Questionnaires and Interviews Steven R. Cummings, MD Director, S.F. Coordinating Center

Where we left my story… Resveratrol increases speed, endurance & strength & lifespan Resveratrol increases speed, endurance & strength & lifespan My hypothesis: Those who consume resveratrol have longer healthy life My hypothesis: Those who consume resveratrol have longer healthy life A randomized trial for mortality was too big and NIA didn’t fund my small trial of resveratrol and gait speed A randomized trial for mortality was too big and NIA didn’t fund my small trial of resveratrol and gait speed So… So…

An opportunity to piggy back A SFCC study about aging is planning a new visit A SFCC study about aging is planning a new visit  Men ≥ age 75 years old I could add questions about intake of resveratrol I could add questions about intake of resveratrol I could test subsequent mortality or cross-sectional associations with health I could test subsequent mortality or cross-sectional associations with health …cheaply …cheaply But additions must be short But additions must be short

Measurements I need to test my hypothesis “Resveratrol intake” “Resveratrol intake” “Healthy” “Healthy” “Lower mortality” “Lower mortality”

Measurements I need to test my hypothesis “Resveratrol intake” “Resveratrol intake” “Healthy” “Healthy” “Lower mortality” “Lower mortality”  But insufficient number of men taking resveratrol and too few deaths to test whether resveratrol is associated with mortality

Measurements I need to test my revised hypothesis “Resveratrol intake” “Resveratrol intake” “Health” “Health”

I need questions to assess “Resveratrol intake” “Resveratrol intake” “Health” “Health”

1st step Are there standard questionnaires? Are there standard questionnaires? Must I make my own? Must I make my own?

Where to find questionnaires Experts and articles in the area of research Experts and articles in the area of research Search the web Search the web e.g. QualityMetrics: e.g. QualityMetrics:  General health status (SF36)  A few disease-specific measurements  Must get a license SF Coordinating Center SF Coordinating Center

Resveratrol intake comes mainly from red wine and supplements I need to quantify the average amount of resveratrol the participant takes I need to quantify the average amount of resveratrol the participant takes Add questions about red wine intake Add questions about red wine intake Add questions about use of resveratrol supplements Add questions about use of resveratrol supplements

The Coordinating Center has a standard questionnaire on alcohol use Basic questions Basic questions  Have you drunk at least 12 ‘drinks’ of alcohol in past 12 months? If yes  Average drinks per week. Easily modified to substitute ‘red wine’ for ‘alcohol’ Easily modified to substitute ‘red wine’ for ‘alcohol’

The Coordinating Center also has a standard questionnaire on medication use Do you currently take ____? Do you currently take ____? __ No (skip to X) __ Yes How often? How often?  __ daily __ weekly __ less often  What dose? ___

I must adapt the questionnaire to measure resveratrol intake Do you currently take ____? Do you currently take ____? __ No (skip to X) __ Yes How often? How often?  __ daily __ weekly __ less often  What dose? ___

Quantifying resveratrol intake from supplements Do you currently take tablets or capsules containing resveratrol? Do you currently take tablets or capsules containing resveratrol? YesNo (skip to X) YesNo (skip to X) How often? How often?  __ daily __ weekly __ less often  What dose? _____ X… X…

Quantifying resveratrol intake from supplements Do you currently take tablets or capsules containing resveratrol? Do you currently take tablets or capsules containing resveratrol? YesNo (skip to X) YesNo (skip to X) How often? How often?  __ daily __ weekly __ less often  What dose? _____ What’s wrong with this question?

Quantifying resveratrol intake from supplements Do you currently take tablets or capsules containing resveratrol? Do you currently take tablets or capsules containing resveratrol? YesNo (skip to X) YesNo (skip to X) How often? How often?  __ daily __ weekly __ less often  What dose? _____ These problems might be discovered by pretesting with people who take resveratrol “Or” can be confusing It is also sold as a liquid Some are not called ‘resveratrol’ May not know; not on label

Clarified the question …but Do you currently take supplements containing resveratrol? Do you currently take supplements containing resveratrol? YesNo (skip to X) YesNo (skip to X) How often? How often?  __ daily __ weekly __ less often  What dose? _____ Some are not called ‘resveratrol’ May not know; not on label

Clarified the question …but Do you currently take supplements containing resveratrol? Do you currently take supplements containing resveratrol? YesNo (skip to X) YesNo (skip to X) How often? How often?  __ daily __ weekly __ less often  What dose? _____  What brand? _____ Some are not called ‘resveratrol’ May not know; not on label Only few brands are absorbed

Assessing intake by interview Please bring all of the medications or supplements that you have taken in the past month Please bring all of the medications or supplements that you have taken in the past month Frequency of use Frequency of use  __ daily __ weekly __ less often Dose __ __ __ mg Dose __ __ __ mg Brand _________ Brand _________ Open ended Must be coded with a dictionary

Some assessments are difficult and inherently imperfect Intakes Intakes Activity Activity Sleep SleepPrefer Direct measurements Direct measurements

Some assessments are difficult and inherently imperfect IntakesBlood or urine levels IntakesBlood or urine levels ActivityMonitors ActivityMonitors SleepActigraphy; home devices SleepActigraphy; home devicesPrefer Direct measurements Direct measurements

“Health” MrOS uses the SF-12 to assess health status MrOS uses the SF-12 to assess health status It is extensively validated It is extensively validated  For example, large differences between patients with and without chronic disease  Changes in response to interventions, such as exercise or medical treatments

‘Standard’ or ‘validated’ instruments Usually the best choice Usually the best choice  Probably free(er) of bugs  Looks better in papers and grants However, However,  May not measure what you want  May not apply to your population  May be longer than you need

Questions in the SF-12 (for patients > 70-95)

Some men >75 might not do these This might be discovered by pretesting men >75

Questions in the SF-12

Does resveratrol improve mood?

Questions in the SF-12

There is no reason to believe that resveratrol would relieve pain

The ‘validated’ SF-12 A good choice because A good choice because  Extensively tested, few/no bugs  Would look better in papers and grants However, However,  Does not measure ‘health’ related to speed, strength, endurance  Many questions about mood and pain  May not apply to men > age 75 years

What do I want to measure? Walking speed Walking speed  Already to be measured in MrOs General health question General health question Physical quality of life Physical quality of life  Just the ‘physical’ components of SF-12

Pretest, pretest, pretest Start with a few friends or colleagues Start with a few friends or colleagues Try it on 2 or 3 like subjects in your study Try it on 2 or 3 like subjects in your study  Men over age 75; extremes (age, education…) Discuss the answers with the volunteers Discuss the answers with the volunteers Revise and retest Revise and retest Test the ‘final’ in more and diverse subjects Test the ‘final’ in more and diverse subjects  Potential goals: clarity, time, frequency of answers Bigger efforts: test reliability and validity Bigger efforts: test reliability and validity

Administering questions Questionnaires are more efficient than interviews Questionnaires are more efficient than interviews  If needed, follow-up review of questions Sometimes, interviews are the only way Sometimes, interviews are the only way  Make sure they are asked verbatim Use electronic methods as much as possible Use electronic methods as much as possible  Online tools (mix of free & pay service)    11 reviewed at (search “online survey tools”)

Summary Carefully define what you want to measure Carefully define what you want to measure Search for ‘standard’ instruments Search for ‘standard’ instruments  Do they measure what you want? If you make your own: avoid pitfalls If you make your own: avoid pitfalls  Clarity; avoid “and,” “or” Pretest, pretest, pretest… Pretest, pretest, pretest…