Purpose
The development of a survey begins with a broad statement of its purpose (Figure 4.1).
Although this fact seems obvious, it is easy to lose focus when developing a survey and end up with a product that lacks integrity. Take, for example, a group of health behavior researchers participating in a research project designed to examine factors related to self-management in persons with epilepsy. As part of the study, the researchers planned to collect background information to describe the participants in the study. They planned to include items such as age, gender, education, and information about seizure history and medication use. The researchers also wanted to know about a number of
other issues, including how long participants had been treated for epilepsy, sources of information, types of insurance, and confidence in the health care system, among other things. They wrote items to collect information on these topics as well as the usual back- ground information. Before long, the background section of the survey extended to fifty-five items, many of which were unrelated to the primary purpose of describing the sample. When the researchers realized it would take participants as much time to com- plete the background section as the items on self-management, they deleted most of the new items. The researchers could have saved considerable time if they had started with a clear statement of purpose.
Objectives
After researchers determine the general purpose of the survey, they list specific ob- jectives or research questions to guide them in the development of actual survey items.
For example, a broad statement of purpose for a survey of hand-hygiene practices of unit personnel in acute care settings might be as follows: to collect information about hand- hygiene practices of unit personnel in acute care settings. Asking one question, such as “Do you wash your hands before caring for each patient?” might be insufficient to address the broad purpose. Daniel, as noted earlier, also wants to know how often unit personnel wash their hands each day, whether or not they have developed contact dermatitis, and what they perceive as barriers to hand-hygiene practices. He is also interested in the types of agents personnel use to clean their hands and the use of alternative
FIGURE 4.1. STEPS IN SURVEY DEVELOPMENT.
State purpose
Write items
Determine survey format
Write objectives
Identify respondents
Write rules for scoring and administration
practices, such as wearing gloves. Finally, Daniel might also want to know how im- portant unit personnel think hand washing is. To meet all his objectives, he will need to include specific questions addressing each of these aims. Thus, for his hand-hygiene survey, Daniel might list the following research questions:
• How often do unit personnel wash their hands before caring for a patient?
• How often do unit personnel use soap and water or antiseptic agents when wash- ing their hands?
• How often do unit personnel use both antiseptic agents and water when washing their hands?
• How often do unit personnel use alcohol-based hand rubs, instead of soap and water or antiseptic agents with water, to clean their hands?
• What percentage of unit personnel have developed irritant contact dermatitis due to frequent hand-hygiene practices?
• What are the perceived barriers to performing hand-hygiene practices?
• How important do unit personnel believe it is to wash their hands?
The research questions guide the selection of items for inclusion in the survey (Ex- hibit 4.1). The more specific the research questions, the easier it is to select items.
Research questions that are broad or vague make the selection of items difficult.
Purpose and Research Questions for a Survey of Students’ Attitudes About Exercise
For a study of the exercise habits of college students, a researcher might state the following purpose and ask the following research questions.
Purpose: To examine college students’ attitudes toward, and participation in, various forms of exercise.
Research Questions
• What percentage of college students exercise three or more times per week?
• What types of exercises or sports do college students participate in?
• What do students believe are the benefits of exercise?
• How confident are students that they can exercise three or more times per week under varying conditions?
EXHIBIT 4.1. EXAMPLE OF SURVEY ITEMS ON HAND-HYGIENE PRACTICES.
Please answer the following questions about your hand-hygiene practices.
What type of unit do you work on?
1. Inpatient floor 2. Intensive care unit
3. Operating room
4. Outpatient unit
About how often do you wash your hands every hour?
1. 0–1 time
2. 2–4 times
3. 5–7 times
4. 9–10 times
5. More than 10 times
How often do you wash your hands before caring for a patient?
1. Every time
2. Most of the time
3. Sometimes
4. Hardly ever
5. Never
How often do you use soap or antiseptic agents when washing your hands?
1. Every time
2. Most of the time
3. Sometimes
4. Hardly ever
5. Never
Have you ever developed irritant contact dermatitis due to frequent hand-hygiene practices?
1. Yes
2. No
3. Not sure
Which of the following reasons prevent you from performing hand-hygiene practices? (Check all that apply)
1. Hand-washing agents cause irritation.
2. Soap or paper towels are not provided.
3. I wear gloves.
4. Sinks are not conveniently located.
Respondents
The next step in developing a survey is to consider the respondents:
• Who are the respondents?
• What are their expected levels of language and reading skills?
• How familiar are they with the topic?
• How will respondents be recruited for the study?
• How much time will they have to complete the survey?
• Will they be willing to respond to the survey?
Young children with limited reading and writing skills would need an interviewer to read questions to them, as would adult respondents with poor literacy or physical limitations that interfere with reading or writing. If the researcher believes some re- spondents might be unfamiliar with the topic, definitions of some terms should be provided.
Just as the researchers assessing epilepsy self-management made decisions about what to include in the epilepsy background information survey, researchers must make tough decisions about the inclusion of survey items based on the amount of time avail- able. If the respondents have only five minutes, ten to fifteen questions may be the maximum number that they can answer.
Nurses and other professionals working on hospital units tend to be extremely busy. Therefore, our public health professionals who want to ask them to complete a survey on hand-hygiene practices must bear in mind the respondents’ time restrictions when developing their survey. A short survey, such as that presented in Exhibit 4.1, would probably take a few minutes to complete, and nurses might be willing to com- plete it during the course of their work day. This survey would be useful to gather pre- liminary information that could be used to develop a more comprehensive questionnaire on hand-hygiene practices.