Surveys that have been carefully designed can be used to gauge opinion on particular occupational health (OH) strategies. Andy Phillips explains.
Surveys can play an important role in occupational health research. They are a useful methodology that can be used to assess opinions and trends in business, commerce and education.
Conversely, and as with all forms of research, surveys that are poorly designed and implemented provide little in the way of meaningful data, as well as having the potential to distort the results to match the views of the survey owners.
The use of surveys is extremely advantageous in healthcare, OH practice and nursing. Examples of how surveys can assist in gaining an understanding of stakeholder views to promote excellence within nursing and OH practice include:
- a survey of nurses’ views on early discussions about the Nursing and Midwifery Council’s (NMC) plans to introduce revalidation for nurses; and
- surveys about accreditation with the OH accreditation scheme SEQOHS (Safe Effective Quality Occupational Health Service).
AOHNP survey approach
A survey of the Association of Occupational Health Nurse Practitioners (UK) (AOHNP) members and other OH nurses and technicians was conducted shortly after the vote in September 2014 by doctors from the Society of Occupational Medicine (SOM) on whether or not to join with the Faculty of Occupational Medicine (FOM) to form a single organisation.
It was noted that, although there had been a good survey response rate, some doctors felt that they were not provided with sufficient information to make an informed choice in voting for such a historic change. However, during the process, some OH nurses expressed a strong commitment to form a single organisation for their profession and preliminary work has now started on mapping out the structure, services and benefits for OH nurses in the future.
As a key stakeholder in any future single organisation, the board members of the AOHNP felt that there was little known on the views of OH nurses and technicians about the setting up of a single organisation for OH nurses, with the potential to incorporate OH technicians. A survey was developed using an online tool with the aim of obtaining the views of as many practising OH nurses and technicians as possible, and finding out whether there is support for them to join a proposed Faculty of Occupational Health Nursing.
The most important step is to establish the aim of the survey, and to ensure that every element relates to that aim, thereby minimising flaws from the outset. The aims of the AOHNP survey were to:
- identify whether OH nurses and technicians knew about the proposal for a single professional OH organisation, which would link many existing groups (including the National School of Occupational Health); and
- to obtain more information about their views on revalidation and who they feel is best placed to take this forward.
As with all research, engagement and participation are important to survey success and this survey needed to reach as many OH practitioners as possible. There are many ways of communicating to the desired participants in a survey, and all have potential advantages and disadvantages when considering the study method.
Regardless of the method used, it is important that the survey sample size is as large as possible in order to provide sufficient statistical power to draw general conclusions about views of the study population. Furthermore, once the data has been collected, it is important to have access to the skills or to be able to source the resources needed to conduct the data analysis (Keough VA and Tanabe P, 2011).
Methods of gathering information in OH research
Face to face
This is a traditional and accurate method to survey within research design. It allows you to be selective about who is used to participate and to explain any areas that the participant fails to understand.
However, this survey method can lead to biases in the population to be surveyed. People can be reluctant to give up their time without some form of incentive and this method can also be costly and impractical (as was the case when surveying the OH nurse population’s view on the single organisation).
Postal surveys are a practical way of targeting a certain section of the population. They also allow for the use of a population based in different locations, but they have both cost and legal implications.
When sending surveys by post, it is important to know the names and addresses of those people you wish to target. This method was quickly ruled out for the single organisation survey as there was insufficient data on the telephone numbers and addresses of OH nurses and technicians within the UK, beyond members of the AOHNP, recruitment agencies and the NMC. In all cases, the Data Protection Act applies and it would be difficult to obtain the use of this personal information for the purposes of posting survey questionnaires.
Another drawback of the mail survey method is that there are limitations on the number of responses that can be obtained within the survey timeframe. A response rate of 70% or higher provides a desirable response to this statistical method and any response lower than this can call into question how representative the study sample is. A typical postal survey can only hope for a 10% response rate.
Surveying by telephone remains a popular way of undertaking market research, but it appears to be uncommon in medical research. It can offer the researcher the opportunity for wider participant coverage and is a fast way of obtaining responses to survey questions. The use of the telephone also gives the interviewer the opportunity to ask for further clarification of unclear responses.
Disadvantages to this method include lack of access to the contact details of the participant population and, as with mailing, contact details were not available for the AOHNP survey.
Online survey tools
There has been a recent trend in the use of web-based surveys. They have gained popularity as they provide a quick, low-cost and flexible way of obtaining the views of a study sample. There is almost no cost involved in the use of online survey tools and they can be embedded within social media sites, placed into websites and included in emailed links. Below is a non-exhaustive list of some of the many online survey tools that may be suitable to use.
Survey Monkey is one of the most popular and well known survey tools available and it will often rank highly on search engines. The basic free package limits the researcher to 10 questions per survey with a maximum number of 100 responses. It also provides examples of survey formats from a pre-installed library.
The free version does not facilitate the use of statistical software packages, or provide the user with the option to export data to software spreadsheet applications, such as Microsoft Excel. However, the software is useful to help the researcher gain an understanding of question layouts and the value of free surveys.
Should you wish to upgrade, £26 per month will provide you with unlimited questions and 1,000 responses per month; £299 per year will provide unlimited questions with unlimited responses with the additional bonus to export data for the purposes of use with statistical software, such as SPSS (Statistical Package for the Social Sciences).
Google forms is useful if you have a Google ID password, or a Gmail account, because you will already be able to use the free Google forms service. It offers an unlimited number of surveys with enough space for 1,000 responses. As with Survey Monkey, Google provides a large number of survey types and enables the user to circulate the surveys with direct links that can be embedded within websites or emails.
Survey Gizmo offers every feature you could ever need or want when undertaking a survey. It offers full customisation and a wide range of packages for both the smaller independent OH practitioner or the larger provider. There is a selection of pre-determined layouts available with different question formats.
The free version limits the researcher to 50 responses per eight-question survey, with the ability to upgrade to unlimited responses for £10 per month for one user.
Structuring and designing a questionnaire
It is important to remember that, in all cases, respondents are busy people and therefore any survey should be designed with this in mind. Try to keep the survey as short as possible and always relevant to its aims. Avoid the temptation to add extra questions or requests for personal details just because you are able to, unless they are directly related to the aims and purpose of the survey.
Should you choose to undertake an online survey with one of the online tools, there is usually a facility to inform the respondent about their progress within the survey, either by percentage completion or an indicator of how many pages have been completed. Providing this can be motivating for the user when they are undertaking short surveys.
It is helpful to begin with an introduction or message that acts as the cover page for the survey. It encourages respondents to complete the questionnaire and gives them a brief overview of the topics that are going to be covered. Take care not to include any leading statements that might bias the respondent to vote in a certain direction. Any later critique of the research methodology would highlight this factor and invalidate your results.
Start with questions that are easy to answer or non-confrontational. It is also advisable to place the most relevant questions first, as the order in which you ask the questions will help to engage the respondent early on.
Some researchers advocate randomising question order to promote accuracy and to avoid habitual answers. However, grouping similar questions together about similar topics makes it easier for the respondent to give an answer. Equally, it is important not to introduce an idea or issue in one question that could bias answers to questions later on in the survey.
Different types of questions that can be used within a survey include multiple choice, numerical and text. Rating scales are one type of question that can be treated either as multiple choice or numeric.
The AOHNP survey tended to use multiple choice questions to enable the respondents to answer the allocated questions and also facilitate many different answers. It is thought that including answers such as “not sure”, or “I do not feel I have enough information” can add real value to a survey as both allow the respondent to feel that they have all the answers to reflect their own opinion.
The main strength to questions with multiple choice answers is that this type of enquiry is easy for the respondent to answer and for you to use the answers for statistical analysis. An example of this type of question is: Were you aware of a proposed “single organisation” for OH professionals?
- yes, or
The provision of “other” free text boxes is a useful addition for surveys, as the respondent is not forced to provide an answer that they do not feel best matches their own belief. However, providing an “other” option does make it more difficult to evaluate the responses received from the survey using statistical analysis.
The use of rating scales, such as the Likert scale, can help to gauge the respondent’s strength of feeling on a particular subject. However, it may be necessary to change the direction of the positive and negative answers on the scales in order to avoid habitual responses to these types of question. When using online tools, it may not be possible for this type of formatting to be completed.
When completing a survey with an online survey tool, the data manipulation appears to be largely dependent upon whether the survey is free or paid. Free online surveys do offer some data analysis, such as percentage responses per question, which can provide the researcher with a guide to the distribution of the answers within multiple choice questions.
However, there could be times when it may be necessary to analyse the relationships between answers provided within the multiple choice options and, in these cases, analysis is necessary with descriptive statistics to find out the likelihood of cause and effect.
There are many ways in which the survey data can be reviewed, such as the use of free online analysis tools (for example, SPSS). These tools can be daunting to use for the first time.
One piece of advice provided on a medical statistics study day was to “make friends with a statistician”, the real experts in establishing relationships within data. These individuals are usually located at universities or can be employed for a reasonable fee. They are often very willing to assist a novice to interpret data sets and to provide advice on statistical tests of significance.
Comment and discussion
With the benefit of hindsight, the accuracy of the questions in the AOHNP survey could have been improved. Unfortunately, the aims of the survey were not clearly defined. This was because of the short timeframe needed to develop a survey for OH nurses and technicians, following the doctors failing to achieve the required vote in favour of a single organisation.
The AOHNP survey was carried out using an online survey tool. The choice of this method was governed predominantly by: the speed of the survey implementation; lack of availability of the contact details of the survey participants; and the requirement to take advantage of known areas of OH nursing activities. The latter were:
- JISCMail email forum;
- social media sites;
- links on OH partner websites; and
- personal/professional contacts.
There are clear limitations to this method of study as it relies on the respondent accessing the survey using electronic means. However, in the absence of meaningful contact information, and having a limited budget and timescale to conduct the survey, online tools were the preferred method on this occasion.
Explorable Psychology Experiments. Survey Research Design, accessed on 21.11.2014.
Keough VA and Tanabe P (2011). “Survey research: an effective design for conducting nursing research”. Journal of Nursing Regulation, vol.1 (4); p.37.
Sage survey research, accessed on 21.11.2014.
At the time of writing this article in late 2014, the results of the AOHNP survey were in the data manipulation stage.