A catalog of biases in questionnaires

Bias in questionnaires is an important issue in public health research. To collect the most accurate data from respondents, investigators must understand and be able to prevent or at least minimize bias in the design of their questionnaires. This paper identifies and categorizes 48 types of bias in questionnaires based on a review of the literature and offers an example of each type. The types are categorized according to three main sources of bias: the way a question is designed, the way the questionnaire as a whole is designed, and how the questionnaire is administered. This paper is intended to help investigators in public health understand the mechanism and dynamics of problems in questionnaire design and to provide a checklist for identifying potential bias in a questionnaire before it is administered.     

Development of indicators for quality assurance in public health medicine.

OBJECTIVES--To develop structure, process, and outcome indicators within a quality rating index for audit of public health medicine. DESIGN--Development of an audit matrix and indicator of quality through a series of group discussions with public health physicians, from which self administered weighted questionnaires were constructed by a modified Delphi technique. SETTING--Five Scottish health boards. SUBJECTS--Public health physicians in the five health boards. MAIN MEASURES--Indicators of quality and a quality rating index for seven selected service categories for each of seven agreed roles of public health medicine: assessment of health and health care needs in information services, input into managerial decision making in health promotion, fostering multisectoral collaboration in environmental health services, health service research and evaluation for child services, lead responsibility for the development and/or running of screening services, and public health medicine training and staff development in communicable disease. RESULTS--Indicators in the form of questionnaires were developed for each topic. Three types of indicator emerged: "global," "restricted," and "specific." A quality rating index for each topic was developed on the basis of the questionnaire scores. Piloting of indicators showed that they are potentially generalisable; evaluation of the system is under way across all health boards in Scotland. CONCLUSION--Measurable indicators of quality for public health medicine can be developed.     

上海市徐汇区公共场所集中空调通风系统卫生管理状况调查

[目的]了解徐汇区各类公共场所集中式空调通风系统的卫生管理状况,以进行监督指导并督促其改进。[方法]采用问卷调查和现场监督相结合的方式,对徐汇区83家公共场所集中式空调设计、管理和使用情况进行调查分析。[结果]徐汇区公共场所集中式空调通风系统的卫生管理状况较差,需加强监督指导,督促管理者改进和提高,保障人民群众的身体健康。     

Using questionnaires through an existing administrative system: a new approach to health interview surveys

This paper reviews recent developments in the field of healthinterview procedures, and their contribution to decentralizedhealth planning. Their importance is reflected in the growingawareness that the perception of health problems by the beneficiariesis an important element in the success or failure of a primaryhealth care (PHC) strategy for disease control and health improvement. The ‘indirect’ health interview procedure representsa methodological evolution of the traditional interview approach,by the fact that questionnaires are not administered directlyby the investigators or their field staff to the chosen keyinformants. They are distributed through an existing administrativesystem and self-administered by the recipients. This reducesthe costs of such surveys, and allows large areas to be screenedrapidly. The paper describes ongoing research designed to test this approachin seven African countries. Methodological problems and limitations,the most important of which is that it is not appropriate forindividual diagnosis, are also discussed. This approach is bestused as a screening strategy to identify high risk communities,on which health resources can then be concentrated.     

The quest for better questionnaires

The development of questionnaires is a neglected enterprise in epidemiology. It has recently been proposed that a prestigious health authority such as the World Health Organization establish a committee to tackle issues of questionnaire quality, moving eventually toward standardized instruments. However, standardization may not be the best way to invigorate this enterprise. As an alternative, the author suggests that the first step in improving questionnaires would be to make them more accessible. Ideally, questionnaires should be as easily scrutinized as a study's methods or results. To this end, the author suggests that when a research paper is published, the entire questionnaire be made available on the worldwide web. Electronic access to questionnaires could stimulate a new era of awareness about the importance of questionnaire design.     

Richtlinien zur Vermeidung von Gender Bias in der Gesundheitsforschung

In contrast to the USA and Canada, for German-language areas there are no guidelines that ensure appropriate attention to gender issues for health research. This paper intends to close this gap by presenting guidelines developed by the Canadian Ministry of Health (Health Canada). The guidelines were translated as well as modified for use for German-language public health research within the context of a project sponsored by the German Ministry for Education and Research. The paper starts by introducing different types of gender bias. We then present the guidelines for avoiding gender bias in the conceptualization and conduct of research. We provide questions, examples and possible solutions for gender bias problems that may occur in any of the various components of a research project. Based on the guidelines a shortened questionnaire is developed to identify gender bias in empirical scientific works.     

Late response and item nonresponse in the Finbalt Health Monitor survey

BACKGROUND: The Finbalt Health Monitor is a collaborative system for monitoring the health-related behaviour, practices and lifestyles in Estonia, Finland, Latvia and Lithuania. This system is based on nationally representative samples and self-administered mailed questionnaires. In comparing the results of national surveys, the awareness of the direction and socioeconomic patterning of the response bias is essential. METHODS: The data were gathered from the cross-sectional surveys conducted in 1998 from Estonia (n = 1362), Finland (n = 3504), Latvia (n = 2322) and Lithuania (n = 1874). An analysis was made of the prevalence of late response, completeness of information obtained from respondents and the magnitude of response bias on the prevalence estimates of health behaviour indicators. RESULTS: The response rates were comparatively high: 68% in Estonia, 70% in Finland, 77% in Latvia and 62% in Lithuania. Late response was weakly related to age, education or place of residence. The total proportion of missing information was below 10% and the sociodemographic patterning for this missing information was similar in all countries. Thus, older and less-educated respondents had more missing information on their questionnaires. Response bias of the prevalence estimates was minimal when it was calculated by using information obtained from late respondents. CONCLUSIONS: The level of nonresponse and missing information was comparable in different countries, not information on health behaviour. Therefore special efforts are needed to design a questionnaire form which appears equally relevant to all respondent groups. The follow-up mailings were an effective way to increase the total response rate, but it was unlikely that they provided an effective way to reach the 'hard core' nonrespondents.     

突发公共事件中公众危机干预现状及需求分析

目的了解公众应对突发公共事件的各个阶段危机心理干预现状与需求,为有针对性地实施心理干预提供依据。方法采取多阶段随机抽样方法 ,在安徽省合肥市瑶海区、庐阳区按一定的年龄结构抽取15～60岁居民为调查对象。采用卫生部应急办"突发公共事件危机心理干预能力资源状况调查和政策研究"项目提供的《公众心理卫生状况及需求调查表》,由经过统一培训的调查员入户进行调查。结果 45.9%的调查对象对突发公共事件危机心理干预不了解,48.7%的人是通过媒体宣传获得心理援助知识的;57.8%的被调查者希望通过媒体宣传来获得心理援助;收到宣传材料是事件发生后公众各时间段都能接受的干预形式;缓解心理反应(50.4%)是被调查者主要希望获得的危机心理干预技能。结论不同类型事件、事件发生不同时间公众心理干预方式的需求不同,应针对不同需求实施具体的心理干预方式,使受到事件波及人群得到最有效的心理援助。     

Medical students and pandemic influenza

To assess knowledge of pandemic influenza, we administered a questionnaire to all medical students at the University of Alberta; 354 (69%) of 510 students responded. Data from questionnaires such as this could help determine the role of medical students during a public health emergency.     

济南市社区卫生服务人力资源现况调查

目的了解济南市社区卫生服务人力资源现状,为合理配置社区卫生服务人力资源提供依据。方法 2009年11月-2010年1月,由统一培训的调查员采用问卷,对济南市辖区所有的211家社区卫生服务机构人力资源现况进行调查。结果济南市社区卫生服务机构医护比为1:0.88;临床医师与公卫医师比例为13.38:1;社区医师接受全科医师规范化培训以及通过资格考试的比例分别为42.24%和0.50%。结论人力资源结构不合理,护士与公卫医师配置不足,全科医学培训有待加强。建议加强社区人才队伍建设,促进社区卫生服务的可持续发展。     

广东某高校本科生生殖健康认知状况调查分析

目的了解广东某高校本科生生殖健康认知状况,为学校教育决策提供参考。方法采用分层整群抽样方法,抽取医学和非医学专业的1～4年级各1个班级。参照国内外问卷,结合该校实际,设计调查问卷,进行问卷调查。结果发出问卷400份,收回有效问卷368份,医科生对艾滋病传播途径和“紧急避孕法不可替代常规避孕法“的知晓率分别为55.9%和66.5%,高于非医科生;低年级学生对艾滋病传播途径的知晓率为58.7%,高于高年级学生（42.6%）,对“紧急避孕法不可替代常规避孕法“的知晓率为49.1%,低于高年级学生（72.8%）;超过60%的学生生殖健康信息主要来源为电视、杂志和父母。超过50%的学生建议的生殖健康教育主要形式是讲座和健康小册子。结论该校本科生生殖健康知识掌握程度较低,生殖健康正规课程教育相对薄弱。     

Customer expectation of e-health systems in Brunei Darussalam

This study seeks to determine the dimension of e-health services in Brunei Darussalam from the customer's perspective. The study seeks to identify, understand, analyze, and evaluate the public's expectation of e-health in Brunei Darussalam. A questionnaire was designed to gather quantitative and qualitative data to survey patients, the patient's family, and health practitioners at hospitals, clinics, or home care centers in Brunei Darussalam from February to March 2011. A 25-item Likert-type survey instrument was specifically developed for this study and administered to a sample of 366 patients. These data were analyzed to provide initial ideas and recommendations to policy makers on how to move forward with the e-health initiative as a means to improve health care services. The survey revealed that there is a high demand and expectation from people of Brunei to have better health care services through an e-health system in order to improve health literacy as well as quality and efficiency of health care. Regardless of the limitations of the survey, the general public has responded to the questionnaire with great support for the abilities of an e-health system. The results of the survey provide a solid foundation for our ongoing research project to proceed further to develop the model of e-health and subsequently to develop a system prototype that incorporates expectations from patients.     

Western organizational change capacity theory and its application to public health organizations in China: A multiple case analysis

As health reform becomes a crucial task for both Chinese and United States government, public health organizations are required to adopt changes based on reform policy. Organizational Change Capacity theory is a Western theory that indicates the capacities that organizations should possess when pursuing successful organizational change. This study seeks to understand the applicability of this theory to Chinese public health organizations by contrasting organizations that have achieved success or remained challenged in implementing organizational change to optimize health reform. The research questions are: Is the Organizational Change Capacity theory applicable in Chinese public health organizations? How should it be modified to best fit Chinese public health organizations? Seventy‐two participants from 12 public health organizations in Beijing and Xi'an were recruited for interviews and follow‐up questionnaires that asked for experiences during their organizational changes. During the analysis, a new Chinese Organizational Change Capacity theory with nine main themes emerged. This new framework provides a guideline for Chinese public health organizations to evaluate their change capacity, and offers a theoretical foundation for researchers to design interventions that increase these organizations' capacity in achieving successful change.     

Zoning should promote public health

Legally, governments use their police powers to protect public health, safety, and welfare through zoning. This paper presents a case for revisiting zoning on the basis of increasing evidence that certain types of community design promote public health, as opposed to the dominant pattern of sprawl development, which does not. Zoning, and the land use planning linked to it, that prohibits or disfavors health-promoting community designs contradicts the inherent public policy goal on which it is based. If there is a paradigm shift underway, from traditional sprawl to health-promoting community designs, then health professionals and others should understand why zoning must be reassessed.     

定西地区公众结核病防治知识知晓情况调查

目的了解定西地区公众结核病防治知识知晓情况,评价结核病健康教育效果,为今后更有效地开展结核病健康教育工作提供科学依据。方法采用分层整群等比例随机抽样方法,使用全国第五次结核病流行病学抽样调查知晓率调查问卷对调查对象进行面对面询问式调查。结果合格调查问卷4485份。定西地区公众结核病防治知识核心信息总知晓率为80．69％．5条核心信息全部知晓率为47．40％。调查对象对结核病主要症状、传播途径和国家免费政策知晓率较高,分别为87．96％、86．89％和85．40％。城镇人群结核病防治知识总知晓率、全部知晓率明显高于农村人群（P〈0．05）;不同县、区之间结核病防治知识总知晓率、全部知晓率有显著性差异（P〈0．05）。结论定西地区结核病健康教育工作成效显著。但不同县、区知晓水平不平衡;边远山区农村人群知晓率低,是今后健康教育工作的重点。     

Critical reading of epidemiological papers. A guide

Many clinicians, medical practitioners and decision makers have no formal training in epidemiology but need to understand and sometimes evaluate results in epidemiologic studies. This paper attempts to give guidance to non-epidemiologists on how to read and evaluate the quality of epidemiologic studies and their results critically. Different methodological issues for evaluating whether the results of a study are causal or by bias, chance or confounding are given. This includes criteria for the choice of an appropriate study design followed by problems of the definition of the study population and the sample selection. We will also point to potential sources of bias in the data collection procedure and list some principles for statistical analysis. Finally, we include comments on how the results should be presented and issues which are related to public health and ethical questions. Although it is not usually possible to perform a perfect study and the correct approach to study design and analysis is often highly dependent on specific features of the population and the surroundings, our paper should help to distinguish between weak and strong investigations and papers.     

Migration bias in ecologic studies

Differential migration may provoke bias in an epidemiological assessment of the public health risks from exposure to environmental agents, particularly in ecologic studies of health outcomes with a long latency or induction period. The potential impact of migration bias on epidemiological research is complex, and it depends not only on the direction of the factor-related migration, but also on its extent. This study shows that even a small amount of differential migration can bias the assessment of the exposure–outcome relationship. Migration bias may result from a number of circumstances that are related to the way in which populations are defined and ascertained. It is important to understand and minimise this type of bias in epidemiological research.     

Nationwide satellite training for public health professionals: Web-based follow-up

INTRODUCTION: Few studies have rigorously evaluated the effectiveness of health-related continuing education using satellite distribution. This study assessed participants' professional characteristics and their changes in knowledge, attitudes, and actions taken after viewing a public health preparedness training course on mass vaccination broadcast nationally by satellite. METHODS: A three-part survey design was used to evaluate training effectiveness. Paper-based questionnaires were distributed at a stratified sample of downlink facilities to collect knowledge and attitude responses before and after the broadcast. Six weeks later, willing participants were invited by e-mail to complete a Web-based follow-up questionnaire to assess actions taken as a result of viewing the broadcast. Paired t-tests and McNemar's chi-square were used to compare changes in attitude from before to after the broadcast, after the broadcast to follow-up, and before the broadcast to follow-up. RESULTS: A total of 544 paper-based questionnaires were received from 59 of 70 sampled sites. The pre- and post assessments administered the day of the broadcast demonstrated statistically significant knowledge gain (p < .001) and an increased belief immediately following the broadcast that mass vaccination clinics are important to their organizations' public health activities (p < .001). Of the 291 respondents who completed the follow-up online questionnaire, 44% (n = 128) reported they implemented or planned some form of action after the broadcast. Reported actions were higher among public health workers most likely to be directly involved in preparedness and immunization activities. DISCUSSION: This evaluation assessed (1) participants' professional characteristics, (2) knowledge gain, (3) self-reported actions taken following the broadcast, (4) program satisfaction, and (5) suggested improvements for future satellite broadcast programs. The study's methodology of using a Web-based survey for follow-up is a relatively economical tool for assessing longer-term continuing education program objectives.     

部分公共卫生类期刊调查研究文献中抽样设计的常见问题分析（一）

目的 分析总结公共卫生类期刊涉及调查研究文献中抽样设计的常见问题及特点,为建立公共卫生类期刊文献中抽样设计的规范体系奠定基础。方法 设计公共卫生类期刊文献调查研究抽样设计常见问题调查表,随机抽取10种公共卫生类核心及以上级别期刊,查阅其2014年发表的所有文献,采用定性研究方法总结分析其中常见抽样方法的问题类型与特点。结果 公共卫生类期刊文献中抽样设计的常见问题主要表现为:（1）分层抽样:未对“层”定义;未说明分层标准;未说明所分层数及每层单位数具体大小;未提供上述各点判定依据;（2）整群抽样:未对“群”定义;未说明分群标准;未说明所分群数及每群单位数具体大小;未提供上述各点判定依据;（3）系统抽样问题:未明确抽样间隔;未明确欲抽样样本组数;（4）多阶段抽样问题:各阶段表达过于简单;单阶段抽样表述不完整;多阶段抽样命名问题。结论 选定公共卫生类期刊文献中,抽样设计问题表现较为集中、特点明显,目前文献中抽样设计的表述尚不规范,有待进一步研究以规范化。     

Public health ethics: teaching survey and critical review

The last decade has witnessed development of the new field of public health ethics, as well as growing emphasis on the importance of ethics education to both students and graduates of the health care professions. Using a topic-based interpretation of public health ethics this paper presents a questionnaire survey of the nature and content of teaching of public health ethics to medical undergraduates and public health postgraduate students in the United Kingdom. Completed questionnaires were returned by 76.9% (20/26) of medical schools and 76.7% (23/30) of institutions teaching postgraduate public health courses. Public health ethics was described as being taught in 75% of medical schools and 52% of institutions providing postgraduate education. However, in both types of location the content and nature of teaching was patchy and often minimal.If medical schools and postgraduate institutions are serious about improving the discussion and teaching of ethical issues in public health, there will need to be considerable investment and commitment, accompanied by creativity and imagination. In parallel, the debate about the meaning of, and approaches to, public health ethics needs to be broadened and enriched. The topic-based interpretation of public health ethics has limitations. Alternatives are explored and critically reviewed.