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2018 Questionnaire Redesign

Call for Public Comment

Detailed outline of topics under consideration for the sample adult questionnaire [PDF - 210 KB] 

Detailed outline of topics under consideration for the sample child questionnaire [PDF - 181 KB]

Rationale for Redesign and Criteria for Prioritizing Content

The content and structure of the National Health Interview Survey (NHIS) will be updated in 2018 to better meet the needs of data users. Aims of the redesign are to improve the measurement of covered health topics, reduce respondent burden by shortening the length of the questionnaire, harmonize overlapping content with other federal health surveys, establish a long-term structure of ongoing and periodic topics, and incorporate advances in survey methodology and measurement.

In general, the following criteria have been used for prioritizing content to be included in the redesigned questionnaire:

  • Strong link to public health
  • Relevant to HHS agency goals, strategic plans, or initiatives
  • Long-term monitoring of the topic area is needed
  • Topic area can be measured well in household interviews
  • Measure is used by other federal surveys for calibration
  • Measure does not duplicate the detail collected by federal surveys with more targeted purposes
  • Topic area can be estimated reliably with only one or two years of data

Content areas with a strong link to public health include:

  • Leading causes of morbidity/mortality
  • Intermediate health outcomes for leading causes of morbidity/mortality
  • Targets of major federal health promotion initiatives
  • Health insurance coverage
  • Health care access and utilization
  • Individual behavioral risk or protective factors for the content areas listed above
  • Other factors that identify priority populations at elevated risk of poorer health or receiving poorer health care

Public Redesign Outreach Activities to Date

In October 2015 and February 2016, NCHS requested comments on the proposed NHIS questionnaire redesign. Many detailed suggestions were received; the most frequent comments were requests to retain questions about disability, health behaviors, health care access and utilization, mental health, identifying members of the family, specific chronic conditions, and health insurance. Data on many dimensions of health insurance, health care access and utilization, chronic conditions, and health behaviors will still be collected in the redesigned NHIS, and comments in these areas have helped to further refine how these topics will be addressed. The redesigned NHIS will continue to identify people with functional limitations and difficulties. A battery of mental health questions to assess depression and anxiety will be added to the new rotating core. Several family relationship variables will be retained.

Comments were also received that have not been incorporated into the current questionnaire proposals. Topics such as caregiving burden, social isolation, or food insecurity may be incorporated occasionally (i.e., without a set periodicity) or as supplemental content sponsored by another federal agency rather than added to the NHIS core. Other topics may be more appropriate for other federal surveys. For example, nutritional inventories and health expenditure amounts are collected in detail in other surveys.

The comments we received have been instrumental in determining the survey content. We continue to welcome and encourage detailed, evidence-based comments on the detailed outline of topics under consideration for the sample adult questionnaire [PDF - 210 KB] and detailed outline of topics under consideration for the sample child questionnaire [PDF - 181 KB].

Proposed Design

Questionnaire Structure

For NHIS interviews in 2018 and beyond, NCHS proposes that one “sample adult” aged 18 years and over and one “sample child” aged 17 years and under (if any children live in the household) will be randomly selected from each household following a brief screener that identifies the age, sex, race, and ethnicity of everyone who usually lives or stays in the household. Information about the sample adult will be collected from the sample adult him/herself unless s/he is physically or mentally unable to do so, in which case a knowledgeable proxy will be allowed to answer for the sample adult. Information about the sample child will be collected from a knowledgeable adult who may or may not also be the sample adult.

In the 1997-2017 NHIS Family Questionnaire, questions were/will be asked about the family as a whole and about each member of the family. For NHIS, a family is defined as an individual or a group of two or more persons residing together who are related by birth, marriage, or adoption, as well as any unrelated children who are cared for by the family (such as foster children) and any unmarried cohabiting partners and their children. In the redesigned NHIS, much of the content from the family section will be collected within the sample adult and sample child interviews. A page on the impact of the move of critical family-level content provides more detail.

An estimated 35,000 completed sample adult interviews and 12,000 completed sample child interviews are expected to be available annually for analysis in the redesigned NHIS. Data users may still pool two or more years of sample if needed to produce reliable estimates for population subgroups.

The sample adult and sample child questionnaire structures will consist of four components: the annual core, rotating core, sustaining supplements, and periodic supplements.

Annual and Rotating Core

The annual core questionnaire will contain the same questions from year to year. The rotating core questionnaire consists of questions that will be included in the interview on some years with fixed periodicity. The core questions (both the annual and rotating) are sponsored by NCHS and reflect the prioritized content areas.

Sustaining and Periodic Supplements

Supplements are questions funded by other federal agencies. In the past, supplements have included content on food security, cancer screening, complementary and alternative medicine, and heart disease, among others. A list of NHIS supplements and co-sponsors is available for download. Sustaining sponsors are agencies that will sponsor related content every year over multiple years; these supplements do not need to contain the same questions from year to year. Periodic supplements will consist of sponsored content that will be included in the interview in one or more years, but not every year.

Content Order

The order of how the questions will appear during the interview is still under development. The order and periodicity of the rotating core content is still being considered.

In households with children, the order of the two interviews (sample adult and sample child) may vary by household.  The relationship between the sample adult and sample child will be obtained to determine whether they are in the same family.  When they are, content areas that refer to the family will be captured only once, in whichever interview comes first.

Public Comment

The Director of the Division of Health Interview Statistics welcomes comments and suggestions on the proposed design and content, but is especially interested in the following:

  • The consequences of the proposed design and content on your topics of interest;
  • Whether the content under consideration in your area of interest has limited utility or is no longer relevant;
  • Whether the content under consideration in your area of interest is sufficient, recognizing the need to reduce burden by keeping the length of the questionnaire short;
  • Whether the proposed periodicity of the content under consideration (annual, every other year, or two-out-of-every-three years) is appropriate, or if the content could be assessed less frequently;
  • Whether the proposed periodicity of the content under consideration will allow for annual estimates for analyses regarding your topics of interest;
  • Whether the proposed content includes the covariates (e.g. other measured variables) necessary for analyses regarding your topics of interest;
  • Suggestions for brief and validated question sets, especially in content areas still under development;
  • Other ideas to reduce respondent burden and streamline the questionnaire.

Data users involved in children’s health are especially encouraged to provide feedback on the proposed topic areas for the sample child questionnaire. This is the first draft of the sample child topic list to be offered for public comment. It was developed with input from experts in children’s health from multiple disciplines and professional backgrounds. These experts offered the following suggestions for NCHS’s consideration:

  • Increase emphasis on social determinants of health
  • Expand coverage on children’s mental health
  • Use functioning as the framework for measurement of disability
  • Decrease focus on rare health conditions
  • Address the gap created by limited collection of family relationships
  • Focus on key measures for which benchmarks and long-term trends are needed
  • Identify priority populations at elevated risk of poorer health or receiving poorer health care

Data users involved in children’s health are welcome to provide comments on these suggestions.

Suggestions for additional or expanded topic areas in either the sample adult or sample child questionnaires should be sure to address the “Criteria for Prioritizing Content” noted above.

The comment period extends through June 30, 2016. To provide comments, please send an email.

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