PHE 327 Module 3 Instrument Short Paper Example

Two Pages, Large Print: Building a Winter Isolation Survey for Older Adults From Tested Questions

[Student Name]

Southern New Hampshire University

PHE 327: Research and Assessment in Public Health

Module Three Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Two Pages, Large Print: Building a Winter Isolation Survey for Older Adults From Tested Questions

The indicators chosen in Module Two include two that exist in no database: loneliness and extended confinement at home during winter. Collecting them requires a survey. The temptation is to write a long questionnaire covering every interest of every partner. The better approach is a short instrument built mostly from questions that others have tested, with a few new items written carefully and checked with the people who will answer them. This paper describes that instrument for older adults in a composite county in Michigan's western Upper Peninsula: its content, the validated measures it uses, the new items and how they were pretested, its format and how it will be checked for reliability.

Content and Length

The survey has four sections on two pages, about twenty questions in total. The first asks about household: age, whether the person lives alone and how far they live from the nearest town. The second measures loneliness and social contact. The third asks about the past winter: days without leaving home, missed medical appointments and why, trouble paying for heat and falls. The fourth asks about support: whether someone checks on the person daily, what services they use and what would help most, with one open question at the end. Length was limited because response rates fall as surveys grow longer and because many respondents will have limited energy or eyesight.

The Loneliness Scale

Loneliness is measured with the three-item scale developed by Hughes et al. (2004) for large surveys. It asks how often the person feels they lack companionship, feel left out and feel isolated from others, with three response options: hardly ever, some of the time and often. Scores range from three to nine. The authors developed the scale for telephone surveys and found that it performed well compared with the longer version from which it was drawn and related as expected to objective measures of social contact. Using a validated scale has three advantages: its meaning is known, its results can be compared with other studies and partners cannot easily argue that the questions were worded to produce a particular answer. Holt-Lunstad et al. (2015) found that loneliness predicts mortality separately from living alone, so measuring it directly rather than assuming it from household composition matters.

Standard Questions

Other items reuse wording from established national surveys, such as the standard question on self-rated health, with its five-step rating running from excellent down to poor, and standard wording on living arrangements. Borrowing wording allows rough comparison with state and national figures, though the comparison is limited by different sampling methods. Where a standard question was long or complex, the shortest accepted version was chosen.

New Items and Pretesting

Four questions had no tested equivalent: the number of days last winter the person did not leave home, whether they missed a medical appointment because of weather or transportation, whether they ever chose between heat and other necessities and whether someone checks on them every day. Writing these well required care. An early draft asked how often the person was snowbound, but two pretest participants said they were never snowbound because they could always get out with help, even when they stayed in for a week. The wording was changed to ask about days not leaving home for any reason. Pretesting followed the cognitive interviewing approach described in survey methods literature: eight older adults recruited through the senior center completed the draft aloud, explaining what each question meant to them. Dillman et al. (2014) recommend this kind of testing because questions that seem clear to designers are often read differently by respondents. Three items were reworded and one was dropped.

Format for Older Readers

Design choices aim to make the form easy to complete. Text is in 14-point type with high contrast, answer boxes are large and the survey uses check boxes rather than writing wherever possible. Each question appears once, with no skip patterns that could confuse readers. Dillman et al. (2014) describe how mailed surveys benefit from a respondent-friendly design, a personalized cover letter and multiple contacts, and the format follows those principles. A large-print cover letter from the area agency on aging director, a familiar name, explains why the survey matters and how answers will be used, and promises confidentiality.

What Was Left Out

Several questions partners wanted were cut. The health department asked for a full list of chronic conditions; the survey keeps only self-rated health and a single question about falls, because a long list would add half a page and the assessment question is about isolation, not disease. The agency asked about satisfaction with each of its services; that belongs in a separate program evaluation. A question on income was replaced by the heat-or-necessities item, which captures the hardship that matters for winter without asking a sensitive question many older adults skip. The open question at the end gives room for anything the form missed. Each cut was discussed with the partner who requested it, and two agreed to collect their items another way. Saying no to good questions is part of designing a survey people will finish.

Reliability and Validity Checks

The loneliness scale's internal consistency will be checked in the county's own data with a reliability coefficient, since a scale that performs well nationally may behave differently in a small rural population. For the new items, validity will be checked in two simple ways: answers to the days-at-home question should relate to loneliness scores, and missed appointments should relate to distance from town. If these expected relationships do not appear, the items may not be measuring what was intended, and the report will say so.

Conclusion

The instrument is short, built mostly from tested parts and adapted to its readers. Its new items were shaped by older residents themselves through pretesting. Module Four will address the harder problem of getting the survey back from the people most likely to be isolated. The final draft fits on one folded sheet.

References

Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, phone, mail, and mixed-mode surveys: The tailored design method (4th ed.). Wiley.

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237. https://doi.org/10.1177/1745691614568352

Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging, 26(6), 655-672. https://doi.org/10.1177/0164027504268574