So the employee health risk assessment is in place, but are you measuring what you think you are? Dr Peter Mills explains the pitfalls
A DESIGN FOR LIFE
It is not just health where we can see the results of poor questionnaire design. How many times have you read about a survey that has been conducted and thought “Really? Can that be true? Is Gravesend really the worst place to live in the UK?” (or similar).
Bizarre results can be generated by having poorly constructed questions or by conducting your survey on a non-representative population.
The latter is not too much of an issue in the corporate health arena, provided you can persuade a significant proportion of your workforce to complete the questionnaire, so focusing on the validity of the question set should improve strategic focus.
The validation of an HRA, or any questionnaire for that matter, can take time and effort. Ultimately, what needs to be determined is whether individuals’ answers are an accurate representation of their true state.
To achieve this, the output from domains within an HRA can be compared with “gold standard” questionnaires that focus upon the specific areas.
As an HRA covers a wide range of health, lifestyle and quality of life constructs, it is often necessary to use a number of gold standards to assess the validity of each of these.
By getting a cohort of individuals to complete both the HRA and the domain-specific questionnaires, one can compare the results and assess whether the (usually briefer) HRA questions correlate well with the gold standards.
If they don’t, it is likely that changes to the wording or responses of the HRA questions are needed.
It is also good practice to do formal user testing on a questionnaire. This is especially important now that the majority of HRAs in use within the corporate setting are delivered via the internet.
Understanding how users interact with on-screen questions is an important first-step in optimising accuracy and timeliness of completion.
In addition the web, together with the increasing penetration of smartphones within society, offers up new opportunities to engage users completing an HRA by using images to help convey concepts and scripting to ensure individuals are not asked questions that are irrelevant.
The days of text-heavy HRAs should be a thing of the past, not only because individuals with lower literacy levels often struggle with this sort of presentation, but also because when asking about such concepts as nutritional balance and physical activity, a picture really does paint a thousand words (see Figure 1 for example).
Dr Peter Mills is director of medical consultancy Glasslyn Health Solutions
