J Korean Med Sci.

2023 Dec 11;38(48):e403

https://doi.org/10.3346/jkms.2023.38.e403
eISSN 1598-6357·pISSN 1011-8934

Review Article
Editing, Writing & Publishing
Designing, Conducting, and Reporting
Survey Studies: A Primer for Researchers

Olena Zimba 1,2,3

and Armen Yuri Gasparyan 4

Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
1

2
National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
3

Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust
4

(Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK

Received: Oct 6, 2023

Accepted: Nov 14, 2023
ABSTRACT
Published online: Nov 24, 2023
Survey studies have become instrumental in contributing to the evidence accumulation in
Address for Correspondence: rapidly developing medical disciplines such as medical education, public health, and nursing.
Olena Zimba, MD, PhD
The global medical community has seen an upsurge of surveys covering the experience and
Department of Clinical Rheumatology and
Immunology, University Hospital in Krakow,
perceptions of health specialists, patients, and public representatives in the peri-pandemic
Macieja Jakubowskiego 2, Krakow 30-688, coronavirus disease 2019 period. Currently, surveys can play a central role in increasing
Poland. research activities in non-mainstream science countries where limited research funding
Email: [email protected] and other barriers hinder science growth. Planning surveys starts with overviewing related
reviews and other publications which may help to design questionnaires with comprehensive
© 2023 The Korean Academy of Medical
Sciences. coverage of all related points. The validity and reliability of questionnaires rely on input from
This is an Open Access article distributed experts and potential responders who may suggest pertinent revisions to prepare forms
under the terms of the Creative Commons with attractive designs, easily understandable questions, and correctly ordered points that
Attribution Non-Commercial License (https:// appeal to target respondents. Currently available numerous online platforms such as Google
creativecommons.org/licenses/by-nc/4.0/)
Forms and Survey Monkey enable moderating online surveys and collecting responses from
which permits unrestricted non-commercial
use, distribution, and reproduction in any
a large number of responders. Online surveys benefit from disseminating questionnaires
medium, provided the original work is properly via social media and other online platforms which facilitate the survey internationalization
cited. and participation of large groups of responders. Survey reporting can be arranged in line
with related recommendations and reporting standards all of which have their strengths and
ORCID iDs
Olena Zimba
limitations. The current article overviews available recommendations and presents pointers
https://orcid.org/0000-0002-4188-8486 on designing, conducting, and reporting surveys.
Armen Yuri Gasparyan
https://orcid.org/0000-0001-8749-6018 Keywords: Research Ethics; Research Design; Social Media; Surveys and Questionnaires;
Writing
Disclosure
The authors have no potential conflicts of
interest to disclose.

Author Contributions
INTRODUCTION
Conceptualization: Zimba O. Formal analysis:
Zimba O, Gasparyan AY. Writing - original Surveys are increasingly popular research studies that are aimed at collecting and analyzing
draft: Zimba O. Writing - review & editing: opinions of diverse subject groups at certain periods. Initially and predominantly employed
Zimba O, Gasparyan AY. for applied social science research,1 surveys have maintained their social dimension and
transformed into indispensable tools for analyzing knowledge, perceptions, prevalence of
clinical conditions, and practices in the medical sciences.2 In rapidly developing disciplines
with social dimensions such as medical education, public health, and nursing, online surveys

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have become essential for monitoring and auditing healthcare and education services3,4 and
generating new hypotheses and research questions.5 In non-mainstream science countries
with uninterrupted Internet access, online surveys have also been praised as useful studies
for increasing research activities.6

In 2016, the Medical Subject Headings (MeSH) vocabulary of the US National Library of
Medicine introduced "surveys and questionnaires" as a structured keyword, defining survey
studies as "collections of data obtained from voluntary subjects" (https://www.ncbi.nlm.
nih.gov/mesh/?term=surveys+and+questionnaires). Such studies are instrumental in the
absence of evidence from randomized controlled trials, systematic reviews, and cohort
studies. Tagging survey reports with this MeSH term is advisable for increasing the retrieval
of relevant documents while searching through Medline, Scopus, and other global databases.

Surveys are relatively easy to conduct by distributing web-based and non-web-based

questionnaires to large groups of potential responders. The ease of conduct primarily
depends on the way of approaching potential respondents. Face-to-face interviews, regular
postmails, e-mails, phone calls, and social media posts can be employed to reach numerous
potential respondents. Digitization and social media popularization have improved the
distribution of questionnaires, expanded respondents' engagement, facilitated swift data
processing, and globalization of survey studies.7

SURVEY REPORTING GUIDANCE

Despite the ease of survey studies and their importance for maintaining research activities
across academic disciplines, their methodological quality, reproducibility, and implications
vary widely. The deficiencies in designing and reporting are the main reason for the
inefficiency of some surveys. For instance, systematic analyses of survey methodologies
in nephrology, transfusion medicine, and radiology have indicated that less than one-
third of related reports provide valid and reliable data.8-10 Additionally, no discussions
of respondents' representativeness, reasons for nonresponse, and generalizability of the
results have been pinpointed as drawbacks of some survey reports. The revealed deficiencies
have justified the need for survey designing and data processing in line with reporting
recommendations, including those listed on the EQUATOR Network website (https://www.
equator-network.org/).

Arguably, survey studies lack discipline-specific and globally-acceptable reporting guidance.

The diversity of surveyed subjects and populations is perhaps the main confounder. Although
most questionnaires contain socio-demographic questions, there are no reporting guidelines
specifically tailored to comprehensively inquire specialists across different academic
disciplines, patients, and public representatives.

The EQUATOR Network platform currently lists some widely promoted documents with
statements on conducting and reporting web-based and non-web-based surveys (Table 1).11-14
The oldest published recommendation guides on postal, face-to-face, and telephone interviews.1
One of its critical points highlights the need to formulate a clear and explicit question/objective
to run a focused survey and to design questionnaires with respondent-friendly layout and
content.1 The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) is the most-
used document for reporting online surveys.11 The CHERRIES checklist included points on

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Table 1. Recommendations for conducting and reporting survey-based studies and their implications
References Guideline titles and acronyms Descriptions Limitations EQUATOR Network listing
Kelley et al., Good practice in the conduct and The checklist and recommendations focus on The checklist and +
20031 reporting of survey research designing questionnaires and ensuring the recommendations are not based
reliability of non-web-based surveys only. on the Delphi method.
Eysenbach, Checklist for Reporting Results of The CHERRIES checklist focuses on web- This checklist is not based on an +
200411 Internet E-Surveys (CHERRIES) based surveys. It ensures the reliability and expert panel consensus (Delphi
representativeness of online responses and method). It does not cover all
prevents duplicate/multiple entries by the same parts of e-survey reports.
users. It is the top-cited e-survey checklist.
Burns et al., A guide for the design and This guide includes statements on designing, The statements are based on +
200812 conduct of self-administered conducting, and reporting web- and non-web- a literature review, but not the
surveys of clinicians based surveys of clinicians' knowledge, attitude, Delphi method.
and practice.
Sharma et al., Consensus-based Checklist for This is a checklist with 19 sections covering Although 24 experts with +
202113 Reporting of Survey Studies all parts of web- and non-web-based survey numerous related publications
(CROSS) reports. It is based on the Delphi method with 3 were initially enrolled, 6 of them
survey rounds in January 2018 -December 2019 were lost to follow-up.
and 24 experts responding to the 1st round.
Gaur et al., Reporting survey based studies - a These recommendations cover points on Although these -
202014 primer for authors planning and reporting surveys in the COVID-19 recommendations are based
pandemic. Various online platforms, including on a comprehensive literature
social media, for distributing questionnaires and review, statements are not
conducting surveys are presented. discussed with a panel of
experts and lack Delphi
consensus agreements.
COVID-19 = coronavirus disease 2019.

ensuring the reliability of online surveys and avoiding manipulations with multiple entries
by the same users.11 A specific set of recommendations, listed by the EQUATOR Network,
is available for specialists who plan web-based and non-web-based surveys of knowledge,
attitude, and practice in clinical medicine.12 These recommendations help design valid
questionnaires, survey representative subjects with clinical knowledge, and complete
transparent reporting of the obtained results.12

From January 2018 to December 2019, three rounds of surveying experts with interest in
surveys and questionnaires allowed reaching consensus on a set of points for reporting web-
based and non-web-based surveys.13 The Consensus-Based Checklist for Reporting of Survey
Studies included a rating of 19 items of survey reports, from titles to acknowledgments.13
Finally, rapid recommendations on online surveys amid the coronavirus disease 2019
(COVID-19) pandemic were published to guide the authors on how to choose social media
and other online platforms for disseminating questionnaires and targeting representative
groups of respondents.14

Adhering to a combination of these recommendations is advisable to minimize the

limitations of each document and increase the transparency of survey reports. For cross-
sectional analyses of large sample sizes, additionally consulting the STROBE standard of the
EQUATOR Network may further improve the accuracy of reporting respondents' inclusion
and exclusion criteria. In fact, there are examples of online survey reports adhering to both
CHERRIES and STROBE recommendations.15,16

ETHICS CONSIDERATIONS
Although health research authorities in some countries lack mandates for full ethics review
of survey studies, obtaining formal review protocols or ethics waivers is advisable for most

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surveys involving respondents from more than one country. And following country-based
regulations and ethical norms of research are therefore mandatory.14,17

Full ethics review or exemption procedures are important steps for planning and conducting
ethically sound surveys. Given the non-interventional origin and absence of immediate
health risks for participants, ethics committees may approve survey protocols without a
full ethics review.18 A full ethics review is however required when the informational and
psychological harms of surveys increase the risk.18 Informational harms may result from
unauthorized access to respondents' personal data and stigmatization of respondents
with leaked information about social diseases. Psychological harms may include anxiety,
depression, and exacerbation of underlying psychiatric diseases.

Survey questionnaires submitted for evaluation should indicate how informed consent is
obtained from respondents.13 Additionally, information about confidentiality, anonymity,
questionnaire delivery modes, compensations, and mechanisms preventing unauthorized
access to questionnaires should be provided.13,14 Ethical considerations and validation
are especially important in studies involving vulnerable and marginalized subjects with
diminished autonomy and poor social status due to dementia, substance abuse, inappropriate
sexual behavior, and certain infections.18-20 Precautions should be taken to avoid
confidentiality breaches and bot activities when surveying via insecure online platforms.21

Monetary compensation helps attract respondents to fill out lengthy questionnaires.

However, such incentives may create mechanisms deceiving the system by surveyees with a
primary interest in compensation.22 Ethics review protocols may include points on recording
online responders' IP addresses and blocking duplicate submissions from the same Internet
locations.22 IP addresses are viewed as personal information in the EU, but not in the US.
Notably, IP identification may deter some potential responders in the EU.21

PATIENT KNOWLEDGE AND PERCEPTION SURVEYS

The design of patient knowledge and perception surveys is insufficiently defined and poorly
explored. Although such surveys are aimed at consistently covering research questions
on clinical presentation, prevention, and treatment, more emphasis is now placed on
psychometric aspects of designing related questionnaires.23-25 Targeting responsive
patient groups to collect reliable answers is yet another challenge that can be addressed by
distributing questionnaires to patients with good knowledge of their diseases, particularly
those registering with university-affiliated clinics and representing patient associations.26-28

The structure of questionnaires may differ for surveys of patient groups with various age-
dependent health issues. Care should be taken when children are targeted since they often
report a variety of modifiable conditions such as anxiety and depression, musculoskeletal
problems, and pain, affecting their quality of life.29 Likewise, gender and age differences
should be considered in questionnaires addressing the quality of life in association with
mental health and social status.30 Questionnaires for older adults may benefit from including
questions about social support and assistance in the context of caring for aging diseases.31
Finally, addressing the needs of digital technologies and home-care applications may help
to ensure the completeness of questionnaires for older adults with sedentary lifestyles and
mobility disabilities.32,33

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SOCIAL MEDIA FOR QUESTIONNAIRE DISTRIBUTION

The widespread use of social media has made it easier to distribute questionnaires to a large
number of potential responders. Employing popular platforms such as Twitter and Facebook
has become particularly useful for conducting nationwide surveys on awareness and concerns
about global health and pandemic issues.34,35 When various social media platforms are
simultaneously employed, participants' sociodemographic factors such as gender, age, and
level of education may confound the study results.36 Knowing targeted groups' preferred online
networking and communication sites may better direct the questionnaire distribution.37-39

Preliminary evidence suggests that distributing survey links via social-media accounts of
individual users and organized e-groups with interest in specific health issues may increase
their engagement and correctness of responses.40,41

Since surveys employing social media are publicly accessible, related questionnaires should
be professionally edited to easily inquire target populations, avoid sensitive and disturbing
points, and ensure privacy and confidentiality.42,43 Although counting e-post views is
feasible, response rates of social-media distributed questionnaires are practically impossible
to record. The latter is an inherent limitation of such surveys.

SURVEY SAMPLING
Establishing connections with target populations and diversifying questionnaire dissemination
may increase the rigor of current surveys which are abundantly administered.44 Sample sizes
depend on various factors, including the chosen topic, aim, and sampling strategy (random or
non-random).12 Some topics such as COVID-19 and global health may easily attract the attention
of large respondent groups motivated to answer a variety of questionnaire questions. In the
beginning of the pandemic, most surveys employed non-random (non-probability) sampling
strategies which resulted in analyses of numerous responses without response rate calculations.
These qualitative research studies were mainly aimed to analyze opinions of specialists and
patients exposed to COVID-19 to develop rapid guidelines and initiate clinical trials.

Outside the pandemic, and beyond hot topics, there is a growing trend of low response rates
and inadequate representation of target populations.45 Such a trend makes it difficult to
design and conduct random (probability) surveys. Subsequently, hypotheses of current online
surveys often omit points on randomization and sample size calculation, ending up with
qualitative analyses and pilot studies. In fact, convenience (non-random or non-probability)
sampling can be particularly suitable for previously unexplored and emerging topics when
overviewing literature cannot help estimate optimal samples and entirely new questionnaires
should be designed and tested. The limitations of convenience sampling minimize the
generalizability of the conclusions since the sample representativeness is uncertain.45

Researchers often employ 'snowball' sampling techniques with initial surveyees forwarding
the questionnaires to other interested respondents, thereby maximizing the sample size.
Another common technique for obtaining more responses relies on generating regular social
media reminders and resending e-mails to interested individuals and groups. Such tactics
can increase the study duration but cannot exclude the participation bias and non-response.

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Purposive or targeted sampling is perhaps the most precise technique when knowing the
target population size and respondents' readiness to correctly fill the questionnaires and
ensure an exact estimate of response rate, close to 100%.46

DESIGNING QUESTIONNAIRES
Correctness, confidentiality, privacy, and anonymity are critical points of inquiry in
questionnaires.47 Correctly worded and convincingly presented survey invitations with
consenting options and reassurances of secure data processing may increase response rates
and ensure the validity of responses.47 Online surveys are believed to be more advantageous
than offline inquiries for ensuring anonymity and privacy, particularly for targeting socially
marginalized and stigmatized subjects. Online study design is indeed optimal for collecting
more responses in surveys of sex- and gender-related and otherwise sensitive topics.

Performing comprehensive literature reviews, consultations with subject experts, and

Delphi exercises may all help to specify survey objectives, identify questionnaire domains,
and formulate pertinent questions. Literature searches are required for in-depth topic
coverage and identification of previously published relevant surveys. By analyzing previous
questionnaire characteristics, modifications can be made to designing new self-administered
surveys. The justification of new studies should correctly acknowledge similar published
reports to avoid redundancies.

The initial part of a questionnaire usually includes a short introduction/preamble/cover letter

that specifies the objectives, target respondents, potential benefits and risks, and moderators'
contact details for further inquiries. This part may motivate potential respondents to consent
and answer questions. The specifics, volume, and format of other parts are dependent on
revisions in response to pretesting and pilot testing.48 The pretesting usually involves co-
authors and other contributors, colleagues with the subject interest while the pilot testing
usually involves 5-10 target respondents who are well familiar with the subject and can swiftly
complete the questionnaires. The guidance obtained at the pretesting and pilot testing
allows editing, shortening, or expanding questionnaire sections. Although guidance on
questionnaire length and question numbers is scarce, some experts empirically consider 5
domains with 5 questions in each as optimal.12 Lengthy questionnaires may be biased due to
respondents' fatigue and inability to answer numerous and complicated questions.46

Questionnaire revisions are aimed at ensuring the validity and consistency of questions,
implying the appeal to relevant responders and accurate covering of all essential points.45
Valid questionnaires enable reliable and reproducible survey studies that end up with the
same responses to variably worded and located questions.45

Various combinations of open-ended and close-ended questions are advisable to

comprehensively cover all pertinent points and enable easy and quick completion of
questionnaires. Open-ended questions are usually included in small numbers since these
require more time to respond.46 Also, the interpretation and analysis of responses to
open-ended questions hardly contribute to generating robust qualitative data.49 Close-
ended questions with single and multiple-choice answers constitute the main part of a
questionnaire, with single answers easier to analyze and report. Questions with single
answers can be presented as 3 or more Likert scales (e.g., yes/no/do not know).

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Avoiding too simplistic (yes/no) questions and replacing them with Likert-scale items
may increase the robustness of questionnaire analyses.50 Additionally, constructing easily
understandable questions, excluding merged items with two or more points, and moving
sophisticated questions to the beginning of a questionnaire may add to the quality and
feasibility of the study.50

CONCLUSION
Survey studies are increasingly conducted by health professionals to swiftly explore
opinions on a wide range of topics by diverse groups of specialists, patients, and public
representatives. Arguably, quality surveys with generalizable results can be instrumental for
guiding health practitioners in times of crises such as the COVID-19 pandemic when clinical
trials, systematic reviews, and other evidence-based reports are scarcely available or absent.
Online surveys can be particularly valuable for collecting and analyzing specialist, patient,
and other subjects' responses in non-mainstream science countries where top evidence-
based studies are scarce commodities and research funding is limited. Accumulated expertise
in drafting quality questionnaires and conducting robust surveys is valuable for producing
new data and generating new hypotheses and research questions.

The main advantages of surveys are related to the ease of conducting such studies with limited
or no research funding. The digitization and social media advances have further contributed to
the ease of surveying and growing global interest toward surveys among health professionals.
Some of the disadvantages of current surveys are perhaps those related to imperfections of
digital platforms for disseminating questionnaires and analysing responses.

Although some survey reporting standards and recommendations are available, none of these
comprehensively cover all items of questionnaires and steps in surveying. None of the survey
reporting standards is based on summarizing guidance of a large number of contributors
involved in related research projects. As such, presenting the current guidance with a list of
items for survey reports (Table 2) may help better design and publish related articles.

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Table 2. Items for reporting survey studies

No. Items Notes
1 Title • Reflect on the survey subject, target respondents (e.g., patients, specialists, public representatives), obtained results, and
study design (online, non-web-based, cross-sectional, longitudinal).
2 Abstract • Provide a structured abstract with an introduction, aims, results, and conclusion.
3 Keywords • Add the term "surveys and questionnaires" along with subject keywords to increase retrieval of the survey report.
4 Introduction • Analyze available evidence, relevant reviews, and surveys to justify the need for current study and questionnaire sections.
5 Aim • Present specific and innovative aims.
6 Methods • Highlight study design (e.g., web-based, non-web-based, cross-sectional, longitudinal).
• Specify the survey datelines and characterize time periods (data collection during a crisis [pandemic, wartime] or certain
global movements, campaigns, or interventions).
• Describe the surveyed respondents’ characteristics.
• Characterize the questionnaire domains and the number of questions in each domain.
• Provide details of preserving confidentiality and anonymity
• Describe pretesting and pilot testing (experts and respondents involved), the number of revision rounds, and the average
time for filling out the questionnaire.
• Report content and face validity (quality, completeness, and feasibility of the questionnaire and its appeal to relevant
respondents).
• Add details of an employed survey platform for web-based surveys (e.g., SurveyMonkey, Google Forms, etc.).
• Report modes of questionnaire distribution (e.g., via certain social media channels, emails, face-to-face interviews, and
postal mail).
• Clarify when and how many times survey reminders were circulated.
7 Adherence to research • Refer to recommendations or their combinations consulted for reporting.
reporting standards
8 Ethics section • Provide ethics committee approval/waiver date, protocol number, and name of the ethics committee.
• Refer to documents of national health research authorities that regulate the ethics review waiver/exemption.
• Justify the ethics review exemption in view of the survey's non-interventional origin and absence of informational and
psychological risks/harms.
• Provide details of monetary or other incentives, written informed consents, confidentiality and anonymity, and mechanisms
to avoid multiple entries by the same respondents.
9 Statistical analyses • Report descriptive statistics, how categorical data were compared (chi-square or Fisher's exact tests), whether parametric
and non-parametric tests and regression analyses were employed, level of significance, and statistical package used.
10 Results • Report response rates in absolute numbers and percentages if the target population was established by methods other than
convenience sampling.
• Reflect on missing data.
• Provide respondents' details to characterize their representativeness and exclude/minimize nonresponse influence.
• Insert eye-catching and color graphs and informative tables pointing to the most remarkable results, without recapitulating
the same data in the text.
11 Discussion • Clarify what is new.
• Analyze limitations by reflecting on low response rate, small sample size, non-response, missing data, a long timeline of
collecting responses, language of the questionnaire other than English, and generalizability of the survey results.
12 Author contributions and • Identify the authors who drafted the questionnaire and survey report.
acknowledgements • List non-author/technical contributions for questionnaire dissemination, promotion, and data collection.
13 Disclosure of interests • Disclose potential conflicts which may affect the validity and reliability of the survey.
14 Funding • Report funding sources, provision of software, and open-access funding, if available.
15 Open data sharing • Add a note about the availability of data for post-publication analyses.
16 Appendix • Submit an English version of the questionnaire.

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