Redesigning a Healthcare Demand Questionnaire for National Population Survey: Experience of a Developing Country

Abstract

Since its inception in 1986, the contents of the National Health and Morbidity Survey (NHMS) have been periodically updated to support emerging health data needs for evidence-based policy and program development. In 2018, the healthcare demand questionnaire was redesigned to capture diverse and changing population demand for healthcare services and their utilization pattern. This paper describes the methods and processes undertaken in redesigning the questionnaire. We aim to highlight the systematic and inclusive approach, enabling all potential evidence users to be involved, indirectly encouraging research evidence uptake for policy and program planning. We applied a systematic approach of comprehensive literature search for national-level population survey instruments implemented globally and translated non-English tools to English. The development phases were iterative, conducted in parallel with active stakeholder engagements. Here, we detailed the processes in the planning and exploratory phase as well as a qualitative assessment of the questionnaire. We included instruments from 45 countries. The majority were from the Organisation for Economic Co-operation and Development (OECD) countries and focused on perceived health, health-related behavior, and healthcare use. Thirty-four stakeholders from 14 areas of expertise were involved. Stakeholders identified additional content areas required, such as chronic pain, alternative use of healthcare services (community pharmacy, home-visit, and private medical laboratory), family doctor, and informal caregiving. The questionnaire, redesigned based on existing literature with concordant involvement and iterative feedback from stakeholders, improved the choice of health topics through the identification of new topics and modification of existing questions to better meet future evidence needs on health problems, strategy, and program planning towards strengthening the nation’s health systems.

The Health-Seeking Behavior among Malaysian Adults in Urban and Rural Areas Who Reported Sickness: Findings from the National Health and Morbidity Survey (NHMS) 2019

“…Rural population with at least one long-term condition were more likely to seek medical treatment than those without, which concurred with previous research that found an association between the presence of chronic illnesses and seeking healthcare services [50,91]. Two-thirds of public primary care clinics in Malaysia are in rural areas [24] and a national cross-sectional study of randomly selected clinics found that doctors in public clinics saw more chronic diseases like hypertension and diabetes, as well as follow-up cases, whereas doctors in private clinics saw more acute and minor illnesses [92].…”

“…In NHMS 2019, data were collected from July to October 2019 by trained research assistants, via face-to-face interviews using a validated questionnaire [ 50 , 51 ]. The questionnaire was programmed into an application and uploaded onto digital tablets as mobile data collection tools.…”

Determining the importance of high-reliability healthcare organizations during the Covid-19 pandemic: Evidence from healthcare workers in Turkey

“…To provide timely and appropriate supporting databases to sustain the health systems in addressing health issues and anticipating emerging healthcare challenges, the use of multiple elements in an iterative process in redesigning the questionnaire proves extremely useful to update and revise contents to suit health systems needs, particularly during the unexpected situation (Woei et al, 2021). Mainly, eight key behavioral dimensions of HROs are examined in this study -shared knowledge pattern, provision of self-care, self-awareness of organizational role, organizational resources to provide safety, flexibility of work, environmental safety, collective mindfulness during Covid-19, and awareness of the Covid-19 consequences.…”

Factors associated with informal caregiving and its effects on health, work, and social activities of adult informal caregivers in Malaysia: findings from the National Health and Morbidity Survey 2019

“…The healthcare demand questionnaire of NHMS 2019 comprised of 10 topics: 1) household, 2) sociodemographic and socioeconomic, 3) payer for healthcare, 4) general health & illness, 5) utilisation of community pharmacy, 6) utilisation of outpatient healthcare, 7) utilisation of inpatient healthcare, 8) utilisation of oral healthcare, 9) home-visit, and 10) informal care [ 34 ].…”

“…Data were collected from July to October 2019 by trained interviewers using a pre-tested and validated questionnaire [ 9 , 34 ]. The questionnaire was programmed into an application and uploaded onto tablets used as mobile data collection devices.…”