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Questionnaire – Definition, Types, and Examples

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Questionnaire

Definition:

A Questionnaire is a research tool or survey instrument that consists of a set of questions or prompts designed to gather information from individuals or groups of people.

It is a standardized way of collecting data from a large number of people by asking them a series of questions related to a specific topic or research objective. The questions may be open-ended or closed-ended, and the responses can be quantitative or qualitative. Questionnaires are widely used in research, marketing, social sciences, healthcare, and many other fields to collect data and insights from a target population.

History of Questionnaire

The history of questionnaires can be traced back to the ancient Greeks, who used questionnaires as a means of assessing public opinion. However, the modern history of questionnaires began in the late 19th century with the rise of social surveys.

The first social survey was conducted in the United States in 1874 by Francis A. Walker, who used a questionnaire to collect data on labor conditions. In the early 20th century, questionnaires became a popular tool for conducting social research, particularly in the fields of sociology and psychology.

One of the most influential figures in the development of the questionnaire was the psychologist Raymond Cattell, who in the 1940s and 1950s developed the personality questionnaire, a standardized instrument for measuring personality traits. Cattell’s work helped establish the questionnaire as a key tool in personality research.

In the 1960s and 1970s, the use of questionnaires expanded into other fields, including market research, public opinion polling, and health surveys. With the rise of computer technology, questionnaires became easier and more cost-effective to administer, leading to their widespread use in research and business settings.

Today, questionnaires are used in a wide range of settings, including academic research, business, healthcare, and government. They continue to evolve as a research tool, with advances in computer technology and data analysis techniques making it easier to collect and analyze data from large numbers of participants.

Types of Questionnaire

Types of Questionnaires are as follows:

Structured Questionnaire

This type of questionnaire has a fixed format with predetermined questions that the respondent must answer. The questions are usually closed-ended, which means that the respondent must select a response from a list of options.

Unstructured Questionnaire

An unstructured questionnaire does not have a fixed format or predetermined questions. Instead, the interviewer or researcher can ask open-ended questions to the respondent and let them provide their own answers.

Open-ended Questionnaire

An open-ended questionnaire allows the respondent to answer the question in their own words, without any pre-determined response options. The questions usually start with phrases like “how,” “why,” or “what,” and encourage the respondent to provide more detailed and personalized answers.

Close-ended Questionnaire

In a closed-ended questionnaire, the respondent is given a set of predetermined response options to choose from. This type of questionnaire is easier to analyze and summarize, but may not provide as much insight into the respondent’s opinions or attitudes.

Mixed Questionnaire

A mixed questionnaire is a combination of open-ended and closed-ended questions. This type of questionnaire allows for more flexibility in terms of the questions that can be asked, and can provide both quantitative and qualitative data.

Pictorial Questionnaire:

In a pictorial questionnaire, instead of using words to ask questions, the questions are presented in the form of pictures, diagrams or images. This can be particularly useful for respondents who have low literacy skills, or for situations where language barriers exist. Pictorial questionnaires can also be useful in cross-cultural research where respondents may come from different language backgrounds.

Types of Questions in Questionnaire

The types of Questions in Questionnaire are as follows:

Multiple Choice Questions

These questions have several options for participants to choose from. They are useful for getting quantitative data and can be used to collect demographic information.

• a. Red b . Blue c. Green d . Yellow

Rating Scale Questions

These questions ask participants to rate something on a scale (e.g. from 1 to 10). They are useful for measuring attitudes and opinions.

• On a scale of 1 to 10, how likely are you to recommend this product to a friend?

Open-Ended Questions

These questions allow participants to answer in their own words and provide more in-depth and detailed responses. They are useful for getting qualitative data.

• What do you think are the biggest challenges facing your community?

Likert Scale Questions

These questions ask participants to rate how much they agree or disagree with a statement. They are useful for measuring attitudes and opinions.

How strongly do you agree or disagree with the following statement:

“I enjoy exercising regularly.”

• a . Strongly Agree
• c . Neither Agree nor Disagree
• d . Disagree
• e . Strongly Disagree

Demographic Questions

These questions ask about the participant’s personal information such as age, gender, ethnicity, education level, etc. They are useful for segmenting the data and analyzing results by demographic groups.

• What is your age?

Yes/No Questions

These questions only have two options: Yes or No. They are useful for getting simple, straightforward answers to a specific question.

Have you ever traveled outside of your home country?

Ranking Questions

These questions ask participants to rank several items in order of preference or importance. They are useful for measuring priorities or preferences.

Please rank the following factors in order of importance when choosing a restaurant:

• a. Quality of Food
• c. Ambiance
• d. Location

Matrix Questions

These questions present a matrix or grid of options that participants can choose from. They are useful for getting data on multiple variables at once.

Dichotomous Questions

These questions present two options that are opposite or contradictory. They are useful for measuring binary or polarized attitudes.

Do you support the death penalty?

How to Make a Questionnaire

Step-by-Step Guide for Making a Questionnaire:

• Define your research objectives: Before you start creating questions, you need to define the purpose of your questionnaire and what you hope to achieve from the data you collect.
• Choose the appropriate question types: Based on your research objectives, choose the appropriate question types to collect the data you need. Refer to the types of questions mentioned earlier for guidance.
• Develop questions: Develop clear and concise questions that are easy for participants to understand. Avoid leading or biased questions that might influence the responses.
• Organize questions: Organize questions in a logical and coherent order, starting with demographic questions followed by general questions, and ending with specific or sensitive questions.
• Pilot the questionnaire : Test your questionnaire on a small group of participants to identify any flaws or issues with the questions or the format.
• Refine the questionnaire : Based on feedback from the pilot, refine and revise the questionnaire as necessary to ensure that it is valid and reliable.
• Distribute the questionnaire: Distribute the questionnaire to your target audience using a method that is appropriate for your research objectives, such as online surveys, email, or paper surveys.
• Collect and analyze data: Collect the completed questionnaires and analyze the data using appropriate statistical methods. Draw conclusions from the data and use them to inform decision-making or further research.
• Report findings: Present your findings in a clear and concise report, including a summary of the research objectives, methodology, key findings, and recommendations.

Questionnaire Administration Modes

There are several modes of questionnaire administration. The choice of mode depends on the research objectives, sample size, and available resources. Some common modes of administration include:

• Self-administered paper questionnaires: Participants complete the questionnaire on paper, either in person or by mail. This mode is relatively low cost and easy to administer, but it may result in lower response rates and greater potential for errors in data entry.
• Online questionnaires: Participants complete the questionnaire on a website or through email. This mode is convenient for both researchers and participants, as it allows for fast and easy data collection. However, it may be subject to issues such as low response rates, lack of internet access, and potential for fraudulent responses.
• Telephone surveys: Trained interviewers administer the questionnaire over the phone. This mode allows for a large sample size and can result in higher response rates, but it is also more expensive and time-consuming than other modes.
• Face-to-face interviews : Trained interviewers administer the questionnaire in person. This mode allows for a high degree of control over the survey environment and can result in higher response rates, but it is also more expensive and time-consuming than other modes.
• Mixed-mode surveys: Researchers use a combination of two or more modes to administer the questionnaire, such as using online questionnaires for initial screening and following up with telephone interviews for more detailed information. This mode can help overcome some of the limitations of individual modes, but it requires careful planning and coordination.

Example of Questionnaire

Title of the Survey: Customer Satisfaction Survey

Introduction:

We appreciate your business and would like to ensure that we are meeting your needs. Please take a few minutes to complete this survey so that we can better understand your experience with our products and services. Your feedback is important to us and will help us improve our offerings.

Instructions:

Please read each question carefully and select the response that best reflects your experience. If you have any additional comments or suggestions, please feel free to include them in the space provided at the end of the survey.

1. How satisfied are you with our product quality?

• Very satisfied
• Somewhat satisfied
• Somewhat dissatisfied
• Very dissatisfied

2. How satisfied are you with our customer service?

3. How satisfied are you with the price of our products?

4. How likely are you to recommend our products to others?

• Very likely
• Somewhat likely
• Somewhat unlikely
• Very unlikely

5. How easy was it to find the information you were looking for on our website?

• Somewhat easy
• Somewhat difficult
• Very difficult

6. How satisfied are you with the overall experience of using our products and services?

7. Is there anything that you would like to see us improve upon or change in the future?

…………………………………………………………………………………………………………………………..

Conclusion:

Thank you for taking the time to complete this survey. Your feedback is valuable to us and will help us improve our products and services. If you have any further comments or concerns, please do not hesitate to contact us.

Applications of Questionnaire

Some common applications of questionnaires include:

• Research : Questionnaires are commonly used in research to gather information from participants about their attitudes, opinions, behaviors, and experiences. This information can then be analyzed and used to draw conclusions and make inferences.
• Healthcare : In healthcare, questionnaires can be used to gather information about patients’ medical history, symptoms, and lifestyle habits. This information can help healthcare professionals diagnose and treat medical conditions more effectively.
• Marketing : Questionnaires are commonly used in marketing to gather information about consumers’ preferences, buying habits, and opinions on products and services. This information can help businesses develop and market products more effectively.
• Human Resources: Questionnaires are used in human resources to gather information from job applicants, employees, and managers about job satisfaction, performance, and workplace culture. This information can help organizations improve their hiring practices, employee retention, and organizational culture.
• Education : Questionnaires are used in education to gather information from students, teachers, and parents about their perceptions of the educational experience. This information can help educators identify areas for improvement and develop more effective teaching strategies.

Purpose of Questionnaire

Some common purposes of questionnaires include:

• To collect information on attitudes, opinions, and beliefs: Questionnaires can be used to gather information on people’s attitudes, opinions, and beliefs on a particular topic. For example, a questionnaire can be used to gather information on people’s opinions about a particular political issue.
• To collect demographic information: Questionnaires can be used to collect demographic information such as age, gender, income, education level, and occupation. This information can be used to analyze trends and patterns in the data.
• To measure behaviors or experiences: Questionnaires can be used to gather information on behaviors or experiences such as health-related behaviors or experiences, job satisfaction, or customer satisfaction.
• To evaluate programs or interventions: Questionnaires can be used to evaluate the effectiveness of programs or interventions by gathering information on participants’ experiences, opinions, and behaviors.
• To gather information for research: Questionnaires can be used to gather data for research purposes on a variety of topics.

When to use Questionnaire

Here are some situations when questionnaires might be used:

• When you want to collect data from a large number of people: Questionnaires are useful when you want to collect data from a large number of people. They can be distributed to a wide audience and can be completed at the respondent’s convenience.
• When you want to collect data on specific topics: Questionnaires are useful when you want to collect data on specific topics or research questions. They can be designed to ask specific questions and can be used to gather quantitative data that can be analyzed statistically.
• When you want to compare responses across groups: Questionnaires are useful when you want to compare responses across different groups of people. For example, you might want to compare responses from men and women, or from people of different ages or educational backgrounds.
• When you want to collect data anonymously: Questionnaires can be useful when you want to collect data anonymously. Respondents can complete the questionnaire without fear of judgment or repercussions, which can lead to more honest and accurate responses.
• When you want to save time and resources: Questionnaires can be more efficient and cost-effective than other methods of data collection such as interviews or focus groups. They can be completed quickly and easily, and can be analyzed using software to save time and resources.

Characteristics of Questionnaire

Here are some of the characteristics of questionnaires:

• Standardization : Questionnaires are standardized tools that ask the same questions in the same order to all respondents. This ensures that all respondents are answering the same questions and that the responses can be compared and analyzed.
• Objectivity : Questionnaires are designed to be objective, meaning that they do not contain leading questions or bias that could influence the respondent’s answers.
• Predefined responses: Questionnaires typically provide predefined response options for the respondents to choose from, which helps to standardize the responses and make them easier to analyze.
• Quantitative data: Questionnaires are designed to collect quantitative data, meaning that they provide numerical or categorical data that can be analyzed using statistical methods.
• Convenience : Questionnaires are convenient for both the researcher and the respondents. They can be distributed and completed at the respondent’s convenience and can be easily administered to a large number of people.
• Anonymity : Questionnaires can be anonymous, which can encourage respondents to answer more honestly and provide more accurate data.
• Reliability : Questionnaires are designed to be reliable, meaning that they produce consistent results when administered multiple times to the same group of people.
• Validity : Questionnaires are designed to be valid, meaning that they measure what they are intended to measure and are not influenced by other factors.

Advantage of Questionnaire

Some Advantage of Questionnaire are as follows:

• Standardization: Questionnaires allow researchers to ask the same questions to all participants in a standardized manner. This helps ensure consistency in the data collected and eliminates potential bias that might arise if questions were asked differently to different participants.
• Efficiency: Questionnaires can be administered to a large number of people at once, making them an efficient way to collect data from a large sample.
• Anonymity: Participants can remain anonymous when completing a questionnaire, which may make them more likely to answer honestly and openly.
• Cost-effective: Questionnaires can be relatively inexpensive to administer compared to other research methods, such as interviews or focus groups.
• Objectivity: Because questionnaires are typically designed to collect quantitative data, they can be analyzed objectively without the influence of the researcher’s subjective interpretation.
• Flexibility: Questionnaires can be adapted to a wide range of research questions and can be used in various settings, including online surveys, mail surveys, or in-person interviews.

Limitations of Questionnaire

Limitations of Questionnaire are as follows:

• Limited depth: Questionnaires are typically designed to collect quantitative data, which may not provide a complete understanding of the topic being studied. Questionnaires may miss important details and nuances that could be captured through other research methods, such as interviews or observations.
• R esponse bias: Participants may not always answer questions truthfully or accurately, either because they do not remember or because they want to present themselves in a particular way. This can lead to response bias, which can affect the validity and reliability of the data collected.
• Limited flexibility: While questionnaires can be adapted to a wide range of research questions, they may not be suitable for all types of research. For example, they may not be appropriate for studying complex phenomena or for exploring participants’ experiences and perceptions in-depth.
• Limited context: Questionnaires typically do not provide a rich contextual understanding of the topic being studied. They may not capture the broader social, cultural, or historical factors that may influence participants’ responses.
• Limited control : Researchers may not have control over how participants complete the questionnaire, which can lead to variations in response quality or consistency.

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Muhammad Hassan

Researcher, Academic Writer, Web developer

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How to Design Effective Research Questionnaires for Robust Findings

As a staple in data collection, questionnaires help uncover robust and reliable findings that can transform industries, shape policies, and revolutionize understanding. Whether you are exploring societal trends or delving into scientific phenomena, the effectiveness of your research questionnaire can make or break your findings.

In this article, we aim to understand the core purpose of questionnaires, exploring how they serve as essential tools for gathering systematic data, both qualitative and quantitative, from diverse respondents. Read on as we explore the key elements that make up a winning questionnaire, the art of framing questions which are both compelling and rigorous, and the careful balance between simplicity and depth.

Table of Contents

The Role of Questionnaires in Research

So, what is a questionnaire? A questionnaire is a structured set of questions designed to collect information, opinions, attitudes, or behaviors from respondents. It is one of the most commonly used data collection methods in research. Moreover, questionnaires can be used in various research fields, including social sciences, market research, healthcare, education, and psychology. Their adaptability makes them suitable for investigating diverse research questions.

Questionnaire and survey  are two terms often used interchangeably, but they have distinct meanings in the context of research. A survey refers to the broader process of data collection that may involve various methods. A survey can encompass different data collection techniques, such as interviews , focus groups, observations, and yes, questionnaires.

Pros and Cons of Using Questionnaires in Research:

While questionnaires offer numerous advantages in research, they also come with some disadvantages that researchers must be aware of and address appropriately. Careful questionnaire design, validation, and consideration of potential biases can help mitigate these disadvantages and enhance the effectiveness of using questionnaires as a data collection method.

Structured vs Unstructured Questionnaires

Structured questionnaire:.

A structured questionnaire consists of questions with predefined response options. Respondents are presented with a fixed set of choices and are required to select from those options. The questions in a structured questionnaire are designed to elicit specific and quantifiable responses. Structured questionnaires are particularly useful for collecting quantitative data and are often employed in surveys and studies where standardized and comparable data are necessary.

Advantages of Structured Questionnaires:

• Easy to analyze and interpret: The fixed response options facilitate straightforward data analysis and comparison across respondents.
• Efficient for large-scale data collection: Structured questionnaires are time-efficient, allowing researchers to collect data from a large number of respondents.
• Reduces response bias: The predefined response options minimize potential response bias and maintain consistency in data collection.

Limitations of Structured Questionnaires:

• Lack of depth: Structured questionnaires may not capture in-depth insights or nuances as respondents are limited to pre-defined response choices. Hence, they may not reveal the reasons behind respondents’ choices, limiting the understanding of their perspectives.
• Limited flexibility: The fixed response options may not cover all potential responses, therefore, potentially restricting respondents’ answers.

Unstructured Questionnaire:

An unstructured questionnaire consists of questions that allow respondents to provide detailed and unrestricted responses. Unlike structured questionnaires, there are no predefined response options, giving respondents the freedom to express their thoughts in their own words. Furthermore, unstructured questionnaires are valuable for collecting qualitative data and obtaining in-depth insights into respondents’ experiences, opinions, or feelings.

Advantages of Unstructured Questionnaires:

• Rich qualitative data: Unstructured questionnaires yield detailed and comprehensive qualitative data, providing valuable and novel insights into respondents’ perspectives.
• Flexibility in responses: Respondents have the freedom to express themselves in their own words. Hence, allowing for a wide range of responses.

Limitations of Unstructured Questionnaires:

• Time-consuming analysis: Analyzing open-ended responses can be time-consuming, since, each response requires careful reading and interpretation.
• Subjectivity in interpretation: The analysis of open-ended responses may be subjective, as researchers interpret and categorize responses based on their judgment.
• May require smaller sample size: Due to the depth of responses, researchers may need a smaller sample size for comprehensive analysis, making generalizations more challenging.

Types of Questions in a Questionnaire

In a questionnaire, researchers typically use the following most common types of questions to gather a variety of information from respondents:

1. Open-Ended Questions:

These questions allow respondents to provide detailed and unrestricted responses in their own words. Open-ended questions are valuable for gathering qualitative data and in-depth insights.

Example: What suggestions do you have for improving our product?

2. Multiple-Choice Questions

Respondents choose one answer from a list of provided options. This type of question is suitable for gathering categorical data or preferences.

Example: Which of the following social media/academic networking platforms do you use to promote your research?

• ResearchGate
• Academia.edu

3. Dichotomous Questions

Respondents choose between two options, typically “yes” or “no”, “true” or “false”, or “agree” or “disagree”.

Example: Have you ever published in open access journals before?

4. Scaling Questions

These questions, also known as rating scale questions, use a predefined scale that allows respondents to rate or rank their level of agreement, satisfaction, importance, or other subjective assessments. These scales help researchers quantify subjective data and make comparisons across respondents.

There are several types of scaling techniques used in scaling questions:

i. Likert Scale:

The Likert scale is one of the most common scaling techniques. It presents respondents with a series of statements and asks them to rate their level of agreement or disagreement using a range of options, typically from “strongly agree” to “strongly disagree”.For example: Please indicate your level of agreement with the statement: “The content presented in the webinar was relevant and aligned with the advertised topic.”

• Strongly Agree
• Strongly Disagree

ii. Semantic Differential Scale:

The semantic differential scale measures respondents’ perceptions or attitudes towards an item using opposite adjectives or bipolar words. Respondents rate the item on a scale between the two opposites. For example:

• Easy —— Difficult
• Satisfied —— Unsatisfied
• Very likely —— Very unlikely

iii. Numerical Rating Scale:

This scale requires respondents to provide a numerical rating on a predefined scale. It can be a simple 1 to 5 or 1 to 10 scale, where higher numbers indicate higher agreement, satisfaction, or importance.

iv. Ranking Questions:

Respondents rank items in order of preference or importance. Ranking questions help identify preferences or priorities.

Example: Please rank the following features of our app in order of importance (1 = Most Important, 5 = Least Important):

• User Interface
• Functionality
• Customer Support

By using a mix of question types, researchers can gather both quantitative and qualitative data, providing a comprehensive understanding of the research topic and enabling meaningful analysis and interpretation of the results. The choice of question types depends on the research objectives , the desired depth of information, and the data analysis requirements.

Methods of Administering Questionnaires

There are several methods for administering questionnaires, and the choice of method depends on factors such as the target population, research objectives , convenience, and resources available. Here are some common methods of administering questionnaires:

Each method has its advantages and limitations. Online surveys offer convenience and a large reach, but they may be limited to individuals with internet access. Face-to-face interviews allow for in-depth responses but can be time-consuming and costly. Telephone surveys have broad reach but may be limited by declining response rates. Researchers should choose the method that best suits their research objectives, target population, and available resources to ensure successful data collection.

How to Design a Questionnaire

Designing a good questionnaire is crucial for gathering accurate and meaningful data that aligns with your research objectives. Here are essential steps and tips to create a well-designed questionnaire:

1. Define Your Research Objectives : Clearly outline the purpose and specific information you aim to gather through the questionnaire.

2. Identify Your Target Audience : Understand respondents’ characteristics and tailor the questionnaire accordingly.

3. Develop the Questions :

• Write Clear and Concise Questions
• Avoid Leading or Biasing Questions
• Sequence Questions Logically
• Group Related Questions
• Include Demographic Questions

4. Provide Well-defined Response Options : Offer exhaustive response choices for closed-ended questions.

5. Consider Skip Logic and Branching : Customize the questionnaire based on previous answers.

6. Pilot Test the Questionnaire : Identify and address issues through a pilot study .

7. Seek Expert Feedback : Validate the questionnaire with subject matter experts.

8. Obtain Ethical Approval : Comply with ethical guidelines , obtain consent, and ensure confidentiality before administering the questionnaire.

9. Administer the Questionnaire : Choose the right mode and provide clear instructions.

10. Test the Survey Platform : Ensure compatibility and usability for online surveys.

By following these steps and paying attention to questionnaire design principles, you can create a well-structured and effective questionnaire that gathers reliable data and helps you achieve your research objectives.

Characteristics of a Good Questionnaire

A good questionnaire possesses several essential elements that contribute to its effectiveness. Furthermore, these characteristics ensure that the questionnaire is well-designed, easy to understand, and capable of providing valuable insights. Here are some key characteristics of a good questionnaire:

1. Clarity and Simplicity : Questions should be clear, concise, and unambiguous. Avoid using complex language or technical terms that may confuse respondents. Simple and straightforward questions ensure that respondents interpret them consistently.

2. Relevance and Focus : Each question should directly relate to the research objectives and contribute to answering the research questions. Consequently, avoid including extraneous or irrelevant questions that could lead to data clutter.

3. Mix of Question Types : Utilize a mix of question types, including open-ended, Likert scale, and multiple-choice questions. This variety allows for both qualitative and quantitative data collections .

4. Validity and Reliability : Ensure the questionnaire measures what it intends to measure (validity) and produces consistent results upon repeated administration (reliability). Validation should be conducted through expert review and previous research.

5. Appropriate Length : Keep the questionnaire’s length appropriate and manageable to avoid respondent fatigue or dropouts. Long questionnaires may result in incomplete or rushed responses.

6. Clear Instructions : Include clear instructions at the beginning of the questionnaire to guide respondents on how to complete it. Explain any technical terms, formats, or concepts if necessary.

7. User-Friendly Format : Design the questionnaire to be visually appealing and user-friendly. Use consistent formatting, adequate spacing, and a logical page layout.

8. Data Validation and Cleaning : Incorporate validation checks to ensure data accuracy and reliability. Consider mechanisms to detect and correct inconsistent or missing responses during data cleaning.

By incorporating these characteristics, researchers can create a questionnaire that maximizes data quality, minimizes response bias, and provides valuable insights for their research.

In the pursuit of advancing research and gaining meaningful insights, investing time and effort into designing effective questionnaires is a crucial step. A well-designed questionnaire is more than a mere set of questions; it is a masterpiece of precision and ingenuity. Each question plays a vital role in shaping the narrative of our research, guiding us through the labyrinth of data to meaningful conclusions. Indeed, a well-designed questionnaire serves as a powerful tool for unlocking valuable insights and generating robust findings that impact society positively.

Have you ever designed a research questionnaire? Reflect on your experience and share your insights with researchers globally through Enago Academy’s Open Blogging Platform . Join our diverse community of 1000K+ researchers and authors to exchange ideas, strategies, and best practices, and together, let’s shape the future of data collection and maximize the impact of questionnaires in the ever-evolving landscape of research.

Frequently Asked Questions

A research questionnaire is a structured tool used to gather data from participants in a systematic manner. It consists of a series of carefully crafted questions designed to collect specific information related to a research study.

Questionnaires play a pivotal role in both quantitative and qualitative research, enabling researchers to collect insights, opinions, attitudes, or behaviors from respondents. This aids in hypothesis testing, understanding, and informed decision-making, ensuring consistency, efficiency, and facilitating comparisons.

Questionnaires are a versatile tool employed in various research designs to gather data efficiently and comprehensively. They find extensive use in both quantitative and qualitative research methodologies, making them a fundamental component of research across disciplines. Some research designs that commonly utilize questionnaires include: a) Cross-Sectional Studies b) Longitudinal Studies c) Descriptive Research d) Correlational Studies e) Causal-Comparative Studies f) Experimental Research g) Survey Research h) Case Studies i) Exploratory Research

A survey is a comprehensive data collection method that can include various techniques like interviews and observations. A questionnaire is a specific set of structured questions within a survey designed to gather standardized responses. While a survey is a broader approach, a questionnaire is a focused tool for collecting specific data.

The choice of questionnaire type depends on the research objectives, the type of data required, and the preferences of respondents. Some common types include: • Structured Questionnaires: These questionnaires consist of predefined, closed-ended questions with fixed response options. They are easy to analyze and suitable for quantitative research. • Semi-Structured Questionnaires: These questionnaires combine closed-ended questions with open-ended ones. They offer more flexibility for respondents to provide detailed explanations. • Unstructured Questionnaires: These questionnaires contain open-ended questions only, allowing respondents to express their thoughts and opinions freely. They are commonly used in qualitative research.

Following these steps ensures effective questionnaire administration for reliable data collection: • Choose a Method: Decide on online, face-to-face, mail, or phone administration. • Online Surveys: Use platforms like SurveyMonkey • Pilot Test: Test on a small group before full deployment • Clear Instructions: Provide concise guidelines • Follow-Up: Send reminders if needed

Thank you, Riya. This is quite helpful. As discussed, response bias is one of the disadvantages in the use of questionnaires. One way to help limit this can be to use scenario based questions. These type of questions may help the respondents to be more reflective and active in the process.

Thank you, Dear Riya. This is quite helpful.

Great insights there Doc

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Designing a Questionnaire for a Research Paper: A Comprehensive Guide to Design and Develop an Effective Questionnaire

Taherdoost, H. (2022). Designing a Questionnaire for a Research Paper: A Comprehensive Guide to Design and Develop an Effective Questionnaire, Asian Journal of Managerial Science, 11(1): 8-16. DOI: https://doi.org/10.51983/ajms-2022.11.1.3087

Posted: 5 Dec 2022

Hamed Taherdoost

Hamta Group

Date Written: August 1, 2022

A questionnaire is an important instrument in a research study to help the researcher collect relevant data regarding the research topic. It is significant to ensure that the design of the questionnaire is arranged to minimize errors. However, researchers commonly face challenges in designing an effective questionnaire including its content, appearance and usage that leads to inappropriate and biased findings in a study. This paper aims to review the main steps to design a questionnaire introducing the process that starts with defining the information required for a study, then continues with the identification of the type of survey and types of questions, writing questions and building the construct of the questionnaire. It also develops the demand to pre-test the questionnaire and finalizing the questionnaire to conduct the survey.

Keywords: Questionnaire, Academic Survey, Questionnaire Design, Research Methodology

Suggested Citation: Suggested Citation

Hamed Taherdoost (Contact Author)

Hamta group ( email ).

Vancouver Canada

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How to Design a Questionnaire

Bryn Farnsworth

In this guide on how to design a questionnaire, we take you through what a good questionnaire is, how to perfect your design and questions, as well as how best to implement the questionnaire in your research. At the end of the guide, readers will have a thorough understanding of how to design a questionnaire, as well as have the opportunity to download our experimental design guide for free for future reference when building studies and experiments.

Table of Contents

If you want to find out something about a person, you’d usually just ask them. If you want to ask a few questions for a group of people, maybe you’d get together as a group. If you want to do research on the answers, you’d give them a questionnaire.

Questionnaires are a crucial part of research. There are many other tools that are used to find out about how people think, feel, and act, but the act of asking remains central to finding out what people explicitly think.

While questionnaires have likely been used for hundreds of years [1], the first recorded instance arose from the result of the work of Adolphe Quetelet , a French polymath, in 1835. He was interested in applying the same rigorous methodologies applied to natural science as to the humanities. By recording – through questionnaires (well, technically surveys) – the physical characteristics of soldiers, he essentially invented the field of sociology. This all goes to say: questionnaires can be powerful things.

Despite the lengthy and illustrious history of questionnaires, they are still not used necessarily in the right way. There remain various ways to carry out such work, and many pitfalls abound.

Below, we will define what a questionnaire actually is (including what separates it from surveys), and provide a guide to making one in the best possible way.

What are questionnaires?

Questionnaires are a set of written questions designed to gather standardized information about the opinions, preferences, experiences, intentions, and behavior of individuals, and can be devised for the purposes of a scientific study. Traditionally, they have been said to contrast with surveys in the sense that they do not collect mass data for further analysis, however the terms are largely used interchangeably these days (and many research studies also use them together).

While questionnaires provide a comparatively cheap, prompt, and efficient means of obtaining large amounts of information, questionnaire design is a multistage process that requires attention to a number of aspects at the same time to gather the information you seek. Why exactly is that?

Depending on the kind of information you aim to acquire, questions need to be asked in varying degrees of detail and in specific ways.

Given the same topic, it’s rather likely that different researchers will come up with different questionnaires that vary widely in their choice of questions, a line of questioning, use of open-ended questions, and length.

Question everything – what makes a good questionnaire?

Basically, well-designed questionnaires are highly structured to allow the same types of information to be collected from a large number of respondents in the same way and for data to be analyzed quantitatively .

Open and Closed Questionnaire Formats

Among others, the design of your questionnaire will depend on whether you choose an open format to collect exploratory information or a closed format to acquire quantitative data.

Advantages of open format:

• Allows to explore the range of possible topics arising from your research question
• Supports the understanding and generation of hypotheses on a topic

Advantages of closed format (multiple choice):

• Easy and quick to complete
• Ensures all respondents receive same stimuli
• Easy to record and analyze results quantitatively

Now how should you go about it? Planning and preparation are key. Although questionnaire design can seem simple at the surface, there are several components you want to make sure you get right. Before you know how to exactly phrase your questions, you need to define the goals and aims of your research, understand who you’ll be talking to, and design everything accordingly. Below, we go through exactly how to do this.

Six steps to good questionnaire design

#1: identify your research aims and the goal of your questionnaire.

What kind of information do you want to gather with your questionnaire? What is your main objective?

Ideally, there are already existing questionnaires that have been validated by published research that you can use (or maybe just to borrow a couple of ideas from). This can occur frequently within psychological research, as there is a broad range of research being carried out in a variety of different fields.

While this can be quite common, it’s not always the case. It might, for example, be rather difficult to find or reuse existing questionnaires for commercial applications. In this case, you might still be able to draw inspiration from pre-existing research, although greater care in the following steps will likely be needed.

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#2: Define your target respondents

Clearly, you can’t test everyone – it’s rather plausible that there have to be certain restrictions with respect to the target audience of your questionnaire. The selection of groups is a key factor for maximizing the robustness of your study.

Another aspect to consider is whether you want to run multiple questionnaire sessions over a longer period of time with a single group ( longitudinal design ), or if you want to present your questionnaire once to two or more groups ( cross-sectional design ).

While the former allows you to analyze how the questionnaire results of the group change over time, the latter delivers insights into differences among groups.

#3: Develop questions

Smart questions are the cornerstone of every questionnaire. To make them work, they have to be phrased in a way that prevents any misunderstandings or ambiguities.

It’s often a lost cause trying to analyze data from a questionnaire where people have mixed things up, selected incorrect answers or haven’t been able to read or understand the questions at all.

It makes a significant difference whether you want to hand a questionnaire to children, adults, or maybe even elderly participants. It’s important to consider the cognitive, attentional, and sensory competencies of your target group – handing out long questionnaires with a huge amount of questions in small letter print and complicated phrasing might be too taxing for many participant groups.

Additionally, remember to avoid jargon or technical language – the text needs to be fully understood by anyone completing the questionnaire.

#4: Choose your question type

There’s a wide variety in how to phrase questions. In explorative questionnaires, you will find mainly open questions, where participants can fill in any answer (this makes sense whenever you try to gain an understanding of the topics associated with your research question).

By contrast, quantitative questionnaires primarily include closed-questions, which have been predefined by the researcher either in form of multiple choice answers or rating scales (such as the Likert scale ).

Here’s one example:

Open question:

“What did you like about the webinar?”

Closed question:

“The webinar was useful.”

[  ] Strongly agree

[  ] Agree

[  ] Cannot decide

[  ] Disagree

[  ] Strongly disagree

As is usually the case, both types of questions have benefits and drawbacks that are worth considering in order to come up with a solid questionnaire design that does the trick for you.

Besides open and closed-format questions, there are several other types of questions that you can use in your questionnaire.

#5:  Design question sequence and overall layout

After optimizing each question separately it is time to improve the overall flow and layout of the questionnaire.

Are there transitions from one question to the next? Are follow-up questions placed correctly? Are skip-rules implemented (if needed) so that participants can skip questions that do not apply to them?

Keep up with the latest in human behavior research and technological developments

#6: Run a pilot

This stage is crucial for evaluation and optimization purposes. Any questionnaire should be handed to a representative sample of your target audience before you go further with it.

During piloting, you can identify issues in readability and understanding, in phrasing and overall arrangement. It could be helpful to discuss the questionnaire with pilot participants to better understand their experience. Also, keep in mind to evaluate your pilot data statistically to make sure that the analytic procedures of interest truly can be applied to the data.

I hope this post helps you set out your questionnaire or survey design. If you’d like to learn more about the fundamentals of experimental design, then download our free guide below.

Free 44-page Experimental Design Guide

For Beginners and Intermediates

• Introduction to experimental methods
• Respondent management with groups and populations
• How to set up stimulus selection and arrangement

[1] Gault, R. (1907). A History of the Questionnaire Method of Research in Psychology. The Pedagogical Seminary , 14(3), 366-383. doi: 10.1080/08919402.1907.10532551

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How to Design and Validate A Questionnaire: A Guide

Affiliations.

• 1 Department of Pharmacology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, 201310, India.
• 2 Department of Pharmacology, AIIMS, Jodhpur, Rajasthan, 342005, India.
• 3 Department of Gynaecology and Obstetrics, AIIMS Jodhpur, Rajasthan, India.
• PMID: 30084336
• DOI: 10.2174/1574884713666180807151328

Background: A questionnaire is a commonly used data collection method and is a very crucial part of the research. However, designing a questionnaire can be a daunting task for postgraduate students.

Methods: This manuscript illustrates the various steps required in questionnaire designing and provides an insight into the essentials of questionnaire construction and validation. Data from a questionnaire should be able to comprehend the objectives of the study; else it may lead to wrong interpretation or bias, decreased power of study and inability to generalize the study results.

Conclusion: Since it is equally important to verify the usefulness of the designed questionnaire, the article briefly describes the process of psychometric evaluation of a questionnaire.

Keywords: Questionnaire validation; WOMAC; pragmatic research; psychometric assessment; questionnaire designing; validity..

Copyright© Bentham Science Publishers; For any queries, please email at [email protected].

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• 10 Research Question Examples to Guide Your Research Project

10 Research Question Examples to Guide your Research Project

Published on October 30, 2022 by Shona McCombes . Revised on October 19, 2023.

The research question is one of the most important parts of your research paper , thesis or dissertation . It’s important to spend some time assessing and refining your question before you get started.

The exact form of your question will depend on a few things, such as the length of your project, the type of research you’re conducting, the topic , and the research problem . However, all research questions should be focused, specific, and relevant to a timely social or scholarly issue.

Once you’ve read our guide on how to write a research question , you can use these examples to craft your own.

Note that the design of your research question can depend on what method you are pursuing. Here are a few options for qualitative, quantitative, and statistical research questions.

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How to Develop a Questionnaire for Research

Last Updated: July 21, 2024 Fact Checked

This article was co-authored by Alexander Ruiz, M.Ed. . Alexander Ruiz is an Educational Consultant and the Educational Director of Link Educational Institute, a tutoring business based in Claremont, California that provides customizable educational plans, subject and test prep tutoring, and college application consulting. With over a decade and a half of experience in the education industry, Alexander coaches students to increase their self-awareness and emotional intelligence while achieving skills and the goal of achieving skills and higher education. He holds a BA in Psychology from Florida International University and an MA in Education from Georgia Southern University. There are 12 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 593,313 times.

A questionnaire is a technique for collecting data in which a respondent provides answers to a series of questions. [1] X Research source To develop a questionnaire that will collect the data you want takes effort and time. However, by taking a step-by-step approach to questionnaire development, you can come up with an effective means to collect data that will answer your unique research question.

Designing Your Questionnaire

• Come up with a research question. It can be one question or several, but this should be the focal point of your questionnaire.
• Develop one or several hypotheses that you want to test. The questions that you include on your questionnaire should be aimed at systematically testing these hypotheses.

• Dichotomous question: this is a question that will generally be a “yes/no” question, but may also be an “agree/disagree” question. It is the quickest and simplest question to analyze, but is not a highly sensitive measure.
• Open-ended questions: these questions allow the respondent to respond in their own words. They can be useful for gaining insight into the feelings of the respondent, but can be a challenge when it comes to analysis of data. It is recommended to use open-ended questions to address the issue of “why.” [2] X Research source
• Multiple choice questions: these questions consist of three or more mutually-exclusive categories and ask for a single answer or several answers. [3] X Research source Multiple choice questions allow for easy analysis of results, but may not give the respondent the answer they want.
• Rank-order (or ordinal) scale questions: this type of question asks your respondent to rank items or choose items in a particular order from a set. For example, it might ask your respondents to order five things from least to most important. These types of questions forces discrimination among alternatives, but does not address the issue of why the respondent made these discriminations. [4] X Research source
• Rating scale questions: these questions allow the respondent to assess a particular issue based on a given dimension. You can provide a scale that gives an equal number of positive and negative choices, for example, ranging from “strongly agree” to “strongly disagree.” [5] X Research source These questions are very flexible, but also do not answer the question “why.”

• Write questions that are succinct and simple. You should not be writing complex statements or using technical jargon, as it will only confuse your respondents and lead to incorrect responses.
• Ask only one question at a time. This will help avoid confusion
• Asking questions such as these usually require you to anonymize or encrypt the demographic data you collect.
• Determine if you will include an answer such as “I don’t know” or “Not applicable to me.” While these can give your respondents a way of not answering certain questions, providing these options can also lead to missing data, which can be problematic during data analysis.
• Put the most important questions at the beginning of your questionnaire. This can help you gather important data even if you sense that your respondents may be becoming distracted by the end of the questionnaire.

• Only include questions that are directly useful to your research question. [8] X Trustworthy Source Food and Agricultural Organization of the United Nations Specialized agency of the United Nations responsible for leading international efforts to end world hunger and improve nutrition Go to source A questionnaire is not an opportunity to collect all kinds of information about your respondents.
• Avoid asking redundant questions. This will frustrate those who are taking your questionnaire.

• Consider if you want your questionnaire to collect information from both men and women. Some studies will only survey one sex.
• Consider including a range of ages in your target demographic. For example, you can consider young adult to be 18-29 years old, adults to be 30-54 years old, and mature adults to be 55+. Providing the an age range will help you get more respondents than limiting yourself to a specific age.
• Consider what else would make a person a target for your questionnaire. Do they need to drive a car? Do they need to have health insurance? Do they need to have a child under 3? Make sure you are very clear about this before you distribute your questionnaire.

• Consider an anonymous questionnaire. You may not want to ask for names on your questionnaire. This is one step you can take to prevent privacy, however it is often possible to figure out a respondent’s identity using other demographic information (such as age, physical features, or zipcode).
• Consider de-identifying the identity of your respondents. Give each questionnaire (and thus, each respondent) a unique number or word, and only refer to them using that new identifier. Shred any personal information that can be used to determine identity.
• Remember that you do not need to collect much demographic information to be able to identify someone. People may be wary to provide this information, so you may get more respondents by asking less demographic questions (if it is possible for your questionnaire).
• Make sure you destroy all identifying information after your study is complete.

Writing your questionnaire

• My name is Jack Smith and I am one of the creators of this questionnaire. I am part of the Department of Psychology at the University of Michigan, where I am focusing in developing cognition in infants.
• I’m Kelly Smith, a 3rd year undergraduate student at the University of New Mexico. This questionnaire is part of my final exam in statistics.
• My name is Steve Johnson, and I’m a marketing analyst for The Best Company. I’ve been working on questionnaire development to determine attitudes surrounding drug use in Canada for several years.

• I am collecting data regarding the attitudes surrounding gun control. This information is being collected for my Anthropology 101 class at the University of Maryland.
• This questionnaire will ask you 15 questions about your eating and exercise habits. We are attempting to make a correlation between healthy eating, frequency of exercise, and incidence of cancer in mature adults.
• This questionnaire will ask you about your recent experiences with international air travel. There will be three sections of questions that will ask you to recount your recent trips and your feelings surrounding these trips, as well as your travel plans for the future. We are looking to understand how a person’s feelings surrounding air travel impact their future plans.

• Beware that if you are collecting information for a university or for publication, you may need to check in with your institution’s Institutional Review Board (IRB) for permission before beginning. Most research universities have a dedicated IRB staff, and their information can usually be found on the school’s website.
• Remember that transparency is best. It is important to be honest about what will happen with the data you collect.
• Include an informed consent for if necessary. Note that you cannot guarantee confidentiality, but you will make all reasonable attempts to ensure that you protect their information. [11] X Research source

• Time yourself taking the survey. Then consider that it will take some people longer than you, and some people less time than you.
• Provide a time range instead of a specific time. For example, it’s better to say that a survey will take between 15 and 30 minutes than to say it will take 15 minutes and have some respondents quit halfway through.
• Use this as a reason to keep your survey concise! You will feel much better asking people to take a 20 minute survey than you will asking them to take a 3 hour one.

• Incentives can attract the wrong kind of respondent. You don’t want to incorporate responses from people who rush through your questionnaire just to get the reward at the end. This is a danger of offering an incentive. [12] X Research source
• Incentives can encourage people to respond to your survey who might not have responded without a reward. This is a situation in which incentives can help you reach your target number of respondents. [13] X Research source
• Consider the strategy used by SurveyMonkey. Instead of directly paying respondents to take their surveys, they offer 50 cents to the charity of their choice when a respondent fills out a survey. They feel that this lessens the chances that a respondent will fill out a questionnaire out of pure self-interest. [14] X Research source
• Consider entering each respondent in to a drawing for a prize if they complete the questionnaire. You can offer a 25$ gift card to a restaurant, or a new iPod, or a ticket to a movie. This makes it less tempting just to respond to your questionnaire for the incentive alone, but still offers the chance of a pleasant reward.

• Always proof read. Check for spelling, grammar, and punctuation errors.
• Include a title. This is a good way for your respondents to understand the focus of the survey as quickly as possible.
• Thank your respondents. Thank them for taking the time and effort to complete your survey.

Distributing Your Questionnaire

• Was the questionnaire easy to understand? Were there any questions that confused you?
• Was the questionnaire easy to access? (Especially important if your questionnaire is online).
• Do you feel the questionnaire was worth your time?
• Were you comfortable answering the questions asked?
• Are there any improvements you would make to the questionnaire?

• Use an online site, such as SurveyMonkey.com. This site allows you to write your own questionnaire with their survey builder, and provides additional options such as the option to buy a target audience and use their analytics to analyze your data. [18] X Research source
• Consider using the mail. If you mail your survey, always make sure you include a self-addressed stamped envelope so that the respondent can easily mail their responses back. Make sure that your questionnaire will fit inside a standard business envelope.
• Conduct face-to-face interviews. This can be a good way to ensure that you are reaching your target demographic and can reduce missing information in your questionnaires, as it is more difficult for a respondent to avoid answering a question when you ask it directly.
• Try using the telephone. While this can be a more time-effective way to collect your data, it can be difficult to get people to respond to telephone questionnaires.

• Make your deadline reasonable. Giving respondents up to 2 weeks to answer should be more than sufficient. Anything longer and you risk your respondents forgetting about your questionnaire.
• Consider providing a reminder. A week before the deadline is a good time to provide a gentle reminder about returning the questionnaire. Include a replacement of the questionnaire in case it has been misplaced by your respondent.

Community Q&A

You Might Also Like

• ↑ https://www.questionpro.com/blog/what-is-a-questionnaire/
• ↑ https://www.hotjar.com/blog/open-ended-questions/
• ↑ https://www.questionpro.com/a/showArticle.do?articleID=survey-questions
• ↑ https://surveysparrow.com/blog/ranking-questions-examples/
• ↑ https://www.lumoa.me/blog/rating-scale/
• ↑ http://www.sciencebuddies.org/science-fair-projects/project_ideas/Soc_survey.shtml
• ↑ http://www.fao.org/docrep/W3241E/w3241e05.htm
• ↑ http://managementhelp.org/businessresearch/questionaires.htm
• ↑ https://www.surveymonkey.com/mp/survey-rewards/
• ↑ http://www.ideafit.com/fitness-library/how-to-develop-a-questionnaire
• ↑ https://www.surveymonkey.com/mp/take-a-tour/?ut_source=header

About This Article

To develop a questionnaire for research, identify the main objective of your research to act as the focal point for the questionnaire. Then, choose the type of questions that you want to include, and come up with succinct, straightforward questions to gather the information that you need to answer your questions. Keep your questionnaire as short as possible, and identify a target demographic who you would like to answer the questions. Remember to make the questionnaires as anonymous as possible to protect the integrity of the person answering the questions! For tips on writing out your questions and distributing the questionnaire, keep reading! Did this summary help you? Yes No

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Questionnaire Method In Research

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

A questionnaire is a research instrument consisting of a series of questions for the purpose of gathering information from respondents. Questionnaires can be thought of as a kind of written interview . They can be carried out face to face, by telephone, computer, or post.

Questionnaires provide a relatively cheap, quick, and efficient way of obtaining large amounts of information from a large sample of people.

Data can be collected relatively quickly because the researcher would not need to be present when completing the questionnaires. This is useful for large populations when interviews would be impractical.

However, a problem with questionnaires is that respondents may lie due to social desirability. Most people want to present a positive image of themselves, and may lie or bend the truth to look good, e.g., pupils exaggerate revision duration.

Questionnaires can effectively measure relatively large subjects’ behavior, attitudes, preferences, opinions, and intentions more cheaply and quickly than other methods.

Often, a questionnaire uses both open and closed questions to collect data. This is beneficial as it means both quantitative and qualitative data can be obtained.

Closed Questions

A closed-ended question requires a specific, limited response, often “yes” or “no” or a choice that fit into pre-decided categories.

Data that can be placed into a category is called nominal data. The category can be restricted to as few as two options, i.e., dichotomous (e.g., “yes” or “no,” “male” or “female”), or include quite complex lists of alternatives from which the respondent can choose (e.g., polytomous).

Closed questions can also provide ordinal data (which can be ranked). This often involves using a continuous rating scale to measure the strength of attitudes or emotions.

For example, strongly agree / agree / neutral / disagree / strongly disagree / unable to answer.

Closed questions have been used to research type A personality (e.g., Friedman & Rosenman, 1974) and also to assess life events that may cause stress (Holmes & Rahe, 1967) and attachment (Fraley, Waller, & Brennan, 2000).

• They can be economical. This means they can provide large amounts of research data for relatively low costs. Therefore, a large sample size can be obtained, which should represent the population from which a researcher can then generalize.
• The respondent provides information that can be easily converted into quantitative data (e.g., count the number of “yes” or “no” answers), allowing statistical analysis of the responses.
• The questions are standardized. All respondents are asked exactly the same questions in the same order. This means a questionnaire can be replicated easily to check for reliability . Therefore, a second researcher can use the questionnaire to confirm consistent results.

Limitations

• They lack detail. Because the responses are fixed, there is less scope for respondents to supply answers that reflect their true feelings on a topic.

Open Questions

Open questions allow for expansive, varied answers without preset options or limitations.

Open questions allow people to express what they think in their own words. Open-ended questions enable the respondent to answer in as much detail as they like in their own words. For example: “can you tell me how happy you feel right now?”

Open questions will work better if you want to gather more in-depth answers from your respondents. These give no pre-set answer options and instead, allow the respondents to put down exactly what they like in their own words.

Open questions are often used for complex questions that cannot be answered in a few simple categories but require more detail and discussion.

Lawrence Kohlberg presented his participants with moral dilemmas. One of the most famous concerns a character called Heinz, who is faced with the choice between watching his wife die of cancer or stealing the only drug that could help her.

Participants were asked whether Heinz should steal the drug or not and, more importantly, for their reasons why upholding or breaking the law is right.

• Rich qualitative data is obtained as open questions allow respondents to elaborate on their answers. This means the research can determine why a person holds a certain attitude .
• Time-consuming to collect the data. It takes longer for the respondent to complete open questions. This is a problem as a smaller sample size may be obtained.
• Time-consuming to analyze the data. It takes longer for the researcher to analyze qualitative data as they have to read the answers and try to put them into categories by coding, which is often subjective and difficult. However, Smith (1992) has devoted an entire book to the issues of thematic content analysis that includes 14 different scoring systems for open-ended questions.
• Not suitable for less educated respondents as open questions require superior writing skills and a better ability to express one’s feelings verbally.

Questionnaire Design

With some questionnaires suffering from a response rate as low as 5%, a questionnaire must be well designed.

There are several important factors in questionnaire design.

Pilot Study

Question order.

Questions should progress logically from the least sensitive to the most sensitive, from the factual and behavioral to the cognitive, and from the more general to the more specific.

The researcher should ensure that previous questions do not influence the answer to a question.

Question order effects

• Question order effects occur when responses to an earlier question affect responses to a later question in a survey. They can arise at different stages of the survey response process – interpretation, information retrieval, judgment/estimation, and reporting.
• Types of question order effects include: unconditional (subsequent answers affected by prior question topic), conditional (subsequent answers depend on the response to the prior question), and associational (correlation between two questions changes based on order).
• Question order effects have been found across different survey topics like social and political attitudes, health and safety studies, vignette research, etc. Effects may be moderated by respondent factors like age, education level, knowledge and attitudes about the topic.
• To minimize question order effects, recommendations include avoiding judgmental dependencies between questions, separating potentially reactive questions, randomizing questions, following good survey design principles, considering respondent characteristics, and intentionally examining question context and order.

Terminology

• There should be a minimum of technical jargon. Questions should be simple, to the point, and easy to understand. The language of a questionnaire should be appropriate to the vocabulary of the group of people being studied.
• Use statements that are interpreted in the same way by members of different subpopulations of the population of interest.
• For example, the researcher must change the language of questions to match the social background of the respondent’s age / educational level / social class/ethnicity, etc.

Presentation

Ethical issues.

• The researcher must ensure that the information provided by the respondent is kept confidential, e.g., name, address, etc.
• This means questionnaires are good for researching sensitive topics as respondents will be more honest when they cannot be identified.
• Keeping the questionnaire confidential should also reduce the likelihood of psychological harm, such as embarrassment.
• Participants must provide informed consent before completing the questionnaire and must be aware that they have the right to withdraw their information at any time during the survey/ study.

Problems with Postal Questionnaires

At first sight, the postal questionnaire seems to offer the opportunity to get around the problem of interview bias by reducing the personal involvement of the researcher. Its other practical advantages are that it is cheaper than face-to-face interviews and can quickly contact many respondents scattered over a wide area.

However, these advantages must be weighed against the practical problems of conducting research by post. A lack of involvement by the researcher means there is little control over the information-gathering process.

The data might not be valid (i.e., truthful) as we can never be sure that the questionnaire was completed by the person to whom it was addressed.

That, of course, assumes there is a reply in the first place, and one of the most intractable problems of mailed questionnaires is a low response rate. This diminishes the reliability of the data

Also, postal questionnaires may not represent the population they are studying. This may be because:

• Some questionnaires may be lost in the post, reducing the sample size.
• The questionnaire may be completed by someone not a member of the research population.
• Those with strong views on the questionnaire’s subject are more likely to complete it than those without interest.

Benefits of a Pilot Study

A pilot study is a practice / small-scale study conducted before the main study.

It allows the researcher to try out the study with a few participants so that adjustments can be made before the main study, saving time and money.

It is important to conduct a questionnaire pilot study for the following reasons:

• Check that respondents understand the terminology used in the questionnaire.
• Check that emotive questions are not used, as they make people defensive and could invalidate their answers.
• Check that leading questions have not been used as they could bias the respondent’s answer.
• Ensure the questionnaire can be completed in an appropriate time frame (i.e., it’s not too long).

Frequently Asked Questions 

How do psychological researchers analyze the data collected from questionnaires.

Psychological researchers analyze questionnaire data by looking for patterns and trends in people’s responses. They use numbers and charts to summarize the information.

They calculate things like averages and percentages to see what most people think or feel. They also compare different groups to see if there are any differences between them.

By doing these analyses, researchers can understand how people think, feel, and behave. This helps them make conclusions and learn more about how our minds work.

Are questionnaires effective in gathering accurate data?

Yes, questionnaires can be effective in gathering accurate data. When designed well, with clear and understandable questions, they allow individuals to express their thoughts, opinions, and experiences.

However, the accuracy of the data depends on factors such as the honesty and accuracy of respondents’ answers, their understanding of the questions, and their willingness to provide accurate information. Researchers strive to create reliable and valid questionnaires to minimize biases and errors.

It’s important to remember that while questionnaires can provide valuable insights, they are just one tool among many used in psychological research.

Can questionnaires be used with diverse populations and cultural contexts?

Yes, questionnaires can be used with diverse populations and cultural contexts. Researchers take special care to ensure that questionnaires are culturally sensitive and appropriate for different groups.

This means adapting the language, examples, and concepts to match the cultural context. By doing so, questionnaires can capture the unique perspectives and experiences of individuals from various backgrounds.

This helps researchers gain a more comprehensive understanding of human behavior and ensures that everyone’s voice is heard and represented in psychological research.

Are questionnaires the only method used in psychological research?

No, questionnaires are not the only method used in psychological research. Psychologists use a variety of research methods, including interviews, observations , experiments , and psychological tests.

Each method has its strengths and limitations, and researchers choose the most appropriate method based on their research question and goals.

Questionnaires are valuable for gathering self-report data, but other methods allow researchers to directly observe behavior, study interactions, or manipulate variables to test hypotheses.

By using multiple methods, psychologists can gain a more comprehensive understanding of human behavior and mental processes.

What is a semantic differential scale?

The semantic differential scale is a questionnaire format used to gather data on individuals’ attitudes or perceptions. It’s commonly incorporated into larger surveys or questionnaires to assess subjective qualities or feelings about a specific topic, product, or concept by quantifying them on a scale between two bipolar adjectives.

It presents respondents with a pair of opposite adjectives (e.g., “happy” vs. “sad”) and asks them to mark their position on a scale between them, capturing the intensity of their feelings about a particular subject.

It quantifies subjective qualities, turning them into data that can be statistically analyzed.

Ayidiya, S. A., & McClendon, M. J. (1990). Response effects in mail surveys. Public Opinion Quarterly, 54 (2), 229–247. https://doi.org/10.1086/269200

Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item-response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365.

Friedman, M., & Rosenman, R. H. (1974). Type A behavior and your heart . New York: Knopf.

Gold, R. S., & Barclay, A. (2006). Order of question presentation and correlation between judgments of comparative and own risk. Psychological Reports, 99 (3), 794–798. https://doi.org/10.2466/PR0.99.3.794-798

Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of psychosomatic research, 11(2) , 213-218.

Schwarz, N., & Hippler, H.-J. (1995). Subsequent questions may influence answers to preceding questions in mail surveys. Public Opinion Quarterly, 59 (1), 93–97. https://doi.org/10.1086/269460

Smith, C. P. (Ed.). (1992). Motivation and personality: Handbook of thematic content analysis . Cambridge University Press.

Further Information

• Questionnaire design and scale development
• Questionnaire Appraisal Form

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• Knowledge Base
• Methodology
• Doing Survey Research | A Step-by-Step Guide & Examples

Doing Survey Research | A Step-by-Step Guide & Examples

Published on 6 May 2022 by Shona McCombes . Revised on 10 October 2022.

Survey research means collecting information about a group of people by asking them questions and analysing the results. To conduct an effective survey, follow these six steps:

• Determine who will participate in the survey
• Decide the type of survey (mail, online, or in-person)
• Design the survey questions and layout
• Distribute the survey
• Analyse the responses
• Write up the results

Surveys are a flexible method of data collection that can be used in many different types of research .

Table of contents

What are surveys used for, step 1: define the population and sample, step 2: decide on the type of survey, step 3: design the survey questions, step 4: distribute the survey and collect responses, step 5: analyse the survey results, step 6: write up the survey results, frequently asked questions about surveys.

Surveys are used as a method of gathering data in many different fields. They are a good choice when you want to find out about the characteristics, preferences, opinions, or beliefs of a group of people.

Common uses of survey research include:

• Social research: Investigating the experiences and characteristics of different social groups
• Market research: Finding out what customers think about products, services, and companies
• Health research: Collecting data from patients about symptoms and treatments
• Politics: Measuring public opinion about parties and policies
• Psychology: Researching personality traits, preferences, and behaviours

Surveys can be used in both cross-sectional studies , where you collect data just once, and longitudinal studies , where you survey the same sample several times over an extended period.

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Before you start conducting survey research, you should already have a clear research question that defines what you want to find out. Based on this question, you need to determine exactly who you will target to participate in the survey.

Populations

The target population is the specific group of people that you want to find out about. This group can be very broad or relatively narrow. For example:

• The population of Brazil
• University students in the UK
• Second-generation immigrants in the Netherlands
• Customers of a specific company aged 18 to 24
• British transgender women over the age of 50

Your survey should aim to produce results that can be generalised to the whole population. That means you need to carefully define exactly who you want to draw conclusions about.

It’s rarely possible to survey the entire population of your research – it would be very difficult to get a response from every person in Brazil or every university student in the UK. Instead, you will usually survey a sample from the population.

The sample size depends on how big the population is. You can use an online sample calculator to work out how many responses you need.

There are many sampling methods that allow you to generalise to broad populations. In general, though, the sample should aim to be representative of the population as a whole. The larger and more representative your sample, the more valid your conclusions.

There are two main types of survey:

• A questionnaire , where a list of questions is distributed by post, online, or in person, and respondents fill it out themselves
• An interview , where the researcher asks a set of questions by phone or in person and records the responses

Which type you choose depends on the sample size and location, as well as the focus of the research.

Questionnaires

Sending out a paper survey by post is a common method of gathering demographic information (for example, in a government census of the population).

• You can easily access a large sample.
• You have some control over who is included in the sample (e.g., residents of a specific region).
• The response rate is often low.

Online surveys are a popular choice for students doing dissertation research , due to the low cost and flexibility of this method. There are many online tools available for constructing surveys, such as SurveyMonkey and Google Forms .

• You can quickly access a large sample without constraints on time or location.
• The data is easy to process and analyse.
• The anonymity and accessibility of online surveys mean you have less control over who responds.

If your research focuses on a specific location, you can distribute a written questionnaire to be completed by respondents on the spot. For example, you could approach the customers of a shopping centre or ask all students to complete a questionnaire at the end of a class.

• You can screen respondents to make sure only people in the target population are included in the sample.
• You can collect time- and location-specific data (e.g., the opinions of a shop’s weekday customers).
• The sample size will be smaller, so this method is less suitable for collecting data on broad populations.

Oral interviews are a useful method for smaller sample sizes. They allow you to gather more in-depth information on people’s opinions and preferences. You can conduct interviews by phone or in person.

• You have personal contact with respondents, so you know exactly who will be included in the sample in advance.
• You can clarify questions and ask for follow-up information when necessary.
• The lack of anonymity may cause respondents to answer less honestly, and there is more risk of researcher bias.

Like questionnaires, interviews can be used to collect quantitative data : the researcher records each response as a category or rating and statistically analyses the results. But they are more commonly used to collect qualitative data : the interviewees’ full responses are transcribed and analysed individually to gain a richer understanding of their opinions and feelings.

Next, you need to decide which questions you will ask and how you will ask them. It’s important to consider:

• The type of questions
• The content of the questions
• The phrasing of the questions
• The ordering and layout of the survey

Open-ended vs closed-ended questions

There are two main forms of survey questions: open-ended and closed-ended. Many surveys use a combination of both.

Closed-ended questions give the respondent a predetermined set of answers to choose from. A closed-ended question can include:

• A binary answer (e.g., yes/no or agree/disagree )
• A scale (e.g., a Likert scale with five points ranging from strongly agree to strongly disagree )
• A list of options with a single answer possible (e.g., age categories)
• A list of options with multiple answers possible (e.g., leisure interests)

Closed-ended questions are best for quantitative research . They provide you with numerical data that can be statistically analysed to find patterns, trends, and correlations .

Open-ended questions are best for qualitative research. This type of question has no predetermined answers to choose from. Instead, the respondent answers in their own words.

Open questions are most common in interviews, but you can also use them in questionnaires. They are often useful as follow-up questions to ask for more detailed explanations of responses to the closed questions.

The content of the survey questions

To ensure the validity and reliability of your results, you need to carefully consider each question in the survey. All questions should be narrowly focused with enough context for the respondent to answer accurately. Avoid questions that are not directly relevant to the survey’s purpose.

When constructing closed-ended questions, ensure that the options cover all possibilities. If you include a list of options that isn’t exhaustive, you can add an ‘other’ field.

Phrasing the survey questions

In terms of language, the survey questions should be as clear and precise as possible. Tailor the questions to your target population, keeping in mind their level of knowledge of the topic.

Use language that respondents will easily understand, and avoid words with vague or ambiguous meanings. Make sure your questions are phrased neutrally, with no bias towards one answer or another.

Ordering the survey questions

The questions should be arranged in a logical order. Start with easy, non-sensitive, closed-ended questions that will encourage the respondent to continue.

If the survey covers several different topics or themes, group together related questions. You can divide a questionnaire into sections to help respondents understand what is being asked in each part.

If a question refers back to or depends on the answer to a previous question, they should be placed directly next to one another.

Before you start, create a clear plan for where, when, how, and with whom you will conduct the survey. Determine in advance how many responses you require and how you will gain access to the sample.

When you are satisfied that you have created a strong research design suitable for answering your research questions, you can conduct the survey through your method of choice – by post, online, or in person.

There are many methods of analysing the results of your survey. First you have to process the data, usually with the help of a computer program to sort all the responses. You should also cleanse the data by removing incomplete or incorrectly completed responses.

If you asked open-ended questions, you will have to code the responses by assigning labels to each response and organising them into categories or themes. You can also use more qualitative methods, such as thematic analysis , which is especially suitable for analysing interviews.

Statistical analysis is usually conducted using programs like SPSS or Stata. The same set of survey data can be subject to many analyses.

Finally, when you have collected and analysed all the necessary data, you will write it up as part of your thesis, dissertation , or research paper .

In the methodology section, you describe exactly how you conducted the survey. You should explain the types of questions you used, the sampling method, when and where the survey took place, and the response rate. You can include the full questionnaire as an appendix and refer to it in the text if relevant.

Then introduce the analysis by describing how you prepared the data and the statistical methods you used to analyse it. In the results section, you summarise the key results from your analysis.

A Likert scale is a rating scale that quantitatively assesses opinions, attitudes, or behaviours. It is made up of four or more questions that measure a single attitude or trait when response scores are combined.

To use a Likert scale in a survey , you present participants with Likert-type questions or statements, and a continuum of items, usually with five or seven possible responses, to capture their degree of agreement.

Individual Likert-type questions are generally considered ordinal data , because the items have clear rank order, but don’t have an even distribution.

Overall Likert scale scores are sometimes treated as interval data. These scores are considered to have directionality and even spacing between them.

The type of data determines what statistical tests you should use to analyse your data.

A questionnaire is a data collection tool or instrument, while a survey is an overarching research method that involves collecting and analysing data from people using questionnaires.

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Chapter 9: Survey Research

Constructing Survey Questionnaires

Learning Objectives

• Describe the cognitive processes involved in responding to a survey item.
• Explain what a context effect is and give some examples.
• Create a simple survey questionnaire based on principles of effective item writing and organization.

The heart of any survey research project is the survey questionnaire itself. Although it is easy to think of interesting questions to ask people, constructing a good survey questionnaire is not easy at all. The problem is that the answers people give can be influenced in unintended ways by the wording of the items, the order of the items, the response options provided, and many other factors. At best, these influences add noise to the data. At worst, they result in systematic biases and misleading results. In this section, therefore, we consider some principles for constructing survey questionnaires to minimize these unintended effects and thereby maximize the reliability and validity of respondents’ answers.

Survey Responding as a Psychological Process

Before looking at specific principles of survey questionnaire construction, it will help to consider survey responding as a psychological process.

A Cognitive Model

Figure 9.1  presents a model of the cognitive processes that people engage in when responding to a survey item (Sudman, Bradburn, & Schwarz, 1996) [1] . Respondents must interpret the question, retrieve relevant information from memory, form a tentative judgment, convert the tentative judgment into one of the response options provided (e.g., a rating on a 1-to-7 scale), and finally edit their response as necessary.

Consider, for example, the following questionnaire item:

How many alcoholic drinks do you consume in a typical day?

• _____ a lot more than average
• _____ somewhat more than average
• _____ average
• _____ somewhat fewer than average
• _____ a lot fewer than average

Although this item at first seems straightforward, it poses several difficulties for respondents. First, they must interpret the question. For example, they must decide whether “alcoholic drinks” include beer and wine (as opposed to just hard liquor) and whether a “typical day” is a typical weekday, typical weekend day, or both . Even though Chang and Krosnick (2003) [2] found that asking about “typical” behaviour has been shown to be more valid than asking about “past” behaviour, their study compared “typical week” to “past week” and may be different when considering typical weekdays or weekend days) . Once they have interpreted the question, they must retrieve relevant information from memory to answer it. But what information should they retrieve, and how should they go about retrieving it? They might think vaguely about some recent occasions on which they drank alcohol, they might carefully try to recall and count the number of alcoholic drinks they consumed last week, or they might retrieve some existing beliefs that they have about themselves (e.g., “I am not much of a drinker”). Then they must use this information to arrive at a tentative judgment about how many alcoholic drinks they consume in a typical day. For example, this  mental calculation  might mean dividing the number of alcoholic drinks they consumed last week by seven to come up with an average number per day. Then they must format this tentative answer in terms of the response options actually provided. In this case, the options pose additional problems of interpretation. For example, what does “average” mean, and what would count as “somewhat more” than average? Finally, they must decide whether they want to report the response they have come up with or whether they want to edit it in some way. For example, if they believe that they drink much more than average, they might not want to report th e higher number  for fear of looking bad in the eyes of the researcher.

From this perspective, what at first appears to be a simple matter of asking people how much they drink (and receiving a straightforward answer from them) turns out to be much more complex.

Context Effects on Questionnaire Responses

Again, this complexity can lead to unintended influences on respondents’ answers. These are often referred to as  context effects  because they are not related to the content of the item but to the context in which the item appears (Schwarz & Strack, 1990) [3] . For example, there is an  item-order effect  when the order in which the items are presented affects people’s responses. One item can change how participants interpret a later item or change the information that they retrieve to respond to later items. For example, researcher Fritz Strack and his colleagues asked college students about both their general life satisfaction and their dating frequency (Strack, Martin, & Schwarz, 1988) [4] . When the life satisfaction item came first, the correlation between the two was only −.12, suggesting that the two variables are only weakly related. But when the dating frequency item came first, the correlation between the two was +.66, suggesting that those who date more have a strong tendency to be more satisfied with their lives. Reporting the dating frequency first made that information more accessible in memory so that they were more likely to base their life satisfaction rating on it.

The response options provided can also have unintended effects on people’s responses (Schwarz, 1999) [5] . For example, when people are asked how often they are “really irritated” and given response options ranging from “less than once a year” to “more than once a month,” they tend to think of major irritations and report being irritated infrequently. But when they are given response options ranging from “less than once a day” to “several times a month,” they tend to think of minor irritations and report being irritated frequently. People also tend to assume that middle response options represent what is normal or typical. So if they think of themselves as normal or typical, they tend to choose middle response options. For example, people are likely to report watching more television when the response options are centred on a middle option of 4 hours than when centred on a middle option of 2 hours.  To mitigate against order effects, rotate questions and response items when there is no natural order. Counterbalancing is a good practice for survey questions and can reduce response order effects which show that among undecided voters, the first candidate listed in a ballot receives a 2.5% boost simply by virtue of being listed first [6] !

Writing Survey Questionnaire Items

Types of items.

Questionnaire items can be either open-ended or closed-ended.  Open-ended items  simply ask a question and allow participants to answer in whatever way they choose. The following are examples of open-ended questionnaire items.

• “What is the most important thing to teach children to prepare them for life?”
• “Please describe a time when you were discriminated against because of your age.”
• “Is there anything else you would like to tell us about?”

Open-ended items are useful when researchers do not know how participants might respond or want to avoid influencing their responses. They tend to be used when researchers have more vaguely defined research questions—often in the early stages of a research project. Open-ended items are relatively easy to write because there are no response options to worry about. However, they take more time and effort on the part of participants, and they are more difficult for the researcher to analy z e because the answers must be transcribed, coded, and submitted to some form of qualitative analysis, such as content analysis.  The advantage to open-ended items is that they are unbiased and do not provide respondents with expectations of what the researcher might be looking for. Open-ended items are also more valid and more reliable. The disadvantage is that respondents are more likely to skip open-ended items because they take longer to answer. It is best to use open-ended questions when the answer is unsure and for quantities which can easily be converted to categories later in the analysis.

Closed-ended items  ask a question and provide a set of response options for participants to choose from. The alcohol item just mentioned is an example, as are the following:

  How old are you?

• _____ Under 18
• _____ 18 to 34
• _____ 35 to 49
• _____ 50 to 70
• _____ Over 70

On a scale of 0 (no pain at all) to 10 (worst pain ever experienced), how much pain are you in right now?

Have you ever in your adult life been depressed for a period of 2 weeks or more?

Closed-ended items are used when researchers have a good idea of the different responses that participants might make. They are also used when researchers are interested in a well-defined variable or construct such as participants’ level of agreement with some statement, perceptions of risk, or frequency of a particular behaviour. Closed-ended items are more difficult to write because they must include an appropriate set of response options. However, they are relatively quick and easy for participants to complete. They are also much easier for researchers to analyze because the responses can be easily converted to numbers and entered into a spreadsheet. For these reasons, closed-ended items are much more common.

All closed-ended items include a set of response options from which a participant must choose. For categorical variables like sex, race, or political party preference, the categories are usually listed and participants choose the one (or ones) that they belong to. For quantitative variables, a rating scale is typically provided. A  rating scale  is an ordered set of responses that participants must choose from.  Figure 9.2  shows several examples. The number of response options on a typical rating scale ranges from three to 11—although five and seven are probably most common. Five-point scales are best for unipolar scales where only one construct is tested, such as frequency (Never, Rarely, Sometimes, Often, Always). Seven-point scales are best for bipolar scales where there is a dichotomous spectrum, such as liking (Like very much, Like somewhat, Like slightly, Neither like nor dislike, Dislike slightly, Dislike somewhat, Dislike very much). For bipolar questions, it is useful to offer an earlier question that branches them into an area of the scale; if asking about liking ice cream, first ask “Do you generally like or dislike ice cream?” Once the respondent chooses like or dislike, refine it by offering them one of choices from the seven-point scale.  Branching improves both reliability and validity  (Krosnick & Berent, 1993) [7] .  Although you often see scales with numerical labels, it is best to only present verbal labels to the respondents but convert them to numerical values in the analyses. Avoid partial labels or length or overly specific labels. In some cases, the verbal labels can be supplemented with (or even replaced by) meaningful graphics. The last rating scale shown in  Figure 9.2  is a visual-analog scale, on which participants make a mark somewhere along the horizontal line to indicate the magnitude of their response.

What is a Likert Scale?

In reading about psychological research, you are likely to encounter the term  Likert scale . Although this term is sometimes used to refer to almost any rating scale (e.g., a 0-to-10 life satisfaction scale), it has a much more precise meaning.

In the 1930s, researcher Rensis Likert (pronounced LICK-ert) created a new approach for measuring people’s attitudes (Likert, 1932) [8] . It involves presenting people with several statements—including both favourable and unfavourable statements—about some person, group, or idea. Respondents then express their agreement or disagreement with each statement on a 5-point scale:  Strongly Agree ,  Agree ,  Neither Agree nor Disagree ,  Disagree , Strongly Disagree . Numbers are assigned to each response (with reverse coding as necessary) and then summed across all items to produce a score representing the attitude toward the person, group, or idea. The entire set of items came to be called a Likert scale.

Thus unless you are measuring people’s attitude toward something by assessing their level of agreement with several statements about it, it is best to avoid calling it a Likert scale. You are probably just using a “rating scale.”

Writing Effective Items

We can now consider some principles of writing questionnaire items that minimize unintended context effects and maximize the reliability and validity of participants’ responses. A rough guideline for writing questionnaire items is provided by the BRUSO model (Peterson, 2000) [9] . An acronym,  BRUSO  stands for “brief,” “relevant,” “unambiguous,” “specific,” and “objective.” Effective questionnaire items are  brief  and to the point. They avoid long, overly technical, or unnecessary words. This brevity makes them easier for respondents to understand and faster for them to complete. Effective questionnaire items are also  relevant  to the research question. If a respondent’s sexual orientation, marital status, or income is not relevant, then items on them should probably not be included. Again, this makes the questionnaire faster to complete, but it also avoids annoying respondents with what they will rightly perceive as irrelevant or even “nosy” questions. Effective questionnaire items are also unambiguous ; they can be interpreted in only one way. Part of the problem with the alcohol item presented earlier in this section is that different respondents might have different ideas about what constitutes “an alcoholic drink” or “a typical day.” Effective questionnaire items are also  specific ,  so that it is clear to respondents what their response  should  be about and clear to researchers what it  is  about. A common problem here is closed-ended items that are “double barrelled.” They ask about two conceptually separate issues but allow only one response. For example, “Please rate the extent to which you have been feeling anxious and depressed.” This item should probably be split into two separate items—one about anxiety and one about depression. Finally, effective questionnaire items are  objective  in the sense that they do not reveal the researcher’s own opinions or lead participants to answer in a particular way. Table 9.2  shows some examples of poor and effective questionnaire items based on the BRUSO criteria. The best way to know how people interpret the wording of the question is to conduct pre-tests and ask a few people to explain how they interpreted the question.

For closed-ended items, it is also important to create an appropriate response scale. For categorical variables, the categories presented should generally be mutually exclusive and exhaustive. Mutually exclusive categories do not overlap. For a religion item, for example, the categories of  Christian  and Catholic  are not mutually exclusive but  Protestant  and  Catholic are. Exhaustive categories cover all possible responses.

Although  Protestant  and  Catholic  are mutually exclusive, they are not exhaustive because there are many other religious categories that a respondent might select:  Jewish ,  Hindu ,  Buddhist , and so on. In many cases, it is not feasible to include every possible category, in which case an  Other  category, with a space for the respondent to fill in a more specific response, is a good solution. If respondents could belong to more than one category (e.g., race), they should be instructed to choose all categories that apply.

For rating scales, five or seven response options generally allow about as much precision as respondents are capable of. However, numerical scales with more options can sometimes be appropriate. For dimensions such as attractiveness, pain, and likelihood, a 0-to-10 scale will be familiar to many respondents and easy for them to use. Regardless of the number of response options, the most extreme ones should generally be “balanced” around a neutral or modal midpoint. An example of an unbalanced rating scale measuring perceived likelihood might look like this:

Unlikely  |  Somewhat Likely  |  Likely  |  Very Likely  |  Extremely Likely

A balanced version might look like this:

Extremely Unlikely  |  Somewhat Unlikely  |  As Likely as Not  |  Somewhat Likely  | Extremely Likely

 Note, however, that a middle or neutral response option does not have to be included. Researchers sometimes choose to leave it out because they want to encourage respondents to think more deeply about their response and not simply choose the middle option by default. Including middle alternatives on bipolar dimensions is useful to allow people to genuinely choose an option that is neither.

Formatting the Questionnaire

Writing effective items is only one part of constructing a survey questionnaire. For one thing, every survey questionnaire should have a written or spoken introduction that serves two basic functions (Peterson, 2000) [10] . One is to encourage respondents to participate in the survey. In many types of research, such encouragement is not necessary either because participants do not know they are in a study (as in naturalistic observation) or because they are part of a subject pool and have already shown their willingness to participate by signing up and showing up for the study. Survey research usually catches respondents by surprise when they answer their phone, go to their mailbox, or check their e-mail—and the researcher must make a good case for why they should agree to participate. Thus the introduction should briefly explain the purpose of the survey and its importance, provide information about the sponsor of the survey (university-based surveys tend to generate higher response rates), acknowledge the importance of the respondent’s participation, and describe any incentives for participating.

The second function of the introduction is to establish informed consent. Remember that this aim means describing to respondents everything that might affect their decision to participate. This includes the topics covered by the survey, the amount of time it is likely to take, the respondent’s option to withdraw at any time, confidentiality issues, and so on. Written consent forms are not typically used in survey research, so it is important that this part of the introduction be well documented and presented clearly and in its entirety to every respondent.

The introduction should be followed by the substantive questionnaire items. But first, it is important to present clear instructions for completing the questionnaire, including examples of how to use any unusual response scales. Remember that the introduction is the point at which respondents are usually most interested and least fatigued, so it is good practice to start with the most important items for purposes of the research and proceed to less important items. Items should also be grouped by topic or by type. For example, items using the same rating scale (e.g., a 5-point agreement scale) should be grouped together if possible to make things faster and easier for respondents. Demographic items are often presented last because they are least interesting to participants but also easy to answer in the event respondents have become tired or bored. Of course, any survey should end with an expression of appreciation to the respondent.

Key Takeaways

• Responding to a survey item is itself a complex cognitive process that involves interpreting the question, retrieving information, making a tentative judgment, putting that judgment into the required response format, and editing the response.
• Survey questionnaire responses are subject to numerous context effects due to question wording, item order, response options, and other factors. Researchers should be sensitive to such effects when constructing surveys and interpreting survey results.
• Survey questionnaire items are either open-ended or closed-ended. Open-ended items simply ask a question and allow respondents to answer in whatever way they want. Closed-ended items ask a question and provide several response options that respondents must choose from.
• Use verbal labels instead of numerical labels although the responses can be converted to numerical data in the analyses.
• According to the BRUSO model, questionnaire items should be brief, relevant, unambiguous, specific, and objective.
• Discussion: Write a survey item and then write a short description of how someone might respond to that item based on the cognitive model of survey responding (or choose any item on the Rosenberg Self-Esteem Scale .
• How much does the respondent use Facebook?
• How much exercise does the respondent get?
• How likely does the respondent think it is that the incumbent will be re-elected in the next presidential election?
• To what extent does the respondent experience “road rage”?

Long Descriptions

Figure 9.1 long description: Flowchart modelling the cognitive processes involved in responding to a survey item. In order, these processes are:

• Question Interpretation
• Information Retrieval
• Judgment Formation
• Response Formatting
• Response Editing

[Return to Figure 9.1]

Figure 9.2 long description: Three different rating scales for survey questions. The first scale provides a choice between “strongly agree,” “agree,” “neither agree nor disagree,” “disagree,” and “strongly disagree.” The second is a scale from 1 to 7, with 1 being “extremely unlikely” and 7 being “extremely likely.” The third is a sliding scale, with one end marked “extremely unfriendly” and the other “extremely friendly.” [Return to Figure 9.2]

Figure 9.3 long description: A note reads, “Dear Isaac. Do you like me?” with two check boxes reading “yes” or “no.” Someone has added a third check box, which they’ve checked, that reads, “There is as yet insufficient data for a meaningful answer.” [Return to Figure 9.3]

Media Attributions

• Study  by XKCD  CC BY-NC (Attribution NonCommercial)
• Sudman, S., Bradburn, N. M., & Schwarz, N. (1996). Thinking about answers: The application of cognitive processes to survey methodology . San Francisco, CA: Jossey-Bass. ↵
• Chang, L., & Krosnick, J.A. (2003). Measuring the frequency of regular behaviors: Comparing the ‘typical week’ to the ‘past week’. Sociological Methodology, 33 , 55-80. ↵
• Schwarz, N., & Strack, F. (1990). Context effects in attitude surveys: Applying cognitive theory to social research. In W. Stroebe & M. Hewstone (Eds.), European review of social psychology (Vol. 2, pp. 31–50). Chichester, UK: Wiley. ↵
• Strack, F., Martin, L. L., & Schwarz, N. (1988). Priming and communication: The social determinants of information use in judgments of life satisfaction. European Journal of Social Psychology, 18 , 429–442. ↵
• Schwarz, N. (1999). Self-reports: How the questions shape the answers. American Psychologist, 54 , 93–105. ↵
• Miller, J.M. & Krosnick, J.A. (1998). The impact of candidate name order on election outcomes. Public Opinion Quarterly, 62 (3), 291-330. ↵
• Krosnick, J.A. & Berent, M.K. (1993). Comparisons of party identification and policy preferences: The impact of survey question format. American Journal of Political Science, 27 (3), 941-964. ↵
• Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology,140 , 1–55. ↵
• Peterson, R. A. (2000). Constructing effective questionnaires . Thousand Oaks, CA: Sage. ↵

Being tested in one condition can also change how participants perceive stimuli or interpret their task in later conditions.

The order in which the items are presented affects people’s responses.

A questionnaire item that allows participants to answer in whatever way they choose.

A questionnaire item that asks a question and provides a set of response options for participants to choose from.

An ordered set of responses that participants must choose from.

A guideline for questionnaire items that suggests they should be brief, relevant, specific, and objective.

Research Methods in Psychology - 2nd Canadian Edition Copyright © 2015 by Paul C. Price, Rajiv Jhangiani, & I-Chant A. Chiang is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Speaker 1: One of the most frequently asked questions that I am asked all the time across my social media platforms, across my YouTube, across my comments, is about the research process. So how do you start? Where do you even begin? You need to submit a dissertation, you need to submit a research proposal, you need to think of a hypothesis, you need to think of a problem statement, you need to find a gap in literature where do you even begin with the whole research process now it isn't as hard as it seems it's just one of those things that you're never told or you're never taught how to do it's one of those things that you just kind of figure out so hopefully in today's video i will be talking to you about the overview and kind of a quick beginner's guide to the research process, giving you the steps of how you get from zero to having something, having a question, having a hypothesis, having somewhere to start. I'm going to be making this into a bit of a series so in today's video I'm going to be giving you an overview as to the different chapters, the different sections of the process, how you get from nothing to something and then in the following videos I will be going through each of those sections in a bit more detail and hopefully if you are someone who is within one of those kind of parts you can just jump to that video and have a have a quick quick watch if you are someone who is just starting off then this is the best place for you to begin have a little think about how you're going to navigate your research process and how you're going to get from the start to the end it is not difficult but it does require a few steps, a few technicalities, which I'll talk you through today. I'll leave the timestamps down below so you feel free to go and jump to the different sections that you are interested in watching. And if you do enjoy this kind of video and you want to see the rest of the videos from me, then don't forget to subscribe to see more on my channel. So step number one is to choose a topic. Now this is the beginning of something beautiful. This is where you choose what you're actually going to be studying and when you're actually going to be reading about now it's really important that you have chosen a topic that you are interested in that there is an interest in within the research space that has something missing so you don't want to choose a topic that we know everything about you want to choose a topic that we don't know everything about and there are things that we want to try to find more about you want to choose a topic that is within your university guidelines so as much as i would love to do a research on the solar system about space well if my course is to do with cell biology well then i can't so you have to think about your limits think about what you are allowed to do within your university guidelines as well but you do need to think about taking that broad topic and making it into something a bit more narrow so it's not good enough to just say i want to do research on alzheimer's okay alzheimer's fine you've got a topic, but you now need to narrow it down. So what about it are you looking at? Are you looking at the risk factors? Are you looking at what happens once you have Alzheimer's? Are you looking at a specific group of people? Are you looking at a specific cell type? What is it that you are looking at? You need to narrow that down. In order to narrow it down, you need to do a bit of a literature search. So whilst choosing a topic, whilst in this first stage, you need to look at literature. So to find literature you want to go to different websites where you have literature and this could be for example Google Scholar is a good place to start, PubMed is a good place to start. These are places where you can find literature about that topic and kind of read around the subject and identify whether firstly is it something that you are actually interested in and secondly is there enough information for you to gather to be able to write your literature review in the future so that first step your first step of your research process is thinking about the topic because without a topic you there's nothing you can't do anything else so the first step has to always be to find a topic and think about it now once you've thought about a topic and you've narrowed it down to the thing that you're interested in at this stage you will then go to your supervisor to your lecturer to your professor to your mentor to your tutor and you will ask them do you think this is a good topic and that is where you will get some feedback and most likely you'll have to go back have another think or try to refine a bit more or try to think about it in a different way but that is always the first step. In the video that I make about finding a good topic we'll talk about it in a lot more depth but to start off with to introduce this is always the first step. So the second step is to identify a problem and this is what we like to call in as you know in research the gap in literature. So a problem slash gap in literature is the part of research that we that is missing. So when you do research in fact in order to graduate from a PhD you have to and this is one of the criteria you have to produce research it has to be in a thesis or in a in a published paper it has to be research it has to be a finding that is new something that we do not know before we did not know before your research right and that is the number one criteria for for actually getting a phd it is the fact that it has to be something new has to be something novel that you have discovered okay so you need to think about the gap in literature where is there a missing piece i understand this i understand that we know this we know that but what is there that we don't quite know and that is the bit that you are then going to try to identify during your research process right chosen a topic now we need to find the problem where is the missing information now in order to do this you need to have read a lot of papers around your topic. So that's why I said initially, you need to have had approval from your committee, from your tutor, your supervisor to say, right, that's okay. It's good for me to go there. Now you've got that topic that you're looking at. You then want to try to find the gap. Where are you going to slot in? What is it that you are going to provide in terms of knowledge? Now, the identifying a problem is actually quite an important and quite critical part of the research process it's almost impossible you to continue on with your research without having identified the problem because if you don't have a problem you don't know what it is you're looking at you don't know what methods you're using you don't know what your research question is going to be or your hypothesis so at this stage you have to have a very well-defined research problem and your question in order to continue on to the next steps so when i say research problem and we'll talk about this more in in the following video that i'm going to produce about it but when i talk about research problem it could be a number of different things so it could be that we understand or we have the knowledge of a certain situation but now you're comparing it to a different situation so it could be more theoretical where you're comparing two things to each other that haven't been compared before so that would be fine as long as what you have is something original or you may be trying to explore a specific relationship let's say for example in my case with my PhD I was looking at two different proteins and the relationship between them so that is one type of research that you can do as well and so just think about your topic and think about where the gap is in the literature you have to read a lot to be able to find this and a question I get a lot emailed to me and directed to me is about this problem so how do I find a problem like how do i find a gap in literature and it's almost impossible for me to to give you any answers because i have to have read all the papers within your topic in order to answer that question which is almost impossible so it's something that you have to do independently and you can always discuss with me you can discuss kind of trying to refine that question but for the most part you need to read around your subject yourself to get that question then step number three is to actually write down your research question now this is usually in the form maybe of a hypothesis or maybe it could be just a you know a standalone question so this is just you saying this is what i'm looking at so i'm looking at whether actin and myosin bind together to have an impact on the motility of the cortex like that is my question and then i'll have a hypothesis saying actin and myosin bind together and they do this so this is just my question and you're just following on from your problem so you've identified your topic you found the problem the gap in literature and then you write down what your question is so what it is exactly that you are looking for and this will be like your guiding star this will be the thing the question the statement that you have at the top you know at the top of your mind whenever you are looking at literature whenever you're writing a literature review whenever you speak to someone you have that question in mind and so that needs to be something that's really well defined it should also be really specific so it can't just be saying is obesity caused by i don't know fatty food i'm just giving a random example that is too vague is obesity in children in male in female different ages what fatty foods what like you need to be very very specific so specific that someone else should be able to pick up your research question and know what it is you're looking at they need to be able to know sort of what methods you're using is it qualitative or is it quantitative what type of research are you actually doing that should really be in the research question so a good research question is one where that is really well defined then step number four is to write a research design so this is where you're kind of creating a bit of a method a bit of a process within a process so you are now writing down and you're now thinking about how you're going to conduct this research so to follow this will be the research proposal but at this stage here you're just thinking about your research design so how are you going to get this research done what are the factors that you need to think about who are the people the participants that you may need are you doing a lab-based thing do you need cells are you you know what do you need humans do you need animals is it just a review paper so do you just need to think about researchers out there what kind of study are you going to conduct in order to find out the results and the answer to your question essentially the research design is a practical framework so it's giving laying out that frame for you in order to answer your research question. And here, it's more of a thinking process. It's more of a discussion. You might want to ask your supervisor, you might want to ask your tutor to talk about it. How are we going to get the answer to this question? And then to finish off the research process, you now want to write a research proposal. And I have a really good video about this, and I'll leave the link for it down below, where you are detailing all the steps for your research so you're detailing your the background of your research the literature review and you're justifying that there is a need for this research you then want to detail your methods your materials the aim your you know your timeline how long it's going to take you to do these things and then that document is what you take with you to your supervisor and say look this is my research proposal you might take it to a potential phd supervisor and say look this is what i've found and this is what i'm really interested in and here is the proposal and you have it all outlined there for you or it's a document that you're able to use in order to build upon your dissertation and so if you're writing an essay dissertation you are able to use that as well so with your research proposal you are detailing the context you are detailing the purpose the plan and your aims the whole process going from finding a topic finding a problem finding the research question defining the actual research and then now you're compiling all of that and you're putting it into a document called the research proposal and all of this information is in there someone should be able to pick that up see what you found find the review of the literature and say right this is a good study this is a good bit of research we are going to approve this and then you can go on and plan the rest of your research so i hope this video helped you summarizing the steps of the research process to begin with and as i mentioned i'm going to be doing each of these five steps as single videos so i can expand on them and i'll make it into a playlist so you're able to sort of follow up and click on the next couple videos but for now i hope this did help with thinking about the research process and thinking about maybe what stage you are at if you are at any of them if you do want further support you can contact me on thepagedoctor.com where i give support and we have a team of consultants top consultants and top editors that can support you through the process of writing your research proposal or even through the post process of thinking about how you're going to find a gap in literature how you're going to find you know your hypothesis and define that for you so don't forget to leave me a comment and let me know if this was helpful and don't forget to leave me a thumbs up and subscribe to see more from me and I'll see you in my next one. Bye.

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Data are based on 2020 US Census estimated total resident population 18 years of age or older of 329 484 123 July 1, 2020. 21 Whiskers represent 95% CI. NSAIDs indicates nonsteroidal anti-inflammatory drugs.

eTable 1. Ingredient Identification Number and Supplement Identification Number Identified the 6 Potential Hepatotoxic Botanical Products

eTable 2. Botanical Products by Name (Alphabetical)

eFigure. Herbal and Dietary Supplement Use Among U.S. Adults Enrolled in NHANES 2017-2020

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The number of individuals (ie., sample size) using each herbal dietary supplement assessed in this study is too small, and even when the 6 supplements are inappropriately pooled, it is impossible to retain the national representation of NHANES. The U.S. CDC publishes guidelines on how to calculate the appropriate sample size for reliability of estimates (1).     Thus, no reliable conclusions can be made here without even getting into discussion of dose (which there are ways to quasi-estimate if you have an adequate sample size).

1. https://wwwn.cdc.gov/nchs/nhanes/tutorials/reliabilityofestimates.aspx

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Likhitsup A , Chen VL , Fontana RJ. Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults. JAMA Netw Open. 2024;7(8):e2425822. doi:10.1001/jamanetworkopen.2024.25822

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Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

• 1 Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan

Question   What percentage of US adults consume at least 1 of 6 potentially hepatotoxic botanical products?

Findings   In this survey study analyzing nationally representative data from 9685 adults, 4.7% of US adults reported exposure to 6 potentially hepatotoxic botanicals: turmeric was most frequently reported, followed in order by green tea, ashwagandha, Garcinia cambogia , red yeast rice, and black cohosh products. Botanical product users were significantly older, more educated, and more likely to have arthritis compared with nonusers.

Meaning   The results of this study suggest that clinicians should be aware of possible adverse events from consumption of these largely unregulated products.

Importance   Use of herbal and dietary supplements (HDSs) accounts for an increasing proportion of drug hepatotoxicity cases. Turmeric or curcumin, green tea extract, Garcinia cambogia , black cohosh, red yeast rice, and ashwagandha are the most frequently reported hepatoxic botanicals, but their prevalence and reasons for use in the general population are unknown.

Objective   To assess the prevalence and clinical characteristics of adult consumers of 6 potentially hepatoxic botanicals.

Design, Setting, and Participants   This survey study analyzed nationally representative data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional survey of the general US population. Prescription drug and HDS exposure data in the past 30 days were analyzed, and 2020 US Census data were used for population estimates. Data were analyzed July 1, 2023, to February 1, 2024.

Exposures   Adult NHANES participants enrolled between January 2017 and March 2020.

Main Outcomes and Measures   Baseline weighted characteristics of HDS users and users of 6 potentially hepatotoxic botanical products were compared with non–HDS users. Multivariable analysis was undertaken to identify factors associated with HDS use or at-risk botanical use.

Results   Among 9685 adults enrolled in this NHANES cohort, the mean (SE) age was 47.5 (0.5) years, and 51.8% (95% CI, 50.2%-53.4%) were female. The overall prevalence of HDS product use was 57.6% (95% CI, 55.9%-59.4%), while the prevalence of using the 6 botanicals of interest was 4.7% (95% CI, 3.9%-5.7%). Turmeric-containing botanicals were most commonly used (n = 236), followed by products containing green tea (n = 92), ashwagandha (n = 28), Garcinia cambogia (n = 20), red yeast rice (n = 20), and black cohosh (n = 19). Consumers of these 6 botanicals were significantly older (adjusted odds ratio [AOR], 2.36 [95% CI, 1.06-5.25]; P  = .04 for 40-59 years of age and AOR, 3.96 [95% CI, 1.93-8.11]; P  = .001 for ≥60 years of age), had a higher educational level (AOR, 4.78 [95% CI, 2.62-8.75]; P  < .001), and were more likely to have arthritis (AOR, 2.27 [95% CI, 1.62-3.29]; P  < .001) compared with non–HDS users. An estimated 15 584 599 (95% CI, 13 047 571-18 648 801) US adults used at least 1 of the 6 botanical products within the past 30 days, which was similar to the estimated number of patients prescribed potentially hepatotoxic drugs, including simvastatin (14 036 024 [95% CI, 11 202 460-17 594 452]) and nonsteroidal anti-inflammatory drugs (14 793 837 [95% CI, 13 014 623-16 671 897]). The most common reason for consuming turmeric and green tea was to improve or maintain health.

Conclusions and Relevance   In this survey study, an estimated 15.6 million US adults consumed at least 1 botanical product with liver liability within the past 30 days, comparable with the number of people who consumed nonsteroidal anti-inflammatory drugs and a commonly prescribed hypolipidemic drug. Given a lack of regulatory oversight on the manufacturing and testing of botanical products, clinicians should be aware of possible adverse events from consumption of these largely unregulated products.

Herbal and dietary supplements (HDSs) include a multitude of products consumed by millions of people every day to improve their general health and to treat minor ailments. Over 80 000 HDS products can be purchased without a prescription at various unregulated retail outlets or via the internet. 1 The largest group of HDS products used include multivitamins, minerals, vitamin D, omega-3 fatty acid, and calcium with well-defined ingredients on the label. However, an estimated 5% to 12% of HDS products are plant-derived, complex multi-ingredient botanicals. 2 , 3 Chemical analyses of HDS products associated with confirmed liver toxic effects show frequent discrepancies between product labels and detected ingredients. 3 The safety and efficacy of HDSs are not well established due to the lack of regulatory requirements by the US Food and Drug Administration for human pharmacokinetic or prospective clinical trials prior to marketing. 4

The Drug Induced Liver Injury Network (DILIN), a multicenter US observational program that collects and analyzes data from patients with hepatotoxic effects attributed to various drugs and HDS products, found that the proportion of DILI cases from HDSs nearly tripled from 7% in 2004 to 2005 to 20% in 2013 to 2014. 5 , 6 The most commonly implicated botanical products in the DILIN include turmeric, kratom, green tea extract, and Garcinia cambogia, with potentially severe and even fatal liver injury. 7 - 13 Furthermore, the multicenter Acute Liver Failure Study Group has also demonstrated that an increasing proportion of DILI-related acute liver failure cases were caused by HDSs, increasing from 12.4% in 1998 to 2007, to 21.1% in 2007 to 2015. 14

The National Health and Nutrition Examination Survey (NHANES) is a periodic, population-based study of the general US population that includes comprehensive data regarding HDS use. 15 In the current study, the proportion of NHANES patients who reported exposure to 6 potentially hepatotoxic botanicals—turmeric or curcumin, green tea, Garcinia cambogia , black cohosh, red yeast rice, and ashwagandha—were identified. 7 - 13 The clinical features and baseline demographics of these individuals along with their self-reported reasons for taking these products are reviewed herein and compared with non–HDS users. To determine population level estimates of exposure to these products, US census data were used.

This survey study used data from NHANES, a cross-sectional, nationally representative survey designed to monitor the health and nutrition of the civilian noninstitutionalized resident US population that has been conducted in 2-year cycles since 1999. 16 NHANES was approved by the research ethics review board of the US Centers for Disease Control and Prevention National Center for Health Statistics, with written informed consent obtained from all adult participants. NHANES collects data from interviews, standardized physical examinations, and analyses of obtained blood and other biological specimens. Due to the COVID-19 pandemic, data collection for the NHANES 2019-2020 cycle was interrupted. Therefore, for the present analysis, data collected from January 2019 to March 2020 among adults older than 18 years of age were combined with data from the NHANES 2017 to 2018 cycle to form a nationally representative sample of NHANES 2017 to March 2020 prepandemic data. 17 The crude response rates during 2017 to March 2020 were 51.4% for children and adolescents aged 2 to 19 years of age and 43.9% for adults aged 20 years or older. 17 All data used in this analysis were extracted from publicly available datasets. 18 This study followed the American Association for Public Opinion Research ( AAPOR ) reporting guideline for survey studies.

Information on participant age, sex, race and ethnicity, marital status, educational level, family income to poverty level index, and medical history were collected through questionnaires. Race and ethnicity data were collected because of a potential difference in the prevalence of HDS use. Race and ethnicity were based on self-report and were categorized as Mexican and non-Mexican Hispanic, non-Hispanic Asian (persons having origins in any of the original peoples of East Asia, Southeast Asia, or Indian subcontinent), non-Hispanic Black or African American, non-Hispanic White, and other (eg, American Indian, Alaska Native, Native Hawaiian, Pacific Islander, >1 race, or any other race). HDS and prescription drug use data were collected through personal interviews for the 30-day period prior to the survey date. The use of HDSs reported in NHANES 2017 to 2018 and 2019 to 2020 is detailed in the NHANES Dietary Supplement Database 1999-2020. 19 An HDS ingredient was classified as a botanical if it is part of plant, tree, shrub, or herb. We targeted our analysis to investigate national levels of exposure to the 6 most frequently implicated causes of HDS-DILI cases in the DILIN. 7 - 13 The 6 potentially hepatotoxic botanicals of interest in our study, including turmeric or curcumin, green tea, Garcinia cambogia , black cohosh, red yeast rice, and ashwagandha, were identified by their ingredient and supplement identification numbers (eTable 1 in Supplement 1 ). However, the daily dose of an HDS product consumed by an individual patient was not recorded or available for analysis. Furthermore, confirmation of the ingredients listed on HDS product labels via analytical chemistry methods was also not available.

Approximately 95% of adults 18 years or older provided blood samples at the mobile examination centers. The blood samples were tested at central laboratories using standard protocols to determine routine laboratory parameters (eg, complete blood count, comprehensive panel) as well as fasting glycated hemoglobin, cholesterol, and triglyceride levels.

Echosens North America Vibration-Controlled Transient Elastography was performed at the mobile examination centers by NHANES technicians. Controlled attenuation parameter was used to quantify the presence and severity of hepatic steatosis. Similarly, the liver stiffness measurement score in kilopascals was used to estimate the severity of hepatic fibrosis. 20

Self-reported chronic medical conditions that were specifically captured were current or prior history of hypertension, diabetes, coronary heart disease, stroke, arthritis, chronic obstructive pulmonary disease, thyroid disorder, cancer, and liver condition. Liver conditions included viral, autoimmune, genetic liver disease, drug- or medication-induced liver disease, alcoholic liver disease, metabolic dysfunction–associated steatotic liver disease (formerly nonalcoholic fatty liver disease), liver cyst, liver abscess, and cirrhosis. Smokers were defined as individuals who smoked 100 or more cigarettes. Regular alcohol consumption was defined as mean alcohol consumption in the past 12 months of 1 or more alcoholic beverages per day for women and 2 or more alcoholic beverages per day for men.

Data from the 2020 US Census were used to estimate the size with associated 95% CIs of the resident population 18 years of age or older. 21 The prevalence of use of the 6 at risk botanicals was compared with the prevalence of widely prescribed potentially hepatotoxic medications with a LiverTox likelihood score of A or B, which included nonsteroidal anti-inflammatory drugs (NSAIDs), sertraline (antidepressant drug), and simvastatin (hypolipidemic drug). 22 , 23 The NSAID prescriptions included ibuprofen, naproxen, meloxicam, celecoxib, indomethacin, ketorolac, piroxicam, and sulindac. The LiverTox likelihood score is a 5-point scale (A to E) that estimates whether a medication is a cause of liver injury: A indicates well-known cause, with more than 50 published cases; B, highly likely cause, with 12 to 49 published cases; C, probable cause, with 4 to 11 published cases; D, possible cause, with 1 to 3 published cases; E, unlikely cause; E b , suspected but unproven cause; and X, unknown. 23

The complex survey design factors in the NHANES, including sample weights, clustering, and stratification, were accounted for as specified in the NHANES statistical analysis guideline. 17 Baseline weighted characteristics were compared and summarized as estimated percentages or means, with a margin of error, following the AAPOR reporting guidance for survey studies. 24 Categorical variables were compared using Fisher exact tests or χ 2 tests if more than 2 categories existed, and continuous variables were compared using the t test. Multivariable analysis of factors that had a value of P  < .10 with univariate analysis was performed to evaluate for factors associated with any HDS use as well as botanical products of interest exposure, adjusted for age group, sex, race and ethnicity, marital status, alcohol use, smoking, poverty index, and educational level. Each chronic medical condition was analyzed after adjusting for age, sex, race and ethnicity, marital status, alcohol use, smoking, income, and educational level. Odds ratios (ORs) and 95% CIs are reported. Median numbers of HDS products and prescription drugs were compared using Mann-Whitney tests. All statistical analyses were conducted from July 1, 2023, to February 1, 2024, using STATA/SE version 16.1 (StataCorp LLC). A 2-sided P  < .05 was considered statistically significant.

Among 9685 adults enrolled in this NHANES cohort, the mean (SE) age was 47.5 (0.5) years, 4971 (51.8% [95% CI, 50.2-53.4]) were female, 4714 (48.2% [95% CI, 46.6-49.8]) were male, 2121 (16.3% [95% CI, 13.5%-19.6%]) were Mexican or non-Mexican Hispanic, 1169 (5.9% [95% CI, 4.3%-8.2%]) were non-Hispanic Asian, 2552 (11.5% [95% CI, 8.8%-14.7%]) were non-Hispanic Black, 3369 (62.2% [95% CI, 57.1%-67.0%]) were non-Hispanic White, and 474 (4.1% [95% CI, 3.4%-4.8%]) were other race or ethnicity ( Table 1 ). Overall, 5271 adults (57.6% [95% CI, 55.9%-59.4%]) reported using at least 1 HDS product within the past 30 days. HDS users were significantly older (mean [SE] age, 51.9 [0.7] vs 41.5 [0.4] years; P  < .001) and more likely to be female (57.7% [95% CI, 55.2%-60.1%] vs 43.7% [95% CI, 42.5%-45.0]; P  < .001), non-Hispanic White (67.6% [95% CI, 62.5%-72.4%] vs 54.8% [95% CI, 49.1%-60.3%]; P  < .001), married (63.5% [95% CI, 59.7%-67.0%] vs 59.0% [95% CI, 57.0%-60.9%]; P  < .001), and have a higher level of education (68.6% [95% CI, 66.0%-72.0%] vs 52.6% [95% CI, 50.9%-59.2%]; P  < .001) compared with non–HDS users. HDS users were also less likely to smoke (39.6% [95% CI, 36.8%-42.4%] vs 44.1% [95% CI, 40.7%-47.5%]; P  = .03) and less likely to be below the poverty line (9.5% [95% CI, 7.6%-11.8%] vs 18.3% [95% CI, 16.0%-20.7%]; P  < .001), indicative of a higher socioeconomic status. Body mass index (calculated as weight in kilograms divided by height in meters squared; mean [SE], 29.7 [0.2] vs 29.9 [0.2]; P  = .37) and history of alcohol use (87.2% [95% CI, 85.0%-89.0%] vs 86.3% (95% CI, 83.4%-88.8%; P  = .63) were similar in the 2 groups.

Consistent with their increased age, HDS users were significantly more likely to have hypertension, diabetes, coronary heart disease, stroke, arthritis, thyroid disorder, cancer, and liver conditions compared with non–HDS users. The median (range) number of HDS products used within 30 days was 1 (1-22). HDS users were also significantly more likely than non–HDS users to be taking a concomitant prescription medication (70.1% [95% CI, 67.7%-72.4%] vs 42.2% [95% CI, 39.5%-44.9%]; P  < .001).

Consistent with their higher prevalence of diabetes, HDS users had significantly higher hemoglobin A 1C and total cholesterol levels, but they had lower triglyceride levels. Furthermore, HDS users tended to have lower serum alanine aminotransferase and alkaline phosphatase levels compared with non–HDS users ( Table 1 ). However, there was no significant difference for controlled attenuation parameter or liver stiffness measurement scores between the 2 groups.

In total, 731 of 9685 US adults assessed (7.5%) used a botanical-containing HDS product within the last 30 days, and 350 participants (4.7% [95% CI, 3.9%-5.7%]) used at least 1 of the 6 botanical products of interest within the past 30 days (eFigure in Supplement 1 ). The most commonly used potentially hepatotoxic botanical products were turmeric or curcumin (n = 236) and green tea (n = 92), followed by ashwagandha (n = 28), Garcinia cambogia (n = 20), red yeast rice (n = 20), and black cohosh (n = 19). The number of unique products was 118 for turmeric, 26 for ashwagandha, 66 for green tea, 13 for Garcinia cambogia , 11 for black cohosh, 10 for red yeast rice, and 275 for other botanicals (eTable 2 in Supplement 1 ). Among 350 patients, 291 had exposure to only 1 of the 6 botanicals, 51 had exposure to 2 botanicals, and 8 had exposure to 3 or more.

Characteristics of the 6 potentially hepatotoxic botanical users (n = 350) were compared with those with no HDS use (n = 4414) ( Table 2 ). At-risk botanical users were significantly older (mean [SE] age, 51.7 [2.0] vs 41.5 [0.4] years; P  < .001) and more likely to be female (56.9% [95% CI, 47.7%-65.5%] vs 43.7% [95% CI, 42.5%-45.0%]; P  = .005), non-Hispanic White (75.2% [95% CI, 65.4%-82.9%] vs 54.8% [95% CI, 49.1%-60.3%]; P  < .001), married (66% [95% CI, 58.5%-72.7%] vs 59.0% [95% CI, 57.0%-60.9%]; P  = .001), and have some college degree or higher (82.8% [95% CI, 76.7%-87.5%] vs 52.6% [95% CI, 50.9%-59.2%]; P  < .001), and were less likely to be below the poverty line (5.1% [95% CI, 3.0%-8.8%] vs 18.3% [95% CI, 16.0%-20.7%]; P  < .001). Among at-risk botanical users, the median number of HDS products used was 4 (range, 2-7) and was highest among those who consumed red yeast rice and ashwagandha (median [IQR], 7 [4-11]). Individuals who used at least 1 the 6 botanicals of interest were also more likely to be taking a prescription medication compared with non–HDS users (66.0% [95% CI, 58.9%-71.8%] vs 42.0% [95% CI, 39.5%-44.9%]; P  < .001). Furthermore, the botanical users were more likely to have arthritis (40.0% [95% CI, 32.4%-48.1%] vs 19.5% [95% CI, 17.7%-21.4%]; P  < .001), thyroid disorder (15.8% [95% CI, 11.0%-22.1%] vs 6.8% [95% CI, 5.6%-8.1%]; P  = .004), and cancer (14.0% [95% CI, 9.7%-19.6%] vs 6.8% [95% CI, 5.6%-8.3%]; P  = .006) compared with non–HDS users.

Laboratory parameters were generally similar, but at-risk botanical users had significantly lower triglyceride and alkaline phosphatase levels ( Table 2 ). However, there was no significant difference for glycated hemoglobin, serum aminotransferase levels or liver elastography parameters.

Independent factors associated with HDS use included older age (adjusted OR [AOR], 1.77 [95% CI, 1.36-2.32]; P  < .001 for 40-59 years; AOR, 3.97 [95% CI, 2.99-5.28]; P  < .001 for ≥60 years,), female sex (AOR, 1.76 [95% CI, 1.42-2.18]; P  < .001), non-Hispanic White race and ethnicity (AOR, 1.25 [95% CI, 1.04-1.49]; P  = .02), poverty ratio higher than 1 (AOR, 1.41 [95% CI, 1.11-1.77]; P  = .006), and some college education (AOR, 2.02 [95% CI, 1.61-2.52]; P  < .001) ( Table 3 ). In addition, the presence of hypertension (AOR, 1.37 [95% CI, 1.11-1.70]; P  < .001), diabetes (AOR, 1.55 [95% CI, 1.21-1.97]; P  < .001), arthritis (AOR, 1.31 [95% CI, 1.13-1.52]; P  = .001) and thyroid disorder (AOR, 1.60 [95% CI, 1.13-2.25]; P  = .01) remained significantly associated with HDS use after adjusting for age, sex, race and ethnicity, marital status, smoking, income, and education level. Features associated with at-risk botanical users included older age (AOR, 2.36 [95% CI, 1.06-5.25]; P  = .04 for 40-59 years of age; AOR, 3.96 [95% CI, 1.93-8.11]; P  = .001 for age ≥60 years), some college education (AOR, 4.78 [95% CI, 2.62-8.75]; P  < .001), and the presence of arthritis (AOR, 2.27 [95% CI, 1.62-3.29]; P  < .001) after adjusting for other covariates ( Table 3 ).

The vast majority of at-risk botanical users were doing so of their own accord, and use of these products was not recommended by their health care providers (87.6% [95% CI, 82.8%-91.9%] for turmeric; 80.4% [95% CI, 63.8%-92.8%] for green tea; 100% for Garcinia cambogia ; 63.2% [ 95% CI, 23.5%-82.5%] for black cohosh; 40% [95% CI, 39.9%-92.2%] for red yeast rice; and 96.4% [95% CI, 75.8%-99.7%] for ashwagandha). The most common reasons for using the botanical were to improve or maintain health or to prevent health problems or boost immunity ( Figure 1 ). In addition, 64 turmeric users (26.8%) consumed those products for joint health or arthritis, and 25 green tea users (27.2%) were trying to improve their energy level. In total, 14 Garcinia cambogia users (70.0%) were trying to lose weight and had the highest median body mass index and proportion with diabetes (34.2% [95% CI, 13.7%-63.1%]) ( Table 2 ). Similarly, 84.2% of black cohosh users were taking these products to treat hot flashes, and the vast majority of these patients were women (87.5% [95% CI, 42.9%-98.5%]). The main stated reason to consume red yeast rice was for heart health (90.0%), and these individuals tended to be older and had the second highest incidence of diabetes.

Extrapolating from the NHANES data, we observed approximately 4.7% (95% CI, 4.0%-5.7%), or an estimated 15 584 599 (95% CI, 13 047 571-18 648 801), of US adults used at least 1 of the 6 potentially hepatotoxic botanical products within the past 30 days. The most common products used were turmeric or curcumin, estimated at 11 400 151 (95% CI, 906 813-14 332 559) adults, and green tea, estimated at 3 327 790 (95% CI, 2 306 389-4 777 520) adults. An estimated 1 252 040 (95% CI, 757 813-2 075 750) adults used ashwagandha, 1 219 091 (95% CI, 724 865-32 075 750) adults used black cohosh, 889 607 (95% CI, 494 226-1 581 524) adults used Garcinia cambogia , and 626 020 (95% CI, 362 433-1 120 246) adults used red yeast rice.

The prevalence of using the 6 potentially hepatotoxic botanical products was compared with the prevalence of the use of known hepatotoxic prescription medications (LiverTox class A or B) that are used for similar indications. Approximately 14 793 837 (95% CI, 13 014 623-16 671 897) US adults used prescription nonsteroidal anti-inflammatory drugs, which are typically used for indications similar to those for turmeric (ie, pain or arthritis). Simvastatin, a hypolipidemic drug used to treat and prevent cardiovascular disease similar to the use for red yeast rice, was consumed by 14 036 024 (95% CI, 11 202 460-17 594 452) individuals. The prevalence of sertraline use was 7 676 980 (95% CI, 6 523 786-8 994 917) individuals. The comparison of the botanical products of interest with commonly prescribed prescription medications is shown in Figure 2 (based on the 2020 US Census estimated total resident population 18 years of age or older of 329 484 123, July 1, 2020 21 ).

This survey study assessed the prevalence and clinical characteristics of consumers of the 6 most frequently reported hepatoxic botanicals, including turmeric or curcumin, green tea extract, Garcinia cambogia , black cohosh, red yeast rice, and ashwagandha, in a representative sample of US adults. We estimated that at least 15.6 million US adults used at least 1 of 6 potentially hepatotoxic botanical products within the past 30 days, which was similar to estimated number of US adults prescribed an NSAID or simvastatin.

The Dietary Supplement Health and Education Act (DSHEA) of 1994 defined an HDS as a product that contains a “dietary ingredient,” such as vitamins, minerals, herbs or botanicals, amino acids, and dietary substances that are intended to supplement the diet. 25 HDS use has dramatically increased over time in the United States. from 32.9% in the NHANES I cohort (1971-1974) to 52% in the NHANES 2011-2012 cohort and 57.6% in the NHANES 2017-2018 cohort. 2 , 26 The economic impact of the HDS products industry in the US is profound, with over $150 billion in marketplace sales in 2023, and rivals that of all prescription drugs combined. 27 The most common HDSs used are multivitamins or minerals, calcium, fish oil, botanical supplements, and vitamin C. 28 , 29 In the US, a variety of adverse events related to HDS use have been described, with an estimated 23 000 annual emergency department visits and 2154 hospitalizations in 2014. 30 The incidence of HDS-DILI is also increasing over time and accounts for over 20% of cases of liver injury recorded in the DILIN prospective registry. 7 The HDS-DILI can be not only severe, leading to hepatocellular injury with jaundice, but also fatal, leading to death or liver transplantation. 31 - 37 Kesar et al 35 reported the number of liver transplants due to HDS-DILI in 2010 through 2020 increased over 70% when compared with 1994 through 2009.

The prevalence of the use of potentially hepatotoxic botanical products rather than use of benign, non-hepatotoxic HDSs, such as vitamins and minerals, has not been systematically studied nor reported. The present study found that between January 2017 and March 2020, approximately 15 million US adults consumed at least 1 potentially hepatotoxic botanical product within the past 30 days, which was comparable to the number of people taking potentially hepatotoxic prescription drugs, such as simvastatin, NSAIDs, and sertraline ( Figure 2 ).

The clinical characteristics of the users of the 6 botanical products of interest were similar to overall HDS users, with older age, more women and non-Hispanic White individuals, higher income, and higher level of education among HDS users compared with non–HDS users. 38 - 40 Use of HDSs has also been shown to be more prevalent among individuals with chronic medical conditions, including cardiovascular disorders, cancer, and obesity. 26 , 40 - 47 In our study, we found diabetes, arthritis, and thyroid disorder independently associated with HDS use, but not cardiovascular disorder or cancer. Arthritis was independently associated with the use of the 6 potentially hepatotoxic botanical products and with overall HDS use ( Table 3 ).

The reasons for botanical use varied substantially by the specific products as well as the age, gender, and demographic features of the individual product users ( Table 2 and Figure 1 ). For example, turmeric-containing products were most commonly used for joint health or arthritis due to the widespread belief that turmeric may have antioxidant and anti-inflammatory properties as touted in ayurvedic medicine. 48 However, multiple randomized clinical trials have failed to demonstrate any efficacy of turmeric-containing products in osteoarthritis. 48 , 49 Green tea–containing products were mostly used as energy supplements. However, multiple studies have failed to demonstrate any objective evidence of weight loss and sustained improvement in mood or energy levels with products that contain high levels of catechins or polyphenols found in green tea extract. 50 - 52  Garcinia cambogia was commonly used for weight loss (70%), as it has been touted that hydroxycitric acid promotes weight loss. 53 Black cohosh was used for hot flashes, and ashwagandha was used as muscle builder.

In the United States, HDSs are regulated under the general umbrella of foods and are not intended to be taken for disease treatment or prevention. 54 , 55 Assuming that HDS products are generally safe similar to foods, the FDA does not require manufacturers to verify the ingredients in a given product or lot. But recent studies by DILIN have shown substantial discrepancies between product labels and the results of mass spectroscopy of the actual products. 3 In addition, human bioavailability and safety studies are not required prior to the marketing of an HDS product unless the formulation contains a novel chemical entity that was not known prior to 1994. The active ingredients and components in botanical products are even more challenging to standardize due to the impact of changes in soil, local environment, and batch to batch variation in plant or cultivar production. The majority of the at-risk botanical users in this study consumed these products without clinician recommendations presumably due to the touted benefits of the products being marketed. The number of HDS products marketed in the US increased from 4000 in 1993 to 55 000 in 2012, and approximately 80 000 products were available by 2022. 1 , 56

Our study has several important limitations. First, the survey response rate for the January 2017 to March 2020 prepandemic cohort was low, at 43.9% for adults aged 20 years or older. Since NHANES is a cross-sectional study, there was no opportunity to determine associations with clinical outcomes, such as episodes of idiosyncratic hepatotoxic effects. In addition, this survey sample size was not adequate to detect hepatotoxic effects from botanicals or other adverse events since these arise in less than 1% of exposed individuals. Thus, our study was not designed to identify any causal relationship between consumption of the 6 botanicals of interest and the development of liver injury over time. Lastly, use of HDS products and medications was obtained by self-report in NHANES and not independently verified by source documents. The ingredients data used in this study may be limited in accuracy due to poor governmental regulation and confirmation of the ingredients listed on the product label, given that previous analysis has shown discrepancies between product labels and detected ingredients. 3 However, NHANES is the largest available nationally representative database with detailed information regarding dietary supplement product usage in the United States.

This survey study found that in the NHANES 2017 to March 2020 study, over 7% of US adults used a botanical-containing HDS product within the last 30 days and that the 6 products most commonly implicated in liver injury in the US are popular among US adults and used as frequently as common hypolipidemic drugs, NSAIDs and antidepressants. In light of the lack of regulatory oversight on the manufacturing and testing of botanical products, it is recommended that clinicians obtain a full medication and HDS use history when evaluating patients with unexplained symptoms or liver test abnormalities. Considering widespread and growing popularity of botanical products, we urge government authorities to consider increasing the regulatory oversight on how botanicals are produced, marketed, tested, and monitored in the general population.

Accepted for Publication: June 6, 2024.

Published: August 5, 2024. doi:10.1001/jamanetworkopen.2024.25822

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Likhitsup A et al. JAMA Network Open .

Corresponding Author: Alisa Likhitsup, MD, MPH, Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, 3912 Taubman Center, 1500 E Medical Center Dr, SPC 5362, Ann Arbor, MI 48109 ( [email protected] ).

Author Contributions: Prof Fontana had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Likhitsup, Fontana.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Likhitsup, Fontana.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Likhitsup, Chen.

Administrative, technical, or material support: Fontana.

Supervision: Fontana.

Conflict of Interest Disclosures: Dr Chen reported receiving grants from Kowa, AstraZeneca, and Ipsen outside the submitted work. Dr Fontana reported receiving grants from Takeda Pharmaceutical Company and Kezar Life Sciences outside the submitted work. No other disclosures were reported.

Data Sharing Statement: See Supplement 2 .

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• NEWS EXPLAINER
• 28 August 2024

Mpox is spreading rapidly. Here are the questions researchers are racing to answer

• Sara Reardon

You can also search for this author in PubMed   Google Scholar

Monkeypox virus particles (shown in this coloured electron micrograph) can spread through close contact with people and animals. Credit: NIAID/Science Photo Library

When the World Health Organization (WHO) declared a public-health emergency over mpox earlier this month , it was because a concerning form of the virus that causes the disease had spread to multiple African countries where it had never been seen before. Since then, two people travelling to Africa — one from Sweden and one from Thailand — have become infected with that type of virus, called clade 1b, and brought it back to their countries.

Monkeypox virus: dangerous strain gains ability to spread through sex, new data suggest

Although researchers have known about the current outbreak since late last year, the need for answers about it is now more pressing than ever. The Democratic Republic of the Congo (DRC) has spent decades grappling with monkeypox clade I virus — a lineage to which Ib belongs. But in the past, clade I infections usually arose when a person came into contact with wild animals, and outbreaks would fizzle.

Clade Ib seems different, and is spreading largely through contact between humans, including through sex . Around 18,000 suspected cases of mpox, many of them among children, and at least 600 deaths potentially attributable to the disease have been reported this year in the DRC alone.

How does this emergency compare with one declared in 2022, when mpox cases spread around the globe? How is this virus behaving compared with the version that triggered that outbreak, a type called clade II? And will Africa be able to rein this one in? Nature talks with researchers about information they are rushing to gather.

Is clade Ib more deadly than the other virus types?

It’s hard to determine, says Jason Kindrachuk, a virologist at the University of Manitoba in Winnipeg, Canada. He says that the DRC is experiencing two outbreaks simultaneously. The clade I virus, which has been endemic in forested regions of the DRC for decades, circulates in rural regions where people get it from animals. That clade was renamed Ia after the discovery of clade Ib. Studies in animals suggest that clade I is deadlier than clade II 1 — but Kindrachuk says that it’s hard to speculate on what that means for humans at this point.

Even when not fatal, mpox can trigger fevers, aches and painful fluid-filled skin lesions.

Growing mpox outbreak prompts WHO to declare global health emergency

Although many reports state that 10% of clade I infections in humans are fatal, infectious-disease researcher Laurens Liesenborghs at the Institute of Tropical Medicine in Antwerp, Belgium, doubts that this figure is accurate. Even the WHO’s latest estimate of a 3.5% fatality rate for people with mpox in the DRC might be high.

There are many reasons that fatality estimates might be unreliable, Liesenborghs says. For one, surveillance data captures only the most severe cases; many people who are less ill might not seek care at hospitals or through physicians, so their infections go unreported.

Another factor that can confound fatality rates is a secondary health condition. For example, people living with HIV — who can represent a large proportion of the population in many African countries — die from mpox at twice the rate of the general population 2 , especially if their HIV is untreated. And the relatively high death rate among children under age 5 could be partly because of malnutrition, which is common among kids in rural parts of the DRC, Liesenborghs says.

Is clade Ib more transmissible than other types?

The clade 1b virus has garnered particular attention because epidemiological data suggest that it transmits more readily between people than previous strains did, including through sexual activity, whereas clade Ia mostly comes from animals. An analysis posted ahead of peer review on the preprint server medRxiv 3 shows that clade Ib’s genome contains genetic mutations that seem to have been induced by the human immune system, suggesting that it has been in humans for some time. Clade Ia genomes have fewer of these mutations.

But Liesenborghs says that the mutations and clades might not be the most important factor in understanding how monkeypox virus spreads. Although distinguishing Ia from Ib is useful in tracking the disease, he says, the severity and transmissibility of the disease could be affected more by the region where the virus is circulating and the people there. Clade Ia, for instance, seems to be more common in sparsely populated rural regions where it is less likely to spread far. Clade Ib is cropping up in densely populated areas and spreading more readily.

Jean Nachega, an infectious-disease physician at the University of Pittsburgh in Pennsylvania, says that scientists don’t understand many aspects of mpox transmission — they haven’t even determined which animal serves as a reservoir for the virus in the wild, although rodents are able to carry it. “We have to be very humble,” Nachega says.

How effective are vaccines against the clade I virus?

Just as was the case during the COVID-19 pandemic, health experts are looking to vaccines to help curb this mpox outbreak. Although there are no vaccines designed specifically against the monkeypox virus, there are two vaccines proven to ward off a related poxvirus — the one that causes smallpox. Jynneos, made by biotechnology company Bavarian Nordic in Hellerup, Denmark, contains a type of poxvirus that can’t replicate but can trigger an immune response. LC16m8, made by pharmaceutical company KM Biologics in Kumamoto, Japan, contains a live — but weakened — version of a different poxvirus strain.

Hopes dashed for drug aimed at monkeypox virus spreading in Africa

Still, it’s unclear how effective these smallpox vaccines are against mpox generally. Dimie Ogoina, an infectious-disease specialist at Niger Delta University in Wilberforce Island, Nigeria, points out that vaccines have been tested only against clade II virus in European and US populations, because these shots were distributed by wealthy nations during the 2022 global outbreak . And those recipients were primarily young, healthy men who have sex with men, a population that was particularly susceptible during that outbreak. One study in the United States found that one dose of Jynneos was 80% effective at preventing the disease in at-risk people, whereas two doses were 82% effective 4 ; the WHO recommends getting both jabs.

People in Africa infected with either the clade Ia or 1b virus — especially children and those with compromised immune systems — might respond differently. However, one study in the DRC found that the Jynneos vaccine generally raised antibodies against mpox in about 1,000 health-care workers who received it 5 .

But researchers are trying to fill in some data gaps. A team in the DRC is about to launch a clinical trial of Jynneos in people who have come into close contact with the monkeypox virus — but have not shown symptoms — to see whether it can prevent future infection, or improve outcomes if an infection arises.

Will the vaccines help to rein in the latest outbreak?

Mpox vaccines have been largely unavailable in Africa, but several wealthy countries have pledged to donate doses to the DRC and other affected African nations. The United States has offered 50,000 Jynneos doses from its national stockpile, and the European Union has ordered 175,000, with individual member countries pledging extra doses. Bavarian Nordic has also added another 40,000. Japan has offered 3.5 million doses of LC16m8 — for which only one jab is recommended instead of two.

Monkeypox in Africa: the science the world ignored

None of them have arrived yet, though, says Espoir Bwenge Malembaka, an epidemiologist at the Catholic University of Bukavu in the DRC. Low- and middle-income nations cannot receive vaccines until the WHO has deemed the jabs safe and effective. And the WHO has not given its thumbs up yet. It is evaluating data from vaccine manufacturers, delaying donors’ ability to send the vaccines.

Even when the vaccines arrive, Bwenge Malembaka says, “it’s really a drop in the bucket”. The African Centres for Disease Control and Prevention in Addis Ababa, Ethiopia, estimates that 10 million doses are needed to rein in the outbreak.

Bwenge Malembaka says that the uncertainty over vaccine arrival has made it difficult for the government to form a distribution plan. “I don’t know how one can go about this kind of challenge,” he says. Bwenge Malembaka suspects that children are likely to receive doses first, because they are highly vulnerable to clade I, but officials haven’t decided which regions to target. It’s also unclear how the government would prioritize other vulnerable populations such as sex workers, who have been affected by clade Ib. Their profession is criminalized in the DRC, so they might not be able to come forward for treatment.

Researchers lament that public-health organizations didn’t provide vaccines and other resources as soon as the clade I outbreak was identified, especially given lessons learnt from the 2022 global mpox outbreak. “The opportunity was there a couple months ago to cut this transmission chain, but resources weren’t available,” Liesenborghs says. “Now, it will be more challenging to tackle this outbreak, and the population at risk is much broader.”

doi: https://doi.org/10.1038/d41586-024-02793-9

Americo, J. L., Earl, P. L. & Moss, B. Proc. Natl Acad. Sci. USA 120 , e2220415120 (2023).

Article   PubMed   Google Scholar  

Yinka-Ogunleye, A. et al. BMJ Glob. Health 8 , e013126 (2023).

Kinganda-Lusamaki, E. et al. Preprint at medRxiv https://doi.org/10.1101/2024.08.13.24311951 (2024).

Yeganeh, N. et al. Vaccine 42 , 125987 (2024).

Priyamvada, L. et al. Vaccine 40 , 7321–7327 (2022).

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• v.95(1); 2013 Jan

A quick guide to survey research

1 University of Cambridge,, UK

2 Cambridge University Hospitals NHS Foundation Trust,, UK

Questionnaires are a very useful survey tool that allow large populations to be assessed with relative ease. Despite a widespread perception that surveys are easy to conduct, in order to yield meaningful results, a survey needs extensive planning, time and effort. In this article, we aim to cover the main aspects of designing, implementing and analysing a survey as well as focusing on techniques that would improve response rates.

Medical research questionnaires or surveys are vital tools used to gather information on individual perspectives in a large cohort. Within the medical realm, there are three main types of survey: epidemiological surveys, surveys on attitudes to a health service or intervention and questionnaires assessing knowledge on a particular issue or topic. 1

Despite a widespread perception that surveys are easy to conduct, in order to yield meaningful results, a survey needs extensive planning, time and effort. In this article, we aim to cover the main aspects of designing, implementing and analysing a survey as well as focusing on techniques that would improve response rates.

Clear research goal

The first and most important step in designing a survey is to have a clear idea of what you are looking for. It will always be tempting to take a blanket approach and ask as many questions as possible in the hope of getting as much information as possible. This type of approach does not work as asking too many irrelevant or incoherent questions reduces the response rate 2 and therefore reduces the power of the study. This is especially important when surveying physicians as they often have a lower response rate than the rest of the population. 3 Instead, you must carefully consider the important data you will be using and work on a ‘need to know’ rather than a ‘would be nice to know’ model. 4

After considering the question you are trying to answer, deciding whom you are going to ask is the next step. With small populations, attempting to survey them all is manageable but as your population gets bigger, a sample must be taken. The size of this sample is more important than you might expect. After lost questionnaires, non-responders and improper answers are taken into account, this sample must still be big enough to be representative of the entire population. If it is not big enough, the power of your statistics will drop and you may not get any meaningful answers at all. It is for this reason that getting a statistician involved in your study early on is absolutely crucial. Data should not be collected until you know what you are going to do with them.

Directed questions

After settling on your research goal and beginning to design a questionnaire, the main considerations are the method of data collection, the survey instrument and the type of question you are going to ask. Methods of data collection include personal interviews, telephone, postal or electronic ( Table 1 ).

Advantages and disadvantages of survey methods

Collected data are only useful if they convey information accurately and consistently about the topic in which you are interested. This is where a validated survey instrument comes in to the questionnaire design. Validated instruments are those that have been extensively tested and are correctly calibrated to their target. They can therefore be assumed to be accurate. 1 It may be possible to modify a previously validated instrument but you should seek specialist advice as this is likely to reduce its power. Examples of validated models are the Beck Hopelessness Scale 5 or the Addenbrooke’s Cognitive Examination. 6

The next step is choosing the type of question you are going to ask. The questionnaire should be designed to answer the question you want answered. Each question should be clear, concise and without bias. Normalising statements should be included and the language level targeted towards those at the lowest educational level in your cohort. 1 You should avoid open, double barrelled questions and those questions that include negative items and assign causality. 1 The questions you use may elicit either an open (free text answer) or closed response. Open responses are more flexible but require more time and effort to analyse, whereas closed responses require more initial input in order to exhaust all possible options but are easier to analyse and present.

Questionnaire

Two more aspects come into questionnaire design: aesthetics and question order. While this is not relevant to telephone or personal questionnaires, in self-administered surveys the aesthetics of the questionnaire are crucial. Having spent a large amount of time fine-tuning your questions, presenting them in such a way as to maximise response rates is pivotal to obtaining good results. Visual elements to think of include smooth, simple and symmetrical shapes, soft colours and repetition of visual elements. 7

Once you have attracted your subject’s attention and willingness with a well designed and attractive survey, the order in which you put your questions is critical. To do this you should focus on what you need to know; start by placing easier, important questions at the beginning, group common themes in the middle and keep questions on demographics to near the end. The questions should be arrayed in a logical order, questions on the same topic close together and with sensible sections if long enough to warrant them. Introductory and summary questions to mark the start and end of the survey are also helpful.

Pilot study

Once a completed survey has been compiled, it needs to be tested. The ideal next step should highlight spelling errors, ambiguous questions and anything else that impairs completion of the questionnaire. 8 A pilot study, in which you apply your work to a small sample of your target population in a controlled setting, may highlight areas in which work still needs to be done. Where possible, being present while the pilot is going on will allow a focus group-type atmosphere in which you can discuss aspects of the survey with those who are going to be filling it in. This step may seem non-essential but detecting previously unconsidered difficulties needs to happen as early as possible and it is important to use your participants’ time wisely as they are unlikely to give it again.

Distribution and collection

While it should be considered quite early on, we will now discuss routes of survey administration and ways to maximise results. Questionnaires can be self-administered electronically or by post, or administered by a researcher by telephone or in person. The advantages and disadvantages of each method are summarised in Table 1 . Telephone and personal surveys are very time and resource consuming whereas postal and electronic surveys suffer from low response rates and response bias. Your route should be chosen with care.

Methods for maximising response rates for self-administered surveys are listed in Table 2 , taken from a Cochrane review.2 The differences between methods of maximising responses to postal or e-surveys are considerable but common elements include keeping the questionnaire short and logical as well as including incentives.

Methods for improving response rates in postal and electronic questionnaires 2

• – Involve a statistician early on.
• – Run a pilot study to uncover problems.
• – Consider using a validated instrument.
• – Only ask what you ‘need to know’.
• – Consider guidelines on improving response rates.

The collected data will come in a number of forms depending on the method of collection. Data from telephone or personal interviews can be directly entered into a computer database whereas postal data can be entered at a later stage. Electronic questionnaires can allow responses to go directly into a computer database. Problems arise from errors in data entry and when questionnaires are returned with missing data fields. As mentioned earlier, it is essential to have a statistician involved from the beginning for help with data analysis. He or she will have helped to determine the sample size required to ensure your study has enough power. The statistician can also suggest tests of significance appropriate to your survey, such as Student’s t-test or the chi-square test.

Conclusions

Survey research is a unique way of gathering information from a large cohort. Advantages of surveys include having a large population and therefore a greater statistical power, the ability to gather large amounts of information and having the availability of validated models. However, surveys are costly, there is sometimes discrepancy in recall accuracy and the validity of a survey depends on the response rate. Proper design is vital to enable analysis of results and pilot studies are critical to this process.

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