Which survey method has the greatest potential for causing resentment on the part of those surveyed? ✅ Tốt
Mẹo Hướng dẫn Which survey method has the greatest potential for causing resentment on the part of those surveyed? 2022
Bùi Thảo Ngọc đang tìm kiếm từ khóa Which survey method has the greatest potential for causing resentment on the part of those surveyed? được Cập Nhật vào lúc : 2022-08-22 03:05:10 . Với phương châm chia sẻ Mẹo về trong nội dung bài viết một cách Chi Tiết 2022. Nếu sau khi Read tài liệu vẫn ko hiểu thì hoàn toàn có thể lại Comments ở cuối bài để Ad lý giải và hướng dẫn lại nha.- Journal List Health Expect v.4(4); 2001 Dec PMC5060080
Health Expect. 2001 Dec; 4(4): 253–259.
Nội dung chính- IntroductionSurvey methodologyReassuranceQuestionnaire administrationSpecific questions regarding items on the questionnaireAcknowledgementsWhich type of question should be avoided on a questionnaire?What is the survey research method?What is the fastest and most cost effective form of primary source research?What is the most difficult step in the marketing research process?
Abstract
Objective To investigate and analyse concerns raised by unsolicited mailing of a health survey to a community sample of older people.
Design Observation and monitoring of all telephone calls received throughout a 6‐week survey mailing period.
Setting and participants A total sample of all those aged over 50 years registered with three general practices in North Staffordshire (n=8995).
Main variable studied The frequency of telephone contact following the receipt of a postal questionnaire, and the nature of any associated distress.
Results and conclusions Individuals who receive unsolicited postal surveys may experience anxiety because of the actual receipt of the questionnaire, concerns about taking part or not taking part, personal issues, anger, worthiness or frustration with NHS services. Anxiety may also be triggered because of administrative issues, for example lost mail or overlap between mailing periods. Researchers can adopt measures both to reduce the potential anxiety and often hidden burden of postal surveys, and to facilitate individuals’ positive participation in research.
Keywords: primary care, questionnaires, research methodology, knee pain, KNEST surveys
Introduction
Postal surveys can play an important role in understanding the health of populations, 1 by allowing us to identify patterns of ill health in the population, determine needs and assess the outcome of treatments and services. The contribution of surveys to health services research has increasingly been recognized, particularly as measures for ensuring the validity, reliability and acceptability of surveys have become more sophisticated.
Pre‐piloting and piloting of survey questionnaires can help to safeguard issues such as the relevance, acceptability and appropriateness of the questions. Question wording and questionnaire design and administration can affect all of these factors and this is well documented in the literature. 1 , 2 , 3 Patient acceptability is indirectly assessed also by pilot estimations of response and completion. The actual psychological impact of receiving a postal questionnaire has not attracted much attention from researchers but is an important ethical and methodological concern. The nature and extent of any distress may influence whether or not somebody participates in the research and, for example, is able to express views about services or their health needs.
In this paper we explore whether distress occurs following the receipt of a postal questionnaire, and if so, what the nature of this distress is. We intend to explore a possible hidden burden or ‘real life impact’ of survey research and its implications for participation in such research.
Survey methodology
Although the prevalence of chronic knee pain has been investigated, there is less information about intermittent pain, GP consultation and wider health care use by knee pain sufferers. The aim of this survey was therefore to identify the prevalence of knee pain (all grades) in the community, GP consultation for knee pain and other health care utilization using a new and recently validated knee pain screening tool (KNEST). 4 The tool includes a new question to act as a sift to identify knee pain sufferers in the general population. This new question asks ‘Have you had pain in the last year in or around the knee?’.
The KNEST formed one part of the survey instrument used in this study. Also included were: a pain manikin, 4 the Short Form 36 (SF36), 5 the Hospital Anxiety and Depression Scale (HADS), 6 demographic questions, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 7 for those who reported knee pain.
The survey was mailed (March 2000) to 8995 patients registered with three general practices in North Staffordshire. Each person received a packet containing a questionnaire, a letter from his or her GP, a patient information sheet and a reply envelope. After 2 weeks a postcard reminder was sent to all non‐responders (n=5374). After a further 2 weeks a second questionnaire and reminder letter were sent to non‐responders (n=3219). Allowing for 301 exclusions because of wrong addresses or removals, the end of the mailing period the adjusted response rate was 78%. The survey was approved by the local Research Ethics Committee.
Guidance on ethical research practice states that:
• It is incumbent upon researchers to be aware of the possible consequences of their work. Wherever possible they should attempt to anticipate, and to guard against, consequences for research participants which can be predicted to be harmful.
• In many of its guises, social research (this includes postal surveys) intrudes into the lives of those studied… Researchers should consider carefully the possibility that the research experience may be a disturbing one and, normally, should attempt to minimize disturbance to those participating in research. 8
In this study, the above guidance was operationalized in three ways. First, strenuous efforts were made to ensure that recent deaths were excluded from the mailing list to avoid distress to relatives. Secondly, it was made very clear in the covering letter that participation was voluntary, information was confidential and individuals’ healthcare would be unaffected whether or not they chose to take part. Thirdly, the name and telephone number of the lead researcher was included so respondents could contact her with queries or problems. Throughout the 6‐week mailing period, the number of phone calls received by the researcher (CJ) was recorded. The reason for each call was also logged. These calls form the basis for analysis presented here. It is important to note that this study has conformed with the draft Research Governance Framework for Health and Social Care recently issued by the government, 9 and taken account of the general principles of the MRC guidelines for research involving people or their information 10 and the Data Protection Act 1998. 11 Particular attention has been given to systems for ensuring confidentiality of personal information. Personal or attributable information has not been used in the analysis, the basis of which is emergent themes and categories.
Results
A total of 198 telephone calls (from 198 individuals) were recorded throughout the mailing period. Figure 1 presents the profile of these calls.
Reasons for telephone calls (n=198) during a postal survey in a registered primary care population of 8995 people.
The profile of telephone calls identified in Fig. 1 can be summarized into three broad groups: exclusions (n=74), survey administration (n=112), and questionnaire queries (n=12).
Exclusions
The question of participation in the research was central in a significant number of calls. A total of 74 calls were received from people, or relatives of people, wishing to be excluded from the study. We looked more closely the reasons why people wished to be excluded and a number of clear themes emerged.
Anxiety caused by the receipt of the questionnaireThis is triggered as soon as the respondent receives the envelope containing the questionnaire.
• Respondents do not fully understand the reason why they have been selected for receipt of the questionnaire.
• Respondents do not fully understand how to complete the questionnaire.
Anxiety about taking part in the studyRespondents are uncertain about what the questionnaire will be used for. For example:
• Is the GP implicitly asking for information to use against them? Will they be struck off the GP register if the questionnaire reveals they have a lot of health problems?
• Fear of financial penalty: is the questionnaire linked to pensions or disability benefit?
• Confidentiality: who is going to see and analyse the answers?
Anxiety about not taking part in the studyIn particular this relates to the implications of their non‐participation for access to their GP and related primary care services.
Personal issuesThe questionnaire brought out a whole spectrum of past or present personal experiences. These are associated with the following:
• Personal ill health or ill health of partner, spouse or other family members.
• Bereavement.
• Abuse.
• Acceptance or otherwise of getting older.
• Specific concerns related to the topic of the survey. In this case, frustration of living with osteoarthritis and the perception that this condition is an inevitable result of ‘wear and tear’ and getting older.
AngerThe questionnaire generates an angry response from some individuals who feel that:
• Receiving the questionnaire is an invasion of their privacy.
• The study is a waste of money.
• The results will not benefit themselves or the health service.
• Previous contact with health services has not been beneficial for themselves or family members (including those who have been involved in legal proceedings).
WorthinessIndividuals feel that they are not eligible to take part in the study either because of their age or because of particular health problems they experience.
Frustration with the NHSThe lack of help available from the GP or other health services to giảm giá with osteoarthritis and/or other health problems was important. The problems of hospital waiting lists and GP waiting times were particularly stressed, together with the perceived attitude of GPs when dealing with osteoarthritis and the perception that there is ‘nothing we can do’.
Reassurance
The issues raised above all had to be addressed by the researcher the time of the telephone call. For example, when dealing with calls from people who were uncertain about whether or not to complete the questionnaire, the reason for the study was reiterated, together with how the caller could help. Reassurances about confidentiality were made. Callers were reminded that participation was voluntary and that individuals’ healthcare would be unaffected whether or not they chose to take part.
A consistent exclusion criterion for specific circumstances was also applied. When, for example, the person who received the questionnaire was in hospital, or had specific health or literacy problems, the caller was reassured that they (or their relative) did not have to complete the questionnaire and was thanked for taking the time to call.
Questionnaire administration
The second category of telephone call in this study was related to the administration of the questionnaire and therefore the facilitation of participation in the research. First, after receiving the reminder postcard, individual requests for another questionnaire were common (n=46). In this case the originals had been mislaid, thrown away or destroyed. Callers were reassured that replacement questionnaires could be mailed straight away. Eighty‐five per cent of people who called for replacements went on to return the form. Secondly, individuals (n=23) called when they had received the postcard reminder but, because of postal problems, had not actually received the original questionnaire. This caused confusion, anxiety and in some cases a degree of panic. Again, callers were reassured that there were no problems, thanked for their call and informed that a replacement questionnaire could be sent to them immediately. Eighty per cent of people who called for this reason went on to return their questionnaire.
Thirdly, people called confirming that they had already returned the questionnaire (n=40). These callers were often anxious to ensure that, after spending time to complete the questionnaire and after disclosing information about their health, their questionnaire was safely received in the office. Each caller was reassured that there may simply have been a cross‐over in the time between us mailing the reminder to them and their sending the initial questionnaire back. The database was checked for each returned questionnaire. The caller was then phoned back (if they wished to be contacted again) to confirm whether or not we had received their form. Finally, a small number of people reported that reply envelopes were missing (n=3). After receiving replacement envelopes, all of these people went on to return their questionnaires.
Most calls about administrative issues were made on the 2 days immediately following mailing of the baseline questionnaire and in the immediate few days following mailings of each reminder.
Specific questions regarding items on the questionnaire
A small number of calls (n=12) were from individuals asking questions about certain items in the questionnaire. In particular people were concerned with the following:
• How specific health problems they experience will affect their answers and whether this matters.
• The last section in the questionnaire is about informed consent asking for permission to review medical records. Respondents wanted clarification of what this meant.
• Individuals with no perceived health problems were unsure whether the questionnaire was relevant or not to them.
For queries relating to specific questionnaire items, the researcher was cautious not to steer the respondent into answering in a specific way. Callers were encouraged to think about how they had interpreted the question and how they should answer. Overall, the small number of specific queries about individual questions suggests that the instructions and questions were clear and understood by most people in the sample.
Discussion
This study illustrates a number of issues relating both to the nature and extent of the psychological impact of postal questionnaires. These issues are important both ethically and methodologically in that they may determine whether or not people decide to participate in the research.
The survey was mailed to a large sample of 8995 people aged over 50 registered with three general practices. The survey itself displayed a telephone number for contact. The proportion of people who called was actually quite low (2.2%). However, the sample was large and so the total number of telephone calls to be taken in a short period of time was high (n=198). While the reasons for this contact varied, the conversations required the personal attention of the lead researcher, particularly because of the distress that some people experienced. Moreover, a lot of these calls lasted longer (between 5 and 25 minutes duration) than those which were administrative in nature.
Some of the callers were anxious because of potential jeopardy to their access to primary care services. In the supporting documentation, care had been taken to provide clear statements about the separation between the questionnaire and access to services. However, as other research has highlighted, information needs to maximize patients’ understanding of the purpose and methods of research in order to reduce their anxiety. 12 To date, no guarantees or standard approach have been developed. This may change given current discussions as to whether use of general practice registers as sampling frames for surveys may need permission from the registrants before such studies are initiated. In the meantime it is clearly important to be alert to possible adverse effects of questionnaires.
A proportion of the patients included in this survey had multiple health problems and, even though the survey focused on knee osteoarthritis, distress relating to other conditions (for example, cancer, stroke, angina) might have been triggered by certain questions. Distress in the wider study population was evident in people who did not call the contact number but who wrote comments directly onto the questionnaire.
From the analysis of the telephone calls we can conclude that unplanned burdens on postal survey respondents do occur. This may not necessarily be a bad thing, since telephone contact with the researcher might be a positive way of expressing broader concerns (and may facilitate participation). In keeping with ethical research practice 10 researchers need to ascertain the presence of such concerns among those who receive questionnaires and to devise strategies for alleviating their effects. The following recommendations result from our research:
• Inclusion of a telephone number on survey documents.
• The availability of the lead researcher to take calls.
• A comprehensive messaging system including a call back procedure.
• Staff awareness: ensure that colleagues know about the survey and what to do if they answer a telephone call about this.
• Answer phone for messages outside of office hours.
• Efficient re‐mailing procedure.
The issues raised by callers must also be dealt with carefully. For example, when dealing with angry callers, the following are important:
• Reiterate the reason why the study is being undertaken.
• Apologise for causing upset or anger.
• Confirm that the person will not be contacted again as part of this study and remove the person immediately from the mailing list.
• Do not take adverse comments made by the caller personally.
When dealing with distressed callers the following are important:
• First apologise to the person for any distress caused.
• Reassure the caller that participation is voluntary and that it does not matter if they do not wish take part.
• If the caller asks for medical advice, state that you are not medically trained (if appropriate) and cannot offer such advice. In cases of severe distress it may be appropriate to suggest that the caller visit his/her GP.
• Reassure the caller that they will not be contacted again as part of this study.
• Thank the person for his/her call and remove them immediately from the mailing list.
Conclusion
The fact that a proportionately small number of respondents phoned the contact number does not prove that distress was low since only distress that engendered a phone call has been recorded and investigated here. However, the high return rate subsequently suggests that most people were comfortable with the survey.
The study presented here was not designed to prove that telephone contact was a beneficial thing, but we consider that the number and content of the calls were such to allow us to conclude that a telephone contact number is an important aspect of survey methodology. It may ease the immediate negative impact that surveys have on some individuals. Through being available for queries and accountable for the research (and by implementing efficient query response systems), researchers can feel that optimal care has been taken to alleviate distress related to the administration of postal questionnaires, and that they may have facilitated individuals’ participation in the research.
Acknowledgements
The authors would like to thank the patients and staff the three health centres involved in the research. We would also like to acknowledge the NHS Executive (West Midlands) who have supported the project through the New Blood Fellowship scheme and the Haywood Foundation in North Staffordshire who kindly supported the survey through a project grant. We would also like to thank the Administration team Primary Care Sciences Research Centre who helped to answer the 198 telephone calls and redirect them efficiently to CJ.
References
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Articles from Health Expectations : An International Journal of Public Participation in Health Care and Health Policy are provided here courtesy of Wiley-Blackwell
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