Relying on self-report when asking people about their health an obvious problem is to make sure that the person being asked the question understands the question the same way that the investigator does. Often, what looks like an easy question for the respondent to answer may in fact pose a number of difficulties for the respondent.
One such area of particular importance for people with diabetes is experiencing low blood sugar levels or hypoglycemia and the potential consequences this can have for the patient. Therefore, when asking people about their sugar levels using a questionnaire, it’s essential that the question is understood to mean the same thing to everyone.
At DHP Research we recently carried out an on-line survey through thepatientoutcomesblog of people with Type 1 and Type 2 diabetes asking them:
What would you describe as an unacceptable low blood sugar level for you?
We had in total 23 responses details of which are in the infographic below.
As can be seen the range of blood sugar levels (mmol/L) reported was wide indicating that when asking a patient we cannot put our own interpretation on what is an unacceptably low blood sugar.
Rather than give a figure, a number of respondents described what they considered an unacceptable low blood sugar level. These are the responses:
- Low enough to snap at people, have trouble functioning normally, or cause a rebound high.
- When you cannot make the appropriate decisions to communicate clearly or to treat the low BG alone w/o a struggle.
- Never been told!
- A level of blood sugar that causes me to be unable to focus, concentrate, express my thoughts, have normal reaction time, become irritable, dizzy, overly fatigued.
- Insufficient energy – pass out, or in the worst case, die.
In addition respondents were asked about the clarity of the question and whether they understood what the question was asking. Overall, respondent considered the question as understandable, however, three respondents considered the term “unacceptable” as unclear and open to misunderstanding.
What does this mean?
Ensuring the question is understandable to the respondent is essential in any survey. Our short survey has demonstrated that even what appears as a straight forward question can have underlying problems. Usually these kind of problems can be identified through cognitive interviewing.
If we really want to know what is “unacceptable” then we recommend the use of such vague terms be avoided and that respondents can choose from a range of options. However, this raises issues around the specific time in which respondent are required to recall and the inherent problems associated with this.
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