1. Seminar
Survey methods in
community medicine

2. survey methods in
community medicine
• Presented by
Dr.S.D.Shekde
JR 2
• Guided by
DR. V. M.HOLAMBE
H.O.D.
Assist. Professor
Dept Of Comm. Medicine
G.M.C. LATUR
Date-17/11/14

3. contents
• 1.introduction and terminology .
• 2. definitions of terms .
• 3. objectives and uses of survey .
• 4. types of survey .
• 5. heath survey & its methods .
• 6. pre-requisites for survey .
• 7. types of information available from survey .
• 8. Types of epidemiological study .
• 9.stages of investigation .
• 10. planning phase .
• 11. qualities of a good research
• 12 .summary .
• 13.references

4. Introduction.
Survey :
• A method of gathering information from a sample of
individuals.
• A powerful, scientific tool for gathering accurate and
useful information.
• Gathering information, asking questions from a
sample of population. It may be;
– Verbal surveys are often known as interviews,
and;
– Written surveys are questionnaires.

5. Introduction and Terminology
• Surveys constitute the basic tool of research in
communities.
• Surveys mainly concerned with groups or
populations rather than individuals.
• Outcome of surveys represents the sum total of the
group and cannot reflect each individual’s concern or
interest.

6. • survey methodology studies the sampling of
individual units from a population and the associated
survey data collection techniques, such as
questionnaire construction and methods for
improving the number and accuracy of responses to
surveys.

7. • Polls about public opinion, public health surveys,
market research surveys, government surveys and
censuses are all examples of quantitative research
that use to answer questions about a population.

8. • Although censuses do not include a "sample", they
do include other aspects of survey methodology, like
questionnaires, interviewers, and non response
follow-up techniques.

9. • Surveys provide important information for all kinds
of public information and research fields, e.g.,
marketing research, psychology, health professionals
and sociology.

10. Definitions of terms
• Survey : survey is defined as non-experimental
observations in population or its sample.
• A survey (or observational study) is an
investigation in which information is systematically
collected, but the experimental method is not used-that
is no active intervention by the investigators.
• In our field observation relate to health, health
related events or disease.

12. • Surveillance --: it is defined as continuous scrutiny of
all aspect of occurrence and spread of disease that
are pertinent to effective control .
• surveillance means maintenance of on going watch
over the status of a group or communities.
• Surveillance is therefore , continuous activity
whereas a survey is done for specific purpose at
specific time only.

13. • Monitoring -: is defined as the performance of and
analysis of routine measurements for detecting changes
in the environment and heath status in population.
• monitoring is on going watch over activities of health
services.
• demographic surveillance means on going measurement
of the size of population.
• exploratory study is a descriptive survey designed to
increase the investigators familiarity with the problem he
wishes to study. it is some times called pilot study.

14. • methodological study is performed for collecting
information on the feasibility or accuracy of research
method.
• a morbidity survey is study of occurrence and
distribution of disease in population.
• house hold survey refers to survey of illness and disability
performed by interviewing persons in their homes.
• KAP study of knowledge attitudes and practices.
• out break investigations aim at determining causes of out
break in order to control it.
• health practice research is concerned with organizational
problems.

15. Objectives of survey
• 1) planning and evaluating health programme .
• 2) to gather accurate, reliable and standardized
information about disease/heath problem.
• 3)to gather information about the effectivity and
efficiency of health programme .
• 4)to obtain new information about disease/ health
problem.

16. USES OF SURVEY
 To assess the magnitude of a specific disease
condition or health related events in specified
community or well-defined geographical area.
 To guide planning of national, regional or local health
programs.
 To evaluate control activities or national health
programs.

17.  To study community perceptions and attitude related to
health and disease.
 To evaluate degree of utilisation of health care facilities.
 To provide data for planning and evaluation of
community intervention and health educational activity.
 To suggest and test hypotheses on health related events
and diseases condition.
 Surveys are useful for research,training,planning and
evaluation.

18. Classification of Surveys
Three broad Classifications
• By size (social, community and school
surveys).
It is about the segment of the society at which
we are focusing upon/ depending upon the
nature of the research and the focus of the
conclusion
• By result type (quantitative or qualitative). 18

19. Types of Survey
Descriptive surveys are used to gather information
largely on what people do and think. Thus a researcher
might use this type of survey to find out what young people
think about drugs, what drugs they might use, and with
what frequency.
Analytic surveys are used to answer research questions
or to test hypotheses. A researcher might collect data from
the general population which detailed information on
health habits, e.g. Diet, exercise, smoking and so on. This
information might then be used to make predictions
concerning the state of health of the population at some
future date.
19

20. Types of Surveys
(Time and Population)
A. Cross-sectional surveys. Collect
information from the sample at the same point time.
B. Longitudinal surveys. Information is collected
at different points in time in order to study changes
over time .
20

21. Types of survey
• Surveys are named according to its main objective (
viz: nutritional survey, diet , social survey etc..) but
depending on methods adopted, there are four basic
types of survey.
• 1) Mass survey .
• 2) Sample survey .
• 3) Pilot survey .
• 4) At risk survey .

22. • Mass survey: When information is collected from the
entire population it is called as mass survey .
• Mass survey are not to be repeated very frequently .
• Census conducted every ten years in our country is
an example of mass survey .

23. • Sample survey: when the information is obtained, not from
the entire population ,but from its sample ,it is called sample
survey .
• If proper sampling procedure is adopted and if the sample size
is adequate ,then sample surveys can give reliable and quick
estimates about population .
• Sample survey are cheaper and faster than mass survey .
• For example- annual surveys conducted for births and deaths
under sample registration scheme are sample survey.

24. • Pilot survey: when survey is to be conducted on
large scale and when it involves complicated design
,questionnaire and information ,a survey on smaller
scale is usually done prior to main survey , this is
called pilot survey .
• It is helpful for pre testing the questionnaire, training
the people and assessing the feasibility of certain
procedures to be conducted in the main survey .

25. • At risk survey: when the information is collected
from individuals/or population that are at a higher
risk of the problem at hand than the general
population the survey is called at risk survey .
• Such survey need the knowledge about who is “at
risk” .
• These surveys give more information about the
section of the population “at risk” for the given
problem .

26. Health survey
• "health surveys" is used for surveys relating to
any aspect of health - morbidity, mortality,
nutritional status, etc.
• When the main variable to be studied is disease
suffered by the people, the survey is referred to as
"morbidity survey".
• Health surveys may be cross sectional or
longitudinal; descriptive or analytic or both

27. Surveys in
the health
sector
Health survey
Studying a population or a particular
segment of population in order to asses
its health problems or to detect
condition to which preventive measures
may be applied.
Morbidity survey
It is a specific survey dealing with only one element in the full range of
possible components of a health survey
Utilization survey
It demonstrate how many people are utilising services
provided by specific facilities.

28. Health survey methods
• Broadly, the following types of surveys would be
covered under health survey
a) surveys for evaluating the health status of a
population, that is community diagnosis of
problems of health and disease.
It is information about the distribution of these
problems over time and space that provides the
fundamental basis for planning and developing
needed services .

29. • B) surveys for investigation of factors affecting
health and disease, e.g, environment,
occupation, income, circumstances associated with
the onset of illness, etc.
• C) surveys relating to administration of health
services, e.g., use of health services, expenditure
on health, evaluation of population health needs
and unmet needs. evaluation of medical care, etc.

30. Methods of health survey
• The method employed for data collection, health
surveys can be broadly classified into 4 types
• a. Health interview (face-to-face) survey .
• b. Health examination survey .
• c. Health records survey .
• d. Mailed questionnaire survey .

31. • The health interview (face-to-face) survey is an
invaluable method of measuring subjective
phenomena such as perceived morbidity, disability
and impairment; economic loss due to illness,
expenditure incurred on medical care;
Opinions, beliefs and attitudes; and some
behavioural characteristics.
It has also the advantage of giving population based
data.

32. • Health examination surveys generally provide more
valid information than health interview surveys.
• The survey is carried out by teams consisting of
doctors, technicians and interviewers.
• The main disadvantage of a health examination is
that it is expensive and cannot be carried out on an
extensive scale.
• The method also requires consideration of providing
treatment to people found suffering from certain
diseases .

33. • Health records survey involves collection of
data from health service records.
• This is obviously the cheapest method of collecting
data.
• This method has several disadvantages :
• a) the estimates obtained from the records are not
population-based .
• b) lack of uniform procedures and standardization in
the recording of data.

34. • Mailed questionnaire survey . An alternative
method of measuring subjective phenomena is the
self-administered Questionnaire, i.e., a
questionnaire without an interviewer.
• The use of questionnaires is simpler and cheaper,
and they may be sent,
• For example- by mail to persons sampled from a
given target population .

35. Pre requisites for survey
• 1) Resources
• 2)Co-operation from population .
• 3)training of the personnel .
• 4)Pre-testing
• 5) Mock –survey
• 6) Administrative planning .

36. • 1. RESOURCES: resources include personnel, finances
and materials (man/money/ materials) .
• Before undertaking the survey adequacy of resources
must be ensured .

37. • 2. Co-operation from the population:
• Survey involve obtaining variety of information
from variety of persons . So necessary to obtain
their co-operation .
• This can be ensured only if the respondents
understand the objectives and utility of survey
• Involvement of influential persons in a
community ( viz- elected representatives, social
worker, lions/rotary club etc..) would facilitate
the efforts in obtaining co-operation .

38. • 3.Training of the personnel: surveys have very
specific objectives and the information to be
collected may be of a specialized nature .
• Training of the persons for all aspects is required and
contents of training are :
• A) explanation of the objectives of the survey .
• B)explanation of the questionnaire/interview
schedule
• C)training in the use of new equipment.
• D)detailed programme of the survey .
• E)participation in mock survey/pilot survey.

39. • 4) Pre-testing : to test the questionnaire on small
number of individuals before the survey. This is
called pre- testing .
• Pre-testing is also used for training the personnel.

40. • 5) Mock survey: this is the trail of the survey on
small scale .
• It give an opportunity for prior use of questionnaire,
equipments, and investigations

41. • 6) Administrative planning : it includes recruitment
of personnel, procurement of equipments , printing
the questionnaire, making the transport
arrangement, fixing the time schedule, etc ..

42. Types of information available from
survey
• 1) Demographic :
• Information about size ,composition and
distribution of the population can be obtained
through survey
• This provides denominator for calculation of
various rates ,ratios and proportions

43. • 2) Vital events : -
• The data about vital events (births, deaths,
marriage & divorce ) is available through surveys,
which is likely to be more accurate ,reliable &
standardized .

44. • 3) Morbidity :-
• Information about the specific aspects of
morbidity like incidence , duration & severity can be
obtained from survey .

45. • 4) Related factors :-
information about factors related to the
problems viz. nutritional status ,educational status ,
occupation, economic, environmental conditions etc
can be obtained from survey.

46. • Requirements of Objectives of
descriptive,analaytical,and evaluative
studies.
• 1. they must meet the purpose of study
• 2. they should be formulated clearly.
• 3. the should be expressed in measurable terms.

47. Types of Epidemiological Study
• 1. Descriptive surveys
• cross sectional
• longitudinal ( studies of change)
• 2. analytic surveys
• group based (ecological, trend studies)
• individual based (cross sectional, Cohort, case
control)
• 3. Experiments and Quasi experiments (intervention
studies, trials)
• Group based
• Individual based

48. Descriptive Surveys
• may be cross sectional (how many blind people are
there in the population)
• may be longitudinal (what is the course of events
after infection with HIV virus)

49. Analytic Surveys
• 1. Group based Analytic Surveys
• comparison of groups or populations
• study of group of groups not group of individuals
(group of countries compared with respective to
their death rates from cirrhosis of liver).
• group based studies may some times yield
misleading results due to inaccuracy or unavailability
of data.

50. • 2. Individual based analytic surveys
• study of groups but utilize information about each
individual in group.
• In simplest form it is used to test hypothesis that a
specific factor is determinant of specific disease.
• cross sectional study examine association existing in
a group at a given time.
• cohort study is analytic follow-up in which people
exposed and non exposed followed.

51. • case control study examine relation between
suspected casual factor and a disease.
• if case control study is perform in the frame word of
cohort study so that experiences of new cases
identified in the study.
• cohort can be compared with that of control of same
cohort it called nested case control study.

52. • A quasi-experiment is an empirical study used to
estimate the causal impact of an intervention on its
target population.
• most common form of a quasi-experimental study
includes a pre-post test design with both a treatment
group and a control group,
• quasi-experimental studies are often an impact
evaluation that assigns members to the treatment
group and control group by a method other than
random assignment.

53. Stages of an Investigation/steps in
survey
• 1. Preliminary stage
• a. clarifying the purpose
• b. previewing the literature
• c. ethical consideration
• d. formulating the topic.
• 2. Planning
• 3. Preparation for data collection

54. • 4. Collection of data.
• 5. Processing of data.
• 6. Interpreting the result
• 7. Reporting the finding

55. The planning phase
• 1.formulation of study objectives:
• 2.planning of methods
a . the study population (whom?):
Selection and definition
Sampling
Size
B . variables (what to measure?)
Selection
Definition
Scales of measurements.
C. Methods of collecting data
D. Methods of recording and processing:

56. First Steps
• clarifying the purpose
• use of the literature.
• ethical considerations.
• formulating the topic.

57. clarifying the purpose
• clarify whether the study is pure or applied.
• is the purpose of obtaining information will form the
basis for utilization of resources.
• is it to identify persons at special risks of a specific
disease.
• is it to add knowledge on specific aspect of aetiology.

58. • is it to stimulate public interest, for welfare of
population, , for application of health programme?
• reason of study should be clear to investigator.
• it is necessary to describe the purpose in some detail to
justify the proposed study.
• review previous work on subject, present state of
knowledge, significance of proposed study that is case
for action.
• honest self examination is desirable to clarify the
purpose and bias.

59. Use of Literature
• published experiences are useful for indicating the
presence and nature of research problem.
• useful for planning and interpretations of findings.
• investigator should be acquainted with important
study Literature before study .

60. • references should be filed in organized way manually
or computer data base.
• it is of limited use to wait until reports of study are
written.
• long list of references without proper use is
unnecessary.
• assess the accuracy of findings . judge if inferences
are valid decide whether the study has relevance to
your needs.

61. Ethical considerations
• Before planning the study satisfy yourself that it is
ethical to do the study and can be done in ethical
way.
• is it ethical to permit the study at the expense of
activities directly promoting community health.
• scientifically unsound studies are unethical.

62. Formulating the topic
• Done after the purpose and moral justification of
study are clear.
• it can be done in general terms and many times it is
simple to formulate.
• at early stage formulation of topic is regarded as
provisional as difficulties may arise in future.

63. 2.PLANNING STAGE

64. 1. State the objectives of the survey
 We have to define specifically the problem
we intend to solve.
 If we cannot state the objectives of the
survey we are unlikely to generate useable
results.
 We have to be able to formulate something
quite detailed, perhaps organized around a clear
statement of a testable hypothesis.
 Clarifying the aims of the survey is critical to its
ultimate success.
64

65. 2. Define the study population
• The study population is group that studied, either in
toto or by selecting a sample consisting of individual
members of the group for investigation.
• If sample is chosen, the study population from which
it is selected may be also be called the sampled
population or the parent population.

66. • Appropriateness & practicability should be taken
into account durning selecting the study population .
• If a study population is believed to be typical of a
broader population to which the findings may be
generalized, the latter population may be termed the
reference population or external population.

67. Sampling
• Sample – a finite subset of statistical individuals in a
population .
• Sample size- the number of individuals in a sample .
• Sampling is most frequently used in survey.
• The sample must be well chosen ,so as to be
representative of parent population.

68. SAMPLING
• The process of selecting a sufficient number of
elements from the population, so that results from
analyzing the sample are generalizable to the
population .

69. THE SAMPLING PROCESS
Define the
population
Determine
the sample
frame
Determine the
sampling design
Execute the
sampling
process
Determine the
appropriate
sample size

70. CHARACTERISTICS OF A GOOD SAMPLE
DESIGN
• (a) Sample design must result in a truly representative
sample.
• (b) Sample design must be such which results in a small
sampling error.
• (c) Sample design must be viable in the context of funds
available for the research study.
• (d) Sample design must be such so that systematic bias
can be controlled in a better way.
• (e) Sample should be such that the results of the sample
study can be applied, in general, for the universe with a
reasonable level of confidence.

71. Types of sampling methods

72. Quota sampling
• Quota sampling: In stratified sampling the cost of taking
random samples from individual strata is often so
expensive that interviewers are simply given quota to be
filled from different strata, the actual selection of items
for sample being left to the interviewer’s judgement .
This is called quota sampling.
• The size of the quota for each stratum is generally
proportionate to the size of that stratum in the
population.
• Quota sampling is thus an important form of non-probability
sampling.
• Quota samples generally happen to be judgement
samples rather than random samples.

73. The Quota Sample
 Determine what the population looks like in terms of
specific qualities.
 Create “quotas” based on those qualities.
 Select people for each quota.

74. The Snowball Sampling
 Find a few people that are relevant to your topic.
 Ask them to refer you to more of them.

75. • Theoretical Sampling
• Definition
• The process of selecting "incidents, slices of life, time
periods, or people on the basis of their potential
manifestation or representation of important
theoretical constructs"
• Theoretical sampling is an important component in
the development of grounded theories.

76. . 3. Method of collecting and
processing data

77. METHODS OF DATA
COLLECTION
Data collection
instruments:
1.Observation
2.Questionnaires and
schedules
3.Interview
 In our discussion we will mainly focus on data
collection instruments.
Supplementary
diagnostic instruments
:
such as hemoglobinometer,
infantometer, microscope, ECG
and X-ray machines, etc.

78. Types of Observation :
• Participant vs Non-participant observation
• Structured vs. Unstructured observation

79. • Non Participant Observation:
• Someone who attempts to observe people without
interacting with them .
• Without their knowledge that they are being
observed .

80. • Participant Observation:
• Observer participates actively, for an extended
period of time
• May require observer to live or work in that area .
• Assumes that observer will become accepted
member of the group or community .
• Historically field research has been associated most
strongly with participant observation.

81. • Unstructured Observation :
• Early phase of the research .
• How to do unstructured observation
• Take a notebook and pen
• Note down when you see something interesting.
• Write down theories as you form them.
• Don’t jump to conclusions straight away.
• Look for more evidence.

82. • Structured Observation :
• Greater control of sampling .
• Measurement of error .
• This is more like a survey, where every respondent is
asked the same set of questions. But in this case,
questions are not asked. Instead, particular types of
behavior are looked for and counted.

83. • Advantages:
 Do not depend on recall of memory
 A good deal of information we can gather.
• Disadvantages:
 Cultural barrier
 An individual’s belief and perception cannot be
adequately represented.
 May consume a lot of time.
 Not everything is amenable to observation.
e.g.,sexual behaviour cannot be observed.

84. INTERVIEWS :
• This is a very popular method of data collection.
• This involves juxtaposition of the interviewer and the
interviewee.
• If the interviewee doesn’t understand a question , it can be
explained to him and if more details are desired , additional
queries can be posed.
• INTERVIEWING IS AN ART.
“ WHAT TO BE ASKED AND HOW TO PROCEED” are
crucial to the success of this method.

85.  Types of Interview:
There are two types of interviewing formats :
• (a) Structured interview :
The format and order of investigation is set out
right at the beginning.
• (b) Unstructured : This consists of only an open ended
questionnaire with everything else left to the discretion
of the interviewer, e.g. a journalist’s interview.

86. • Advantages of interviews :
• It has flexibility which is not offered by questionnaire
.
• Better coverage is obtained.
• Validitiy of the collected information can be tested.
• Interviewer can motivate the poorly motivated
responders .

87. QUESTIONNAIRES
• An effective questionnaire will follow these rules:
– As brief as possible.
– Focus on information, not otherwise accessible to the
investigator.
– Aimed at obtaining factual data, rather than opinions,
impressions, or estimates.
– The wording of every item ought to be understandable
and familiar .

88. – For the same reason, the items should be
arranged in a neat and logical order.
– The questionnaire should be conveniently
planned and set up to take a minimum of the
respondent’s time.
– Clear instructions must be included as to the way
the answers are to be indicated.

89. QUESTIONNAIRES
• Requirements of questions :
• 1. must have (at least) face validity .
• 2. respondents can be expected to know the answer .
• 3.must be clear and unambiguous .
• 4. must be fair .
• 5. must be user friendly .

90. • Advantages of questionnaire :
• A) it is less expensive than interview .
• B) it can be ensure uniformity especially for
impersonal data( age, sex, etc..) .
• C) information can be given at leisure without
pressure of time on respondent .

91. Kind of Question Structure.
Which kind of question structure to use?
• Open-ended.
• Close-ended with ordered choices.
• Close-ended with out unordered choices .
• For example
• Questions may be open-ended ("Why do you feel that way?")
or closed ("Do you approve or disapprove?").

93. Investigations/Measurements
• Some investigations may be done to obtain
information about specific aspects .
• For example-a)
weighing food cooked daily in a diet survey
b) anthropometric measurements in nutritional
survey .

94. Compilation & Data Analysis in Survey
• Compilation is the systematic arrangement and
presentation of the data .for this data is arranged in
various groups viz - chronological groups, groups as
per specific characteristics like age, sex, occupation,
etc…
• The compilation and analysis must be relevant to the
predecided objectives .
• Dummy tables are prepared for this before the
compilation is made and data is compiled
accordingly. .

95. Compilation & Data Analysis in Survey
• Analysis work after tabulation is generally based on
the computation of various percentages, coefficients,
etc., by applying various well defined statistical
formulae.
• In brief, the researcher can analyse the collected
data with the help of various statistical measures.

96. . Data analysis
• Clean the questionnaires.
• Code the questionnaires.
– Close-ended questions.
– Open-ended questions.
– Partially close-ended questions.
– Missing data.
• Decide which statistics are most useful to you.
• Interpretation. Look for results that matter.

97. Results/ Reporting of survey
• The report may also be presented with the help of
tables and graphs .
• This consists of informing the appropriate authorities
,the observation made in the survey . This contain
objectives, materials and methods used, and
observation in the survey.
• A good report also indicates the extent to which the
objectives of survey are fulfilled .

98. Results/ Reporting of survey
• Abstract or executive summary of the survey
• Problem statement.
• Methods and procedures undertaken.
• Error structure and the acceptability thereof.
• Findings.
• Implications.
• Appendices.

99. • The layout of the report should be as follows:
• (i) the preliminary pages;
(ii) the main text,
(iii) the end matter.
• In its preliminary pages the report should carry title
and date followed by acknowledgements and
foreword.
• Then there should be a table of contents followed by
a list of tables and list of graphs and charts .

100. • The main text of the report should have the following
parts:
(a) Introduction:
(b) Summary of findings:
(c) Main report:
(d) Conclusion:
• At the end of the report, appendices should be
enlisted in respect of all technical data. Bibliography,
i.e., list of books, journals, reports, etc.,

101. Qualities of a good research
• 1. Good research is systematic:
• 2. Good research is logical:
• 3. Good research is empirical:
• 4. Good research is replicable:

102. SUMMARY
• survey is a scientific and systematic search for
pertinent information on a specific topic. In fact,
research is an art of scientific investigation
• It is a careful investigation or inquiry specially
through search for new facts in any branch of
knowledge .

103. • Survey/research comprises defining and redefining
problems, formulating hypothesis or suggested
solutions; collecting, organising and evaluating data;
making deductions and reaching conclusions; and at
last carefully testing the conclusions to determine
whether they fit the formulating hypothesis.

104. • Surveys are useful for
• Research,
• Training,
• Planning
• Evaluation.

106. REFERENCES
• Textbook of survey methods in community medicine ,by J.H.ABRAMSON
, Z.H. ABRAMSON . Fifth edition .
• Textbook of community medicine by Dr .J .P. Baride , Dr. A. P. Kulkarni .
Third edition .
• K Park Textbook of Preventive and Social Medicine; Banarasidas Bhanot
Publication;22th edition .
• Text Book of Public Health and Community Medicine, Published by
Department of Community Medicine, Armed Forces Medical College,
Pune .
• Principles and practice of biostatistics , by DR J. V. DIXIT . Fifth edition .
• Textbook of research methodology ( methods and techniques) second
revised edition by C.R. KOTHARI
• Frankel, J. And Wallen, N.. How to design and valuate research in
education. McGrawHill (2000).
Hill way , T. Introduction to research. H.M.Co. (1964).
• Brochure, what is a survey?, Bill Kalsbeek, 1995 publications
officer, ASA section on survey research methods