Designing Surveys

Assessing current health status and health behaviors may point to the need for particular health education programs. Some organizations may find web-based surveys convenient, while other organizations may feel that their employee population is less likely to respond to a survey or questionnaire and so individual or group interviews may be more practical.

Survey format options

It is important to select a method that works for the particular organization, as response rates and honesty will contribute to meaningful information for program and policy decisions. See table below for detailed pros and cons for each potential format.

Survey Format Options⁸

Type	Pros	Cons
Paper and Pencil Questionnaire (In-Person)	-Tangible survey that can less easily be lost in an email inbox -Respondents more likely to complete during work than at home -Completed surveys stored in one place -Can be anonymous or confidential	-Limited to responses from just those who are on-site -possible bias -Respondents must be able to read, see, or write or have access to accommodations to assist individuals with these limitations -Respondents can jump from section to section to complete the survey
Postal/Email Questionnaire	-Can reach a large geographical area (e.g., multiple work sites) -People are used to completing paper-and-pencil surveys -Can take the survey and complete it anywhere and anytime	-No clarification available during completion -Need a motivated population to return the survey -Respondents must be able to read, see, or write or have access to accommodations to assist individuals with these limitations -Need functioning email address or permanent address
Web-Based Tool	-Order of questions can be preprogrammed -Only “acceptable” answers are allowed (validation) -Can give respondent links that give additional explanation -Data are automatically entered in a database and can be automatically analyzed OR exported to other software programs -Can easily track user response rate OR choose anonymous -Progress bar to inform respondents of the percentage completed -Require the question to be answered	-Need reliable access to Internet – Respondent must be “online” – System can go down or be unreliable -Respondents must be able to use a computer, a mouse, and/or keyboard or have access to accommodations to assist individuals with these limitations
Face-to-Face Interviews	-High rate of survey completion -Can explore qualitative answers with respondents for clarification -Can assist respondents with unfamiliar words or questions -Able to get more qualitative data	-Difficult to reach certain populations -Expensive and time consuming -Some may feel reluctant to share personal information or beliefs -Need trained interviewers -Must find a suitable place to conduct interview – Interviewer bias (verbal or nonverbal)
Focus Groups	-Generate, explore, and identify key ideas/concepts -Read non-verbal feedback -Can assist respondents with unfamiliar words or questions -Questions can be asked as they arise -Respondents can build on others’ comments	-Bias / Small Group -Quality of data influenced by the moderator -Some may feel reluctant to share personal information or beliefs -Need trained interviewers or moderators -Must find a suitable place to conduct interview

Employee demographic profiles

Employee health surveys can provide a relatively low cost method to gather information and can yield reasonably informative data at the worksite level. They provide a way to reach a large number of employees, and can be quite helpful for planning.

With that idea in mind, there are a few additional considerations to think about when designing health-related employee self-assessment surveys.

An organization might begin by creating a general demographics profile of the employees gathered from human resources or payroll departments, including:

Gender
Age
Job Type
Number of employees per business unit
Education
Race/Ethnicity
Marital status/children
Employee length of service

Further information about employee demographics may be solicited in the employee survey, but it is important to remember that this data will only be representative of survey respondents, not the entire employee population.

Survey topic areas

Decide the topic areas on which to focus the survey questions. Validated survey tools or individual survey questions should be used to aid with analysis and evaluation. When choosing topics areas, some possibilities include:

Health status
- Self-perceived general health status (i.e., poor to excellent)
- Number of days per month impaired by poor physical/mental health
- Specific questions about diseases or health conditions (e.g., high blood pressure, high cholesterol, asthma, arthritis, stress)
Use of preventive health services
- Doctor visits
- Dental visits
- Flu vaccines
- Blood pressure and cholesterol checks
- Colonoscopies, mammograms, and PAP smears
Health behaviors
- Tobacco Use – current smokers or other tobacco use, tobacco cessation
- Diet and Physical Activity – weight and height (to calculate Body Mass Index); self-perceptions of weight; fruit/vegetable consumption; activity level at work; recent moderate/vigorous activity outside of the job
- Alcohol Consumption – drinks per week; drinks per sitting
- Safety – seatbelt use

Use validated and tested survey tools and questions

Plan for comparisons to statewide or national samples using such surveys as the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS)
These comparisons will allow organizations to see if their employees demonstrate better or worse health profiles than the population as a whole. To make the comparison, the best strategy is to use the same items or minor modifications of the items used in the state and/or national surveys.
Use existing or modified versions of existing surveys
Questions can be drawn from established surveys (as mentioned above to create comparisons) such as:

The employer may suspect that specific health issues are particularly prevalent in the employee population. In this case, additional modules or questions may be added to a broad-based employee health survey and target specific issues such as depression.

In addition to the surveys mentioned above, there are several surveys available that delve deeper into issues that affect the workplace. These surveys may be proprietary and may require a modest fee to use. The Patient Health Questionnaire 9 symptom checklist (PHQ-9) questionnaire focuses on depression, the Physical Activity Readiness Questionnaire (PAR-Q) assesses an individual’s need to consult with a physician before beginning a physical activity program, and the Work Limitations Questionnaire (WLQ), addresses general work limitations. These types of surveys may need to be administered by qualified health professionals and conducted in face-to-face situations with employees rather than using other survey methods.

Using one or many of the above surveys can most appropriately tailor the employee questionnaire to the employee population and their related health issues. Generalized surveys like the BRFSS, NHANES, and NIOSH surveys can provide an overall ‘report card’ of the workforce’s health, while alternating questions from the specific modules such as PHQ-9, PAR-Q, and WLQ can help investigate and elaborate on suspected or established health problems, such as depression, within the workforce.