The survey instruments from the NCHS-conducted NNHS and National Home and Hospice Care Survey (NHHCS), as well as ASPE’s National Study of Assisted Living for the Frail Elderly, were used to inform the development of the survey domains, data elements, and questions for NSRCF. The NNHS questionnaire is available from the survey’s website: http://www.cdc.gov/nchs/nnhs/ nnhs_questionnaires.htm, and the NHHCS questionnaire also is available from that survey’s website: http://www.cdc.gov/nchs/nhhcs/ nhhcs_questionnaires.htm. Proposed survey domains and a list of suggested facility-level and resident-level data elements for each domain were first compiled from a review of these instruments (Appendix III). The TAP then reviewed these documents and identified what survey domains to include. After this review, specific questions for each domain and data element were crafted. A subset of TAP then reviewed and provided written comments on the draft survey instruments. NCHS, ASPE, and AHRQ also provided input and guidance throughout the questionnaire development process.
After finalizing the content of the facility and resident questionnaires, they were converted into computer-assisted personal interview (CAPI) instruments for testing. In April and May 2007, on-site cognitive interviews were conducted with eight residential care facilities across six states: two extra-large (over 100 beds), three large (26–100 beds), one medium (11–25 beds), and two small facilities (4–10 beds). The facilities, identified through the use of local contacts, recommendations from professional associations, and word-of-mouth contacts were chosen to achieve diversity in size, geographic region, and degree of urbanization. The interviewers used pre-established probes and spontaneous concurrent probing techniques to assess the effectiveness of the proposed questions. Cognitive interviews for the facility questionnaire (including probes) averaged 90 minutes and for the resident questionnaire averaged 45 minutes to complete. Each facility was provided with a $100 cash incentive for participation. In all cases, directors responded to the facility questions. A combination of facility directors, direct care workers, activities staff, and medical staff were respondents for the resident questionnaires. Facilities also were sent an Advance Data Collection Form (ADCF) to complete prior to the interview. The ADCF was a self-administered questionnaire that contained questions about the facility—also asked during the in-person interview—that might require consulting records or other staff to answer accurately, and thus enabled faster interview completion when on-site. Overall, facility administrators believed completing the ADCF prior to the visit was beneficial.
Findings from this cognitive testing activity provided an informed question-by-question assessment of the facility and resident questionnaires that then guided question item changes for the pilot test.