Beware the pitfalls of ill-placed questions – revisiting questionnaire ordering

Abstract

One of the early lessons of good questionnaire design is the ordering of the questions – making sure that bias is not introduced by the inappropriate placement of a question or series of questions. Sometimes the bias can be intentional when questions are strategically placed in order to infl uence the respondent’s response and encourage recall (Sudman et al. 1996). This is usually the exception – not the rule. A lesson learnt and willingly shared involves the placement of a single question asking respondents to rate their overall health. The use of a single question is increasingly being used as other measures of overall health status and functioning can be lengthy and diffi cult to interpret and score. A general health question often used is the fi rst question of the MOS Short Form 36 (SF36) (Ware & Sherbourne 1992), and is commonly referred to as the SF1. The SF1 refers to physical and mental health, as assessed by individuals, according to their own values, and has been found to be a strong indicator of future health care use and mortality (McCallum et al. 1994). Based on fundamentals of good survey design that the questionnaire should start with “something easy” so as to build respondent confi dence and rapport (Dillman 1978; O’Rourke 2001), the SF1 has been included in many South Australian (SA) telephone surveys – usually as the fi rst health question. This question is deemed to be of interest, non-threatening and easy to answer (Trochim 2000).