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2018 Questionnaire Redesign

Proposed Design

The comments received throughout 2016 have been instrumental in determining the survey content for the redesigned NHIS. Below are detailed outlines of core topics in the sample adult and sample child questionnaire.

Detailed outline of core topics in the sample adult questionnaire [PDF - 226 KB]

Detailed outline of core topics in the sample child questionnaire [PDF - 196 KB]  

Revised sample adult and sample child questionnaires following these outlines will be released by Spring 2017.

The three-letter section acronyms in each document indicate the division of the questionnaire into thematic sections. Revised sample adult and sample child questionnaires following these outlines will be released by Spring 2017.

Questionnaire Structure

For NHIS interviews in 2018 and beyond, NCHS proposes that one “sample adult” aged 18 years or older and one “sample child” aged 17 years or younger (if any children live in the household) 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 can answer for the sample adult. Information about the sample child will be collected from an adult who is knowledgeable about and responsible for the health of the sample child.  This adult may or may not also be the sample adult.

In the 1997-2017 NHIS, questions from the Family Questionnaire were asked about the family as a whole and about each member of the family. The NHIS has consistently defined a family as an individual or a group of two or more people residing together who are related by birth, marriage, or adoption.  A family additionally includes 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 design still allows for data users to 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 Core

The annual core questionnaire will contain the same questions from year to year. These questions focus on demographic characteristics, health insurance, health conditions, and disability.

Rotating Core

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. Efforts have been made to ensure that rotating content on the sample adult and sample child interviews is consistent, so that similar topics are addressed in both the sample adult and sample child interviews in a given year.

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 proposed periodicity of each rotating core topic and years in which rotating core sections will first appear is available in the content draft documents above.

In households with children, the order of the sample adult and sample child interviews will vary by household.  The relationship between the sample adult and sample child will be obtained, including whether the selected individuals 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.  If they are not, family questions will be repeated, with one set of questions for each family.

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, February 2016, and June 2016, the National Center for Health Statistics (NCHS) requested input on the proposed NHIS questionnaire redesign. Many suggestions were received; the most frequent areas of input were requests to retain detailed questions about disability, health behaviors, health care access and utilization, mental health, specific chronic conditions, health insurance, and the health of other family members.  In October 2016, NCHS requested public comments through the Federal Register. The most frequent requests were for additional questions on dental and oral health, behavior of children aged 0-3 years, adult disability, and allergies.

Some comments were incorporated into the redesigned core questionnaire. 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. Chronic conditions with sufficient prevalence were considered for inclusion. Some data on family relationships will be collected, including marital status of sample adults and parents of sample children. Several family context variables will be retained, including race/ethnicity, education, and employment status of all adults in the family.

Comments were also received that have not been incorporated into the current questionnaire. 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 (including details on common allergens) and health expenditure amounts are collected in detail in other surveys.

We continue to welcome and encourage evidence-based comments on the detailed outline of topics under consideration for the sample adult questionnaire [PDF - 226 KB] and detailed outline of topics under consideration for the sample child questionnaire [PDF - 196 KB].

The next public comment period will be through the Federal Register in Spring 2017. Until then, comments may be directed via email.