagnosed with pertussis) CONTACT WITH INDEX CASE (Index case Infant diagnosed with pertussis) CONTACT WITH INDEX CASE (Index case Infant diagnosed with pertussis) CONTACT WITH INDEX CASE (Index case Infant diagnosed with pertussis)
What level of contact do you have with the infant? What level of contact do you have with the infant? What level of contact do you have with the infant? What level of contact do you have with the infant? What level of contact do you have with the infant?
? No physical contact ? No physical contact ? Close contact (play, cuddle, feeding) ? Close contact (play, cuddle, feeding)
? If close contact, specify the average daily duration ? If close contact, specify the average daily duration ? If close contact, specify the average daily duration ? If close contact, specify the average daily duration ? If close contact, specify the average daily duration
? lt 1h ? 2-5 hours ? 2-5 hours ? gt5 hours
  • Whats wrong with this question?
  • Not all inclusive (1-1.9 hours?)
  • Did not discriminate well almost everyone gt5
    hours of contact
  • Bad question or bad training of interviewers?

127
PERTUSSIS VACCINATION / PERTUSSIS HISTORY PERTUSSIS VACCINATION / PERTUSSIS HISTORY PERTUSSIS VACCINATION / PERTUSSIS HISTORY
(In this section, you household contact) YES NO UNKNOWN
Have you ever been vaccinated against pertussis ? ? ? ?
? If yes, specify if it was as an infant ? ? ?
at age 4-6 years ? ? ?
at adolescent age ? ? ?
  • Ambiguous question for children less than 4 years
    of age
  • Primary series given at 2, 4, and 6 months
  • 1st booster given at 18 months
  • Adolescent booster uncommon
  • Better if followed with If yes, did you
    participate in a vaccine trial?

128
CONTACT WITH PERTUSSIS CONTACT WITH PERTUSSIS CONTACT WITH PERTUSSIS CONTACT WITH PERTUSSIS CONTACT WITH PERTUSSIS CONTACT WITH PERTUSSIS CONTACT WITH PERTUSSIS
Have you been in contact with a person diagnosed with pertussis, other than the index case? (index casehospitalized infant) Have you been in contact with a person diagnosed with pertussis, other than the index case? (index casehospitalized infant) Have you been in contact with a person diagnosed with pertussis, other than the index case? (index casehospitalized infant) Have you been in contact with a person diagnosed with pertussis, other than the index case? (index casehospitalized infant) Have you been in contact with a person diagnosed with pertussis, other than the index case? (index casehospitalized infant) Yes ? No ?
? If yes, specify if this was ? If yes, specify if this was ? If yes, specify if this was ? If yes, specify if this was ? If yes, specify if this was ? If yes, specify if this was ? If yes, specify if this was
? Colleague Relatives outside the home Household member Household member Household member Household member
? Other, precise ? Other, precise ? Other, precise ? Other, precise ? Other, precise ? Other, precise
? If yes, specify how many days ago you saw him/her for the last time ? If yes, specify how many days ago you saw him/her for the last time ? If yes, specify how many days ago you saw him/her for the last time ? If yes, specify how many days ago you saw him/her for the last time Days ______ Days ______ Days ______
  • Index questionnaire didnt ask this question
  • Not detailed enough
  • IRB conflict?
  • Ambiguous study nurses didnt know how to
    answer this question

129
Consistency Across Questionnaires
  • Non-household contacts
  • Population included both adults and children
  • Only had one form designed for adults

130
Site-Specific Opinions
  • Get input from study team, especially those
    collecting the data
  • French and Houston investigators wanted to
    collect additional pieces of data
  • Tuberculosis study in South Africa
  • Personnel who collected data changed
    questionnaire without notifying principal
    investigator

131
People Can Make the Difference
  • Pittsburgh started strong quality decreased
    with new staff
  • Houston great at recruiting contacts (both
    household and non-household)
  • Rapport, incentives, etc.
  • France great at follow-up with second visit

132
Beyond Pertussis. . .
  • Salmonella outbreak
  • Intro paragraph
  • Too long
  • Just to review questions
  • Too redundant
  • I dont know option
  • Important to allow for all possible responses
  • People dont like to appear ignorant

133
Summary of Lessons Learned
  • Interviewer training
  • Pilot testing
  • Application of skip patterns
  • Clear questions asked of participants
  • Unambiguous questions to collect detailed
    information
  • Consistency in data collection
  • Research team input

134
Question AnswerOpportunity
135
Session IV Summary
136
Session Summary
  • With an understanding of good questionnaire
    design principles, you will ask only about what
    you need to meet your research objectives.
  • In preparation for questionnaire design, you
    should have clear research objectives list
    variables to be measured identify an analysis
    plan and consider cost and logistical aspects.

137
Session Summary
  • Use a hypothesis generating questionnaire to
    explore all potential sources of infection, but
    with a small number of cases and no comparison
    group.
  • A hypothesis testing questionnaire literally
    tests a research hypothesis based on data
    collected via a hypothesis generating
    questionnaire. Include both cases and controls in
    the survey sample population.

138
Session Summary
  • The three broad question types are
    closed-ended open-ended and fill-in-the-blank.
    You may use only one or a combination of all,
    depending on the purpose of your survey.
  • Key elements of question design are
    reliability validity specificity simplicity
    asking only one question mutually exclusive
    answer choices providing date / time references
    and using response options that parallel existing
    data sources.

139
Session Summary
  • A well-formatted questionnaire minimizes
    respondent burden by using question order,
    spacing, distinctive font, symbols, and simple,
    short instructions to facilitate navigation and
    using customized components for interviewer
    administered versus self-administered settings.
  • Question type and response option formatting
    impact how you can manage and analyze your data.

140
Next Session October 6th100 p.m. 300 p.m.
  • Topic Interviewing Techniques

141
References and Resources
  • American Statistical Association (1999). What Is
    a Survey? Designing a Questionnaire. Alexandria,
    VA Section on Survey Research Methods.
  • American Statistical Association (1997). What Is
    a Survey? More About Mail Surveys. Alexandria,
    VA Section on Survey Research Methods, American
    Statistical Association.
  • Centers for Disease Control and Prevention, Food
    borne and Diarrheal Diseases Branch, Food borne
    Outbreak Response and Surveillance Unit (2003).
    Outbreak Investigation Toolkit Standard
    Questionnaire. Online resource
    http//www.cdc.gov/foodborneoutbreaks/standard_que
    stionnaire.htm
  • Data Skills Online web site, Office of
    Continuing Education, Institute for Public
    Health, UNC Chapel Hill.
  • An Overview of Primary Data Collection
    Instruments and Designing Questionnaires
    online self-instructional tools.
    http//www.sph.unc.edu/toolbox/.

142
References and Resources
  • Centers for Disease Control and Prevention.
    Standard Food Borne Disease Outbreak
    Questionnaire. (PDF file) at http//www.cdc.gov/f
    oodborneoutbreaks/question/standard_questionnaire.
    pdf
  • Centers for Disease Control and Prevention (CDC).
    2005. Behavioral Risk Factor Surveillance System
    Survey Questionnaire. Atlanta, Georgia U.S.
    Department of Health and Human Services, Centers
    for Disease Control and Prevention.
  • Fowler, F.J. (1993). Survey Research Methods
    Second Edition. Sage Publications Newbury
    Park.

143
References and Resources
  • Reingold, A. (1998). Outbreak Investigations A
    Perspective. Emerging Infectious Diseases. Vol.
    4 No. 1 January March 1998.
  • Salant, P. and Dillman, D. (1994). How to
    Conduct Your Own Survey. John Wiley Sons,
    Inc. New York.
  • Stehr-Green, J.K. (2002). A Multi-state Outbreak
    of E. coli 0157H7 Infection Case Study
    Instructors Guide. Atlanta, GA U.S. Department
    of Health and Human Services, Public Health
    Service, Centers for Disease Control and
    Prevention. http//www.phppo.cdc.gov/phtn/casestud
    ies/classroom/ecoli.htm

144
References and Resources
  • Stehr-Green, J. and Stehr-Green, P. (2004).
    Hypothesis Generating Interviews. Module 3 of a
    Field Epidemiology Methods course being developed
    in the NC Center for Public Health Preparedness,
    UNC Chapel Hill.
  • Torok, M. (2004). FOCUS on Field Epidemiology.
    Case Finding and Line Listing A Guide for
    Investigators. Volume 1, Issue 4. NC Center for
    Public Health Preparedness.
  • Wiggins, B. and Deeb-Sossa, N. (2000).
    Conducting Telephone Surveys. Chapel Hill, NC
    Odum Institute for Research in Social Science.
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