Designing a patient survey questionnaire whether it’s to measure patient satisfaction or patient experience is more than simply writing some questions expecting patients to understand them and provide reliable and valid answers. Designing a patient satisfaction or experience questionnaire involves initiating a relationship with patients that stimulates their interest and encourages them to provide the best answers possible.
Collecting information using a questionnaire to measure patient satisfaction, experience and health is now common practice. There is a variety of questionnaire types that can be used. Whichever way questionnaires are used and for whatever purpose, the same design rules should apply in their construction to ensure that they are appropriate for the intended use and provide reliable and valid data.
Patient survey questionnaires designed with little thought will lead to the collection of unreliable and invalid information.
Who is this guide for?
For the healthcare professional, clinician and researcher who requires information on patient satisfaction, health and or experience, the choice and use of a well-designed and validated questionnaire is essential.
How this guide help you
By applying the 7 steps you will be assured that your health survey questionnaire will be designed based on these first principles of questionnaire design and that with proper planning you will have greater confidence in the quality of information collected.
UNDERSTANDING THE BIG PICTURE
It is essential that the overall objectives of the patient survey are defined at the outset. This will include establishing the purpose of the survey e.g. measuring patient satisfaction, experience and outcomes, clarifying the target population the questionnaire will be administered to e.g. patient group, disease type, how the information will be collected e.g. paper/pencil, interview, web and how that information will be used e.g. improve patient experience.
- If the objectives of the survey are, for example, to gain an insight into the health status of homeless people, then a self-completion or telephone administered questionnaire is not feasible.
- If, however, we wanted to find out the level of patient satisfaction of a sample of patients registered with a general practice using a five-item questionnaire, this could be carried out using either a self completion or a telephone interview.
- The mode of administration can have an impact on the quality of the data generated. This includes sampling method and the ability to reach all eligible respondents, response rates, confidentiality, interviewer effects, the volume and complexity of the data collected.
- Availability of resources include costs, personnel to conduct interviews or handle administrative tasks, skill and time to develop and administer the questionnaire, data coding and entry, data analysis.
- Characteristics of the target population include their overall educational level and the accessibility to the respondents. If the potential respondents are geographically widely dispersed then face-to-face interviewing will be impractical.
Throughout all the 7 steps it’s essential that the practical value of a questionnaire depends on the reliability and validity of the information it collects is kept in mind.
Reliability – refers to how well data collected by using a questionnaire can be reproduced. The most common indicator of reliability is test-retest reliability. This is a measure of how stable the respondents’ responses are between time 1 and time 2, when we can assume that there should be no natural change in the responses, e.g. because of treatment, maturation etc. A poorly-designed questionnaire might result in variation in the responses of the respondents between times 1 and 2, leading to measurement error.
Validity – is how well the questionnaire measures what it is intended to measure. For a measure to be valid it must be reliable, but something can be reliable without being valid – a clock that is always 10 minutes fast is reliable, but is not a valid indicator of time. Validity of a questionnaire can be measured in a number of ways, including face, and content validity.
Face validity is the least scientific and is based on a basic review of whether the items look appropriate. If we were asking about attitudes to smoking then the measure would have face validity if the questions appeared to be about attitudes to smoking.
Content validity which is often and incorrectly confused with face validity, is assessed on the extent to which the questionnaire’s content includes everything it should, and does not include anything it should not. Evaluating content validity of a questionnaire should be based on expert review, e.g. expert panels including patients.
It’s essential that the overall aims and objectives behind the use of the questionnaire are clearly established including, deciding on how the questionnaire will be administered, the target patient group and also what resources will be required to develop, implement the questionnaire and undertake the data analysis and reporting.
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Categories: Questionnaire design