7 Steps to successful questionnaire design – Start at the end

Designing a health 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. It’s also knowing what your research question is.

Collecting information using a survey 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 survey 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 helps 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.



The aims of the health survey will provide the important basis for the structure of the survey questionnaire and developing the content to collect the information required to address the study aims e.g. patient satisfaction or experiences of the different touch points of the patient’s journey, access to treatment etc.

Without a clear aim as to the purpose of the survey it will not be possible to identify just what information is required and how this will be managed.

Tailoring the content to meet the aims and objectives of the health survey ideally includes both a comprehensive review of the literature and the undertaking of a small-scale qualitative study to identify the range of behaviours, attitudes and issues relevant to the objectives of the survey. A literature review will provide information on any other studies which have been done on the topic, the current state of knowledge in the area, help build on or extend current work, identify methods of data collection, and highlight the content of existing questionnaires and any problems experienced that can act as guide for you.

Getting respondent input

This is an essential part of survey questionnaire design to ensure that its content is based around the health survey’s aims and objectives and importantly your respondents’ experiences, views and behaviours etc. This can be achieved through a small scale qualitative research involving 6-12 open-ended interviews with respondents selected from your target group in combination with the literature review. Interviews need to be unbiased and respondents should be probed rather than prompted. A topic guide can be used which lists the various areas you will need to cover. Note this is only a guide and the interview should not take the format of a question and answer session. Here we are looking for open and free responses from the respondent.

How are you going to collect the information?

A key decision at this stage is choosing the type of questionnaire you will use to collect the required information. The types of questionnaires can be broadly defined as

1. Self-completion

2. Interviewer-administered

The Self-completion questionnaire

Self-completion health survey questionnaires are completed in writing by the respondent. The most common use of self-completion questionnaires is delivery and return through the post. However, they can also be completed in the presence of the researcher (supervised self-completion), who can provide assistance and check the questionnaire for completeness.

Self-completion questionnaires offer low cost relative to other methods, potential coverage of a widely dispersed population and a wider coverage in the study population. They avoid the possibility of interviewer bias, although weaknesses in design and wording can still lead to biased reporting. However, self-completion questionnaires have the potential for low response rates; require a level of literacy to complete the questionnaire as well as the availability of an accurate list or sampling frame from which to select the sample of respondents. Self-completion questionnaires are appropriate for less complex topics and need to be easy to complete without assistance. It’s generally suggested that self-completion questionnaires be shorter than those administered during interview and contain mostly closed ended questions. They are less suitable for recording open-ended data, complex questioning and question skip patterns (in which the answer to one question dictates which subsequent questions are answered).

Interviewer-administered questionnaire

With interviewer-administered survey questionnaires, each respondent is asked the same questions by the interviewer, in the same way, in order to eliminate as far as possible any bias. Advantages of this mode of administration include the collection of more detailed and complex data, the possibility to clarify misunderstandings and the opportunity for the interviewer to probe for additional information. Open ended questions can be used, in addition to filter questions and complex question skip patterns. Recording of the information is undertaken by the interviewer, so is not dependent on the respondent’s level of literacy.

Interviewer-administered questionnaires are generally more costly and resource-needy than self-completion questionnaires, because interviewers often need to be trained and their administration may involve travel. They can also be more time consuming. The personal characteristics of the interviewer – e.g. age, class, sex, race, level of experience – can have an effect on the response rates and the nature of the responses. Interviewers can also introduce both random and systematic error, e.g. in the recording of answers, by changing the wording of the questions or by selective recording of answers and differential probing between interviewers.

Once we have:

  • established the aims and objectives of the study
  • gained an insight into the issues relevant to the respondent which correspond to the aims and objectives of the survey
  • Selected the mode of collecting the information i.e. self-administred, interviewer administered…

…we can move onto the next step of developing the structure of the questionnaire. This involves listing and ordering the  topic areas and variables to be measured, and their relationships with other variables identified from the literature review  and interviews with respondents which might need to be included in the questionnaire.

But remember:

The practical value of a questionnaire depends on the reliability and validity of the information it collects. Reliability refers to how well data collected by using a questionnaire can be reproduced.Validity is how well the questionnaire measures what it is intended to measure.

Without reliability and validity no amount of statistical manipulation will provide you with useful information

Next week’s blog will focus on structuring the questionnaire including, identifying the topic areas and variables, and their relationships with other variables identified from the literature review  and qualitative research which need to be included in the questionnaire. How these should be listed and decisions made on how best they can be measured.

To download our 7 Tips for questionnaire design click here

Please share your thoughts in the comments and share this post with others looking for advice on questionnaire design

Also if you would like to know more about questionnaire design contact: info@dhpresearch.com

Why not visit www.healthsurveysolutions.com to find out more about how we can help you with questionnaire design

Categories: Questionnaire design

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