Research using self-developed questionnaires is a popular study design in family practice and is frequently used for gathering data on knowledge, beliefs, attitudes, and behaviors. A Medline literature search from 1966 to 2000 identified 53,101 articles related to questionnaires, of which 2088 were directly related to family practice. Despite the large number of questionnaire-related articles, however, only 2 in the general medical literature1,2 and 1 in the family practice literature3 were directly related to research methodology.
To obtain guidance on survey research methodology, novice family practice researchers often must go through volumes of information by specialists in other disciplines. For example, a search of a psychology database (PsychInfo)4 from 1966 to 2000 produced 45 articles about questionnaire methodology. The goal of this article is to synthesize pertinent survey research methodology tenets-from other disciplines as well as from family practice-in a manner that is meaningful to novice family practice researchers as well as to research consumers. This article is not aimed at answering all questions, but rather is meant to serve as a general guideline for those with little formal research training who seek guidance in developing and administering questionnaires.
Avoiding common pitfalls in survey research
Although constructing a questionnaire is not exceedingly complex, simple mistakes can be avoided by following some basic rules and guidelines. The Figure is a checklist for conducting a survey research project that combines guidelines and suggestions from published survey research literature,5-9 and the cumulative experience of the authors. Two of the authors (M.J.D. and K.C.O.) are experienced survey researchers who have published, in peer-reviewed journals, numerous studies that used questionnaires.10-19 One of the authors (MJD) has been teaching research to residents and junior faculty for over a decade, and has been an advisor on scores of resident, student, and faculty research projects. The perspective of the novice researcher is represented by 1 author (C.R.W.).
Getting started
The “quick and dirty” approach is perhaps the most common pitfall in survey research. Because of the ease of administration and the relatively low cost of survey research, questionnaires can be developed and administered quickly. The researcher, however, should be sure to consider whether or not a survey is the most appropriate method to answer a research question. Adequate time must be given to thoroughly searching the relevant literature, developing and focusing on an appropriate research question, and defining the target population for the study (see Figure A, Getting Started). Large, multisite surveys are more likely to be generalizeable and to be published in peer-reviewed journals.
One way to avoid undertaking a project too rapidly and giving inadequate attention to the survey research process is for novice researchers to avoid independent research. Those with little or no experience must realize that researchers in both family practice and other fields perform research in teams, with the various participants bringing specific skills to the process.20 Oversights, mistakes, and biases in the design of questionnaires can always occur, whether a researcher is working independently or as a member of a team. It seems reasonable to assume, however, that significant problems are much less likely to occur when a multidisciplinary team approach is involved rather than an individual researcher undertaking a study independently.
Ideally, a research team should include a statistician, a professional with experience in the content areas of the study, and a senior investigator.21 The desirable area of expertise, however, is often not readily available to family physicians, especially those in community-based settings. Individuals with some training in research who are interested in being involved can usually be found in colleges and universities, hospitals, and at the local public health department. Psychologists, sociologists, health services researchers, public health epidemiologists, and nursing educators are all potential resources and possible collaborators. Establishing the necessary relationships to form an ad hoc research team is certainly more time and labor intensive than undertaking research independently, but generally results in the collection of more useful information.
Novices should consult survey methodology books before and during the study.5-9 Excellent resources are available that provide a comprehensive overview of survey methods,22 means for improving response rates,23 and methods for constructing relatively brief but thorough survey questions.5 Academic family practice fellowships often provide training in survey methodology. In addition, many family practice researchers respond favorably to requests for information or advice requested by telephone or email contact. The novice author of this article reports excellent success in contacting experts in this manner. With the advent of the Internet, a “cyberspace” team comprised of experts in the topic and the methodology is a reasonable and helpful option for the novice.