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2018 Questionnaire Redesign

Rationale for 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

Call for Public Comment

On October 7, 2016 a notice was placed in the Federal Register regarding the 2018 National Health Interview Survey (NHIS) questionnaire redesign. This Federal Register notice represents an additional step in the ongoing process of reaching out to users of the NHIS. The National Center for Health Statistics (NCHS) has conducted three solicitations for public comment to date (October 2015, February 2016, and June 2016). Public input has been of exceptional value during the redesign process, with many comments informing content decision making. Prior public comment periods have focused on the proposed structure, periodicity, and content areas. The present Call for Public Comment requests feedback on specific question text for the first time. These questionnaires, which are first drafts and subject to revision and further changes, can be found below:

Adult NHIS Questionnaire [PDF - 690 KB]

Child NHIS Questionnaire [PDF - 911 KB]

Feedback about these questionnaires at this early stage of development will be critical as we continue to revise and improve the content and question text during the redesign process. The comment period closes on November 7, 2016. You may submit comments, identified by Docket ID: CDC-2016-0092, using the Federal eRulemaking Portal. Follow the instructions for submitting comments. For further information, please send an email to the Division of Health Interview Statistics Redesign Team.

To help orient reviewers, updated outlines are provided below which list the major sections of each questionnaire.

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]

For more information about the proposed design, rationale for redesign and criteria for prioritizing content, and the results of public redesign outreach activities to date, please continue reading below.

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.

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.

Sponsored 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 Redesign Outreach Activities to Date

Detailed suggestions have been received during three prior public comment periods. We greatly appreciate the time and careful thought that our data users have contributed to this effort, and we assure you that we have read and discussed every comment. 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. Content on mental health symptoms and treatment has been expanded in both the annual and rotating core in response to public comment.

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.

Commenters also helped us to identify topics that are difficult to accurately assess due to respondents’ limited knowledge or recall ability. Some topic areas (e.g., specialty areas or training of providers seen) have been dropped as a result.

All content areas remain subject to change and revision. For example, further development is needed to align questions on preventive services with national recommendations and to capture critical data on injuries. We are also considering which additional demographic information will be collected for all household members rather than just sample adults and sample children. Finally, some important content areas may still be dropped or the periodicity of their collection may be changed because of the need to reduce respondent burden by shortening the length of the questionnaire.

We continue to welcome all comments on the proposed content and question text, the proposed periodicity of the content (annual, every other year, or two-out-of-every-three years), and ideas to reduce respondent burden and streamline the questionnaire.

Frequently Asked Questions

We have compiled a list of frequently asked questions about the NHIS redesign. Please feel free to contact us with other questions.