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STRUCTURED QUESTIONNAIRES
6.10: Overview
A structured questionnaire, on the other hand, is one in which the questions asked are
precisely decided in advance. When used as an interviewing method, the questions are asked
exactly as they are written, in the same sequence, using the same style, for all interviews.
Nonetheless, the structured questionnaire can sometimes be left a bit open for the interviewer to
amend to suit a specific context.
6-1
in advance, while others evolve as the interview proceeds.
Drug use studies that employ the structured questionnaire method share
some of the characteristics of other methods. Several steps are involved;
these are outlined and described below.
6-2
Table 6.1:Key Steps in Using a Structured Questionnaire in Drug Use Studies
Step 2: Define and identify the target group for the study.
During the planning you must decide which target group will answer your
questionnaire, how to select a sample, design the questionnaire, and select
and train interviewers.
In addition, you need to plan study logistics and equipment. These include
stationery, forms, transport and whether incentives will be offered to
respondents. Field allowance for interviewers must also be decided at this
stage. These issues are addressed in the rest of this chapter.
Of all the methods described in this manual, questionnaires are the most
familiar to many health professionals, and the one technique with which
many people have had experience. An investigator with some experience
may be able to manage a small study by merely following the steps
described here, since the skills required to design and implement a
structured questionnaire are not as demanding as other methods. For a
large study, you may consider the assistance of a social scientist who is
experienced in questionnaire design and survey research.
One important decision is to identify the study population (the target groups
of respondents who can best provide the information you need). The
following steps provide a guide to the issue of sampling.
! systematic sampling
! stratified sampling
! cluster sampling
! multi-stage sampling
c. Number to Interview
Sample size depends upon the aim of your study, and in particular how
precise the sample estimates must be. Using the antibiotic example, if the
purpose is simply to explore beliefs and attitudes about antibiotics in the
treatment of cough in children, a small sample may be sufficient. However,
if the purpose of a study is to estimate specific knowledge deficits in a
population of paramedics in order to design a curriculum, a larger sample
might be necessary. Generally, if the goal of the study is to test a
hypothesis or generalize the findings to a large population, then an
adequate representative sample -- usually a large one -- must be taken to
achieve a reliable result.
d. Contacting Respondents
During the initial contact, the aim of the study, when and for how long it will
take place, and how it will benefit them should be explained to the agencies
involved. Such information may encourage greater cooperation.
The design of a questionnaire and how questions are worded can greatly influence the reliability
of the data collected. Developing a structured questionnaire is a relatively familiar activity,
since questionnaires are so commonly used. Despite this, creating a good questionnaire is not a
simple task, but one which requires careful testing and retesting. The suggested sequence of
steps to assemble a questionnaire is:
The first task is to determine which topics the questionnaire will cover and how it will be
administered. The number of topics will depend on the objectives of the study, and on the
length of time it is reasonable to expect respondents to cooperate. Remember that the
information collected should be relevant to the design of an intervention. The most frequent
problem in questionnaire design is asking too many questions that are not directly useful or
relevant. You can organize your work as follows:
After identifying the sections of the questionnaire, you must formulate individual questions to
gather the specific pieces of information needed.
Wording questions so that they are uniformly understood and tap into the desired category of
response requires patience, practice, and, above all, pre-testing. Some general guidelines on
good question formulation include:
For example, a question such as "Where do you normally seek treatment when your child falls
ill?" may be perceived differently by different respondents. AIllness@ can include many
different types of health problems, and varying degrees of severity. AWhere@ can be
interpreted as a physical location or a type of practitioner. ANormally@ is an imprecise word
that means different things to different people. ASeek treatment@ may exclude self-medication
in the minds of some respondents.
To overcome this problem, it is best to specify questions in clear, short and simple language.
You may for instance break the question into pieces to assist respondents, for example, by
asking specifically about ARI. Further limiting the duration to the last two weeks preceding the
study or the last episode of illness will also enhance recall of respondent. You can further ask
them to mention specifically the various actions they took since the illness was noticed. These
may involve the following questions:
Has your child been ill with cough within the past two weeks?
(If the answer is yes): Did you visit anyone for advice or treatment? Did you give the
child any medicines?
(If the respondent indicates medicine(s) were given): Would you please list any
medication(s) that the child has used since the illness started?
2. Each question must measure one thing at a time
Questions which measure two or more different things should be avoided. For example, the
question "How do you and your staff normally treat children who present with cough?" should
be divided into several questions to enable the respondent to give separate answers for different
types of prescribers in the facility, since they may each have a preferred way of treating cough.
Leading questions can lead to biased responses. A leading question is one which suggests the
expected answer. For example, the question: "When a child presents with ARI, do you
prescribe an antibiotic?" is a leading one because it mentions antibiotic. An alternative would
be to ask "What do you do when a child presents with ARI?"
Leading questions may also arise when presumptions are made about the respondents. For
example, the question: "What additional fluids did you give your child when he was last ill with
cough?" is biased because of the presumption that when the child has had an attack of cough, the
respondent would give the child extra fluids.
A better set of questions might be: "Has your child had cough within the last two weeks?" (If
yes): "Did you take any action?" (If yes): "What action did you take?"
Words which are vaguely defined or have double meanings should be avoided. The question:
"What kind of patient was he?" may lead to different types of responses such as `"poor" or
"rich," "simple" or "complex," "cooperative" or "un-cooperative," and so on.
Also, "double barreled" questions, such as: "Do you think ampicillin and tetracycline are
effective for treating cough?" are not good questions since a respondent could like one and not
the other. In this case, a Yes or No response would not truly reflect the respondent's opinion.
Divide such questions into two, each containing a single idea.
After framing the questions, they must be organized in a sequence that is helpful for
respondents. Following is a useful approach:
! Ensure a logical order of topics, and of questions within a topic. Ideas should
flow smoothly from one question to another, moving from more general
questions to more specific ones within each topic.
! Begin with relatively non-controversial and interesting questions, e.g., How many
years have you worked at this health post?"
! Any instructions for skipping one or more questions should be clearly indicated
and, if possible, written in a different font or typeface.
Finalizing the draft questionnaire involves planning the layout to make it both "consumer" and
"user" friendly. This involves the following:
! Provide necessary headings and spaces for labeling and identifying all
questionnaires, ie., identifying information for respondent, date and place of
interview, as well as name of interviewer.
Most interviews involving patients in developing countries are conducted in local languages. To
ensure consistency in the use of words and meanings, questionnaires must be thoroughly
translated before the field work begins.
One effective way of checking the accuracy of translations is to have a different translator do a
back translation into the original language in which the questionnaire was written. The two
versions can then be compared to iron out any differences. Table 6.2. is an example of a
questionnaire.
Table 6.2.: Example of A Structured Questionnaire
Name of Facility..........................................................................
Name of Patient...........................................................................
DIAGNOSIS
1. Can you tell me in your own words what the problem is with your child?
2. Why did you choose to come to this facility today for treatment?
Yes________
No________
Yes________
No________
DRUG USE
5. Could you please show me the drugs you were given here today? Examine drugs
to be able to later fill in the questions on drug labeling on the dispensing form.
No________
Yes________
No________
3. Can you explain why you were not satisfied, or in what ways might you have been
more satisfied?
4. If your child's cough does not improve after taking these drugs, what do you plan
to do?
d) Socio-Demographic characteristics
8. Sex of Respondent Male Female
a.
b.
c.
d.
e.
8. If you could change one thing about the care here to make it better, what would that
be?
9. If your child=s cough does not improve after taking these drugs, what do you plan to
do?
SOCIO-DEMOGRAPHIC CHARACTERISTICS
The calibre of field personnel who administer the questionnaire have a great
influence on the quality of data. In structured questionnaire interviews, the
field team personnel usually include interviewers and supervisors.
a. Selecting Interviewers
The interviewer is the one who "sells" the aims, objectives, and intended use
of the information to the respondents. The following are qualities to
consider when recruiting interviewers.
1. Educational qualifications
2. Personal qualities
used;
A supervisor is responsible for seeing that the field work is done properly. In
addition to the personal qualities listed under Interviewer (above), the role
of the supervisor demands the following additional qualities:
You may decide to select your personnel through interview, or written test
(for language competency). It is advisable to make the selection
provisional, subject to good performance during training and field testing.
The purpose of training is to impart the needed skills to the field team
before they embark upon the field work. The training curriculum must cover
both the technical aspects of questionnaire surveys, as well as practical
training in how to implement them effectively.
a. Technical Background on Structured Questionnaires
Inform the team about the problem, purpose and objectives of the study so
that they can understand it in context. Provide information about the study
community and target population.
Each respondent has to answer open-ended questions in his or her own way.
The interviewer therefore needs to be cautious in recording open-ended
responses. Such responses should be written in full. However sometimes
this is impractical, and interviewers must learn to extract the key
information. The respondent can be asked politely to repeat a response if it
is not well understood.
Interviewers must not spend a lot of time writing since this can
interrupt the flow of the session. Abbreviations are very useful, but
interviewers should avoid those that are difficult to read later. Introducing
a common set of abbreviations for vocabulary that will be frequently used is
very helpful.
The practical sessions of training consist of two parts. First are the role
plays in which interviewers and other field staff practice among themselves
in artificially created situations. Interviews should play the part of both
interviewers and respondents.
The trainer and other experienced interviewers can observe and comment
on the performance of interviewers in order to improve both the
interviewers' style and the questionnaire.
e. Pilot Tests
After the pilot test, review and revise the questionnaire and the guidelines
for the actual field work. This review should take into account all issues
related to the successful administration of the questionnaire. These will
include the following:
As part of your preparation for the field work, you need a work plan and a
time-table of how you will proceed with the field interviews. Particularly if
the study is a large one with several interviewers and other staff, your work
schedule will involve:
! schedule of work.
Before you finally move into the field, ensure that instruments and other
interviewing materials and logistics for the field work are ready. Your
checklist should include:
! introductory letters;
Interviews are best conducted with respondents alone in a place that offers
reasonable comfort and privacy. Providers and patients/clients may be
interviewed in a health facility or drug retail outlet. Community members
can also be interviewed in their homes which is where they are most likely
to stock and take their medicines.
! introduce himself/herself;
Remember: the interview does not end until the interviewer has
said Athank you@ to the respondent.
There are some problems that are commonly encountered during interview
surveys. Sometimes these can be anticipated and prevented. Common
problems and suggested ways to deal with them include:
! Noisy environment:
Queues of patients, curious onlookers, and young children can
all distract respondents. Finding a more private place for the
interview is the best solution. If this is impossible, carry on as
best as you can; find out from the respondent whether
something can be done about the problem.
After the field work, data from the questionnaires must be processed,
analyzed, and presented in the form of a report. The process involves the
following activities:
The first stage of data processing involves categorizing the responses. This
is the process of listing all responses to a question under clearly defined
options. In structured questionnaire, categorization is necessary for open-
ended questions. For example, an answer to the question: "Why did you
choose to come here today for treatment?", could contain possible
categories such as "accessibility", "faith in treatment", "treatment is
scientific", and "referred".
The process begins by first examining the raw data to draw up a list of
clearly defined responses for each question. Each category should be
precisely described in a few words. Again, the list of categories for each
question should not be too long as this can make the analysis difficult. For
each question, place similar responses under one category. The process
takes the analysis a step on to coding.
3. Code Data
For each question, if the number of categories does not exceed 9, which
may be the case in most situations, assign A1" to the first category, A2" to
the second category, and so on. If the number of categories exceeds 9,
assign "01" to the first group, "02" to the second group, "03" to the third
group, and so on.
Example: No = Ш
Yes = 1
There are no common types of missing values that must be assigned codes.
Sometimes a response is missing because the respondent did not know the
answer; this is sometimes assigned the code A8" or A88" in numerically
coded questions or ADK@ in categorical systems. A response can also be
missing if the respondent refuses to answer, the interview was not finished,
the item was skipped, or for other reasons; these missing values are after
assigned A9" or A99" codes in numeric systems, or ANA@ if categories are
used. When you have finished developing your codes, compile them into a
code book and ensure that there are enough copies for all coders. During
coding a supervisor must periodically review a sample of each coder's work
to ensure that coding is being done correctly.
4. Analyzing Data
After coding, the stages of analysis will vary depending upon whether it is
manual or involves a computer. If the analysis is manual, the use of dummy
tables or a master sheet is very helpful.
When data are to be analyzed manually, you will need tools for organizing
the coded data from the questionnaires and aggregating them into
summary tables. The data master sheet is one tool for organizing data.
This technique is particularly helpful for small samples. Basically, it is a
sheet containing the various coded responses on the questionnaire that
makes it easier to tally the individual responses by hand.
The advantage of using a master sheet is that direct counts can be done
easily for coded responses, e.g., for socio-economic and other background
characteristics. It may not be feasible to use master sheets if the
questionnaire involves many open-ended responses. In such cases, hand
compilation may be more useful in order to capture the whole range of
responses. Table 6.3. is an example of part of a master sheet.
Etc.
TOTAL
ARI
Diarrhea
Malaria
Other
Diagnoses
Once a dummy table has been laid down, each respondent=s data from the
master sheet can be recorded as a tick mark in the appropriate cell of the
table. After all respondents= data are entered, tallying the tick marks gives
the totals for the sample as a whole.
5. Enter data
For the data to be entered into a computer, a data entry format must first
be developed. This is a screen containing the questions in the questionnaire
with a space provided for entering appropriate responses. Epi Info 6 is
especially well-suited for developing data entry routines directly from the
wordprocessing files used to print the questionnaire. When this has been
done, the data are then entered into the computer in their coded form. It is
fastest to have specially trained data entry clerks do the data entry.
6. Edit data
After all data have been entered into the computer, a verification must be
done to correct errors and omissions made in the process. Examples of
such obvious mistakes may involve wrong codes such as entering 6 as code
for sex when the allowable codes for sex in most cases are 0 or 1, and so
on.
To avoid or minimize such mistakes, it is sometimes possible to build checks
into the program to detect and refuse such data entry mistakes. Another
option is to enter data twice and have the computer check the equivalence
of both entries.
Conclusion and
Recommendations: Inferences, suggestions, and likely follow-up
interventions.