Form 0920-0214 Methodological Projects

Attachment 7 - Methodological Projects

Form Approved OMB Number 0920-0214 Expires: xx/xx/20xx
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The Division of Health Interview Statistics (DHIS) is implementing a redesigned survey instrument beginning
in January 2019. New rotating and supplemental content will be introduced in the survey in 2020. For
example, a new survey module about injuries will be introduced in the 2020 NHIS. The NHIS team is currently
in the process of designing these questions and considering the best way to ask about injuries on a person
level rather than injury event level. To inform and support decision making for these types of development
activities, a number of short, web- and/or mail-based, quick-turnaround methodological, cognitive and field
testing projects are anticipated for 2018.
The aims of these projects are to test new and updated questionnaire items, evaluate the impact of
different response options on response frequencies, and measure respondents’ comprehension of health
care-related terms and concepts. To this end, these projects will build on information learned in prior NHIS
follow-back surveys and methodological research. We outline research below.
Research using a commercial web panel
Respondents from commercial web panels can be used to test conceptual understanding of key terms in
surveys. DHIS previously tested web panel respondents’ comprehension of key terms related to health
insurance through a brief web questionnaire that took approximately 10 minutes to complete. For example,
respondents were asked questions to measure their understanding of deductibles, co-pays, and premiums.
We would like to continue to use this method to aid in the development of new and revised content in the
redesigned questionnaire.

Follow-back surveys with NHIS respondents
DHIS has obtained e-mail addresses from respondents who completed the NHIS. This information can be used
to recontact NHIS respondents to participate in additional follow-back surveys where we can test new
versions of survey questions. This would involve testing components of the full NHIS instrument with new or
revised content, or penetration and uptake of different, innovative modes of collecting data. Specifically, we
would use follow-back surveys to explore the following research questions:
1. How does alternate question wording affect respondent comprehension of the constructs to be
measured?
2. What is the test/retest reliability of newly-developed questions?
3. What are preferred answer choices for categorical questions?
4. What probes (e.g., time frames or date ranges) work best to promote recall of medical visit
dates?
5. What is the validity of new or existing questions and are there alternative methods to collect
data? (e.g., do NHIS respondents use wearable activity monitors, are they willing to share access
to data from those devices, and do the data correlate with reported physical activity?)
The sample for these projects will consist of current- and prior-year (2013-2018) NHIS respondents who
provided a valid email address and are not in the MEPS sample. NCHS has several thousand email addresses.
Lab and field pretesting
Cognitive testing will be used to understand how respondents interpret new and revised survey questions for
the redesigned survey (e.g., stressful life events for children; adult pain management). DHIS uses the cognitive
lab through the Collaborating Center for Question Design and Evaluation Research (CCQDER) at NCHS to
conduct this testing. These and other similar cognitive testing projects typically involve recruiting 20-30
research participants through advertisements to visit the lab. An interviewer administers the questions and
observes the participants’ answers. The interviewer will then ask follow-up questions to understand how the
participants processed the question and any problems that the respondent had answering the survey
questions.
In addition, a small scale field pretest will be conducted in June to July 2018 to ensure the final functionality
of the redesigned computer instrument. Between 100 and 300 households will be included in this systems
test, which is a dress rehearsal to ensure that the instrument is working properly in preparation for the larger
field test at the end of the year. Participating households will represent a convenience sample drawn from
one to two Census regional field offices that are located in proximity to NCHS and Census headquarters, to
facilitate observations of interviews by NCHS and Census staff. Selected households will be contacted using
the same recruitment procedures and computerized instrument that will be used beginning with the largerscale test in the last quarter of 2018 and into 2019 and 2020. NCHS and Census will review the output from
the field test to ensure the instrument is functioning properly. For example, it will be important to identify
any issues with the skip logic or routing of respondents through the instrument. We will also conduct
interviewer debriefings to identify any major issues with the instrument, and to pinpoint any specific training
points that need addressing prior to launch of the redesigned questionnaire.
Requests for continued permission to conduct developmental studies (such as pilot, feasibility,
methodological and other developmental testing) for future NHIS will be submitted through non-substantive
change requests. Special projects would be submitted for approval using a non-substantive change request
or full revision, as appropriate.