Reaching beyond the white middle classes
- 10 June 2004
- Vol. 328 (7453) , 1433-1436
- https://doi.org/10.1136/bmj.328.7453.1433
Abstract
Understanding and meaning The meaning of a question may be obvious to you and your research staff, but this does not mean all participants will interpret it similarly. Ambiguous questions will lead to responses that do not accurately capture participants' views2 or to them not bothering to respond.5 The greater the social distance between researcher and participant, the greater the risk of misunderstandings. A common problem is when researchers use abstract concepts but participants interpret these literally. For example, a questionnaire seeking to measure emotional wellbeing might include a question “Are you blue?” but some participants may interpret this as an inquiry about their physical health (with blue referring to skin colour or a mark on the body). Whenever you ask about an abstract concept, include a prompt or example, and take careful note of people's reactions during the pilot phase. Phrases that researchers use routinely may not be familiar to participants or may have alternative (and even opposite) meanings in the real world. Most people understand the word homosexual, but heterosexual is less widely used and may be wrongly interpreted as synonymous with homosexual (the alternative of which, for some people, would be normal). A simple descriptor (such as men who have sex with men, instead of homosexual) will extend the accessibility of your instrument. Questionnaire items often include unconscious assumptions about how people live. A small survey of elderly people's alcohol intake, for example, classified 5% of respondents as drinking excessively when questions were framed in terms of number of drinks per day. But when a question was included on tots of alcohol added to tea and coffee (which respondents generally did not count as a drink), the prevalence of excessive drinkers doubled to 10%.6 Even something as simple as “how many days of the week do you watch television?” can be interpreted in several ways (does days of the week include weekends; does “you” mean just me, or me and my family; does having the television on in the background count?7). Implicit in the question format is a middle class notion that you are either watching or not watching television. Complex routing instructions (if no, go to question 3; if yes, go to question 12) reduce motivation and may lead to indiscriminate box ticking. If participants do not follow the correct routing, additional statistical analysis may be required. For example, if someone ticks they are a non-smoker but then indicates they smoke 20 cigarettes a day, both data items would need to be removed from the analysis.Keywords
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